Datasets:

xNoper

/

pubmed-test-memsum-20sent

like 0

[ [ "this article traces the growth in the use of swing - bed services by medicare beneficiaries from 1984 through 1987 . in the context of the medicare program ,", "the increasing participation of hospitals in the provision of post - acute skilled nursing care services resulted in swing beds gaining an increasing share of the medicare snf market .", "accordingly , the per diem reimbursement rate for the routine care component of post - acute services covered under medicare in a swing bed was set at a rate equal to the average paid by the medicaid program to snfs for skilled nursing care during the prior calendar year in the state where the hospital is located .", "the regulations governing medicare coverage of post - acute services furnished in swing - bed hospitals were issued by the health care financing administration in july 1982 ." ], [ "the data presented in this article and the findings of the evaluation indicate that the rural hospital swing - bed program has been working as might have been anticipated : swing - beds have assumed the provision of a significant portion of post - acute care services in many states with large rural areas .", "the post - acute case mix in swing - bed hospitals represent more short term , intense level of care requirements than those in snfs .", "swing - bed hospitals seem better suited to meeting nursing care needs of these types of patients than do rural snfs , which seem more suited to meeting the needs of the traditional long - term care nursing home patients ." ] ]

[ [ "patients with univentricular heart malformations are at increased risk of suffering from thromboembolic events ( te ) . at least 20% of patients with univentricular hearts have reported to experience te , of which 25% are fatal . despite the high incidence of te , no consensus has been reached regarding the role of long - term anti - thrombotic treatment in this group of patients . here ,", "we present a case of a 19-year - old woman with a univentricular heart who suffered a major stroke ." ], [ "a 19-year - old woman born with a univentricular heart was found unconscious in her bed in the morning .", "symptoms were caused by heart failure due to high pulmonary flow , which was treated by pulmonary artery banding . at the age of 6 years , a total cavopulmonary connection ( tcpc ) , including a lateral tunnel with fenestration to the right atrium , was established .", "these scans unveiled a major stroke located in the left cerebral ( figure 1 ) and cerebellar hemispheres , corresponding to the areas supplied by the left middle and posterior cerebral arteries and the left superior cerebellar artery .", "a segmental occlusion in the top of the basilar artery was identified ( figure 3 ) .", "cardiac ultrasound and catheterization had revealed a double inlet left ventricle ( figure 5 ) and a hypoplastic right ventricle without transposition of the great arteries ." ], [ "spontaneous thrombi in 19-year old patients are , however , extremely rare . hence , seen in the light of a known cardiac malformation , the probability of a cardiac - derived cerebral embolus is very high .", "since no cardiac thrombi were identified , it is not known whether the described stroke was caused by a cardiac - derived embolus or spontaneous cranial thrombi .", "therefore , in these patients , the benefit of long - term prophylactic antiplatelet or anticoagulation therapy must be carefully considered and weighed against the risk of detrimental hemorrhagic side effects .", "disagreement about antithrombotic therapy in tcpc patients warrants future study that compares the different therapeutic strategies ." ] ]

[ [ "all patients were randomly assigned to one of the two groups : group a patients were given tablet imipramine and placebo .", "group b patients were administered tablet imipramine and tablet lithium carbonate as per schedule given below .", "cases having contraindication for imipramine and/or lithium treatment were also excluded from the study . the aim of the study and the method adopted was explained to each patient and his / her cooperation was solicited .", "the assessment of psychopathology was done by structured interview of the hamilton depression / melancholia scale designed by williams .", "lithium carbonate was administered in such a way as to achieve a serum lithium concentration in the range of 0.60.8 meq / l by day 7 .", "lithium concentration was measured by atomic absorption spectrophotometry . the nursing staff who administered the drugs was blind to the nature of regimen given to the patients .", "barring unforeseen developments , each patient was to be brought up to dose of 150 mg by day 14 ." ], [ "the investigator had reviewed the records maintained at this center and found that clinical response was recorded in almost all cases at the dose range of 100150 mg . barring unforeseen developments , each patient was to be brought up to dose of 150 mg by day 14 .", "lithium carbonate was administered in such a way as to achieve a serum lithium concentration in the range of 0.60.8 meq / l by day 7 .", "lithium concentration was measured by atomic absorption spectrophotometry . the nursing staff who administered the drugs was blind to the nature of regimen given to the patients ." ], [ "students t - test was utilized to test the significance of the difference of means of scores at weekly intervals while categorical data were put to chi - square test , using the statistical package for social sciences - version 16.0 ( spss 16.0 ." ], [ "demographic and clinical details of depressed patients duration of index episode at outset most common symptoms at the time of initial assessment depression scores of group a patients at baseline and at weekly intervals depression scores of group b patients at baseline and at weekly intervals comparison of two groups in depression ratings at baseline and at weekly intervals ( unpaired t - test ) mean percentage reductions in depression ratings at weekly intervals for both the groups revealed a larger reduction in depression ratings for group b as compared to group a at end of 1 , 2 , 3 , and 4 week [ figure 1 ] .", "manic switch for 2 patients in group a and dysarthria and arrhythmia in one patient each for group b were exclusively group specific [ table 10 ] .", "comparison of two groups in depression ratings at baseline and at weekly intervals [ table 6 ] .", "depression scores of group a and group b patients at baseline and percentage reduction of scores at weekly intervals is shown in tables 4 and 5 , respectively .", "the two groups did not differ in duration for their current depressive episode [ table 2 ] ." ], [ "the current study was a step in this direction wherein an attempt was made to curtail the lag period of tca response by the addition of lithium from the outset and comparing it with the same tca monotherapy in a double - blinded randomized controlled study .", "it appears fairly reasonable to presume at this stage that the response to lithium plus imipramine combination was quicker and superior than tricyclic monotherapy alone and it was seen across majority of depressed subjects .", "patients receiving lithium and imipramine combination responded more rapidly and completely than the imipramine - placebo groups [ tables 4 , 5 and figure 1 ] .", "the mean percentage change in depression ratings [ figure 1 ] after 1 week ( 38.37% ) for the lithium + imipramine group was higher than the imipramine + placebo group ( 14.97% ) .", "the mean percentage reduction at 4 weeks [ figure 1 ] of depression ratings was higher ( 96.2% ) for group b ( imipramine + lithium combination ) than that of 60.5% for group a ( imipramine + placebo combination ) implying that the combination brought a more complete remission .", "lithium was administered for 4 weeks because the intent was to augment imipramine and interest was in early response .", "the means are comparable to a similar study where mean age was about 39 years ( 39.5 for imipramine and 38.5 for imipramine + lithium group ) ." ], [ "concurrent administration of lithium and imipramine from the outset produced quicker antidepressant response in unipolar depression and the effect was evident in 70% of the patients by the end of the 1 week ." ], [], [] ]

[ [ "the subject of ideals in topological space has been studied by kuratowski and vaidyanathaswamy .", "an ideal on a topological space ( x , ) is a nonempty collection of subsets of x which satisfies ( i ) a and b a implies b and ( ii ) a and b implies a b . given a topological space ( x , ) with an ideal on x and if (x ) is the set of all subsets of x , a set operator ( ) : (x ) (x ) , called a local function of a with respect to and , is defined as follows : for a x , a( , ) = { x xu } , for every { u (x ) } where (x ) = { u x u}. a kuratowski closure operator cl ( ) for a topology (x , ) , called the -topology , finer than is defined by cl(a ) = a a( , ) ; when there is no chance for confusion , we will simply write a for a( , ) and for ( , ) . if is an ideal on x , then ( x , , )", "a of an ideal space ( x , , ) is said to be -open if a int(a ) .", "a subset a of an ideal space ( x , , ) is said to be pre--open if a int(cl(a ) ) .", "let ( x , , ) be an ideal space and let a be a subset of x. then pint(a ) = aint(cl(a ) ) . \n " ], [ "a pre--open set a of a space ( x , , ) is said to be pre--regular pre--open if a = pint(pcl(a ) ) .", "prooflet a be an --open and --closed set . then a is a pre--open and pre--closed set and hence a is a pre--regular pre--open set . \n let a be an --open and --closed set . then a is a pre--open and pre--closed set and hence a is a pre--regular pre--open set . \n", "the complement of a pre--regular pre--open set is called pre--regular pre--closed set , equivalently a = pcl(pint(a ) ) .", "a subset a of a space ( x , , ) with an ideal is said to be pre--regular if it is pre--open and pre--closed .", "a is pre--open which implies a = pint(a ) = pint(pcl(a ) ) . hence a is pre--regular pre--open . but" ] ]

[ [ "lichen sclerosus et atrophicans ( lsa ) is a chronic inflammatory muco - cutaneous disorder , characterized by sclerotic and atrophic lesions , most commonly found in adult women .", "it affects the anogenital area in 8598% of the cases and less frequently the extrgenital area .", "the involvement of the scalp is not frequent and its outcome could be similar to scarring alopecia , which could be the result of different diseases .", "the etiology of lsa is still unknown . besides the genetic and local factors ( koebner phenomenon ) and the autoimmune hypothesis , supported by the association of different autoimmune disorders , especially of thyroid origin ( 30% of cases ) , an infectious hypothesis has also been proposed .", "the most commonly affected extragenital areas are the neck and the shoulders , but also the inner thighs , the submammary area , the wrist and occasionally the oral mucosa ." ], [ "a 57-year - old caucasian woman presented with a history of asymptomatic frontoparietal lesion . such lesion , which had been developing over the 3 previous years , was initially erythematous and became progressively atrophic and sclerodermic .", "the patient had been living in a highly endemic area for borrelia burgdorferi , but she could not recall any tick bite or erythema chronicum migrans .", "thanks to this combined therapy a remarkable regression of the atrophic - sclerodermic lesion was observed .", "moreover , she presented migrating paresthesias involving the left side of the body for one month .", "after about 6 months since the beginning of antibiotic therapy , the lesion had not progressed , all other clinical symptoms improved and blood pcr resulted negative .", "the diagnosis of lyme borreliosis was made on the basis of clinical data , supported by the pcr positivity for borrelia genome ." ], [ "this report describes a case of lsa , which was unusual for the involvement of the scalp", ". the lesion was mimicking scleroderma en coup de sabre , which is a frontal or frontoparietal linear morphoea characterized by a linear band of depressed atrophy on skin and scalp .", "is proposed . to our knowledge , this is the first case of lsa , mimicking scleroderma en coup de sabre , which was associated with lyme borreliosis ." ], [ "in conclusion we propose that tissue pcr for dna of borrelia should be performed in patients with lsa in endemic area , because it could represent a rare manifestation of borreliosis , and in those cases lsa should be treated with proper antibiotic therapy in order to eradicate the microorganism ." ] ]

[ [ "the researchers of the present study aimed to define and conduct a study on the quality of work life and its association with workplace violence of nurses in the emergency departments , with regard to the effective role of nurses in health services efficiency and patients and families satisfaction .", "the obtained results can make nursing managers determined to make a more proper background for improvement of the function and work life of nurses exposed to workplace violence , as well as patients care through control and management of workplace violence and making necessary changes in the working conditions .", "workplace violence is one of the factors that lead to a decline in nurses work life quality and satisfaction and has a negative effect on the quality of patients care and satisfaction as well as nurses efficiency and competency .", "workplace is one of the factors affecting the quality of given care , retaining nurses , and cost efficacy .", "with regard to the importance and notable role of human power in an organization , investigation of the elements , which increase staff 's function and reduce absenteeism and desertion and ultimately lead to an increase in efficiency , is of great importance for researchers and experts ." ], [ "questionnaire of exposure to workplace violence was a researcher - made brief form of a standard questionnaire which was designed by the who , international nursing association , and public services association in 2003 , whose questions were modified to four questions related to goals of the present study .", "this is a descriptive correlational study conducted in the emergency wards of selected hospitals in isfahan in 2012 .", "quality of nursing work life(qnwl ) questionnaire was designed by brooks and anderson in 2001 and its validity was confirmed .", "content validity was used for assessing its validity , wherein the questionnaire was given to 10 academic members of the nursing faculty after preparation of the primary draft , and then , their indications were applied to the questionnaire .", "the number of nurses with at least 1 year of work experience in the emergency ward ( n = 360 ) ok was determined by referring to nursing offices of the selected hospitals . to calculate the sample size ,", "total number of nurses with bs and at least 1 year of work experience in the research environment was 360 ." ], [ "frequency distribution and mean scores of work life quality and its dimensions in emergency nurses responses of nurses in emergency wards to work life items association between the number of nurses exposure to verbal , physical workplace violence and work life quality and its dimensions", "association between the number of nurses exposed to verbal and physical workplace violence and their work life quality and its dimensions have been presented in table 3 .", "subjects mean age was 33.76 ( 7.13 ) years ; 70.4% of nurses were married and 29.6% were single .", "about 26.9% were males and 73.1% were females , 32.3% had work experience of 1 - 5 years , 30.1% had 610 years , and 37.7% had > 10 years work experience in the emergency ward .", "the highest number of exposures to verbal violence ( 41.4% ) was more than four times , and for physical violence ( 9.1% ) , it was two times .", "about 76.9% of the nurses were exposed to verbal violence and 26.9% to physical violence ." ], [ "as the staffs in health care system are exposed to workplace violence , prevention of violence and providing education of the necessary interventions against violence should be followed at all levels of an institute .", "the findings of the present study showed that 76.9% and 26.9% of nurses were exposed to verbal and physical violence , respectively , in the year prior to study , which shows a high prevalence and is in line with a study conducted in babol university of medical science in 2009 .", "there is a negative correlation between the number of exposures to verbal and physical violence and work life quality and its dimensions , which has not been studied so far .", "previous studies on quality of work life for nurses show that nurses recognition and function directly affect their intention to stay in nursing profession .", "nurses work life quality dimensions and their association with the number of workplace violation exposures are discussed as follows .", "the authorities should also help promotion of staffs services , especially that of nurses , by making a secure workplace ." ], [ "most of the nurses were dissatisfied with this dimension and mentioned the reasons as family 's needs , working hours , and low energy after doing their daily tasks .", "nurses reported that they spend a long time at their workplace , so they have little energy after work and can not fulfill their families needs , which is consistent with the results reported in previous studies ." ], [ "disproportionate salary and reward was one of the reasons for nurses dissatisfaction with their work life quality . behavioral theories like mallow and herzberg behavioral theories showed that fulfillment of primary needs is essential as the individuals can not concentrate on higher needs if their primary needs are not met . in the present study", ", 93.5% of nurses believed that their salary was not balanced with the inflation rate in market , which is in line with previous studies .", "meanwhile , 57% of nurses in the us believed their salary was balanced with their expenses .", "nurses low income is one of the major reasons for their job dissatisfaction and desertion ." ], [ "67.2% of the nurses believed they were not independent in taking care of the patients , which concords with former studies in which nurses reported they had low autonomy in decision making about patients care .", "about 81.2% of the nurses believed that they had high workload , which is consistent with previous studies . on the other hand ,", "about 88.7% of the nurses believed there were not adequate nursing personnel in their work environment and 64.5% believed that they were given extra non - nursing tasks .", "shortage in human resources and increase of nurses workload act as pressure factors among nurses , which lead to professional and organizational desertion . despite the shortage in human resources ,", "these dimensions of malutilization of nursing force can increase the shortage of nursing force in a vicious cycle and affect nurses skills and experiences .", "such challenges may impose a notable pressure on nurses and negatively affect nurses perception of work life ." ], [ "managerial methods act as one of the problems in this dimension , which include lack of managers supervision , feedback , participation in decision making , higher level of managers respect toward nurses , inefficient nursing strategies and policies concerning facilitation of work , and modification of nurses concerns so that they think their struggles are not officially noted by nursing managers .", "as the staffs in health care system are exposed to workplace violence , prevention of violence and providing education of the necessary interventions against violence should be followed at all levels of an institute .", "the authorities should also help promotion of staffs services , especially that of nurses , by making a secure workplace .", "about 58.5% of nurses believed they were not able to communicate with their supervisors and nurse managers . in a study on the quality of work life among nurses in the us ,", "the findings of the present study showed that 76.9% and 26.9% of nurses were exposed to verbal and physical violence , respectively , in the year prior to study , which shows a high prevalence and is in line with a study conducted in babol university of medical science in 2009 .", "previous studies on quality of work life for nurses show that nurses recognition and function directly affect their intention to stay in nursing profession .", "there is a negative correlation between the number of exposures to verbal and physical violence and work life quality and its dimensions , which has not been studied so far ." ], [ "with regard to the above - mentioned negative correlation , it can be noted that workplace violence is a negative element reducing nurses work life quality . \n", "as the work life quality of nurses working in selected hospitals in isfahan is less than moderate , managers and authorities in hospitals should make policies for promotion of nurses work life quality through the following interventions : hospital managers should consider improvement of working conditions and making a supportive , friendly , and intimate environment for all the staffs , involving nurses in decision making and respecting their viewpoints , and designing a payment system based on nurses real function and nursing managers and supervisors more efficient humanistic communications.nurses work life quality is influenced by social , executive , managerial , and specific cultural conditions , and the present study revealed a negative correlation between the number of nurses exposed to violence and work life quality . with respect to the outcomes of workplace violence and its effect on work life quality , managers and authorities of these hospitals should think of solutions for the same .", "as the work life quality of nurses working in selected hospitals in isfahan is less than moderate , managers and authorities in hospitals should make policies for promotion of nurses work life quality through the following interventions : hospital managers should consider improvement of working conditions and making a supportive , friendly , and intimate environment for all the staffs , involving nurses in decision making and respecting their viewpoints , and designing a payment system based on nurses real function and nursing managers and supervisors more efficient humanistic communications .", "nurses work life quality is influenced by social , executive , managerial , and specific cultural conditions , and the present study revealed a negative correlation between the number of nurses exposed to violence and work life quality . with respect to the outcomes of workplace violence and its effect on work life quality" ], [ "\n as the work life quality of nurses working in selected hospitals in isfahan is less than moderate , managers and authorities in hospitals should make policies for promotion of nurses work life quality through the following interventions : hospital managers should consider improvement of working conditions and making a supportive , friendly , and intimate environment for all the staffs , involving nurses in decision making and respecting their viewpoints , and designing a payment system based on nurses real function and nursing managers and supervisors more efficient humanistic communications.nurses work life quality is influenced by social , executive , managerial , and specific cultural conditions , and the present study revealed a negative correlation between the number of nurses exposed to violence and work life quality .", "as the work life quality of nurses working in selected hospitals in isfahan is less than moderate , managers and authorities in hospitals should make policies for promotion of nurses work life quality through the following interventions : hospital managers should consider improvement of working conditions and making a supportive , friendly , and intimate environment for all the staffs , involving nurses in decision making and respecting their viewpoints , and designing a payment system based on nurses real function and nursing managers and supervisors more efficient humanistic communications .", "with respect to the outcomes of workplace violence and its effect on work life quality , managers and authorities of these hospitals should think of solutions for the same .", "nurses work life quality is influenced by social , executive , managerial , and specific cultural conditions , and the present study revealed a negative correlation between the number of nurses exposed to violence and work life quality . with respect to the outcomes of workplace violence and its effect on work life quality" ] ]

[ [ ". the primary goal of the present work was to investigate the product ion distributions for the reactions with no ions of 22 aldehydes involved in human physiology and pathophysiology using a sri - tof - ms , a variant of the well - established ptr - ms technique .", "proton - transfer reaction mass spectrometry ( ptr - ms ) is frequently employed in biological , medical , and environmental studies for detecting and quantifying volatile organic compounds [ 4350 ] .", "the application of a time - of - flight ( tof ) mass analyser in ptr - ms instruments notably improves their resolving power and , thereby , the discrimination between isobaric compounds .", "the reactions of no with vocs in sri - tof - ms are relatively poorly known , inhibiting their use for trace gas analysis , but it is certain that for most such reactions multiple product ions will result , as can also happen using h3o reagent ions in ptr - ms .", "an interesting advantage of no as a reagent ion is that different chemical classes of vocs have their typical reactions with no ( charge / electron transfer , hydride ion ( h ) , transfer , hydroxide ion ( oh ) transfer , alkoxide ion ( or ) transfer , and no / analyte molecule association ) , as has been summarized in a detailed review paper .", "it is well established that the human body generates a wide variety of volatile organic compounds ( vocs ) some that are present in exhaled breath , emitted through the skin and released by urine samples . as human - specific signatures ,", "the recent employment of additional precursor ( reagent ) ions such as no , o2 , and kr instead of the usual h3o ( creating a selective reagent ionization time of flight mass spectrometry ( sri - tof - ms ) ) has further enhanced the analytical possibilities of this technique" ], [ "the no / aldehyde reactions occurred in the carrier / aldehyde sample gases in the flow / drift tube at a total pressure of 2.23 mbar and a gas temperature of 60 c .", "the settings of the ion source were chosen as follows : ion source current 5 ma , source voltage ( us ) 20 v , source - out voltage ( uso ) 70 v , and source valve opening 40% . with these settings the major parasitic impurity ions , as detected downstream by the analytical tof - ms , were h3o , o2 , and no2 at relative levels ( parasitic ion / no ) of 0.30.6% , 11.5% , and 12% , respectively in the air carrier / buffer gas .", "this high resolution allows the separation of ions at nominally the same integer mass , for example , the nominally isobaric ions c3h7 and ch3co ions that are sometimes produced simultaneously in the analysis of gaseous matrices containing hydrocarbons , aldehydes and ketones . the mass calibration was based on three impurity peaks always present in the spectra : h3o ( 19.0178 ) , no ( 30.9945 ) , and no2 ( 45.9924 ) .", "the no precursor / reagent ions were generated by the ionization mechanism extensively described elsewhere , essentially by charging the hollow cathode discharge ion source with high purity dry air .", "effectively , for each compound the product ion distribution was investigated using 3 distinct concentration levels of each aldehyde in air ranging approximately from 25 to 150 ppbv and at two different absolute humidity levels of essentially 0 and 3.5% .", "the compound purities are also given in table 2 for assistance in the interpretation of the product ion distributions of the no / aldehyde reactions ." ], [ "effectively , for each compound the product ion distribution was investigated using 3 distinct concentration levels of each aldehyde in air ranging approximately from 25 to 150 ppbv and at two different absolute humidity levels of essentially 0 and 3.5% .", "the compound purities are also given in table 2 for assistance in the interpretation of the product ion distributions of the no / aldehyde reactions .", "usa ) filled with predefined amounts of purified and humidified air , the latter being produced by a gaslab calibration mixtures generator ( breitfuss messtechnik , germany ) .", "single - compound standard mixtures were prepared from liquid aldehydes , the majority of which were purchased from sigma aldrich ( austria ) ; acetaldehyde ( 99% ) , n - propanal ( 97% ) , n - butanal ( 99% ) , n - pentanal ( 97% ) , n - hexanal ( 98% ) , n - heptanal ( 95% ) ," ], [ "the no / aldehyde reactions occurred in the carrier / aldehyde sample gases in the flow / drift tube at a total pressure of 2.23 mbar and a gas temperature of 60 c .", "this high resolution allows the separation of ions at nominally the same integer mass , for example , the nominally isobaric ions c3h7 and ch3co ions that are sometimes produced simultaneously in the analysis of gaseous matrices containing hydrocarbons , aldehydes and ketones . the mass calibration was based on three impurity peaks always present in the spectra : h3o ( 19.0178 ) , no ( 30.9945 ) , and no2 ( 45.9924 ) .", "the settings of the ion source were chosen as follows : ion source current 5 ma , source voltage ( us ) 20 v , source - out voltage ( uso ) 70 v , and source valve opening 40% . with these settings the major parasitic impurity ions , as detected downstream by the analytical tof - ms , were h3o , o2 , and no2 at relative levels ( parasitic ion / no ) of 0.30.6% , 11.5% , and 12% , respectively in the air carrier / buffer gas .", "the no precursor / reagent ions were generated by the ionization mechanism extensively described elsewhere , essentially by charging the hollow cathode discharge ion source with high purity dry air .", "the standard mixtures entered the flow / drift tube of the sri - tof - ms instrument at a steady flow rate of 10 ml / min via a two - meter - long , heated ( 40 c ) teflon transfer line .", "effectively , the average of these 10 spectra was used to determine the percentages of the product ions resulting from each no / aldehyde reaction ." ], [ "molecule interactions in the sri - tof - ms flow / drift reactor and because of the very large number density of the h2o molecules in the sample / carrier gas at an absolute humidity of 3.5% .", "- alkanals the hydride ion transfer process may be followed by the elimination of an h2o molecule ( or formation of dihydroxyamine h3no2 as a single neutral product ) , but this could only be substantiated by detailed consideration of the energetics of the reactions ; this uncertainty is indicated by bracketing the probable neutral products of each reaction in table 2 . the energy required for fragmentation of the primary product ion ( mh ) to eliminate co or h2o molecules can be acquired in multiple collisions with the n2 and o2 molecules that excites internal vibrational modes of ( mh ) ions , since at an e / n of 130 td the effective temperature of the interaction can be 500800 k .", "this strongly implies that these no / aldehyde reactions in the thermalized sift - ms , and even the suprathermal sri - tof - ms reactors , do proceed via close interactions and the initial formation of the intermediate ( nom ) * excited complexes . in the sift experiments , the observed product ions for the saturated alkanals mostly result from h transfer , occasionally the partial formation of nom adduct ions in the case of the unsaturated alkenals , and rarely ions that result from chemical rearrangements within the excited complex", "significantly , the abundance of the c3h5 product ion for other aldehyde reactions reduced somewhat in the spectra obtained for the humid sample / carrier gas ( see e.g. , this product ion for the 2-methyl propanal and the 3-methyl butanal reactions ) ." ], [ "the results of the present study of the reactions of no with some 22 aldehydes , compromising several n - alkanals , several branched chain alkanals , and several alkenals , indicates that most of the reactions result in multiple ion products , but common ( mh ) product ions are seen that result from hydride ion transfer with the fractional abundance of these ions increasing with the alkanal molecular mass .", "a series of hydrocarbon ions , cnhm , appear at widely differing percentages of the total ion products at m / z values that reflect the complexity ( atomicity ) of the aldehyde molecules .", "more specifically , alkanals exhibited a higher degree of fragmentation than the alkenals and the branched aldehydes dissociated most commonly at the position 2 . it must be emphasized that these ion product distributions will surely depend on the actual value of e / n used in the sri - tof - ms instrument . whilst increasing the humidity of the sample / carrier gas had little effect on the product ion branching ratios , such serious fragmentation limits the value of sri - tof - ms using no reagent ions for the identification of aldehydes , especially when more than one of these compounds occur together in real samples such as exhaled breath and the headspace of biological fluids ." ] ]

[ [ "the primary goal of the present exploratory study was to compare the mental health status of a sample of women who experienced a 1st trimester abortion ( up to 12 weeks gestation ) to women who had a 2nd or 3rd trimester abortion ( 13 weeks and beyond ) .", "a secondary goal was to provide additional descriptive data on women who delay abortion decisions until the 2nd and 3rd trimesters with a focus on variables pertaining to the abortion decision .", "in the analyses , sociodemographic and personal history factors , particularly those related to significant life stressors such as exposure to abuse , that may systematically vary across the two groups ( early and late ) were controlled in order to more accurately examine the independent effects of abortion timing .", "the majority of abortions in the united states are performed early in pregnancy and most of the research pertaining to indicators of postabortion health has logically involved the study of women who have undergone 1st trimester abortions . however , it is significant to note that 12%-13% of the annual 1.2 million u.s ." ], [ "posttraumatic stress disorder symptoms were assessed with the ptsd checklist - civilian version ( pcl - c ) .", "surveys were posted on an internet website from april , 2005 through august , 2008 .", "internal consistency reliability estimates using cronbach 's alpha for the full scale and for the intrusion , avoidance , and hyperarousal subscales were equal to .92 , .82 , .80 , and .82 , respectively .", "specific analyses conducted included independent t - tests , analyses of variance ( anova ) , analyses of covariance ( ancova ) , multivariate analyses of variance ( manova ) , multivariate analyses of covariance ( mancova ) , and logistic regression . in the analyses wherein statistical controls were employed , the following variables were entered : race , marital status at the time of the abortion , number of years of formal education , number of abortions , number of years since the target abortion , having received mental health counseling before the abortion , having been hospitalized for emotional problems before the abortion , meaningfulness of the respondent 's religion , and a childhood or adult history of physical or sexual abuse .", "for the purposes of the present investigation , a score of 1 was entered for each item endorsed on the scale at the level of moderately , quite a bit , or ", "although the time frame was chosen for convenience , the goal was to collect data until a minimum of 50 women who experienced a late - term abortion had responded in order to insure adequate statistical power .", "reliability and validity evidence for the pcl is provided by weathers and colleagues . with the current sample ," ], [ "additional respondents identified the following countries of citizenship : england ( 4% ) , canada ( 6.4% ) , and australia ( 2.7% ) , with smaller percentages from france , ireland , norway , romania , czechoslovakia , germany , sweden , new zealand , south africa , kenya , mexico , nicaragua , brazil , nepal , and south korea .", "in contrast , women who secured earlier abortions were more likely to report abortion decision agreement with their partner and they were more likely to report that mental health , financial , and educational concerns factored into their decision to abort . in order to test the hypothesis that 2nd and 3rd trimester abortions would be more stressful than 1st trimester abortions , several analyses were conducted that enabled the researchers to determine if women experiencing late - term abortions are generally more at risk for ptsd symptoms ." ], [ "the purpose of this study was to test the hypothesis that women who undergo 2nd and 3rd trimester abortions would be more traumatized than their peers who experience 1st trimester abortions as evidenced by significantly higher rates of ptsd symptoms .", "a secondary objective of this study was to identify possible differences in the context of abortion decision - making associated with an early versus late abortion .", "these data suggest that women who postpone their abortion into the 2nd or 3rd trimester experience elevated risk for certain forms of unwelcome re - experience of the abortion procedure , likely requiring active professional intervention .", "based on societal interest in the morality and legality of late - term abortion , data related to the psychological sequelae of late - term abortion is needed in order to protect women 's mental health . " ] ]

[ [ "finally , understanding patient preference may be a strategy to improve adherence to osteoporosis therapy , since a lower treatment satisfaction is associated with an increased risk of discontinuing or switching the ongoing osteoporosis medication , as compared with a higher treatment satisfaction.23 in this review , we will focus on the results of studies that investigated patient preference and adherence to dmab for the treatment of postmenopausal osteoporosis in comparison with alternative osteoporosis therapies , especially bisphosphonates , in order to establish who can take more advantage of dmab therapy , to understand the possible factors that influence medication - taking behavior , and to discover potential strategies for improving adherence .", "moreover , patient perception about the necessity of the prescribed medication to treat osteoporosis and their concerns about potential adverse effects are important and potentially modifiable determinants of adherence , especially if clarified and addressed at the beginning of the treatment .", "however , both bisphosphonates and dmab , in association with calcium and vitamin d , appear to be about equally effective in clinical trials in reducing the risk of fragility fractures,14 which represent a considerable problem of public health , considering the increasing fracture - related morbidity , mortality , and medical costs in many regions of the world.15 it must be considered , however , that any therapy , even if proved to be effective in clinical trials , requires adherence to achieve successful treatment outcomes ." ], [ "patient preference to and satisfaction with a specific drug are important determinants of adherence to therapies for chronic diseases , including osteoporosis.23,24 preference is a relative index of desirability , and it can be measured as a choice between alternatives or scaled as a degree of desirability,25 while treatment satisfaction measures the degree to which patient expectations with different features of the ongoing treatment ( eg , perceived efficacy , presence and severity of side effects , convenience , and bother with treatment ) are met.25 available studies typically compared patient preference to and satisfaction with dmab versus bisphosphonates , especially alendronate , which is usually the first - line medication for the treatment of postmenopausal osteoporosis.2628 since existing questionnaires assessing preference to and satisfaction with osteoporosis treatments were considered inadequate for the comparison between a weekly oral tablet and a 6-monthly subcutaneous injection , a new tool , the preference and satisfaction questionnaire ( psq ) , was developed to compare dmab and alendronate.25 the psq consists of 34 items that explore preference ( the treatment choice made by a patient ) , satisfaction ( the degree to which the features of a specific drug actually meet the patient expectations ) , and finally , bother ( the degree to which the patient is disturbed by certain features of the treatment).25 in the determining efficacy : comparison of initiating denosumab versus alendronate ( decide ) trial and the study of transitioning from alendronate to denosumab ( stand ) , two international , double - blind , double - dummy , randomized , phase 3 head - to - head trials comparing dmab with alendronate,9,10 psq was completed after 12 months of treatment or upon study discontinuation.26 among the subjects who expressed a preference , significantly more patients , who were blinded to their treatment assignment , preferred the injection over the tablet , and were more satisfied overall and with the dosing frequency of a 6-monthly injection over a weekly tablet after 12 months of treatment .", "moreover , more patients indicated that they would choose the 6-monthly injection , which was better fitted to their lifestyles , for long - term use or continuation of treatment .", "subject concerns about potential side effects were significantly lower for dmab than for alendronate at the follow - up visits after the cross - over , when patients had experienced both forms of treatment administration , but not at previous time points.27,28 these variations in subject perceptions about treatment resulted in a significantly higher necessity concerns differential ( ncd ) ( ie , how much treatment necessity outweighs treatment concerns ) for dmab compared with alendronate at 6 months for both treatment years.36 finally , the bmq survey in the daps study provided significantly lower mean preference scores for alendronate than for dmab at every visit , consistent with the preference scores of the psq.27,28" ], [ "many of the studies , which investigated preference for and satisfaction with dmab , also evaluated adherence to the treatment , overall or in comparison with oral bisphosphonates , especially alendronate .", "indeed , higher ncd scores were significantly associated with lower odds of nonadherence , thus suggesting that positive perceptions of treatment positively influence medication - taking behavior.36 by extension , it seems feasible that understanding the factors that influence patient perceptions of osteoporosis treatments may result in an improved educational effort to increase adherence . in relation to this hypothesis , a successive study , although with several limitations , showed that in osteoporotic patients starting with a first dmab injection , a positive feedback given to the patient already 6 months thereafter , based on the demonstration through a careful medical explanation of a rapid and highly significant bmd increase and on a good safety profile , was able to guarantee in 99% of patients the willingness to accept a second injection , thus reinforcing the role of patient perceptions and of their assessment during doctor patient interactions on adherence to treatment.37 several studies on medication - taking behavior of patients receiving dmab are now ongoing , and data available so far confirm a high adherence to this 6-monthly subcutaneous treatment.38,39 the 12-month interim results of a european noninterventional study involving germany , austria , greece , and belgium showed that 82.7%89.3% of patients received a second dmab injection within 6 months 4 weeks , and therefore , these patients were considered adherent to treatment,38 a proportion of patients significantly greater than that observed in similar studies on bisphosphonates.17,19 in all four countries , these percentages increased as the permissible time window was extended , and up to 95.3% of patients received a second administration within 6 months 8 weeks.38 at baseline , all participants completed the morisky 8-item medication adherence scale ( mmas-8 ) questionnaire , a tool used to measure the probability of adherence.40 however , although the majority of patients had a low or medium score for adherence to prior treatments , their adherence to dmab was high anyway , suggesting that some features of dmab , such as the dosing schedule , may have positively influenced adherence behavior .", ", several baseline variables were found to be significantly associated with persistence among us patients and others among canadian patients.39 in particular , it is worth signaling that us patients with greater ncd obtained by means of bmq had a higher odds ratio for persistence,32 further confirming the role of patient perceptions of a specific medication in influencing medication - taking behavior , as already described in previous studies.23,36,37" ], [ "nevertheless , although several studies suggested that dmab is cost - effective as compared to bisphosphonates,4145 it must be considered that the effect of these aspects may be very difficult to assess since health care and reimbursement systems vary extensively between countries , and thus studies performed in different regions of the world become scarcely comparable .", "a conflict of interest can not be excluded , and the provision of a drug to study participants by the study sponsor may have concealed the possible influences of treatment cost and accessibility on patient preference and adherence .", "this observation is supported by the finding that the rates of bisphosphonate adherence observed in the studies cited so far are meaningfully higher than rates observed in previous retrospective observational reports ( less than half in the first year).17,19 the main reasons that may explain this phenomenon are the willingness of subjects to participate in a study and thus to accept the treatment offered , and the awareness of patients that their medication - taking behavior is being monitored .", "these two factors , differently from real - world behaviors , eliminate primary nonadherence patient behaviors in trials ( ie , the refusal of a medication at first prescription ) .", "however , the participation in any prospective study , even observational , may influence patients behavior , potentially leading to an overestimation of adherence to and preference for a specific treatment .", "moreover , in the clinical trials , participants are selected according to given inclusion criteria , and this aspect may limit the generalizability of results . secondly , in many of the cited studies,2629,3639", "this difference may be observable to a greater extent in randomized clinical trials , where patients are regularly followed up by a skilled health care professional according to a precise study protocol ." ], [ "in spite of these limitations , available data suggest that , in comparison with bisphosphonates , postmenopausal women report greater preference to and satisfaction with dmab , both overall and with its dosing frequency and route of administration , and they would choose dmab over bisphosphonates for long - term osteoporosis treatment.2629 moreover , patient beliefs about the necessity of osteoporosis treatment and patient concerns about potential adverse events appear higher and lower , respectively , with dmab than with bisphosphonates .", "current evidence underlines the necessity to personalize osteoporosis treatment , taking patient preference into account , especially in regards to frequency and route of administration .", "these efforts are addressed to improve adherence to osteoporosis treatment and , as a consequence , to achieve more successful treatment outcomes , thus positively impacting on the cost - effectiveness of the chosen drug.45 from this perspective , according to the data demonstrating a better adherence to dmab compared to other osteoporosis treatments , especially bisphosphonates , dmab may represent a reasonable and effective alternative to bisphosphonates , particularly for osteoporotic women in whom a suboptimal or even poor adherence to oral treatments is expected .", "moreover , patient perception about treatment seems to influence medication - taking behavior,36,39 and during treatment follow - up , positive reinforcement based on the evidence of actual successful treatment outcomes , such as the bmd increase913 or bone turnover suppression,912 could help to further improve patient adherence.37 indeed , due to the asymptomatic nature of osteoporosis , until a fracture occurs or even later , the patient could easily underestimate the importance of osteoporosis medication , resulting in poor adherence and therefore an increased risk of fracture . in conclusion ,", "therefore , it is possible that in clinical practice , the differences between dmab and oral bisphosphonates in term of compliance and persistence may be even higher , although additional real - life studies are needed to confirm this assumption ." ] ]

[ [ "transcranial magnetic stimulation ( tms ) and magnetoencephalography ( meg ) have both been applied in stroke patients to reveal cortical excitability changes .", "we hypothesized to see correlations between erd and mt related to the early cortical excitability and between ers and sici , both attributed to gaba - a - related processes .", "moreover , we expected that icf , reflecting glutamatergic activity , would correlate with the somatosensory modifications in meg , as glutamate is associated with late somatosensory plasticity .", "movement - related beta erd was significantly reduced in lh of stroke patients . the hand representation in the somatosensory cortex ( s1 ) , estimated by somatosensory evoked fields ( sefs ) , is the largest one month after stroke and its increase was correlated with the affected hand function . in tms mapping", "reduction of beta ers , however , correlated with clinical improvement after physiotherapy of patients with chronic stroke ." ], [ "meg and ntms were recorded from thirteen patients ( age 67.3 11 years , 8 women ) , with first - ever ischemic stroke in the middle cerebral artery territory one ( t1 ) and three months after stroke ( t2 ) .", "time - frequency representations ( tfr ) in the 1030 hz band were calculated to define the frequency range of beta modulation , which was quantified by the temporal spectral evolution method ( tse ) from signals of 2 to 4 meg sensors showing the strongest reactivity . only the contralateral beta modifications ( the affected hand stimulation for the lh and the unaffected hand for nh ) were analyzed .", "the absolute erd and ers strengths were calculated from the peak amplitudes and converted into relative values in relation to the 300 ms prestimulus baseline . for sefs , about 120 responses were averaged for stimulation of d2 ( isi 3005 ms ) , and d1 and d5 ( isi 1005 ms ) in separate sessions .", "as the patients having both tms and meg recordings are a subset of the previous patient groups , we recalculated the group - level electrophysiological parameters to show that the present patient group is sufficiently similar to those reported previously ( see supplementary tables 1 and 2 in supplementary material available online at http://dx.doi.org/10.1155/2015/309546 ) .", "onset and offset of the erd and ers were defined as a time point when the signal differed 2 sds from the baseline ." ], [ "in addition to hypothesized correlations , sici of the nh and erd of the lh at t2 were correlated ( r = .82 , p < .001 ) , indicating that strong erd in the lh was associated with a strong sici in the nh .", "in the lh , meps were found in 11 patients both at t1 and at t2 and were present in the nh in all patients .", "pp12ms stimulation of lh facilitated meps ( icf ) in 10 out of 11 patients at t1 and in all patients at t2 . in nh" ], [ "our study is the first to compare meg and ntms excitability parameters during stroke recovery .", "the patients were not tested in the acute stage with tms , and meg recordings showed most dramatic erd and ers modifications between the acute phase and t1 . although mt in the lh is correlated with the paretic hand function in acute stroke , this correlation , however , weakens during recovery , and tms intracortical excitability parameters correlated with the clinical performance best at 3 months .", "the sici and beta ers , both attributed to gabaergic mechanisms , were correlated in one of their four possible intrahemispheric conditions ( in the nh at t2 ) .", "we found correlations between cortical excitability estimates derived from ntms and meg . as expected , we found correlations between mt and erd , but in only one of the four possible intrahemispheric and two out of four interhemispheric conditions .", "the 2 ms or 12 ms isis , selected for our paired - pulse stimuli , produce clear sici and icf in healthy subjects and in stroke patients , but we did not test other parameters , which could have produced stronger correlations between ntms and meg .", "recovery of sensorimotor fmri activation to digit stimulation from 1 to 3 months was correlated with final motor function , emphasizing the importance of this time period for stroke recovery ." ], [ "numerous correlations of the excitability parameters between the lh and nh emphasize the importance of the hemispheric balance of the excitatory - inhibitory properties of the sensorimotor system in analyzing the stroke - related dysfunction during stroke recovery .", "icf and si response amplitude and area size , mt and the erd of the hemisphere harboring the stroke lesion , and sici and ers of the nonlesioned hemisphere are correlated in stroke patients ." ] ]

[ [ "stereotactic body radiotherapy ( sbrt ) is a technique that allows the delivery of a precise dose of radiation to a tumor while sparing adjacent normal tissues .", "the insertion of a fiducial marker near to the tumor before radiotherapy allows respiratory motion to be tracked , thus enabling accurate dose delivery while the patient breathes freely .", "although surgery is the current standard treatment for localized surgically operable lesions , many patients with liver metastases can not undergo surgical resection because of associated comorbidities , concerns about their age , the extent of the disease , or the patient 's wishes .", "however , the movement of intra - abdominal organs due to respiration has hampered the use of sbrt .", "recently , the percutaneous insertion of fiducial markers has been described [ 4 , 5 ] , but experience of such procedures is still limited .", "treatment choice is guided by the barcelona clinic liver cancer staging system and recommended treatment strategy .", "this marker is made from gold , which makes it biocompatible and ensures it exhibits good contrast on x - ray images . in this study , we describe our initial experience with this new fiducial marker and evaluate the technical feasibility , clinical efficacy , and safety of sbrt using this marker ." ], [ "since the patient accrual for this sbrt study was relatively slow , we report our initial experience with a gold flexible linear fiducial marker ( visicoil , radiomed corporation , barlett , tn , usa ) in this article . between july 2012 and february 2015 , 18 patients underwent percutaneous fiducial marker placement under computed tomography ( ct ) fluoroscopic guidance or ultrasonographic guidance before sbrt for liver tumors .", "first , all patients underwent diagnostic ct scans of their abdomen composed of 35 mm - thick contiguous axial tomographic sections . after reviewing these preliminary images , an appropriate puncture site and the optimal needle guidance method , i.e. ct fluoroscopic or ultrasound guidance , was determined in advance .", "the marker placement was performed during breath - holding under ct fluoroscopic guidance in 8 cases and under ultrasound guidance in 10 cases .", "was evaluated by comparing abdominal plain x - ray images at an inspiratory phase in the supine position taken after marker placement with fluoroscopy images taken at an inspiratory phase of the treatment system ; thereby the marker position was evaluated in relation to the rib bones and diaphragm .", "migration of a marker before radiotherapy was defined as its displacement exceeding 3 mm from the initial position on ct images ; the marker position within or relative to the tumor was evaluated . during radiotherapy , migration of a marker", "therefore , when migration of the marker that could influence treatment accuracy ( e.g. > 3 mm ) was suspected by fluoroscopy , ct scanning was scheduled for further evaluation to determine whether the displacement was significant or not .", "it was difficult to evaluate subtle displacements of the marker by fluoroscopy images alone , especially once radiotherapy was started , because the size of the tumor and the surrounding tissue could change with treatment ." ], [ "( b ) the gold flexible linear fiducial marker . a 73-year - old man with metastasis from carcinoma of the ampulla of vater .", "( c ) ct image shows the successful placement of the gold flexible linear fiducial marker ( arrow ) in the tumor . the gold flexible linear fiducial marker ( visicoil ) .", "( c ) ct image shows the successful placement of the gold flexible linear fiducial marker ( arrow ) in the tumor .", "( b ) ct image shows the percutaneous insertion of the gold flexible linear fiducial marker .", "first , all patients underwent diagnostic ct scans of their abdomen composed of 35 mm - thick contiguous axial tomographic sections . after reviewing these preliminary images , an appropriate puncture site and the optimal needle guidance method , i.e. ct fluoroscopic or ultrasound guidance , was determined in advance .", "local anesthesia was achieved via the subcutaneous administration of 1% lidocaine . after confirming that the needle tip had reached the target lesion , the fiducial marker was deployed , and then the needle was removed ( fig .", "( b ) ct image shows the percutaneous insertion of the gold flexible linear fiducial marker ." ], [ "was evaluated by comparing abdominal plain x - ray images at an inspiratory phase in the supine position taken after marker placement with fluoroscopy images taken at an inspiratory phase of the treatment system ; thereby the marker position was evaluated in relation to the rib bones and diaphragm .", "migration of a marker before radiotherapy was defined as its displacement exceeding 3 mm from the initial position on ct images ; the marker position within or relative to the tumor was evaluated . during radiotherapy , migration of a marker", "it was difficult to evaluate subtle displacements of the marker by fluoroscopy images alone , especially once radiotherapy was started , because the size of the tumor and the surrounding tissue could change with treatment .", "therefore , when migration of the marker that could influence treatment accuracy ( e.g. > 3 mm ) was suspected by fluoroscopy , ct scanning was scheduled for further evaluation to determine whether the displacement was significant or not .", "the target site was chosen by consensus by an interventional radiologist and a radiation oncologist before the procedure .", "marker position was checked by ct or cone - beam ct images taken immediately after placement and planning ct images taken before radiotherapy .", "clinical success was defined as the completion of sbrt without the marker dropping out of position ." ], [ "the target sites for marker insertion were as follows : inside the tumor in 11 cases ( 61% ) and near the tumor in 7 cases ( 39% ) .", "the 18 tumors consisted of 5 hepatocellular carcinomas ( 28% ) and 13 liver metastases ( 72% ) .", "the characteristics of patients , tumors and fiducial marker placement are summarized in table 1 .", "the median period between marker implantation and sbrt was 16 days ( range : 031 ) . \n", "sbrt was successfully performed in all 18 cases , and none of the markers was judged to have dropped out of its position ." ], [ "the new gold flexible linear fiducial marker is useful for percutaneous insertion because of its good stability . in this study , we were unable to determine the local control rate of patients undergoing sbrt with this fiducial marker due to the short follow - up periods involved .", "the placement of the gold flexible fiducial markers near or inside a tumor is considered to be the most direct version of this method . in the present study , fiducial markers were inserted before tumor - tracking sbrt ( using a cyberknife g4 ) during abdominal compression to improve the accuracy of localization .", ", the fiducial marker placement method should be decided based upon a consensus being reached between radiation oncologists and interventional radiologists after consideration of the tumor location and the anatomy of the hepatic artery , which should be confirmed with ct and angiography .", "no marker migration was observed ; thus , this gold flexible linear fiducial marker seems to be superior . however , pneumothorax occurred in one case , and a previous report found that percutaneous insertion of the gold flexible linear fiducial marker into the lungs is associated with a high risk of pneumothorax . in our experience ,", "for example , a previous study described cardiac embolization due to the migration of a nester embolization coil that was used as a fiducial marker . unlike traditional cylindrical gold seed fiducial markers , for which the migration rate was reported to be 5% , the marker used in this study is flexible and has a coiled design , which might reduce the incidence of fiducial migration . in our study ,", "one is to minimize tumor motion via the inhalation of oxygen , abdominal compression , learning of regular respiratory patterns , or breath - holding techniques [ 79 ] ." ], [], [ "funding to pay the open access publication charges for this article was provided by each of the co - authors in this search ." ] ]

[ [ "the joint labour of otology and sociology gives way to otosociology , a discipline dedicated to the study , intervention , and prevention of organic and functional pathologies of the auditory system with special emphasis on the influence of social factors . in the following sections , we describe how otosociology is capable of explaining both the social consequences and causes of certain diseases identified by otology as idiopathic . in the following section ( diseases , ischaemia , and alterations )", ", we describe the process of passing from identification of audiovestibular diseases recognised by otology to discuss these abnormalities as symptoms from the viewpoint of otosociology . in the third section ( otosociology )", ", we explain both the training and work focus of otosociologists and the methodologies employed by this new perspective , justifying its use in daily otorhinolaryngological practice .", "more specifically , it is the close collaboration between otology , which involves the biological study of diseases and abnormalities of the ear , and health sociology that directly collaborates with doctors and other health professionals , in addition to the syncretic integration of other disciplines such as anthropology and social / clinical psychology . in this manner ,", "currently , collaborative work teams can be found in several different medical specialties such as oncology , geriatrics , and forensic medicine , whose health teams are primarily composed of health care professionals ." ], [ "until now , audiovestibular pathologies have been treated by otological medicine , which identifies them exclusively as biological diseases , attempting to situate the aetiopathogenesis in the audiovestibular organ itself , and as a result , the causes and consequences remain hidden , making any treatment strategy strictly palliative in nature . in contrast , otosociology views and treats these pathologies as symptoms of a social problem that affects the biological part of the subject .", "many examples of the aetiology , incidence , diagnosis , treatment , and prognosis of these audiovestibular diseases are available in the medical literature and are discussed here .", "otosociology , by identifying social problems that cause these symptoms and alterations in the patient 's environment , can apply effective medical treatment and directly address the social consequences ( table 1 ) .", "these diseases cause patients to seek otological care and are immediately ascribed to the ear and are produced by the ear and are treated as exclusively otic pathologies .", "this theory is supported by the findings that social stress can extend itself farther than simply one 's social situation and can even produce physiological damage . in other fields of medicine , many diseases such as gastric ulcer [ 68 , 69 ] , diabetes , hypertension , and acute myocardial infarction have a social component in their origins , whether from previous conditions or sustained stress through time ( chronic stress ) . after providing a detailed description of how otology defines , diagnoses , and treats that which it considers to be audiovestibular diseases , we have introduced the variable of ischaemia as an aetiopathogenic explanation , from the point of view of otosociology , of the true causes of these alterations .", "the most important otological pathologies are sudden deafness , mnire disease , benign paroxysmal positional vertigo , tinnitus , and hyperacusis , commonly grouped within the category of audiovestibular diseases ." ], [ "we have already established that otosociology is a discipline dedicated to the study , intervention , and prevention of organic and functional pathologies of the auditory system , with special emphasis on the influence of social factors . as we can appreciate", "the issue to be researched is based on finding an explanation for the causes of these alterations with the goal of elucidating an effective treatment ; since viewed solely through the lens of biomedical methodology , the diagnosis is idiopathic and the treatment of symptoms alone is not sufficient to resolve this pathology . in the case of sociology ,", "the quality of the medical care given undergoes a substantial and objective improvement , and the perception of the patient is very positive .", "an otosociologist is an otologist with training in sociology that takes into account the influence of social factors in dealing with patients .", ", otosociology involves a new theoretical framework with different names , concepts , and research processes from those used in the otological approach ." ], [ "thirdly , the integration of a sociologist and the training of otologists in otosociology will benefit all parties involved . the health system will benefit because its principles are centred on the needs of the patient , and the objectives therein are orientated towards promoting health and preventing disease , whether in conditions of treatment , recovery , or palliative care .", "we have reached a new mutual intellectual understanding through fluid communication and reciprocity . to this end , a positive disposition has been necessary for including other points of view and recognising complementary abilities , that is to say , being open to learning and adapting , maintaining the principle of respect for the capacities and contributions from both sides to concrete points as a whole .", ", the otosociologist can resolve these cases by collaborating with the sociologist in those situations in which the social and cultural causes of the issue and proper interventions to treat it are not clear .", "secondly we can also affirm that the collaboration between otologists and sociologists in health centres is possible in several different combinations . in an otorhinolaryngology department with one sociologist for every given number of otorhinolaryngologists", "to conclude , otosociology has arisen due to the inability of otology to provide effective solutions to the aforementioned audiovestibular symptoms . with this in mind , otosociology provides an aetiopathogenic explanation based on the cultural and social environment of the patient , delivering a correct diagnosis and definitive treatment .", "the otosociologist has the opportunity to elucidate the sociocultural causes that produces audiovestibular alterations and can carry out successful interventions to treat it , increasing doctor satisfaction and prestige . for the patient within the health system , otosociology provides high - quality medical care , demedicalisation of the issue , and a consequent recovery of the patient 's identity as an individual , with substantial improvement in his / her condition .", "this all leads to improved perception of the multidimensional concept referred to as quality of life . by improving a person 's concept of health ,", "the objective of the doctor is to cure , but this is often impossible in idiopathic diseases , which constitutes a source of frustration for medical practice ." ] ]

[ [ "we report the case of a relapsing para - oesophageal abscess posing a great diagnostic challenge .", "however , isolated oesophageal cd is a very rare condition [ 1 , 2 , 3 , 7 , 10 , 11 ] . the clinical presentation and endoscopic and histologic findings of oesophageal cd are mostly non - specific and share features of more common diseases of the oesophagus .", "crohn 's disease ( cd ) is a chronic inflammatory disorder of the gastro - intestinal tract [ 1 , 2 , 3 ] ; its exact aetiology and pathogenesis is not known .", "exacerbations are due to flares of inflammation of the wall of the gastro - intestinal tube ." ], [ "also serologic findings and preclusion of other diseases , we made the diagnosis of cd with isolated involvement of the oesophagus complicated by a recurrent para - oesophageal abscess .", "a 42-year - old male patient with a para - oesophageal abscess and a fistula into the distal oesophagus was referred to our gastroenterology department in september 2012 for further evaluation and treatment .", "thoraco - abdominal computed tomography ( ct ) revealed a para - oesophageal abscess with a maximal extension of 6 cm adjacent to the oesophago - gastric junction and a fistula into the distal part of the oesophagus ( fig .", "we performed an endoscopic ultrasound ( eus ) that revealed an asymmetrical thickening of the oesophageal wall adjacent to the abscess , which caused a narrowing of the lumen .", "endoscopy combined with eus confirmed the complete resolution of the fistula and the abscess , whereas the thickening of the oesophageal wall and the enlarged lymph nodes persisted ." ], [ "the european crohn 's and colitis organization ( ecco ) proposes ppi for the treatment of oesophageal and gastroduodenal cd .", "there are only limited data available regarding the prevalence of oesophageal cd , and the prevalence of upper gastro - intestinal involvement is estimated to be 0.216% in patients with co - existing ileo - colic cd [ 1 , 3 , 4 , 5 , 6 , 7 , 8 , 9 ] .", "since most cases of oesophageal cd occur in patients with known cd or concurrent intestinal cd , diagnostic procedures may lead towards the correct diagnosis .", "inflammation remains unclear . in view of the clinical history of relapsing abscess formation and fistulization , the macroscopic aspect of diffuse ulcerative lesions , histologically chronic and acute inflammation , the positive anti - saccharomyces cerevisiae antibody titre as well as the lack of other aetiologies , we established the diagnosis of isolated oesophageal cd .", "different study populations are analysed , and also different diagnostic criteria are used to define cd involvement of the upper gastro - intestinal tract and oesophagus .", "furthermore , the prevalence of upper gastro - intestinal involvement has increased since the 1990s compared to older reports [ 1 , 5 , 12 ] ." ], [ "other , more frequent diseases ( e.g. , malignancy , eosinophilic oesophagitis , and viral or fungal infections ) must be ruled out .", "diagnosis of isolated oesophageal cd can be challenging [ 3 , 8 , 9 , 11 ] , since clinical findings often are non - specific .", "the diagnosis has to be made by integration of symptoms as well as endoscopic , histologic , and serologic findings [ 3 , 8 , 9 , 11 ] ." ], [], [] ]

[ [ "hence , this study was undertaken to evaluate the disinfection of dentinal tubules when contaminated with e. faecalis using m. citrifolia gel , papain gel , and aloe vera when compared with calcium hydroxide and chlorhexidine gel .", "there is no study to comparatively evaluate the antimicrobial activity of natural extracts of m. citrifolia , papain , and aloe vera ( all in gel formulation ) , 2% chlorhexidine gel and calcium hydroxide , against enterococcus faecalis .", "cosmetic and some medicinal products are made from the mucilaginous tissue in the center of the aloe vera leaf and is called as aloe vera gel .", "complete debridement and effective disinfection of the root canal space is an important prerequisite for achieving long - term success of nonsurgical endodontics .", "even 2% chlorhexidine gluconate has been used as an irrigant and intracanal medicament in endodontics ." ], [ "ltd , gujarat , india . ) was used as a thickening agent in the ratio of 2:1 ( vol / wt ) for group 3 ( papain raw extract taken from fruit ) , group 4 ( m. citrifolia raw extract taken from fruit ) , group 5 ( aloe vera raw extract taken from leaf ) , and group 6 ( chlorhexidine ) .", "hydroxyethyl cellulose is a nonionic , highly inert , and water - soluble agent and has been used in various studies for gel formation .", "a rotary diamond disk was used to decoronate the teeth 5 mm below cementoenamel junction and the apical part of the root to obtain 6 mm of the middle third of the root .", "contamination of the dentin blocks were carried out for a period of 21 days . at the end of 21 days", "fifty microliters of the inoculum containing the e. faecalis was transferred into each of the microcentrifuge tubes . at the end of 24 h", "the collected dentin shavings were transferred into 1 ml of sterile ts broth and incubated in an anaerobic environment at 37c for 24 h. after 24 h , the contents of each tube was serially diluted , 100 l of the broth in 100 l of sterile saline for 5 times ." ], [ "a rotary diamond disk was used to decoronate the teeth 5 mm below cementoenamel junction and the apical part of the root to obtain 6 mm of the middle third of the root .", "3 ( mani inc , tachigi - ken , japan ) in a slow speed handpiece was used to standardize the internal diameter of the root canals .", "the blocks were treated in an ultrasonic bath of 17% ethylene diamine tetra acetic acid for 5 min followed by 3% naocl for 5 min to remove the organic and inorganic debris .", "the first cycle was at 121c and the second was with the blocks immersed in 1 ml of tryptone soya ( ts ) broth in individual microcentrifuge tubes .", "the traces of chemicals used were removed by immersing the blocks in an ultrasonic bath containing distilled water for 5 min ." ], [ "the test organism used for this study was e. faecalis , which is a gram - positive facultative anaerobic bacterium .", "fifty microliters of the inoculum containing the e. faecalis was transferred into each of the microcentrifuge tubes . at the end of 24 h", "purity of the culture was checked by subculturing 5 l of the broth from the incubated dentin blocks in ts broth on ts agar plates .", "each dentin block was placed in presterilized microcentrifuge tubes containing 1 ml of the ts broth .", "e. faecalis ( atcc 29212 ) was grown in ts agar for 24 h. the culture was suspended in 5 ml of ts broth and incubated for 4 h at 37c and its turbidity was adjusted to 0.5 mcfarland standard ." ], [ "ltd , gujarat , india . ) was used as a thickening agent in the ratio of 2:1 ( vol / wt ) for group 3 ( papain raw extract taken from fruit ) , group 4 ( m. citrifolia raw extract taken from fruit ) , group 5 ( aloe vera raw extract taken from leaf ) , and group 6 ( chlorhexidine ) .", "hydroxyethyl cellulose is a nonionic , highly inert , and water - soluble agent and has been used in various studies for gel formation .", "the collected dentin shavings were transferred into 1 ml of sterile ts broth and incubated in an anaerobic environment at 37c for 24 h. after 24 h , the contents of each tube was serially diluted , 100 l of the broth in 100 l of sterile saline for 5 times .", "fifty microliters of the dilution was then plated on ts agar plates and incubated for 24 h. colonies were counted and readings were tabulated as shown in table 1 .", "group 1 : saline ( negative control ) group 2 : calcium hydroxide group 4 : m. citrifolia gel group 5 : aloe vera gel group 6 : 2% chlorhexidine gel calcium hydroxide ( sigma aldrich , mumbai , india ) was mixed with sterile saline in a ratio of 1.5:1 ( wt / vol ) to obtain a paste - like consistency .", "mean colony counts for different intracanal medicaments at 200 and 400 m depths at different time intervals", "they were incubated in an anaerobic environment for 37c . at the end of 1 , 3 , and" ], [ "the data were statistically analyzed with one - way analysis of variance followed by tukey multiple comparison means to check the difference in bacterial inhibition between the groups ( p < 0.05 ) .", "the paired t test was used to check for differences in growth at different time intervals within groups and for differences at the 2 depths ( p < 0.05 ) ." ], [ "group 2 ( calcium hydroxide ) showed sufficient antibacterial activity on day 1 , which decreased on day 3 and again increased by day 5.group 3 ( papain gel ) showed a decrease in antibacterial activity at the end of day 5.group 4 ( m. citrifolia gel ) showed constant antimicrobial efficacy on all the days ( 1 , 3 , and 5 days).group 5 ( aloe vera gel ) showed comparable antibacterial activity to m. citrifolia gel on first day , but there was a gradual decrease in the efficacy by the end of day 5 . \n ", "group 5 ( aloe vera gel ) showed comparable antibacterial activity to m. citrifolia gel on first day , but there was a gradual decrease in the efficacy by the end of day 5 . to summarize the results ,", "contamination of the dentin blocks was confirmed when debris samples harvested from the saline group ( negative control ) yielded positive growth .", "group 3 ( papain gel ) showed a decrease in antibacterial activity at the end of day 5 .", "the inhibition of growth in all the groups was statistically significant in comparison to the control group ( saline ) ." ], [ "the in vitro model developed by haapasalo and rstavik has been used to assess the efficacy of endodontic medicaments in the disinfection of dentinal tubules .", "the use of a biocompatible intracanal medicament possessing antimicrobial properties between appointments may reduce or eliminate bacteria in the root canal system and significantly increase the success of root canal treatment .", "this study reveals the effect of newer organic intracanal medicaments ( when used as raw extracts ) against e. faecalis . on an average ," ], [ "chlorhexidine gel showed the maximum antimicrobial activity against e. faecalis , whereas calcium hydroxide showed the least . among the natural intracanal medicaments , m. citrifolia gel consistently exhibited good inhibition up to the day 5 followed by aloe vera gel and papain gel ." ] ]

[ [ "are known to be complicated by aps ; however , aps with pleural effusion is extremely rare . here ,", "we present a case of aps complicated by unilateral pleural effusion that responded well to oral corticosteroid therapy .", "antiphospholipid syndrome ( aps ) is an autoimmune disease characterized by thrombosis and morbidity , specifically in pregnancy , due to antiphospholipid antibodies .", "about half of the cases of aps occur as a primary disorder , while the rest arise in association with other autoimmune diseases , such as systemic lupus erythematosus ( sle ) . some diseases , such as pulmonary thrombosis and pulmonary hypertension ," ], [ "a 75-year - old japanese man was admitted to our hospital for spreading erythema on his trunk and extremities , as well as dyspnea .", "one year prior to admission , he visited us with a 1-year history of erythema and purpura on his legs , accompanied by intermittent fever .", "in addition , a chest x - ray and computed tomography demonstrated a large pleural effusion in the left lung ( fig .", "the skin lesions and the pleural effusion improved rapidly , eventually disappearing without complication ( fig .", "a biopsy specimen revealed marked thrombosis in the dermal and subcutaneous small vessels ( fig ." ], [ "corticosteroids might be an effective choice of treatment for intractable pleural effusion in aps patients .", "common causes of pleural effusion include malignancies , infectious diseases , pulmonary embolism , collagen vascular disease , and heart failure .", "aps - related pleural effusion has rarely been reported , and those cases that have been reported appeared to be complications of accompanying pulmonary embolism , sle , or catastrophic aps [ 4 , 5 , 6 ] .", "corticosteroids and immunosuppressants continue to be the treatment of choice for severe sle complications , including pleural effusion ." ], [] ]

[ [ ", we evaluated mitotic index as a possible prognostic marker in a large cohort of 282 patients with primary hcc who received long - term follow - up for 120 months .", "however , the practical utility of mitotic index as a predictor of prognosis in patients with hcc has not been determined . in this study", "we also attempted to determine the cutoff value for mitotic index that showed the most significant prognostic role in hcc patients .", ", previous studies indicated a potential role of high mitotic index as an adverse prognostic indicator in cohorts of fewer than 200 patients .", "surgically treated patients with hepatocellular carcinoma ( hcc ) , which represent a highly selected group , have higher survival rates compared to those of medically treated patients at a comparable stage .", "the prognostic role of mitotic index in patient survival has been confirmed in several cancers .", "however , long - term prognosis remains unsatisfactory because of the high incidence of tumor recurrence and metastasis after hepatectomy ." ], [ "a total of 290 patients who were pathologically confirmed to have primary hcc and underwent curative resection at samsung medical center , seoul , korea between july 2000 and may 2006 were enrolled in this study .", "eight patients who received preoperative treatments , including transcatheter arterial chemoembolization , radiofrequency ablation , and radiation therapy , were excluded ; therefore , 282 patients were included in this study .", "recurrence - free survival ( rfs ) was measured from the date of surgery until detection of tumor recurrence .", "disease - specific survival ( dss ) was defined as the interval between the date of surgery and the date of hcc - related death , which was defined as : ( 1 ) the tumor occupying more than 80% of the liver , ( 2 ) portal venous tumor thrombus proximal to the second bifurcation , ( 3 ) obstructive jaundice due to the tumor , ( 4 ) distant metastases , and ( 5 ) variceal hemorrhage with portal venous tumor thrombus proximal to the first bifurcation . two liver pathologists ( s.y.h . and c .- k.p . )", "histopathologic features of hccs , including histologic differentiation , microvascular invasion , major portal vein invasion , intrahepatic metastasis , multicentric occurrence , and non - tumor liver pathology , were reviewed by two pathologists ( s.y.h . and c .- k.p . ) .", "intrahepatic metastasis and multicentric occurrence were determined according to the criteria of the liver cancer study group of japan ." ], [ "a total of 290 patients who were pathologically confirmed to have primary hcc and underwent curative resection at samsung medical center , seoul , korea between july 2000 and may 2006 were enrolled in this study .", "eight patients who received preoperative treatments , including transcatheter arterial chemoembolization , radiofrequency ablation , and radiation therapy , were excluded ; therefore , 282 patients were included in this study .", "disease - specific survival ( dss ) was defined as the interval between the date of surgery and the date of hcc - related death , which was defined as : ( 1 ) the tumor occupying more than 80% of the liver , ( 2 ) portal venous tumor thrombus proximal to the second bifurcation , ( 3 ) obstructive jaundice due to the tumor , ( 4 ) distant metastases , and ( 5 ) variceal hemorrhage with portal venous tumor thrombus proximal to the first bifurcation .", "hcc recurrence within the first two years following surgery is mainly due to intrahepatic metastasis , whereas late recurrence usually results from multicentric occurrence . using 2 years as a cutoff ,", "recurrence - free survival ( rfs ) was measured from the date of surgery until detection of tumor recurrence .", "intrahepatic metastasis and multicentric occurrence were determined according to the criteria of the liver cancer study group of japan ." ], [ "two liver pathologists ( s.y.h . and c .- k.p . ) counted the number of mitotic cells in 10 high - power fields ( hpfs ) of hematoxylin and eosin - stained slides , and found areas containing the most mitotic figures , the so - called hot spot . after counting the mitoses in the hot spot ,", "if no hot spot could be found and mitoses were sparse and randomly scattered throughout the lesion , a representative mitosis was chosen and the count began with that field and was extended to adjacent fields . according to the criteria of mitotic figures defined by baak , mitotic cells were counted only if there was complete concordance between the two pathologists using a multi - head microscope .", "the x - tile statistics package ( yale university , new haven , ct ) was used to determine the optimal cutoff value with the highest level of statistical significance related to patient survival ; cases were dichotomized into low and high mitotic index groups based on the established cutoff value ." ], [ "we examined the proportional hazard assumption graphically to determine whether variables in the cox proportional hazard model were constants that do not depend on time .", "the cox proportional hazard regression model was used to assess the association between clinicopathologic factors and survival time .", "analysis of the association between mitotic index and clinicopathologic parameters was performed using the chi - square test , fisher exact test , or cochran armitage test .", "differences in survival rates were assessed using the log - rank test or breslow test ." ], [ "larger tumor size and high mitotic index ( p=0.004 ) were found to be independent predictors of shorter dss .", "larger tumor size , edmondson grade iii , microvascular invasion , major portal vein invasion , intrahepatic metastasis , higher ajcc t - stage , higher bclc stage , lower albumin level , and higher afp level showed unfavorable influences on both rfs and dss .", "multivariate analysis of rfs with mitotic index could not be performed , because the survival curves according to mitotic index were crossed and the proportional hazard assumption was violated .", "patients with high mitotic index were more likely to suffer from disease - specific death compared to those with low mitotic index ( hazard ratio , 1.818 ) ( table 3 ) ." ], [ "two hundred and eighteen patients ( 77.3% ) were infected with hepatitis b virus , and 26 ( 9.2% ) with hepatitis c virus .", "the median patient age was 53 years ( range , 17 to 76 years ) ; 234 patients were males , and 48 were females .", "two hundred and three patients ( 72.0% ) suffered from tumor recurrence ; 153 patients ( 54.3% ) from early recurrence , and 50 patients ( 17.7% ) from late recurrence .", "seventeen of the 29 deaths were due to hepatic failure ; eight were due to non - hepatic causes , and four were due to unknown causes .", "twenty - nine of the 127 deaths were due to non - hcc related causes ." ], [ "the mean mitotic index was 7.75 ( 95% confidence interval , 6.47 to 9.03 ) and the median value was 3.00 ( range , 0 to 60 ) . using the x - tile package , mitotic index was graded as low ( 4 or less mitoses per 10 hpfs ) or high ( 5 or more mitoses per 10 hpfs ) ( fig .", "high mitotic index showed significant association with younger age ( p < 0.001 ) , larger tumor size ( p=0.022 ) , higher edmondson grade ( p < 0.001 ) , microvascular invasion ( p < 0.001 ) , major portal vein invasion ( p=0.026 ) , intrahepatic metastasis ( p < 0.001 ) , higher afp level ( p < 0.001 ) , hepatitis b virus etiology ( p=0.012 ) , and liver cirrhosis ( p=0.016 ) . as the ajcc t - stage or bclc stage increased , the frequency of high mitotic index also showed a significant increase ( p < 0.001 and p < 0.001 , respectively ) ." ], [ "the 3- , 5- , 7- , and 9-year rfs rates for 282 hcc patients were 43.5% , 37.2% , 31.1% , and 30.0% , respectively .", "larger tumor size , edmondson grade iii , microvascular invasion , major portal vein invasion , intrahepatic metastasis , higher ajcc t - stage , higher bclc stage , lower albumin level , and higher afp level showed unfavorable influences on both rfs and dss .", "patients with high mitotic index were more likely to suffer from disease - specific death compared to those with low mitotic index ( hazard ratio , 1.818 ) ( table 3 ) .", "larger tumor size and high mitotic index ( p=0.004 ) were found to be independent predictors of shorter dss .", "multivariate analysis of rfs with mitotic index could not be performed , because the survival curves according to mitotic index were crossed and the proportional hazard assumption was violated .", "in addition , we found that high mitotic index showed an unfavorable influence on dss ( p < 0.001 ) ( table 2 ) . because ajcc t - stage and bclc stage were associated with vascular invasion , to avoid potential bias we did not perform multiple analyses using these indices . in multivariate analysis , intrahepatic metastasis and lower albumin level" ], [ "in the current study , we elucidated the prognostic significance of mitotic index in a large cohort of patients with primary hcc who received long - term follow - up .", "the most outstanding finding of this study is that subgroup analysis among patients with larger tumor size , microvascular invasion , intrahepatic metastasis , higher ajcc t - stage , and higher blcl stage showed unfavorable influences of high mitotic index on dss . counting mitotic cells is a simple , rapid , and inexpensive method which can be routinely performed in daily practice .", "this is the first report to show that high mitotic index is an independent predictor of shorter dss .", "we attempted to establish a cutoff value for mitotic index that showed the most significant prognostic role in hcc patients ." ], [ "our data show , for the first time , that high mitotic index is an independent predictor of shorter dss in surgically resected hccs .", "prospective studies are needed to further investigate the role of mitotic index as a prognostic factor in hcc ." ], [] ]

[ [ "the stage and grade of cancer will obviously influence treatment options , as will the presence of various co - morbidities.4 men with metastatic prostate cancer may be offered pharmacologic androgen deprivation therapy ( adt ) , specific chemotherapeutic medication or be treated with orchidectomy.5 in new zealand , mori men are less likely to be diagnosed with prostate cancer but have a 70% increased risk of dying compared with non - mori men.6 moreover , mori men diagnosed with non - localised prostate cancer have a threefold risk of dying from the disease compared with non - mori men.7 variation in treatment may be one of the reasons for the observed survival disparities . in the uk , increased use of adt has been linked to the trend of decreasing mortality.8 it is possible that variation in the use of adt also contributes to the survival differences between mori and non - mori men with non - localised prostate cancer . however , little information is available on the use of adt and chemotherapeutic agents in prostate cancer patients in new zealand .", "the aim of this study was to ascertain the patterns of dispensing adt , including anti - androgens and luteinising hormone - releasing hormone ( lhrh ) analogues , and chemotherapeutic agents in new zealand men within the first year after prostate cancer diagnosis .", "prostate cancer is the most common cancer diagnosed in new zealand ( nz ) males and the third most common cause of male cancer deaths.1 generally prostate cancer is a slow growing cancer with relatively good prognosis , with 80% of patients with localised disease being still alive at 15 years.2 around 70% of men in nz are identified with low - grade prostate cancer with a good prognosis.3 unfortunately , some men present with advanced disease and their first symptoms may be due to metastases .", "we also explored the effect of age , ethnicity , year of diagnosis and orchidectomy on pharmacologic adt use ." ], [ "this nationwide audit of androgen deprivation therapy and chemotherapy treatment for prostate cancer was undertaken in new zealand , a nation of 4.5 million people with a universally subsidised health system that includes free public hospital and pharmaceutical care .", "we identified a cohort of men diagnosed with prostate cancer between 1 january 2006 and 31 december 2011 from the new zealand cancer registry ( nzcr , http://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/new-zealand-cancer-registry-nzcr ) , which collects data on all new cases of malignant cancers in nz excluding squamous cell carcinoma and basal cell carcinoma of the skin . for each patient nzcr data included date of diagnosis , extent of disease at diagnosis , age at diagnosis , and ethnicity .", "multivariate logistic regression models were constructed to assess the likelihood of use of adt for patients with advanced ( regional spread and metastatic ) prostate cancer , adjusting for age , ethnicity , year of diagnosis and orchidectomy .", "we examined the frequency of adt and chemotherapy use in the first year after the initial diagnosis by patients ' age ( < 60 years , 60 - 69 years , 70 - 79 years , 80 + years ) , ethnicity ( mori , pacific and non - mori / non - pacific ) , and extent of disease at diagnosis . differences between distributions were tested using the or fisher exact test ( when sub - group sample sizes were small ) . probability ( p )", "data for the cohort of men identified from the nzcr were linked to the pharmaceutical collection by a unique encrypted number derived from the national health index ( nhi ) number , which is unique for every public health system user in new zealand .", "only about one - quarter of prostate cancer cases have an extent at diagnosis listed in the nzcr , and the accuracy of the extent has not been assessed yet ." ], [ "the final study population included 15,947 men diagnosed with prostate cancer in new zealand in the six years between 2006 and 2011 .", "age was a contributing factor , with older men with advanced cancer being more likely to receive adt .", "mori and pacific men ( compared with non - mori / non - pacific men ) were approximately 2.1- and 3.1-fold more likely to receive pharmacologic adt when adjusting for age and combinations of age , year of diagnosis and orchidectomy ." ], [ "the aim of this study was to assess the frequency of use of adt and chemotherapeutic agents for nz men in the first year after cancer diagnosis , particularly for metastatic patients for whom adt should be prescribed immediately.9 therefore , we have not followed up the cohort for a longer period of time .", "this audit showed that there is a clear under - utilisation of adt and particularly chemotherapeutic agents in nz men with advanced prostate cancer . particularly in men with distant metastases", "the dispensing of pharmacologic adt and use of orchidectomy for reduction of testosterone levels in advanced prostate cancer was influenced mainly by patients ' age and ethnicity ." ] ]

[ [ " to describe the surgical technique and initial experience with a single - port retroperitoneal renal biopsy ( sprrb ) ." ], [ "after lower pole exposure , a laparoscopic biopsy forceps was introduced through the nephroscope working channel to collect a renal tissue sample .", "a single 1.5 cm incision was performed under the 12th rib at mid - axillary line , and an 11 mm trocar was inserted ." ], [ "the mean operative time was 32 minutes , and mean estimated blood loss was less than 10 ml .", "the hospital stay of all patients was two days because they were discharged in the second postoperative day , after remaining at strict bed rest for 24 hours after the procedure ." ], [ " sprrb is a simple , safe and reliable alternative to open and videolaparoscopic approaches to surgical renal biopsy ." ], [ "hence spread its use , we outlined a renal biopsy technique through a single retroperitoneal laparoscopic access using standard urological instruments .", "the aim of this paper is to describe the technique now standardized in our institution and our initial experience with the single port retroperitoneal renal biopsy ( sprrb ) .", "open and laparoscopic approaches are well - established alternatives and should be considered , although with a higher level of invasiveness and complexity . in search for an alternative that could minimize surgical aggressiveness of these procedures and", "image - guided percutaneous renal biopsy is the most widely used method to sample renal parenchyma for the evaluation of malignancy or diffuse renal disease .", "in addition , children may be unable to cooperate , requiring general anesthesia . in these settings ,", "the risks of this procedure are minimal and the overall success rate of all renal biopsies varies from 70 to 100% ( 1 ) . its major indications rest on diagnosis and follow - up of several systemic and nephrological conditions that lead to glomerular damage and renal function impairment , providing useful data for treatment and prognosis .", "bleeding and inadequate amounts of renal tissue for diagnosis are not infrequent , and constitute potential disadvantages of the procedure ." ], [ "once the biopsy site is cleared from fat , one or two samples are taken with the aid of a toothed biopsy forceps , also through the nephroscope ( figure-2 ) . bleeding is expected to be negligible , as the injury caused by the forceps is shallow ( figure-3 ) , but the parenchyma can be coagulated with the same instruments , and a cellulose hemostatic bolster can be applied , if needed .", "standard laparoscopic surgical aspirator , scissors or hooks can be inserted through the working channel of the nephroscope , and then be used to dissect , cut and coagulate nearby structures , allowing a clear renal surface to be assessed .", "it is frequently possible to expose the renal surface bluntly , by using gentle movements of the tip of the scope to drag the perirenal fat away from the intended site of biopsy . alternatively ,", "an initial digital dissection is done aiming to identify the lower renal pole , while also displacing the peritoneum anteriorly . during this step", ", care must be taken in order to avoid peritoneal tearing , as the pneumoperitoneum resulting from gas insufflation would hamper the maintenance of adequate retroperitoneal working space .", "retroperitoneal inspection and identification of the psoas muscle and the lower pole of the kidney are now performed with a standard 26 french nephroscope , as shown in figure-1 ." ], [ "a similar approach has been described previously , in pediatric surgery , for appendectomies and varicocelectomies , but with only one case of renal biopsy ( 3 ) . between january and april/2013", "mini - perc nephroscopes are not available at our institution at this time , but its use could be a step forward , in this regard , and further decrease the required size of the access port incision . additionally , the ease for urologists in using regular urological equipment , and the possibility that the surgeon simultaneously controls both the camera and laparoscopic scissor / biopsy forceps , are other advantages of this alternative method . in our hospital , retroperitoneal laparoscopy is the procedure of choice for renal biopsy in children and the sprrb is an even less invasive option for these patients , performed through a single incision and with very satisfactory results and only minor pain .", "at our institution , laparoscopic retroperitoneal renal biopsy is currently often performed for pediatric patients with nephrological conditions ( 2 ) . as the surgical team s experience progressed and the procedure was standardized", ", five children underwent sprrb in our hospital , referred from the nephrology clinic for renal biopsy .", "the procedure was successfully performed with the technique above described , by a supervised resident in - training .", "the overall mean operative time was 32 minutes , and mean estimated blood loss was less than 10 ml . no open conversion was needed .", "the hospital stay of all patients was two days because they were kept in absolute bed rest for 24 hours after the procedure , before being discharged home ." ] ]

[ [ "therefore , we designed this study to compare the results obtained by these two methods . in this study , 60 children with clinical signs suggestive of cf , who were referred to the children 's medical center , pediatrics center of excellence in iran , were investigated .", "this study demonstrates the validity of sweat crystal formation test to support a diagnosis of cf in children whenever conventional sweat test is unavailable .", "classic sweat tests ( gibson and cooke sweat test ) and crystallization test were performed for each subject for at least two times in the referral laboratory of the hospital .", "comparing these two methods of sweat test showed good positive predictive value of 96.7% and the negative predictive value of 100% with specificity and sensitivity of 96.7% and 100% , respectively .", "1 ) , which provided the test with 100% sensitivity ( ci : 93.1100 ) . only one of 31 subjects without cf ( 17 males and 14 females ; aged 9 months to 2 years ) had positive crystallization test , which provided the test with 96.7% specificity ( 95%ci : 92.9100 ) .", "cf was diagnosed for the remaining 29 patients who showed positive values of sweat classic test .", "meq / l , while it was 49.81meq / l in the male group without any significant difference between genders ( p>0.05 ) ." ], [ "in this study , 60 children with clinical signs suggestive of cf , who were referred to the children 's medical center , pediatrics center of excellence in iran , were investigated .", "localized sweating was produced by iontophoresis of pilocarpine nitrate ( gibson and cook method ) using wescor gel discs [ 5 , 12 ] a copper electrode was then attached and a weak electrical current of about 3 milli - amperes ( ma ) was generated using a 9-volt battery for 5 minutes to stimulate sweating . immediately following stimulation ,", "a preweighed filter paper was placed directly over the site of the positive electrode . at the end of the collection about one hour later , the filter paper was removed and the weight was determined .", "meanwhile one drop of each sample was put on lamella and heated by the light of microscope for 5 minutes .", "classic sweat tests ( gibson and cooke sweat test ) and crystallization test were performed for each subject for at least two times in the referral laboratory of the hospital .", "the test was repeated for two or three times in all subjects to confirm the results .", "the study protocol was approved by the research ethics board of the childrens medical center , tehran university of medical sciences ." ], [ "sixty children ( 29 females and 31 males ) with age range of 9 months to 2 years had taken part in this study .", "meq / l , while it was 49.81meq / l in the male group without any significant difference between genders ( p>0.05 ) .", "1 ) , which provided the test with 100% sensitivity ( ci : 93.1100 ) . only one of 31 subjects without cf ( 17 males and 14 females ; aged 9 months to 2 years ) had positive crystallization test , which provided the test with 96.7% specificity ( 95%ci : 92.9100 ) .", "cf was diagnosed for the remaining 29 patients who showed positive values of sweat classic test ." ], [ "forming of salt crystallization of perspiration seems as an attractive and alternative test for easy detecting cf patients . in this study , we have shown that looking for salt crystals in just one drop of sweat could diagnose cf , since crystal formation of sweat under light microscope was detected in a significant number of cf patients .", "determination of chloride concentration in sweat is the current diagnostic gold standard for cf . \n ", "since the classic sweat test measuring chloride levels with the use of acceptable methods ( gibson - cooke or wescor macroduct ) should be performed in centers that conduct sweat tests frequently with properly documented controls , we recommend sweat crystallization test as an alternative test for cf diagnosis at least in areas where neither classic sweat test nor genotyping are accessible .", "the conventional sweat test with elevated sweat sodium and chloride concentration after iontophoresis of pilocarpine is the standard laboratory test for cf .", "comparing these two methods of sweat test showed good positive predictive value of 96.7% and the negative predictive value of 100% with specificity and sensitivity of 96.7% and 100% , respectively ." ], [ "this study demonstrates the validity of sweat crystal formation test to support a diagnosis of cf in children whenever conventional sweat test is unavailable ." ], [] ]

[ [ "a matter of great concern that can influence the results of epidemiological studies of dental caries is the variation in disease diagnosis between two or more examiners ( interexaminer error ) and for the same examiner in two or more occasions ( intraexaminer error ) .", "therefore , it is very important that data collection measures are standardized in order to minimize measurements variations1 . the calibration process including the determination of reliability , with both previous and ongoing epidemiological survey , is a basic step to understand and standardize the examination criteria , and also to evaluate the interexaminer variability in order to ensure accurate results15,17 .", "an important aspect of any research is the use of appropriate methodologies either to control or to reduce the effects of potential confounding factors .", "reliability is related to the extent to which examiners agree in their evaluations16 . the most used measures to assess reliability in epidemiological studies of dental caries are the overall percentage of agreement and the kappa statistics11 .", "the assessment of reliability is the most employed measure in dental caries surveys during the examiners ' calibration .", "the purposes of this study were : a ) to evaluate interexaminer reliability in caries detection considering different diagnostic thresholds and b ) to indicate , by using kappa statistics , which is the best way of measuring interexaminer agreement during the calibration process in dental caries surveys .", "kappa test is a measurement of reliability that takes into consideration the agreement among raters by chance , providing better evaluation of interexaminer disagreement during calibration processes5 ." ], [ "thus , interexaminer reliability was calculated by using kappa statistics , according to two diagnosis thresholds ( who ; who+il ) and considering : a ) the entire dentition ; b ) upper / lower jaws ; c ) sextants : upper / lower right / left , upper / lower anterior ; d ) each teeth individually . for each evaluation ,", "the objective of the statistical analysis was to assess interexaminer reliability under different caries diagnostic thresholds and different ways of analysis .", "codes from examination made by each examiner were compared to those of other examiners , ( example : 1x2 , 1x3 1x11 ; 2x3 . 2x11 ; 10x11 ) .", "dentists with previous experience in epidemiological surveys examined schoolchildren at baseline , 3 and 6 months after initial training , using two diagnostic thresholds on dental caries : who criteria , traditionally used in epidemiological surveys17 and who+il including the diagnostic of initial caries lesions ( il , white spot lesions ) , after being calibrated by a \" gold standard \" examiner , a dentist who routinely uses the who criteria for exams and had been previously trained and calibrated in il diagnosis .", "schoolchildren aged 6 - 7 years from two public schools in piracicaba , sp , brazil , were selected by a dentist , according to their caries activity .", "eleven dentists with previous experience in epidemiological surveys of dental caries were invited to participate in this study ." ], [ "the epidemiological examinations were initiated after approval of the study design by the research ethics committee of the dental school of piracicaba , state university of campinas , brazil ( protocol no .", "the volunteers ' parents signed an informed consent form authorizing the enrollment of the children in the study ." ], [ "dentists with previous experience in epidemiological surveys examined schoolchildren at baseline , 3 and 6 months after initial training , using two diagnostic thresholds on dental caries : who criteria , traditionally used in epidemiological surveys17 and who+il including the diagnostic of initial caries lesions ( il , white spot lesions ) , after being calibrated by a \" gold standard \" examiner , a dentist who routinely uses the who criteria for exams and had been previously trained and calibrated in il diagnosis ." ], [ "schoolchildren aged 6 - 7 years from two public schools in piracicaba , sp , brazil , were selected by a dentist , according to their caries activity .", "the exclusion criteria were : use of fixed orthodontic device , presence of severe fluorosis and/or hypoplasias , and severe systemic diseases .", "eleven dentists with previous experience in epidemiological surveys of dental caries were invited to participate in this study .", "the dentists used mirror , cpi probe , air - drying for examination after the children brushed their teeth .", "for each training or calibration period of training , 10 to 13 different children were selected ." ], [ "two diagnostic thresholds were used to record dental caries : 1 ) who threshold ( dmft index ) following the who codes and criteria17 , in which a tooth is considered as decayed when a cavitation is present ; 2 ) who+il threshold , in which active initial lesions were also recorded following criteria adapted from nyvad , et al.13 and fyfee , et al.6 .", "an il was defined as an active carious lesion which , upon visual assessment by a calibrated examiner , presented intact surface , no clinically detectable loss of dental tissue , with a rough , whitish / yellowish colored area of increased opacity presumed to be carious ( when the cpi probe was used , its tip should be moved gently across the surface ) .", "il locates close to gingival margin in smooth surfaces or extending along walls of fissure in occlusal surfaces ." ], [ "each examiner was helped by a recorder during the study . a benchmaker examiner ( \" gold standard \" ) conducted the training processes with both theoretical and practical activities , which lasted 20 hours ; and the calibration exercises , which lasted 8 hours at each phase : baseline , 3 and 6 months after initial training .", "the benchmaker examiner showed the examiners some photographic slides with clinical examples of each criterion that would be used in the study , in order to determine the examiners ' knowledge about epidemiological diagnosis , to instruct them on the criteria and examination method to be used , and finally , to achieve an initial standardization among them .", "each dentist examined 10 to 13 children , with distinct caries activity and prevalence , per period . during this phase , examiners discussed clinical diagnosis , study codes and criteria , recording and other errors in order to reach an acceptable level of agreement ( kappa>0.8517 ) .", "the training and calibration processes were conducted by the gold - standard examiner using two diagnostic thresholds on dental caries , as described in previous studies2,3 . during theoretical discussions ,", "the calibration exercises , in which the examiners did not discuss their findings , were carried out in 2 periods of 4 hours each , with a 1-week interval .", "the clinical training consisted of 4 periods of 4 hours each , and was conducted in an outdoor setting .", "these were also undertaken after 3 and 6 months , after the first calibration phase ( baseline ) ." ], [ "the epidemiological examinations were carried out in an outdoor setting , under conditions such as natural light , with dental mirror and ball - ended cpitn probes with a diameter of 0.5 mm ( to remove debris , assess the presence of fissure sealants and , in case of doubt , to check the surface texture of il ) .", "toothbrushing with fluoridated dentifrice was performed by the children , under supervision of a dental hygienist , following the bass modified technique during approximately two minutes .", "tooth air - drying ( approximately 5 seconds per tooth ) was performed by using compressed air delivered by a dental compressor ( wetzel : medical line 3.6/30 0.5 hp ) ." ], [ "a program using microsoft excel has been developed by the department of community dentistry of fop - unicamp to calculate the interexaminer reliability by means of the kappa statistics7 that has been recommended by the who17 and the british association of community dentistry15 for evaluation of agreement among examiners in oral health surveys .", "the code recorded for each dental unit or surface was entered for each examiner , in accordance with the different diagnosis thresholds ( who ; who+il ) used in the three calibration phases .", "thus , interexaminer reliability was calculated by using kappa statistics , according to two diagnosis thresholds ( who ; who+il ) and considering : a ) the entire dentition ; b ) upper / lower jaws ; c ) sextants : upper / lower right / left , upper / lower anterior ; d ) each teeth individually . for each evaluation ,", "the objective of the statistical analysis was to assess interexaminer reliability under different caries diagnostic thresholds and different ways of analysis .", "codes from examination made by each examiner were compared to those of other examiners , ( example : 1x2 , 1x3 1x11 ; 2x3 ." ], [ "the results of interexaminer reliability considering each tooth individually showed that the main difficulty was related to caries diagnosis in posterior teeth , especially the permanent first molars , for both thresholds with , in general , lower values for the who+il threshold ( tables 3 and 4 ) .", "e1 = exercise at baseline ; e2= exercise after 3 months ; e3= exercise after 6 months .", "interexaminer agreement was constant when considering the entire dentition , jaws and sextants ( tables 1 and 2 ) .", "e1=exercise at baseline ; e2= exercise after 3 months ; e3= exercise after 6 months .", "kappa values above 0.85 were obtained by analysis of sextants according to who threshold . however , when considering the who+il threshold , the values for posterior sextants decreased ( tables 1 and 2 ) .", "for both diagnostic thresholds , high mean values of kappa were obtained ( tables ) . moreover ," ], [ "the process of examiners ' calibration is an important aspect in planning and conducting oral health surveys .", "such measures were not taken into consideration because the main goal of this study was to evaluate interexaminer reliability by using different diagnostic thresholds for caries detection as well as to verify the behavior of kappa statistics in order to indicate the most adequate way to measure reliability during the examiners ' calibration process in dental caries surveys .", "the present study showed , in general , high means of interexaminer reliability for both diagnosis thresholds when considering the entire dentition , the upper / lower jaws and sextants ( tables 1 and 2 ) . on the other hand , lower kappa values", "kappa test provides a better evaluation of disagreement among examiners during calibration processes since it is a measurement of adjusted agreement by taking into consideration the ratio of chance agreement5 ." ], [ "the results of this study showed that the interexaminer reliability and its maintenance for six months were possible , under both caries diagnosis thresholds .", "nevertheless , great disagreement was observed for the posterior teeth , especially when the who+il criteria were used .", "the analysis considering dental elements individually was the best way of detecting disagreements among examiners during the calibration sections ." ] ]

[ [ "we report an r function ( www.rproject.org ) named microarray outlier filter ( mof ) , which was designed to screen outliers at the whole array level by using the arrays from the current experiment and those from the historical archive that meet defined criteria .", "dna microarray analysis has gained widespread application and a wide variety of methods have been developed to analyze the large and complex datasets generated by this technology ( 1 ) . due to the sheer volume of data , and the high number of sources of potential error , quality control and quality assurance", "since error may be the result of many factors at multiple steps , a number of qc / qa measures have been proposed to monitor specific sources of error .", "other methods monitor an individual array as a whole during the experimental process using classification methods ( 4 ) or by comparison of the statistical features of an array with the same statistical features based on historical data ( 5 ) . here", "our lab now routinely applies this software to the qa of our microarray experiments ( 6 ) .", "most of these methods focus on individual spots or spots within a single array ( 3 ) ." ], [ "in essence , mof examines the consistency of arrays in a large scale experiment ( multiple arrays ) .", "this analysis is based on two assumptions : first , that all samples are similar in gene expression profile ( that is , technical or biological replicates ) and that they have been subjected to the same experimental procedure ( in principle , the results should be similar between arrays since expression levels should be uniform for the majority of the probes ) ; second , that data from most of the arrays are of good quality , resulting in only a few unusual arrays being labeled as potentially failed ones .", "therefore , mof can be used to assist in the detection of potentially failed arrays . as an r function", ", mof is a ready - to - use tool for listing the arrays by the possibility of failure .", "this is based on our observation that an outlier array , which is largely different from the majority of comparable arrays in its gene expression profile , tends to have more data points distributed at extremes .", "otherwise , it is possible for a systematic experimental error to result in the few good arrays being suspected as failures because they are identified as abnormal by mof ." ], [ "in essence , mof examines the consistency of arrays in a large scale experiment ( multiple arrays ) .", "this analysis is based on two assumptions : first , that all samples are similar in gene expression profile ( that is , technical or biological replicates ) and that they have been subjected to the same experimental procedure ( in principle , the results should be similar between arrays since expression levels should be uniform for the majority of the probes ) ; second , that data from most of the arrays are of good quality , resulting in only a few unusual arrays being labeled as potentially failed ones .", "therefore , mof can be used to assist in the detection of potentially failed arrays . as an r function", ", mof is a ready - to - use tool for listing the arrays by the possibility of failure .", "this is based on our observation that an outlier array , which is largely different from the majority of comparable arrays in its gene expression profile , tends to have more data points distributed at extremes .", "otherwise , it is possible for a systematic experimental error to result in the few good arrays being suspected as failures because they are identified as abnormal by mof ." ], [ "the input text file is a matrix containing preprocessed microarray data with rows as probes and columns as arrays . for maximum reliability ,", "a heat map is generated to provide a general visualization of this table ( figure 1a ) as a guide for the utilization of the data for additional detailed analysis .", "the output is three text files and two heat maps . in the first text file ,", "data points with expression levels close to the background or within the scanner saturation range should be discarded .", "two lists of arrays are ordered according to the average correlation coefficient to the rest of the arrays and percentage of outlier spots , respectively ." ], [ "we would like to caution that the user needs to adjust the threshold based on their experience and the available resources . for reference , we report here two scenarios in using mof , illustrated with experimental data generated by our core facility . in one scenario ,", "using mof requires setting proper thresholds for the two statistics to flag problematic arrays . in our practice", "a couple of problematic arrays are so different from the rest of the arrays that the two statistics effectively singled them out .", "then , common arrays on the two lists reported by mof satisfying the thresholds respectively can be considered primary candidates of problematic arrays . another way to set", "for example , we have a dataset composed of 35 arrays using the universal human reference ( uhr ) rna sample ( stratagene , la jolla , usa ) , both indices flagged the same 3 arrays as outlier arrays ( figure 1 ) .", "the threshold is to take the top 15%20% worst arrays as indexed in the two lists , and then identify common arrays ." ], [ "mof has been successfully applied to our in - house microarray data as a routine qa measure ( 6 ) .", "however , users should note that in order to apply mof to any microarray datasets , the two assumptions mentioned above must be met . in our practice , when applying mof to a mouse dataset from different tissue types , tissue specific clusters were generated apparently due to the differences in gene expression profiles between tissue types .", "although a minimal of three arrays is required for correlation coefficient to pick out an outlier array , we recommend that mof should be used on datasets comprised of ten or more arrays .", "historical data obtained with the same technology on the same tissue type can be used in the analysis to increase the normal array base .", "users are encouraged to identify more realistic cut - offs in their specific settings using our thresholds as guidance .", "as an additional note , the percentage of outliers changes when using different z - scores . selecting different z - scores may make some arrays to stand out with apparently higher percentages of outlier data points .", "therefore , the relative level of percentage of outliers is a more meaningful characteristic for judgment than the absolute value itself ." ], [], [] ]

[ [ "this paper focuses on well - known interactions of tsp-1 with key receptors and growth factors during the initial inflammatory events throughout the chronic inflammatory processes .", "new developments are also herein discussed , showing the involvement of tsp-1 in pivotal transcriptional pathways related to inflammation and inflammation - induced carcinogenesis .", "tsp-1 is the best - studied member of the thrombospondin ( tsp ) family , which consists of five extracellular calcium - binding multifunctional proteins : tsp-1 , tsp-2 , tsp-3 , tsp-4 , and tsp-5 . tsp-1 and tsp-2 are structurally similar , and they are expressed on the cell surface during physiological events . a variety of normal cells , including endothelial cells , fibroblasts , adipocytes , smooth muscle cells , monocytes , macrophages , and transformed cells such as malignant glioma cells , secrete tsp-1 [ 2 , 3 ] . ", "this tsp-1 domain also binds heparin sulfate proteoglycans and a number of integrins that have an important function in angiogenesis , chemotaxis adhesion , and cell motility .", "cd36 ( also known as fatty acid translocase , fat ) is a glycosylated protein member of the class b scavenger receptor family ." ], [ "expression of cd47 in apoptotic granulocytes can influence the phagocytic functions of the macrophages in inflammatory sites suggesting a critical role of this factor in the resolution of the process ( figure 2 ) .", "cd47 can directly cause apoptosis through mitochondrial mechanisms , or by activation of the fas / cd95 pathway .", "the inflammatory acute process begins when cells sense the injury , and they release chemical mediators called cytokines .", "once activated , tlr triggers the release of more cytokines promoting inflammation and attracting white blood cells .", "tsp-1 is secreted in response to inflammation , promoting the resolution of the inflammatory process and facilitating phagocytosis of damaged cells [ 25 , 26 ] .", "the tsp-1 receptor cd47 is critical for the migration of leukocytes through endothelial and epithelial barriers ." ], [ "activated endothelial cells secrete cytokines , chemokines , matrix metalloproteinases , and growth factors that can greatly influence the inflammatory reaction and promote carcinogenesis .", "angiogenesis is an active component of chronic inflammatory diseases such as rheumatoid arthritis , atherosclerosis , diabetic retinopathy , airway inflammation , and others .", ", cd47 seems to have pivotal functions in inflammation and provides a major mechanistic pathway for the functions of tsp-1 in that process . ", "tsp-1 exerts a powerful antiangiogenic effect , and this function has a significant impact in chronic inflammation .", "the normal gut flora is a characteristic of the pathogenesis of inflammatory bowel disease ( ibd ) .", "chronic inflammation is characterized by infiltration of mononuclear cells , macrophages , lymphocytes , and plasma cells .", "tgf1 favors the formation of ros , and , as a cycle , ros can also activate tgf1 promoting apoptosis and fibrosis . " ], [ "antiangiogenic compounds , such as tsp-1 , might be useful for achieving a better perfusion and oxygenation in organ transplants .", "tsp-1 enhances fibrosis and renal damage by its interaction with tgf1 , while lskl , a peptide antagonist of tsp-1 , reduces renal interstitial fibrosis in a rat experimental model of kidney disease .", ", tsp-1 could modulate the functions of tgf1 in cardiovascular diseases , atherosclerosis , and obesity .", "tsp-1 has anti - inflammatory and proinflammatory effects observed in several diseases and animal models ." ], [ "therefore , activation of this pathway is critical for further activation of stat3 in colitis .", "these data suggest that this mimetic peptide directly binds to tsp-1 receptors such as cd36 or indirectly interacts with other membrane domains to downregulate stat3 pathway , thereby depressing the immune response . ", "tsp-1 enhances the binding of nf-b to dna inhibiting angiogenesis , and these events are reverted by blocking the nf-b pathway .", "recently , it has been reported that blocking the activation of nf-b upregulates tsp-1 expression in rat granulation tissue .", "furthermore , activated stat3 has been recently reported as crucial for intestinal carcinogenesis in colitis - associated cancer .", "importantly , nf-b activates the transcription of genes such as tnf - alpha and il-6 , which have major roles in regulating the immune response ." ], [ "leukocytes migrate to areas of injury or infection in elevated numbers ; similarly , tsp-1 is secreted at high levels in some areas in order to activate specific mechanisms for regulating the inflammatory response . in some cases", "finally , new insights about key signaling pathways such as nf-b and stat3 were discussed . because chronic inflammation is linked with tumor development", "we discussed herein the interactions of tsp-1 with well - known partners such as cd36 , cd47 , no , and tgf1 .", "we also reviewed recent developments explaining how tsp-1 and its derived peptides directly or indirectly regulate inflammatory events in animal models and human diseases . ", "tsp-1 interacts with a variety of factors in a synergistic way , playing a crucial role in many stages of the inflammatory response .", ", further studies analyzing the role of tsp-1 in these pathways could elucidate the similar contradictory functions of tsp-1 in cancer .", "the unraveling of these mechanisms will make possible the development of new and more effective therapies for controlling inflammation and blocking carcinogenesis ." ] ]

[ [ "since a large number of dentists all over the world report msds , this study was conducted in western india with an aim to determine if dentists are using cam therapies to manage their msds and , if so , to determine if cam therapies are associated with their job satisfaction and longevity , compared with conventional therapy users .", "high frequency of musculoskeletal disorders ( msds ) in dentists has been reported in the literature .", "a recent review of the literature that examined the prevalence and risk factors of msds in dentists reported that the prevalence of general musculoskeletal pain in dental professionals ranges between 64% and 93% .", "there are currently no reports that link musculoskeletal pain , cam , and career satisfaction among dentists working in western india .", "a healthy dentist is one of the most important components in a successful dental practice .", "many studies have reported cam therapies , including yoga , ayurveda , homeopathy , reiki , acupressure , massage , prayers , and acupuncture , to be effective in managing chronic musculoskeletal pain and other discomforts in the general population ." ], [ "the questionnaire consisted of five domains : demographic profile of the dentist , experience with musculoskeletal pain , use of conventional therapies or use of cam therapies for its management , opinions about cam and conventional therapies , and job / career satisfaction related to cam .", "univariate and bivariate analyses were performed to determine the demographic information , frequently reported areas of location of pain , the number of respondents that used cam or conventional therapies , types of cam or conventional therapies frequently used , work disruption caused by msds , and job satisfaction by using cam and conventional therapies .", "association between conventional therapy and cam use in relation to career variables was assessed using odds ratio ( or ) .", "independent samples t - tests were used to determine the opinions about cam and conventional therapies for msd management .", "dentists who participated in the pilot study , dental students , members of the general public , dental hygienists , dental assistants , and others who were not registered dentists were excluded .", "a pilot study was conducted among dentists working in the teerthankar mahaveer dental college and research centre . following these pilot tests ," ], [ "univariate and bivariate analyses were performed to determine the demographic information , frequently reported areas of location of pain , the number of respondents that used cam or conventional therapies , types of cam or conventional therapies frequently used , work disruption caused by msds , and job satisfaction by using cam and conventional therapies .", "association between conventional therapy and cam use in relation to career variables was assessed using odds ratio ( or ) .", "independent samples t - tests were used to determine the opinions about cam and conventional therapies for msd management ." ], [ "cam use among dentist with msd association between conventional therapy and cam usage with job / career satisfaction", "dentists who believed in cam therapies and used them alone had significantly higher odds of agreeing that they were satisfied with their career as a dentist ( or = 3.2 , 95% ci = 1.5 - 5.7 ) and that it contributed to career longevity ( or = 1.92 , 95% ci = 1.4 - 7.3 ) , increased overall health ( or = 1.67 , 95% ci = 1.11 - 6.1 ) , and improved the working efficiency ( or = 2.37 , 95% ci = 1.1 - 7.3 ) , and thus were satisfied with the job ( or = 1.51 , 95% ci = 1.7 - 7.3 ) when compared to users of conventional therapies .", "dentists who suffered from musculoskeletal pain agreed 3 times more that cam therapies were acceptable for msd management ( or = 3.7 , 95% ci = 2.7 - 3.9 ) than those with no pain , and were 3 times more likely to use cam therapies for msd management ( or = 3.4 , 95% ci = 1.4 - 5.9 ) .", "a total of 79% ( n = 1249 ) reported having msds , with the mean duration of pain being 8.3 years ( median = 3.5 ) .", "dentists who never used cam reported poorer general health when compared to cam users ( or = 1.16 , 95% ci = 1.06 - 2.4 ) .", "older dentists had significantly high rate of cam usage than younger dentists ( or = 2.17 , 95% ci = 1.157 - 1.007 ) .", "dentists degree of pain improved significantly after using cam therapies versus conventional therapies ( p = 0.004 ) ." ], [ "many different types of cam therapies , including whole medical systems ( homeopathic and naturopathic medicine ) , mind body medicine ( meditation , prayer , and mental healing ) , biologically based practices ( ayurveda / herbal products ) , manipulative and body - based medicine ( chiropractic care and massage ) , and energy medicine ( reiki and therapeutic touch ) are practiced worldwide .", "most of the dentists ( 81% ) reported use of both cam and conventional therapies in a complementary way for the treatment of musculoskeletal problems .", "modern research scientists have conducted many scientific researches to assess the safety , efficacy , and anti - inflammatory potential of these drugs .", "cam therapies have been effective in reducing the risk of and treating musculoskeletal pain in the general population for several decades . in our study , individuals who used cam therapies alone were less likely to report temporarily quitting work .", "many plants are used in various formulations such as decoctions , powders , medicated oils , paste , etc ." ], [ "education and additional research are needed to promote an understanding of the complexity of the problem and to address the problem 's multifactorial nature .", "dentists using cam therapies reported they had greater overall health and more life satisfaction compared to conventional therapy users .", "cam education should be incorporated in the dental curriculum to train the budding dentists about better management of msds .", "knowledge and training of alternative therapies is very much required among professionals , especially dentists , so that they can use these therapies as a preventive and treatment modality for chronic pain emerging in day - to - day life and prolong their career ." ] ]

[ [ "we therefore performed an adjusted comparison of the lotus valve system with the balloonexpandable edwards sapien 3 prosthesis in patients with aortic stenosis undergoing tavi within the nationwide swiss transcatheter aortic valve implantation registry ( nct01368250 ) .", "transcatheter aortic valve implantation ( tavi ) has gained wide acceptance for the treatment of severe aortic stenosis among patients deemed to be at increased risk for surgical aortic valve replacement .", "expansion of tavi to lower risk patients is critically dependent on the refinement of earlygeneration devices to further reduce the risk of paravalvular regurgitation , device malposition , atrioventricular ( av ) conductance disturbances , accesssite complications , and periinterventional bleeding .", "newergeneration devices feature external cuffs or internal skirts to seal the prosthesis to the aortic annulus and reduce the risk of paravalvular regurgitation ." ], [ "all patients undergoing tavi procedures performed in switzerland are consecutively captured in a nationwide , prospective cohort study ( clinicaltrials.gov nct01368250).5 for the purpose of the present analysis , we investigated all patients with severe aortic stenosis treated with the edwards sapien 3 prosthesis or the lotus valve system .", "the prespecified end point was the varc2 early safety outcome , a composite of allcause mortality , stroke , lifethreatening bleeding , acute kidney injury stage 2 or 3 , coronary obstruction requiring intervention , major vascular complication , and valverelated dysfunction requiring repeat procedure .", "event rates at 30 days were compared for patients treated with the lotus versus the edwards sapien 3 bioprosthesis using cox regressions , censoring patients at death or lost to followup . reported", "the lotus valve system received ce mark approval on october 28 , 2013 , and on july 14 , 2014 , for its 23/27 mm and 25 mm prosthesis , respectively , and since then has become available for commercial use and implantation in switzerland .", "the edwards sapien 3 valve ( edwards lifesciences , irvine , ca ) is the fourth iteration of the first balloonexpandable transcatheter aortic valve prosthesis .", "patients underwent transthoracic echocardiography before hospital discharge , and were contacted for clinical followup at 30 days ." ], [ "all patients undergoing tavi procedures performed in switzerland are consecutively captured in a nationwide , prospective cohort study ( clinicaltrials.gov nct01368250).5 for the purpose of the present analysis , we investigated all patients with severe aortic stenosis treated with the edwards sapien 3 prosthesis or the lotus valve system .", "selection of tavi candidates , device allocation , and periprocedural management was left to the discretion of the operators .", "all data were recorded in a webbased database held at the clinical trials unit of the university of bern , switzerland . the swiss tavi registry has been approved by the local cantonal ethics committee and the institutional review boards of all participating sites ." ], [ "the lotus prosthesis is fully repositionable and allows for an assessment of the final result before detachment of the valve from the coupling fingers of the delivery system .", "the lotus valve system received ce mark approval on october 28 , 2013 , and on july 14 , 2014 , for its 23/27 mm and 25 mm prosthesis , respectively , and since then has become available for commercial use and implantation in switzerland .", "the lotus valve system consists of a single nitinol wire that is braided into a stent frame upon foreshortening and mechanical expansion .", "the prosthesis is attached to the delivery system with 3 coupling fingers ; buckles at the distal end connect to posts located at the commissures of the 3 leaflets upon shortening , and lock the valve in its final configuration .", "an adaptive seal in the distal portion of the prosthesis and an outer sleeve have been designed to reduce paravalvular regurgitation .", ". an outer sealing skirt in the distal portion of the prosthesis complements the inner pet skirt and aims at a reduction of paravalvular aortic regurgitation .", "the edwards sapien 3 valve ( edwards lifesciences , irvine , ca ) is the fourth iteration of the first balloonexpandable transcatheter aortic valve prosthesis ." ], [ "the prespecified end point was the varc2 early safety outcome , a composite of allcause mortality , stroke , lifethreatening bleeding , acute kidney injury stage 2 or 3 , coronary obstruction requiring intervention , major vascular complication , and valverelated dysfunction requiring repeat procedure .", "all end points were defined according to the updated version of the valve academic research consortium ( varc2 ) definitions.7 an independent clinical event committee adjudicated all events .", "patients underwent transthoracic echocardiography before hospital discharge , and were contacted for clinical followup at 30 days .", "standardized interviews , documentation from referring physicians , and hospital discharge summaries were used for the collection of clinical end points ." ], [ "reported are adjusted hrs ( 95% cis ) , with the two valves compared , adjusting for age , dyslipidemia , peripheral vascular disease , aortic regurgitation moderate or severe , aortic valve area , new york heart association class iii or iv , and society of thoracic surgeons ( sts ) predicted risk of mortality score .", "events are reported as counts of first occurrence per ( sub)type of event within 30 days of followup ( % of all patients ) .", "event rates at 30 days were compared for patients treated with the lotus versus the edwards sapien 3 bioprosthesis using cox regressions , censoring patients at death or lost to followup . reported", "are crude hazard ratios ( hrs ; with 95% cis ) with p values from wald chisquare tests , or continuity correct risk ratios with p values from fisher exact tests in case of zero events .", "continuous data are reported as meansd , and categorical variables are reported as number ( percentage ) of patients .", "the estimates of adjusted hrs from 20 data sets after multiple imputation of missing values were combined using rubin 's rule and presented with adjusted p values . twosided p values <", "median ) , sex ( female versus male ) , left ventricular ejection fraction ( 40% versus > 40% ) , peripheral vascular disease ( yes versus no ) , sts risk score ( > 4 versus 4 ) , and p value for the interaction between subgroups and valve type ." ], [ "between february 4 , 2014 , and september 29 , 2015 , 140 patients were treated with the lotus valve system and 815 patients with the edwards sapien 3 prosthesis in 12 centers across switzerland .", "the early varc2 safety end point occurred in 14.3% of patients treated with the lotus and 14.6% of patients treated with the edwards sapien 3 prosthesis with no difference in crude ( hr , 0.97 ; 95% ci , 0.611.56 [ p=0.915 ] ) and adjusted ( hr , 1.03 ; 95% ci , 0.641.67 [ p=0.909 ] ) analyses ( figure 1 ) .", "the number of permanent pacemaker implantations was higher in patients treated with the lotus ( 34.3% ) as compared with the edwards sapien 3 prosthesis ( 14.1% ) ( hr , 2.76 ; 95% ci , 1.973.87 [ p<0.001 ] ) ( figure 3 ) .", "device success was 77.1% among patients treated with the lotus valve and 75.7% among patients treated with the edwards sapien 3 prosthesis ( p=0.713 ) .", "patients treated with the lotus valve more commonly had no aortic regurgitation after intervention ( 71.4% versus 53.2% , difference 18.3% ; 95% ci , 9.427.1 ) ( table 2 ) . whereas 7 patients ( 0.9% ) treated with the edwards sapien 3 prosthesis underwent valve in series implantation due to malpositioning , no case of valve malpositioning was reported in the lotus cohort ( p=0.271 ) .", "allcause mortality at 30 days was 2.2% among patients treated with the lotus valve system , and 2.8% among patients treated with the edwards sapien 3 valve ( adjusted hr , 0.75 ; 95% ci , 0.222.51 [ p=0.636 ] ) . estimated and observed mortality are illustrated in figure 2 ." ], [ "between february 4 , 2014 , and september 29 , 2015 , 140 patients were treated with the lotus valve system and 815 patients with the edwards sapien 3 prosthesis in 12 centers across switzerland .", "patients treated with the edward sapien 3 prosthesis more commonly had peripheral vascular disease ( 15.5% versus 7.9% , p=0.01 ) and higher estimated surgical risk as assessed by the logistic euroscore ( 18.914.8% versus 15.08.6% , p=0.018 ) and sts score ( 5.03.8% versus 4.12.4% , p=0.005 ) .", "age , sex , medical history , and cardiovascular risk factors were well balanced between the two treatment arms . compared with patients treated with the lotus valve system ,", "baseline characteristics values are expressed as means with sds ( p value from t tests ) or counts ( % of all patients ; p value from fisher or chisquare tests ) .", "ccs indicates canadian cardiovascular society ; nyha , new york heart association ; sts , society of thoracic surgeons ." ], [ "mi indicates myocardial infarction ; tia , transient ischemic attack ; varc2 , valve academic research consortium .", "cox regressions reporting hazard ratios ( hrs ; with 95% cis ) or continuity corrected risk ratios ( 95% cis ) in case of zero events with fisher exact p values . adjusted hr from cox regressions , adjusting for age , dyslipidemia , peripheral vascular disease , aortic regurgitation moderate or severe , aortic valve area , new york heart association class iii or iv , and society of thoracic surgery risk score ( combining the estimates of 20 data sets using rubin 's rule because of missing data )", "procedural characteristics are shown in table 2 . although procedure time was comparable , the amount of contrast media was greater with the lotus valve system compared with the edwards sapien 3 prosthesis ( 17777 ml versus 15393 ml , p=0.004 ) .", "there were no significant differences between the two devices with regards to transprosthetic gradient , patient prosthesis mismatch , or postprocedural aortic valve area , respectively ( table 3 ) .", "patients treated with the lotus valve more commonly had no aortic regurgitation after intervention ( 71.4% versus 53.2% , difference 18.3% ; 95% ci , 9.427.1 ) ( table 2 ) . whereas 7 patients ( 0.9% ) treated with the edwards sapien 3 prosthesis underwent valve in series implantation due to malpositioning , no case of valve malpositioning" ], [ "stratified analysis for the valve academic research consortium 2 early composite safety outcome ( based on crude hazard ratios ) .", "society of thoracic surgeons ( sts ) risk scores were used to estimate mortality at 30 days . despite a higher amount of contrast used in patients treated with the lotus valve", "the number of permanent pacemaker implantations was higher in patients treated with the lotus ( 34.3% ) as compared with the edwards sapien 3 prosthesis ( 14.1% ) ( hr , 2.76 ; 95% ci , 1.973.87 [ p<0.001 ] ) ( figure 3 ) . in a stratified analysis for the varc2 early safety outcome , there were no significant interactions across major subgroups , with the exception of a positive effect for treatment with the lotus valve among patients 83 years and older ( p for interaction=0.030 ) ( figure 4 ) .", "the early varc2 safety end point occurred in 14.3% of patients treated with the lotus and 14.6% of patients treated with the edwards sapien 3 prosthesis with no difference in crude ( hr , 0.97 ; 95% ci , 0.611.56 [ p=0.915 ] ) and adjusted ( hr , 1.03 ; 95% ci , 0.641.67 [ p=0.909 ] ) analyses ( figure 1 ) .", "kaplan meier estimates of the valve academic research consortium 2 ( varc2 ) early safety composite outcome at 30 days ." ], [ "the key findings of our analysis can be summarized as follows . \n in a nationwide prospective registry of patients undergoing tavi , we found no differences for the primary end point , the early composite safety end point within 30 days between patients treated with the fully repositionable lotus valve system versus the balloonexpandable edwards sapien 3 prosthesis.rates of device success were comparable for both devices.more than mild residual aortic regurgitation was exceedingly low with both devices.patients treated with the lotus valve system had a 2 to 3fold increased risk of permanent pacemaker implantation compared with patients treated with the edwards sapien 3 prosthesis . \n in a nationwide prospective registry of patients undergoing tavi", "patients treated with the lotus valve system had a 2 to 3fold increased risk of permanent pacemaker implantation compared with patients treated with the edwards sapien 3 prosthesis .", "however , our analysis reflects routine clinical practice with the 2 devices by experienced operators . finally , implantation depth and oversizing have both been associated with an increased rate of conductance disturbances , respectively .", "third , differences in balloon valvuloplasty prior to device implantation may have confounded the clinical results .", "moreover , differences in the delivery catheter diameter , flexibility , and steerability may affect the risk of plaque abrasion in the aortic arch ." ], [ "second , the number of patients included in the analysis was limited , and the duration of followup did not extend beyond 30 days .", "first , there was no random allocation to treatment with the lotus valve or the edwards sapien 3 prosthesis , respectively .", "although baseline characteristics between the two treatment arms were comparable , we can not exclude selection of treatment according to concealed confounders .", "however , our analysis reflects routine clinical practice with the 2 devices by experienced operators . finally , implantation depth and oversizing have both been associated with an increased rate of conductance disturbances , respectively .", "however , it constitutes the largest series reported to date and data are consistent with previously reported singlearm registries .", "third , differences in balloon valvuloplasty prior to device implantation may have confounded the clinical results ." ], [ "in a nationwide registry , no statistical difference was found between the repositionable lotus valve system and the balloonexpandable edwards sapien 3 prosthesis with respect to the varc2 early safety outcome for the treatment .", "the need for new permanent pacemaker implantation was more frequent among patients treated with the lotus valve ." ], [ "the swiss tavi registry is supported by a study grant from the swiss heart foundation and the swiss working group of interventional cardiology , and is sponsored by unrestricted funds from boston scientific , edwards lifesciences , medtronic , st .", "the study sponsors had no role in the study design , data collection , data analysis , data interpretation , or writing of the report ." ], [ "jude medical , and received research contracts to the institution from edwards lifesciences and symetis .", "dr wenaweser serves as proctor for medtronic , edwards lifesciences , and boston scientific and has received an unrestricted grant from medtronic to the institution ( university of bern ) .", "jude medical and has received reimbursement for travel expenses from medtronic , boston scientific , and edwards lifesciences .", "dr windecker has received research contracts to the institution from abbott , boston scientific , biosensors , cordis , medtronic , and st .", "dr toggweiler is a proctor for symetis and received speakers ' fees from edwards lifesciences and medtronic .", "dr roffi received institutional research grants from abbott vascular , boston scientific , biotronik , biosensor , and medtronic ." ], [ "\n table s1 . missing baseline characteristics , multiple imputation , and adjusted analyses \n appendix s1 . collaborators and swiss transcatheter aortic valve implantation registry investigators ." ] ]

[ [ ", leptin has been shown to induce natriuresis which may in turn result in an increase in arterial pressure so as to maintain sodium and water balance .", ", we examined the independent relation between plasma leptin levels and ckd in a multiethnic sample of us adults , after adjusting for main confounding factors .", "leptin is an adipose tissue - derived hormone that has been shown to be related to several metabolic , inflammatory , and hemostatic factors involved in the development of hypertension and cardiovascular disease .", "recent studies have reported that infusion of recombinant leptin into normal rats for 3 weeks fosters the development of focal glomerulos 4.clerosis .", "however , few human studies have examined the putative association between plasma leptin levels and chronic kidney disease ( ckd ) in humans . in this context", "leptin has also been shown to serve as a cofactor of tgf - beta activation , promote renal endothelial cell proliferation , and potentially may play a role in renal glomerulosclerosis [ 57 ] ." ], [ "trends in the or of ckd across increasing plasma leptin category were determined by modeling median within - quartile leptin level as a continuous variable . to examine the dose - response relationship of the observed association between plasma leptin level and ckd without linearity assumptions ,", "therefore , in a supplementary analysis , to examine if the observed association between plasma leptin and ckd was explained by c - reactive protein levels , fasting insulin , glucose levels , or systolic blood pressure , we adjusted for these variables in the multivariable - adjusted model .", "we used flexible nonparametric logistic regression employing the generalized additive modeling approach ( r system for statistical computing , available from comprehensive r archive network [ http://www.cran.r-project.org/ ] ) to calculate odds ratio of ckds mellitus , adjusting for all covariates in the multivariable model ; the predicted odds ratio of ckd was then plotted against increasing leptin levels ( on the log scale ) .", "fg / l ) . the multivariable - adjusted odds ratio [ ( or ) ( 95% confidence interval ( ci ) ] of ckd associated with leptin quartile was calculated with the lowest quartile as the referent , using logistic regression models .", "ckd was defined as an egfr of < 60 ml / min/1.73 m , consistent with national kidney foundation kidney disease outcomes quality initiative ( kdoqi ) stage 3 chronic kidney disease . ", "the current study is based on data from the third national health and nutrition examination survey ( nhanes iii ) ." ], [ "the positive association between leptin and ckd was attenuated , but still present . compared to quartile 1 of plasma leptin ( referent ) ,", "a positive association between higher leptin quartiles and ckd was present in the age , sex - adjusted model as well as the multivariable model . when analyzed as a continuous variable after log transformation , a positive association was present between leptin and ckd . \n", "when we employed nonparametric models to graphically examine the dose - response relationship between plasma leptin levels and ckd without linearity assumptions involved in traditional regression models , we observed an overall positive association between plasma leptin and ckd , consistent with the results in tables 1 , 2 , and 3 .", "to examine if the observed association between leptin and ckd was explained by c - reactive protein , a marker of inflammation , or fasting insulin or glucose levels , or systolic blood pressure , we additionally adjusted for these variables to the multivariable - adjusted model .", "table 3 presents the association between plasma leptin levels and ckd within subgroups defined by gender , bmi categories , and diabetes and hypertension ." ], [ " in a multi - ethnic , population - based sample of us adults , we found that higher plasma leptin levels were positively associated with ckd .", "our results suggest that leptin may explain part of the reported association between obesity and kidney disease", ", we found that higher plasma leptin levels are associated with ckd , independent of traditional factors such as age , sex , smoking , alcohol intake , bmi , diabetes , hypertension and serum cholesterol .", "overall , our findings of a positive association between plasma leptin and ckd are in agreement with these previous studies ; in addition , we were able to study a large multiethnic sample that includes both men and women and also adjusts for multiple confounders such as bmi , diabetes , hypertension , lipid levels , and c - reactive protein . ", "furthermore , the observed association between plasma leptin levels and ckd was present even after adjusting for c - reactive protein and fasting insulin levels , suggesting an association between this adipokine and ckd that is independent of these factors . " ] ]

[ [ "therefore , the purpose of present study was to compare the quality of life and mental health of hypothyroid patients with normal people referring to motahari clinic , affiliated to shiraz university of medical sciences . \n", "therefore , in the present study , the mental health condition and the quality of life level of patients with hypothyroidism have been compared with the normal people in order to perform appropriate care programs to increase these patients mental health condition and quality of life .", "thyroid hormones failure leads \n to significant interferences and malfunctions at different physical , mental and social aspects .", "changes in mental health condition of these patients have been approved . also , mental health is one of the most important factors affecting the quality of life .", "mental health is considered as one of the most important indicators of the health and hygiene of a society and is mainly affirmed by the psychologists and other scientists of behavioral and social sciences ; \n this has developed a background for evaluating and assessing mental disorders caused by hypothyroidism .", "anyway , psychological factors affect the occurrence of all diseases and the fact that whether their role is related to the beginning , \n progression , severity or recurrence of the disease or predisposing or reaction to the disease has been a controversial issue and it is variable among different diseases . \n generally , the importance of quality of life and mental health in hypothyroid patients is considerable ." ], [ "evaluated the reliability of whoqol - bref questionnaire in iranian community with test - retest of all domains ; physical health , mental health , \n social relations and environmental health respectively 0.77 , 0.77 , 0.75 , 0.84 . also , internal consistency of all domains using alpha cronbach between patients and healthy subjects was reported 0.52 - 0.84 . \n", "this study is a descriptive - analytic investigation performed in motahari clinic of shiraz city .", "then , the individual questionnaire , general health questionnaires ( ghq ) and the quality \n of life questionnaire were delivered to the study units .", "data collection tool in this study was a 3 part questionnaire . in the first part , the demographic information was gathered through 5 questions ( age , sex , marital status , level \n of education and occupation ) and in the second part , the questions of ghq through 28 questions in 4 domains of physical signs , anxiety , social dysfunction and depression on \n the basis of a 4- choice likert scale ( not at all , normally , more than usual and much more than usual ) .", "research samples were 95 patients ( more than 20 years old ) with hypothyroidism confirmed by specialists ; \n they referred to motahari clinic and were selected through convenience sampling method .", "eligible patients with hypothyroidism referring to motahari clinic of shiraz university of medical sciences were placed in the test \n ( patients ) group ." ], [ "normal people ( control group ) were the eligible relative of the other patients ( except patients with hypothyroidism ) with or with no other diseases except hypothyroidism referring \n to the motahari clinic without any direct relationship or affinity to patients with hypothyroidism . \n", "eligible patients with hypothyroidism referring to motahari clinic of shiraz university of medical sciences were placed in the test \n ( patients ) group .", "exclusion criteria were lack of willingness \n to participate and cognitive disorders or chronic diseases .", "age more than 20 years old and ability to write and read or to participate in the interview were the inclusion criteria .", "then , the sample volume was calculated and determined using med - calc statistical software with 5% error rate and 80% statistical power ( attrition of 20% ) as 190 cases . \n \n" ], [ "then , the individual questionnaire , general health questionnaires ( ghq ) and the quality \n of life questionnaire were delivered to the study units .", "if the participants were not able to fill the questionnaire , the questions were read to them by the researcher and their answers were recorded completely . \n", "the purpose of the research was explained to the participants , \n written consent forms were obtained , and they were ensured about the privacy of the data .", "after approval of the ethics committee of shiraz university of medical sciences ( no 93 - 01 - 08 - 8062 ) and coordination with the clinic , the researcher attended the clinic \n on all working days of the week and at two work shifts of morning and afternoon and selected the eligible samples ." ], [ "data collection tool in this study was a 3 part questionnaire . in the first part , the demographic information was gathered through 5 questions ( age , sex , marital status , level \n of education and occupation ) and in the second part , the questions of ghq through 28 questions in 4 domains of physical signs , anxiety , social dysfunction and depression on \n the basis of a 4- choice likert scale ( not at all , normally , more than usual and much more than usual ) .", "the third part was about the questions of whoqol - bref questionnaire , evaluating the quality of life generally and totally ; this part consisted of 26 questions \n in 4 fields of physical health , mental health , social relations and environmental health ( 3 , 6 , 7 and 8 questions for each field respectively ) and 2 other miscellaneous questions surveying the health \n condition and quality of life level in a general manner .", "nejat et al . evaluated the reliability of whoqol - bref questionnaire in iranian community with test - retest of all domains ; physical health , mental health , \n social relations and environmental health respectively 0.77 , 0.77 , 0.75 , 0.84 . also , internal consistency of all domains using alpha cronbach between patients and healthy subjects was reported 0.52 - 0.84 . \n", "each field was given a score range of 4 - 20 , scoring 4 representing the worst and score 20 the best condition in the related field .", "the simultaneous validity was obtained 0.55 through midlex questionnaire and the construct \n validity was reported 0.72 to 0.87 .", "reliability coefficient of \n the whole test were reported as 0.88 and those of the fields were 0.77 , 0.81 , 0.50 and 0.58 , respectively ." ], [ "independent t - test was performed to examine mental health , quality of life and quantitative demographic information . \n", "data were analyzed in spss software version 19 ( spss statistics ; ibm corporation , chicago , illinois , usa ) using descriptive statistical methods and independent t- test , pearson \n correlation coefficient and anova and p<0.05 was considered statistically significant .", "frequencies and percentages \n were calculated for categorical variables , means and standard deviations for continuous variables ." ], [ "95 patients ( male and female ) in the patient group and 95 people ( male and female ) in the control group were studied .", "the sample s demographic characteristics \n \n different aspects of the quality of life were assessed and compared between the two groups using independent t - test and no significant difference was noted between the test and control groups . \n in other words ,", "mean and standard deviation between the quality of life and mental health in hypothyroidism patients and healthy subjects \n comparison of the mean scores of mental health and quality of life in hypothyroidism patients and normal subjects \n comparison of demographic data and both of mental health and quality of life showed a significant relationship ( p=0.005 ) just between education \n and mental health ( table 4 ) . also ,", "evaluation of the relationship between demographic variables and mental health and quality of life revealed \n that there was a significant difference only between the mental health condition and physical signs ( p>0.001 ) and anxiety ( p>0.001 ) with degree of education . \n but", "mental health and quality of life based on demographic variables \n \n these results also confirm the significant correlation between the mental health and quality of life in hypothyroid patients ( p>0.001 ) . \n", "the patients mental health mean score was 59.70 , compared with that of the normal people which was 48.68 ( p>0.001 ) . \n", "in fact , the physical signs , anxiety and depression were higher and more severe in the test ( patients ) group ." ], [ "the present study was performed to assess and compare the quality of life and mental health between patients with hypothyroidism and normal people .", "results showed that hypothyroid patients have \n significant differences in all aspects of mental health compared with the normal people .", "but there was no significant difference in the quality of life and its aspects between the patients and the normal people . \n ", "it was revealed that these patients have the highest severity of depression , physical signs and anxiety . \n" ], [ "also , these results indicate the relationship between mental health and quality of life ; therefore , it is necessary to \n pay attention to their importance in such patient s care and treatment programs design . \n", "with regard to the results of the present study indicating lower levels of mental health in patients with hypothyroidism , holding educational programs and protocols \n about this disease to improve the mental health is suggested ." ] ]

[ [ "genetic disorders caused by mutations in the -globin gene are widely known as the human -hemoglobinopathies , in which -thalassemia and sickle cell disease ( scd ) are the most prevalent ones , particularly in the mediterranean , africa , and southeast asia , leading to great mortality and morbidity [ 14 ] .", "allogeneic hematopoietic stem cell transplantation ( hsct ) is one of the gene transfer therapies aimed at the underlying molecular causes of scd and -hemoglobinopathies .", "owing to this , ( i ) discovering novel screening platform for identifying potential inducers with high efficiency and accuracy and ( ii ) identifying new hbf - inducing agents from the natural world with the combination of efficacy , safety , and ease of use will be high on the agenda .", "fetal hemoglobin reactivation by chemical agents appears promising enough to develop into effective interventions to cure human -hemoglobinopathies ." ], [ ", researchers have successfully discovered that transgenic mice carrying human a -globin gene , which can act as a new in vivo model for screening novel pharmaceutical compounds for hbf induction in the adult [ 44 , 45 ] .", "however , this animal model is expensive to purchase , feed , and maintain in conditions appropriate to modern animal husbandry . in order to understand the influence of hbf synthesis and its induction mechanism , till the 90s", "with the aim of determining the therapeutic potency of the novel inducing compounds and studying the underlying regulatory mechanism of the embryonic and fetal human globin genes expression , various in vitro and in vivo screening platforms have been widely utilized . for in vitro models , there are six human cell lines carrying an embryonic - hbf phenotype ; they are k562 human chronic myelogenous leukemia cells , m - tat , nsmeg , ocim1 , ocmi2 , and as - e2 , while k562 cell line is one of the most well - known and widely used screening platforms for hbf inducers [ 13 , 30 ] .", "there was an influential research conducted by de simone and colleagues that the adult baboon has been shown to respond to erythropoietic stress with the reverse hemoglobin switch during which an increase in the number of hbf - containing erythrocytes ( f cells ) and an increase in hbf synthesis can be observed in adult baboon [ 40 , 42 , 43 ] .", "moreover , human bone marrow cd34 + hematopoietic progenitors drawn from -thalassemia patients and primary erythroid progenitors stem cells ( epscs ) obtained from peripheral blood are also great in vitro models to study the effect of different hbf - inducing agents [ 1 , 13 ] . back to the 1980s , baboons , a nonhuman primate model , have already been used for the study of fetal and adult hemoglobin synthesis during fetal development [ 40 , 41 ] ." ], [ "some of them are classified as chemotherapeutic agents , for example , hydroxyurea ( hu ) , 5-azacytidine ( 5-aza ) , decitabine , and citarabine .", "in contrast , some studies argue that globin histone hyperacetylation induced is not the primary mechanism of scfa ; yet , hdac inhibitors are often potent -globin inducers [ 47 , 48 ] .", "erythropoietin ( epo ) is a cytokine that have been shown to induce hbf production during in vitro differentiation of primary human cells in several trials [ 47 , 5255 ] .", ", it is found that these dna - binding drugs were capable of interacting with -globin promoter of human genomic dna . in recent years , researches have been done on immunomodulatory drugs , such as thalidomide , revlimid , and pomalidomide .", "is not related to cytotoxicity and cell growth inhibition , scientists are very interested in further studying if the enhancement of -globin mrna medicated by rapamycin is associated with xmni polymorphism .", "hu is also known as a ribonucleotide reductase inhibitor due to its ability of inhibiting dna analysis , while 5-aza , decitabine and citarabine are dna methyltransferase inhibitors who responsible for the hypomethylation of dna [ 8 , 13 ] .", "further study has demonstrated their activity is associated with the increase in histone acetylation at -globin gene promoter ." ], [ "the extract of aegle marmelos containing bergatene was found to be responsible for the activation of erythroid differentiation and hbf induction in human leukemic k562 cells [ 31 , 69 ] .", "thus , it is known as a potential therapeutic approach for both -thalassemia and sickle cell anemia .", "they are powerful inducers of erythroid differentiation , -globin gene expression and hbf synthesis in human erythroid cells .", "in recent years , scientists have conducted numerous studies in order to identify the natural remedies that could be possibly applied in treating -hemoglobinopathies , including scd and -thalassemia , summarized in table 2 .", "recently , it is reported that an indian almond , called terminalia catappa , has long been used as a traditional herbal treatment for sca in nigeria ." ], [ "therefore , they both indicated p38 mapk pathway plays a vital role in promoting -globin gene expression . during the past few years , researchers come up with different mechanistic models of hbf induction while most of the models are generally based on what are thought to be the primary actions of hbf - inducing agents , for instance , global dna hypomethylation induced by dna methyltransferase inhibitors ( dnmt inhibitors ) or global histone hyperacetylation induced by histone deacetylase inhibitors ( hdac inhibitors ) , including scfa derivatives . however , when we come across with the recent key experimental findings , including the fact that 5-aza can promote hbf production without dna hypomethylation , that -globin promoter hypomethylation is inadequate to stimulate gene expression , and that the ability of hdac inhibitors to induce hbf is regardless of the potency of hdac inhibitions , some of these proposed mechanistic models are no longer capable to explain those results .", ", p38 mapk signaling pathway is critical for the upregulation of the production of hbf .", "therefore , the control of -globin mrna stability can be known as a significant regulatory mechanism of -globin gene expression .", "besides p38 mapk signaling pathway , the potential of camp signaling pathway in hbf production has also been mentioned in the cell stress signaling model .", "various studies have also revealed the effect of numerous hbf - inducing agents , such as butyrate , apicidin , and trichostatin a , are associated with p38 mapk signaling pathway ." ], [ "in -thalassemia , due to the precipitation of excess -globin chains , rapid cellular apoptosis of early erythroblasts and red blood cell membrane damage are well characterized [ 9496 ] .", "therefore , in order to correct the pathophysiology of -thalassemia , it is of essence to improve the underlying erythroid cell survival and proliferation , with the intention that hbf - inducing agents can exert their effect on stimulating the fetal globin expression prior to the activation of irreversible programmed cell death pathway . owing to this issue , perrine et al .", "a large portion of identified hbf - inducing agents , such as 5-azacytidine and hydroxyurea , are chemotherapeutic agents which inhibit cell proliferation and cause cell growth arrest .", "in contrast , those chemotherapeutic agents may have beneficial effect on activating -globin gene expression and hbf production in scd ; yet , the dose of inducing agents must be strictly monitored in order to ensure it is high enough to activate stress signaling pathway but not too high to trigger cell - cycle arrest or apoptosis in hematopoietic precursor cells that will result in dangerously low blood counts ." ], [ "recently , effort has been put on investigating the efficacy and safety of yssxg by a randomized single - blinded trial .", "in light of the lack of promising hbf - inducing agents for -thalassemia treatment , up to now , different research groups have paid lots of effort on identifying the existing or novel natural chinese herbal medicines which have the possibility to effectively induce hbf synthesis without any apparent growth - inhibitory effects .", "taken all together , natural herbal medicines , which exhibit a higher potency in hbf induction compared with chemotherapeutic agents and have much lower cytotoxicity , will definitely be the novel therapeutic candidates for -thalassemia by targeting the activation of -globin gene expression ; yet , some of the candidates are still required further investigation on their safety and efficacy .", ", acute and chronic toxicity test in vivo is strongly required in the future in order to ensure the ethanol extract of ft is safe for clinical use on human .", ", another group of researchers have identified cucurbitacin d ( cud ) , a chemical inducing agent that can be found in fructus trichosanthis , is a novel therapeutic agent for treating -thalassemia ." ], [ ", further studies are required with the aim of exploring more natural herbal medicines as well as studying the efficacy and safety of from the laboratory to clinical use for the individuals with -hemoglobinopathies .", ", it is expected that increasing number of hbf inducing agents could be found from natural remedies and folk medicines all over the world . in this context", "will be done to explore and optimize new interventions and nature remedies to reactivate hbf synthesis for -thalassemia patients . in the future", "chemotherapeutic agents , such as 5-azacytidine , hydroxyurea , myleran , and butyrate , had long been used for -thalassemia treatment by stimulating hbf synthesis ; yet , cytotoxicity , growth - inhibitory effect , fear of long - term carcinogenesis , and only modest hbf - inducing activity have limited the clinical usage of these agents in -thalassemia and scd treatment .", "it is because the rapid cellular apoptosis of erythroid progenitors in -thalassemia causes a significant obstacle that overstimulating the cell stress signaling pathway by the hbf inducer may possibly lead to irreversible cellular apoptosis before -globin gene expression and hbf synthesis can be stimulated . with the advancement of biotechnologies , increasing number of studies", "also , through understanding the pathology of -thalassemia , it is revealed that most of the identified hbf - inducing agents have limitation on treating -thalassemia ." ] ]

[ [ "was noted during a physical examination , and transthoracic echocardiography revealed a peri - membranous ventricular septal defect ( vsd ) with a septal aneurysm , a small patent foramen ovale ( pfo ) , and a small right - sided patent ductus arteriosus ( pda ) from the innominate artery .", "the intraoperative findings were a perimembranous vsd , a pfo , a mildly patent right ductus arteriosus , and isolation of the left subclavian artery connected to the left pulmonary artery via a left pda ." ], [ "our case shows that early surgical reconstruction is reasonable , regardless of the symptoms , in cases of isolation of the left subclavian artery .", "since surgical reconstruction of the isolated left subclavian artery leads to antegrade flow in the left subclavian artery , it can prevent hypoplasia of the left vertebral artery and subclavian / pulmonary steal syndrome .", "the therapeutic management of isolation of the left subclavian artery remains controversial , especially when it is associated with complicated congenital heart disease .", "isolation of the left subclavian artery with a right aortic arch is known to be commonly associated with congenital heart disease , but may also occur with normal intracardiac anatomy , although few such cases have been described ." ] ]

[ [ "we performed a retrospective cohort study of 191 patients older than 69 years who were diagnosed with locally advanced esophageal squamous cell cancer ( escc ) , treated with radiation therapy .", "the main objective was to assess the overall survival and local control rates after ebrt plus neutron brachytherapy for elderly escc patients .", "we also evaluated the impact of age on treatment tolerance , prognostic factors , and patterns of failure .", "however , a few published results indicate that ebrt combined with brachytherapy in elderly patients with ec .", "neutron brachytherapy is a form of high linear energy transfer ( let ) radiotherapy , which has been proven to be effective for treating intracavitary cancers of the cervix when used in combination with ebrt [ 9 , 10 ] .", "thus , management of elderly patients with ec remains a therapeutic challenge , and the most relevant treatment modalities are still being debated ." ], [ "from january 2001 until november 2012 , a total of 191 consecutive patients older than 69 years with localized , advanced escc were referred to our department at the changzhi cancer hospital for radiotherapy and cf nbt .", "the initial anterior - posterior parallel - opposed fields received 30 gy , and the off - cord fields received 20 - 30 gy , for a total dose of 40 - 54 gy in 20 - 27 fractions in 4 - 5.5 weeks .", "the tumor regression conditions before each of the four neutron brachytherapy treatments under an x - ray treatmentplanning simulator from a - d \n the patients were examined weekly during the ebrt .", "were evaluated with repeated computed tomography ( ct ) scans , barium swallow studies , and endoscopy . the objectives of the study were to evaluate overall acute toxicity and local - regional control rates .", "the reasons were as follows : 30 patients were medically inoperable ( 6 patients were diabetic , 11 had chronic obstructive pulmonary disease , and 13 patients had a prior or concurrent malignancy ) ; 34 patients rejected surgery ; 76 patients were too old ( 75 years or older , 33 of 85 had t4 lesion ) ; and 85 patients had unresectable lesions . of these , 191 patients were treated with ebrt combined with brachytherapy .", "patients with good performance status ( at least able to care for himself or herself ) and adequate hepatic , renal , and hematologic functions were selected for curative treatment .", "local and regional recurrence included the primary tumor and regional lymph nodes . overall survival and local - regional control were estimated using the kaplan - meier method ." ], [ "the reasons were as follows : 30 patients were medically inoperable ( 6 patients were diabetic , 11 had chronic obstructive pulmonary disease , and 13 patients had a prior or concurrent malignancy ) ; 34 patients rejected surgery ; 76 patients were too old ( 75 years or older , 33 of 85 had t4 lesion ) ; and 85 patients had unresectable lesions . of these , 191 patients were treated with ebrt combined with brachytherapy .", "from january 2001 until november 2012 , a total of 191 consecutive patients older than 69 years with localized , advanced escc were referred to our department at the changzhi cancer hospital for radiotherapy and cf nbt .", "patients with good performance status ( at least able to care for himself or herself ) and adequate hepatic , renal , and hematologic functions were selected for curative treatment .", "the patients clinical stage was diagnosed by barium examination , endoscopy , endoscopic ultrasonography , or tumor histology ." ], [ "images ( a - d ) showing a 75 years male patient , middle site esophageal squamous cell cancer .", "the tumor regression conditions before each of the four neutron brachytherapy treatments under an x - ray treatmentplanning simulator from a - d \n", "the water balloon can clearly be seen as it is filled with an x - ray contrast agent . the total nbt dose ( to the reference point ) given to each patient varied between 8 and 25 gy - eq in two to five fractions , with 4 - 5 gy - eq per fraction per week .", "neutron brachytherapy with a one - balloon applicator ( figure 1 ) was used in conjunction with the cf lzh-1000 remote after - loading system ( linden science and technology co. , shenzhen , china ) .", "the physical characteristics of the cf neutron , the characteristics of the applicator , and the process of nbt were described in detail by liu [ 12 , 13 ] .", "the water balloon is an essential part of the applicator . for tumors that are eccentric with respect to the axis of the esophagus", "the source applicator is a custom - made catheter , which not only allows the source wire to travel inside , but also includes a water balloon surrounding the source ." ], [ "all adverse events were graded according to the national cancer institute s common terminology criteria for adverse events , version 3.0 .", "the patients usually underwent follow - up examinations every 3 - 4 months after the completion of treatment .", "weekly blood tests were obtained , and any admission for treatment - related complications was recorded .", "tumor response and nodal disease were evaluated with repeated computed tomography ( ct ) scans , barium swallow studies , and endoscopy ." ], [ "the time to first failure , time to any local failure , and time to any distant metastases were calculated from the date of consultation .", "the objectives of the study were to evaluate overall acute toxicity and local - regional control rates .", "the pattern of failure ( local and/or regional vs. distant ) was defined as the first site of failure .", "survival was calculated from the date of consultation until death or last follow - up evaluation .", "pearson s test was used to assess measures of association in the frequency data .", "overall survival and local - regional control were estimated using the kaplan - meier method ." ], [ "age of the escc patients who were treated with radiation therapy ( nbt and ebrt ) ranged from 70 to 84 years ( median : 75 years ) .", "results of multivariate cox regression analysis of overall survival and local - regional control ci confidence interval , hr hazard ratio , c clinical comparison of the overall survival rate ( a ) , and local control rate ( b ) between the two treatment groups at the time of the analysis , 80 patients were alive and free of disease , and 5 patients were alive with disease evolution .", "we used the following nine factors for the univariate analysis of survival rates and local control rate : sex , age , karnofsky score ( kps ) , tumor location , tumor length , tumor t stage , nodal stage , clinical stage , and radiation dose . among them , three ( age , tumor length , and clinical n stage ) were found to have relevance to os ( p = 0.010 , p = 0.016 , and p = 0.009 , respectively ) ." ], [ "age of the escc patients who were treated with radiation therapy ( nbt and ebrt ) ranged from 70 to 84 years ( median : 75 years ) .", "the cancer stages were categorized according to the 6 edition of the ajcc cancer staging manual , with 72 patients categorized as stage iia , 10 patients categorized as stage iib , and 109 patients were categorized as stage iii . the detailed patient data and log - rank test are provided in table 1 .", "there were 115 patients aged 70 - 74 , and 76 patients aged > 74 years .", "patient and tumor characteristics rt radiotherapy alone , os overall survival rate , lcr local control rate" ], [ "the median survival time for the 191 patients was 23.6 months , and the 1- , 2- , 3- , and 5-year rates for overall survival ( os ) were 68.5% , 48.2% , 40.3% , and 28.7% , respectively .", "we used the following nine factors for the univariate analysis of survival rates and local control rate : sex , age , karnofsky score ( kps ) , tumor location , tumor length , tumor t stage , nodal stage , clinical stage , and radiation dose . among them , three ( age , tumor length , and clinical n stage ) were found to have relevance to os ( p = 0.010 , p = 0.016 , and p = 0.009 , respectively ) .", "the duration of follow - up ranged from 6 to 106 months ( median : 30.4 months ) .", "results of multivariate cox regression analysis of overall survival and local - regional control ci confidence interval , hr hazard ratio , c clinical comparison of the overall survival rate ( a ) , and local control rate ( b ) between the two treatment groups", "the 1- , 2- , 3- , and 5-year rates for local - regional control ( lrc ) were 82.2% , 67.0% , 61.8% , and 54.2% , respectively .", "in multivariate analysis , age and clinical n stage were associated with os and lrc ( p = 0.011 [ 0.041 ] and p = 0.005 [ 0.005 ] ) ( table 2 ) ." ], [ "at the time of the analysis , 80 patients were alive and free of disease , and 5 patients were alive with disease evolution .", "the main sites of distant metastases were the lung ( n = 9 ) , liver ( n = 5 ) , brain ( n = 2 ) , and bones ( n = 8) . in 14 patients , metastases developed in more than one organ .", "local - regional recurrence occurred in 59 ( 59/191 , 30.9% ) patients , with 9/59 ( 15.3% ) occurrences outside the radiation fields and 50/59 ( 84.7% ) occurrences inside the radiation fields .", "additionally , 15 patients died of mixed causes , including pneumonia , cerebral hemorrhage , and heart infarction ." ], [ "in terms of acute toxicity , no perforations were observed during this treatment period . in total , 88 ( 46.1% )", "grade 2 esophagitis , expressed by clinical odynophagia , was observed in 64 cases ( 33.5% ) , and it was managed with the early introduction of h2 blockers and surface anesthesia at the initiation of the nbt . in total , eight ( 4.2% ) patients had grade 2 irradiation dermatitis . from the time of treatment completion to the development of local - regional recurrence or death , 5 ( 2.6% ) and 15 ( 7.9% ) patients experienced fistula and massive bleeding , respectively .", "dysphagia was relieved after the second or third nbt treatment in 87% of the patients , and a temporary feeding tube was not required in most of the patients ." ], [ "to our knowledge , this is the first reported clinical experience of the treatment using nbt and ebrt for elderly patients with escc .", "we also found that , firstly , nbt + ebrt is safe and beneficial in terms of local control in the radical treatment of elderly patients with escc , and secondly , the os rate was significantly increased , and the late complication rate was significantly decreased in patients aged 70 - 74 years compared to that of patients aged > 74 years . during the treatment period , no severe treatment related complication occurred .", "it should nonetheless be recalled that the aim of the study was to retrospectively identify the parameters to be associated with the key therapeutic decision ." ], [ "our results suggest that elderly patients with escc could benefit from nbt + ebrt without major toxicities .", "patient s age , clinical stage n status , and radiation dose could be used to select the appropriate treatment in an elderly patient ." ], [] ]

[ [ "aggregatibacter actinomycetemcomitans is an inhabitant of the oral cavity and periodontal pathogen . in periodontal disease ,", "this work provides a novel mechanism for a. actinomycetemcomitans - induced tissue damage during infection .", "the bacterium infects and proliferates within the periodontal pocket , between the gingival tissue and the tooth .", "inflammation leads to tissue damage and alveolar bone loss that is characteristic of periodontal diseases ." ], [ "human microvascular endothelial cells ( immortalized cell line hcmec / d3 were used at a passage number 2832 .", "cells were grown in 6-well plates without changing of medium for 48 or 72 h without treatment , with ltxa - buffer or with ltxa at doses ranging from 5 g / ml to 5 ng / ml . the pan - caspase inhibitor , z - vad - fmk , at a final concentration of 25 m was added to high concentrations of ltxa ( 5 g / ml and 500 g / ml ) to evaluate apoptosis via caspase activation .", ", between 50,000 and 60,000 cells were seeded per well in a collagen coated 12-well plate without treatment or with immediate addition of ltxa - buffer , or ltxa at 5 g / ml , 500 ng / ml , 50 ng / ml or 5 ng / ml .", "hcmec / d3 cells were grown in 6-well plates for 48 h without changing of medium and in the presence or not of ltxa 5 ug / ml to 5 ng / ml or ltxa - buffer .", "medium was changed every other day and cells were grown until untreated wells were confluent ( three to four days ) . for short - term ltxa effect evaluation , hcmec / d3 were grown in collagen - coated 24-well or 12-well plates until confluence and then treated for 16 h with ltxa at 5 g / ml , 500 ng / ml , 50 ng / ml , 5 ng / ml , ltxa - buffer or medium alone .", "hcmec / d3 cells were grown in pre - coated 12-well plates without treatment , with ltxa - buffer or with ltxa at doses ranging from 5 g / ml to 5 ng / ml for 24 , 72 or 96 h. cells were harvested by trypsinization , washed in rpmi containing 10% fcs , then washed in ice - cold pbs and resuspended in 1 ml 80% ethanol .", ", hcmec / d3 cells were seeded in collagen - coated 24-well or 12-well plates with or without ltxa at 5 g / ml , 500 ng / ml , 50 ng / ml , 5 ng / ml or ltxa - buffer .", "seventy - two or 96 h after seeding with or without treatment , cells were trypsinized , washed and counted in a malassez haematocytometer in triplicates and results were expressed as cells / cm .", "after trypsinization , cells were seeded in 96-well plates pre - coated with 0.3% collagen ( 5000 cells / well ) ." ], [ "thus , cytotoxicity was due to ltxa in our purified preparation . to assess the effect exerted by purified ltxa ( fig . 1 ) on human brain endothelial cells ( hcmec / d3 ) proliferation ,", "k562 cells are a white blood cell line that does not express lfa-1 and are therefore resistant to ltxa - mediated cytotoxicity .", "monolayer formation and even generation of cell cell contacts seemed to be inhibited by ltxa treatment and could not be observed .", "1a ) . to confirm that our preparation contained only ltxa and not other products that could potentially affect cells ( eg . lps , cytolethal distending toxin , endotoxin ) , ltxa ( 5 g / ml ) was incubated with hl-60 cells and k562 cells .", "after short - term treatment of a confluent monolayer 87.2% of untreated cells compared to 95.3% of ltxa 500 ng / ml and 99% of ltxa 5 g / ml treated cells expressed icam-1" ], [ "our present findings of ltxa - induced apoptosis and activation of microvascular endothelial cells , never previously reported , amplify the spectrum of pathogenetic mechanisms of a. actinomycetemcomitans and provide further explanation for tissue destruction in localized aggressive periodontitis and other diseases associated with this bacterium . as the interface between circulation and site of infection , the vascular endothelium plays a pivotal role in recruitment of leucocytes and launch of immune responses , as well as in the basic function of blood circulation and tissue maintenance .", "we found that a single dose of purified ltxa administered to human microvascular endothelial cells ( hcmec / d3 ) importantly and irreversibly inhibits cell proliferation by g2/m cell cycle arrest .", ", we demonstrate that ltxa significantly increased expression levels of icam-1 and vcam-1 in endothelial cells further corroborating pro - inflammatory effects of ltxa . additionally , ltxa has important anti - proliferative as well as pro - apoptotic effects on microvascular endothelial cells and induces a g2/m phase cell cycle arrest .", "it has been reported that apoptosis of endothelial cells in vitro is associated with the establishment of a pro - inflammatory milieu leading to paracrine induction of icam-1 and vcam-1 and , in turn , increased adhesiveness resulting in adhesion and transmigration of monocytic cells into the vessel wall . in our study , we found that levels of icam-1 and vcam-1 increased on endothelial cells upon treatment with ltxa .", "evidence to date suggests that a. actinomycetemcomitans ltxa disrupts the host immune response mainly by killing of host immune cells ." ] ]

[ [ ", we examined bone mass in a trabecular abundant site of lumbar spine and ca balance such as intestinal ca absorption and ca accumulation in ovx rats after 8 weeks of dhea administration .", "we previously observed that dhea replacement increased e2 ( estradiol ) centration in the blood .", "however , to our knowledge , the effect of dhea administration on intestinal ca absorption in estrogen deficiency state has not been studied yet .", "accordingly , we hypothesized that dhea administration would increase intestinal ca absorption via increasing e2 concentration in the blood and prevent trabecular bone loss caused by estrogen deficiency . in the present study", "the presence of estrogen receptors in the intestinal mucosa and estrogen stimulates intestinal calcium absorption via an estrogen receptor ." ], [ "seventeen female sprague - dawley rats , 6 weeks old , were surgically ovariectomized and randomized into two groups : ovx control rats ( oc , n = 8) and ovx rats with dhea treatment ( od , n = 9 ) .", "dhea dissolved in sesame oil was administered to the od group intraperitoneally at 20 mg dhea / kg body weight for 8 weeks beginning one week after ovariectomy while the oc group was treated with vehicle only ( sesame oil , 0.5 ml ) .", "thereafter , bmc and bmd value for the l3-l6 lumbar spine were measured by dual - energy x - ray absorptiometry ( dxa ; aloka dcs-600r instrument ) . in the present study", "therefore , we normalized body weight for bmc to evaluate the effect of dhea on bone mass . at the each dissection", ", two balance studies were carried out to determine the rate of intestinal ca absorption and ca accumulation .", ", we used young ovx rats whose growth of bone is considerably influenced by body mass .", "rats were not treated with dhea or vehicle every fourth day ( i.e. , they were treated for 3 consecutive days ) ." ], [ "seventeen female sprague - dawley rats , 6 weeks old , were surgically ovariectomized and randomized into two groups : ovx control rats ( oc , n = 8) and ovx rats with dhea treatment ( od , n = 9 ) .", "dhea dissolved in sesame oil was administered to the od group intraperitoneally at 20 mg dhea / kg body weight for 8 weeks beginning one week after ovariectomy while the oc group was treated with vehicle only ( sesame oil , 0.5 ml ) .", "rats were not treated with dhea or vehicle every fourth day ( i.e. , they were treated for 3 consecutive days ) .", "the rats were kept in individual cages ( 15 25 19.5 cm ) and allowed access to food and distilled water ad libitum . food consumption and body weight gain", "briefly , all rats were fed a diet with 1.05% calcium and 1.01% phosphate purchased from clea japan ( ce-2 , clea japan , inc . ,", "the room temperature was maintained at 24 1c , and the humidity at 50 5% ." ], [ "thereafter , bmc and bmd value for the l3-l6 lumbar spine were measured by dual - energy x - ray absorptiometry ( dxa ; aloka dcs-600r instrument ) . in the present study", "the lumbar spine , left , and right tibiae of each rat were isolated by dissection , and all the muscle and connective tissue was carefully removed .", ", we used young ovx rats whose growth of bone is considerably influenced by body mass .", "therefore , we normalized body weight for bmc to evaluate the effect of dhea on bone mass ." ], [ "the bone strength of the middle diaphysis of the femur was then tested by measuring the mechanical strength , breaking force with an iio dyn-1255 instruments .", "length was measured from the proximal tip of the femur head to the distal tip of the medial condyle .", "the mediolateral ( long width ) and anteroposterior ( short width ) dimensions were measured at the midpoint of the femur diaphysis .", "the force necessary to produce a break at the center of the femur was measured under the following conditions ; the sample space was 1.0 cm , the plunger speed was 100.0 mm / min , the load range was 50.0 kg , and the chart speed was 120.0 cm / min .", "thereafter , the femoral length , long width , and short width were measured with a caliper .", "after the adhering connective tissues had been trimmed off , the femoral wet weight was measured ." ], [ "the first phase was carried out on the 4th and 5th day after starting the experimental diets period ( metabolic cage phase 1 : mc 1 ) . the next phase ( mc 2 ) was carried out at the end of the experimental period . at each phase ,", "in this study , two balance studies were carried out to determine the rate of intestinal ca absorption and ca accumulation .", "intestinal ca absorption and ca accumulation were calculated using the amount of ca intake , the fecal ca excretion and the urinary ca excretion .", "urine was collected under acidic conditions by using 2ml 2n hydrochloric acid , thus preventing ca precipitate and putrefaction .", "all urine was centrifuged at 2,500 rpm for 15 min to eliminate refuse . in the fecal determination ,", "all daily feces were burnt to ash at 550 - 600 for approximately 18 hours , and the resulting ash was dissolved in 1n nitric acid .", "the level of serum ca was measured by the inductively coupled plasma atomic emission spectroscopy ( icap - aes - 575 v nippon jarrell - ash ) ." ], [ "two - way analysis of variance ( anova ) was used for determining the effects of time and group on intestinal ca absorption and accumulation .", "all the data are expressed as mean se . statistical significance ( p < 0.05 ) was determined using an unpaired student s t - test between groups .", "statistical analysis was carried out by one - way anova followed by fisher`s f - test for multiple comparisons among four points in intestinal ca absorption and accumulation ." ], [ "the intestinal ca absorption , rate of intestinal ca absorption , ca accumulation , and rate of ca accumulation decreased from mc 1 ( the 4th and 5th of the experimental diet period ) to mc 2 ( the end of the experimental period ) , but the interaction of time and group was not observed . in both mc1 and mc2 , all parameters did not differ between the groups .", "the bmc normalized by body weight of the lumbar spine ( trabecular - abundant region ) in the od group was found to be significantly higher compared to that in the oc group . to eliminate the effect of body weight on growing bone", "the femoral wet weight normalized by body weight in the od group was found to be significantly higher compared to that in the oc group , but the long and short width and length of femur did not differ between the groups ( table 2 ) .", "the bmd of the lumbar spine in the od group tended to be higher compared to that in the oc group , but it did reach statistically significant levels .", "the initial body weight did not differ between the groups . the final body weight and the body weight gain were significantly lower in the od group than in the oc group .", ", we normalized body weight for bmc for evaluating the effect of dhea on bone mass .", "the body weight gain , food intake , and food efficiency are presented in table 1 ." ], [ "the present study demonstrated that dhea administration increased the bone mass of lumbar spine in ovariectomized rats . on the other hand", "we found that the bone mass of lumbar spine ( trabecular abundant site ) was increased after 8 weeks of dhea administration .", "in addition , we observed that dhea administration increased bmc normalized body weight even though it did not increase bmd . during the growing phase , bmd", "sometimes may not precisely reflect the alteration of bone mass since growth of bone is considerably influenced by body mass . because bmd is calculated by dividing the bmc with area ( cm )", ", the bmd measurement by dxa did not provide the details of bone parameters such as cortical width and periosteal circumferences ." ], [ "the present study confirmed the positive effect of dhea on trabecular bone mass of lumbar spine in ovariectomized rats . on the other hand , dhea administration did not affect intestinal ca absorption .", "we suggest that dhea administration might have limited impact on intestinal ca absorption in estrogen deficiency state ." ] ]

[ [ "has been proposed . \n \n in the present study , we investigated the anti - hbs seroconversion in 2 groups of blood donors with isolated anti - hbc and their controls after hb vaccination .", "we also attempted to find the predictors of non - response status among individuals with isolated anti - hbc . \n", "the indefinite deferral of donors with false - positive anti - hbc is a major disappointing side effect of anti - hbc screening in countries with low endemicity of hbv infection .", ", iranian health policy makers have not introduced anti - hbc screening among blood donors , partly because of the lack of empirical data on the benefit of introducing anti - hbc screening in a donor population with low prevalence of hbv . on the other hand ,", "\n chronic hepatitis b virus ( hbv ) infection is a potentially life - threatening liver disease with serious complications such as cirrhosis and hepatocellular carcinoma ." ], [ "however , primary response was observed in 43 ( 47.8% ) isolated anti - hbc positive cases and 92 ( 92% ) controls ( p<0.0001 ) , of whom 15 cases and two controls seroconverted after the first dose of hb vaccine ( early responder ) .", "hbc positive participants were more likely to develop anti - hbs titer 50 miu / ml 30 days after receiving the first dose of vaccine ( table 3 ) . \n \n", "1 ) abnormal level was defined as levels > 1.5 times upper than normal limit \n \n 2 ) ns : not significant \n \n 3 ) linear by linear association ( chi - squared for linear trend ) ; exact method . \n \n * participants with anti - hbs titer 50 miu / ml 30 days after the first dose of vaccine and those with positive hbv dna were excluded \n \n as noted earlier , early response ( anti - hbs titer 10 miu / ml 30 days after the first vaccination ) was found in 17 subjects .", "non - responders were individuals with < 10 miu / ml anti - hbs titers after receiving three doses of hb vaccine . \n \n", "afterwards , all subjects received three doses of 20 g of hepatitis b recombinant vaccine ( heberbiovac hbr , havana , cuba ) at 0 , 1 , and 6 months , if applicable ( see below ) .", "furthermore , anti - hbs titer 50 miu / ml 30 days after the first dose of vaccine was significantly higher among cases ( 31.1% vs. 5% , p<0.0001 ) ." ], [ "odd s ratios ( ors ) were chosen to measure the association between dichotomous variables , and the results were adjusted for potential confounders by multivariate logistic modeling .", "\n data were analyzed using spss for windows software , version 11.5 ( spss inc . ," ], [ "we compared early responders to late responders ( the table is not included ) and found a trend toward a higher seroprotective response rate after the first vaccination in the subjects with abnormal baseline alt levels and those aged>50 years ( ors : 6.9 and 8 , p<0.02 and p<0.001 , respectively ) . \n", "the case group had also higher male / female ratio , and more history of transfusion and tattoo ( p<0.05 ) . however , history of infection in spouse , familial history of hbv infection , and serum ast and alt levels was not significantly different between cases and controls . \n \n totally , 19 ( 21.1% ) cases and 3 ( 3% ) controls did not seroconvert ( non - responder ) after three doses of hb vaccine ( p<0.0001 ) .", "however , primary response was observed in 43 ( 47.8% ) isolated anti - hbc positive cases and 92 ( 92% ) controls ( p<0.0001 ) , of whom 15 cases and two controls seroconverted after the first dose of hb vaccine ( early responder ) .", "* participants with anti - hbs titer 50 miu / ml 30 days after the first dose of vaccine and those with positive hbv dna were excluded \n \n as noted earlier , early response ( anti - hbs titer 10 miu / ml 30 days after the first vaccination ) was found in 17 subjects .", "also , anti - hbc positive participants were more likely to develop anti - hbs titer 50 miu / ml 30 days after receiving the first dose of vaccine ( table 3 ) . \n \n", "both of these two hbv dna positive cases did not seroconvert after receiving 3 doses of vaccination . none of the cases and controls showed adverse effects after receiving recombinant hb vaccine . \n \n" ], [ "\n in our setting , we vaccinated isolated anti - hbc as well as healthy blood donors and monitored their response to hbv vaccination .", "therefore , at least 20% of isolated anti - hbc positive cases may suffer from occult hepatitis b infection , for whom a diminished ability to mount an anti - hbs response is proposed . \n \n", "therefore , isolated anti - hbc subjects aged > 50 years would more likely either develop anti - hbs titers 50 miu / ml 30 days after receiving the first dose of vaccine or never respond to hb vaccine . as a result , one month after the first dose of hb vaccine in isolated anti - hbc subjects aged > 50 years , we can make a decision regarding whether to advise a strict follow - up ( occult hbv infection ) or assure the patient that he / she has a resolved hbv infection .", "notably , the isolated anti - hbc subjects with false positive results ( 47.8% in our setting ) are susceptible to hepatitis b infection and should receive a complete course of hb vaccine .", "hbc positive , blindly rejecting anti - hbc positive donors would cause the exclusion of a consistent number of donors , most of whom could safely be included in the donor pool ." ], [], [ "\n this study was financially supported by zahedan university of medical sciences and iranian blood transfusion organization research center ( zahedan branch ) . \n" ], [] ]

[ [ "we searched medline ( between 1966 and 2007 ) and the cochrane library central registry of controlled trials ( between 1984 and 2007 ) for relevant publications using the following medical subject heading terms : diabetes and ( food or diet ) .", "we searched for studies of the effects of two kinds of prescribed diets differing according to proportions of carbohydrate and fat under conditions that the prescribed total energy and protein intake did not differ significantly between groups of patients with type 2 diabetes .", "we additionally conducted linear multivariable regression analyses to determine whether the characteristics of the patients were independent predictors that influenced the effect of the lfhc diet versus that of the hflc diet . in this analysis , age ,", "extracted data included features of the study design ( i.e. , crossover or parallel design and presence of a washout period ) , intervention periods , characteristics of patients ( mean age , bmi , percent men , and percent those using hypoglycemia agents ) . other extracted data regarded the characteristics of each diet , such as macronutrient composition ; a weight - loss diet , which was defined as caloric restriction resulting in weight reduction ; a weight - maintenance diet , which was defined by a weight change of 1 kg during the intervention period , and a monounsaturated fat ( mufa ) diet within the hflc - diet group , which was defined as the addition of mufa to the hflc diet .", "descriptive statistics of studies included in the meta - analysis c / f / p , proportion of carbohydrate / fat / protein to total energy of the prescribed diet ; n / a , not assessed . among the studies" ], [ "the elevation in fasting insulin was greater in younger and leaner patients in response to the lfhc diet compared with that in response to the hflc diet . moreover , mean age and bmi were independent predictors of percent change in fasting insulin .", "multiple regression analysis indicated that every 1 kg / m of bmi and 1 year of age were independently associated with a greater elevation in fasting insulin by 2.6% ( p = 0.002 ) and 1.7% ( p = 0.005 ) , respectively . for patients not taking antihyperglycemic drugs ,", "ecological analyses showed trends indicating that the wmd in fpg was positively associated with that in fasting insulin ( r = 0.45 ; p = 0.04 ) and triglycerides ( r = 0.59 ; p = 0.004 ) and that the wmd in fasting insulin and triglycerides was mutually associated ( r = 0.43 ; p = 0.04 ) .", ", the magnitude of the elevation in fasting insulin did not differ between the mufa diet and non - mufa diet ( i.e. , regardless of dietary fat quality ) .", "< 0.001 ) , respectively , and a significant reduction in hdl cholesterol compared with that associated with the hflc diet ." ], [ "four articles ( 19,20,24,31 ) included two trials in one study , and two articles ( 27,28 ) used the same cohort .", "of 2,203 potentially relevant publications based on search terms and 22 references obtained from manual searches , 19 ( 1331 ) met the inclusion criteria .", "three studies ( 19,22,26 ) with 4 trials prescribed a weight - loss diet , and 11 studies ( 13,14,1719,21,2325,27,28 ) with 11 trials provided a mufa diet to the hflc - diet group .", "none of the 19 articles described methods of randomization , which led to a low quality score for the trial .", "a crossover design was used in 17 studies ( 1318,20,21,2331 ) ( with 19 trials ) , whereas a parallel design was used in two studies ( 19,22 ) with three trials .", "studies included in the current analysis had intervention periods ranging from 10 days to 6 weeks and patient numbers ranging from 8 to 42 .", "median carbohydrate / fat proportion of total energy ( c / f ratio ) in the lfhc and hflc diets was 58%/24% ( 2.4 ) and 40%/40% ( 1.0 ) , respectively ." ], [ "there were no significant differences in the reduction in a1c , total cholesterol , and ldl cholesterol between the lfhc and hflc diets .", "however , the lfhc diet produced significant increases in fasting insulin and triglycerides levels of 8.4% ( p = 0.02 ) and 13.4% ( p", "< 0.001 ) , respectively , and a significant reduction in hdl cholesterol compared with that associated with the hflc diet .", "overall percent changes resulting from lfhc versus hflc diet on metabolic profiles and data on publication bias and their likely effect on the estimates * studies ( n ) added by the trim - and - fill method .", "these outlying trials comprised a large part of study heterogeneity in percent change in total , hdl , and ldl cholesterol ( 22.2 , 59.1 , and 53.0% , respectively . ) therefore , they were excluded from the following analyses for the outcome that they affected .", "two - h glucose and insulin values were higher in the lfhc - diet group than in the hflc - diet group by 10.3% ( p < 0.001 ) and 12.8% ( p < 0.001 ) , respectively ." ], [ "ecological analyses showed trends indicating that the wmd in fpg was positively associated with that in fasting insulin ( r = 0.45 ; p = 0.04 ) and triglycerides ( r = 0.59 ; p = 0.004 ) and that the wmd in fasting insulin and triglycerides was mutually associated ( r = 0.43 ; p = 0.04 ) .", "these associations remained significant after adjustment for whether a weight - loss diet was prescribed ( fpg vs. fasting insulin , r = 0.58 and p = 0.004 ; fpg vs. triglycerides , r = 0.44 and p = 0.04 ; and fasting insulin vs. triglycerides , r = 0.44 and p = 0.04 ) ." ], [ "table 2 also shows data on publication bias and its likely effect on estimates of outcome according to the trim - and - fill method ( 12 ) .", "there was a relatively strong suspicion of publication bias for hdl cholesterol ( egger 's test , p = 0.08 for hdl cholesterol ; recommended level of significance , p 0.10 [ ( 32 ) ] ) . according to results of the compensatory trim - and - fill method , the effect of publication bias would slightly underestimate the adverse effect of the lfhc diet ." ], [ "stratified analysis to examine the effects of characteristics of studies and patients on each metabolic profile * studies having neither a washout period nor baseline data .", "the elevation in fasting insulin was remarkable ( 17.1% ; p = 0.001 ) in lfhc diets with a c / f ratio 3 ( in this case , an lfhc diet with 60% carbohydrate and 20% fat of total energy ) while the c / f ratio in the lfhc diet did not influence triglycerides .", "parallel study design or cross - sectional design studies that have a washout period and/or baseline data . p < 0.05 .", "the elevation in fasting insulin was greater in younger and leaner patients in response to the lfhc diet compared with that in response to the hflc diet . moreover , mean age and bmi were independent predictors of percent change in fasting insulin .", "of the 17 studies with a crossover design , 9 with 10 trials ( 1416,21,2326,29 ) did not include a washout period , which could lead to an underestimation due to a carryover effect ( 33 ) .", "whereas a larger elevation in triglycerides was observed in trials limited to weight - maintenance diets , the lfhc diet did not significantly elevate triglycerides compared with the hflc diet when only trials with weight - loss diets were examined ( i.e. , diets for weight loss ) ( p = 0.48 ) .", "moreover , none of these studies had baseline data . however , the effect of these nine studies on results was not significant for any of the measures .", ", the lfhc diet could be more harmful for fasting insulin than the hflc diet ." ], [ "although central to mnt , the influences of various dietary c / f ratios on glycemic control and lipid profiles in patients with type 2 diabetes have not been systematically reviewed .", "our results fundamentally support current dietary guidelines ( 1 ) stating that replacing fat with carbohydrate significantly elevates postprandial glucose and insulin levels when total energy intake is consistent .", "future studies focused on the following are suggested : 1 ) providing a possible explanation for the greater adverse effect on the fasting insulin by the lfhc diet than by the hflc diet , especially in younger and leaner individuals ; 2 ) identifying the long - term effect of a low - carbohydrate diet on factors other than metabolic effects ( e.g. , adaptation in glucose and lipid metabolism , ad libitum energy intake in patients with type 2 diabetes or obesity [ ( 40 ) ] ) and the safety of such a diet ( e.g. , with regard to the digestive system ) ; and 3 ) addressing whether a subject 's medication status and the characteristics of diabetes drugs could influence the effect of changing the dietary c / f ratio in patients with type 2 diabetes . in conclusion ,", "the lfhc diet also adversely affects triglycerides and hdl cholesterol compared with the hflc diet .", "we found that younger and leaner patients had higher fasting insulin responses with the lfhc diet , although the biological mechanism was not fully investigated ." ], [] ]

[ [ "we also report the correlation between the years of meditation experience and the level of mindfulness .", "given the fact that past studies have looked at the levels of mindfulness in various practices , health and disease conditions , we planned the current study to asses the levels of mindfulness in a moving meditation practice .", "meditation imbibes an initial phase of mindfulness , making mindfulness a key determinant of meditation practice . during the last decade ,", "several studies have been conducted across the globe to report the development of mindfulness and its effects on health and well - being .", "one such study conducted on a martial art technique aikido using a mindfulness attention awareness scale ( maas ) concluded that consistent practice of aikido leads to development of mindfulness ." ], [ "we also calculated the partial correlation ( r ) between the years of meditation experience against the levels of mindfulness .", "this was a cross - sectional study , where subjects ( meditators ) were recruited from s - vyasa yoga university and other universities ( non - meditators ) by convenience sampling .", "maas is known to have good reliability ratings and a history of clinical and research use that was developed to assess the core attentional aspect of mindfulness , and the capacity for moment - to - moment attention in particular .", "one hundred and thirty - three ( n = 133 ) healthy male volunteers ( 66 meditators and 67 non - meditators ) with ages ranging from 25 to 35 years [ group mean age standard deviation ( s.d . ) , 24.6 4.5 for meditators and 24.1 4.7 for non - meditators ] participated in the study .", ", 5.12 1.35 years ) . non - meditators had no exposure to any yoga practices and were unaware of the aims of the study .", "maas is a brief , easy to administer scale , and has therefore been used in wide range of studies related to assessing mindfulness trait .", "maas is a 15-item self - reported single - factor scale that is exclusively focused on attention / awareness component of mindfulness construct ." ], [ "this was a cross - sectional study , where subjects ( meditators ) were recruited from s - vyasa yoga university and other universities ( non - meditators ) by convenience sampling ." ], [ "maas is known to have good reliability ratings and a history of clinical and research use that was developed to assess the core attentional aspect of mindfulness , and the capacity for moment - to - moment attention in particular .", "maas is a 15-item self - reported single - factor scale that is exclusively focused on attention / awareness component of mindfulness construct .", "maas is a brief , easy to administer scale , and has therefore been used in wide range of studies related to assessing mindfulness trait .", "this scale has been widely used for various studies and has reported positive overall quality ratings for most of the psychometric properties reviewed .", "this instrument has been independently used to assess individuals either with or without meditation experience .", "the items are answered on a six - point scale ( 1 = almost always ; 6 = almost never ) on which higher scores are an indication of higher trait mindfulness . the maas has been validated in various samples of students ( = 0.82 ) and adults from the general community ( = 0.87 ) .", "i find it difficult to stay focused on what 's happening in the present ) ." ], [ "the questionnaire was scored by computing a mean of the 15 items in the questionnaire ." ], [ "we also calculated the partial correlation ( r ) between the years of meditation experience against the levels of mindfulness .", "the data were checked for normality and an independent samples t - test was employed to compare the means of both the groups .", "for all the analysis , we present 95% confidence intervals and considered p < 0.05 as significant ." ], [ "maas scores were significantly higher in meditators as compared to with the non - meditators ( independent samples t - test , t = 10.391 , p < 0.001 ) . the 95% confidence interval for the difference in the levels of mindfulness trait between meditators and non - meditators was ( 1.05 , 1.55 ) .", "we found a positive correlation ( r = 0.620 ) between the years of meditation practice and the levels of trait mindfulness .", "mean total scores of meditators and non - meditators on the mindfulness attention awareness scale ." ], [ "in the present study , we studied trait mindfulness and its correlation with duration of meditation practice using a maas .", "we found that meditators had higher levels of trait mindfulness and were positively correlated with the duration of meditation practice . while there are known differences between buddhist views of mindfulness and modern psychological adaptations , there is broad agreement that a clearly formulated mental training , usually referred to as meditation ,", "one of the limitations of our study is that the meditators participating in this study lived in a yoga institute and practiced other yoga techniques .", "majority of the studies on mindfulness meditation and other mindfulness training programs have demonstrated significant changes in the pfc ." ], [ "this may positively impact mental states and attention , which can in turn help psychological well - being of individuals .", "consistent practice of moving meditation practices like cm can lead to development of higher levels of mindfulness .", "this furthers the scope for clinical trials with cm as an intervention in the management of psychological disorders ." ] ]

[ [ "therefore , this study investigated a new neck support tying ( nst ) method that used \n a thera - band for the prevention of neck and shoulder pain in workers performing overhead \n work .", "previous studies have focused on risk \n factor analysis and the development of therapeutic exercises for overhead work - related \n disorders rather than prevention6 , 7 .", "long - term overhead working \n postures result in strain and fatigue of the shoulder muscles because arm elevation is \n associated with shoulder muscle fatigue4 , 5 .", "the head and neck posture of an individual can influence soft - tissue relationships in the \n cervical and shoulder region1 , 2 .", "some studies have been performed on \n postural ergonomic interventions including working techniques for overhead work6 , 7 . \n", "the new nst method supports the neck during hyperextension and prevents excessive \n upward rotation of the scapula during overhead work .", "the purpose of the present study was to \n investigate the effect of this nst method on cervical rom and shoulder pain after overhead \n work .", "however , we found that few studies have focused on protective ergonomic devices for overhead \n workers ." ], [ "this study \n examined a new nst method that uses a thera - band for the prevention of neck and shoulder \n pain in workers performing overhead work . for the nst method", "the \n initial values of cervical flexion , extension , and right and left lateral flexion in the \n control group were 63.44.2 , 72.86.0 , 53.92.9 , and 51.35.6 degrees , respectively .", "the \n initial values for cervical flexion , extension , and right and left lateral flexion in the \n nst group were 62.35.1 , 72.53.9 , 53.33.0 , and 52.22.4 degrees , respectively .", "the subjects were divided into two groups as follows : a control group consisting of 7 males \n without nst , and a nst group consisting of 7 males with nst .", "the initial cervical rom and \n initial ppts of the ut and mt were not significantly different between the two groups .", "the nst provided support for neck hyperextension and \n prevented excessive upward scapular rotation during overhead work .", "the midpoint of the thera - band supported the \n posterior aspect of the neck , and both ends of the thera - band were passed under both \n axillae , and tied behind the back ." ], [ "the cervical flexion , extension , and lateral flexion angles of the nst group were \n significantly larger than those of the control group ( p < 0.05 ) .", "the cervical flexion , \n extension , and right and left lateral flexion of control group were 50.48.2 , 64.711.3 , \n 41.77.9 , 43.29.2 degrees , respectively .", "the cervical flexion , extension , and right and \n left lateral flexion of nst group were 61.511.2 , 69.46.9 , 48.75.6 , 49.86.7 degrees , \n respectively .", "the ppt of ut of the nst group ( 7.21.8 lb ) was significantly higher than \n those of the control group ( 6.32.0 lb ) ( p < 0.05 ) .", "the ppt of mt of the nst group \n ( 5.81.4 lb ) was significantly higher than those of the control group ( 5.01.2 lb ) ( p < \n 0.05 ) ." ], [ "this study proposed a new neck \n support tying method using thera - band and investigated its effect on cervical rom and \n shoulder pain after overhead work .", "repeated and sustained working with elevated arms is known to lead to neck and shoulder \n pain8 .", "the nst method prevented rom reduction \n and pain in the cervical and shoulder regions .", "reductions in rom have implications for the safety and \n efficiency of functional activities , and lead to a loss of corrective or protective \n reactions1 , 9 ." ] ]

[ [ "this new evidence provides further support to the contention that environmental change may play a critical role in the emergence of chronic diseases ; however , many questions remain regarding the clinical scenarios in which edcs exert their deleterious metabolic effects .", ", we ve shown that dietary exposure to tf has the capacity to promote weight gain and increase adiposity despite not altering total food intake ; rather , these changes appear to occur through altered circadian rhythms of food intake", "rates of diabetes mellitus are rising dramatically across the globe , threatening both individual health as well as the stability of national health systems . in the united states , diabetes is the leading cause of adult blindness , kidney failure , and non - traumatic amputations while also playing a central role in the development of cardiovascular disease , the leading killer of those with the disease . with estimates that diabetes currently affects nearly 24 million people in the us and that this number will rise to over 44 million individuals by 2034 , the staggering $ 245 billion spent annually on diabetes - related healthcare costs is sure to rise dramatically .", "such metabolic disruptors include a diverse array of compounds such as bisphenol a , persistent organic pollutants ( pops ) , phthalates , antifouling agents , and pesticides .", ". moreover , adult mice exposed to tf exhibited glucose intolerance as well as systemic and adipose - specific insulin resistance , phenotypic features commonly seen in the pathogenesis of type 2 diabetes .", "our own recent work has added to this list a novel class of metabolism - perturbing agents , namely phenylsulfamide fungicides , as exemplified by tolylfluanid ( tf ) . in this work" ], [ "our recent work demonstrates that dietary exposure to tf increases adiposity , promotes glucose intolerance , and decreases insulin sensitivity both globally and at the level of the adipocyte . like many metabolic investigations", "determining whether edcs may promote metabolic dysfunction through these pathways is vital as it may provide vital insights into the best approaches to treat patients with environmentally - mediated diabetes .", ", animal models that are resistant to edc - induced metabolic disruption may provide novel insights into detoxification or resistance pathways that may be exploited pharmacologically to treat or prevent edc - induced obesity and diabetes . built upon and supporting the developmental origins of health and disease hypothesis ( dohad ) , recent evidence demonstrates that exposure to various edcs during critical developmental windows can promote metabolic dysfunction in adulthood .", "more intriguing may be genes implicated in the pathogenesis of neonatal diabetes and maturity onset diabetes of the young ( mody ) ." ], [ ". this may be significant as the transformation of the american diet over the last 30 years has been one of increased carbohydrate content , particularly the refined grains and simple sugars found in processed foods .", "western diet , may be particularly deleterious in the context of exposure to tf and potentially other edcs", "as increased fructose intake has been implicated in the explosion in diabetes rates , understanding how edcs interact with secular trends in dietary carbohydrate content and composition will be important for contextualizing the importance of edcs in the current metabolic disease epidemic .", "it is clear that the deteriorating quality of our diet plays an important role in promoting the development of obesity and diabetes ; moreover , the exportation of the american diet may be a significant contributor to the global plague of metabolic disease . despite the importance of diet in modulating energy handling", "indeed , potentiation of metabolic disruption by a high fat diet has been demonstrated for bisphenol a , perfluorooctane sulfonate , pops , and chemical mixtures .", "furthermore , as the burden of diabetes spreads to low- and middle - income countries , understanding how edcs interact with specific dietary factors in these countries will be essential for estimating the risk posed by environmental toxicants as drivers of the metabolic disease epidemic in the developing world ." ], [ "this evidence provides some of the first experimental support for edc - induced disruptions in energy homeostasis arising through perturbations in circadian rhythms . in humans ,", "clinically , the timing of food intake has been shown to contribute to weight gain .", "an intriguing finding of our work on tf was that adiposity ( fat mass as a fraction of total body mass ) and weight gain were increased in the presence of this edc despite no change in total food intake .", "we were , however , able to discern an intriguing change in the circadian pattern of food intake , with tf - exposed mice consuming more food during the normally fasting light - phase ." ], [ "we demonstrated that tf activates adipocytic gr signaling both ex vivo and in vivo , suggesting one mechanism by which this novel endocrine disruptor promotes metabolic dysfunction .", "some of the early evidence suggesting edcs have the capacity to alter energy metabolism came from studies examining their ability to promote adipocyte differentiation from preadipocytes or mesenchymal stem cells .", "in many of these studies the 3t3-l1 cell line is used as a model of adipogenesis , with preadipoctye - to - adipocyte differentiation classically induced by exposure to insulin , a glucocorticoid , and an agent to raise camp levels .", "many environmental contaminants have been shown to promote adipocyte differentiation ( reviewed in ref . ) . as we have recently dissected for the prototypical obesogen tributyltin ," ], [ "finally , future studies may take advantage of the known mechanisms by which anti - diabetic medications lower blood sugar ( e.g. , sulfonylurea receptor , peroxisome proliferator - activated receptor- , amp - activated protein kinase , sodium - glucose co - transporter-2 , incretin receptors , etc . )", "to : a. ) unravel the molecular mechanisms of metabolic disruption ; b. ) identify potential edc - drug antagonism that limit therapeutic efficacy ; and c. ) develop molecularly - based approaches to treat edc - mediated diabetes in a new era of precision environmental medicine .", "conversely , knowledge of the mechanisms by which edcs induce metabolic disease may suggest therapeutic avenues to treat environmentally - mediated obesity and diabetes or identify individuals whose exposure to certain edcs should be aggressively limited .", "as our knowledge of the mechanisms by which edcs exert deleterious metabolic effects expands , we will be better equipped to predict how various disease states and their treatments may render a subset of patients particularly sensitive to environmental contaminants modulating those pathways .", "reciprocal to the concept that underlying diseases might augment an individual s sensitivity to the deleterious metabolic effects of an edc , disease treatments themselves may generate a permissive environment under which edcs induce metabolic dysfunction .", "as argued for states of endogenous corticosteroid overproduction , pharmacological treatment with glucocorticoids , as employed in the care of individuals with inflammatory diseases , may potentiate the action of edcs working through or in conjunction with gr signaling . similarly ," ], [ "improved understanding of the impact of exposure to edcs through breast milk on later life energy homeostasis is of critical importance for both predicting risk and developing novel treatment strategies to address pollutant - induced metabolic dysfunction .", "a core therapy for myriad metabolic diseases is weight loss . whether achieved through dietary interventions , exercise , anti - obesity drugs , or surgery , reductions in body weight", "have multiple salutary effects on energy metabolism and overall health , effectively raising rmd in the disease progression model ( fig .", "the precise impact of this release on global energy homeostasis is poorly characterized , but evidence suggests that the subsequent rise in serum organochlorine levels is associated with changes in muscle metabolism that suggest an impairment in energy handling ." ], [ "more comprehensive understanding of the complex interplay between these patient - specific variables and edc action will be essential for determining the contribution of environmental pollutants to the current epidemic of metabolic disease and for devising strategies to address the threat of environmental degradation on human metabolic health .", "our recent work demonstrating that dietary exposure to the phenylsulfamide fungicide tf promotes weight gain , adipose accretion , and glucose intolerance as well as systemic and cellular insulin resistance provides further support to the theory that environmental toxicants likely contribute to the current global epidemic of metabolic disease . while exposure to certain edcs has been shown to be sufficient to initiate the development of diabetes , this occurs rarely .", "alternatively , edc - mediated metabolic dysfunction may be enhanced or accelerated by patient - specific parameters that alter an individual s sensitivity to metabolic disruption , including underlying genetics , diet , lifestyle factors , preexisting diseases , pharmaceuticals , and clinical states of fat redistribution .", "it is more likely that the contribution of edcs to the current epidemic of obesity and diabetes results from coordinate exposures to multiple edcs , each affecting the same or complimentary signaling pathways that regulate energy handling ." ] ]

[ [ "in this issue of critical care , laporta and coworkers review a multidisciplinary working group 's analysis of a case study on the causes of and solutions for staff turnover in an intensive care unit ( icu ) setting .", "the authors discuss that data on icu turnover comes from nursing literature and that this research may be applicable to other health care professionals .", "staff turnover is a critical issue that icu leaders need to understand and address in their unit settings .", "this issue is of profound significance to health care leaders in western countries because the workforce is shrinking as a result of impending baby boomer retirements and , as the population ages , the demand for intensive care services will grow considerably ." ], [], [] ]

[ [ ", we describe the first case of appendiceal perforation as a complication of ct - guided percutaneous rfa of an smr .", "due to the widespread use of imaging modalities , such as ultrasonography , computed tomography ( ct ) , and magnetic resonance imaging , the incidences of incidentally found small cortical renal masses ( srms ) and renal cell carcinoma ( rcc ) , have increased during the past years . for decades , the standard therapy for patients with clinically suspected rcc consisted of radical nephrectomy , an invasive surgical procedure with high morbidity .", "however , in a recently published randomized trial of nephron - sparing surgery ( nss ) in patients with srm yielded comparable oncological outcome with radical nephrectomy . in addition", "nephron - preserving procedures , such as partial nephrectomy and image - guided minimally invasive ablative procedures , have therefore increasingly been applied in patients with srm [ 6 , 7 ] ." ], [ "* appendix , renal mass our technique of rfa in renal masses has extensively been described in previous articles [ 17 , 18 ] . in short ,", "* appendix , renal mass a small , exophytic , rapidly enhancing renal mass at the lower pole of the right kidney .", "b retrocecal position of the appendix on the lateral site of the right kidney in the vicinity of the renal mass ( c ) .", "b retrocecal position of the appendix on the lateral site of the right kidney in the vicinity of the renal mass ( c ) ." ], [ "a 60-year - old male patient was referred to our outpatient clinic with an incidental mass in the right kidney , which was recently diagnosed during work - up of his microscopic hematuria .", "* appendix , renal mass a small , exophytic , rapidly enhancing renal mass at the lower pole of the right kidney .", "b retrocecal position of the appendix on the lateral site of the right kidney in the vicinity of the renal mass ( c ) .", "b retrocecal position of the appendix on the lateral site of the right kidney in the vicinity of the renal mass ( c ) ." ], [ "our technique of rfa in renal masses has extensively been described in previous articles [ 17 , 18 ] . in short ,", "subsequently a 20 g needle was inserted lateral in the anterior pararenal space for injection of dextrose in water to hydrodissect the renal mass from the surrounding vital tissues , such as the colon and appendix .", "the rfa procedure was performed by a highly experienced interventional radiologist ( w.p . ) who at that time had already performed > 180 percutaneous image - guided ablative procedures ( including renal , liver , and lung ) .", "after the patient received an antibiotic prophylaxis ( 1,500 mg cefuroxim ) and epidural analgesic before the rfa procedure , he was placed in prone position on the ct table .", "a planning ct scan was performed to locate the renal mass . under fluoroscopic ct guidance ,", "after the hydrodissection and the positions of the needles were checked with a ct scan of the area of interest , ablation was started ." ], [ "fluid collection with air configuration on the lateral and anterior side of the renal mass as a result of hydrodissection can be seen .", "presence of air configurations in the right anterior pararenal space suggesting abscess formation intraoperative view after abscess drainage .", "retrocecal appendix ( * ) is in the vicinity of the ablative field patient in left lateral decubitus position during rfa procedure .", "fluid collection with air configuration on the lateral and anterior side of the renal mass as a result of hydrodissection can be seen .", "3leakage of contrast material from the perforated cecum / appendiceal base into the right anterior pararenal space suggesting appendiceal perforation . presence of air configurations in the right anterior pararenal space suggesting abscess formationfig . ", "4 ) , the approach had to be extended intra - abdominally to allow necessary resection of the ileocecal region followed by primary anastomosis between the ileum and ascending colon and an omental plasty . during this step ," ], [ "currently we start the hydrodissection before placement of the rfa electrode in the target tissue . in addition , instead of injecting 100 cm fluid during hydrodissection , we attach the needle to a continuous drip system .", "a lateral dissection was performed with glucose in water to dissect the renal mass from the appendix and the colon , which was located caudolateral with respect to the renal mass .", "percutaneous renal rfa can be performed with the patient prone or in lateral decubitus position . in both positions ,", "third , the rfa electrodes can be used to lift the ablated tumor away from vital structures .", "the first step in preventing thermal complications is thorough assessment of the tumor location on preprocedural ct scans during the process of patient selection .", "nevertheless , on the ct images performed during the procedure , the appendix was considered to be at sufficient distance from the ablative field .", "unfortunately , in this way the appendix came even closer to the tract of the needle ." ], [ "in conclusion , in this article we described a case of appendiceal perforation leading to retroperitoneal abscess formation as a complication of percutaneous rfa of an srm .", "although rfa of srm is generally a minimally invasive and safe procedure , one should be aware of the possibility of particular minor and major complications when performing this innovative and promising procedure .", "if vital structures remain in close vicinity of the ablative field , one should consider treatment options other than rfa ." ] ]

[ [ "the purpose of this study was , therefore , to investigate the influence of contamination with two different types of maintenance sprays on the microtensile bond strength ( tbs ) of dentin bonded with a 2-step self - etching adhesive system .", "the null hypothesis tested was that contamination with maintenance spray does not influence the tbs of the bonded dentin .", "the handpiece is briefly operated for several minutes to remove excess spray ; however , it has been reported that this usual practice of removing excess spray is ineffective for preventing surface contamination.14 some studies have evaluated the influence of maintenance spray on resin bonding to enamel , and almost of those indicated that contamination of maintenance spray had little effect on bonding.1519 on the other hand , the contamination of maintenance spray to dentin has been some reported to affect the lower bond strength.19 however , the reports have been equivocal,20 and further studies should be needed .", "the routine use of maintenance spray for prolonging the superior performance of dental cutting handpieces is also of importance when considering sources of contamination ." ], [ "these specimens were then randomly divided to one of the following three groups , with three teeth in each group : oil - free spray group : dentin surface contaminated with an oil - free maintenance spray for air bearing handpieces ( astron cleaner , j. morita mfg .", "failure modes were classified as cohesive failure of resin , failure of the adhesive interface ( fracture between the dentin or the hybrid layer and the overlying adhesive in the same sample ) , mixed resin and adhesive ( r&a ) failure ( interfacial and partial cohesive failure of the adhesive only or cohesive failure in the same sample ) , mixed that included the dentin ( failure within the dentin only or mixed failure that included the dentin ) or cohesive failure of dentin , wherever relevant .", "the specimens were then subjected to tbs testing at a crosshead speed of 1 mm / min until failure occurred .", "bonding agent was then applied to the surface and polymerized by quartz - tungsten - halogen light curing unit for 10 s ( new light vl - ii , gc , tokyo , japan ) . after applying the bonding agent to each specimen , resin composite ( clearfil ap - x , shade a2 , kuraray medical ) was built - up incrementally ( in five steps ) to a height of 5 mm .", "bonded samples prepared by same procedure as for tbs testing were ground with increasingly finer silicon carbide paper and highly polished with a slurry solution of aluminum polishing suspension ( refine tec , co. , yokohama , japan ) ( 1 m , 0.3 m , 0.05 m ) .", "nine caries - free extracted human molars stored in 0.5% chloramine t solution at 4c was used for tbs study ." ], [ "these specimens were then randomly divided to one of the following three groups , with three teeth in each group : oil - free spray group : dentin surface contaminated with an oil - free maintenance spray for air bearing handpieces ( astron cleaner , j. morita mfg .", "bonding agent was then applied to the surface and polymerized by quartz - tungsten - halogen light curing unit for 10 s ( new light vl - ii , gc , tokyo , japan ) . after applying the bonding agent to each specimen , resin composite ( clearfil ap - x , shade a2 , kuraray medical ) was built - up incrementally ( in five steps ) to a height of 5 mm .", "all specimens were then treated with a self - etching priming adhesive system ( clearfil se bond , kuraray medical , tokyo , japan ; also known as clearfil megabond in japan ) according to the manufacturer s instructions .", "the self - etching primer was applied with a three - way syringe to the surfaces for 20 s prior to drying .", "nine caries - free extracted human molars stored in 0.5% chloramine t solution at 4c was used for tbs study .", "tokyo , japan ) in order to form a long , flat dentin surface at the mid - crown level ." ], [ "failure modes were classified as cohesive failure of resin , failure of the adhesive interface ( fracture between the dentin or the hybrid layer and the overlying adhesive in the same sample ) , mixed resin and adhesive ( r&a ) failure ( interfacial and partial cohesive failure of the adhesive only or cohesive failure in the same sample ) , mixed that included the dentin ( failure within the dentin only or mixed failure that included the dentin ) or cohesive failure of dentin , wherever relevant .", "both the dentin and composite halves of all fractured specimens were visually inspected under a light microscope ( ms-803 , moritex , tokyo , japan ) at 210 magnification and further observed using a field - emission scanning electron microscope ( fe - sem ; jsm-6340f , jeol , tokyo , japan ) at 15 kv , under the magnifications of 75 to classify the failure mode of each specimen , and 1000 to observe the details of peculiar images .", "the specimens were then subjected to tbs testing at a crosshead speed of 1 mm / min until failure occurred .", "the tensile bond strength was calculated as the load at failure ( n ) divided by the bonded area ( mm ) .", "the specimens were then attached to a bencor multi - t testing apparatus ( danville engineering co , san ramen , ca , usa ) with cyanoacrylate adhesive ( model repair ii blue , dentsply - sankin , ohtawara , japan ) connected to a universal testing machine ( tensilon rtc-1150-tsd , orientec , tokyo , japan ) .", "after storage , each bonded specimen was sectioned into four or five slabs , approximately 0.7-mm thick , perpendicular to the bonded surface using a low - speed diamond saw ( isomet , buehler , lake bluff , il , usa ) under water cooling . the slabs were trimmed using a superfine - grit diamond bur ( sf # 114 , shofu , kyoto , japan ) to an hourglass shape to form a gentle curve along the adhesive interface from both sides , as described by sano et al.21 the width at the narrowest portion was approximately 1.4 mm , and the thickness of the bonded area of each specimen was verified by a digital micrometer ( mitutoyo , tokyo , japan ) .", "bond strength data were analyzed by one - way anova and the tukey - kramer test ." ], [ "to determine the mode of failure , both the dentin and composite halves of all fractured specimens were visually inspected under a light microscope ( ms-803 , moritex , tokyo , japan ) at 210 magnification and further observed using a field - emission scanning electron microscope ( fe - sem ; jsm-6340f , jeol , tokyo , japan ) at 15 kv , under the magnifications of 75 to classify the failure mode of each specimen , and 1000 to observe the details of peculiar images .", "failure modes were classified as cohesive failure of resin , failure of the adhesive interface ( fracture between the dentin or the hybrid layer and the overlying adhesive in the same sample ) , mixed resin and adhesive ( r&a ) failure ( interfacial and partial cohesive failure of the adhesive only or cohesive failure in the same sample ) , mixed that included the dentin ( failure within the dentin only or mixed failure that included the dentin ) or cohesive failure of dentin , wherever relevant ." ], [ "three human molars were used . bonded samples prepared by same procedure as for tbs testing were ground with increasingly finer silicon carbide paper and highly polished with a slurry solution of aluminum polishing suspension ( refine tec , co. , yokohama , japan ) ( 1 m , 0.3 m , 0.05 m ) .", "all specimens were subsequently dehydrated in ascending grades of ethanol ( 50% , 70% , 80% , 90% , 95% , 99% , and 99.9% ) for 10 min each , and were further desiccated in a box with silica gel for 24 h. the dried specimens were placed on an aluminum stub and sputter - coated with au - pd using a cool sputter coater ( sc500a , vg microtech , east sussex , uk ) .", "the coated specimens were examined using the fe - sem at 15 kv , under the magnification of 4000.", "the samples were then subjected to 32% phosphoric acid ( uni - etch , bisco , schaumburg , il , usa ) treatment for 30 s and rinsed with tap water for 30 s. the specimens were further treated with 1% sodium hypochlorite solution ( wako pure chemical , osaka , japan ) for 10 min ." ], [ "most commonly , a mixture of cohesive failure of the resin and failure of the adhesive interface / hybrid layer ( r&a failure ) was observed in each group .", "failure in the adhesive interface was observed only in the two sprayed groups and not in the control group .", "resin tags were evident in all three groups , with no significant difference among the groups .", "the non - sprayed control showed significantly higher tbs than the two sprayed groups ( p < 0.05 ) .", "the percentage of mixed failure that included the dentin was higher in the control group than in the two sprayed groups ." ], [ "the purpose of this study was to investigate the influence of contamination with two different types of maintenance sprays on the microtensile bond strength ( tbs ) of dentin bonded with a 2-step self - etching adhesive system , clearfil se bond .", "these results indicated that the lower tbs in the oil - containing spray group might not be due to the inhibition of resin penetration . since both spray cans contain liquefied petroleum gas as an aerosol propellant , this might be attributable to decrease in the mechanical properties of the adhesive interfacial area .", "intra spray contains iso - paraffin oil for lubrication , and astron cleaner contains ethanol but do not contain any type of oil . in fe - sem micrographs of the fractured surface , the failure within the hybridized dentin area", "therefore , the adverse effect of maintenance spray on self - etch adhesive might be larger than that on etch and rinse adhesive . in the results of this study" ], [ "within the limitations of this study , the following conclusions are drawn : contamination from maintenance spray significantly affects the microtensile bond strength to dentin", ". however , there is no difference between the effects of oil - free and oil - containing maintenance sprays on the reduction in the microtensile bond strength to dentin ." ] ]

[ [ "microbiome of human skin refers to complete collection of microorganisms comprising bacteria , fungi and virus .", "fungi have been extensively isolated and investigated from skin in various parts of the world .", "infectious diseases , mostly the ones that affect the epidermal or mucous membrane , are serious troubles all over the world because of hygiene and education deficiency .", "determining the mycoflora of normal people is important when the role of skin is considered as a reservoir for microorganisms .", "cutaneous mycoses refer to skin infection and its appendages are involved in yeasts and filamentous fungi .", "fungi are among the most significant groups of these skin pathogens ( 2 ) . " ], [ "the current study aimed to investigate the incidence of fungal flora on interdigital spaces of the human foot ." ], [ "the tested web spaces did not show any signs of infection such as erythema , scaling , blistering and itching .", "yeasts were identified on the bases of germ tube formation , morphology on the corn meal agar medium , and assay of unease activity .", "samples were collected from toe webs of 865 girl students who lived in the dormitories of ahvaz jundishapur university of medical sciences in autumn 2008 .", "the filamentous fungi were identified after slide culturing according to their gross and morphological features .", "a part of the samples were digested with 20% koh and screened by a light microscope for fungal elements .", "the samples were collected into sterilized clean pockets and transferred immediately to the mycology medical laboratory .", "another part of the samples were cultured on sabouraud glucose agar ( sga ) and sga containing 0.05 mg / ml chloramphenicol and 0.5 mg/ ml cyclohexmide ." ], [ "out of the 865 samples , 616 ( 71.2% ) were positive in direct examination or culture .", "the culture was positive in 349 ( 40.3% ) specimens ; and 22 ( % 2.5% ) samples were also positive for both direct examination and culture .", "the most common fungal isolates in direct test were yeast ( 29.4% ) , followed by conidia ( 0 .", "92% ) , melanised hypha ( 0.35% ) and non - septated hypha ( 0.23% ) ." ], [ "the current study performed a comprehensive and quantitative analysis of the mycoflora on the surface of interdigital skin of girl students .", "the rates of the total yeast counts were much higher than those of molds in samples of skin in the direct examination . ", "overall fungal structure was found on the skin of 30.9% of the students in the direct examination with koh .", "the present study demonstrated the incidence of fungal flora on interdigital spaces of human foot .", "the obtained results showed that fungi can survive on the surfaces of skin without showing the sign of infection ." ] ]

[ [ "single attachment elements for overdentures include single retentive anchors , single magnet anchors , and individually cast telescopic copings.1 among these , telescopic copings have the benefit of implant splinting found in bar overdentures and the retrievability of single attachment overdentures", ", a telescopic implant - supported overdenture prosthesis was made using a new material , polyaryletherketone ( paek ) based polymer ( pekkton ivory , cendres + mtaux sa , biel / bienne , switzerland ) .", "it shares benefits of typical telescopic coping , in additional to being highly economical , wear resistant , and light in weight compared to conventional implant overdenture prostheses .", ". however , this method is typically fabricated using gold materials , so it is not an economical treatment option .", "also , if an inner crown will be worn , it is difficult to maintain appropriate retentive forces . in this case report", "implant - supported overdenture prostheses can be divided into bar overdentures and single attachment overdentures ." ], [ "the definitive prosthesis was planned as a telescopic overdenture using paek based polymer . after a making definitive impression by polyvinylsiloxane ( honigum , dmg , hamburg , germany ) , a polymer telescopic abutment and an outer overdenture frame were fabricated with consideration of the patient 's vertical dimension ( fig .", "after maxillary teeth extractions and use of provisional maxillary complete denture for six months , six small diameter implant fixtures ( 3.0 10.0 mm usii , osstem implant co. ltd . , seoul , korea )", "4 ) ; the design and weight of the prosthesis were adjusted to achieve acceptable esthetics and phonetics . after 6 months , there were no problems with alveolar bone around the implant fixtures and retention of the overdenture prosthesis .", "1 ) presented to the department of prosthodontics at chonnam national university dental hospital . after clinical and radiographic examinations", "after that , the definitive prosthesis was made by autopolymerized pour - type resin ( press lt , retec , rosbach , germany ) ( fig .", "telescopic abutment and framework design were laid out by cad software ( exocad dental cad , exocad gmbh , darmstadt , germany ) . the milling machine", "( s1 , vhf camfacture ag , ammerbuch , germany ) made the final framework and abutment according to the design .", "polymer abutment and titanium link were sandblasted by 110 um grit aluminum oxide , and bonded with primer ( sr link , ivoclar vivadent , schaan , liechtenstein ) and bonding agent ( multilink n , ivoclar vivadent , schaan , leichtenstein ) ." ], [ "paek based polymer , pekkton ivory , as used in this case , is a member of the high performance semi - crystalline thermoplastic resin group , recognized for its keto and ether group ratio .", "paek has good dimensional stability at high temperature , high chemical and mechanical resistance against wear , and high tensile , fatigue and flexural strength , making it an attractive material with expanded uses in medicine and dentistry.3 however , peek ( polyetheretherketone ) , a conventional paek - based polymer , can not be used as a permanent material due to its relatively weak physical properties . a new material , pekkton , is mainly composed of pekk ( polyetherketoneketone ) ; its molecular structure has an added ketone to the structure of peek with and has a wide range of uses due to its amorphous and crystalline structure .", "therefore , this material is found to be mechanically suitable for fpd frameworks , milled overdenture bars , clasps , telescopic crowns , and other applications . despite the reportedly good bond strength ,", "now , many new prosthetic materials are available to overcome these limitations , and as in this case , a new polymer can be used to make telescopic crowns and frameworks to obtain satisfactory results .", "she reported satisfaction with its strength and esthetics , and no negative symptoms . due to the lack of evidence on the long term retentive capabilities of this material ," ], [ "due to its functional and economic advantages , paek based polymer is a good alternative material to conventional materials and methods in the fabrication of implant overdenture ." ] ]

[ [ "the question of structural and mechanical alterations of the arterial wall in the case of renal transplantation has not yet been completely resolved .", "meanwhile , some modern devices for ambulatory blood pressure monitoring ( abpm ) allow the assessment of some as indices , and the approach to the analysis of these indices may be quite similar to that of abpm.10 accordingly , the aim of our study was to assess the feasibility of this approach in the management of patients with renal transplantation .", "an insufficiency of endogenous regulators of calcium and phosphate is well known to be a significant factor affecting extraosseous calcifications.1 in dialysis patients and kidney transplant patients , volume overload and disturbances of calcium and phosphate metabolism add to the atherogenic profile , and these serve as independent risk factors for cardiovascular mortality.2 the presence of arterial calcifications was strongly and independently predictive of the outcome in end - stage renal disease ( esrd).3 on this basis , estimating the arterial stiffness ( as ) in esrd is of great interest . measuring the pulse - wave velocity ( pwv ) is a reliable means of determining the as.4,5 there are several studies of pwv in patients with renal transplantation.69 notably , 24-hour pwv analysis has not yet been conducted in adults ." ], [ "the vasotens technology is an innovative method used for pulse - wave analysis based on oscillometric blood pressure measurements , using the bplab ( nizhniy novgorod , russia ) device for abpm.11,12 the technology was developed by the petr telegin company in nizhniy novgorod , russia .", "management of patients included the monitoring of calcium and phosphate serum levels and their correction .", "the recordings are made using a conventional blood pressure cuff for adults . during the blood pressure measurement ,", "overall , 41 patients were recruited from the kidney transplant waiting list of the privolzhsky district medical center in nizhniy novgorod , russia .", "all measurements were performed before kidney transplantation and at 1 and 20 weeks after transplantation .", "our study group included 27 ( 65.8% ) men and had a mean age of 35.2 years , with a mean systolic blood pressure of 134 mmhg , mean diastolic blood pressure of 86 mmhg , and mean heart rate of 74 beats per minute ." ], [ "the inclusion criteria were the following : age between 18 years and 55 years , esrd resulting from nondiabetic glomerulopathy ( glomerular filtration rate < 15 ml / min per 1.73 m ) , and candidate for a first kidney transplant .", "our study group included 27 ( 65.8% ) men and had a mean age of 35.2 years , with a mean systolic blood pressure of 134 mmhg , mean diastolic blood pressure of 86 mmhg , and mean heart rate of 74 beats per minute .", "overall , 41 patients were recruited from the kidney transplant waiting list of the privolzhsky district medical center in nizhniy novgorod , russia .", "patients with a history of prior kidney transplant or who were candidates for a kidney - pancreas transplant were excluded from the study .", "the additional exclusion criteria were cardiac rhythm disturbances , body mass index higher than 35 kg / m , severe dyslipidemia , and unstable clinical presentation .", "all the patients were receiving dialysis at enrollment , including 40 by hemodialysis and one by peritoneal dialysis ." ], [ "the vasotens technology is an innovative method used for pulse - wave analysis based on oscillometric blood pressure measurements , using the bplab ( nizhniy novgorod , russia ) device for abpm.11,12 the technology was developed by the petr telegin company in nizhniy novgorod , russia .", "the separation and timing of the forward and reflected pulse waves are determined by a special mathematical algorithm .", "the principle of the ptin calculation is where tm is the entire period of monitoring and t1 , t2 , and tn represent the periods in which the pwv does not exceed the cut - off value of 10 m / second .", "the recordings are made using a conventional blood pressure cuff for adults . during the blood pressure measurement ,", "the pressure waveforms in the cuff are registered while performing a step - by - step deflation .", "the distance for the pwv equation used by the vasotens was measured according to the bplab user s guide requirements .", "the pulse time index of norm ( ptin ) is calculated by the vasotens for the estimation of the 24-hour pwv ." ], [ "we used bpstat software , version 05.00.04 ( bplab ) to tabulate all the indices of every measured 24-hour waveform automatically .", "essentially , all the data are shown as the mean and standard deviation ( sd ) ." ], [ "the effect of renal transplantation on blood pressure ( table 2 ) was similar to the effect on the ptin .", "then , a week after the renal transplantation , we observed a decrease in the ptin in most cases .", "the analysis of variance showed that in the first group , the ptin changed significantly ( p < 0.05 ) , whereas in the second group , the ptin was not significantly different .", "after 20 weeks , the mean ptin in the whole group increased again to 52.0 ( sd , 23.6 ) , but the detailed analysis showed that those patients who had a higher value of ptin before transplantation had a higher increase at this time . using the receiver operating characteristic curve , we determined the cutoff value of ptin that could predict the two ptin states : a state of improvement or a state of decline / without change ( figure 2 ) ." ], [ "thus , the analysis of the 24-hour pulse wave velocity in the management of patients with renal transplantation using ptin is feasible .", ", this mismatching is a result of the smoothing effect of the nocturnal pattern of pwv in ptin , which integrates the pwv values over the course of 24 hours .", "it is known that the prevalence of postoperative hypertension in patients with renal transplantation is high , and this is one reason for an aggressive therapeutic approach by physicians , reflected by administering more antihypertensive medications.16 the ptin seems to give us an opportunity to optimize this approach . regarding the influence of hemodialysis on the variability of the pwv , a study in which the measurements were performed immediately before ( pre ) and 1 hour after ( post ) the end of each dialysis session should be noted .", "cyclic intradialysis changes in the pwv were similar during the three dialysis sessions ; as a consequence , all postdialytic pwv values were lower with respect to the predialytic levels.17 as our analysis showed , the ptin did not depend on the time of the interdialysis period at which the monitoring was performed . in our opinion", "this improvement is particularly important for the management in the initial period after implantation , when increased damage to the arterial wall , resulting in a decreased ptin in most patients , is observed ." ] ]

[ [ "xanthogranulomatous pyelonephritis ( xgp ) is a rare , distinct and aggressive form of chronic infectious pyelonephritis .", "it is essential to suspect and diagnose this condition early to prevent the morbidity and mortality . owing to its rarity and clinical curiosity", "it accounts for lesser than 1% of chronic pyelonephritis . though common in fifth to sixth decade", "complications can occur in the form of psoas abscess , nephro cutaneous fistula , enterocolonic fistula , paranephric abscess and sepsis ." ], [ "a 75-year - old man presented with difficulty in micturition since 15 days , fever , abdominal and flank pain and burning micturition since 7 days .", "( a ) yellowish lobulated renal mass with ureter ; ( b ) dilated pelvis , calyces and cortical atrophy covered with thick purulent material atrophic and dilated renal tubules showing thyroidisation , sclerosed glomeruli and fibrosis .", "x - ray , ultrasonography ( usg ) and computed tomography ( ct ) scan abdomen findings include pyonephrosis and cortical atrophy in the right kidney .", "histopathology revealed atrophic and dilated renal tubules showing thyroidisation and sclerosed glomeruli and interstitial fibrosis [ figure 2 ] ." ], [ "we presented this unusual case of elderly male to stress the importance of through evaluation of renal function who gave a history of recurrent urinary tract obstruction and infection .", "xgp is a severe chronic renal inflammatory condition leading to focal or diffuse kidney destruction .", "it may be due to defect in degradation of bacteria in the macrophages especially when associated with infection and obstruction by stones .", "three forms of xgp are recognised : diffuse is characterized by diffuse involvement of kidney , segmental by segmental involvement and focal - is located within the cortex .", "it is often misdiagnosed pre - operatively as pyelonephritis , tuberculosis , perinephric abscess and renal cell carcinoma ( rcc ) ." ], [ "chronic renal infection and obstruction are two common etiological factors for xgp . in all patients of prostatic", "enlargement , renal function must be assessed for the extent of damage . in non - functioning kidney" ] ]

[ [ "however , the diagnosis of bsis is still challenging in this patient group , because about half of all bsi cases are culture negative mainly because of the frequently used prophylactic antibiotics . to overcome the inhibitory effect of antibiotics , special blood culture bottles containing resin", "infectious complications , especially bloodstream infections ( bsis ) , are major causes of morbidity and mortality among patients who suffered from malignant hematological diseases and treated with intensive chemotherapeutic regimens [ 1 , 2 ] . in these clinical settings , bacterial cultures from blood", "are of great diagnostic value and the gold standard to detect bloodstream infections ; in addition to this , the results of blood cultures provide epidemiological data which are useful to determine empiric antibiotic therapy .", "the aim of this study was to evaluate occurrence of bacterial species causing bloodstream infections due to febrile neutropenic episodes in the hematology ward of the university hospital in szeged , hungary , between 2005 and 2008 .", "have been developed ; thus , modest increase in the sensitivity of culture has been achieved . in the early 1970s , introducing empiric treatment protocols and antibiotic prophylaxis , increasing use of certain chemotherapeutic drugs associated with frequent oral mucositis , and frequent use of central venous catheters have changed the spectrum of pathogens in febrile neutropenic patients shifting it from gram - negative to gram - positive bacteria , especially viridans group streptococci and coagulase - negative staphylococci [ 36 ] ." ], [ "between 2005 and 2008 , 469 patients with febrile neutropenia ( 230 females and 239 males , median age 60 years ) were observed in our department with various hematological diseases .", "vancomycin was used in patients with central venous devices , persistent fever , and hypotension . on day 45 , in patients with persistent fever suggesting fungal infection on the basis of clinical signs and computed tomography ( ct ) scans , amphotericin b was applied .", "infectious complications were categorized into three groups : 1 fever of unknown origin ( fuo ) , 2 microbiologically documented infection ( mdi ) , and 3 clinically documented infection ( cdi ) .", "medical database of patients was used to collect information on the hematologic diseases , presence of febrile neutropenic episode , duration of neutropenia , and source of infection .", "collected data from patients documentations included demographics of patients , diagnosis , febrile episodes , source of fever and source of infection , neutrophil count , and clinical significance of the isolated organism ." ], [ "infectious complications were categorized into three groups : 1 fever of unknown origin ( fuo ) , 2 microbiologically documented infection ( mdi ) , and 3 clinically documented infection ( cdi ) .", "between 2005 and 2008 , 469 patients with febrile neutropenia ( 230 females and 239 males , median age 60 years ) were observed in our department with various hematological diseases .", "collected data from patients documentations included demographics of patients , diagnosis , febrile episodes , source of fever and source of infection , neutrophil count , and clinical significance of the isolated organism ." ], [ "febrile neutropenia was defined if a single oral temperature was measured higher than 38.3 c , or temperature was 38.0 c or higher for 1 h. neutropenia was defined as absolute neutrophil count ( anc ) less than 0.5 10/l or less than 1.0 10/l and rapidly declined below 0.5 10/l . a single positive blood culture ( bc )", "common skin contaminants ( cns , propionibacteria ) were considered significant only if they could be found in two consecutive bc samples or if there were concurrent skin , soft tissue , or catheter - related infections .", "medical database of patients was used to collect information on the hematologic diseases , presence of febrile neutropenic episode , duration of neutropenia , and source of infection .", "bsi was defined as polymicrobial if more than 1 bacteria grew from bc on the same day ." ], [ "bottles were immediately placed in an incubator , where these were incubated for 514 days depending on the type of the putative pathogens . in the case of positive signal produced by the instrument on the basis of bacterial or fungal growth , microscopic examinations ( phase contrast microscopy and examination of gram - stained preparations ) and", "bc samples were taken at the onset of fever . in patients having central venous catheters , bcs were taken from both central and peripheral veins . for collection of blood culture ,", "bridgend , uk ) under a gas composition of 85% n2 , 10% h2 , and 5% co2 . from pure culture", "plates were incubated at 37 c for 24 h in a 5% co2 incubator or 37 c for 24 h under normal atmosphere or at 37 c for 48 h in an anaerobic cabinet ( concept 400 ; ruskinn technology ltd . ,", "the blood culture system ( bd bactec , beckton dickinson , usa ) including aerobic , anaerobic bottles , and bottles for fungi was used . after taking blood ,", ", antibiotic susceptibility tests were performed on the basis of clinical laboratory standard institute recommendations [ 811 ] ." ], [ "vancomycin was used in patients with central venous devices , persistent fever , and hypotension . on day 45 , in patients with persistent fever suggesting fungal infection on the basis of clinical signs and computed tomography ( ct ) scans , amphotericin b was applied .", "at the onset of fever , after taking bc , broad spectrum antibiotics were started empirically ( piperacillin tazobactam , cefepime , and imipenem or meropenem ) .", "changes in empiric antibiotic therapy depended on bc results and clinical response . in afebrile and culture - negative patients with stable clinical state" ], [ "high prevalence of escherichia coli ( 52% ) could be detected in these specimens , while 14% of samples contained pseudomonas aeruginosa , 9.6% klebsiella spp .", ", contamination could be the source of cns . among rarely isolated pathogens , listeria sp .", "the most frequent isolates were coagulase - negative staphylococci ( 65% ) , staphylococcus aureus ( 10% ) , enterococcus spp ." ], [ "in this review , the results of four articles were analyzed , and , among gram - negative organisms , the most important pathogens were also e. coli , klebsiella spp . , and p. aeruginosa . among rarely isolated bacteria , achromobacter xylosoxidans and burkholderia cepacia", "are usually associated with catheter - related sepsis , while s. maltophilia can cause mainly nosocomial bacteremia and the possible source of haemophilus influenzae , neisseria spp . , and gemella spp .", "because of the possible presence of unusual pathogens , such as anaerobic bacteria or fastidious microorganisms , the use of various blood culture bottles including anaerobic bottles should be considered . because of its rapid progression of infection in febrile neutropenic patients and difficulties in distinguishing infection from noninfected patients on the basis of clinical presentation in this patient group , the use of empirical antibiotic treatment is essential and may provide the possibility to reach better outcome .", "recognition of changes in the epidemiology of bsis is very important to modify the antibiotic policy because , on the basis of these findings , we can reduce the infection - related morbidity and mortality [ 15 , 16 ] . during the four - year study period , the incidence of bacteremia was 20.4% .", "showed that the prevalence of staphylococci is higher than the prevalence of streptococci and enterococci in febrile neutropenic patients ." ] ]

[ [ "the sami remained very isolated , not only because of their economy and culture but also because of the great distances between households and the intense cold of the region for most of the year . at the end of the 17 century", "this transition coincided with the swedish state 's increased interest in spmi , the distant regions of the north which were the sami 's traditional lands .", "research indicates that many sami became reindeer herders in the early 17th century , as a response to a population crisis ( 9 ) .", ", the state also tried to encourage settlers to move to the area , offering free land , and 15 years free from taxes .", "further interest in the area was stirred in the late 17th century by the discovery of silver , but the mining epoch lasted for only 50 years .", "courts were held annually , market places were built , and the first printed books in the sami language appeared ( 10 ) .", "this had , however , a limited impact on in - migration , a trend that did not change until the mid-18th century . during the following 100 years , the ethnic balance in spmi changed , turning the sami into a position as minority in their own lands ." ], [ "the present study is a set of data files from the demographic database ( ddb ) at ume university , one of the world 's most information - dense historical population databases .", "indigenous peoples were not mentioned in his work , but few researchers would dispute that the indigenous populations of the world experienced demographic transitions much later than non - indigenous populations . however , although an indigenous demographic or health transition is generally acknowledged , due to lack of longitudinal data , it is rarely examined ( 14 , 15 ) . the main source material used for", "long - term infant mortality trends are analyzed to compare sami and non - sami groups in the three parishes.using both northern and southern sami areas , the cultural complexity of the sami society is recognized .", "omran 's essay on the epidemiological transition , modeling societies change from high mortality due to infectious diseases to low mortality caused by chronic diseases , has had a great impact on the public health community and stirred research in a variety of disciplines ( 12 , 13 ) .", "this is consistent with the occurrence of a delayed indigenous demographic and epidemiologic transition ( 20 ) , and because infant mortality is one of the early indicators of intensified change , our study aims to find evidence for declining imr among the sami before 1900 that could be interpreted as a forerunner of a general transition .", ". a complementary source of information about infant mortality is the annual reports of the district physicians in the area ." ], [ "the sami have lived in spmi for thousands of years and have learned to adapt to the extreme conditions there . nevertheless , the nomadic sami lifestyle , the hazardous character of reindeer herding , and a shifting food resource resulted in a high mortality , including infant mortality .", "the sami were devoted parents with strong emotions and traditions attached to their children , and had developed customs for reducing risk during pregnancy , delivery , and child care .", "it is universally reported by the clergy , physicians , travelers , politicians and later also expressed by the sami themselves that sami children were breast - fed for at least 2 years , and sometimes for as long as four years . during the first days after birth ,", "the child was believed to be endangered by evil spirits and other threats , and a newborn child was put in a skin from a newborn reindeer calf , with a piece of steel close to the infant to protect it ( 22 ) .", "before the mother produced milk , the infant was given a piece of sugar or reindeer fat in a small napkin .", "some sami women consumed alcohol during pregnancy but not during the last days before birth giving . however , when the infant was born , the woman was encouraged to drink quite a lot of alcohol ( 22 ) .", "colonization was promoted by the state from the late 17th century , but the great explosion of in - migration occurred in the second half of the 19th century , when mining , railroads , and improved agricultural techniques offered new opportunities .", "the non - sami settlers were mostly from other parts of sweden , but sometimes from finland or norway ." ], [ "medical instructions were published concerning the care of infants , and district doctors were employed , even though in the 1870s it was still a rare event for someone in northern sweden to have a visit by the doctor ( 23 ) . in earlier times , the clergy were given responsibility for health care , but during the 19th century they became less and less involved .", "from the mid-18th century , the swedish health care system tried to reduce the very high infant mortality in the country .", "in stockholm and other urban areas , sometimes more than half of the newborn children died within their first year of life .", "they were officially released from health duties in 1830 , and after this , their participation in medical issues in the parish was greatly reduced , although many clergy continued to assist with medical advice . from this time , midwifery services increased , although economic difficulties caused many parishes to resist official requests to employ a midwife ( 24 ) ." ], [ "the period of study includes great social , political , economic , demographic , and environmental changes . due to the unreliability of the data during the 18th century", "in the early 19th century , the northern parishes had among the highest infant mortality in sweden .", "the more balanced the ethnic proportions became , the less differences occurred in infant mortality . in the southern parish of fllinge ,", "nevertheless , many areas in northern sweden experienced a great reduction in infant mortality during the 19th century . in some parishes , it dropped from over 50% to below 18% 50 years later ( 23 ) .", "there is a general trend of decreasing sami infant mortality in 17501899 . in the northern parish of jukkasjrvi ,", "the imr declined over the 19th century , as a result of improved hygiene , and increased breast - feeding . in many places in sweden ," ], [ "the settlers may have lacked the well - developed traditional knowledge needed for dealing with the cold climate and other risks specific to the northern inland area .", "the mothers who gave birth for the fifth time or more were also older than those giving birth for the first time .", "although we can not control for the number of older siblings that were actually alive , it seems clear that large families were less able to avoid infant mortality .", "the health status of the mother is an important determinant of infant survival , especially during the first week . among the sami", ", first - born infants had the second largest risk of dying , whereas among the non - sami they experienced the greatest risk .", "both ethnic groups in all parishes had the lowest risks for mortality for infants born as number two , three , or four in the birth order of the mother .", "this was often based on an assumption that a large family was an obstacle to the nomadic life of the reindeer herders ( table 4 ) . \n ", "infant mortality ( per 1000 ) after parity in jukkasjrvi , jokkmokk , and fllinge 17501899 source : demographic database , ume university . in all three parishes , sami infants", "it was often claimed that sami families were smaller than non - sami families in the area ( 28 ) ." ], [ "the period of study includes great social , political , economic , demographic , and environmental changes . due to the unreliability of the data during the 18th century", "the northern parish jukkasjrvi experiences a dramatic shift from twice as high sami infant mortality in18001849 to slightly lower imr compared to the non - sami during the second half of the century .", "cox regression of infant mortality in jokkmokk , jukkasjrvi , and fllinge , 18001899 note : e is the relative risk , p is the p - value for each parameter in the model .", "the results show geographical differences between the three sami groups . in jokkmokk with an ethnic majority shift around the 1830s ,", "the more balanced the ethnic proportions became , the less differences occurred in infant mortality . in the southern parish of fllinge ,", "this is also the only parish with the highest mortality risk among the first born infants in 18501899 ." ], [ "therefore , the first half of the 20th century is crucial for our understanding of the imr transition in spmi , and hence for our understanding of the sami demographic , epidemiologic , and health transitions .", "if infant mortality is used as an indicator of a positive shift in the demographic , epidemiologic , and health transitions , it can be concluded that by 1900 these transitions had not begun in the northern parts of the area .", "infant mortality was a difficult obstacle to overcome , and the final breakthrough did not occur until the 20th century .", "the traditional nomadic life style is important for our understanding of sami infant mortality ( 25 ) , but there is no reason to believe that hard working conditions caused the sami women to stop breast - feeding their infants , as was often the case in other contexts ( 34 ) ." ], [ "the authors have not received any funding or benefits from industry to conduct this study ." ] ]

[ [ "so far , anthropometric variables and their relation to conventional coronary risk factors in railway employees have been inadequately studied in india . to assess anthropometric variables and their relation to coronary risk factors ,", "this particular section of the population was selected , as it comprises all classes of employees , including both sexes , sedentary and nonsedentary job workers of various socioeconomic groups , religions , and from different parts of india .", "the purpose of this study was to examine the association of obesity with cad risk factors by different anthropometric variables .", "this cross - sectional survey was carried out in solapur division of the central railway in the year 2004 ." ], [ "this study was designed to investigate conventional cad risk factors and their relation to anthropometric variables among the solapur division railway employees .", "tobacco consumption in the form of smoking and in the form of tobacco chewing were grouped separately .", "a proforma was prepared that incorporated information regarding demography ( age and sex ) , anthropometric ( height in meter , weight in kilograms , waist and hip circumferences in centimeters ) variables , occupation ( sedentary or nonsedentary ) , physical examination ( pulse , blood pressure ) , clinical data ( history of diabetes hypertension , smoking , tobacco chewing , exercise ) , and biochemical investigations [ fasting blood sugar level ( bsl ) and complete lipid profile ] .", "a total of 995 railway employees participated in this cross - sectional survey with age 30 and 60 years .", "this study was conducted among the railway employees of solapur division of the central railway .", "physical activity according to the type of job were classified as , nonsedentary job ( moderate to heavy physical activity ) sedentary job ( low physical activity ) \n physical activity was classified into 2 levels , moderate to high physical activity was referred as nonsedentary ( rpf , drivers , gangmen , and others ) low physical activity referred ( sedentary ) to people involved in office work , research work , and so on .", "diabetes mellitus ( dm ) : if a subject is a known diabetic on treatment with any bsl or if fasting bsl ( f - bsl ) 126 mg / dl ." ], [ "each person was examined for height , weight , wc , and hip circumference without shoes and chappals with minimal clothing as per cardiovascular survey methods .", "avi was calculated using volume formulas for cylinder ( v = rh ) and vertical cone v = ( 1/3)rh . the formula developed was avi = [ 2 cm ( waist ) + 0.7 cm ( wc hc)]/1000 , which estimates overall abdominal volume between symphysis of pubis and xiphoid appendix and theoretically includes intra - abdominal fat and adipose tissue volumes .", "bmi was calculated by formula of weight in kg / height m. whr was calculated by wc / hc in centimeters ." ], [ "a person smoking one or more cigarettes or bidis per day at the time of study was considered as a smoker and one chewing tobacco currently , a tobacco chewer . in the present study ,", "\n a smoker in india consumes tobacco in the form of bidi / cigarettes and chewing tobacco .", "tobacco consumption in the form of smoking and in the form of tobacco chewing were grouped separately.physical activity according to the type of job were classified as , nonsedentary job ( moderate to heavy physical activity)sedentary job ( low physical activity ) \n physical activity was classified into 2 levels , moderate to high physical activity was referred as nonsedentary ( rpf , drivers , gangmen , and others)low physical activity referred ( sedentary ) to people involved in office work , research work , and so on . \n ", "physical activity according to the type of job were classified as , nonsedentary job ( moderate to heavy physical activity ) sedentary job ( low physical activity ) \n physical activity was classified into 2 levels , moderate to high physical activity was referred as nonsedentary ( rpf , drivers , gangmen , and others ) low physical activity referred ( sedentary ) to people involved in office work , research work , and so on .", "a smoker in india consumes tobacco in the form of bidi / cigarettes and chewing tobacco .", "tobacco consumption in the form of smoking and in the form of tobacco chewing were grouped separately .", "a person smoking one or more cigarettes or bidis per day at the time of study was considered as a smoker and one chewing tobacco currently , a tobacco chewer . in the present study ," ], [ "the data were pooled , computerized , and analyzed by evaluation version of epi info . 6 [ ( epi info is public domain statistical software for epidemiology developed by centers for disease control and prevention ( cdc ) in atlanta , georgia ( usa ) ] .", "cutoff values of whtr and avi were calculated by using this curve as a tool for diagnosing central obesity . correlation ( r ) : r = 0.8 ( high correlation coefficient ) , r= 0.40.7 ( moderate correlation ) , and r= 0.3 and above ( low correlation coefficient ) .", "roc curve is used to find out the cutoff point for particular value of a test as a diagnostic test .", "correlation of anthropometric variables and coronary risk factors in different age groups were determined using r and multiple linear regression analysis ." ], [ "relation of anthropometric variables and coronary artery disease risk factors in males and females furthermore , the whr was the single independent variable to all or most of the cad risk factors by multiple regression analysis .", "correlation of anthropometric indices with coronary artery disease risk factors in female population , age 45 years had an odds ratio of 1.673 with bmi .", "high values of bmi , wc , whr , whtr , and avi were negatively associated with physical inactivity .", "dm was statistically significant and positively associated with high values of bmi , wc , whr , whtr , and avi . in dyslipidemia low hdl was correlated with high values of whr , whtr , and avi , whereas ldl cholesterol , t - cho , and trg were correlated only with high bmi and high whtr in this population [ table 4 ] . in multiple regression analysis a model was utilized that included age , bmi , whr , whtr , wc , avi , sbp , dbp , plasma t - cho , trg , and smoking ." ], [ "bmi had partial positive correlation ( moderate to low ) with coronary risk factors , such as age weight , sbp , dbp , f - bsl , t - cho , ldl cholesterol , trg , and other anthropometric variables .", "whr had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , height , weight , sbp , dbp , f - bsl , total , trg , and other anthropometric variables .", "multiple regression analysis for whtr and whr showed that both of them were significantly associated with most of the cad risk factors , such as age 45 years , high sbp , high dbp , dm , low hdl , high ldl , high t - cho , and high trg [ table 5 ] .", "avi had partial positive correlation ( moderate to low ) with coronary risk factors , such as age , weight , height , sbp , dbp , f - bsl , trg , and other anthropometric variables [ table 4 ] . in male population , age 45 years had odds ratio of 2.15 with whtr and 1.95 with avi . sedentary job had an odds ratio of 1.402 with bmi .", "in dyslipidemia low hdl was correlated with high values of whr , whtr , and avi , whereas ldl cholesterol , t - cho , and trg were correlated only with high bmi and high whtr in this population [ table 4 ] . in multiple regression analysis a model was utilized that included age , bmi , whr , whtr , wc , avi , sbp , dbp , plasma t - cho , trg , and smoking .", "high values of bmi , wc , whr , whtr , and avi were negatively associated with physical inactivity .", "high sbp , high dbp , and sedentary job were significantly and positively correlated with high values of bmi , wc , whr , whtr and avi .", "multiple logistic regression analysis revealed whtr and whr were significantly associated with age ( p < 0.001 ) , bmi ( p < 0.001 ) dm ( p = 0.005 ) , sbp ( p < 0.001 ) , dbp ( p < 0.001 ) , low hdl in females , and high trg in males ( p < 0.001 ) [ figure 1 ] ." ], [ "conventional cad risk factors , such as physical inactivity , central obesity , hypertension , low hdl , age 45 years , and hypertriglyceridemia were highly prevalent in males , whereas physical inactivity , central obesity , hypertension , age 45 years , and hypercholesterolemia were highly prevalent in female population .", "compared to overall obesity , central obesity was better correlated with most of the cad risk factors .", "among all the components of metabolic syndrome , high wc was most prevalent in females and systolic hypertension in males .", "the prevalence of metabolic syndrome ( using atp iii criteria modified for indians ) was 25.17% in males and 27.35% in females .", "whtr was better predictive of cad risk factors than wc and whr in present study ." ], [ "in the current study , the most common cad risk factor was truncal obesity in the solapur division railway employees .", "generalized obesity , overweight , and central obesity problem was more prevalent in subjects with age 45 years , sedentary job , physical inactivity , and female gender .", "there was a significant lack of physical activity and exercise among sedentary job workers , leading to overweight and obesity .", "generalized obesity , overweight , and central obesity were significantly correlated with cad risk factors , such as age 45 years , dyslipidemia , hypertension , dm , and physical inactivity .", "the present study shows a disturbing burden of coronary risk factors mainly truncal obesity , physical inactivity , hypertension in a sample population of railway employees .", "central obesity measured by whtr was strongly correlated with majority of cad risk factors than whr , wc , and avi ." ] ]

[ [ "polymerase chain reaction ( pcr ) is a commonly used laboratory procedure nowadays for a variety of tasks , such as dna cloning , sequence determination and snp detection .", "additionally , all the primer data can be exported in csv format for further processing .", "consequently , numerous primers need to be designed for dna amplification in order to produce enough dna . for dna sequencing , to design primers for the promoter and exon regions of a gene , one needs to retrieve the required sequence information for each single exon and promoter , including their corresponding flanking sequences , convert them to the correct format , switch to a primer design application like primer 3 ( 1 ) , import the sequence information and adjust parameter settings if necessary before submitting the request . while this is tolerable for primer design for a gene that has a single exon , a human , mouse or rat gene can easily have more than 10 exons , and each of the above steps may thus need to be repeated 10 times or more .", "a snp i d or up to 100 batched snp ids , in most cases all the primer sequences should be returned in a minute or two . the generated information , including gene transcript graph , primer data from primer3 , and direct links to ucsc in - silico pcr ( 3,4 ) for pcr product prediction , to ncbi blast and to ensembl source data , is integrated and displayed on a single page for convenient viewing .", "there are a multitude of user - definable options available including product size , maximum exon length , excluded regions of the query sequence , gc - content and maximum allowable local alignment score . simply by submitting a candidate gene name ," ], [ "primerz takes advantage of the well - developed public - domain database ensembl , through its api ( application programming interface ) .", "when a gene query is received , primerz will access the ensembl database through ensj api ( 5 ) to retrieve promoter and exon information . by default but with an adjustable setting ,", "primerz retrieves one region of 1440 bp upstream from the start of 5-utr which it treats as the promoter region .", "all exons are directly flanked with 240 bp sequences , except when an exon of the gene is > 360 bp , when the sequence will be split into segments of 360 bp for a better quality sequencing result .", "the promoter region is thereafter divided into four 360 bp non - overlapping segments plus their respective flanking sequences .", "java language is used to pipeline gene data into primer 3 and merge the returned results .", "for example , an exon of 1000 bp will produce two 360 bp segments and one 280 bp segment . the above sequence information , plus parametric settings packaged by primerz are then fed into primer3 for primer design ." ], [ "the excluded region value allows the program to bypass regions with low sequence quality or containing repetitive elements such as alus or lines for primer design . for snp primer design , a snp rsid or an affy_probid(6 ) as well as a batch file containing mixed", "i d types can be accepted as input , where the maximum number of snps per batch is limited to 100 .", "primerz is an easy - to - use tool to design primers for genes and snps , using only a few simple steps to design the wanted primers .", "it currently provides gene primer design for all ensembl species while snp primer design is currently only available for human snps . for gene primer design ,", "there are some essential parameters required for optimal design of primers , such as maximum exon length , exon flanking region , product size range and excluded region ." ], [ "ensembl link button offers the ensembl exon report of the transcript so that a user can trace all primers to their original sequence information .", "the result page comprises three major parts : initial input data and parameters , the gene transcript diagram ( only available for gene primer design ) and designed primer information .", "the second part shows each promoter fragment and exon of a transcript diagram , and links to their accompanying original primer3 output . finally , the third section presents tabulated primer information and incorporates executable links to ncbi blast and ucsc in - silico pcr to check specificity and product prediction .", "the first part lists all the input data and parameters plus ensembl database version , for ease of reference .", "a csv format text file of the results can be downloaded at this results page ." ], [ "in a manual operation benchmarking test , it took a person very familiar with all processes about 1260 s and 380 discrete steps to design the primers of hadhsc ( l-3-hydroxyacyl - coenzyme a dehydrogenase , short chain ) , our benchmark gene with 10 exons .", "this comparison clearly demonstrates the superior efficiency and ease - of - use of primerz for gene primer design .", "with automated primerz , the same operation took only 16 s and three steps .", "a benchmark test on batched snps showed a similar dramatic reduction in workload from 90 discrete steps to two steps , from 840 to 49 s , and from 40 result pages to a single page ." ], [ "the results from ncbi and ensembl will be shown in the same page . following the release of primer3 web interface in november 2006 , we are installing and testing a local copy of primer3 web to alleviate the burden on the original primer3 website and the restriction on the number of snps allowed .", "primerz has been designed to obtain reliable primers for pcr experiments and to allow standardized , automated primer design for batch operation .", "primerz also allows users to modify the conditions of primer design , including the maximum exon size , the flanking region of the target sequence , the exclusion region and the maximum allowed polya and ca - repeats in the pcr products .", "primer z is a simple - to - use program that greatly facilitates and enhances the traditionally time - consuming task of accurate primer design for pcr , and should be an excellent additional tool for the modern molecular biologist .", "users can access the ucsc in - silico pcr directly from the result page to verify their primers to achieve higher accuracy and lower cost .", "in addition , primerz will offer primer design from ncbi transcripts in the near future , which should be of great interest to those users who use ncbi data to design primers ." ] ]

[ [ "the prevalence rates of t2 dm increase with age , and older people are a growing population that account for a high proportion of cases among adults .", ". however , elderly patients are systematically excluded from clinical trials , and there is also a lack of reliable data on the response to pharmacological treatments in this age group .", "older patients are more likely to present cardiovascular complications and comorbid conditions , which entail specific goals to control the disease" ], [ "in a primary care reallife setting , t2 dm patients in the older age subgroup ( > 65 years ) had a better control of glycaemic targets and cardiovascular risk factors than younger patients in spite of having a higher prevalence of chronic complications . moreover ,", "this age subgroup was less intensively treated with glucoselowering and lipidlowering drugs than younger patients .", "t2 dm in elderly people should be clinically managed taking into account the observed differential agerelated pattern of the disease ." ], [ "indeed , the benefits associated with glycaemic control require 510 years to reduce the incidence of microvascular complications 4 , 10 , and it is not yet certain whether it has an actual impact in the incidence of cardiovascular disease ( cvd ) in these patients . the objective of the present populationbased crosssectional study was to retrospectively assess and compare the clinical characteristics , degree of glycaemic and cardiovascular risk factors control , treatments , and diabetesrelated complications between older t2 dm patients and younger adults in a primary care population database in catalonia , spain .", "the strong link between age and diabetes is of concern if we take into account the progressive increase in life expectancy , which is likely to result in a substantial increase in the number of older people with diabetes , and a concomitant increase in the costs for the health system in the near future .", "type 2 diabetes mellitus ( t2 dm ) has become one of the most serious and challenging public health issues of our time , and the human , social and economic burden associated with the disease has dramatically increased over the past few decades . according to the international diabetes federation 382 million people worldwide have diabetes , and 316 million are at high risk of developing t2 dm 1 . in spain , a recent epidemiological survey estimated that the prevalence rate of t2 dm is around 13.8% , and that about 6% of the spanish population is unaware of their disease 2 . moreover", ", the study showed that diabetes is more frequent in men and prevalence rates increase with age 2 .", "secondarily , we aimed to compare these same variables stratifying by gender and different age subgroups ." ], [ "as for comorbidities , the diagnose of hypertension and/or dyslipidaemia was considered if mentioned in an active record up to the cutoff date , and we also extracted information on the presence of diabetesrelated chronic complications , namely ischaemic heart disease , heart failure , stroke , peripheral artery disease , diabetic retinopathy and chronic kidney disease ( defined according to egfrmdrd4 and acr values ) .", "patients with type 1 diabetes mellitus or gestational diabetes were excluded . for the objective of the study , we extracted demographic data , including age ( further categorised into age subgroups : 65 , 6675 , 7685 , and > 85 years ) and sex ; clinical variables included diabetes duration ; smoking status ; body mass index ( bmi ) ; blood pressure ( bp ) ( systolic and diastolic ) ; standardised glycated haemoglobin ( hba1c ) values ; lipid levels including total cholesterol ( tc ) , lowdensity lipoproteins or ldl cholesterol ( ldlc ) , highdensity lipoproteins or hdl cholesterol ( hdlc ) , nonhdl cholesterol , and triglycerides ( tg ) , estimated glomerular filtration rate ( egfr ) using the modified diet in renal disease ( mdrd4 ) formula and urine albumintocreatinine ratio ( acr ) .", "data were obtained for patients 30 years diagnosed with t2 dm by 31 december 2011 and attended a primary care centre during 2011 .", "descriptive , populationbased , crosssectional study at the primary care setting in catalonia , spain .", "data were extracted from sidiap ( information system for the development of research in primary care ) 11 , which is a computerised database containing anonymised patient 's records for the 5.8 million people attended by general practitioners in the catalan health institute .", "values of clinical variables corresponded to the most recent registered value in the last 15 months except for bmi , which was the most recent value in the last 24 months , and smoking status , which corresponded to the most recent information recorded in the medical history ." ], [ "data were extracted from sidiap ( information system for the development of research in primary care ) 11 , which is a computerised database containing anonymised patient 's records for the 5.8 million people attended by general practitioners in the catalan health institute .", "descriptive , populationbased , crosssectional study at the primary care setting in catalonia , spain .", "sidiap includes data on demographic variables , diagnoses , clinical variables , prescriptions , specialist referrals , laboratory test results , and medications withdrawn from pharmacist offices , obtained from the catsalut general database ." ], [ "patients with type 1 diabetes mellitus or gestational diabetes were excluded . for the objective of the study , we extracted demographic data , including age ( further categorised into age subgroups : 65 , 6675 , 7685 , and > 85 years ) and sex ; clinical variables included diabetes duration ; smoking status ; body mass index ( bmi ) ; blood pressure ( bp ) ( systolic and diastolic ) ; standardised glycated haemoglobin ( hba1c ) values ; lipid levels including total cholesterol ( tc ) , lowdensity lipoproteins or ldl cholesterol ( ldlc ) , highdensity lipoproteins or hdl cholesterol ( hdlc ) , nonhdl cholesterol , and triglycerides ( tg ) , estimated glomerular filtration rate ( egfr ) using the modified diet in renal disease ( mdrd4 ) formula and urine albumintocreatinine ratio ( acr ) .", "values of clinical variables corresponded to the most recent registered value in the last 15 months except for bmi , which was the most recent value in the last 24 months , and smoking status , which corresponded to the most recent information recorded in the medical history . as for comorbidities ,", "data were obtained for patients 30 years diagnosed with t2 dm by 31 december 2011 and attended a primary care centre during 2011 .", "the diagnose of hypertension and/or dyslipidaemia was considered if mentioned in an active record up to the cutoff date , and we also extracted information on the presence of diabetesrelated chronic complications , namely ischaemic heart disease , heart failure , stroke , peripheral artery disease , diabetic retinopathy and chronic kidney disease ( defined according to egfrmdrd4 and acr values ) .", "control of cv risk factors were defined as follows : no current smoking ; bmi < 30" ], [ "all hypothesis contrasts were bidirectional and the statistical significance level was set at 0.05 . moreover , the prevalence of diabetesrelated complications and the degree of glycaemic control was studied stratifying by t2 dm duration ( 5 , 510 , 1020 and > 20 years ) .", "a descriptive analysis was performed stratified by gender and age subgroup . for qualitative variables ,", "proportions and means were compared by pearson 's chisquared test and analysis of variance ( anova ) , respectively .", "all analyses were performed with stata / se version 13 for windows ( stata corp . , college station , tx , usa ) and r software version 3.0.1 ( the r foundation for statistical computing , vienna , austria ) ." ], [ "p < 0.001 ) . in the case of diabetic retinopathy , patients with a longer duration had also a higher prevalence of diabetic retinopathy ( 6.7% vs. 26% after 20 years of diabetes , p < 0.001 )", "impact of t2 dm duration , age and gender on the prevalence of diabetic retinopathy ( dr ) we further studied whether diabetes duration ( 5 years , 510 years , 1020 years and > 20 years ) was related to the degree of glycaemic control and presence of diabetesrelated complications .", "a total of 318,020 subjects with a diagnosis of t2 dm were included in the study ; 53.8% of them were males ( n = 171,219 ; table 1 ) ." ], [ "acr , albumintocreatinine ratio ; bmi , body mass index ; bp , blood pressure ; egfrmdrd , estimated glomerular filtration rate ( egfr ) using the modified diet in renal disease ( mdrd4 ) formula ; hba1c , standardised glycated haemoglobin ; hdlc , highdensity lipoproteins hdl cholesterol ; ldlc , lowdensity lipoproteins ldl cholesterol ; tc , total cholesterol . there was a progressive improvement in glycaemic control values ( hba1c ) with age in both genders ( p < 0.001 ) despite longer diabetes duration in older age groups . in the total sample ,", "mean age of the overall population was 68.8 years ( sd = 11.9 ) ; the mean age at diagnosis was 61.6 years ( sd = 11.7 ) , and the median disease duration was 6.7 years [ interquartile range ( iqr ) = 6.2 years ) . according to prespecified age categories , 38.0% of subjects were 65 ( 62.9% males ) ; 29.4% were 6675 ( 54.3% males ) ; 25.8% were 7685 ( 45% males ) ; and 6.8% were > 85 years ( 33.4% males ) .", "a total of 318,020 subjects with a diagnosis of t2 dm were included in the study ; 53.8% of them were males ( n = 171,219 ; table 1 ) .", ", in both genders the mean values of diastolic bp , tc , ldlc and tg were significantly lower in the older age groups ( p < 0.001 ) .", "the average values of egfrmdrd also decreased gradually with age in both genders ; thus , the percentage of patients with renal failure ( egfr < 60 ml / min ) and urine acr increased gradually with age in both genders ( p < 0.001 ) .", "kg / m vs. 31.0 kg / m , respectively ) , and declined with age for both genders ( p < 0.001 ) . of note", "demographic and clinical characteristics of the study population by gender and age group the number of patients with available data varied depending on each studied variable ." ], [ "the percentage of subjects with fair glycaemic control ( hba1c 7% ) was significantly higher among older age groups ( p < 0.001 ) ; moreover , a lower proportion of patients in the older age groups were not well controlled ( hba1c > 10% ) in spite of having more comorbid conditions .", "the degree of control of main cardiovascular risk factors for t2 dm and pharmacological treatments is shown in table 2 .", "its use was progressively reduced with increasing age , with a total of 71.5% of men and 68.4% of women older than 85 years taking any glucoselowering agent .", "as for the pharmacological treatment of hypertension , there was a greater proportion of older subjects being pharmacologically treated compared with younger adults , and more frequently treated with a combination of different drugs .", "additionally , lipidlowering drugs were used less frequently by both women and men in the older age groups ( p < 0.001 ) . as for the use of antiplatelet agents ," ], [ "there was a sharp increase in the frequency of heart failure and all macrovascular complications ( ischaemic heart disease , stroke and peripheral artery disease ) with increasing age ( p < 0.001 in all complications ) .", "the assessment of kidney disease by egfrmdrd showed a progressive increase in renal failure cases ( egfrmdrd < 60 ml / minute ) with age , which was also the case for acr values , and both complications together were observed up to a 20% of men and 19.3% of women older than 85 years compared with a 2.2% of men and 1.9% of women", "the prevalence of chronic micro and macrovascular complications associated with t2 dm by gender and age subgroup is shown in table 3 .", "impact of t2 dm duration , age and gender on the prevalence of diabetic retinopathy ( dr )", "prevalence of diabetesrelated complications by gender and age subgroup acr , albumintocreatinine ratio ; cvd , cardiovascular disease ; egfrmdrd , estimated glomerular filtration rate ( egfr ) using the modified diet in renal disease ( mdrd4 ) formula . as for microvascular complications , diabetic retinopathy was more frequent among patients > 65 years ( p < 0.001 ) , although taking into account the diabetes duration , there was a progressive decrease in frequency with increasing age , particularly in men ( figure 1 ) .", "furthermore , albuminuria ( acr > 30 mg / mmol ) increased with age and was more frequent in men than in women in all age groups ( p < 0.001 ) ." ], [ "the older the patients were the higher the percentage achieving a glycaemic goal of hba1c values 7% , and this was true in all age subgroups regardless the duration of t2 dm .", "we further studied whether diabetes duration ( 5 years , 510 years , 1020 years and > 20 years ) was related to the degree of glycaemic control and presence of diabetesrelated complications .", "moreover , patients in older age subgroups were more likely to achieve target glycaemic values irrespective of having a cvd or heart failure .", "for instance , the proportion of patients with a disease duration 15 years and no cvd who achieved target hba1c values 7% was 49% among those aged 65 years , and 54% among those aged 6575 years ; in patients with a disease duration > 15 years and cvd , 56% aged 65 years and 83% aged 6575 years achieved target hba1c values 7% and 8.5% , respectively .", "as for individual diabetesrelated complications , there was a higher prevalence among subjects with a longer duration of t2 dm and increasing age , particularly in those with a disease lasting for more than 20 years ." ], [ "the present descriptive study assessed the clinical and characteristics , the degree of glycaemic control , the presence of chronic diabetesrelated complications and the use of pharmacological treatments in a population of 318,020 adults with t2 dm treated in a reallife clinical setting .", "older people are a growing population with t2 dm that account for approximately 50% of all cases of diabetes in adults and have differential characteristics , requiring tailored management approaches 1 , 5 , 8 .", "the results evidenced the existence of different profiles between age groups : except for the control of bp , diabetic patients older than 65 years had a better glycaemic control and a better control of dyslipidaemia , obesity and tobacco smoking than patients 65 years ; they were less frequently treated with glucoselowering and lipidlowering drugs , but more frequently with antiplatelet agents .", "in addition , and inherent to all crosssectional studies conducted in elderly populations , there is a survival bias because patients with diabetesrelated complications , poor control and/or severe forms of t2 dm usually die at a younger age than patients with a late onset and/or well controlled disease .", "they also had a better control of glycaemic targets and cardiovascular risk factors in spite of a progressive increase in the prevalence of chronic complications with increasing age ." ], [ "patients with t2 dm older than 65 years have a better glycaemic control and a better global control of cardiovascular risk factors than younger adults . however , older age groups were also more likely to achieve glycaemic targets irrespective of having cvd and longer diabetes duration . finally , the use of agents to control hyperglycaemia and dyslipidaemia was lower in older ages .", "this differential age and genderrelated pattern stresses the need to individually adapt the therapeutic and care approaches of t2 dm in elderly people to allow the best benefit and the lowest risk at all stages of the disease .", "further research is warranted to investigate through prospective and interventional studies the observed differences in the clinical behaviour and treatment of t2 dm in elderly people ." ], [ "jbdlp , mmc and jfn wrote the manuscript and contributed to the discussion ; xmt , ac and jmfrl contributed to the discussion ; jfn , mmc and dm designed and conducted the study , reviewed / edited the manuscript and contributed to the discussion .", "mmc had full access to all data in the study and takes responsibility for the integrity of data and the accuracy of the data analysis ." ] ]

[ [ "the present study aims to satisfy this experimental challenge by considering the role of cue integration in both action and tone binding . in many sensorimotor tasks ,", "first , if cue integration underlies both action and tone binding measures , action binding will be weakest under high tone uncertainty , whereas tone binding will be strongest .", "in this study , we investigated the contribution of cue integration to action and tone binding . to this end , we manipulated the reliability of the tone event by modulating its intensity relative to a background white noise .", "we tested three main predictions of the cue integration hypothesis under different conditions of tone reliability .", "based on each subject s individual auditory detection threshold , we generated three tones with increasing intensities , which in the presence of noise provided high , intermediate and low levels of uncertainty in the perception of tone onset .", ", there are few studies which examine the mechanisms of both action and tone binding .", "2011 ) . despite the growing use of binding as a measure of agency , the underlying mechanisms of action and tone binding remain largely unclear ." ], [ "to explore the effect of uncertainty on binding , we performed repeated - measures anovas with uncertainty ( high , intermediate and low ) as a within - subject factor on the following datasets : ( 1 ) sds of estimation errors in baseline tone condition ; ( 2 ) action and tone binding values ; and ( 3 ) mean estimation errors in baseline and operant tone conditions .", "tone events , and those in the corresponding baseline conditions , when the action and tone occur separately in contrast to previous intentional binding studies , a background white noise was played throughout the trials in order to increase the uncertainty about the time of tone onset .", "tone events , and those in the corresponding baseline conditions , when the action and tone occur separately illustration of the modified intentional binding task . subjects attended to a ", "two additional analyses were performed : ( 1 ) correlating the ratios between action binding in low and high uncertainty and the corresponding ratios in tone binding , using spearman s ranked correlation , and ( 2 ) pairwise comparisons of sds in baseline versus operant action and tone conditions for each level of uncertainty .", "these three amplitudes were used to produce three levels of uncertainty with regard to estimating the time of tone onset .", "anovas were followed by two - tailed paired t tests , except for the comparisons of binding across uncertainties , in which the direction was hypothesized according to the cue integration prediction .", "the three levels of uncertainty were pseudorandomly interleaved in the three task conditions in which tones were played ." ], [ "twenty right - handed volunteers ( ten females ) aged 1836 ( mean : 26 , sd : 6 ) took part in the study and were compensated 14.5 for their participation .", "all subjects reported no history of neuropsychiatric disorders and had normal or corrected - to - normal vision ." ], [ "tone events , and those in the corresponding baseline conditions , when the action and tone occur separately in contrast to previous intentional binding studies , a background white noise was played throughout the trials in order to increase the uncertainty about the time of tone onset .", "the three levels of uncertainty were pseudorandomly interleaved in the three task conditions in which tones were played .", "tone events , and those in the corresponding baseline conditions , when the action and tone occur separately illustration of the modified intentional binding task .", "these three amplitudes were used to produce three levels of uncertainty with regard to estimating the time of tone onset .", "binding is measured as the difference between the means of estimation errors for action or ", "binding is measured as the difference between the means of estimation errors for action or ", "each of the four block types consisted of 30 trials and was repeated four times . in total , 120 trials were performed for each condition , 40 trials per level of uncertainty ." ], [ "the mean estimation errors in baseline action and tone conditions were subtracted from their corresponding operant conditions to obtain action and tone binding measures , respectively . to explore the effect of uncertainty on binding , we performed repeated - measures anovas with uncertainty ( high , intermediate and low ) as a within - subject factor on the following datasets : ( 1 ) sds of estimation errors in baseline tone condition ; ( 2 ) action and tone binding values ; and ( 3 ) mean estimation errors in baseline and operant tone conditions .", "the preliminary tone detection performance was fitted with a psychometric ( weibull ) function , using a maximum - likelihood procedure ( wichmann and hill 2001 ) . each subject s amplitude of detection threshold was calculated at 50 % threshold in the psychometric function .", "anovas were followed by two - tailed paired t tests , except for the comparisons of binding across uncertainties , in which the direction was hypothesized according to the cue integration prediction .", "in addition to the threshold amplitude , two more amplitudes were calculated , by multiplying that of the detection threshold by 2 and 5 .", "two additional analyses were performed : ( 1 ) correlating the ratios between action binding in low and high uncertainty and the corresponding ratios in tone binding , using spearman s ranked correlation , and ( 2 ) pairwise comparisons of sds in baseline versus operant action and tone conditions for each level of uncertainty .", "mean estimation errors ( i.e. , the difference between actual and estimated time of event ) were calculated separately for each level of uncertainty for action and tone in the baseline and operant conditions ." ], [ "the mean sd in operant action condition was lower than sd in baseline action condition for low and intermediate uncertainties , although not statistically significant ( t19 = 1.66 , p = 0.3 ; and t19 = 1.67 , p = 0.3 ) . taken together , the results suggest that in contrast to action binding , tone binding is unlikely to be driven by action ", "taken together , these results indicate that the differences observed in tone binding across the three levels of uncertainty were driven by changes in estimation errors in the baseline condition , in which only the tone cue was provided . on the other hand , in action binding these differences could only arise from changes in the operant condition , indicating a contribution of cue integration .", "we next examined the relation between changes in tone binding and changes in action binding across uncertainties .", "we correlated the ratio between action binding in the low and high uncertainty conditions and the corresponding ratio in tone binding .", "if the extent of change in action binding , arising from cue integration , is correlated with the extent of change in tone binding , this would support a common effect of cue integration on tone binding as well .", "therefore , if cue integration contributes to tone binding , sd in the operant condition should be lower than the sd in the corresponding baseline condition ." ], [ "we studied the contribution of action effect cue integration to the perception of action and its sensory outcome in intentional binding . according to the cue integration hypothesis , the compression in the perceived temporal interval between a voluntary action and its sensory consequence results from using both events as temporally informative cues .", ", our results suggest that cue integration between action and effect contributes to the intentional binding effect for actions .", "the cue integration hypothesis also predicted an increase in the shift of the perception of the sensory outcome toward the action with increasing uncertainty ( i.e. , increased tone binding ) .", "our data support the use of intentional binding in the investigation of the mechanisms of volition , but suggest that action and tone binding should be considered separately in future studies .", "our data show that reducing the reliability of the sensory outcome results in a smaller shift in the perceived time of action toward its outcome ( reduced action binding ) ." ] ]

[ [ "the knee , hip and elbow joints are frequently reported to be involved by the condition . however , shoulder and ankle joints are involved extremely rarely .", "the disease is commonly seen in men and between the 3rd and 5th decades of life . although the exact etiology is not known", "synovial chondromatosis is a disease with unknown etiology , originating from synovia and characterized by the presence of metaplastic cartilaginous nodules in the synovial cavities , bursa or tendon sheaths .", "the disease is classified in 3 stages and evaluated according to following criteria : the early stage with intrasynovial differentiation without loose bodies , the transitional stage by intrasynovial cartilaginous nodules with loose bodies and late stage with multiple loose bodies .", ", we presented an arthroscopically managed adult patient with anteriorly localized right ankle chondromatosis and discussed the potential benefits of arthroscopic surgery .", "the hypertrophic synovia and multiple loose bodies are typical arthroscopic findings . in this case report", "the main advantages of the arthroscopic approaches are decreased morbidity , synchronous visualization and treatment feature for intra and extra articular pathologies ." ], [ "a twenty - eight year old male patient was admitted to our hospital with decreased range of motion , swelling and increased pain during movement in the right ankle joint .", "the laboratory tests were within the normal limits and the patient was scheduled for arthroscopic surgery with the diagnosis of anterior impingement syndrome due to right ankle synovial chondromatosis .", "1 ) . magnetic resonance imaging ( mri ) revealed multiple calcified well - circumscribed loose bodies at the same location and synovitis in the ankle joint ( fig .", "the ankle joint was entered via anteromedial and anterolateral arthroscopic portals during spinal anesthesia and tourniquet application .", "no complications were diagnosed in the follow - up period with no recurrence on the plain x - ray images and mri ." ], [ "trauma , degenerating joint diseases , osteochondritis dissecans , rhomatoid arthritis and tuberculosis arthritis are examples of the secondary form .", "although the classical treatment approach for ankle joint chondromatosis is open surgery , arthroscopic surgery is rarely encountered in the literature .", "our case was evaluated in the primary synovial osteochondromatosis group due to the absence of previous trauma or inflammatory pathologies .", "the tenosynovial giant cell tumor , calcifying aponeurotic fibroma , periosteal chondroma , osteocartilaginous loose bodies and soft tissue chondrosarcoma must be kept in mind in the differential diagnosis . the disease is slowly progressive and is considered to be a self - limiting condition . in the early stages of the disease and in asymptomatic patients , treatment can be planned conservatively with frequent follow - up visits .", "mri investigation enabled the diagnosis of the disease in the early stage , the exact localization of the disease and intrinsic property of chondroid tissue ." ], [ "arthroscopic surgery enables wide regional visualization , lowers morbidity , promotes early rehabilitation , shortens the recovery period and decreases the immobilization period ." ], [], [], [ "a copy of the written consent is available for review by the editor - in - chief of this journal upon request .", "written informed consent was obtained from the patient for publication of this case report and accompanying images ." ], [ "nevres hurriyet aydogan , ahmet ozmeric , onur kocadal , murad pepe , talip kara took part in surgical procedure , literature search , preparation of the paper and review .", "serap gozel took part in pathological investigation.key learning pointssynovial chondromatosis is a disease originating from synovia and characterized by the presence of metaplastic cartilaginous nodules.pain , swelling of the joint especially after physical activity and decreased range of motion are main symptoms.treatment is arranged according to the patient 's complaints , age and disease stage.there are many advantages of arthroscopic surgery in selected patients .", "synovial chondromatosis is a disease originating from synovia and characterized by the presence of metaplastic cartilaginous nodules .", "synovial chondromatosis is a disease originating from synovia and characterized by the presence of metaplastic cartilaginous nodules.pain , swelling of the joint especially after physical activity and decreased range of motion are main symptoms.treatment is arranged according to the patient 's complaints , age and disease stage.there are many advantages of arthroscopic surgery in selected patients .", "pain , swelling of the joint especially after physical activity and decreased range of motion are main symptoms ." ] ]

[ [ "the norfolk component of the european prospective investigation into cancer and nutrition ( epic - norfolk ) study recruited 25,639 men and women aged 4079 years at baseline in 19931997 .", "we additionally adjusted for bmi ( continuous ) , waist circumference ( continuous ) , education level ( low , o level , a level , or degree ) , townsend deprivation index ( continuous ) , occupational social class ( manual or nonmanual ) , physical activity level ( inactive , moderately inactive , moderately active , or active ) , smoking status ( current , former , or never ) , family history of diabetes ( yes or no ) , total energy intake ( continuous ) , and season of diary completion ( december , january , february = winter ; march , april , may = spring ; june , july , august = summer ; and september , october , november = autumn ) . in model 3 , in order to estimate the association between quantity of f&v consumption and hazard of diabetes independent of the effect of variety , we additionally adjusted for variety of f&v intake and vice versa for the analysis of variety in intake .", "the recruitment procedures , collection of questionnaire data , and anthropometric and dietary measures have been described in detail elsewhere ( 10,11 ) . in brief , participants residing in norfolk , england , were recruited from age - sex registers of general practices and attended a baseline health check .", "this subcohort was representative of the entire epic - norfolk cohort in terms of age , bmi , education level , physical activity level , smoking status , and total energy intake ( data not shown ) . among the subcohort", "we ascertained incident t2d cases by self - report of doctor - diagnosed diabetes from three follow - up health and lifestyle questionnaires , i.e. , answering ", "the epic - norfolk study was initiated to investigate the relationship between diet and cancer but has since broadened its scope to include a range of chronic diseases , including t2d ." ], [ "the recruitment procedures , collection of questionnaire data , and anthropometric and dietary measures have been described in detail elsewhere ( 10,11 ) . in brief , participants residing in norfolk , england , were recruited from age - sex registers of general practices and attended a baseline health check .", "the norfolk component of the european prospective investigation into cancer and nutrition ( epic - norfolk ) study recruited 25,639 men and women aged 4079 years at baseline in 19931997 .", "the epic - norfolk study was initiated to investigate the relationship between diet and cancer but has since broadened its scope to include a range of chronic diseases , including t2d .", "this subcohort was representative of the entire epic - norfolk cohort in terms of age , bmi , education level , physical activity level , smoking status , and total energy intake ( data not shown ) . among the subcohort", "from the 25,639 participants in epic - norfolk at baseline , we ascertained incident cases of t2d ( n = 892 ) and selected a random subcohort of 4,000 participants .", "follow - up of participants constituted a postal questionnaire at 18 months , a second health check in 19982000 , and a further postal questionnaire in 20022004 .", "of the 4,749 participants , we excluded those with unknown diabetes status ( n = 1 ) or prevalent diabetes at baseline ( n = 121 ) , those with fewer than 7 days of diary data ( n = 435 ) or who did not return a diary ( n = 15 ) , or those with missing information on potential confounding variables ( n = 73 ) ." ], [ "we ascertained incident t2d cases by self - report of doctor - diagnosed diabetes from three follow - up health and lifestyle questionnaires , i.e. , answering yes to has a doctor ever told you that you have diabetes ? or diabetes medication that was self - reported or brought to the second health check .", "in addition , external sources of information through record linkage included listing of any epic - norfolk participant in the general practice diabetes register , local hospital diabetes register , hospital admissions data with screening for any diabetes - related admissions among study participants , and office of national statistics mortality data with coding for diabetes . participants who gave a self - report of history of diabetes that could not be confirmed against any other sources of ascertainment were not considered as a confirmed case of t2d .", "follow - up was censored at the date of diagnosis of t2d , 31 july 2006 , or the date of death , whichever came first ." ], [ "variety of fruit , vegetables , and combined f&v intake was derived by calculating the total number of different items consumed at least once in a 1-week period , irrespective of quantity of intake .", "intake of f&v ( including tinned and dried ) was calculated from food diary data to give average daily quantity of intake for each participant . in order to precisely quantify the actual intake of", "at the baseline medical examination , participants were instructed by trained interviewers on how to complete the 7-day food diary ( 11,12 ) . the food diary consisted of 45 color pages containing food portion photographs and detailed instructions on how to record and describe preparation methods and quantities of foods eaten at main meals , snacks , and between meals .", "the groupings of items included 58 different fruit items ( range 058 ) , 59 different vegetable items ( range 059 ) , and hence a total of 117 different f&v items consumed over a 1-week period , as recorded in the 7-day food diary . at recruitment", "participants self - reported their education level ( low , o level , a level , or degree ) , occupational social class ( manual or nonmanual ) , smoking status ( current , former , or never ) , and baseline history of myocardial infarction , stroke , and cancer ( yes or no ) .", "potatoes were not included as a vegetable because they differ from vegetables regarding energy and carbohydrate content and are frequently used as a substitute for cereals ( 15 ) ." ], [ "multivariable , prentice - weighted cox regression ( 19 ) was used to estimate the associations between quantity and variety of fruit , vegetables , and combined f&v intake and hazard of diabetes , with intake defined as tertiles ( with the lowest tertile as the reference category ) . to check the proportional hazards assumption of the models ,", "additionally , spline regression was used to demonstrate the continuous association between quantity and variety of combined f&v intake and the hr ( 95% ci ) of diabetes with knots placed at quartiles of the distribution ( 20 ) .", "interactions between quantity and variety of fruit , vegetables , and combined f&v intake and current age ( i.e. , the underlying timescale ) were tested .", "the association between f&v quantity and variety and the hazard of diabetes was also investigated by including other potentially confounding variables in model 3 , including hypertension ( yes or no ) , dairy intake ( continuous ) , total fiber intake ( continuous ) , red and processed meat intake ( continuous ) , and percentage energy from carbohydrate ( continuous ) , protein ( continuous ) , fat ( continuous ) , and alcohol intake ( continuous ) .", "multiplicative interaction terms were added to model 3 for quantity and variety of combined f&v intake to examine effect modification by sex , age ( < 60 or 60 years ) , bmi ( normal weight < 25 kg / m , overweight / obese 25 kg / m ) , and smoking status ( never smoker or ever smoker ) by using the wald test .", "baseline characteristics were summarized by tertiles of combined f&v quantity and variety among the subcohort participants , using means with sds , medians with interquartile ranges ( iqrs ) , or frequencies ( where appropriate ) ." ], [ "we found no evidence of interaction between either quantity or variety in f&v intake with sex , age , bmi , or smoking status and incident diabetes ( p > 0.10 ) .", "a : the association between quantity of f&v intake and hr ( 95% ci ) of diabetes adjusted for sex , bmi , waist circumference , education level , townsend deprivation index , occupational social class , physical activity level , smoking status , family history of diabetes , total energy intake , and season .", "c : the association between variety of f&v intake and hr ( 95% ci ) of diabetes adjusted for sex , bmi , waist circumference , education level , townsend deprivation index , occupational social class , physical activity level , smoking status , family history of diabetes , total energy intake , and season .", "participants who consumed higher quantities and a greater variety of combined f&v had more favorable lifestyle , anthropometric , and dietary profiles .", "results were unaffected in sensitivity analyses after excluding participants who 1 ) developed t2d within the first 2 years of follow - up , 2 ) had a baseline hba1c level of 6.5% in the subsample with hba1c data , and 3 ) were in the top and bottom 1% of energy intake to energy expenditure ( data not shown ) ." ], [ "in this prospective study of nearly 4,000 men and women with dietary information from prospective 7-day food diaries , we observed that a greater quantity of vegetable intake and a greater variety of fruit , vegetables , and combined f&v intake may independently be beneficial for reducing the risk of t2d .", "after accounting for potential confounding factors and the effects of quantity of intake , each different additional two item per week increase in variety of f&v intake was associated with an 8% reduction in the incidence of t2d .", "these findings support current public health recommendations encouraging consumption of f&v as part of a balanced diet and place particular emphasis on the important and independent role that both quantity and variety in f&v intake may play in helping to prevent the development of t2d ." ] ]

[ [ "we report a case of dramatic outcome of an observation of severe hemolytic anaemia in a newborn due to rh1 incompatibility , which led to death .", "the immunoprophylaxis by anti - rh1 immunoglobulins has been established since the 1970s , but this disease remains the leading cause of fetal anemia .", "the severe forms of hemolytic disease are observed in 10% of fetuses or newborn affected by this disease .", "it exposes to fetal complications such as hydrops , hypoxic brain damage and fetal death .", "the rh1 alloimmunization responsible for the hemolytic disease of the newborn occurs when the rh1-negative mother s blood comes into contact with the foetus s rh1 positive red blood cells . after the passing of foetal red blood cells into the maternal circulation , the rh1 antigens on foetal red blood cells , which are foreign antigens to the maternal immune system , trigger the immunological processes producing anti - rh1 allo - antibodies of the immunoglobulin class igg .", "these antibodies cross the placenta , attack foetal red blood cells and lead to a foetal hemolytic anemia ." ], [ "a male newborn presenting the antecedents of consanguinity was admitted 30 minutes of life to the pediatric department of mohammed v military teaching hospital for the issue of hydrops fetalis on rhesus incompatibility ; the birth weight was 1800 g and his blood group was a rh1 .", "after birth , the baby was intubated and placed on mechanical ventilation due to respiratory distress and hypoxia .", "the evolution was unfavorable with a steady increase of total serum bilirubin level ( 71 mg / l ) , hemoglobin ( 9.4 g / dl ) , reticulocytes ( 187203/l ) and circulating erythroblasts ( 1386 erythroblasts per 100 leukocytes ) and a decrease in platelet count ( 72 000/l ) on the second day ( table i ) and died three days after the death of his mother , who died from pulmonary embolism in the intensive care unit .", "after drainage of the ascites fluid , the newborn was transfused with red blood cell concentrates and was also treated with conventional phototherapy ." ], [ "our patient died four days after his birth with hemolysis , kidney failure , jaundice and hypoxia .", "the feto - maternal blood incompatibility constitutes the major cause of autoimmune hemolytic anaemia among newborns and must be evoked first before a neonatal anemia with early onset jaundice .", "our case report shows that there is rh1 incompatibility between the ab rh1-negative mother and the a rh1 newborn .", "the best treatment is to prevent causal anti - d immunization with intravenous ( iv ) anti - rh1 immunoglobulin in rh1 negative pregnant women to neutralize the foetal red blood cells in the maternal vascular compartment ." ], [ "hemolytic disease of the newborn related to rh1 incompatibility is rare but serious . in order to avoid this drama ,", "it is necessary to strengthen the prevention and clinico - biological monitoring in patients with a history of feto - maternal rhesus alloimmunization by sensitizing and advising all rh1 negative unimmunized women that rh1 prophylaxis should be applied after all birthing of rh1 child and must also always be carried out after any miscarriage ." ] ]

[ [ "since 1995 , researchers have been working toward the use of stereotactic surgery in the treatment of ts . in 1999 , bilateral subthalamic deep brain stimulation ( dbs ) was first applied in the treatment of ts with substantial efficacy .", "while ts symptoms are often controlled effectively via behavioral and drug therapies , conventional therapy does not work for a small number of patients .", "tourette syndrome ( ts ) is a childhood neuropsychiatric disorder characterized by motor and phonic tics .", "subsequently , researchers have attempted the use of dbs for the treatment of ts with various targets .", "we performed globus pallidus internus ( gpi ) dbs on 25 patients with drug - resistant ts and conducted follow - up assessments of 24 of the patients for over 1 year .", "ts is often complicated by behavioral disorders such as attention - deficit hyperactivity disorder ( adhd ) , obsessive - compulsive disorder ( ocd ) , and anxiety and emotional disorders ." ], [ "baseline clinical characteristics and dbs complications of the 24 patients with tourette syndrome one patient experienced a mild sexual dysfunction , subcutaneous fluid accumulation , and infection in the ipg site .", "twenty - five patients with refractory ts were admitted to our hospital for treatment between september 2007 and august 2014 . following the electrode placement surgery ,", "we conducted bilateral gpi stimulation in twenty patients and unilateral gpi stimulation in four other patients who could not afford bilateral stimulation device or whose symptoms affected only one side .", "dbs : deep brain stimulation ; dci : diagnostic confidence index ; ygtss : yale global tic severity scale ; adhd : attention deficit hyperactivity disorders ; ed : emotional disorder ; ocd : obsessive - compulsive disorder ; sib : selfinjury behavior ; ipg : implantable pulse generator .", "the symptoms of ocd were assessed using the yale - brown obsessive - compulsive scale ( y - bocs ) .", "the severity scores for motor tics , phonic tics , overall damage , and global tics were assessed based on the yale global tic severity scale ( ygtss ) ." ], [ "baseline clinical characteristics and dbs complications of the 24 patients with tourette syndrome one patient experienced a mild sexual dysfunction , subcutaneous fluid accumulation , and infection in the ipg site .", "dbs : deep brain stimulation ; dci : diagnostic confidence index ; ygtss : yale global tic severity scale ; adhd : attention deficit hyperactivity disorders ; ed : emotional disorder ; ocd : obsessive - compulsive disorder ; sib : selfinjury behavior ; ipg : implantable pulse generator .", "twenty - five patients with refractory ts were admitted to our hospital for treatment between september 2007 and august 2014 . following the electrode placement surgery ,", "diplopia , flashing , fatigue , dizziness , and limb convulsions were observed as transient complications and disappeared following adjustment the stimulation parameters and electrode settings .", "the observation that dbs produced no remarkable improvement in ts symptoms , the patient requested that the stimulator to be switched off . as this patient refused to undergo a procedure to adjust the electrode position , we excluded him from our research sample .", "thus , the study population included 24 patients : 22 male and two female individuals aged 1841 years ( mean age : 25.3 6.4 years ) with an average medical history of ts of 14.7 years ( 821 years ) ." ], [ "the surgical inclusion criteria were as follows : ( 1 ) ts diagnosis according to diagnostic and statistical manual of mental disorders , 4 edition , text revision criteria and the dci , ( 2 ) chronic and severe tic disorder with severe functional impairment , ( 3 ) the patient had not responded to adequate doses of three classes of drugs administered for at least 12 weeks each or could not tolerate medications because of side effects , and ( 4 ) the patient was over 18 years of age .", "our exclusion criteria barred patients whose tic disorder was attributable to another medical , psychiatric , or neurological disease , those with severe cardiovascular , pulmonary , or hematological disorders , and those with cerebral structural abnormalities from participation ." ], [ "we conducted bilateral gpi stimulation in twenty patients and unilateral gpi stimulation in four other patients who could not afford bilateral stimulation device or whose symptoms affected only one side .", "we first performed magnetic resonance scanning ( 1.5 tesla , siemens , germany ) and identified the three - dimensional coordinates of the posterior ventral globus pallidus according to the schaltenbrand ", "the stimulation parameters included a pulse width of 90120 s , frequency of 65185 hz , and amplitude of 2.53.7 v. the stimulation parameters were individually adjusted according to the extent of symptomatic improvement and degree of side effects with the goal of obtaining an optimal treatment with minimal side effects .", "after drilling a hole in the skull , we ensured that the dura mater had been coagulated before opening it via a cruciate incision . using a high - impedance microelectrode with a tip diameter of 12 m , we recorded extracellular discharges 10 mm above the target and confirmed the tissue characteristics .", "we then incised the retroauricular and subclavian regions and implanted the connecting wire and implantable pulse generator ( ipg , kinetra 7428 or soletra 7426 ) .", ", we created a 2.5 cm long incision in the scalp , starting 2.5 cm from the coronal suture and running parallel to the midline .", "patients continued the use of any medications they had been treated with before the surgery ." ], [ "the assessments were performed 1 week before the surgery and 3 , 6 , and 12 months after the surgery .", "the severity scores for motor tics , phonic tics , overall damage , and global tics were assessed based on the yale global tic severity scale ( ygtss ) .", ". the postoperative improvement rate of symptoms was calculated as follows : improvement rate = ( preoperative ygtss score postoperative ygtss score)/preoperative ygtss score 100% .", "the follow - up data were compiled by an assessment group that was independent from the surgical group .", "surgical safety was evaluated by means of the wechsler adult intelligence scale - revised in china ( wais - rc )", "the symptoms of ocd were assessed using the yale - brown obsessive - compulsive scale ( y - bocs ) ." ], [ " keuls test for post hoc comparisons after assessing the normality of data distribution . a criterion of p < 0.05 was used for statistical significance .", "statistical differences were assessed through a one - way analysis of variance ( anova ) using the student newman" ], [ "y - bocs : yale - brown obsessive - compulsive scale ; gpi : globus pallidus internus ; dbs : deep brain stimulation ; ts : tourette syndrome .", "among 24 cases , 18 patients experienced a lesion - like effect after the dbs surgery and exhibited varying symptomatic improvement ranging from 10% to 80% ( self - assessment ) .", ", all patients had significantly improved symptoms and 56% of patients had a significant decrease in ygtss scores compared with the baseline ( p < 0.01 ) . at the 12-month follow - up", "particularly , the mean score of global impairment was reduced to 14.2 points , which suggested that the social function of the patients was significantly improved . at the 12-month follow - up assessment", "we found a statistical difference between baseline score and scores at 3 , 6 , and 12 months . at the 12-month follow - up ," ], [ "among 24 cases , 18 patients experienced a lesion - like effect after the dbs surgery and exhibited varying symptomatic improvement ranging from 10% to 80% ( self - assessment ) .", "this might be because the patients felt that their active control over tics had greatly increased after operations , such that the associated symptoms , such as emotional disorders and ocd , decreased as well .", "the improvement reflected by the self - assessment was higher than that of the ygtss score ." ], [ "the y - bocs reflected a decrease in obsessive - compulsive tendencies at the 3 and 6-month follow - up assessments .", "we found a statistical difference between baseline score and scores at 3 , 6 , and 12 months . at the 12-month follow - up ,", "y - bocs scores had stabilized such that they were similar to those at 6 months , with an average improvement of 38.59% compared with baseline [ figure 1 ] .", "y - bocs scores before and after gpi - dbs in ts patients . compared with baseline values ,", "y - bocs : yale - brown obsessive - compulsive scale ; gpi : globus pallidus internus ; dbs : deep brain stimulation ; ts : tourette syndrome .", "y - bocs scores were statistically lower at 3 , 6 , and 12-month follow - up assessments . * p < 0.01 versus baseline ." ], [ "the mean preoperative scores from the wais - rc were as follows : the verbal intelligence quotient ( viq ) was 98.04 7.87 , the performance - iq ( piq ) was 99.21 7.26 , and the full - iq ( fiq ) was 98.30 6.74 . at the 12-month follow - up assessment , the mean viq , piq , and fiq scores were 100.08 7.71 , 99.29 7.32 , and 99.88 7.21 , respectively . there were no significant changes before versus after the surgery in any of the patients [ figure 2 ] .", "another patient also experienced postoperative subcutaneous fluid accumulation in the ipg pocket , which , although improved by puncture and aspiration at 12 months , finally resulted in infection 22 months postoperation and subsequent removal of the implanted device .", "one patient reported mild sexual dysfunction 3 months after the dbs had been switched on , and his dbs device was removed because of infection in the ipg site happening at 23 months after the operation .", "a similar incident occurred in a third patient 26 months after the surgery whose tics began to mildly deteriorate following the removal of his ipg and electrode .", "we found no significant difference between viq , piq , and fiq scores at baseline , 3 , 6 , and 12-month assessments .", "dbs - on ( immediately after the stimulator had been turned on ) , temporary complications included diplopia , flashing , fatigue , dizziness , and limb convulsions . by adjusting the stimulation parameters and electrode settings , we found that these transient complications could be eliminated ." ], [ "overall , our data indicate that bilateral gpi - dbs can be used to effectively regulate abnormal nerve impulses in the basal ganglia - related loop , thereby ameliorating tics and various accompanying symptoms in patients with ts , and improve patients quality of life with no significant changes in their intelligence or personality .", "the improvement in ocd symptoms that we found is similar to the outcome reported for the use of ventral capsule / ventral striatum as dbs targets for treatment of ocd .", ", we treated 24 ts patients with gpi - dbs and conducted follow - up assessments for over 12 months . before the surgery", ", we found that the motor and phonic tics had significantly improved in all 24 patients . specifically , gpi - dbs was effective for rapid and transient motor tics ( clonic tics ) , phonic tics , and slow and sustained movements ( dystonic tics ) . the impulse to move ( sensory tics or premonitory urge ) was also significantly alleviated by the surgery in this patient group .", "therefore , the application of dbs to the treatment of ts seems appropriate and efficacious .", "the application of dbs in the treatment of refractory ts has gained increasing attention in the academic community .", "described the first use of dbs for the treatment of ts . according to the literature ," ], [ "first , this study as an open research project lacks randomized , double - blind , safety / efficacy study design and thus can not exclude the possibility of placebo effect .", "second , the follow - up study lasted for only 1 year , and longer - term effect was not available .", "in addition , this study is limited by the lack of a comparison target of stimulation , and it is insufficient to conclude that gpi serves as the optimal stimulation target .", "postoperative neuroimaging study would be helpful in future research to further delineate the relationship between actual stimulation area and treatment effect ." ], [ "this project was supported by a grant from national natural science foundation of china ( no ." ], [] ]

[ [ "the purpose of this paper is to highlight the importance of exercise in patients with ra and to demonstrate the multitude of beneficial effects that a properly designed exercise intervention has in this population . in order to present this aim", "\n\t\t\t\t rheumatoid arthritis ( ra ) is a chronic , systemic , autoimmune disease , and the most common form of chronic joint inflammation , affecting 0.51% of the uk population .", "secondly , the benefits of exercise in ra are highlighted , focusing on the areas of cardiovascular disease , musculoskeletal and joint health , and overall function .", "in addition to the articular features of the disease , ra is associated with increased morbidity and mortality from cardiovascular disease ( cvd ) [ 7 , 8 ] .", "although outcomes of the disease have improved with modern approaches to drug treatment , using agents such as methotrexate and biologics , the disease is still a progressive one with long - term joint damage and disability the expectation rather than the rule . ", "overview of the benefits of exercise in the general population : older adultsit is widely acknowledged that regular exercise / physical activity provides multiple health benefits for the general population and patients with chronic diseases ." ], [ "( i ) exercise can reduce pain , morning stiffness , and even reduce fatigue in ra ; ( ii ) exercise can improve functional ability and psychological well - being ; ( iii ) exercise has not been shown to exacerbate disease activity .", "summary : it is important to note the following(i ) exercise can reduce pain , morning stiffness , and even reduce fatigue in ra ; ( ii ) exercise can improve functional ability and psychological well - being ; ( iii ) exercise has not been shown to exacerbate disease activity . \n ", "furthermore , when comparing the effectiveness of high and low intensity exercise training in stable ra , it is found that the former was more effective in increasing aerobic capacity , muscle strength , joint mobility , and physical function with no detrimental effect on disease activity in patients with controlled [ 5 , 36 ] and active ra . a goal for any ra treatment regime should be to reduce cardiovascular comorbidity , in line with the overall aim of prolonging and improving quality of life .", "a systematic review which explored the effectiveness of nonpharmacological interventions for fatigue also concluded that both aerobic and resistance exercise interventions reduce ra fatigue . \n", "clearly , future studies are required to specifically investigate the effect of exercise training and cardiorespiratory fitness on cvd risk in ra . \n", "summary of rheumatoid cachexia and musculoskeletal health and exercise types for treatment(i ) at least 50% ra patients suffer loss of lean mass ; ( ii ) intensive progressive resistance training can increase lean mass , reduce fat mass , increase strength and improve function ; ( iii ) prt is the most effective exercise to improve skeletal muscle size and strength ; ( iv ) prt , even performed at high intensity , is safe in ra . \n " ], [ "therefore , it is important for those involved in the care of ra patients to be aware of factors that may positively and negatively affect the uptake of and compliance to an exercise prescription", "the obstacles to action study ( new zealand ) investigated factors influencing exercise participation for individuals with self - reported arthritis who were defined as ", "thus , understanding the perceptions of ra patients regarding exercise is salient to the role of the health professional .", "their qualitative analysis of focus group discussions revealed that active people with arthritis believed more strongly in the benefits of physical activity , reported significantly higher levels of encouragement from others , and had greater overall levels of self - efficacy when compared with the less active participants .", ". the perceptions of people with ra may provide reasoning for the lower physical activity levels of ra patients when compared to the general population .", "( i ) impart better advice regarding the effects and benefits of exercise ; ( ii ) clarify specific exercise recommendations ; ( iii ) consider methods of overcoming individual barriers to exercise ." ], [ "however , whilst the exercise benefits for ra patients are widely recognized , further studies are required to investigate the most effective exercise prescription ( intensity , frequency , duration , and mode ) , the optimum modes of exercise delivery , and how adherence to training can be facilitated .", "these examples have assisted in recommendations for strength training being developed , a summary of which is presented in table 1 . the optimum exercise program for ra patients would include both aerobic and resistance training . with poor cardiovascular health being the main cause of death in ra and with ra patients tending to have poor cardiorespiratory fitness", "thus , as with healthy individuals , the beneficial effects of exercise ( prt , aerobic , mobility ) are lost if training is discontinued .", "typically exercise interventions have focused on effects of aerobic training , strength training and a combination of aerobic training and strength training . ", ", the requirement of aerobic exercise as part of treatment is crucial . whilst the addition of strengthening exercises helps to mitigate rheumatoid cachexia and other musculoskeletal and joint health issues , and induces substantial improvements in physical function and the ability to perform adls .", "the aerobic activities most often included in exercise interventions are walking , running , cycling , exercise in water , and aerobic dance .", "several studies have demonstrated the beneficial effects for ra patients of performing muscle strengthening exercises , in particular prt ." ], [ "thus all ra patients should be encouraged to include some form of aerobic and resistance exercise training as part of their routine care . more research is still required on the optimal dose and types of exercises , especially when combining types , as well as how best to incorporate exercise into the lives of ra patients across the variable course of the disease .", "exercise in general seems to improve overall function in ra without any proven detrimental effects to disease activity .", "the importance for the inclusion of exercise training in the treatment of ra is now clear and proven ." ] ]

[ [ "successful shunt facilitates abdominal surgery and avoids varices bleeding that could represent a risk for the transplanted organ . for the rare patients with repeated acute or chronic cholangitis , who develop cirrhosis , or for those with pulmonary complications , liver transplantation is a potential therapeutic option .", "portal obstruction is the single most common etiology of portal hypertension in children , representing roughly 50% of all cases in the majority of series .", "decision about when ( and if ) to combine it with kidney transplantation should be considered on a case - by - case evaluation .", "portal obstruction in children is usually detected early in the first decade , because of splenomegaly , gastrointestinal bleeding , or both .", "development of esophageal varices is almost universal , and the actuarial risk of bleeding reaches 76% at 24 years of age .", "given the relatively benign liver disease , management recommendations for children with chf - related portal hypertension are based on endoscopic eradication of varices ." ], [ "results of combined liver - lung transplantation are currently not encouraging ; hence waiting for advanced lung disease before deciding to go for liver transplantation does not seem to be advisable .", "this disease affects 1 in 15000 to 1 in 20000 newborns and constitutes the main indication for liver transplantation in children .", "however , concern remains over the long - term endoscopic treatment due to the need for multiple anesthetics procedures , and the possible development of pulmonary complications from portal hypertension itself . in patients with", "current treatment strategy includes the kasai portoenterostomy operation , followed by liver transplantation in cases of its failure or later complications from cirrhosis .", "endoscopic treatment should be offered to all , being especially useful in the context of acute hemorrhage .", "patients with advanced liver disease , or severe and refractory bleeding , with good pulmonary function are probably best managed with liver transplantation [ 24 , 26 , 28 ] .", "approximately 5% of cystic fibrosis patients develop liver cirrhosis before adolescence . like other cholestatic type of cirrhosis" ], [ "this presinusoidal type of portal hypertension is produced by intimal thickening of small intrahepatic portal vein radicles .", "budd - chiari syndrome encompasses a series of different causes producing obstruction to the hepatic venous outflow .", "it is the most common indication for liver transplantation from metabolic diseases in the western hemisphere .", "chronic hepatitis associated to hbv or hcv infection can rarely present in the first two decades of life with a picture of portal hypertension secondary to cirrhosis ." ], [ "regarding the second goal , the absence of controlled randomized trials in primary prophylaxis of esophageal varices bleeding in children makes any recommendation problematic and debatable .", "recent data coming from pediatric series , albeit small in number of patients , have reproduced the rates of success obtained in adult patients , making tips a good option even in small children and expanding indications to postransplant portal hypertension , and children with portal vein obstruction with a favorable anatomy .", "avoiding the morbidity and mortality associated with the first bleed from esophageal varices is the rationale behind primary prophylaxis .", "a group of expert analyzed possibilities on primary prophylaxis of variceal hemorrhage in children , concluding that future research should focus on the natural history , diagnosis of varices , prediction of variceal bleeding , and explore therapeutic efficacy of different protocols . ", "future studies will clarify the role of this therapy in the management of pediatric portal hypertension ." ], [ "treatment of hemorrhagic complications from portal hypertension in children has its own specificities because of the different etiologies involved , and the natural history of these disorders compared to adults ( table 1 ) .", ", considerable progress has been achieved in the last years , mainly derived from better control of bleeding from esophageal varices .", "longer followup , however , uncovers new complications for which endoscopic treatment is inappropriate , promoting a renewed interest on surgical approaches . as a general principle , management of portal hypertension in children rests on two main characteristics : the etiology of the portal hypertension and the age of the patient ." ] ]

[ [ "catheter - based radiofrequency ablation ( rfa ) delivered during endoscopic retrograde cholangiopancreatography ( ercp ) has recently emerged as a possible therapeutic option within the bile duct 1 \n 2 \n 3 \n 4 .", "herein we present 4 cases assessing the technical feasibility , safety , and treatment outcomes of rfa employed at the time of ercp to treat ampullary lesions with intraductal extension .", "intrabiliary extension of neoplasm remains an important challenge in the endoscopic eradication of complex ampullary lesions 5 \n 6 , and rfa may represent a viable treatment adjunct for this problem .", "recently , the use of rfa at the ampulla and within the distal bile duct has been described 7 \n 8 ." ], [ "3 patients had visual and histologic evidence of complete eradication ; the patient with a focus of adenocarcinoma who declined surgery developed overt invasive ampullary cancer . \n", "we excluded patients who underwent rfa of a stricture not associated with an ampullary lesion .", "fap , familial adenomatous polyposis ; lgd , low - grade dysplasia ; hgd , high - grade dysplasia ; imc , intramucosal cancer ; apc , argon plasma coagulation ; rfa , radiofrequency ablation ; pep , post - endoscopic retrograde cholangiopancreatography pancreatitis ; eus , endoscopic ultrasound \n video 1 presents a synopsis of 2 representative cases .", "three patients ( 75 % ) had a history of familial adenomatous polyposis ( fap ) .", "clinical success was defined as endoscopic absence of polypoid or adenomatous - appearing tissue at the treatment site and histologic absence of neoplasm based on extensive follow - up biopsies from the papilla , pancreaticobiliary septum , biliary orifice , and distal bile duct ." ], [ "based on its ease of use and the ability to precisely position the probe within the distal duct , radiofrequency ablation may represent the first viable treatment adjunct for this challenging scenario .", "however , broad adenomatous involvement of the distal bile is associated with limited treatment success ( < 50 % ) and has been considered an indication for surgical resection 5 .", "although endoscopic ampullectomy is the preferred treatment for noninvasive ampullary lesions with a success rate reported as high as 92 % 10 , biliary extension of neoplasm represents a significant obstacle to endoscopic eradication .", "exposure and eversion of the adenoma through a biliary sphincterotomy to allow resection or ablation has been described in amenable cases 5 \n 11 \n 12 .", "first , while rfa has been associated with a favorable safety profile when applied to malignant biliary strictures 1 \n 2 \n 3 \n 4 , it remains unclear whether rfa in the intra - pancreatic portion of the bile duct without the protective buffer of a surrounding tumor especially in the vicinity of the pancreatic orifice will be associated with an increased risk of pancreatitis . until additional data on the risk of post - ercp pancreatitis in this context" ] ]

[ [ "rtis in many cases are asymptomatic among women , making their detection and diagnosis difficult.(3 ) an effort has been made in this regard to detect rti cases among the women in the field practice area of urban health training centre ( uhtc ) , hubli , karnataka .", "reproductive tract infections ( rtis ) , including both sexually transmitted infections ( stis ) and non - sexually transmitted infections ( non - stis ) of the reproductive tract are responsible for major ill - health throughout the world.(1 ) world health organization estimates that each year there are over 340 million new cases of sexually transmitted infections in which 7585% occur in developing countries . in india", "alone , 40 million new cases emerge each year.(2 ) a majority of women continue to suffer from rtis leading to complications like pelvic inflammatory disease ( pid ) , infertility , cervical cancer , postabortal , and puerperal sepsis , chronic pelvic pain , and ectopic pregnancy ." ], [ "the objective of the study was to know the prevalence of rtis among the reproductive age group women and the socio - demographic factors influencing the occurrence of the disease .", "this study was undertaken in the field practice area of uhtc , hubli , and reproductive age group women of 1545 years were identified for the study purpose .", "a pretested structured pro forma was used to interview the women about their socio - demographic , reproductive history , current , and past rti symptoms .", "it is a cross - sectional time bound study , conducted from september 2003 to august 2004 .", "houses were selected on the basis of a simple random sampling technique until 656 women of the reproductive age group were covered in 520 families .", "the sample size 656 was calculated by taking into consideration 19% of women under 1545 years in urban community , at 95% confidence interval and 3% permissible error covering 1.96 under normal curve .", "all 656 women were given referral slips and encouraged after counseling to attend for clinical examination and laboratory tests in uhtc ." ], [ "statistical tests like proportions , z - test , and chi - square test were used .", "data were tabulated on microsoft excel sheets and analyzed using software epi info version 6 ." ], [ "it was found that the prevalence of rti among pregnant women was 51% ( p<0.05 ) [ table 4 ] .", "sd ( 7.61 years ) . socio - demographic profile of the women in the reproductive age group of 15 - 45 years with rti signs it was found that the number of women 50% among muslims had rti compared to other religion ( p<0.001 ) [ table 4 ] .", "the present study revealed that 265 women were found to be suffering from rti based on their symptoms , giving a prevalence of 40.4% [ table 1 ] ." ], [ "from this study , the prevalence of rti was 34.3% based on the laboratory findings against 40.4% based on only the symptoms .", "this study will serve as a reference for researchers interested in the field of rti / sti epidemiology , who may in future take up similar studies to compare and highlight the performance of reproductive and child health programme ( rch ) over the years in combating this disease .", "was found in the reproductive age group women of 2029 years , which differs from the study of rathore et al .", "where a majority of women , 53.4% , complained of abnormal vaginal discharge.(5 ) our study showed that a majority of women , 242 ( 36.9% ) , had vaginitis on examination followed by pid in 205 women ( 31.25% ) which is in accordance with the observation of garg et al . and singh et al . where a majority of women on clinical examination had vaginitis of 94.6% and 52.1% , respectively.(67 ) this study is in accordance with the observations made by parikh et al . and ranchan et al . , where the prevalence of rti on laboratory findings was 17% and 26.3% , respectively , with majority of women having candidiasis.(89 )" ] ]

[ [ "we hereby report a case where the patient first presented with a scrotal abscess and vesicocutaneous fistula after surgical repair of sliding hernia .", "the incidence of bladder forming a part of an inguinal hernia is 14% . with correct knowledge of anatomy and careful dissection , injuries to the bladder during hernia repair" ], [ "a 65-year - old morbidly obese man underwent mesh hernioplasty for large right inguinal hernia . after removing the urethral catheter , he developed gradually increasing right scrotal swelling with fever .", "our main concerns were inguinal hernia repair and creation of extraperitoneal space to reposition the bladder in the normal position , which was not possible without performing right high inguinal orchiectomy .", "hence , we performed right high inguinal orchiectomy and removal of mesh and extraperitoneal space was made to reposition the urinary bladder to its normal position .", "scars of previous surgery with vesicocutaneous fistula and cystogram showing contrast in the left hemiscrotum the entire urinary bladder lying in the scrotum , with the bladder re - positioned into the normal position" ], [ "high inguinal orchiectomy was performed to create space for the bladder and for proper closure of the inguinal canal .", "levine coined the term scrotal cystocoele in 1951 for inguinoscrotal herniation of the bladder .", "urinary bladder herniations are usually diagnosed at the time of inguinal herniorraphy and are commonly repaired through the same incision .", "the diagnostic triad of lateral displacement of the distal one - third of the ureter , small asymmetric bladder and incomplete visualization of the bladder base on an intravenous urogram has been described by reardon and lowman .", "they are sometimes found incidentally during the evaluation of a patient with lower urinary tract symptoms and associated inguinal hernias ." ], [ "urinary bladder rarely forms a part of an inguinal hernia and , with the correct knowledge of anatomy and careful dissection injuries to the bladder during hernia repair , surgery can be prevented .", "surgically creation of an extraperitoneal space for bladder repositioning is of paramount importance , sometimes needing inguinal orchiectomy in the elderly ." ] ]

[ [ "the purpose of this study was to describe the clinical characteristics and diagnosis of mucoid degeneration of the acl and to assess the outcomes of arthroscopic treatment in a series of 20 patients .", "unlike tears and ganglion cysts of the anterior cruciate ligament ( acl ) , mucoid degeneration is a less - understood entity .", "the injury or loss of functional synovial lining protecting the acl is the primary lesion causing mucoid degeneration of acl though there was no significant preceding trauma that patients can relate to current symptoms.1 but the symptomatology , mri findings , and arthroscopy appearance are consistent.2 the excision of the degenerated acl has been the treatment of the choice , the authors believe that if the taut and hypertrophied acl were to be debulked and notchplasty done , full extension could be achieved without having to excise the entire acl ." ], [ "the mean age was 42.2 years ( range 28 - 52 years ) in males and 39.4 years ( range 30 - 54 years ) in females .", "thus , the remaining acl consisted of some intact anteromedial or posterolateral portion of the acl interspersed with degenerate acl tissue .", "arthroscopic examination of a left knee , showing impingement ( arrow ) of hypertrophied posterolateral portion of acl to lateral wall and roof of intercondylar notch during extension the aim of surgery was to remove as much of the degenerative mass as possible without having to sacrifice the entire acl .", "the materials were stained with h and e and then with mucoid tissue - specific alcian blue [ figure 4 ] . in knees without notch narrowing , debridement of the hypertrophied acl was performed first beginning with the removal of small osteocartilaginous fragments from the upper portion of the lateral wall and roof by use of a 6.4-mm curved osteotome .", "the chondral lesion of each patient was described according to the outerbridge classification.7 the locations of the lesions on the articular surfaces of the patella , trochlea , medial femoral condyle , lateral femoral condyle , medial tibial plateau , and lateral tibial plateau were recorded ." ], [ "a soft endpoint on anterior translation would imply no intact acl tissue in the intercondylar area . the histopathologic appearance and reports of the biopsy specimens were consistent with mucoid degeneration of the acl .", "regression of the size and bulkiness of the treated acl was seen , with the t2-weighted images showing decreased signal with some intact acl fibers between the tibia and femur .", "arthroscopic treatment consisted of debridement of the afflicted portion of the acl in all cases . in six knees with evident notch narrowing", "although in one patient after debridement , the remaining portion of the acl was not enough to stabilize the knee , so we had to reconstruct the acl with hamstring graft which is comparable with the study by lintz et al.(7%).1 at an average followup time of 24 months ( range 12 - 36 months ) , all except two patients had a full range of painless motion ." ], [ "the mucoid hypertrophy of the acl is a rare condition found in middle - aged individuals .", "mucoid degeneration of anterior cruciate ligament is not an uncommon pathology , but is often unknown . according to bergin", "our findings were incidental in initial 4 cases where clinical and radiological findings were not correlated as radiologist reported partial rupture of acl only . in practice and in the literature , it is often confused with a diagnosis of partial acl rupture . it becomes apparent in two subpopulations of patients ." ], [ "mucoid hypertrophy of the acl should be clinically suspected in elderly person presenting with persistent knee pain on terminal extension without preceding trauma , especially when associated with extension deficit , which is more common in elderly individual with degenerated knee .", "arthroscopic debridement of mucoid hypertrophy of the acl in conjunction with notchplasty can effectively provide symptomatic improvement without instability ." ] ]

[ [ ", we used the vn to determine the efficacy of this model in the detection of pca in our local population .", "thus , the use of the vn should result in higher pca detection rates , especially in younger patients and those with larger prostates , and , at the same time , should avoid the detection of insignificant cancers , especially in older patients .", "pca volumes to be detected can be larger in older patients , and thus fewer cores are needed , which reduces over - diagnosis of tumors ( insignificant pca ) at biopsy . on the basis of the above information and using data from the european prostate cancer detection study , the use of the vienna nomogram ( vn ) prostate biopsy model was developed .", "is considered a major potential drawback of prostate - specific antigen ( psa ) screening , especially in older patients .", "several extended biopsy techniques have been introduced to improve the pca detection rate compared with that of systematic sextant biopsy .", "the current concept regarding prostate biopsy is that systematic sextant biopsies , even when directed laterally , do not provide adequate prostate sampling ." ], [ "all other findings ( high - grade prostatic intraepithelial neoplasia , atypia , and dysplasia ) were considered negative . in this study ,", "the study population consisted of consecutive referrals for evaluation of elevated psa scores ( > 4 ng / ml ) and/or abnormal digital rectal examination ( dre ) findings .", "trus - guided biopsy performed according to the vn protocol was restricted to the first biopsy .", "patients were excluded from the study if they had a history of pca , acute or chronic prostatitis , histologic evidence of prostatic intraepithelial neoplasia of any grade , urinary retention , indwelling urinary catheter , or confirmed urinary tract infection . before the procedure ,", "biopsy tissue was considered positive if adenocarcinoma was diagnosed , and the number of positive cores , the gleason score , and the grade were reported .", "further management was dependent on individual urologists , and complication rates were subsequently updated by chart reviews ." ], [ "the mean psa score was 13.42 ng / ml , and the mean number of cores obtained was 9.683.1 . according to the vn , 27 out of a total of 120 patients had pca , for a detection rate of 22.5% . in the group of patients with psa scores", "two of these cases were diagnosed on repeat trus biopsy , and two were discovered on transurethral prostatectomy , for a false - negative rate of 3.3% .", "the group of patients with psa scores > 10 ng / ml had a detection rate of 50% ( 13 of 26 ) .", "the patients ' mean age was 62.68.3 years ( range , 40 - 86 years ) .", "< 10 ng / ml , the detection rate was 14.9% ( 14 of 94 patients ) .", "four patients ( 3.3% ) had bleeding per rectum : one of them required adrenaline injection , another required hemostasis under spinal anaesthesia , and the other two had rectal bleeding that resolved spontaneously without further intervention ." ], [ "recent reports in the literature have queried the adequacy of sextant biopsy for the detection of small nonpalpable pca . in our study , we used the vn , and the positive predictive value was 22.5% , a value that is comparable to other published data from asian countries .", "the low positive predictive value of elevated psa scores in asian countries may be due to the low incidence of pca in this geographic area , but it also may be partly due to inadequate sampling .", "detection rates of pca have varied , and review of the literature from several asian countries found that the detection rate of pca in patients with raised psa scores is in the range of 14.6% to 26.5% . the austrian study that used the vn had a detection rate of 36.7% ( table 2 ) .", "the key to higher pca detection rates with the use of the vn is varying the number of cores according to prostate volume . because larger prostate glands can result in more sampling errors during biopsy", "this rate was comparable to the rates in large - scale studies looking at morbidities of trus prostatic biopsy ." ], [ "the nomogram offers an easy tool with which to select the optimal number of prostate biopsy cores on the basis of patient age and total prostate volume . with this biopsy strategy", "with the use of the vn , our pca detection rate of 22.5% is comparable to published data for asian patients ." ] ]

[ [ "selective laser trabeculoplasty ( slt ) is a new and promising treatment that uses the 532-nm frequency - doubled q - switched neodymium : yytrium aluminum garnet laser .", "slt was developed to selectively target pigmented trabecular meshwork ( tm ) cells without causing thermal or collateral damage to the nonpigmented cells or structures of the tm.1 clinical trials of slt have been encouraging , with reasonable response rates , effective intraocular pressure ( iop ) reduction and minimal side effects.25 comparable studies have shown slt to be as effective as argon laser trabeculoplasty ( alt),6 while histological investigations have demonstrated less damage to the ultrastructure of the tm.78 as a result of these studies , slt has been advocated as a treatment for the management of open - angle glaucoma ( oag ) with a role as a possible primary treatment.3 in the current study , we assess the iop lowering effect and the complications of slt in egyptian patients with primary open - angle glaucoma ( poag ) ." ], [ "patients with a diagnosis of oag were considered eligible for this study if they were newly discovered on no previous medication ( primary group of 41 eyes [ group 1 ] ) , or had confirmed glaucoma poorly controlled on medications , or requesting a decrease number of medications ( adjunctive group of 65 eyes [ group 2 ] ) .", "sixty - five patients ( 106 eyes ) were enrolled in this prospective study from june 2007 to january 2009 .", "patients were excluded from the study if they had evidence of glaucoma other than oag ( angle closure , inflammatory , or neovascular ) in the study eye , were younger than 18 years , had any ocular condition in the study eye that hindered adequate visualization and treatment of the tm , ( 4 ) had prior glaucoma surgery in the study eye .", "preoperative assessment included ophthalmic examination snellen visual acuity , iop measurement by goldmann applanation tonometry , slit - lamp examination and gonioscopy , and funduscopy with evaluation of cup : disc ratio and pallor .", "at least two preoperative iop readings were taken within 2 weeks before the laser treatment was performed .", "approximately 100 adjacent , but nonoverlapping , laser spots were placed over 360 of the tm . immediately after the laser treatment , prednisolone acetate ( 1% ) drops were administered once in the treated eye then three times daily for 3 days .", "the visual acuity and iop were measured , and slit - lamp examination of the anterior segment was performed .", ", irvine , ca ) were installed in the eye before laser treatment to assist in visualization of tm and to prevent iop spikes ." ], [ "patients were treated with the ellex , solo slt laser ( ellex medical pty . ltd , adelaide , australia ) a frequency - doubled q - switched nd : yag laser emitting at 532 nm with a pulse duration of 3 nsec and a spot size of 400 m , coupled to a slit - lamp delivery system . a low - power helium neon laser served as an aiming beam to provide easy targeting of the treatment area .", "if no cavitation bubble was observed , the pulse energy was increased by 0.1 mj until bubble formation and then decreased as described above .", "if cavitation bubbles appeared the laser energy was reduced by 0.1 mj until only a few bubbles formed and treatment was continued at this energy level .", "approximately 100 adjacent , but nonoverlapping , laser spots were placed over 360 of the tm .", "a goldmann three - mirror goniolens or latina lens was placed on the eye with methylcellulose 1% .", "the procedure was performed with topical benoxinate hydrochloride 0.4% for anesthesia . with the patient seated at the laser slit - lamp system ," ], [ "immediately after the laser treatment , prednisolone acetate ( 1% ) drops were administered once in the treated eye then three times daily for 3 days .", "all ophthalmic medications were recorded before surgery and at each subsequent visit . gradual reduction of antiglaucoma medications was initiated 1 week following the procedure , after ensuring an adequate pressure drop .", "patients were evaluated at 1 day , 1 week , 2 weeks , 3 weeks , 4 weeks , and at 3 , 6 , 12 and 18 months . at each visit , the visual acuity and iop were measured , and slit - lamp examination of the anterior segment was performed .", "the same preoperative antiglaucoma medication regimen was continued until the second postoperative visit ( 1 week ) ." ], [ "comparison of iop over the study period was performed with one - way analysis of variance ( anova ) with multiple comparisons post hoc for the two groups .", "data are described are range , mean standard deviation , frequencies ( number of cases ) and relative frequencies ( percentages ) as appropriate .", "comparison of the number medications was performed with the kruskal - wallis analysis of variance ( anova ) test with multiple comparisons post hoc for the two groups . a probability value ( p - value )", "chicago , il ) version 13 for microsoft windows , arcus quickstat ( biomedical ) ( research solutions , cambridge , uk ) ." ], [ "we had five cases ( 4.7% ) of increased iop 1 week following the procedure , the increase in iop ranged from 2 to 10 mmhg , only three eyes had an iop spike of 5 mmhg or more .", "one hundred and six eyes with oag were enrolled in the study and received 360 laser treatment of tm . females comprised 53% of the cohort and the mean age of the cohort was 53.2 years ( range , 18 - 78 years ) .", "mean preoperative iop was 19.55 4.8 mmhg which dropped significantly after 24 hours post - slt to 12.03 2.7 mmhg .", "iop was 14.32 3.0 mmhg , 14.72 2.1 mmhg , 15.16 3.6 mmhg and 16.03 2.8 mmhg at 1 , 6 , 12 , and 18 months of follow - up , respectively .", "there was a tendency towards increased iop with follow - up , yet the mean final iop at the end of the study was statistically significantly lower than the pretreatment mean iop ( p<0.05 ) .", "mean intraocular pressure changes ( mmhg ) in both primary and adjunctive groups over the study period success was defined as iop < 21 mmhg with at least a twenty percent drop of iop from baseline and no secondary surgeries . at 1-month follow - up ,", "there was a tendency toward and increase in iop during follow - up , with a mean iop reduction of 3.52 mmhg ( 18% from baseline ) at 18 months ( p= 0.001 ) ." ], [ "one hundred and six eyes with oag were enrolled in the study and received 360 laser treatment of tm . females comprised 53% of the cohort and the mean age of the cohort was 53.2 years ( range , 18 - 78 years ) .", "mean preoperative iop was 19.55 4.8 mmhg which dropped significantly after 24 hours post - slt to 12.03 2.7 mmhg .", "there was a tendency towards increased iop with follow - up , yet the mean final iop at the end of the study was statistically significantly lower than the pretreatment mean iop ( p<0.05 ) .", "iop was 14.32 3.0 mmhg , 14.72 2.1 mmhg , 15.16 3.6 mmhg and 16.03 2.8 mmhg at 1 , 6 , 12 , and 18 months of follow - up , respectively .", "the decrease in mean iop was statistically significant throughout follow - up ( p < 0.001 ) ." ], [ "the greatest drop in iop occurred 24 hours after slt ( 7.52 mmhg ) which was equivalent to a 38% drop from the baseline iop .", "there was a tendency toward and increase in iop during follow - up , with a mean iop reduction of 3.52 mmhg ( 18% from baseline ) at 18 months ( p= 0.001 ) .", "success remained similar at 18 months postoperatively with 74 eyes attaining the desired drop ( 70% of cases ) . hence despite a mean drop of iop of 18% at the end of follow - up , 70% of the patients met the success criteria . by the end of follow - up ,", "six patients required laser retreatment and none needed any other surgical intervention to lower the iop .", "mean intraocular pressure changes ( mmhg ) in both primary and adjunctive groups over the study period success was defined as iop < 21 mmhg with at least a twenty percent drop of iop from baseline and no secondary surgeries . at 1-month follow - up ,", "the intraocular pressure reduction expressed as mean and percentage drop from baseline we further compared the mean iop for each group individually .", "group i ( primary treatment with no preoperative medications ) had a preoperative mean iop of 21.54 mmhg that decreased significantly to 17.4 mmhg ( p<0.001 ) ." ], [ "among patients using preoperative medications ( group ii ) , the mean number of medications used dropped statistically significantly throughout the study from 2.25 0.97 before the procedure to 1.0 ( 1.3 ) at the end of 18 months follow - up ( p= 0.004 ) .", "mean number of medications used in the adjunctive group throughout the study during the first 24 hours following the procedure , mild flare and cells were noted in the anterior chamber .", "we had five cases ( 4.7% ) of increased iop 1 week following the procedure , the increase in iop ranged from 2 to 10 mmhg , only three eyes had an iop spike of 5 mmhg or more .", "this resolved spontaneously without treatment except in one case , which was successfully treated with topical steroids and resolved in 1 week ." ], [ "thus , pulsed lasers with low threshold radiant exposures can selectively target pigmented tm cells and avoid collateral thermal damage to adjacent non - pigmented cells.9 histologically , slt has not been reported to cause coagulative damage to the tm.78 the literature has reported variable rates of the short and long - term efficacy of slt , with mean reductions in iop ranging from 2 to 14 mmhg at 1 month postoperatively , 36 mmhg at 3 months postoperatively , and 57 mmhg at 6 months postoperatively.3461011 to our knowledge this is the first study to address the effect of this technique on egyptian patients whether it was used alone or as an adjunct to medical therapy for glaucoma .", "our study shows slt to be an effective procedure with continued average iop lowering over 18 months consistent with the previous studies .", "reports of iop spikes in the literature range widely from 0 to 27%,129 this can be explained by the use of different a preoperative regimen .", "slt proved effective for the primary treatment of poag and ocular hypertention , with a mean drop of iop of 30 % from baseline at 18 months postoperatively in melamed et al.,3 study ." ], [ "slt was also effective in reducing the number of medications used by patients which is an economic advantage in developing countries .", "there is a tendency of the iop lowering effect to wane over time hence , regular follow - up is required ." ] ]

[ [ "perceived quality is one of the principal determinants of utilization and non - utilization of health care services ( 6 , 7 ) , a major issue in developing and transitional countries including albania , a former communist country in the western balkans which has undergone tremendous political and socioeconomic changes in the past two decades associated with significant health consequences ( 8 , 9 ) .", ", there is a complexity of elements or components , which contribute separately , but influence in a harmonized manner the perceptions towards a given health care system ( 1 , 2 ) .", "in addition , the rapid process of transition in albania over the past two decades has been associated with an intensive process of internal migration ( from rural areas to urban areas of the country , especially in tirana , the albanian capital city ) and external migration ( mainly to the neighboring countries including greece and italy ) ( 9 ) .", "the aim of our study was to assess the quality of the primary health care services in albania with a main focus on family physicians perceptions towards the quality of health care services provided to the general population .", "currently , the health care system in albania consists of three main pillars : primary , secondary and tertiary health care services ( 3 ) . the quality of health care is the consequence of strong links between service providers and users of the health care services at all levels ( 5 ) .", "migration is linked to an increased aging which , in turn , enhances the general and already existing aging effect on healthcare utilization ( that is the relative care needs of the albanian population ) . to date", ", however , the available information regarding the quality of primary health care services in albania is scarce . in this framework ," ], [ "the questionnaire consisted of self - assessment of the following key dimensions / components of primary health care services : physical conditions at the workplace ( measurement scale : good [ score : 2 ] , average [ score : 1 ] , bad [ score : 0 ] ) ; availability and quality of working devices and equipment for proper diagnostic and treatment services ( measurement scale : not available [ score : 0 ] , available but not good [ score ; 1 ] , available and good [ score : 2 ] ) ; sources of scientific information available at the workplace ( not available [ score : 0 ] , available but outdated [ score : 1 ] , available and updated [ score ; 2 ] ) ; level of autonomy in decision - making ( no autonomy [ score : 0 ] , partial autonomy [ score : 1 ] , sufficient autonomy [ score : 2 ] ) . a summary score ( ranging from 0 to 8)", "a cross - sectional study was conducted in january - march 2013 including a representative sample of 132 physicians providing primary health care services in several polyclinics ( health centers ) of tirana .", "a structured self - administered and anonymous questionnaire was applied to all male and female primary health care physicians who agreed to participate in this survey .", "was calculated for each physician based on these four dimensions of the quality of health care services which was dichotomized into inadequate quality ( overall score : 0 - 4 ) vs. adequate quality of health care services ( summary score : 5 - 8 ) .", "initially , a simple random sample of 150 physicians operating at primary health care level in tirana was targeted for recruitment . of these ,", "in addition , demographic data ( age and sex of physicians ) , information on working experience , number of population served , working place ( polyclinic , or health center ) , type of specialization received and involvement in teaching / training activities were collected for all physicians included in the study .", "binary logistic regression was used to assess the association between the self - assessed overall quality of primary health care services ( adequate vs. inadequate ) with baseline characteristics of primary health care physicians . odds ratios ( ors ) , 95% confidence intervals ( 95%ci ) and their respective p - values were calculated ." ], [ "age of physicians was positively related to the self - perceived level of quality of health care services .", "distribution of selected key dimensions of primary health care services according to physicians perceptions table 3 presents the association of the self - assessed quality of services with characteristics of primary health care physicians included in this survey .", "demographic characteristics , working experience , specialization received , teaching involvement and population coverage of primary health care physicians included in this survey are presented in table 1 .", "association of quality of services with characteristics of primary health care physicians ; odds ratios ( adequate vs. inadequate quality ) from binary logistic regression", "involvement in teaching or training activities was not significantly related to the self - perceived quality of primary health care services ( table 3 ) .", "about 24% of the physicians perceived that there were no devices and equipment for a proper diagnosis and treatment of their patients , as opposed to 40% of the physicians who considered the equipment and devices available and appropriate .", "baseline characteristics of a representative sample of primary health care physicians in tirana in 2013 ( n=132 ) ." ], [ "our findings indicate that albanian doctors face several difficulties in performing their everyday tasks and , therefore , health authorities must undertake measures to improve their performance through provision of better working environment , availability and improvement of the instruments and diagnostic devices for diagnostic and treatment services .", "this is an intuitive finding , in line with the expected direction , as the level of physicians competencies is related to the experience gained in the course of their health care practice ( 6 ) .", "main findings of this survey relate to a positive association of an adequate quality of primary health care services with female gender , older age , working experience and training in family medicine of physicians operating at primary health care level in tirana , the albanian capital . these are generally in line with previous reports from the international literature ( 5 - 7 ) .", "the current survey was an attempt to provide evidence about the perceptions of primary health care physicians regarding different aspects of their profession .", "our study was based on doctors perceptions about their working conditions and working environment and this can imply a subjective evaluation that can bear the possibility of information biases in the assessment of the current situation in terms of the quality of primary health care services in albania . therefore , health authorities in albania should develop and implement suitable instruments to measure the quality of health care services at all levels .", "furthermore , there is also a need to place in the public domain tool kits that can be used by physicians , administrators , and patient groups to assess and improve the quality of care .", "albanian doctors working at the primary health care sector face many difficulties in their professional practice ." ], [ "our findings provide useful evidence on the self - perceived quality of health care services from primary health care physicians perspective in transitional albania ." ] ]

[ [ "this study was conducted to investigate the rostellar hook morphometry and the influence of mitochondrial gene variations on the hook length in sheep isolates of t. multiceps . \n", "coenurosis , also known as gid or sturdy , is a larval helminth infection of herbivorous animals .", "however no study has been undertaken to investigate possible association of variability within different genes and the larval rostellar hook length in taeniid cestodes .", "a few human cases has been reported from different countries including italy , egypt and the united states ( 4 , 5 ) .", "adult tapeworm of t. multiceps inhabits small intestine of some domestic and wild carnivores , e.g. dogs , jackals , foxes and coyotes ." ], [ "a total of 4500 sheep heads were examined for the presence of t. multiceps metacestodes in the period of october 2010 to may 2011 in three major food processing companies in tehran , alborz and qom provinces of iran.after opening the skulls , coenuri were detached from the brain and were transferred to the helminthology lab in the school of medicine , kerman university of medical sciences .", "all measurements were taken by a single person ( s.r).representative mitoch - ondrial co1 and 12s rrna gene sequences of all the isolates were obtained from ncbi genbank to find out possible association between mitochondrial gene variability and hook morphometry .", "all the scoleces within each coenure were counted and biometric characters based on the larval rostellar hook size were measured . for each metacestode five scoleces were randomly selected .", "the fluid - filled coenuri were contained several scoleces surrounded by a thin , transparent membrane .", "total lengths of each of three large and three small hooks per scolex were measured by a calibrated eyepiece micrometer under medium power magnification ( fig .", "the metacestodes were then rinsed three times in normal saline and the specimens were stored at -20c until used .", "the large and small hook length data as well as the corresponding co1 and 12s rrna haplotypes were managed in the statistical package for the social sciences ( spss , v. 21 ) ." ], [ "a total of 4500 sheep heads were examined for the presence of t. multiceps metacestodes in the period of october 2010 to may 2011 in three major food processing companies in tehran , alborz and qom provinces of iran.after opening the skulls , coenuri were detached from the brain and were transferred to the helminthology lab in the school of medicine , kerman university of medical sciences .", "the metacestodes were then rinsed three times in normal saline and the specimens were stored at -20c until used ." ], [ "all measurements were taken by a single person ( s.r).representative mitoch - ondrial co1 and 12s rrna gene sequences of all the isolates were obtained from ncbi genbank to find out possible association between mitochondrial gene variability and hook morphometry .", "all the scoleces within each coenure were counted and biometric characters based on the larval rostellar hook size were measured . for each metacestode five scoleces were randomly selected .", "the fluid - filled coenuri were contained several scoleces surrounded by a thin , transparent membrane .", "total lengths of each of three large and three small hooks per scolex were measured by a calibrated eyepiece micrometer under medium power magnification ( fig ." ], [ "random effects model was applied to estimate how much of variation in thehook length was attributable to the genetic differences between the subjects .", "the large and small hook length data as well as the corresponding co1 and 12s rrna haplotypes were managed in the statistical package for the social sciences ( spss , v. 21 ) .", "cluster analysis was applied to classify the subjects into homogeneous subgroups using interclass correlation coefficient ( icc ) .", "dendrogram and scatter plot were generated based on the large and small hook length using hierarchical cluster analysis ." ], [ "the dendrogram contained two main clades one of which comprised 97.1% of the isolates.subclades a , b and c contained the majority of the isolates i.e.44 isolates ( 43.1% ) in the subclade a , 25 isolates ( 24.5% ) in the subclade b and 18 isolates ( 17.6% ) in the subclade c.no associations were found between hook length and co1 gene variability , however 12s rrna variability was significantly associated with theboth large and small hook length ( table 1 ) .", "the results indicated that respectively 57.0% and 22.6% of variation in large and small hook lengths are attributable to different individuals in t. multiceps isolates .", "significant icc s were obtained from random effects models showing that the large and small hook lengths are significantly different among t. multiceps isolates ( p<0.001 , table 1 ) .", "this means that based on large and small hook length , statistically significant clusters are distinguishable within the isolates.the results of hierarchical analysis are presented as a dendrogram in fig .", "inspection of 4500 sheep brains revealed that 114 ( 2.5% ) heads were infected by t. multiceps metacestodes ." ], [ "mixed model analysis in the present study established a significant association between 12s rrna variability and larval rostellar hook lengths . according to the results of the present study 38% and 8% of the large and small hook length variations", "according to the present study the prevalence of ovine coenurosis was 2.5%.previous studies in iran indicated a range of relative frequency between 0.3 and 18.7% .", "most of the isolates were located in the three main sub clades a , b and c. however , morphologically defined variants have not been described in t. multiceps so far .", "3 ) hook lengths of the majority of the isolates were found to be 150 - 165 m and 105 - 120 m for the large and small hooks respectively .", "table 2 compares the rostellar hook morphometric characters of t. multiceps derived from existing data in the literature.the results of morphometric study showed that the mean sd total length of the large and small hooks were 158.99.3 m and 112.19.4 m respectively .", "the present study revealed that the average number of scoleces in the metacestode is 85 with a range of 40 - 550 scoleces per coenure ." ], [ "morphometric analyses in the present study showed an association between the rostellar hook length and sequence variability in the mitochondrial 12s rrna .", "hook length analysis revealed statistically significant difference among individual isolates , indicating intraspecific variation within t. multiceps in iran ." ] ]

[ [ "we systematically investigated the temperature dependency \n of tta - uc in neutral pegylated liposomes made of different lipids \n with different transition temperatures tm , to optimize the lipid composition of red - to - blue \n tta - uc drug - delivery systems functioning at human body temperature .", "our group recently demonstrated that green - to - blue and red - to - blue \n tta - uc can be realized in the phospholipid membrane of neutral pegylated \n liposomes composed of 1,2-dimyristoyl - sn - glycero-3-phosphocholine \n ( dmpc ) .", "tta - uc is based \n on the photophysical interplay of photosensitizer and annihilator \n chromophores ( see figure s1 ) ." ], [ "all liposome formulations were prepared \n by the classical hydration - extrusion method . as an example , the preparation \n of liposome sample o12 is described here .", "temperature \n dependent luminescence experiments were done with continuous irradiation \n and temperature ramping , except for phosphorescence measurements of \n compound 1 to prevent bleaching during the experiment . \n", "aliquots of \n chloroform stock solutions containing the liposome constituents were \n added together in a flask to obtain a solution with 5.0 mol \n dopc , 0.20 mol dspe - mpeg-2000 , 2.5 nmol compound 1 , and 25 nmol compound 2 .", "the liposome dispersions were degassed for 1015 min \n prior to measurement on a nalgene degassing station . for each sample , \n", "the resulting dispersion was extruded through \n a whatman nuclepore 0.2 m polycarbonate filter at least 10 \n c above the main phase transition temperature of the lipid for \n at least 11 times using a mini - extruder from avanti polar lipids , \n inc .", "all optical parts were connected \n with fc - uvxxx-2 ( xxx = 200 , 400 , \n 600 ) optical fibers from avantes ( apeldoorn , the netherlands ) , with \n a diameter of 200600 m , respectively , and that were \n suitable for the uv vis range ( 200800 nm ) . typically , \n 2.25 ml of sample was placed in a 111-os macro fluorescence cuvette \n from hellma in a cuv - uv / vis - tc temperature - controlled cuvette holder \n with stirring from avantes . deoxygenated toluene samples were prepared \n in a glovebox in a sealed fluorescence cuvette ." ], [ "it is thus concluded that the combination \n of these three temperature - dependent phenomena results in the maxima \n that were observed in the uc versus temperature \n curve at 25 , 33 , and 42 c for samples m12 , pd12 , and p12 , respectively ( figure 2c ) . finally , for the \n biological application of these upconverting liposomes \n in bioimaging or phototherapy , it would be beneficial to achieve the \n highest upconversion intensity at human body temperature ( 37 c ) . \n from our results ,", "altogether , the results \n suggest that even though uc maximizes around tm ( for m12 , pd12 , and p12 ) , choosing a lipid with a tm near 37 c does not \n result in an optimized upconverting liposome formulation .", "overall , these results explain \n that the decrease of tta - uc with rising temperature is most likely \n due to increased thermal deactivation and self - quenching of 1 . based on these data", "it is evident that the systems o12 , l12 , and m12 achieve similar upconversion quantum \n yields at 37 c , while pd12 , p12 , and s12 exhibit lower quantum yields .", "finally , \n considering that little has been reported about the biocompatibility \n of dlpc , we conclude that o12 and m12 upconverting \n liposomes are the most promising for biological applications .", "these \n results indicate that for liposome samples m12 , pd12 , p12 , and s12 compounds 1 and 2 were indeed buried in the lipid bilayer , \n and that their presence only minimally perturbed the physical properties \n of the membranes ." ], [ "the temperature dependence of red - to - blue tta - uc was studied in \n pegylated liposomes with pc lipids with different lipophilic chain \n lengths and transition temperatures , and it was found that the upconversion \n efficiency maximizes around the order disorder transition temperature \n of the membrane , tm . \n", "three major effects contribute to this temperature dependency : ( 1 ) \n an increase in lipid bilayer fluidity above tm results in higher diffusion rates and thus \n in higher rates of ttet and tta and higher upconverted intensity ; \n ( 2 ) perylene aggregates dissociate when t approaches tm , which results in higher \n annihilator emission intensity ; and ( 3 ) higher thermal deactivation \n and self - quenching rates of the photosensitizer at higher temperatures \n lead to a lower ttet rate and lower upconversion intensity beyond tm .", "finally , the upconverted \n intensity in dopc , dlpc , and dmpc liposomes were very similar at 37 \n c , which highlights that not being at the optimum temperature \n for a given lipid composition does not necessarily mean that the upconverted \n intensity is lower than when being at the optimum temperature for \n another lipid composition .", "overall , tta - uc in liposomes can be realized \n with many different lipids of different tm , and for both saturated and unsaturated lipids . \n for applications in bioimaging and phototherapy", "furthermore , for \n tta - uc applications that require high performance at elevated temperatures , \n the results underline the importance of selecting photosensitizers \n that are minimally affected by temperature .", "measuring the point at which iuc maximizes may be exploited for probing the \n transition temperature of phospholipid membranes .", "such \n versatility allows for further optimizing the liposomal formulation \n in terms of other properties such as stability to medium , biocompatibility , \n toxicity , clearance from the bloodstream , and/or surface functionalization .", ", the phospholipid \n can be rather freely chosen among dlpc , dmpc , and dopc , while dppc , \n dpdpc , and dspc lead to slightly lower upconverted intensities ." ] ]

[ [ "whether the presence of amoeba in two different beverage products , milk and orange juice , influenced the survival of c. jejuni , the following three treatments were used : c. jejuni preincubated with a. polyphaga before the addition of product ( treatment a ) , c. jejuni mixed with a. polyphaga after the addition of product ( treatment b ) , and c. jejuni in product without a. polyphaga ( treatment c ) . for treatment a , 12-well plates with confluent a. polyphaga layers in pyg medium were inoculated with 100 l of the c. jejuni stock solution , generating a concentration of 10 cfu / ml and a multiplicity of infection ( moi ) of one bacteria per amoeba , in each well . before inoculation with c. jejuni , the medium in all wells were gently removed and replaced with 1 ml fresh pyg medium .", "the c. jejuni strain ccug 11284 and the a. polyphaga strain ( linc ap-1 ) were used in all experiments .", "after the addition of product , the plates for treatment b and c were inoculated with 100 l of the c. jejuni stock solution generating a concentration of 510 cfu / ml and an moi of one bacteria per amoeba in treatment b , in each well .", "basingstoke , uk ) was added to the products to inhibit growth of other bacteria than c. jejuni .", "all experiments were done in triplicates , resulting in three similar wells for each treatment and product . for each well and each time point , a measure of c. jejuni cell survival was calculated by dividing the bacterial concentration of the sample ( estimated from colony counts ) by the bacterial concentration of that well at time 0 h ( the addition of product ) ." ], [ "the c. jejuni strain ccug 11284 and the a. polyphaga strain ( linc ap-1 ) were used in all experiments .", "the stock solution was striven to obtain a concentration of approximately 10 cfu / ml , as were detected by plate counting .", "ccug 11284 is a wild - type strain that was originally isolated from bovine feces . before each experiment , bacteria were grown on conventional blood agar plates ( columbia agar ii containing 8% vol / vol whole horse blood ) at 42c for 20 h in a microaerobic environment , using a campygen gas generating system ( cn0025a ; oxoid ltd . , basingstoke , uk ) and a bbl gaspak system ( bd , franklin lakes , nj ) .", "basingstoke , uk ) was added to the products to inhibit growth of other bacteria than c. jejuni .", "a. polyphaga stock cultures were maintained in pyg medium at 27c in 75 cm culture flasks ( sarstedt , nrnbrecht , germany ) , as described by axelsson - olsson et al .", "bacterial cells were harvested and diluted in a peptone - yeast extract - glucose ( pyg ) medium and used as stock solution for all treatments ." ], [ "to mimic the conditions of storage in the fridge or at the bench , experiments were incubated at room temperature and 4c . to test whether the presence of amoeba in two different beverage products , milk and orange juice , influenced the survival of c. jejuni , the following three treatments were used : c. jejuni preincubated with a. polyphaga before the addition of product ( treatment a ) , c. jejuni mixed with a. polyphaga after the addition of product ( treatment b ) , and c. jejuni in product without a. polyphaga ( treatment c ) . for treatment", "compared to initial ph ( milk : 6.41 and juice : 3.89 ) only a small increase in ph was observed ( milk : 0.4 and juice : 0.1 ) .", "after the addition of product , the plates for treatment b and c were inoculated with 100 l of the c. jejuni stock solution generating a concentration of 510 cfu / ml and an moi of one bacteria per amoeba in treatment b , in each well .", "the ph level of the fluid in each well was measured after 48 h , when experiments were completed .", "all plates were incubated in an aerobic environment and each treatment was done in triplicate wells , resulting in three similar wells for each temperature , treatment and product . from each" ], [ "for pasteurization experiments , the same settings were used , as described above for treatments a , b , and c. directly after the addition of product , samples of 100 l were taken from the different treatments , a , b , and c and added to tubes containing 500 l of milk or juice .", "incubation conditions for milk tubes were 7274c for 15 sec ( equivalent to swedish low pasteurization guidelines ) .", "incubation conditions for juice tubes were 85c for 15 sec ( equivalent to swedish pasteurization guidelines ) .", "all experiments were done in triplicates , resulting in three similar wells for each treatment and product .", "after heating , the sample tubes were put on ice and 100-l samples were spread on blood agar for colony counting ." ], [ "for each well and each time point , a measure of c. jejuni cell survival was calculated by dividing the bacterial concentration of the sample ( estimated from colony counts ) by the bacterial concentration of that well at time 0 h ( the addition of product ) ." ], [ "a. polyphaga did not show any protective effect on c. jejuni when heated to recommended pasteurization temperatures , neither in milk nor in orange juice ( data not shown ) .", "survival of c. jejuni co - incubated with a. polyphaga in milk ( a ) or orange juice ( b ) at 4c after 0 h , 3 h , 6 h , 24 h , and 48 h. data are based on three independent experiments with c. jejuni treated in three different ways treatment a ( dots ) , c. jejuni preincubated with a. polyphaga before the addition of product ; treatment b ( squares ) , c. jejuni inoculated to a. polyphaga after the addition of product ; and treatment c ( triangles ) , c. jejuni in product without a. polyphaga . to use the log10 scale , a constant 1 had to be added to all cfu values to manage zeros .", "jejuni survival was seen in treatment a , where bacteria were pre - incubated with amoebae before addition of milk ( 2.8% , 18 h ; 3.8% , 24 h ; 0.8% , 48 h ; table 1 ; fig .", "after 3 h , the survival of c. jejuni without amoebae ( treatment c ) decreased more rapidly compared to co - cultures ( treatments a and b ) , and the fraction of the inoculum surviving after 18 h was only 3.510 ( equivalent to 6 cfu / ml ; table 1 ) ." ], [ "jejuni survival was seen in treatment a , where bacteria were pre - incubated with amoebae before addition of milk ( 2.8% , 18 h ; 3.8% , 24 h ; 0.8% , 48 h ; table 1 ; fig .", "after 3 h , the survival of c. jejuni without amoebae ( treatment c ) decreased more rapidly compared to co - cultures ( treatments a and b ) , and the fraction of the inoculum surviving after 18 h was only 3.510 ( equivalent to 6 cfu / ml ; table 1 ) .", ". survival of c. jejuni co - incubated with a. polyphaga in milk ( a ) or orange juice ( b ) at room temperature after 0 h , 3 h , 6 h , 24 h , and 48 h. data are based on three independent experiments with c. jejuni treated in three different ways treatment a ( dots ) , c. jejuni preincubated with a. polyphaga before the addition of product ; treatment b ( squares ) , c. jejuni inoculated to a. polyphaga after the addition of product ; and treatment c ( triangles ) , c. jejuni in product without a. polyphaga . to use the log10 scale , a constant", "treatment b showed 0.05% survival at 18 h and reached a fraction of 6.710of the inoculum at 48 h ( equivalent to 14 cfu / ml ; table 1 ) .", "1b ) and the lowest survival was found in treatment c , c. jejuni without amoebae ." ], [ "at 4c , c. jejuni generally survived better in both milk and juice and the differences were less pronounced between co - cultures and bacteria incubated alone . in milk , the highest c.", "survival of c. jejuni co - incubated with a. polyphaga in milk ( a ) or orange juice ( b ) at 4c after 0 h , 3 h , 6 h , 24 h , and 48 h. data are based on three independent experiments with c. jejuni treated in three different ways treatment a ( dots ) , c. jejuni preincubated with a. polyphaga before the addition of product ; treatment b ( squares ) , c. jejuni inoculated to a. polyphaga after the addition of product ; and treatment c ( triangles ) , c. jejuni in product without a. polyphaga . to use the log10 scale , a constant 1 had to be added to all cfu values to manage zeros .", "jejuni survival was seen in treatment a for time point up to 24 h ( 90.3% , 18 h ; 34.3% , 24 h ; table 1 ; fig .", "jejuni survival was seen in treatment c ( 3.3% table 1 ) , and the survival in treatments a and b were 0.4 and 0.6% , respectively ( table 1 ) ." ], [ "\n a. polyphaga did not show any protective effect on c. jejuni when heated to recommended pasteurization temperatures , neither in milk nor in orange juice ( data not shown ) .", "growth was totally inhibited in all samples from treatments a , b , and c. results were based on three independent experiments ." ], [ "\n campylobacter causes approximately 200,000 human infections annually in the european union , with sometimes very severe chronic complications such as guillain barre syndrome ( gbs ) ( 36 , 37 ) . in this study , we investigated the protective effect of the free - living amoeba a. polyphaga on c. jejuni survival in milk and orange juice .", "together , our results suggest that a. polyphaga can prolong c. jejuni survival both in milk and juice .", "amoebae associated c. jejuni in milk and juice survived better than free bacteria both at room temperature and at 4c , but a. polyphaga could not protect the bacteria from pasteurization .", "we studied if c. jejuni in co - culture with a. polyphaga could survive heating to recommended pasteurization temperatures for milk ( 7274c ) and juice ( 85c ) ." ], [] ]

[ [ "induced retinal vasodilation between individuals with diabetes and control subjects and in individuals with diabetes between those with and without dr .", "multiple logistic regression models were constructed using the generalized estimating equation models to account for correlation between the right and left eyes and to assess the odds of diabetes ( vs. nondiabetic control subjects ) or diabetic retinopathy ( vs. no diabetic retinopathy among subjects with diabetes ) , comparing the lower versus upper tertiles of flicker light ", "we initially adjusted for age , sex , and fasting blood glucose level ( model 1 ) and further adjusted for duration of diabetes ( in analysis of diabetic patients ) , use of antihypertensive and lipid - lowering medications , current smoking status , sbp , and cholesterol and triglyceride levels ( model 2 ) .", "we conducted a hospital - based clinical study between october 2006 and april 2008 , prospectively recruiting 224 caucasian / white participants with diabetes ( 85 with type 1 diabetes and 139 with type 2 diabetes ) from the diabetic eye clinics at the international diabetes institute ( melbourne , vic , australia ) and 103 white nondiabetic control subjects from the general eye clinics at the royal victorian eye and ear hospital ( melbourne , vic , australia ) .", "levels 10 , 11 , and 12 were defined as no diabetic retinopathy , 14 to 20 as minimal nonproliferative diabetic retinopathy ( npdr ) , 31 and 41 as early to moderate npdr , and 5180 as severe npdr ( proliferative diabetic retinopathy ) . a detailed questionnaire was used to obtain participant information , including past medical history , current cigarette smoking , and the use of antihypertensive and lipid - lowering medications .", "all participants and control subjects had a standardized clinical examination , measurement of blood chemistry , retinal photographs , and assessment of flicker - induced vasodilation using the dynamic vessel analyzer ( dva ; imedos , jena , germany ) ." ], [ "it was represented as an average increase in the vessel diameter in response to the flicker light during the three measurement cycles and was defined as the percent increase relative to the baseline diameter size .", "when the eye blinked or moved , the system automatically stopped the measurement and restarted it once the vessel segments were automatically reidentified .", "baseline vessel diameter was measured for 50 s , followed by a provocation with flicker light of the same wavelength for 20 s and then a nonflicker period for 80 s. this measurement cycle was repeated twice , with a total duration of 350 s / eye .", "the participant focused on the tip of a fixation bar within the retinal camera while the fundus was examined under green light .", "the mean diameters of the arterial and venous vessel segments were calculated and recorded automatically .", "retinal arteriolar and venular dilation in response to flicker light was calculated automatically by the dva software .", "an arteriole and venule segment between one - half and two disc diameters from the margin of the optic disc were selected .", "the dva measures retinal vessel dilation in response to diffuse luminance flicker ( 12 ) ." ], [ "details of the digital image preparation are described elsewhere ( 15 ) . in brief , diameters of the largest six arterioles and venules passing through the circular zone between one - half and one disc diameter away from the optic disc margin were summarized as the central retinal arteriolar equivalent and central retinal venular equivalent using the parr - hubbard formula further modified by knudtson and colleagues ( 15 ) .", "in addition to quantifying the flicker - induced vasodilation , we assessed overall static arteriolar and venular diameter using a computer - assisted program ." ], [ "fasting blood samples were drawn from participants at suburban pathology centers for measurement of fasting blood glucose level within 2 weeks of their eye testing . all participants with diabetes were patients recruited from the diabetic eye clinics and were managed with oral hypoglycemic mediations and/or insulin .", "control subjects ( individuals without diabetes ) had confirmed nondiabetic status based on a lack of history of diabetes and fasting glucose < 7.0 mmol / l ( 126 mg / dl ) ." ], [ "in participants with diabetes , diabetic retinopathy was graded from fundus photographs at the centre for eye research australia , by graders masked to clinical details . for each eye ,", "a retinopathy severity score was assigned based on modification of the airlie house classification system ( 16 ) . for our analysis , levels 10 , 11 , and 12 were defined as no diabetic retinopathy , 14 to 20 as minimal nonproliferative diabetic retinopathy ( npdr ) , 31 and 41 as early to moderate npdr , and 5180 as severe npdr ( proliferative diabetic retinopathy ) ." ], [ "a detailed questionnaire was used to obtain participant information , including past medical history , current cigarette smoking , and the use of antihypertensive and lipid - lowering medications .", "fasting blood samples were drawn from participants at suburban pathology centers for fasting blood glucose level , cholesterol and triglyceride levels , and a1c within 2 weeks of their eye testing .", "dyslipidemia was defined as cholesterol > 5.5 mmol / l or triglyceride > 2.0 mmol / l or current use of lipid - lowering medications .", "hypertension was defined as systolic blood pressure ( sbp ) > 140 mmhg , diastolic blood pressure ( dbp ) > 90 mmhg , or current use of antihypertensive medications ." ], [ "multiple logistic regression models were constructed using the generalized estimating equation models to account for correlation between the right and left eyes and to assess the odds of diabetes ( vs. nondiabetic control subjects ) or diabetic retinopathy ( vs. no diabetic retinopathy among subjects with diabetes ) , comparing the lower versus upper tertiles of flicker light ", "we compared flicker light induced retinal vasodilation between individuals with diabetes and control subjects and in individuals with diabetes between those with and without dr .", "flicker - induced arteriolar / venular dilation was analyzed as percent increase over baseline diameter , both as a continuous measure and in categories ( tertiles ) .", "we initially adjusted for age , sex , and fasting blood glucose level ( model 1 ) and further adjusted for duration of diabetes ( in analysis of diabetic patients ) , use of antihypertensive and lipid - lowering medications , current smoking status , sbp , and cholesterol and triglyceride levels ( model 2 ) .", "in addition , multiple linear regression models were used to estimate the mean difference in arteriolar and venular dilation ." ], [ "however , the association of reduced flicker light induced vasodilation with diabetic retinopathy was stronger in participants with type 1 diabetes ( arteriolar dilation or 3.1 [ 95% ci 1.18.5 ] ; venular dilation or 3.8 [ 95% ci 1.410.0 ] ) compared with those with type 2 diabetes ( arteriolar dilation or 1.8 [ 95% ci 0.84.0 ] ; venular dilation or 1.3 [ 95% ci 0.63.1 ] ) , although the interaction with type of diabetes was not statistically significant ( p value for interaction term : p = 0.50 for arteriolar dilation and p = 0.09 for venular dilation ) .", "induced venular dilation was 2.83 2.10% in individuals with diabetes and 3.98 1.84% in normal control subjects ( p < 0.001 after multivariable adjustment ) and again was not significantly different by type of diabetes : 2.84% in those with type 1 and 2.83% in those with type 2 diabetes ( p = 0.99 ) . mean differences in flicker light induced vasodilation between participants with diabetes and normal control subjects and by grades of diabetic retinopathy severity in participants with diabetes * adjustment for age , sex , fasting cholesterol and triglyceride levels , use of antihypertensive and lipid - lowering medications , current smoking status , and fasting glucose ( for analysis of diabetic retinopathy severity ) .", "selected characteristics of normal control subjects ( n = 103 ) , participants with diabetes ( n = 224 , 85 with type 1 and 139 with type 2 diabetes ) , and those with ( n = 144 ) and without ( n = 80 ) diabetic retinopathy are shown in table 1 .", "comparing those with and without diabetic retinopathy in those with diabetes , adjusted for age .", "induced retinal vasodilation was reduced in participants with diabetes compared with that in control subjects ( table 2 ) .", "retinal arteriolar dilation was not significantly different by type of diabetes : 1.57% in those with type 1 and 1.24% in those with type 2 diabetes ( p = 0.98 ) ." ], [ "in this study , we demonstrated a reduction in flicker light induced retinal arteriolar and venular dilation in individuals with diabetes compared with nondiabetic control subjects and , among individuals with diabetes , in those with retinopathy signs .", "induced retinal vasodilation in individuals with diabetes and , among those with diabetes , in those with retinopathy signs .", "these findings further support the concept that early endothelial dysfunction is a likely key pathophysiological mechanism that underlies diabetes and its microvascular complications .", "importantly , we showed that these associations were independent of major risk factors for either diabetes or diabetic retinopathy and independent of static measurements of retinal arterioles and venular diameters ." ] ]

[ [ "de lamorce dune antirtrovirothrapie prophylactique associative ( arpa ) contenant du raltgravir ( ral ) sur la charge virale ( cv ) du vih chez les femmes enceintes do nt la suppression de la cv est leve ou sous - optimale en fin de grossesse ." ], [ "les chercheurs ont extrait le dossier des femmes enceintes infectes par le vih qui avaient amorc une arap contenant du ral aprs 28 semaines de grossesse dans deux centres hospitaliers universitaires entre 2007 et 2013 ." ], [ "onze femmes infectes ont entrepris un traitement de ral une mdiane de 35,7 semaines de grossesse ( plage de 31,1 38,0 semaines ) .", "la cv moyenne au dbut du traitement au ral tait de 73 959 copies / ml ( plage de moins de 40 copies / ml 523 975 copies / ml ) ." ], [ "la prsente tude fournit des donnes provisoires pour soutenir lutilisation darpa contenant du ral afin dacclrer la rduction de la cv du vih-1 chez les femmes qui prsentaient une cv leve ou une suppression sous - optimale de leur cv pendant la grossesse , ainsi que pour rduire le risque de transmission prinatale du vih tout en vitant une csarienne ." ], [ "the standard of care in both clinics included treatment of hiv - infected pregnant women with cart regardless of baseline cd4 cell - count and hiv-1 vl , as well as assessment of the women s clinical , virological and immunological status every four weeks .", "a retrospective review of two canadian hiv perinatal databases ( those of the oak tree clinic at bc woman s hospital , vancouver , british columbia , and of the grossesse avec maladie infectieuse clinic at sainte - justine hospital , montreal , quebec ) was conducted to identify hiv - infected pregnant women who initiated treatment with ral ( 400 mg twice per day orally ) after 28 weeks gestation .", "hiv - negative status in infants was defined presumptively by at least two negative hiv rna polymerase chain reaction test results before four months of age , and confirmed by the absence of hiv-1 antibody at 18 months of age .", "infants were evaluated at least at birth , two weeks of age , one month of age and then every three to four months until 18 months of age .", "hiv-1 vl was measured either using the ultrasensitive amplicor hiv-1 monitor test or cobas taqman hiv-1 test , v1.0 ( roche molecular systems inc , usa ) for cases in vancouver , and the abott realtime hiv-1 assay ( abbott molecular inc , usa ) for cases in montreal .", "maternal and neonatal adverse reactions were systematically addressed according to who criteria ( 27 ) , with specific attention devoted to hematological and hepatic complications ." ], [ "a nonparametric survival analysis was then conducted to compute the time to achieve a vl < 50 copies / ml and < 1000 copies / ml , respectively .", "a descriptive analysis of population characteristics was performed . because of the non - normal distribution , median and range are reported .", "the statistical analysis was performed using r version 2.11.1 ( r core team , 2013 ) ." ], [ "a total of 11 women who initiated ral during the third trimester of their pregnancies were identified .", "three women ( cases 3 , 5 and 7 ) had a new diagnosis of hiv during the current pregnancy .", "there were no cases of hiv perinatal transmission observed in the in utero - exposed infants .", "indications for ral were late presentation in pregnancy ( n=4 ) and suboptimal vl reduction secondary to poor adherence or viral resistance ( n=7 ) ." ], [ "in our experience , adding ral to a cart regimen was useful in rapidly reducing hiv-1 vl to prevent perinatal transmission in women who have high vl or suboptimal suppression late in pregnancy . our findings are consistent with previously published cases of ral use late in pregnancy , which are summarized in table 2 ( 8,1518,2022,2426,28 ) . among these ,", "only one case of perinatal transmission has been reported ( 8) ; the clinical presentation in that case suggested in utero hiv transmission .", "the reported case of liver toxicity ( 23 ) is , to our knowledge , the second that has been described with ral use in pregnancy ( 29 ) ." ], [ "our findings support the consideration of the use of ral to reduce the risk of perinatal transmission in late - presenting hiv - infected pregnant women and in women with vl rebound near term . however , long - term data are needed to assess the impact of ral use for short - term therapy in the obstetrical setting on the resistance profile . indeed , there is a legitimate concern about the effectiveness of future ral - based regimens .", "moreover , current canadian ( 5 ) and united states perinatal guidelines ( 4 ) are permissive but do not advocate for ral use in this setting due to the lack of established data .", "further research needs to be performed to understand the role of ral in women with hiv acquisition in pregnancy , who are at even higher risk for perinatal transmission .", "the results of two ongoing clinical trials ( nct01854762 and nct01618305 ) will help to assess advantages of ral compared with other antiretrovirals in pregnancy ." ] ]

[ [ "based on this assumption , an aim was set at researching the influences of friction on the \n popliteal region as a manipulation of the body surface , and at considering the mechanism of \n friction s effects from the viewpoint of venous flow .", ", we obtained certain effects such as the relief of pain or improvement \n of the range of joint motion by providing friction to patients with popliteal edemas due to \n osteoarthritis of the knees or disorder of venous flow .", "massages are reported to be effective to alleviate pain and to \n enhance bodily functions . however , while these reports refer to the effects of massages , \n there are some cases which do not actively research the mechanism for how the massage is \n effective . therefore , there are those who insist that massotherapy lacks scientific evidence \n and needs to be verified scientifically10,11,12 . in clinical practice", "massotherapy , defined as a manipulation of the soft tissues , is often provided to specific \n areas or whole body parts aiming at the following effects : enhanced blood flow , relief of \n muscle tension , improvement of autonomic nerve functions , prevention of bad conditions or \n injuries , and easing of pains1,2,3 . in recent years , \n massages have been admitted in international treatment guidelines4 , 5 as one of the \n recommended therapies requiring further scientific verification ." ], [ "changes in blood flow velocity of the popliteal vein was \n monitored before and after intervention ( a comparative study : after versus before ) .", "during this study , friction massage was performed on the area surrounding the popliteal \n vein in healthy volunteers .", "friction massage was performed by \n the thumbs , moving them in small circles ( 23 cm ) at a frequency of 3 hz . \n", "friction massage was performed on the intermediate point between \n the medial and lateral heads of the gastrocnemius muscle .", "the measurement profiles of the blood flow velocity were obtained from pictures of the \n right popliteal vein by reference to the international guideline17 . based on all the pictures ,", "after that , the blood flow velocity of the popliteal vein was measured for the \n first time .", "measurement of the popliteal vein was conducted using doppler ultrasonography with the \n subjects in a prone position .", "the pictures of popliteal veins were identified \n in the b mode on the location two centimeters from the central region of the popliteal \n fossa ." ], [ "participants characteristics are shown in table \n 1table 1.characteristics of study participantsparameters(n=15)age ( years)21.4 1.7height ( cm)173.6 3.8weight ( kg)59.3 3.2bmi ( kg / m)19.7 0.9values are expressed as means sd.bmi : body mass index .", "in addition , parameter values before and after friction are shown in table 2table 2.blood flow velocity changes before and after friction massageprepostblood flow velocity ( cm / s)13.8 2.8 23.3 6.9*values are expressed as means sd .", "based on this \n result and the average values , it is possible to understand that the blood flow of the \n popliteal vein had a higher velocity after friction compared to before friction .", "significantly different between pre- and post - friction measurements , * p<0.01 . when a t - test was conducted , there were significantly large differences \n between pre- and post - friction measurements ( t=7.162 , df=14 , p<0.01 ) ." ], [ "in this study , regarding the venous flow of the lower legs , the effects of friction on \n popliteal regions was evaluated , using the blood flow velocity of the popliteal vein as an \n index .", "the blood flow velocity of the popliteal vein increased when friction was provided to \n the popliteal region .", "the result of this study showed that friction had an effect to heal these clinical \n conditions and disorders ." ] ]

[ [ "the most common cardiac disorder is an ostium secundum asd , followed by ventricular septal defect ( vsd ) and ostium primum asd .", "holt - oram syndrome ( hos ) is an autosomal dominant condition with complete penetrance . manifested in 1:1 , 00 , 000 live births and characterized by forelimb deformities , congenital heart disease and/or cardiac conduction abnormalities .", "congenital cardiac and upper limb malformations frequently occur together and are classified as heart hand syndromes .", "it is linked to a single - gene tbx5 protein - producing mutation with gene map locus 12q24 and is the most commonly occurring heart - hand syndrome ." ], [ "a full term female neonate born out of a nonconsanguineous marriage by cesarean section ( indication - previous cesarean section with polyhydramnios ) to a 25-year - old ( weight 58 kg , height 155 cm ) booked g3p1l1a1 with unremarkable antenatal history .", "the neonate was referred to a cardiac center for further management , however due to lack of resources the baby died on day 4 of life .", "family history revealed that the father has radial ray deformity of left upper limb without any cardiac anomaly ." ], [ "holt - oram syndrome is an autosomal dominant disorder characterized by distinctive malformation of bones of the upper limbs and abnormalities of the heart .", "the association with aortic atresia is extremely rare . as per best of our knowledge ,", "till date there were no cases reported in the literature having a description of hos with aortic atresia ." ], [ "has / have given his / her / their consent for his / her / their images and other clinical information to be reported in the journal .", "the authors certify that they have obtained all appropriate patient consent forms . in the form the patient(s )", "the patients understand that their names and initials will not be published and due efforts will be made to conceal their identity , but anonymity can not be guaranteed ." ] ]

[ [ "idiopathic dilated cardiomyopathy ( dcm ) is a heart muscle disorder characterized by systolic dysfunction and dilation of the left or both ventricles in the absence of any other possible cause.1 dcm can develop in people of any age or ethnicity , although it is more common in male than female persons ( occurring at a ratio of 3:1 in male to female persons ) and typically manifests in the third to fourth decades of life.2 , 3 dcm is the predominant cause of cardiomyopathy in both adult and pediatric populations.3 , 4 in adults , dcm has an estimated prevalence of 1:2500.3 in contrast , annual incidence in pediatric populations has been reported to be much lower : 1:170 000 in the united states5 and 1:140 000 in australia.6 \n although pediatric dcm has a lower annual incidence than adult dcm , the outcome for pediatric dcm patients is particularly severe.7 , 8 , 9 dcm is the most frequent cause of heart transplantation ( htx ) in pediatric patients.10 data from international pediatric dcm registries indicate that the rates of death or htx over 1 and 5year periods were 31% and 46% , respectively.4 conversely , recent data showed that the htxfree survival rate in adult dcm patients receiving optimal treatment is > 85% at 8 years.2 \n comparative studies between pediatric and adult dcm populations are currently lacking in the literature .", "the aim of this study was to provide insights into the longterm characterization and outcome of dcm in a pediatric population compared with an adult one to ultimately improve the clinical management of dcm in children .", "in fact , because of the difficulty of performing controlled clinical trials with pediatric populations , the number of such trials has been limited.10 consequently , the treatment strategies used for pediatric dcm patients have been extrapolated primarily from data based on clinical trials using adult dcm patients . by better characterizing the baseline and longterm progression and outcome of pediatric dcm patients in comparison to adult dcm patients , for which ample data have already been collected , it is thought that improved treatment strategies could be developed for pediatric patients ." ], [ "second , linear mixedeffects models with time and group as the covariates ( in which time is the followup visit and group was defined as either pediatric or adult ) were used to investigate whether a different behavior was present between the groups over time ( by means of the interaction term timegroup evaluated in the models ) . for the binary parameters , generalized linear mixed models were applied.17 because of the size difference between the pediatric and adult groups , we compared the survival of the pediatric patients with that of a sample of adult patients randomly matched in a 1:3 ratio to increase the efficacy of the survival comparison .", "patients who were aged 18 years at enrollment were considered part of the pediatric population.6 , 16 to improve the accuracy of our comparisons between 2 differently sized populations , prognostic assessment statistics compared the pediatric population with a sample of adult controls randomly matched in a 1:3 ratio ( 47 pediatric patients to 141 adult patients ) .", "last , univariate and multivariate cox regression models were estimated in the target population ( pediatric patients ) .", "three outcome measurements were primarily investigated : ( 1 ) death or htx , ( 2 ) sudden cardiac death or malignant ventricular arrhythmia ( mva ) , and ( 3 ) death caused by pump failure or htx .", "clinical and instrumental data were recorded at enrollment and then after 6 months ( range 38 months ) , 12 months ( range 918 months ) , and 24 months ( range 1936 months ) in followup evaluations . at > 24 months after enrollment , patients were recorded at least once every 2 years .", "only univariable hazard ratios were estimated for the secondary end points ( sudden cardiac death or malignant ventricular arrhythmia and death from pump failure or htx ) ." ], [ "we analyzed data from all dcm patients that had consecutively enrolled in the trieste heart muscle disease registry in italy between 1988 and 2014 , according to the protocol approved by the institutional review board of the trieste hospital administration and the local ethics committee .", "clinical and instrumental data were recorded at enrollment and then after 6 months ( range 38 months ) , 12 months ( range 918 months ) , and 24 months ( range 1936 months ) in followup evaluations . at > 24 months after enrollment , patients were recorded at least once every 2 years .", "patients who were aged 18 years at enrollment were considered part of the pediatric population.6 , 16 to improve the accuracy of our comparisons between 2 differently sized populations , prognostic assessment statistics compared the pediatric population with a sample of adult controls randomly matched in a 1:3 ratio ( 47 pediatric patients to 141 adult patients ) .", "conventional 2dimensional echocardiographic mmode pulsed doppler and tissue doppler imaging were all performed according to international guidelines.14 , 15 after enrollment , if not contraindicated , all patients received standard medical therapy with angiotensinconverting enzyme inhibitors , angiotensin receptor blockers , and beta blockers titrated to the highest tolerated dose .", "the investigation was in line with the principles outlined in the declaration of helsinki.11 \n the diagnosis of dcm was assigned according to the current guidelines.1 , 12 , 13 we excluded patients with a secondary cause of myocardial damage , including coronary artery disease ( investigated with coronary angiography / computed tomography ) , hypertensive disorder , valvular disease , biopsyproven active myocarditis , associated congenital heart disease , history of chemotherapy or pharmacologic cardiotoxicity , pulmonary parenchymal or vascular disease , immunological disease , and mitochondrial disease ( studied by complete neurological examination , plasma lactate and amino acids , urine amino and organic acids , and pyruvate and acylcarnitine profiles , if indicated).2 neuromuscular disease was investigated with a laboratory test ( ie , creatine kinase ) and electromyography and , for final diagnosis , by skeletal muscle biopsy if clinically indicated . in the absence of family history of dcm and in the presence of severe recentonset heart failure ( hf ) , all pediatric patients underwent endomyocardial biopsy and , from 2010 , cardiac magnetic resonance to exclude active myocarditis . at enrollment , all patients underwent an initial screening that included a detailed clinical and family history interview , a complete clinical examination , an electrocardiogram , 24hour holter monitoring , and a comprehensive echocardiographic evaluation .", "this was adjusted for the most relevant baseline differences between the 2 groups , as explained in the statistical analysis section ." ], [ "three outcome measurements were primarily investigated : ( 1 ) death or htx , ( 2 ) sudden cardiac death or malignant ventricular arrhythmia ( mva ) , and ( 3 ) death caused by pump failure or htx .", "all patients with refractory hf requiring inotropic treatment and/or mechanical support or with lifethreatening arrhythmias unresponsive to medical therapy and/or catheter ablation and who did not have contraindications were listed for urgent htx.2 \n sudden death was defined as immediate death occurring within 1 hour after the onset of symptoms or during sleep in stable patients with new york heart association ( nyha ) class i to iii disease .", "mvas were defined as ventricular fibrillation / flutter or sustained ventricular tachycardia ( > 30second duration of > 200 beats per minute or hemodynamically significant ) , as recorded by an implantable cardioverterdefibrillator or external defibrillation .", "data were collected over followup periods of 1 , 6 , and 9 years .", "other investigated outcomes included cardiovascular death , noncardiac death , and death from unknown causes ." ], [ "the trieste heart muscle disease registry is a local relational database , active since 1978 , that systematically collects the data of patients affected by dcm and other cardiomyopathies consecutively evaluated in the cardiovascular department of the azienda ospedalierouniversitaria ospedali riuniti of trieste .", "used as a client interface , the system has all of the characteristics of a rapid application development client / server system .", "data registration is composed of a table series corresponding to the clinical ( history , family study , clinical examination ) and instrumental evaluation ( laboratory examinations ; electrocardiography ; holter monitoring ; echocardiography ; and , when indicated , cardiac catheterization and endomyocardial biopsy ) and pharmacological therapy at baseline and at scheduled followup evaluations . a section dedicated to fatal and nonfatal events and their causes is also present ." ], [ "second , linear mixedeffects models with time and group as the covariates ( in which time is the followup visit and group was defined as either pediatric or adult ) were used to investigate whether a different behavior was present between the groups over time ( by means of the interaction term timegroup evaluated in the models ) . for the binary parameters , generalized linear mixed models were applied.17 because of the size difference between the pediatric and adult groups", ", we compared the survival of the pediatric patients with that of a sample of adult patients randomly matched in a 1:3 ratio to increase the efficacy of the survival comparison .", "the limited sample size and number of events in this group were taken into account using a backwardconditional stepwise procedure to select the subset of the most powerful independent predictors .", "last , univariate and multivariate cox regression models were estimated in the target population ( pediatric patients ) .", "the matching procedure accounted for the variables that were significantly different at baseline between the 2 populations and that had known possible relevance for the outcome in dcm patients .", "this was achieved by 1way anova for continuous variables or the nonparametric median test , as necessary ; for categorical variables , the chisquare or fisher exact test was used , as appropriate . to assess the longitudinal changes in the investigated parameters ,", "first , simple tests for repeated consecutive measures were calculated separately for each group ( the mcnemar test for binary parameters and the paired t test for continuous parameters ) .", "eventfree survival curves for the 3 primarily investigated outcomes ( described in the clinical outcomes section ) were estimated and plotted using the kaplan meier method ." ], [ "incidence of major cardiovascular outcomes in pediatric and adult patients with idiopathic dilated cardiomyopathy hf indicates heart failure ; htx , heart transplant ; icd , implantable cardioverterdefibrillator ; mva , major ventricular arrhythmias ; sd , sudden death .", "pediatric age ( ie , < 18 years ) was associated with increasing risk of all major events : d / htx ( a ) , dhf / htx ( b ) , sd / mva ( c ) .", "of the entire population of 927 dcm patients enrolled between 1988 and 2014 , 47 ( 5.1% ) were pediatric ." ], [ "of the entire population of 927 dcm patients enrolled between 1988 and 2014 , 47 ( 5.1% ) were pediatric .", "table 1 shows the clinical data of the pediatric population at baseline compared with the adult group.18 a family history of dcm was significantly more common among the pediatric population ( 34.8% versus 17.5% ; p<0.03 ) .", "the median followup time after the first clinical evaluation was 110 months ( interquartile range 54185 months ) .", "pediatric patients were also characterized by a shorter duration of hf symptoms ( median 0 months [ interquartile range , 1st3rd quartiles : 06 months ] versus 1 month [ interquartile range , 1st3rd quartiles : 07 months ] ; p<0.04 ) . both groups received optimized treatments for hf without agerelated differences . despite different features at baseline , no significant differences were observed between the pediatric and adult populations regarding the longterm longitudinal trends in nyha functional classes iii iv , left ventricular enddiastolic diameter and volume , lvef , and restrictive filling pattern .", "the pediatric patients presented with significantly lower systolic arterial blood pressure ( 11620 versus 12517 mm hg ; p<0.01 ) , a lower presence of left bundlebranch block ( 4.4% versus 31.9% ; p<0.001 ) , and a higher occurrence of left ventricular ejection fraction ( lvef ; 3613 versus 3211 ; p<0.03 ) ." ], [ "incidence of major cardiovascular outcomes in pediatric and adult patients with idiopathic dilated cardiomyopathy hf indicates heart failure ; htx , heart transplant ; icd , implantable cardioverterdefibrillator ; mva , major ventricular arrhythmias ; sd , sudden death .", "pediatric age ( ie , < 18 years ) was associated with increasing risk of all major events : d / htx ( a ) , dhf / htx ( b ) , sd / mva ( c ) .", "d / htx indicates death or heart transplantation ; dhf / htx , heartfailure death or heart transplantation ; sd / mva , sudden death or major ventricular arrhythmias . finally , we performed a univariate and subsequent multivariate cox analysis among the pediatric population to identify possible prognostic indicators .", "table 2 shows the incidence of major events in the pediatric population and the entire adult dcm population ." ], [ "this study compared the characterizations , longterm progression , and outcomes of adult and pediatric dcm patients .", "this topic highlights a challenging issue in the management of dcm : whether to implant an implantable cardioverterdefibrillator for primary prevention in children .", "furthermore , in the current literature , comparative studies of adult and pediatric dcm patients are lacking .", "this underscores the relevant role of pediatric age for short and longterm management of dcm .", ", it remains a major event in the natural history of dcm that has the same impact of death in the prognostic evaluation of the disease , especially considering that only urgent htx examples were included ." ], [ "this study compared the characterizations , longterm progression , and outcomes of adult and pediatric dcm patients .", "this underscores the relevant role of pediatric age for short and longterm management of dcm .", "furthermore , in the current literature , comparative studies of adult and pediatric dcm patients are lacking .", "familial screening allows diagnosis at an earlier stage of the disease , with a consequently better longterm outcome ." ], [ "this topic highlights a challenging issue in the management of dcm : whether to implant an implantable cardioverterdefibrillator for primary prevention in children .", "nevertheless , an important arrhythmic profile in the pediatric patients compared with the adults clearly emerged in this study .", "interestingly , at univariate analysis , family history positive for dcm emerged as the only significant predictor of arrhythmic events in the pediatric population .", "this could suggest that some clusters of gene mutations have an important role in inducing specific arrhythmic phenotypes .", "the identification of predictors of sudden death and mva in pediatric dcm patients was beyond the scope of our study because of the limited number of events .", "notably , in our study , the poorer prognosis in pediatric cases resulted not only from the progression of hf and htx but also from arrhythmic events ( figures 2c and 3c ) . in the current literature ," ], [ "because of the observational nature of the present study , it is possible that beta blocker intolerance was a surrogate for advanced disease state , and a largescale randomized trial is needed to definitively assess the benefit of beta blockers in a pediatric dcm population .", "finally , the resulting independent prognostic factors that emerged from our multivariate analysis ( tolerance of beta blocker therapy , lvef , nyha class ) confirm previous studies24 , 25 and reflect the same features that are included in adult dcm prognostic models.2 the protective role that emerged for beta blockers could confirm their benefit in pediatric as well as adult dcm patients . nevertheless ,", "accordingly , our study showed twice the prevalence of familial forms of dcm in the pediatric population compared with the adult patients ( 34.8% versus 17.5% ) , encouraging genetic screening in these patients and their relatives . in some cases , a positive result may influence clinical management , as in the presence of lamin a / c ( lmna ) mutations.21 , 22 in other cases , the discovery of a mutation has no impact on the clinical management of the disease because , currently , wide genotype phenotype correlation data are still lacking .", "most cases are idiopathic , followed by familial forms3 ; therefore , pediatric forms may be caused by particularly aggressive genetic mutations leading to rapidly progressive disease ." ], [ "moreover , the rarity of this disease among the pediatric population in general influenced the size of the samples studied . to overcome this issue ,", "another limitation concerns the availability of longterm followup data , which were not complete for all patients because of the event rates and censoring mechanism .", "consequently , the longterm trends of the main clinical and echocardiographic features shown in figure 1 should be interpreted with caution and confirmed by future studies that go on for a longer time . in our opinion , however , the comparison with the adult population ( affected by the same limit ) is reliable . for most of the patients ,", "a casecontrol like strategy was achieved by means of a random matching procedure .", "finally , we included htx in the composite end point even though it is not a fatal event . in our opinion , it remains a major event in the natural history of dcm that has the same impact of death in the prognostic evaluation of the disease , especially considering that only urgent htx examples were included .", "the genetic data and cardiac magnetic resonance information were lacking , thus we could not include these data in our analyses . because of the limited number of events , uni and multivariable analyses were presented mainly for exploratory purposes and should be confirmed in larger series .", "future focused studies are warranted to assess the possible prognostic role of these tools in pediatric populations compared with adults ." ], [ "the data of this italian registry suggest that pediatric dcm patients are rare but have a worse outcome than adult patients .", "these findings were further confirmed after adjusting for other covariates that were significantly different from adults at the time of the onset of the disease .", "this is despite similar treatments , a less advanced stage of the disease at baseline in children , and similar clinical and echocardiographic longterm progression .", "finally , pediatric age emerged as an important prognostic predictor of both death from hf and lifethreatening ventricular arrhythmias ." ], [] ]

[ [ "though limited in efficacy in many cases , the control methods available today represent a major progress when compared to the lack of any means for the control of these plants one or two decades ago .", "the application of ngs technologies will provide a new research framework and molecular tools to be applied in resistance to ascochyta blight in legumes .", "crops can be protected by resistance , by selective fungicides , by biocontrol agents , and by cultural methods that did not existed before . the current focus in applied", "breeding is leveraging biotechnological tools to develop more and better markers to allow marker assisted selection with the hope that this will speed up the delivery of improved cultivars to the farmer . to date , however , progress in marker development and delivery of useful markers has been slow in legumes .", "we are now also facing an accelerated progress in the genomic and biotechnological research , which should soon provide important understanding of some crucial developmental mechanisms in both the parasites and their host plants and will provide candidate genes for resistance to ascochyta blight ." ], [ "the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest ." ] ]

[ [ ", we describe a rare case in which a lesion was initially thought to be a single tumor but was ultimately diagnosed as 2 contiguous tumors ( malt lymphoma and hemangioma ) using contrast - enhanced ultrasonography ( ceus ) with sonazoid ( daiichi sankyo , tokyo , japan ) .", "marginal zone b - cell malignant lymphoma is a low - grade malignant non - hodgkin 's lymphoma that develops in mucosa - associated lymphoid tissue ( malt ) .", "most cases are diffuse large b - cell lymphoma , and the incidence of hepatic malt lymphoma is low among cases of primary hepatic malignant lymphoma [ 2 , 3 , 4 , 5 ] . here", "this disease frequently develops in the stomach and also occurs in the salivary gland , thyroid , and lung ." ], [ "based on these findings , the medial part of the tumor was diagnosed as hemangioma . in the lateral part ,", "furthermore , the lateral part showed a defect in the postvascular phase , and this defect led to the suspicion of a malignant tumor , including hepatocellular carcinoma ( hcc ) .", "the lateral part of the tumor was diagnosed as marginal zone b - cell lymphoma .", "liver hemangioma was suspected for the medial part of the lesion based on the typical contrast findings on mri and ceus . in the lateral part ,", "grayscale us showed a tumor with a snowman - like appearance and a relatively clear boundary in the s6 of the liver , with hypo- and hyperechoic areas in the lateral and medial parts of the lesion , respectively ( fig .", "the patient was a 60-year - old female in whom a tumor of 15 mm in diameter was detected in the couinaud 's segment ( s6 ) of the liver on the grayscale us in a medical examination ." ], [ "it is possible that the absence of this feature differentiates primary hepatic malt lymphoma from other malignant lymphomas .", "a literature search indicated that 2 cases of simultaneous malt lymphoma and hemangioma in the liver have been reported , with focal nodular hyperplasia also present in 1 of these cases [ 11 , 12 ] . in both previous cases ,", "primary hepatic malignant lymphoma is rare , with most cases being diffuse large b - cell lymphoma and less than 10% being malt lymphoma [ 2 , 3 , 4 , 5 ] .", "malt lymphoma is a low - grade malignant non - hodgkin 's lymphoma that develops in mucosa - associated lymphoid tissue , and accounts for 78% of all cases .", "malt lymphoma frequently develops in the stomach , and also occurs in the salivary gland , thyroid , and lung .", "the development of a malt lymphoma is thought to involve persistent chronic inflammation , and helicobacter pylori infection is well - known in gastric malt lymphoma . in primary hepatic malt lymphoma" ], [ "the concomitant occurrence of these tumors is rare , and no cases with 2 tumors in contact have been previously reported .", "the lesion in our patient was initially considered to be a single tumor , but contiguous hepatic malt lymphoma and hemangioma were actually present .", "the tumors gave different enhancement patterns on ceus and their presence was confirmed histopathologically , based on which we were able to make the final diagnosis ." ] ]

[ [ "mdr tb , multidrug - resistant tuberculosis ; xdr tb , extensively drug - resistant tb .", "dst , drug susceptibility testing ; mdr tb , multidrug - resistant tb ; xdr tb , extensively drug - resistant tb . among xdr", "determination of prevalence of tuberculosis ( tb ) and drug resistance among persons with suspected tb , tugela ferry , south afica , 20082009 .", "mdr tb and xdr tb incidence was 118 cases and 72 cases/100,000 population , respectively , in 2007 ( 4 ) ." ], [ "routine drug - resistance surveillance to first- and second - line drugs is conducted in tugela ferry , which has a high incidence of tb and hiv co - infection . in this study", ", we expanded second - line testing for 2 additional bactericidal drugs ( capreomycin and ethionamide ) for treatment of patients with xdr tb .", "although new drugs are being developed , efforts must target prevention of xdr tb and its transmission , earlier identification of cases , support of treatment completion for tb and mdr tb , and greater use of antiretroviral therapy for patients who are co - infected with hiv .", "according to the standard xdr tb regimen used in this province , patients were receiving <3 active drugs ( pyrazinamide , p - aminosalicylic acid , and cycloserine ) , which increases the risk for treatment failure and further amplification of drug resistance ." ] ]

[ [ "we report a rare case of ps that presented with hypertrophy of index and middle finger without any other abnormalities or complications .", "proteus syndrome ( ps ) is a rare and sporadic disorder that causes postnatal overgrowth of tissues in a mosaic pattern .", "the complications of ps include , progressive skeletal deformities , invasive lipomas , benign and malignant tumors , and deep venous thrombosis with pulmonary embolism ." ], [ "incidentally we noticed that he had enlarged index and middle fingers of both hands and thumb of right hand [ figure 1 ] . on probing patient revealed that it was present since childhood with onset around the age of 5 years and gradual progression over years to the present size .", "no similar tissue growth in other parts of the body and there was no one in the family with similar features . on examination", "hypertrophy of index and middle finger of both the hand ( a , b , c ) and thumb of the right hand ( c ) laboratory investigations revealed normal renal and liver function tests .", "his x - ray of hands showed hyperostosis of involved fingers [ figure 2 ] ." ], [ "our patient was managed as a case of inferior wall mi and is presently on anti - ischemic medications with no new complications . in conclusion , ps is a very rare and highly variable , progressive tissue overgrowth disorder .", "criteria for the diagnosis of proteus syndrome there is no specific molecular marker , or laboratory test , for the diagnosis of ps . the diagnosis is mainly based on history , clinical examination and imaging studies .", "patients should be kept under regular follow - up for the development of complications and their management .", "the tissue overgrowth is usually absent or mild at birth and progressive in nature but usually appears to plateau after adolescence ." ] ]

[ [ "zorca et al.11 reported that elevated plasma tg is a potential risk factor for pulmonary hypertension ( ph ) in sca subjects . the impact of disordered lipid metabolism on the course of sca and its numerous complications are not yet clearly defined . also , there is little information on the lipid profile of sca subjects in voc . due to the present dearth of knowledge", "; this study determined the lipid profile of adult nigerians with sca in vaso - occlusive crisis ( voc ) and in steady state ( ssca ) .", "sickle cell anaemia ( sca ) is a monogenic disorder resulting from substitution of glutamic acid with valine in position 6 of the -chains of haemoglobin ( hb ) .", "it is characterised by the production of abnormal hb referred to as sickle hb or hbs.123 the prevalence of sca is high in sub - saharan africa with nigeria having the highest burden.45 sca has been associated with hyperhaemolysis , cerebrovascular disease , acute chest syndrome , vaso - occlusive crisis , pulmonary hypertension and premature death among others.67 relatively , individuals with sca enjoy a compensated state of ill health interspersed with periods of acute exacerbation characterised by hyperhaemolytic ( anaemic ) or vaso - occlusive ( voc ; painful crisis ) with infection , tissue hypoxia and micro - vascular occlusion as important predisposing events.68 abnormal lipid homeostasis has been reported in sca as well as other haematological disorders such as -thalassemia and this has been suggested to have the potential to alter membrane fluidity and function of red blood cell ( rbc ) in individuals with sca.91011 earlier studies reported significant increase in plasma triglyceride ( tg ) levels and concurrent significant decrease in plasma levels of total cholesterol ( tc ) , high - density lipoprotein - cholesterol ( hdl ) and low - density lipoprotein - cholesterol ( ldl ) in sca subjects.91112 several inconclusive mechanisms such as heightened erythropoiesis ( causing increased cholesterol utilization ) , defective liver function ( due to iron overload ) and defects in postabsorptive plasma homeostasis of fatty acids have been put forward to explain the pathogenesis of this sca - associated lipid abnormalities.913 however , it is worthy of note that this lipid phenotype is generally recognized as a risk factor for cardiovascular diseases ." ], [ "eighty - two participants comprising 58 adults with sca ( 30 in steady state and 28 in voc ) and 24 age - matched healthy individuals with hbaa genotype were recruited into this study .", "haemoglobin phenotype of each subject was determined using standard electrophoretic method at ph 6.8 while pcv and wbc were determined as described by cheesbrough.15 plasma lipid profile was determined using enzymatic method while ldl was calculated using friedwald equation.16 the distribution of the data was assessed using histogram with normal curve .", "after an overnight fast of about 10 hr , 5 ml of venous blood was obtained from each sca subject in steady state ( ssca ) and the controls .", "blood pressure ( bp ) was obtained using a mercury sphygmomanometer after at least 10 minutes of rest .", "blood samples were dispensed into edta - containing samples bottles and after determining the packed cell volume ( pcv ) and total white blood cell count ( wbc ) , plasma was appropriately obtained and stored at 20c until analyses were done .", "samples were collected upon admission in the voc group as voc is an acute clinical condition hence ; could not have been predicted for possible overnight fast .", "steady state ( ssca ) and vaso - ooclusive crisis ( voc ) were defined as earlier reported.14 subjects with other forms of genotype apart from hbss and hbaa , diabetes mellitus , hypertension , human immunodeficiency virus ( hiv ) , hepatitis , cancer and with established endocrine dysfunctions were excluded from the study ." ], [ "results are presented as mean standard deviation or as median ( interquartile range ) for gaussian and non - gaussian distributed data , respectively .", "analysis of variance ( anova ) or kruskal - wallis test was used to compare all the three groups while differences between two groups were determined using independent student 's t - test or man - whitney u as appropriate ." ], [ "pcv , tc , hdl and ldl were significantly lower while wbc was significantly higher in sca compared with the control subjects .", "similarly , tc and ldl were significantly lower in sca subjects in vaso - occlusive crisis ( voc ) compared with controls . however , tc , tg , ldl and tg / hdl were significantly lower while hdl was significantly higher in voc compared with ssca .", "other components of the lipid profile had no specific pattern of differences . characteristics of the subjects in table 3 , tc and hdl were significantly lower while tg / hdl was significantly higher in sca subjects in steady state ( ssca ) compared with the control subjects .", "there was insignificant reduction in the levels of tc , tg , ldl , tg / hdl and insignificant elevation of hdl level in sca subjects with > 11.97 ( 10/l ) wbc compared with sca subjects with 11.97 ( 10/l ) lipid profile in ssca , voc and control subjects pattern of lipid profile based on mean total white blood cell count ( wbc ) in sca subjects" ], [ "despite intense research for over 4 decades , mechanism of lipid homeostasis alteration in sca subjects is not yet fully understood.11 the observed lower levels of tc , hdl and ldl in the combined sca subjects ( ssca and voc ) are not novel findings .", "it was , therefore , suggested that sca - associated hypocholesterolemia is a consequence of anaemia itself and not increased erythropoiesis.1117 the interaction between sca complications such as voc and disturbed metabolic homeostasis in individuals with sca has been reported.1419 in this study , tc and ldl decreased progressively from control - to - ssca - to - voc .", "hypocholesterolemia has been widely reported in sca subjects1112 and was thought to be due to increased cholesterol utilization consequent to increased erythropoiesis of sca .", "however , the reports of westerman17 and ngogang et al.,18 showed that hypocholesterolaemia is a common feature of both haemolytic and non - haemolytic anaemia and that serum cholesterol is in equilibrium with the cholesterol content of total red cell mass .", "unfavorable plasma fatty acid composition has been associated with clinical severity of sca.23 similarly , nouraie et al.20 reported that intensity of haemolytic anaemia is an independent risk factor for the development of sca complications such as ph and hypoxaemia . in this study ,", "zorca et al.11 reported that high tg / hdl is associated with endothelial dysfunction and suggested that high tg / hdl is a potential risk factor for pulmonary hypertension ." ], [ "our study further confirms the widely reported defective lipid homeostasis in adults with sickle cell anaemia .", "it also showed that the alteration in the lipid metabolism becomes pronounced with vaso - occlusive crisis ." ] ]

[ [ "\n obesity is a key public health issue for us youth , particularly among specific sociodemographic groups , including some racial / ethnic and sexual orientation groups [ 1 , 2 ] .", "disparities in bmi among sexual minorities have been explained primarily using the minority stress model , which suggests that experiences of prejudice and discrimination based on minority status negatively affect health .", "however , little is known about the intersection of race / ethnicity and sexual orientation and its impact on youth weight status .", "we are aware of only one study with a representative sample of adolescents examining sexual orientation disparities in bmi in a multiethnic sample , which found that bisexual female and male youth were at elevated risk for obesity compared to same - gender heterosexual youth across race / ethnicity groups .", "we hypothesized that female sexual minorities , particularly bisexual individuals , would have consistently higher bmi over time than heterosexual females ." ], [ "after exclusion criteria were applied ( described below ) , the current sample included 7,140 females and 6,166 males , who contributed data to at least one of the four waves of add health , a us nationally representative longitudinal cohort .", "analyses were restricted to participants who provided a report of sexual orientation identity at wave iii and self - identified as non - latino white ( 59% ) , non - latino black / african american ( 23% ) , and latino ( 18% ) at wave i. other race / ethnicity groups were excluded due to a small sample size within some sexual orientation groups .", "age was modeled both linearly and quadratically and sexual orientation - by - age was used to model repeated measures of continuous bmi across ages 1134 years , with age and bmi updated at each wave .", "race and ethnicity were assessed separately at wave i but recoded and combined into the following groups for analysis : non - latino white , non - latino black / african american , and latina / o .", "participants who responded that they were not sexually attracted to either gender were excluded from the analyses , and mostly homosexual and 100% homosexual were combined into lesbian / gay due to small sample sizes , yielding the following sexual orientation identity groups : heterosexual , mostly heterosexual , bisexual , and lesbian / gay . to address the nonlinearity of bmi across development [ 2123 ] ,", "age in years and age - specific bmi ( kg / m ) calculated from self - reported height and weight were assessed at each wave .", "sexual orientation identity was assessed at wave iii with one item asking participants to choose the description that best fits how they think about themselves , with the following response options : 100% heterosexual ( straight ) ; mostly heterosexual ( straight ) , but somewhat attracted to people of your own sex ; bisexual , that is , attracted to men and women equally ; mostly homosexual ( gay ) , but somewhat attracted to people of the opposite sex ; 100% homosexual ( gay ) ; not sexually attracted to either males or females .", "self - reported height and weight were used because measured height and weight were not available at all four waves . to test the hypotheses , we conducted longitudinal unweighted linear generalized estimating equation analyses in sas ( version 9.3 ; cary , nc ) .", "we conducted unweighted analyses because the complexity of the models in examining bmi trajectories across waves and accounting for clustering by schools did not allow for the incorporation of weights ." ], [ "bisexual individuals showed a different pattern , with bisexual males showing greater one - year bmi gains over time compared to heterosexual males , but only among non - latino white participants .", "sexual orientation and race / ethnicity group differences in mean age at each wave were found . among females , bisexuals and", "mostly heterosexual individuals were significantly younger ( bisexual range : 0.33 to 0.43 years ; mostly heterosexual range : 0.25 to 0.30 years ) than completely heterosexual individuals at all waves , p < 0.02 to p < 0.0001 .", "non - latina white and latina bisexual individuals had higher bmi compared to their heterosexual female counterparts , while no sexual orientation differences were observed among non - latina black / african american females ( see table 2 , figure 1 ) . among males , the association between sexual orientation and bmi differed significantly by age within each of the three race / ethnicity groups .", "gay males had higher bmi than heterosexual males in early adolescence . however , heterosexual males showed greater one - year bmi gains over time surpassing gay males by approximately age 17 years , with disparities widening further as participants aged into adulthood ( see table 2 , figure 1 ) .", "descriptively , among both females and males across sexual orientation and race / ethnicity groups , age - specific bmi increased substantially across time from age 11 to 34 years ( table 1 , figure 1 ) . among females ," ], [ "previous research with a predominantly white cohort of youth found that age modified sexual orientation disparities in bmi in males .", "the current research extended these findings to non - latino black / african american and latino young men . during adolescence and young adulthood , heterosexual males demonstrated greater yearly increases in bmi compared to gay males , putting them at excess risk for obesity .", "other research has suggested that sexual minority male adolescents and young adults are less likely to attempt to gain weight compared to completely heterosexual male youth , which may represent a protective factor against the development of obesity among sexual minority male youth .", "in addition , more research is needed to understand why bisexual females and males and heterosexual males have greater risk for increased bmi and whether membership in other sexual orientation groups may confer specific protective factors against weight gain and development of obesity .", "results from the current study highlight the need for research on health outcomes within sexual minority subgroups , in addition to comparing sexual minorities with completely heterosexual individuals ." ], [ "non - latina white and latina bisexual individuals had higher bmi than same - race / ethnicity heterosexual individuals regardless of age ; there were no sexual orientation differences in non - latina black / african americans .", "obesity prevention and intervention efforts should target healthy body image and weight - management methods for all youth , but additional resources may be needed for sexual minority youth . in particular , interventions should be designed in such a way as to not exacerbate risk of unhealthy weight control behaviors and eating disorders . in summary ,", "findings from this study demonstrated that sexual orientation and gender differences in bmi are not limited to non - latino white youth and young adults . among males ,", "heterosexual males showed greater one - year bmi gains than gay males across all race / ethnicity groups . among females ,", "it is clear from these results that sexual orientation disparities in bmi are a public health concern across race / ethnicity groups .", "obesity prevention initiatives and treatment interventions addressing unhealthy weight gain in adolescence and young adulthood must be relevant for all sexual orientations and race / ethnicities ." ] ]

[ [ "we present the case of a 67-year - old asian woman who had a m. intracellulare infection presenting with multiple cavitating pulmonary nodules , which was differentiated from metastatic lung disease by percutaneous transthoracic needle aspiration ( pcna ) .", "there have been many reports concerning its radiologic findings.123 ) although uncommon , several cases of solitary pulmonary nodules ( spn ) caused by mac pulmonary infections have been reported,456 ) which is different from the typical presentation of mac .", "nontuberculous mycobacteria ( ntm ) have emerged as an increasingly important pathogen in the last two decades . unlike other environmental pathogens that are largely opportunistic in patients with malignancy and immunodeficiency , as well as transplant recipients , ntm can cause significant disease in otherwise healthy individuals .", "the ntm most commonly associated with pulmonary infection is the mycobacterium avium complex ( mac ) , which is a microbial complex of mycobacterium avium and mycobacterium intracellulare .", "however , a case of a multiple cavitating nodular infection with neither a fibrotic change nor nodular bronchiectasis associated with m. intracellulare has not been reported ." ], [ "the lung tissue from the biospy confirmed the diagnosis obtained from the bronchial washing fluid culture . with the diagnosis of ntm infection", "this finding was consistent with ntm infection , and we could exclude metastatic lung disease . in conclusion ,", "we isolated the patient because we could not exclude the possibility of mtb along with metastatic lung disease .", "she presented to a local clinic after a single occurrence of hemoptysis 10 days prior .", "therefore , the patient was diagnosed with ntm , so the patient 's quarantine was lifted ." ], [ "our case report highlights the importance of differentiating among mtb , mac infection , and metastatic lung disease in cases of multiple cavitary nodules .", "the traditionally recognized presentation of mac lung disease is as an apical fibrocavitary lung disease with large cavities , located in the upper lobe .", "m. avium is the more important pathogen in a disseminated disease , whereas m. intracellulare is the more common respiratory pathogen .", "we believe that pcna can be a valuable diagnostic tool for differentiating mtb and mac , and differentiating between malignant diseases and infectious diseases when a pulmonary nodule is revealed on chest radiography or chest ct scans . in conclusion , to the best of our knowledge , this is a very rare report of a mac pulmonary infection presenting with multiple cavitary nodules . as the prevalence of mac infections increases , more cases start to show atypical radiographic findings , compared to the typical apical fibrocavitary or bronchiectatic nodular forms . other forms of mac have been reported , such as spn and multiple nodules . in this report , we present another form of mac pulmonary infection .", ", we differentiated the atypical presentation of mac lung infection from mtb lung disease or metastatic lung disease ." ] ]

[ [ "pain of medium severe intensity is dominant symptom in patients with advanced stages of cancer .", "progression of the disease in these patients requires frequent evaluation of symptoms of pain and adjustment of therapeutic doses of weak opioids or switch to strong opioid analgesics .", "mild ( weak ) opioid analgesics are intended for the treatment of moderate pain and are used in case of treatment failure with non - opioid analgesics or if the initial pain intensity was 4 to 6 by the ias , either alone or in combination with non - opioid , with or without other analgesics .", "is used in the treatment of moderately severe pain , and can suppress the cough , while in wide range of analgesic doses not suppress respiration . depending on the method of application", "tramadol is mild opioid analgesic with effects on the central nervous system , acting as a non - selective pure agonist of , and opioid receptors with higher affinity for the receptor . by inhibiting the reuptake of norepinephrine and", "the combined use of tramadol and paracetamol in one product , taking into account the pharmacokinetic and pharmacodynamic criteria can improve the benefit : risk ratio , increase efficiency by synergistic mechanisms , improve the tolerability of the drug ( lower individual dose ) and patient compliance ( 11 ) . combining tramadol and paracetamol" ], [ "the goal of the research was to determine the efficacy of a fixed combination tramadol and acetaminophen in the treatment of pain in patients with the advanced stage of cancer ." ], [ "study entered 369 patients who were due to pain intensity 4 - 8 ( medium severe to severe pain ) on the numeric rating scale ( nrs ) , treated with a fixed combination of tramadol and acetaminophen ( 37.5 mg and 325 mg ) in the initial dose 3x1 tablets for pain intensity 4 , up to 4x2 tablets for pain intensity 7 and 8 . every day ( 10 days )", "a prospective study was conducted at the center for palliative care , university clinical center tuzla , bosnia and herzegovina , from january 1 to december 31 2013 .", "patients excluded from the study during the first ten days of treatment . * of the total respondents , 369 patients the study ended 353 patients , with mean age of 65.3412.15 years ( 24 - 92 years ) , 211 ( 59.77% ) males and 142 ( 40.23% ) females . from the baseline 102 patients ( 28.89% ) had verified metastatic changes in bones while 251 patients ( 71.11% ) had no bone metastases ( p<0.0001 ) . in the study was 33.43% of patients with tumors of the gastrointestinal system , 25.22% with lung tumor , while the tumors of other organs account for less than 10% , with varying percentages of bone metastases ( table 2 ) . tumor localization . * from total of 353 patients ; * * from total of 102 patients ; o * * * = other tumors of bones and connective tissue , unknown localization , non cancer pain ; & esophagus , stomach , intestines ; liver , gallbladder , pancreas from total sample 158 ( 44.76% ) patients were in the palliative stage of cancer disease in period less than 12 months , and 195 or 55.24% of the patients in the period after 12 months ( p=0.067 ) ( table 3 ) .", "pain intensity was recorded and if the previous day was patient had two or more episodes of pain , the dose of fixed combination tramadol and paracetamol was increased to a maximum of 8 tablets daily . during the first 10 days of study 16 patients", "time from ph * diagnosis until psd * * from total of 353 patients ; * ph = histopathological diagnosis ; psd * * = palliative stage of the disease in 13 ( 3.68% ) of patients palliative stage of the disease is verified in less than three months , with 126 ( 35.69% ) in the period up to 36 months , while in 48 ( 13:59% ) patients specific oncological treatment lasted up to 72 months and in 21 ( 5.96% ) cases for more than six years ." ], [ "the frequency of side effects in the treatment of pain with a fixed combination of tramadol and paracetamol .", "* from 103 patients with side effects ; * * from total of 353 patients nausea that was present in 39.8% and vomiting with 34.9% were the dominant side effects in the treatment of pain with a fixed combination tramadol and acetaminophen , while the dizziness was observed in 8 ( 7.77% ) and somnolence in 2 ( 1.94% ) patients ( table 9 ) .", "duration of treatment with a fixed combination tramadol and acetaminophen . * total 353 patients ; * * transfer to morphine ; * * * fixed combination used until death in patients with bone metastases , the average duration of treatment with a fixed combination tramadol and acetaminophen was 69 days ( 14 - 330 ) , and in patients without bone metastases , the median duration of treatment was 52 days ( 13 - 278 ) , which is significantly lower than compared to patients with bone metastases ( p=0.0047 ) . in our study , disease progression and higher pain intensity was sign for transfer to strong opiates in 57 ( 16.15% ) patients , while until the end of life the pain was adequately treated with a fixed combination tramadol and acetaminophen in 51 patients ( 14.45% ) ( table 4 ) .", "a ) the duration of treatment with a fixed combination tramadol and acetaminophen the average duration of treatment with a fixed combination tramadol and paracetamol for all 353 patients was 57 days ( from the shortest treatment duration of 13 to the longest of 330 days ) ." ], [ "a study published in 2011 on the efficacy and safety of a fixed combination tramadol and acetaminophen in the treatment of medium to severe pain ( 16 ) states a significant analgesic efficacy of this combination with a reduction in average pain intensity from an initial 6.1 to 3.1 , with 64.8% of patients described significant pain relief .", "review paper , published in 2008 ( 17 ) , the efficiency of a fixed combination tramadol and acetaminophen in the treatment of mild to moderate pain included 15 studies .", "similar results on the efficacy of a fixed combination tramadol and paracetamol in the treatment of pain in a group of patients with bone metastases ( muscle bone pain ) shows our research . in our study , the average pain intensity in patients with bone metastases ( muscle bone pain ) on the first day of treatment was 6.07841.1831 , on the fifth day significantly lower 1.94120.6265 ( p<0.001 ) and on the tenth day of treatment 1.58820.5691 ( p<0.001 ) which supports the analgesic efficacy of a fixed combination tramadol and paracetamol ." ], [ "fixed combination of tramadol and acetaminophen can be used as an effective combination in the treatment of chronic cancer pain , with frequent dose evaluation and mild side effects ." ] ]

[ [ "the term amyotrophic lateral sclerosis ( als ) was first coined by charcot , who postulated the primacy of the upper motor neuron ( umn ) in als pathogenesis.1 assessment of cortical function in als and identification of the characteristic clinical phenotype involving combined upper and lower motor neuron abnormalities remain the key for als diagnosis.24 however , despite charcot 's initial observations , the site of disease onset and mechanisms underlying als pathophysiology remain areas of intense study and debate.5 in this setting , assessment of motor cortical and corticospinal function using non - invasive techniques , such as transcranial magnetic stimulation ( tms ) , has enhanced our understanding of als pathophysiology and resulted in novel diagnostic approaches .", "transcranial magnetic stimulation excites a network of neurons in the underlying motor cortex with motor evoked potentials recorded over the contralateral abductor pollicis brevis muscle .", "the motor cortex is preferentially stimulated when the current flows in a posterior anterior direction within the motor cortex .", "single- , paired- and multiple - pulse tms techniques have all been used ( figure 1 ) with the following measures taken to reflect corticomotoneuronal function : motor threshold ( mt ) , motor evoked potential ( mep ) amplitude , central motor conduction time ( cmct ) , cortical silent period ( csp ) , intracortical inhibition and facilitation .", "the present review will focus on the mechanisms underlying the generation of these tms measures , while at the same time assessing the contributions tms has made in the understanding of als pathophysiology . with an eye towards the future , the review will also consider the potential diagnostic utility of tms in als and incorporation of tms as a disease biomarker in the assessment of neuroprotective medications in a clinical trial setting ." ], [ "reduced mt early in als supports an anterograde transsynaptic process , whereby cortical hyperexcitability underlies the development of progressive neurodegeneration .", "this suggests that the mep amplitude changes in als are excitotoxic in nature.4447 ( a ) the motor evoked potential ( mep ) amplitude , expressed as a percentage of compound muscle action potential ( cmap ) response , is significantly increased in sporadic amyotrophic lateral sclerosis ( als ) and familial als ( fals ) when compared with healthy controls .", "( b ) the mep amplitude is significantly increased in als when compared with pathological and healthy controls , thereby distinguishing als from als mimic disorders . *", "mt reflects the ease with which corticomotoneurons are excited and is proposed to be assessed by the international federation of clinical neurophysiology as the minimum stimulus intensity required to elicit a small ( usually > 50 v ) mep in the target muscle in 50% of trials.6 with the recent adaptation of threshold tracking techniques , mt can also be measured as the stimulus intensity required to elicit and maintain a target mep response of 0.2 mv.79 mt reflects the density of corticomotoneuronal projections onto the spinal motor neuron with the highest density of projections to intrinsic hand muscles having the lowest mts.1012 mts are lower in the dominant hand12 and correlate with the ability to perform fine ( fractionated ) finger tasks,13 so that mt has the potential to map corticomotoneuronal representation and function . as well as reflecting the density of corticomotoneuronal projections" ], [ "motor cortical excitability may also be assessed using paired - pulse techniques , in which a conditioning stimulus modulates the effect of a second test stimulus .", "several different paired - pulse paradigms have been developed,37 \n 38 but short interval intracortical inhibition ( sici ) , intracortical facilitation ( icf ) and long interval intracortical inhibition have been most frequently used in als clinical research as methods to determine cortical excitability . to identify sici and icf ,", "the previous section has covered conventional tms parameters that can be assessed through activation of the motor cortex by single impulses .", "although synaptic neurotransmission through the gabaa receptor mediates the second phase of sici,74 \n 7880 the precise mechanisms underlying the first phase of sici remain uncertain . it was initially suggested that the first phase of sici reflected local excitability properties , particularly relative refractoriness of cortical axons , with resultant resynchronisation of cortico - cortical and corticomotoneuronal volleys.7 \n 81 subsequently , it has been argued that synaptic processes best explain the development of the initial phase of sici , possibly driven by activation of cortical inhibitory circuits that were distinct to those that mediated the later sici phase.76 \n 77 \n 82 ( a ) short interval intracortical inhibition ( sici ) , defined as the stimulus intensity required to maintain a target motor evoked potential of 0.2 mv , as assessed by the threshold tracking transcranial magnetic stimulation technique ." ], [ "a peristimulus time histogram technique can assess the function of a select subset of corticomotoneurons by recording the perturbation of voluntarily recruited motor units induced by a threshold cortical stimulation.53 in healthy controls , there is a well synchronised primary peak with a latency of approximately 2030 ms recording from hand or forearm muscles.28 \n 53 analysis of this primary peak in disease states such as als provides information on corticomotoneuronal conduction time , the extent of desynchronisation of corticomotoneuronal descending volleys , the degree of corticomotoneuronal synaptic input onto the anterior horn cell and the timing of excitatory and inhibitory inputs to the motor neuron.33 in als , the primary peak becomes desynchronised , prolonged in duration and delayed.28 \n 91 \n 92 in addition , the amplitude of the primary peak may be increased with additional subcomponents both suggestive of corticomotoneuronal hyperexcitability.53 \n 93 these primary peak abnormalities appear early in als , accompanied by reduced mts . with progression of disease , there is prolongation and increased desynchronisation of the primary peak , findings possibly specific to als when compared with healthy controls and kennedy 's disease.53 \n 94" ], [ "a third stimulus is subsequently delivered to erb 's point ( axilla ) after an appropriate delay , eliciting a highly synchronised motor response in those fibres in which the collision had occurred . the amplitude and area of this test cmap response", "recently , however , a combination of tst with single- and paired - pulse tms techniques has reaffirmed the functional integrity of corticomotoneuronal tracts in kennedy 's disease,100 and thereby the diagnostic utility of tst .", "collision takes place along the proximal segment of the peripheral nerve at the upper arm .", "over recent years , collision techniques such as the triple stimulation technique ( tst ) have been used to reduced the degree of mep desynchronisation which normally occurs following a single cortical stimulus.95 \n 96 this complex technique is performed by first delivering a high - intensity magnetic stimulus to motor cortex followed by supramaximal electrical stimulation of the peripheral nerve supplying the target muscle at the wrist such that the descending corticomotoneuronal volley is ", "are compared with the response induced by the conditioned tst paradigm ( erb 's point - wrist ", "erb 's point stimulation ) yielding an amplitude ratio of > 93% and area ratio of > 92% in healthy controls.95 \n 96 in als , the tst is sensitive at detecting subclinical corticomotoneuronal dysfunction.54 \n 97 corticomotoneuronal dysfunction was also reported in kennedy 's disease using the tst technique,98 \n 99 potentially limiting the diagnostic utility of tst in als ." ], [ "given the well documented tms abnormalities in als patients , the tms techniques may be of utility in the diagnostic process of als .", "although umn signs may be clinically evident in als , in some phenotypes such as the flail arm variant , this may not be the case , and detection of subclinical umn dysfunction may facilitate the diagnosis.42 abnormalities of cortical excitability , including an increase in mep amplitude along with reduction of sici and rmts , have been reported in the flail - arm variant of als , underscoring the utility of tms in detecting subclinical umn dysfunction.42 of further relevance , subclinical umn dysfunction has been reported in progressive muscular atrophy ( pma),101103 suggesting that pma may be a phenotype of als . while corticomotoneuronal integrity was recently reported to be intact in pma using a -band intermuscular coherence technique,104 assessment of cortical function with tms techniques may be of diagnostic utility , especially in light of presence of subclinical umn pathology in pma.102 \n 103 importantly , single- and paired - pulse tms techniques reliably distinguish als from the mimic disorders ( table 1 ) , hastening the diagnosis of als by up to 8 months.47 a reduction in averaged sici , between isi 1 and 7 ms , and peak sici at isi 3 ms were the most robust diagnostic tms parameters , with the finding of absent sici exhibiting a sensitivity of 97%.47 of further relevance , tms studies have established the presence of early and subclinical dysfunction of cortico - bulbar and cortico - respiratory tracts in als,26 \n 105107 thereby suggesting a potential diagnostic utility of bulbar and diaphragmatic mep recordings . in addition , combining tms with radiological techniques , such as mr spectroscopy , may further add to the diagnostic yield especially given the sensitivity of mr spectroscopy in detecting subclinical umn dysfunction.108110 consequently , combining tms techniques , in particular the recording of sici as well as bulbar and diaphragmatic meps , together with radiological techniques , such as mr spectroscopy , may enable an earlier diagnosis of als and thereby commencement of neuroprotective therapies and recruitment into clinical trials .", "* neuromuscular disorders include demyelinating neuropathy , myasthenia gravis , lead toxicity and hirayama 's disease .", "transcranial magnetic stimulation ( tms ) techniques in amyotrophic lateral sclerosis ( als ) mimic disorders single - pulse tms studies have established a normal resting motor threshold ( rmt ) and cortical silent period ( csp ) duration in all als mimic disorders ." ], [ "three schools of thought have developed pertaining to the role of the umn , and related pathophysiological processes in als : ( i ) the dying forward hypothesis , ( ii ) the dying back hypothesis and ( iii ) the independent degeneration hypothesis ( figure 4 ) . while the site of disease onset in als remains uncertain , tms studies have tended to favour a cortical origin , with excitotoxicity mediating motor neuron degeneration in als.5 \n 112 the dying forward and dying back hypothesis of amyotrophic lateral sclerosis ( als ) .", "the dying forward hypothesis proposed that als was primarily a disorder of the corticomotoneurons ( highlighted in red ) , with anterior horn cell degeneration mediated via an anterograde glutamate - mediated excitotoxic process .", "molecular approaches have provided further corroborating evidence for glutamate excitotoxicity in als . specifically , a significant reduction in the expression and function of the astrocytic glutamate transporter , excitatory amino acid transporter 2 ( eaat2 ) , has been reported in the sod-1 mouse model and the motor cortex and spinal cord of als patients.124128 in addition , dysfunction of eaat2 transporter appeared to be a preclinical feature in the sod-1 mouse model.129 \n 130 further underscoring the importance of astrocytes in als pathophysiology are recent stem cell studies documenting that motor neuron degeneration appears to be initiated by dysfunction of astrocytes.131 on the postsynaptic side , increased expression of glutamate receptors permeable to excessive influx of na and ca ions132 have been reported in als,133137 potentially rendering the motor neurons more susceptible to glutamate excitotoxicity.138 further support for a role for glutamate excitotoxicity has been indirectly provided by the clinical benefit of riluzole , a glutamate antagonist , in als patients.139142 for the glutamate hypothesis to be a plausible mechanism of motor neuron degeneration , the issue of selectivity of motor neuron involvement in als , together with sparing of motor neurons in non - als conditions exhibiting cortical hyperexcitability,38 must be explained .", "the site of als onset has been revisited , to a large extent precipitated by the advent of tms ." ], [ "although first described by charcot some 150 years ago , the pathophysiological mechanisms underlying als , variability , rate of progression and site of disease onset remain obscure .", "objective assessment of umn function in als remains a difficult task in clinical neurophysiology.185 while tms is mainly used as a clinical research tool , conducted in specialised neurophysiological laboratories , there is an urgent need to objectively assess umn function in als .", "this has been underscored by the recent awaji diagnostic criteria.155 \n 186 although needle electromyography is used by the criteria to objectively assess lower motor neuron dysfunction , the detection of umn involvement is based solely on clinical examination .", "such tms systems may result in the development of more functional als biomarkers that could be used in future drug trials for early patient recruitment and monitoring of drug efficacy .", "much has recently been learnt about als from mri , especially diffusion tensor mri , functional imaging and network analysis,110 \n 187198 but these tools remain prohibitively expensive , not readily available and may exhibit a modest diagnostic sensitivity.190 commercially available tms systems that will enable an objective assessment of umn function could be readily developed , facilitating the diagnosis of als ." ] ]

[ [ "it is estimated that rheumatoid arthritis ( ra ) and psoriatic arthritis ( psa ) each affects approximately 1% of the population ( firestein , 2003 ; gladman , 2009 ) , leading to patient pain and disability as well as contributing to a great economic burden in terms of lost working days and patient health services ( cooper , 2000 ) and therefore is an area of intense investigation . as our understanding of inflammation progresses , including the recent concept that resolution of inflammation is an active process rather than a passive return to homeostasis , the role of m is increasingly appreciated .", "the inability to resolve acute inflammation may lead to a chronic inflammatory state . depending on their phenotype", "while ra and psa are considered more inflammatory than osteoarthritis ( oa ) , it can still contain an inflammatory component , of which m play a large part . in all of these conditions", "the culmination of this work has led to sub - lining cd68 positive synovial m currently being the only validated biomarker for disease severity ( tak et al . , 1997 ) and", "the importance of m in driving the inflammatory response has been highlighted by several quantitative microscopic studies , where they have shown that m number ; correlates with disease activity ( tak et al . , 1997 ) , has potential use as a biomarker for disease ( kruithof et al ." ], [ "besides the abundant pro - inflammatory cytokines and chemokines present in inflamed synovial tissue , activation , and survival of m can be achieved through acetylation or de - acetylation of histones .", "two recent studies have found evidence of depressed hdac activity in ra , particularly in synovial macrophages and fibroblasts .", "the cellular receptors for igg are the fc receptors , fcri ( cd64 ) , fcrii ( cd32 ) , and fcriii ( cd16 ) .", "fcriii has been demonstrated to play a role in the development of arthritis through animal models ." ], [ "in the immune system m are effective antigen presenting cells with phagocytic activity which respond to lymphocyte derived cytokines . however , the responses elicited by m are variable and depend entirely on the tissue environment .", ". however gm - csf drives the m1 phenotype in monocyte derived macrophages so this may be the driving force for inflammatory responses in these experiments .", "this is consistent with the classification that m2c m , which are driven by il-10 are involved in suppression of the immune response ( mantovani et al . , 2004 ) .", "dedicated reviews on this topic discuss in more detail the cytokines and chemokines involved in promoting one phenotype over another ( mantovani et al ." ], [ "further rationale for the involvement of tnf in the progression of inflammatory arthritis was provided when transgenic mice expressing a modified human tnf gene spontaneously developed arthritis which exhibited increased human tnf protein , joint inflammation , bone erosion , and cartilage destruction . in this study , antibodies specific for human , but not mouse tnf reduced disease severity ( keffer et al .", ", 2006 ) where it promotes transcription of pro - inflammatory genes . in arthritis , and inflammation in general ,", "nr4a is part of the orphan nuclear receptor superfamily which have roles in lipid metabolism and inflammation ( desreumaux et al . , 2001 ;", "tnf is a master cytokine in inflammation and as such is a potent inducer of other pro - inflammatory cytokines ( nawroth et al . , 1986 ; butler et al . , 1995 )", ", 1991 ) . in subsequent studies administration of a monoclonal antibody to tnf ameliorated inflammation and joint damage after disease onset in a cia model of arthritis ( williams et al . , 1992 ) .", "tnf cytokine targeted therapies have now been developed for inflammatory arthritis . the first clinical trial was undertaken in the uk in 1992 and demonstrated that targeted biologic therapy decreased serum il-6 levels , swollen joint numbers and levels of the acute phase proteins crp and a - saa which are markers of inflammation ( elliott et al . , 1993 ) .", "the m1 m phenotype is induced by interferon- ( ifn ) in combination with either lipopolysaccharide ( lps ) or tnf. ifn is highly expressed in ra synovial tissue and its levels significantly correlate with disease severity ( milman et al . , 2010 ) ." ], [ "there is a growing understanding of the molecular drivers of inflammation and an appreciation that the resolution of inflammation is an active process rather than a passive return to homeostasis .", "endogenously produced mediators that actively promote the resolution of inflammation are now under investigation for their therapeutic use .", ") . however , as is increasingly the case for many mediators , the role of annexin a1 may not be as unambiguous as initially described and it may also potentiate pro - inflammatory actions in arthritis .", "further to this , it has also been shown that administration of human recombinant annexin a1 during the immunization phase of the collagen induced arthritis model perpetuated the development of the signs and symptoms of arthritis ." ], [ "this remains an interesting and a yet to be fully explored option in terms of treatment for synovial inflammation .", ", m will continue to be a focal point for therapeutic intervention which , currently , centers around cytokine blockade but now has the possibility of extending into m re - programming .", "in the study of inflammation and our efforts to promote its normal resolution , m remain to the fore of our interest . in the inflamed joint" ], [ "the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest ." ] ]

[ [ "two recently published studies highlighted the benefits of evidence - based , multidisciplinary , multimodal approach to optimizing care in joint replacement patients potentially requiring allogenic transfusion1213 ) .", "a critical component of successful patient care in total knee arthroplasty ( tka ) is a blood management strategy .", "available blood management strategies can be broadly divided into 3 stages : preoperative optimisation , intraoperative and postoperative protocols14 ) .", "both studies stressed the importance of optimizing preoperative red cell mass , minimizing perioperative blood loss and being judicious with the threshold for transfusion based on each individual 's clinical status . by introducing a multimodal program supported by evidence - based guidelines ,", "tka can result in substantial perioperative blood loss , rendering patients at increased risk of requiring allogenic blood transfusion12 ) .", "several studies have highlighted the disadvantages of allogenic blood including a negative effect on postoperative complications , length of hospital stay , cost and mortality8910 ) ." ], [ "several studies have highlighted the significant influence of preoperative hb on the requirement for transfusion in tka1115 ) .", "the use of preoperative autologous blood donation has therefore fallen out of favour and we no longer use it in our tka patients .", "however preoperative autologous donation is associated with a high rate of wasted blood and is no longer deemed to be cost effective .", "there are no clear guidelines or consensus on the optimal bridging therapy for patients on warfarin for conditions such as atrial fibrillation , previous embolic cerebrovascular events or mechanical valve replacement , and further clinical trials are required to clarify the optimal regime . with regards to aspirin and antiplatelet therapy , its cessation prior to surgery is believed to result in an increased risk of cardiovascular complications and major cardiac events2324 ) .", "a common reason in elderly patients is iron deficiency , as a result of poor dietary intake and occult gastrointestinal bleeding secondary to non - steroidal anti - inflammatory drug use .", "the decision and timing of cessation of antiplatelelet and anticoagulant therapy needs to take into consideration risks of thrombosis versus risk of bleeding ." ], [ "we have been using intraoperative red cell salvage for primary and revision tka , with success in reducing allogenic transfusion requirement ( dan m , unpublished data ) .", "the technique of acute normovolemic hemodilution attempts to achieve a similar effect to preoperative autologous blood donation without the preoperative inconvenience .", "the risk of intraoperative bleeding is influenced by difficulty of the procedure and patient factors such as obesity , comorbidities and bleeding disorders .", "the authors concluded topical application of fibrin sealant was not effective in reducing perioperative blood loss in tka .", "the efficacy of cell salvage in tka in our cohort compared to previously published studies353637 ) is outlined in table 3 . we concluded perioperative red cell salvage reduces but does not eliminate the need for allogenic blood ." ], [ "our preference in tka is to use topical txa , with no patients contraindicated to its use .", "the routine use of intra - articular wound drainage in tka has been shown to increase blood transfusion requirement40 ) .", "evidence for use of an intra - articular drain in tka therefore remains inconclusive and very much an individual decision based on surgeon preference .", "this needs to be balanced with the reported increased risk of persistent ooze , bruising and hematoma formation41 ) .", "a number of studies have directly compared intravenous txa with topical txa demonstrating the efficacy and safety of topical administration in tka545556 ) . both patel et al.51 ) , using a single intravenous dose , and soni et al.57 ) , using a 3 dose intravenous regimen , concluded topical txa had similar efficacy to intravenous txa in terms of perioperative change in hb , lowest postoperative hb , total drain output and transfusion rate , and no increase in complications in randomized prospective studies . in a study comparing 3 methods of administration in tka , single dose intravenous txa was more effective than topical and intra - articular txa injected via the drain in reducing hb drop58 ) .", "the authors concluded a preoperative dose prior to tourniquet inflation was important to inhibit the activation of the fibrinolysis cascade .", "txa is one such agent , being a synthetic plasminogen - activator inhibitor , showing both clinical efficacy and an acceptable safety profile ." ], [ "the recommendations for a restrictive transfusion protocol include transfusion in patients with hb<7 g / dl , hb<8 g / dl in setting of cardiac disease , or specific patient situations where additional oxygen carrying capacity is needed .", "transfusion of a single unit of packed red blood cells at a time is advised12 ) . the blood management strategy algorithm used in our hospital", "another principal arm of effective blood management is to restrict allogenic transfusion to patients meeting well - established transfusion criteria .", "adherence to evidence - based transfusion guidelines and utilization of appropriate transfusion triggers is the key element in achieving this ." ], [ "a blood management program in tka aims to reduce allogenic transfusion rate and its associated risks , whilst at the same time maximizing hb level and oxygen carrying capacity in the postoperative period .", "effective blood conservation encompasses optimizing preoperative red cell mass , salvaging blood lost during the perioperative period , minimsing blood loss with hemostatic measures and individualizing the transfusion trigger according to the patient 's clinical status and medical comorbidities .", "we use a combination of preoperative intravenous iron infusion , intraoperative red cell salvage , and topical txa . a proactive approach to blood management", "will lead to a positive effect on early and long - term outcomes and greater success in care of tka patients ." ] ]

[ [ "the aim of this study was to compare the utility of lamp , pcr , and elisa for diagnosis of leptospirosis and to correlate clinical features with the diagnosis of leptospirosis .", ". microscopic agglutination test ( mat ) is the reference method for serological diagnosis of leptospirosis .", "can diagnose all cases of leptospirosis , composite diagnostic criteria , which includes clinical , epidemiological , and laboratory parameters , have been defined called as faines and modified faines criteria .", "leptospirosis is a zoonotic disease caused by pathogenic species under the genus leptospira which have twenty genomospecies based on dna hybridization analysis and 24 serogroups and 250 serovars based on the surface exposed lipopolysaccharide .", "the use of culture as a diagnostic method is limited by its long turnover time , requiring at least 68 weeks for growth . polymerase chain reaction ( pcr ) targeting the 16s rrna has been used to detect the presence of leptospires in serum , urine , cerebrospinal fluid , and autopsy tissue .", "detection of igm antibodies by elisa is the most widely used method for diagnosis of leptospirosis especially as a part of modified faine 's criteria . like faine 's criteria it includes clinical features such as a headache , fever , temperature , conjunctival suffusion , meningism , joint pain , jaundice , albuminuria , and epidemiological features but unlike faine 's criteria which use culture and mat for laboratory diagnosis , in addition , modified faine 's criteria uses igm elisa also ." ], [ "serum was collected from 150 patients with acute febrile illness from december 2012 to july 2014 .", "igm antibodies to leptospira were detected by elisa ( panbio ltd , brisbane , australia ) in 150 acute serum samples and 32 convalescent sera .", "the homology of the sequence obtained with that of the existing leptospira sequence in the gene bank was performed using the basic local alignment search tool ( blast , available from www.ncbi.nlm.nih.gov/blast ) program with the available standard reference sequences in the genebank for homology .", "the case definition used in this study included the samples which were positive by pcr or lamp or fulfilling modified faine 's criteria based on clinical features , epidemiological features and igm elisa for leptospirosis .", "a nested pcr was performed targeting and amplifying a 547 bp segment of the 16s rrna gene ( rrs gene ) .", "two amplified products for rrs gene were sequenced to confirm the appropriateness of the target amplified ." ], [ "serum was collected from 150 patients with acute febrile illness from december 2012 to july 2014 .", "these patients had a fever ( 100f ) of duration 15 days without eschar , who were malaria and blood culture negative .", "after the study was approved by the institutional review board , clinical information , and 4 ml blood was collected from these patients ( after obtaining informed consent ) in a red capped tube with clot activator ( bd vacutainer , franklin lakes , nj , usa ) ." ], [ "in addition , an in - house qc ( close to the cutoff value ) sample was used for assay validation .", "igm antibodies to leptospira were detected by elisa ( panbio ltd , brisbane , australia ) in 150 acute serum samples and 32 convalescent sera .", "each elisa run was validated only if the relevant controls ( positive , negative , and cutoff controls ) were within the range described by the manufacturer .", "the igm elisa for leptospira was considered to be positive if the value was 20 panbio units ." ], [ "dna was extracted from the serum samples ( 200 l ) using the qiaamp blood mini kit ( qiagen , hilden , germany ) and stored at 70c ." ], [ "the cycling conditions used for both ( first and second round ) were the same and included 95c for 2 min for initial denaturation , followed by 95c for 10 s , 67c for 15 s , 72c for 30 s for a total of 40 cycles and one cycle of 72c for 7 min for the first run .", "the primer sequence used was as described by boonsilp et al . in each cycle of the nested pcr , the reaction volume was 50 l which contained 2 pcr mix ( thermo fisher scientific , marietta , usa ) , 20 pmol of each of the primers , 4 mm mgcl2 and pcr grade water along with 5 l of dna .", "a nested pcr was performed targeting and amplifying a 547 bp segment of the 16s rrna gene ( rrs gene ) .", "the final extension of 72c for 7 min was performed before detection of amplification products .", "gel electrophoresis was performed in a 2% agarose gel containing ethidium bromide ( 10 g / ml ) , and the 547 bp product was visualized using a gel documentation system ( gel doc , bio - rad laboratories , hercules , ca , usa ) ." ], [ "run positive control which was leptospira interrogans strain icterohemorrhagiae obtained from regional medical research centre , port blair , india and a negative control were used .", "the detection of the lamp products was done by visual detection for turbidity , centrifugation at 14,000 rpm for 1 min for pellet formation and gel electrophoresis using a 2% agarose gel containing ethidium bromide ( 10 g / ml ) .", "the lipl32 and lipl41 lamp assay was performed at 63c using the protocol and primer sequence described by chen et al . in each", "l. interrogans serovar pomona , serovar icterohemorrhagiae , and serovar hardjo ( kindly provided by rmrc , port blair , india ) were used as positive controls for the nested pcr and the lamp assay .", "the product was visualized using a gel documentation system ( gel doc , bio - rad laboratories , hercules , ca , usa ) ." ], [ "the homology of the sequence obtained with that of the existing leptospira sequence in the gene bank was performed using the basic local alignment search tool ( blast , available from www.ncbi.nlm.nih.gov/blast ) program with the available standard reference sequences in the genebank for homology .", "two amplified products for rrs gene were sequenced to confirm the appropriateness of the target amplified .", "the abi 310 genetic analyzer ( applied biosystems , foster city , ca , usa ) was used to enumerate the sequences ." ], [ "the case definition used in this study included the samples which were positive by pcr or lamp or fulfilling modified faine 's criteria based on clinical features , epidemiological features and igm elisa for leptospirosis ." ], [ "the sensitivity and specificity of elisa , pcr , and lamp assay were evaluated using latent class analysis ( lca ) using stata version 13 ( statacorp lp , texas , usa ) .", "chi - square test was used to check the association of categorical variables and a p < 0.05 was taken as statistically significant .", "all the data were entered into an excel spreadsheet 2010 ( microsoft office , redmond , washington , usa ) ." ], [ "among the 150 patients recruited , 52 were diagnosed to have leptospirosis based on our case definition .", "clinical features among those with leptospirosis and those without ( based on study case definition ) it was seen that lamp assay was positive for all 10 ( 100% ) within the 1 week of illness . in case of pcr ,", "of these three were positive by igm elisa , pcr , and lamp , two were positive only by pcr for rrs gene ( 547 bp ) , and 7 were positive only by lamp assay for lipl32 and lipl41 genes , another forty fulfilled modified faine 's criteria ( clinical criteria plus igm elisa positive ) .", "only , decreased urine output , jaundice , renal compromise , and low platelet count were found to be significantly related to leptospirosis as given in table 1 .", "as all patients positive by igm elisa for leptospirosis ( as per the inclusion and exclusion criteria ) were having a clinical picture compatible with leptospirosis , the lca results for elisa have been extrapolated as results obtained for modified faines criteria for leptospirosis .", "three samples were positive in the 1 week of illness and other two in the 2 week of fever . by elisa ,", "however , the specificity was highest for pcr with 98.64% , followed by lamp 95.24% and least for elisa ( modified faines criteria ) 72.79% .", "igm antibodies were detectable within 47 days of illness for 20 ( 46.5% ) , including the three positive by molecular assays and 23 ( 53.5% ) were positive between 8 and 15 days of fever ." ], [ "our preliminary data suggest that a combination of lamp and igm elisa is likely to pick up most cases of suspected leptospirosis especially when they have no eschar , are blood culture and malaria negative .", "hence , igm elisa is still a useful tool for diagnosis of leptospirosis in a tertiary care center like ours .", "in the 1 week of illness , lamp assay performed best , whereas igm elisa was the mainstay of diagnosis of leptospirosis from the 2 week onward .", "future studies including paired sera for a demonstration of rise in titer or seroconversion and detection of leptospiral dna in urine are required to assess the validity of these findings ." ], [ "institutional review board , christian medical college , vellore ( min no 8109 dated 05.12.2012 ) for funding the study ." ], [] ]

[ [ "the study was conducted with the following aims : \n to estimate and compare the levels of opn in plasma of subjects with healthy periodontium and generalized chronic periodontitis.to estimate opn levels in plasma of generalized chronic periodontitis subjects 2 months after scaling and root planing.to compare opn levels in plasma of generalized chronic periodontitis subjects before and after two months after scaling and root planing.to correlate opn with periodontal disease index before and two months after scaling and root planing . \n to estimate and compare the levels of opn in plasma of subjects with healthy periodontium and generalized chronic periodontitis . to estimate opn levels in plasma of generalized chronic periodontitis subjects 2 months after scaling and root planing . to compare opn levels in plasma of generalized chronic periodontitis subjects before and after two months after scaling and root planing . to correlate opn with periodontal disease index before and", "this study is planned with an objective to provide a diagnostic tool which is expected to play an important role in the assessment of periodontal disease severity and it may also help in prevention and control of systemic diseases such as cvd , inflammatory kidney disease , diabetes mellitus , and respiratory disease etc .", "thus by treating periodontal disease , we may lower the risk of future cardiovascular events by reducing opn levels after periodontal therapy .", "this increase in systemic inflammation has been implicated in having a modulating role in cardiovascular disease ( cvd ) , on an adverse pregnancy outcome , and on diabetes mellitus and in respiratory disease . in recent years", "periodontal diseases comprise of a group of inflammatory diseases affecting the supporting tissues of the teeth resulting from a complex interplay between specific gram - negative microorganisms , their by products , and the host - tissue response ." ], [ "the study was conducted with the following aims : \n to estimate and compare the levels of opn in plasma of subjects with healthy periodontium and generalized chronic periodontitis.to estimate opn levels in plasma of generalized chronic periodontitis subjects 2 months after scaling and root planing.to compare opn levels in plasma of generalized chronic periodontitis subjects before and after two months after scaling and root planing.to correlate opn with periodontal disease index before and two months after scaling and root planing . \n to estimate and compare the levels of opn in plasma of subjects with healthy periodontium and generalized chronic periodontitis . to estimate opn levels in plasma of generalized chronic periodontitis subjects 2 months after scaling and root planing . to compare opn levels in plasma of generalized chronic periodontitis subjects before and after two months after scaling and root planing . to correlate opn with periodontal disease index before and" ], [ "systemically healthy patients patients in age group of 20 - 45 years random selection of male and female patients twenty subjects with healthy periodontium twenty subjects with generalized chronic periodontitis . \n", "group ii- 20 subjects with generalized chronic periodontitis . for opn assessment , non - fasting ,", "history of systemic diseases ( e.g. , diabetes mellitus , ischemic heart disease , other cvds contributing to arthrosclerosis , stroke , hypertension history of any bone disorders subjects who had undergone periodontal treatment in the last six months subjects who had taken antibiotics , anti - inflammatory drugs , steroids and contraceptives in the last six months subjects who are on antiresorptive drugs such as bisphosphonates ( eg , alendronate ) pregnant or lactating females informed consent was obtained from those subjects who agreed to participate voluntarily in this study after institutional ethical clearance was obtained . based upon the periodontal disease index scores , the subjects were divided into two groups : group i- 20 subjects with healthy periodontium .", "venous blood samples were collected from the subjects at the time of clinical examination ( group i , ii ) and two months after scaling and root planing in group ii .", "periodontal disease index was assessed after two months of scaling and root planing and plasma samples were also collected to estimate levels of opn .", "screening examination included : ( 1 ) medical history ( 2 ) dental history , and ( 3 ) periodontal disease index ( ramfjord ) \n systemically healthy patientspatients in age group of 20 - 45 yearsrandom selection of male and female patientstwenty subjects with healthy periodontiumtwenty subjects with generalized chronic periodontitis . \n ", "in the present study , 40 subjects were selected from the outpatient department of periodontology ( post- graduate section ) of bharati vidyapeeth university dental college and hospital , pune ." ], [ "in the present study , 40 subjects were selected from the outpatient department of periodontology ( post- graduate section ) of bharati vidyapeeth university dental college and hospital , pune .", "screening examination included : ( 1 ) medical history ( 2 ) dental history , and ( 3 ) periodontal disease index ( ramfjord )" ], [ "\n systemically healthy patientspatients in age group of 20 - 45 yearsrandom selection of male and female patientstwenty subjects with healthy periodontiumtwenty subjects with generalized chronic periodontitis . \n ", "systemically healthy patients patients in age group of 20 - 45 years random selection of male and female patients twenty subjects with healthy periodontium twenty subjects with generalized chronic periodontitis . \n", "group ii- 20 subjects with generalized chronic periodontitis . for opn assessment , non - fasting ,", "history of systemic diseases ( e.g. , diabetes mellitus , ischemic heart disease , other cvds contributing to arthrosclerosis , stroke , hypertension history of any bone disorders subjects who had undergone periodontal treatment in the last six months subjects who had taken antibiotics , anti - inflammatory drugs , steroids and contraceptives in the last six months subjects who are on antiresorptive drugs such as bisphosphonates ( eg , alendronate ) pregnant or lactating females informed consent was obtained from those subjects who agreed to participate voluntarily in this study after institutional ethical clearance was obtained . based upon the periodontal disease index scores , the subjects were divided into two groups : group i- 20 subjects with healthy periodontium .", "venous blood samples were collected from the subjects at the time of clinical examination ( group i , ii ) and two months after scaling and root planing in group ii .", "periodontal disease index was assessed after two months of scaling and root planing and plasma samples were also collected to estimate levels of opn ." ], [ "systemically healthy patients patients in age group of 20 - 45 years random selection of male and female patients twenty subjects with healthy periodontium twenty subjects with generalized chronic periodontitis .", "\n systemically healthy patientspatients in age group of 20 - 45 yearsrandom selection of male and female patientstwenty subjects with healthy periodontiumtwenty subjects with generalized chronic periodontitis . \n " ], [ "venous blood samples were collected from the subjects at the time of clinical examination ( group i , ii ) and two months after scaling and root planing in group ii .", "group ii- 20 subjects with generalized chronic periodontitis . for opn assessment , non - fasting ,", "periodontal disease index was assessed after two months of scaling and root planing and plasma samples were also collected to estimate levels of opn .", "history of systemic diseases ( e.g. , diabetes mellitus , ischemic heart disease , other cvds contributing to arthrosclerosis , stroke , hypertension history of any bone disorders subjects who had undergone periodontal treatment in the last six months subjects who had taken antibiotics , anti - inflammatory drugs , steroids and contraceptives in the last six months subjects who are on antiresorptive drugs such as bisphosphonates ( eg , alendronate ) pregnant or lactating females informed consent was obtained from those subjects who agreed to participate voluntarily in this study after institutional ethical clearance was obtained . based upon the periodontal disease index scores , the subjects were divided into two groups : group i- 20 subjects with healthy periodontium .", "\n history of systemic diseases ( e.g. , diabetes mellitus , ischemic heart disease , other cvds contributing to arthrosclerosis , stroke , hypertensionhistory of any bone disorderssubjects who had undergone periodontal treatment in the last six monthssubjects who had taken antibiotics , anti - inflammatory drugs , steroids and contraceptives in the last six monthssubjects who are on antiresorptive drugs such as bisphosphonates ( eg , alendronate)pregnant or lactating femalessmokers . \n ", "thereafter , scaling and root planing was carried out for subjects with generalized chronic periodontitis and oral hygiene instructions were given to the subjects ." ], [ "the data obtained was subjected to statistical analysis using two sample t - tests , paired t - test to compare opn levels in group ii before and after treatment and un - paired t - test to compare opn levels in group i and ii .", "correlation of the opn levels with the clinical parameter in each group was analyzed by pearson 's correlation coefficient ." ], [ "in this study , an attempt was made to evaluate opn levels in subjects with healthy periodontium and generalized chronic periodontitis and its assessment after scaling and root planing using an osteopontin enzyme immunometric assay kit ( quantikine ) .", "the mean concentration of opn in plasma was observed to be higher in the generalized chronic periodontitis group ( 153.08 ng / ml ) as compared with the subjects with healthy periodontium ( 55.09 ng / ml ) [ table 1 ] .", "opn levels in plasma of group i and ii subjects at baseline comparison of opn levels in plasma of group i and ii subjects at baseline opn levels decreased to 91.52 ng / ml in group ii , two months after scaling and root planing .", "this suggests that opn levels in plasma show a positive correlation with the severity of the periodontal disease .", "both the parameters show improvement after scaling and root planing , but correlation could not be established which can be attributed to the other factors such as hosts response or patients compliance in the resolution of periodontitis after treatment of the same ." ], [ "the results of this study demonstrated the elevated opn levels in plasma in subjects with generalized chronic periodontitis as compared with subjects with healthy periodontium .", "the result of this study indicates a significant association between inflammatory marker opn and periodontal disease and a tendency for significant reduction of plasma opn levels after treatment of periodontitis .", "as the correlation between opn and cardiovascular disease has already been established and the opn levels also increase periodontal diseases which is evident from our results ; this may indicate a strong correlation between periodontitis and cvd with one of the mediator as opn .", "thus , it is clear that the risk of cvd can be reduced in otherwise healthy individuals with prevention/ treatment of periodontitis at an early stage .", "they found a highly significant elevation of opn plasma in subjects with chronic periodontitis group as compared with the healthy group ." ], [ "from the above observation , it can be concluded that elevated levels of opn were seen in subjects with periodontitis as compared with healthy individuals . it was also found that the opn levels significantly decreases two months after periodontal therapy .", "as the correlation between opn and cardiovascular disease has already been established and the opn levels also increases in periodontal diseases which is evident from our results ; this may indicate a strong correlation between periodontitis and cvd with one of the mediator as opn .", "thus , it is clear that the risk of cvd can be reduced in otherwise healthy individuals with prevention / treatment of periodontitis at an early stage .", "this implies that the assessment of periodontal status at the time of cardiovascular examination should also be incorporated in routine practice . for clinical application of this approach", "studies could also be carried out in relation to the subjects with periodontitis and pre - existing cvd to evaluate the effect of periodontal therapy on severity of cvd .", ", a long term study of large sample size is required with relevant laboratory investigations to evaluate cardiovascular status ." ] ]

[ [ "together with sensory inputs from the eye and ear in human they produce a movement output as a consequence of reflexes or higher brain cognitive functions .", "the development of the spinal cord plays a central role towards execution coordinated movements and of sensory inputs as well .", "the restauration of such disturbed motor output functions is the main goal for physicians and scientists all over the world .", "if we therefore take a closer look at the time cell differentiation and establishment of those motor circuits , this may help to restore the original function in disease .", "these circuits are mainly disturbed in motoneuron diseases like amyotrophic lateral sclerosis ( als ) , spinal muscular atrophy ( sma ) or in cases of lesions caused by accidents ." ], [ "the fact that the motor system has great abilities to compensate dysfunctions for a longer time even makes it harder to start curing a disease as the loss of functional cells has started sometimes even years before .", "the spinal cord as a central nervous system ( cns ) structure builds up connections to the periphery of the body .", "the complexity of dysfunctions affecting the motor system makes it unable to apply cures on single cell type level but rather needs a more systemic approach .", "disorders affecting the function of the motor system including als or sma are characterized by the progressive inability not only to walk and move but also suffer from the increasing inability to breathe or speak .", "this includes muscle movement , breathing and rhythmic activities of muscle cells with a constant feed back to the higher brain regions .", "knowledge on the development of the spinal motor circuits might help to understand and might even help finding cures against such degenerative diseases .", "for example usually more than 50% of all motoneurons are already dysfunctional for a longer period before a patient comes to the clinic due to compensatory effects of the remaining functional cells in the spinal cord ." ], [ "different regional signals along the rostro - caudal axis start to instruct the positional identity of the cells defining forebrain , midbrain , hindbrain , and spinal cord .", "the cns epithelial cells of the neural tube are pseudo stratified cells and perform symmetric cell divisions to increase the number of neural precursor cells ( npcs ) .", "these hox transcription factors represent the concept for a neuronal subtype identity of the embryonic hindbrain and spinal cord ( wu et al . , 2008 ) .", "the second early molecule necessary for the specification of the spinal cord is the fibroblast growth factor ( fgf ) .", "regionalization within the caudal part is performed by expression of the homeobox domain transcription factors ( hoxgenes ) ( diez del corral et al . , 2003 ) .", "both fgf and ra form antagonizing gradients to determine the anterior hindbrain and the posterior spinal cord along the rostro - caudal axis .", "caudalization is induced by the vitamin a derivative retinoic acid ( ra ) followed by expression of pax3 by neuroepithelial cells ." ], [ "future research will have to focus not only on the transcription factor code but rather on the matrix and their specific discrete changes influencing position , differentiation and the total number of cells .", "the elimination of sulfation during in vitro neural stem cell differentiation changes the relative proportion of early neurons generated from the stem cell pool and appears to block the further differentiation of these post - mitotic cells .", "while fgfs and ra define the cellular identity for the rostro - caudal axis , cellular identities along the dorso - ventral axis of the developing hindbrain and spinal cord are defined by members of the bone morphogenetic protein ( bmp ) and of the wingless / int-1 ( wnt ) family , secreted from the roof plate cells .", "the resulting progenitor cells , as well as the resulting cells from these progenitor pools are characterized by a specific expression patterning of homeodomain transcription factors ." ], [ "the motoneurons of mediomedial column present throughout the spinal cord innervate the axial trunk muscles while the lateral motor column ( lmc ) , which is positioned in the brachial and lumbal part of the spinal cord innervates the skeletal muscles of the limbs and thereby regulates fine motor skills ( bonanomi and pfaff , 2010 ) . segmentation and motoneuron connection during spinal cord development in mice .", "the excess in cells is reduced first due to the limited amount of trophic support and second by electric activity and connectivity to the target cells , the skeletal muscle .", "apart from the terminal differentiation and positioning of the motoneuron cell bodies within the motor columns the growth of axons combined with correct targeting is critical for the latter function of the body .", "the motoneuron subtypes are well organized along the rostro - caudal and dorso - ventral axis in the spinal cord sorted by function and innervation targets .", "they modulate the response of the muscle spindle in accordance to the muscle extension and receive no direct input from proprioceptive sensory afferents ." ], [ "the combination of attraction and repulsion reveals that the growing axon finds the exit point from the spinal cord to target the muscle tissue .", "the correct positioning and function of interneurons is important for coordination and gait . here , the eph / ephrins and netrin / dcc act as important mediators .", "the interaction of the bcs and the growing motor axons is performed by semaphorins and their receptors neuropilin 2 ( nrp2 ) and/or plexin - a2 .", "sperry postulated in 1963 his chemo - affinity theory , by which the axons find their target cells according to the receptors in the growth cone so that they can recognize the guiding molecules along their way ( sperry , 1963 ) .", "in contrast , the dorsal root ganglionic neurons behave totally different . when taken into culture" ] ]

[ [ "studies of gillnet fishery selection on pacific salmon ( oncorhynchus spp . ) are aided by their anadromous and semelparous life history .", "in this study , commercial gillnet fishery catch and escapement data from 1946 to 2005 were used to quantify the magnitude and nature of selection on age and size at maturity for a commercially important and biologically diverse population complex of sockeye salmon ( o. nerka ) from the nushagak district of bristol bay , southwest alaska .", "comparison of the sizes and ages of fish that are caught with those that are not caught is essential for understanding the patterns of size selection , but such data are very difficult to obtain in most wild fish populations and fisheries .", "the common phenotypic effect of fishing ( i.e. , reduction in mean age and size ) is widely known ( trippel 1995 ; hutchings 2004 ) , but more recently the possible genetic effects of fishery selection on life history traits such as age and size at maturity have received attention ( policansky 1991 ; law 2000 ; olsen et al . 2004 ; kuparinen and merila 2007 ) . experimental exploitation studies on captive atlantic silversides ( menidia menidia ) showed evolutionary effects of size - selective mortality on somatic growth , yield , and population biomass , among other traits ( conover and munch 2002 ; walsh et al .", "overall , human exploitation can cause significant changes to life history and morphological traits of wild populations , including fish ( darimont et al .", "humans have domesticated animals and plants through selective breeding , producing individuals with specific traits deemed beneficial ( hazel 1950 ) ." ], [ "we also created yearly length and length at age frequency histograms ( in 10 mm bins ) of sockeye salmon in the catch and escapement to reconstruct their distribution in the total run .", "we used the yearly asl data to characterize length and length at age for all sockeye salmon in the nushagak district , treating males and females separately . because sockeye salmon of different ages , sizes , and sexes may enter the fishery and migrate upriver at different times", "we first performed analyses on fish of all ages and then grouped fish by the number of years that they had been in the ocean ( ocean age ) . because salmon put on > 99% of their weight at sea , ocean age largely determines their overall size ( quinn 2005 ) , and thus vulnerability to being caught in a gillnet .", "we characterized the age , sex , and length of all individuals escaping into each of the three rivers to avoid biases resulting from variation in proportions migrating to each river among years . to calculate the total escapement on a given day", "fishing occurs throughout the nushagak fishing district , close to shore and in the open water , and the fishery is very effective at catching fish ( tim sands , alaska department of fish and game , pers .", "the five fishing districts , and associated freshwater systems , of bristol bay , alaska , including the nushagak district . the history of the bristol bay sockeye fishery is well documented and knowledge of its management and its many changes allows greater understanding of the nature of fishery selection ." ], [ "number of sockeye salmon in the nushagak district run and proportion of the run caught by the fishery , 19462005 .", "the five fishing districts , and associated freshwater systems , of bristol bay , alaska , including the nushagak district . the history of the bristol bay sockeye fishery is well documented and knowledge of its management and its many changes allows greater understanding of the nature of fishery selection .", "since 1946 , 1986% of the annual sockeye salmon run in the nushagak district was caught , with an average harvest of 54% ( fig .", "1 ) , produces one of the most abundant and biologically diverse sockeye salmon runs in the world , and these salmon have been exploited by a commercial gillnet fishery since 1884 ( bue 1986 ) ." ], [ "since 1946 scientists and fishery managers have estimated the nushagak district sockeye salmon catch and escapement , and collected age , sex , and length ( asl ) data on individual fish on a daily basis throughout the fishing and escapement periods . at fish processing plants ,", "beach seine nets , which collect adults of all sizes , are used to sample the escapement for asl data each day ( range : 1503542 fish per year per river ) .", "the wood , nushagak , and igushik rivers have counting towers or sonar devices to enumerate upstream migrating salmon that have escaped the fisheries .", "catch numbers are estimated and a sample ( range : 10656643 fish per year ) is measured for length and weight , scales are collected to be read for age determination , and sex of each fish is recorded .", "( 1963 ) by measuring a sample of the salmon for asl and expanding these by the overall counts during the sampling time periods .", "daily catch and escapement counts were available from 1946 to 1959 but raw asl data were not available during this time .", "therefore , from 1946 to 1959 these calculations , rather than data on individual fish , were used to characterize fishery selection ." ], [ "fishing occurs throughout the nushagak fishing district , close to shore and in the open water , and the fishery is very effective at catching fish ( tim sands , alaska department of fish and game , pers .", "we used the yearly asl data to characterize length and length at age for all sockeye salmon in the nushagak district , treating males and females separately . because sockeye salmon of different ages , sizes , and sexes may enter the fishery and migrate upriver at different times", "doctor ( 2008 ) provided evidence of subtle differences in migration timing among some populations within the nushagak fishing district but this complex , like others in bristol bay , is characterized by compressed migration timing and broad overlap among the components ." ], [ "we also created yearly length and length at age frequency histograms ( in 10 mm bins ) of sockeye salmon in the catch and escapement to reconstruct their distribution in the total run .", "next we constructed yearly gillnet vulnerability profiles for each sex and age group showing , for each length bin , the proportion of fish that were caught ( lagler 1968 ) .", "confidence bands about the vulnerability profiles and ssds were determined by bootstrapping the asl data on a daily basis , with 500 replicates per year ( 0.025 and 0.975 quantiles of the replicates ) . to better understand how changing fishery management , run size , fish size , and catch levels have affected selection over time , we performed ordinary least squares regression analysis of the form : these models regressed ssds and year - specific subsets of the following factors : ( i ) gillnet mesh size regulations ( as a categorical variable ) , ( ii ) run size , ( iii ) length deviation from the long term average , and ( iv ) date at which half of the total catch is reached ( catch date, which describes fishery timing ) .", "for each year that data were available , we calculated exploitation ratio ( total proportion caught ) for fish of each age group ( all ages , ocean age 2 , and ocean age 3 ) and sex on a yearly basis ( py , a , s ) ( equation 1 ) . where cy , a , s is the number of fish of a certain age and sex caught in a given year and ey , a , s is the number of fish of a given age and sex in the escapement in that year .", "this value is the difference in mean length of fish in the run ( , where ) versus those in the escapement ( ) ( i.e. , before versus after fishing ) ( law and rowell 1993 ) divided by the standard deviation of length of fish in the run ( ) to allow comparison between years ." ], [ "length vulnerability profiles of female ( a ) and male ( b ) sockeye salmon of all ages from 1946 to 2005 in the nushagak district .", "we found inconsistent patterns of vulnerability to the fishery over time for ocean ages 2 and 3 sockeye salmon .", "more complex models , which had higher r values of 0.540.56 , including ( i ) both gillnet mesh size regulation and run size and ( ii ) mesh size regulations , run size , and length deviation , explained selection best for ocean age 3 sockeye ; the factors affected ssds in the same way they did for ocean age 2 fish . significant first - order temporal autocorrelation was found for ssd regressions of ocean age 2 male fish .", "length frequency histograms showed variation in the length and length at age distributions of males and females over time .", "total yearly exploitation rates , or proportions of the fish that were caught , increased significantly over the years for males and females and fish of all age groups ( p < 0.05 ; fig ." ], [ "examination of age- and size - selective harvest of sockeye salmon in a commercial gillnet fishery over 57 years revealed higher susceptibility and exploitation of older and larger fish in most years .", "2007 ) . for bristol bay sockeye salmon and many other species , age at maturity and length at age result from a blend of natural , sexual , and anthropogenic selection .", "the fact remains the larger than average fish have been harvested in most years from the nushagak district sockeye salmon stock .", "proportion of ocean age 3 sockeye salmon in the nushagak district run ( the vast majority of the remaining fish are of ocean age 2 ) , 19632005 . for fish and wildlife populations under size - selective exploitation , it may be important to maintain large numbers of phenotypically diverse breeders to buffer against the detrimental effects of selection ( darimont et al .", "depend on the size distribution of fish that encounter the nets . in the nushagak district fishery , age composition , and thus length frequency , can change dramatically from year to year due to ocean conditions and the strength of different brood years , which can affect the vulnerability curves and size - selectivity . in most years more males than females and more ocean age 3 than ocean age 2 fish were caught ( fig .", "thus , the variable nature of fishery selection over time in the nushagak district fishery , and likely many other fisheries , may hinder evolution of fish towards an optimal life history .", "our results revealed that the nushagak district fishery has caught longer than average fish during most of the past 60 years ." ] ]

[ [ "we investigated the regulatory effects of lllt on monocyte m1 polarization to provide evidence for the use of lllt for immunologic disorders .", "because different types of lasers have been used for the treatment of th2-dominant disease , we evaluate the influence of lllt on monocyte polarization in this study .", "similarly , the clinical value of the potential immune modulation effect of laser therapy has recently been studied in the treatment of allergic rhinitis .", "it is unknown , however , whether lllt modulates human monocyte polarization and immune function via epigenetic regulation .", "lllt is known to be a noninvasive treatment modality and has been applied in various fields ." ], [ "the cells were pretreated with methylthioadenosine ( mta , a histone methyltransferase inhibitor ) or anacardic acid ( aa , a histone acetyltransferase inhibitor ) 1 hour before lllt . to investigate the mitochondria involvement in lllt - related monocyte polarization", "the m1-related cytokine and chemokine genes are as follows : ccl2/mcp-1 , cxcl10/ip-10 , and tnf-. the ccl2/mcp-1 , cxcl10/ip-10 and tnf- concentrations in the cell supernatants were determined using commercially available elisa - based assay systems ( r&d systems , minneapolis , mn )", "immune complexes were collected using a protein a slurry ( invitrogen ) , and the dna was reverse cross - linked , extracted , and quantified using a taqman sds 7900ht . for pcr amplification of chip products , primers and probes were designed to analyze the proximal promoter and intronic enhancer regions of the tnf- gene as previously described [ 19 , 20 ] , encompassing the following subregions relative to the transcription start site : tnf1 ( t1 , + 99 to 42 ) ; tnf2 ( t2 , + 32 to 119 ) ; tnf3 ( t3 , 100 to 250 ) ; tnf4 ( t4 , 195 to 345 ) ; and + 1417 , + 720 , and 1700 .", "cell supernatants were collected 12 , 24 , and 48 hours after lps stimulation . to investigate epigenetic regulation ,", "thp-1 cells were treated with different doses of lllt and total rna was isolated from cells immediately ( t = 0 ) or 6 hours after lps stimulation .", "the relative copy number of mtdna was computed via normalizing the crossing points in the quantitative pcr curves between the mitochondrial nd1 gene and the nuclear 18s rrna gene , and the ratio was normalized to the control ." ], [ "therefore , these findings suggested that the effect of lllt on m1 polarization is associated with the cellular regulation of differential histone modification .", "studies in monocytes and macrophages have shown that although there are different patterns of histone modifications , the main regulatory regions associated with histone modifications could be identified in lllt - treated monocytes . in fact , the involvement of histone acetylation in the regulation of tnf- expression was further supported by the finding that aa significantly suppressed tnf- expression in lllt - treated thp-1 cells ( figure 6(a ) ) . to determine whether histone modifications occurred in thetnf- gene locus in monocytes , chip analysis of thp-1 cells treated with lllt", "next , we investigated whether lllt - induced ip-10 expression in human monocytes was induced by increasing histone acetylation and trimethylation .", "the inhibition of lllt - induced ccl2 mrna expression by oligomycin and antimycin suggested mitochondrial involvement ( figure 4 ) .", "because lllt could induce m1-related cytokine and chemokine mrna expression in monocytes , we examined whether lllt could also induce m1-related cytokine and chemokine protein expression ." ], [ "lllt may be a potent immune - enhancing agent that is suitable for the treatment of allergic diseases but may not be a good therapy for autoimmune and rheumatoid disorders .", "m1-related immunoregulations play important roles in the antiviral and antitumor immunity and the pathogenesis of inflammation in autoimmune diseases .", "therefore , lllt may be useful to promote antiviral immunity but may not be a suitable therapy for autoimmune or rheumatoid diseases . considering the importance of m1-polarized macrophages in various disease contexts , especially immunity to intracellular microorganisms and tumors", "it is also important to understand how to modulate the function of macrophages , induce m1 immunity to promote intracellular killing and tumor resistance , and prevent allergic reaction .", "therefore , the effect of lllt on monocyte polarization may be a potential treatment for allergic diseases and may also promote immunity to viral infections and tumors .", "macrophages are the major antigen - presenting cells involved in the induction of the primary immune response and play a critical role in immunity .", "not only is tnf- a pro - inflammatory cytokine , but it is also an immunoregulatory molecule that can modify the balance of t regulatory cells . in addition , tnf- is a central cytokine that triggers inflammation in rheumatoid arthritis ( ra ) , indicating that the inhibition of tnf- is an effective treatment strategy for ra ." ] ]

[ [ "we are here with reporting a case of craniopharyngioma which recurred at a site removed from the original site 5 years after surgery and radiotherapy .", "craniopharyngioma is an uncommon tumor of the nervous system ; it is well - known to recur even several years after surgery ." ], [ "a 4-year - old girl was admitted for progressive deterioration of vision of 2 months duration . in addition", "the 5-year surveillance imaging showed a recurrence in the right sylvian fissure along the route taken during the first surgery .", "she underwent a right frontotemporal craniotomy and transsylvian exploration and almost total excision of the tumor .", "two years after surgery and radiotherapy no recurrence imaging was being done periodically to check for recurrence .", "( a and b ) showing the preoperative images ( before first surgery ) ( a and b ) images after first surgery showing no residual tumour in the primary site but a small fragment adherent to the pons she was given a course of radiotherapy for this residue 54 gy in 30 fractions .", "( a and b ) showing remote recurrence five years after first surgery and radiotherapy ." ], [ "recurrences at a site removed from the original site are very rare < 25 cases have been reported .", "although craniopharyngiomas are benign tumors they are known to recur even after years and even after the administration of radiotherapy , recurrence rates ranging from 25% to 70% .", "these ectopic recurrences are not to be misinterpreted as ectopic primary occurrences since craniopharyngioma can occur anywhere along the obliterated rathke 's pouch", ". these ectopic recurrences may occur along the surgical pathway or at a site , not along the surgical pathway .", "is why this phenomenon is not seen with respect to other benign tumors like meningiomas or even malignant tumors ." ] ]

[ [ "herein , we report our use of a platform composed of novel sirna targets , sirna - lnp delivery technology , and ccl4-induced liver fibrosis , resulting in the identification of novel modifiers of fibrogenesis in vivo .", "we aimed to identify novel modifiers of tissue fibrosis expressed in myofibroblasts or their progenitors through rna silencing in vivo .", "both the initiation and persistence of pathological fibrosis involves the activation and differentiation of progenitors to myofibroblasts , the key effectors in fibrosis .", ", we employed recently generated transcriptomes from myofibroblasts and their precursors in models of liver and kidney injury and fibrosis.6 , 7 to achieve effective gene silencing in vivo , we used small interfering rna ( sirna ) delivery with lipid nanoparticles ( sirna - lnps ) , an emerging technology for gene silencing in vivo , particularly in the liver , and hence deployed this technology in a model of liver fibrogenesis . the sirna - lnp technology has been previously used to show that silencing of the collagen type i alpha 1 gene ( col1a1 ) reduced its mrna levels and collagen accumulation in liver fibrosis models.9 , 10 however , the use of sirna - lnp technology in a targeted assay for identifying novel fibrosis modifiers has not yet been reported ." ], [ "we aimed to silence genes in key fibrogenic cell lineages , myofibroblasts , and pericytes to identify novel mediators of tissue fibrosis .", "the assessment of col1a1 mrna levels was used as an expedient approach to functionally assess a relatively large number of sirna targets and flag fibrogenic genes of interest . given the sirna - lnp delivery system targets multiple liver cell types , including hscs , hepatocytes , kupffer cells , but not endothelial cells,11 , 12 , 13 , 14 we validated the ability to kd genes expressed in hscs in mice using sirna - lnps ( figures s1d s1h ) .", "egr2 emerged as the strongest modifier of fibrosis in the ccl4 liver fibrosis / sirna kd platform .", "we also demonstrate the ability to kd the hsc - specific gene col1a1 in liver .", "we aimed to directly demonstrate that egr2 kd in an hsc would reduce col1a1 and pdgfrb mrna levels .", "we tested the effect of egr2 kd in the human hsc line lx-2 using three independent sirnas ( figure 4 ) .", "indeed , administration of tgfbr1-lnps and col1a1-lnps , but not luc - lnps , reduced the transcription of col1a1 mrna ( figure s1f ) as well as collagen accumulation ( figures s1 g and s1h ) . to test the role of genes identified in our transcriptomic analysis , we modified the sirna administration protocol to allow pre - existing protein to be turned over and therefore achieve pre - clearance of proteins encoded by the genes of interest and ensure continued kd throughout the experiment ( figure 2a ) ." ], [ "myofibroblasts are key effectors of fibrosis and therefore the elucidation of pathways that promote this cell lineage would be a significant advance in the field . here , we report the use of a targeted in vivo sirna kd platform to identify novel mediators of fibrogenesis . we leveraged novel biology - targeting genes upregulated during liver and kidney fibrosis in myofibroblasts and their progenitors and sirna - lnp technology to silence these genes in ccl4-induced liver injury and fibrosis in mice .", "the results implicate five novel modulators of the fibrogenic process in the liver and demonstrate the feasibility of sirna - lnp for interrogating gene function in the liver . because these genes are commonly upregulated in pericytes and myofibroblasts in both liver and kidney fibrosis models , these genes warrant follow - up to further explore their function and mechanism of action in liver and other organs and to inform their role in both physiological and pathophysiological fibrosis .", "taken together , our studies have identified fstl1 and has2 as fibrosis modifiers in our in vivo liver fibrosis platform and reveal surprising effects of silencing these genes , supporting their complex role in the regulation of fibrogenesis .", "we further directly demonstrated that egr2 kd in human hscs reduced the expression of fibrotic genes .", "we propose grouping them as follows : egr2 , a gene with potential function in hsc expansion ; atp1a2 and fkbp10 , genes that regulate mechanosensing ; and fstl1 and has2 , genes involved in matrix - cell signaling ." ], [ "animals were sacrificed on day 10 by co2 asphyxiation , followed by cardiac perfusion with 10 ml of pbs , and liver lobes were harvested for qpcr and histopathological analysis . target fibrosis modifier genes were selected by intersecting transcriptomic data generated from isolated hscs of mice treated with ccl4 for 2 months , and genes specifically expressed in pericytes / myofibroblasts in the mouse kidney 2 and 5 days after uuo.6 , 7 169 genes were common to both datasets and significantly upregulated at least 2-fold . among these , we excluded transcripts that were not associated with a gene product , genes with no known human homolog , and well - known modifiers in fibrosis ( validated in vivo by independent investigators ) , resulting in 24 genes for further evaluation .", "we used an ssmd method to analyze the suitability of the mrna readout genes in our sirna - lnp / ccl4 liver fibrosis platform ( figure s2 ) .", "each of the ten aforementioned sirna molecules / target gene was screened for its potency to kd gene expression in a cell - based reporter assay . for each target gene ,", "this sirna delivery system can target multiple liver cell types , including hepatocytes , monocytes , tissue macrophages , dendritic cells ( dcs ) , and myofibroblasts / pericytes .", "the sirna antisense strands lacked a seed region ( nucleotides 27 ) identical to a seed region ( nucleotides 27 ) of known mouse mirnas ( mirbase , release 20 , june 2013 ) .", "the regions of their coding sequences targeted by the sirnas were synthesized and inserted to the 3 utr of the firefly luciferase gene in pcmvluc(v ) validation vector ( origene ) , generating an mrna transcript that encodes both the luciferase ( luc ) and the target gene when expressed in cells ." ], [], [] ]

[ [ "however , its association with pheochromocytoma in indian subjects has not been reported till date .", "pheochromocytomas are rare catecholamine producing tumors arising from chromaffine cells in the sympatho adrenal system .", "its prevalence is estimated at 0.1% to 0.6% . they secrete various catecholamines , predominantly norepinephrine , and epinephrine to small extent .", "these catecholamines are responsible for the manifestations with sustained or paroxysmal symptoms . diagnosis is established by measuring metanephrines in the urine or blood .", "localization of the tumor is done using computed tomography ( ct ) or magnetic resonance imaging ( mri ) scans .", "hypercoagulability related to hematological or neoplastic abnormalities , venous stasis secondary to extraluminal pressure from tumors or inflammatory processes , and vessel injury due to trauma have all been implicated as primary mechanism in the pathophysiology of ivc thrombosis ." ], [ "a 48-year - old man was admitted to our hospital with complaints of headache , sweating , anxiety , dizziness , nausea and vomiting .", "mri imaging demonstrated resolution of the thrombosis and return of patency of the ivc at 4 months [ figure 5 ] . the typical growth pattern of nests of tumor cells ( zellballen ) surrounded by a discontinuous layer of sustentacular cells and fibrovascular stroma in the biopsy specimen of the patient in the study .", "there is distal enlargement of inferior vena cava a diagnosis of ivc thrombosis with pheochromocytoma was established , and surgical treatment was planned .", "magnetic resonance imaging ( mri ) revealed intraluminal thrombus extending proximally up to the confluence of hepatic veins immediately inferior to the right atrium without distal extension to femoral veins bilaterally [ figure 2 ] ." ], [ "two aspects render our case unusual : 1 ) the coexistence of pheochromocytoma with ivc thrombosis 2 ) though there are case reports citing the association between malignant pheochromocytoma and ivc thrombus , to our sincere belief ; this is the first such report citing this uncommon association from india .", "surgical reconstruction of the ivc and bypass of an aberrant section are both recognized modalities reserved for the most severe cases and are associated with morbidity and mortality risk .", "management of patients with coexisting pheochromocytoma and ivc thrombosis needs operative resection of the adrenal mass and medical / interventional management of ivc thrombosis .", "endovascular stent placement in combination with angioplasty is recommended in the cases of residual stenosis and chronic ivc occlusion . in the case of ivc thrombus", "dean et al . took a view , which is quite similar to that of ours , that a caval anomaly is a permanent risk factor for venous stasis and thrombosis and that anticoagulant treatment should be lifelong . since our patient had no anatomic abnormality or any other predisposing factors , we decided to give the treatment for 4 months only and stopped it then after documenting radiologic luminal restoration .", "lower back pain , nephrotic syndrome , hepatic engorgement , cardiac failure and pulmonary embolus have also been described ." ], [ "though cases of renal artery stenosis , renal artery aneurysm and inferior vena cava thrombosis have been described , we found the uncommon association with ivc thrombosis in an indian patient .", "pheochromocytoma does not seem to have any effect on the outcome of the coexisting ivc thrombosis .", "ct or preferably mri imaging are required to delineate ivc anatomy and ascertain proximal extent of the thrombus .", "although invasive therapeutic modalities exist , long - term and commonly life - long anticoagulation is often required ." ] ]

[ [ "thus , the present study aims to assess the characteristic demographic findings of cf patients who attended the children s hospital medical center during a ten - year - period . \n", "\n cystic fibrosis ( cf ) is a worldwide disease occurring among virtually all ethnic groups . in caucasians", "early genetic tests demonstrating a molecular defect in the cftr gene confirms the clinical diagnosis of cf , improves quality of life and prolongs survival .", "the condition results from mutations in a single gene of chromosome 7 , which encodes the cf transmembrane conductance regulator ( cftr ) . \n \n" ], [ "\n during a ten - year period ( 1991 - 2000 ) , all patients hospitalized with cf or diagnosed with cf during hospitalization in the children s hospital medical center , tehran , iran were enrolled and related data were extracted from their medical records . sweat chloride tests", "the diagnosis of cf was established when relevant clinical manifestations were associated with a positive sweat chloride test .", "clinical manifestations included respiratory signs such as chronic cough or recurrent pneumonia and gi manifestations in the form of chronic diarrhea or fatty diarrhea , failure to gain weight and failure to thrive ( ftt ) . \n" ], [ "onset of disease was before the first month of life in 12.1% , between 1 - 6 months of age in 75.1% and between 6 - 12 months of age 6.9% of patients . \n \n", "\n among the 233 patients , 91 ( 39% ) were girls and 142 ( 61% ) were boys .", "endoscopy was performed in 65 patients and the most frequent finding was esophagitis ( 81.5% ) . in stool samples , fat droplets greater than 100 per hpf were reported in 100% , whereas 62.7% had decreased trypsin activity . \n \n among patients with respiratory symptoms ,", "a positive family history of cf or suspected clinical signs was present in 26.6% of patients ." ], [ "one of the earliest signs of cf was meconium ileus , which ranged from 8% to 20% in different studies .", "the prevalence of cf in european caucasians is 1:2500 and is rare in asia . \n \n", "death occurred in 13.4% of patients in the present study which was less than actual statistical values because a number of cf patients were not followed . in a study from shiraz ( iran ) ,", "the cf mortality rate was 70% but in another study it was 0% , which probably resulted from the lack of follow up . \n \n", "the male to female ratio was 1:1.5,the most frequent age of onset of symptoms occurred in the first six months of life ( 78% ) and consanguineous marriages were significant ( 42% ) . \n \n", "the incidence of ftt in the asian population was almost equal ( 75% - 100% ) . \n \n" ], [ "\n the authors thank miss maral sayyad and the personnel of the archive of medical documents , endoscopy and gastroenterology departments of children hospital medical center for their assistance . \n" ], [] ]

[ [ "nasal dermal sinus is a very rare congenital anomaly that is frequently associated with inclusion cysts ( dermoid or epidermoid).1 \n 2 \n 3 at the end of the second month of gestation , the nasal and frontal bones are separated by the fonticulus frontalis . in this period ,", "the dura projects into the nasal area through the anterior skull base opening ( foramen cecum ) , and lies in contact with the skin at the tip of the nose ." ], [ "the nasal sinus tract is a ductal structure ( black star ) lined by stratified squamous epithelium .", "there is a dumbbell - shaped mixed intense dermoid ( white arrow ) at the junction of the frontal bone and the anterior fossa ( at the foramen cecum ) , and a strand of isointensity ( nasal sinus tract ) between the tumor and the nasion .", "a bony defect is evident at the midline of the junction of the frontal bone and the anterior fossa with bifid crista galli ( white arrow heads ) .", "the dermoid cyst wall is lined by a keratinizing squamous epithelium ( white asterisk ) .", "1a ) . the sagittal view of a t2-weighted image demonstrated a dumbbell - shaped , mixed intense dermoid at the foramen cecum . the sinus tract was depicted as a strand of isointensity between the dermoid and the nasion .", "an abscess in the subcutaneous tissue of the forehead ( black asterisk ) is noted adjacent to the dermoid ." ], [ "( j ) schematic drawing demonstrating the anatomical relationship of the dermoid ( d ) , subcutaneous abscess ( a ) , and swelling ( s ) with surrounding structures .", "1a ) . the sagittal view of a t2-weighted image demonstrated a dumbbell - shaped , mixed intense dermoid at the foramen cecum . the sinus tract was depicted as a strand of isointensity between the dermoid and the nasion .", "there is a dumbbell - shaped mixed intense dermoid ( white arrow ) at the junction of the frontal bone and the anterior fossa ( at the foramen cecum ) , and a strand of isointensity ( nasal sinus tract ) between the tumor and the nasion .", "a bony defect is evident at the midline of the junction of the frontal bone and the anterior fossa with bifid crista galli ( white arrow heads ) .", "an abscess in the subcutaneous tissue of the forehead ( black asterisk ) is noted adjacent to the dermoid ." ], [ "the nasal sinus tract is a ductal structure ( black star ) lined by stratified squamous epithelium .", "inset is a three - dimensional computed tomography image shown in the same orientation as ( a ) the white box indicates the extent of the operative field .", "the dermoid cyst wall is lined by a keratinizing squamous epithelium ( white asterisk ) .", "the part of the dermoid capsule that was tightly adherent to the dura was carefully coagulated .", "( a ) intraoperative photograph taken after removal of the dermoid through a coronal skin incision showing the bony defect ( white arrows ) ." ], [ "the body of the dumbbell - shaped dermoid was located in the enlarged fonticulus frontalis and foramen cecum remnant ; the head of the dumbbell was the intracranial extension of the dermoid with bulging dura .", "1j demonstrates the detailed anatomical relationship between the sinus tract with dumbbell - shaped dermoid and the surrounding structures .", "a bifid and bulging crista galli was also attributed to the intracranial extension of the dermoid . although bacteriologic examination failed to reveal the causative agents , the microscopically opened sinus tract resulted in the formation of the subcutaneous abscess adjacent to the purulent dermoid ." ] ]

[ [ "since laparoscopic gastrectomy was introduced by kitano et al . , laparoscopic ( assisted ) distal gastrectomy ( ladg ) has become more commonly performed for early gastric cancer in korea [ 2 - 6 ] .", "however , there have been several reports on early surgical outcomes of laparoscopic assisted total gastrectomy ( latg ) [ 7 - 10 ] . in these studies , although latg has been shown to be safe and feasible for early gastric cancer , it has not yet been directly compared with the early surgical outcomes of conventional open total gastrectomy ( otg ) . in fact , ladg had not yet become popularized compared with ladg , because of its technical difiiculties and fear of postoperative complications .", "therefore , the purpose of this study was to evaluate the effectiveness of latg and to introduce techniques from our experiences ." ], [ "we retrospectively reviewed the prospectively collected data on 190 consecutive patients who underwent otg and latg , for gastric cancer between january 2009 and april 2010 at a single institution .", "all patients in whom the proximal margin too short to perform gastrojejunostomy had total gastrectomy : these patients were included in this study .", "after explaining the merits of laparoscopic surgery , the level of difficulty of procedures , and the cost for otg and latg , the decision of otg and latg resided with the patient .", "also , all patients who were preoperatively diagnosed with early gastric cancer were enrolled in this study .", "to evaluate the patients ' postoperative pain , we calculated the number of additional doses of analgesics until the patient was discharged from the hospital . also , we applied an nrs for all patients .", "pathologic results were analyzed for tumor size , number of retrieved lymph nodes , resection margins , and american joint committee on cancer / international union against cancer staging . to evaluate the intra - operative blood loss ," ], [ "we retrospectively reviewed the prospectively collected data on 190 consecutive patients who underwent otg and latg , for gastric cancer between january 2009 and april 2010 at a single institution .", "all patients in whom the proximal margin too short to perform gastrojejunostomy had total gastrectomy : these patients were included in this study .", "after explaining the merits of laparoscopic surgery , the level of difficulty of procedures , and the cost for otg and latg , the decision of otg and latg resided with the patient .", "also , all patients who were preoperatively diagnosed with early gastric cancer were enrolled in this study ." ], [ "the duodenum is transected below the duodenal bulb using an endoscopic linear stapler ( endopath ets 60 , ethicon endo - surgery inc . ,", "after the dissection of the lymph nodes around the right gastroepiploic area , the infrapyloric area was dissected . in some patients , dissection was advanced to the superior mesenteric vein to include enlarged 14v lymph nodes .", "dissection of the lymph nodes around the left gastroepiploic vessels and short gastric vessel was performed .", "lymph nodes around the suprapyloric area ; hepatoduodenal ligament ( along the hepatic artery ) , common hepatic , splenic , celiac , and left gastric arteries ; and right and left paracardial areas were dissected in that order .", "the falciform ligament was fixed to the anterior wall of the peritoneum for retraction of the liver using endo close .", "dissection was begun by dividing the greater omentum ( 4 cm from gastroepiploic arcade ) from the mid - portion of the gastroepiploic arcade to the short gastric vessels .", "if the operating field was not sufficient , an additional 5-mm trocar was inserted into the epigastric area to retract the liver ." ], [ "this was based on the observation of the number of surgical sponges used , the amount of fluid in the suction device , and a calculation of the amount of irrigant used during the operation .", "to evaluate the patients ' postoperative pain , we calculated the number of additional doses of analgesics until the patient was discharged from the hospital .", "pathologic results were analyzed for tumor size , number of retrieved lymph nodes , resection margins , and american joint committee on cancer / international union against cancer staging . to evaluate the intra - operative blood loss , the attending anesthesiologist recorded the estimated blood loss .", "early surgical outcomes included operation time , postoperative complications , intra - operative blood loss , postoperative change in hematocrit , time to first flatus , day of commencement on soft diet , number of administrations of analgesics , numeric rating scale ( nrs ) , and postoperative hospital stay .", "patients were discharged if they had no problems eating a soft diet , showed an absence of inflammatory conditions , including leukocytosis , unstable vital sign and abrupt onset abdominal pain , and were generally comfortable . also , we left the final decision about discharge up to the patients .", "clinical data obtained from medical records included patient age , gender , body mass index ( bmi ) , and american society of anesthesiologists ( asa ) score ." ], [ "patient data was analyzed by one - way analysis of variance , followed by a post - hoc turkey test and the test ." ], [ "extra - luminal bleeding was solved by laparoscopic reoperation for bleeding of suprapancreatic branch around the splenic artery .", "operation time , it took longer to perform for latg than otg ( latg vs. otg ; 150.8 minutes vs. 131.2 minutes ; p < 0.001 ) .", "intra - abdominal abscesses developed in 4 patients . in four of eight patients , extra - luminal bleeding , anastomosis leakage , cholecystitis , and wound complication occurred , respectively .", "in pathologic results , there were no significant differences for tumor size , the number of retrieved lymph nodes , resection margins , tumor 's depth and nodal staging ( table 3 ) . in patients who underwent latg , postoperative complications occurred in 8 patients .", "the clinical characteristics of the 190 patients are presented in table 1 . in comparison of patients", "overall , there was no difference in gender , age , asa score , and bmi between the latg and otg groups ." ], [ "the clinical characteristics of the 190 patients are presented in table 1 . in comparison of patients", "overall , there was no difference in gender , age , asa score , and bmi between the latg and otg groups ." ], [ "there were significant differences for the amount of estimated blood loss ( latg 179.7 ml vs. otg 272.7 ml ; p < 0.001 ) and postoperative change in hematocrit ( hct ) ( latg 36.2 vs. otg 34.5 ; p = 0.002 ) . the mean day to first flatus ( p < 0.001 ) and commencement of soft diet ( p = 0.034 ) were checked earlier in the latg group than in otg group .", "operation time , it took longer to perform for latg than otg ( latg vs. otg ; 150.8 minutes vs. 131.2 minutes ; p < 0.001 )", ". there was no significant difference for postoperative complication rate ( latg 12.7% vs. otg 18.9% ; p = 0.291 ) .", "the postoperative hospital stay was significantly shorter in the latg group than in the otg group ( p = 0.045 ) .", "in pathologic results , there were no significant differences for tumor size , the number of retrieved lymph nodes , resection margins , tumor 's depth and nodal staging ( table 3 ) .", "nrs scores were significantly lower in the latg group than in the otg group at pod 0 at 11:00 am , pod 1 at 8:00 am , pod 1 at 11:00 pm , pod 2 at 8:00 am , pod 3 at 8:00 am , pod 5 at 8:00 am ( p < 0.001 , p = 0.003 , p = 0.005 , p = 0.008 , p = 0.010 , p = 0.004 ) ." ], [ "intra - abdominal abscesses developed in 4 patients . in four of eight patients , extra - luminal bleeding , anastomosis leakage , cholecystitis , and wound complication occurred , respectively .", "extra - luminal bleeding was solved by laparoscopic reoperation for bleeding of suprapancreatic branch around the splenic artery .", "intra - abdominal abscess were managed by pig - tail insertion and administration of antibiotics .", "anastomosis leakage was managed by conservative treatment and upper gastrointestinal series showed closure at postoperative 14 days ." ], [ "we speculate that the accumulated experiences of surgeons in laparoscopic gastrectomy will aid us in getting over these difficulties . in our institution , we had experienced 1,100 cases of laparoscopic gastrectomy including ladg with gastroduodenostomy , ladg with roux - en - y reconstruction , latg and total laparoscopic distal gastrectomy with delta - shaped anastomosis by 2008 . from the accumulated experiences of experts , we could learn the method to reconstruct anastomosis easily . in reconstruction", ", the present study has suggested that latg is not only a feasible procedure for postoperative complications but also contributes to the improvement of early surgical outcomes including bowel movement , pain during recovery , and hospital discharge .", "however , latg is not a generally accepted approach among many surgeons due to technical difficulties and high complication rate . up to now , there have been some reports about the technical feasibility and safety compared with conventional open gastrectomy [ 7 - 10 ] . in practical procedures of latg , we often had difficulty in reconstruction of anastomosis due to limited operation field .", "many studies have reported that ladg with gastroduodenostomy ( billroth i ) is as safe as that of open gastrectomy and less invasive than open gastrectomy [ 2 - 5 ] ." ] ]

[ [ "given the number of rules and constraints on the length of journal publications , it is difficult to assemble all the parameters in one publication and provide meaningful tutorials for using the parameters .", "the nearest neighbor database ( nndb ) is a web - based tool for assembling and archiving complete nearest neighbor sets , including rules and values .", "nearest neighbor approaches were developed to predict the folding stabilities of nucleic acid secondary structures ( 1 ) .", "currently , the 1999 and 2004 sets of rna folding parameters are provided ( 25 ) .", "additional approaches that use statistical learning of parameters for rna folding have also used the rules from the nearest neighbor methods and derived new parameter values ( 13,14 ) ." ], [ "this tutorial demonstrates the prediction of folding free energy change for a hairpin loop of six unpaired nucleotides using the 2004 parameters ( 2,3 ) .", "this tutorial demonstrates the prediction of folding free energy change for a hairpin loop of six unpaired nucleotides using the 2004 parameters ( 2,3 ) . an example tutorial from the database .", "the nndb is built using a set of static html , specifically xhtml 1.0 transitional pages with a page hierarchy shown in figure 1 .", "text is encoded in unicode ( utf-8 ) to facilitate display of equations in pages with diverse browsers running on diverse operating systems .", " crick helix parameters are covered with two tutorials , one for self - complementary and one for non - self - complementary strands .", "the top - level page provides access to a help page , available parameter sets and a page of references to rna optical melting experiments .", ", a page defines the basic equations and provides links to parameter values ( in plain text and html ) , references and tutorial pages ( e.g. figure 3 ) .", "an rna secondary structure illustrating the types of features included in nearest neighbor parameter sets .", "the basic equations for utilizing the parameters to extrapolate folding free energy changes to temperatures other than 37c and to predict melting temperatures are also provided . \n" ], [ "these rules represent the most recent set of parameters and a prior set that is widely used in software packages . because folding rules are derived to work as a set , the two versions of rules and values should not be mixed and the website hierarchy reinforces this .", "the first release of the nndb contains the rna folding rules assembled in 1999 and 2004 ( 25 ) .", "additionally , the values derived from the re - estimation of the values of the 1999 parameter set using the set of known rna secondary structures will also be included ( 14 ) .", "it is anticipated , for example , that additional pages will be written to include nearest neighbors for dna folding ( 6,7 ) and for predicting rna pseudoknot stabilities ( 1518 ) ." ], [ "the nndb is designed to provide a convenient location for assembling parameter sets for predicting the stability of nucleic acid secondary structures .", "furthermore , the web format makes it feasible to provide extensive tutorials for utilizing the parameters , which is generally not possible in print .", "it is modular in design , which facilitates its future expansion to contain additional parameter sets ." ], [ "the creation of the nndb was supported by united states national institutes of health grants gm076485 to d.h.m . and gm22939 to d.h.t . funding for open access charge : united states national institutes of health ." ] ]

[ [ "mucocele of the appendix ( collection of mucus within the appendiceal lumen ) is a rare lesion , found in only 0.2% to 0.3% of 43,000 appendectomies reviewed .", "in such cases , clinical findings and other investigative modalities are warranted to aid the diagnostic process . in spite of extensive preoperative investigations ,", "the diagnosis may still remain elusive and may only be made at the time of surgery . some regard this lesion as benign , a result of obstruction of the proximal lumen by fibrosis ; others believe it to be a neoplasm of the appendix .", "several studies ( mostly case reports ) on laparoscopic resection of mucocele have been reported .", "currently , the assessment of pelvic masses relies heavily on usg as the primary diagnostic tool .", "is the method of choice in the management of simple mucocele and for cystadenoma with an intact base ." ], [ "a 60-year - old female presented with pain in lower part of abdomen and palpable tender lump in the right ileac fossa .", "the mucocele of the appendix was isolated after separating the mesoappendix from it with the help of bipolar cautery . following this ,", "appendicular lump from the distal portion of appendix after removal the appendicular lump filled with mucinus material", "ultrasound of the abdomen reports a cystic mass of size 12 15 cm with thin internal septations in the right adnexa .", "mucocele of the appendix [ figure 1 ] was retrieved out in a plastic bag through the umbilical port .", "a 0 telescope was introduced through the umbilical port for the complete examination of the abdomen ." ], [ "therefore mucocele of the appendix can mimic an adnexal mass and prove to be a diagnostic challenge . in a woman presenting with right iliac fossa mass and with clinical features not indicative of gynecological pathology , an appendiceal origin should be considered in the differential diagnosis .", "the preoperative clinical diagnosis of appendiceal mucoceles can therefore be difficult because of this lack of clinical symptomotology .", "pre - operative diagnosis is important to avoid unintended rupture and the development of pseudomyxoma peritonei during surgery .", "surgery is the treatment of choice and should be done early as tumor can not be ruled out as the causative factor for the mucocele ." ], [ "laparoscopic resection of mucocele of the appendix is feasible in spite of the danger of malignancy , provided necessary precautions are taken .", "mucocele of the appendix can mimic an adnexal mass and prove to be a diagnostic challenge ." ] ]

[ [ "our secondary objective was to study the relationship between the psychiatric morbidity and specific sociodemographic and clinical variable correlates in postpartum women ( within 4 weeks ) in a tertiary care hospital .", "hence , our primary objective was to assess the proportion and types of psychiatric morbidity and correlates in postpartum women in a tertiary care hospital as per dsm - iv tr .", "pregnancy and postpartum period are widely considered periods of increased vulnerability to psychiatric disorders . after more than 50 years and four revisions , ", "postpartum psychiatric disorders , described as lactational psychoses by hippocrates in the 4 century bc , have long been of interest to the medical community .", "the traditional view that there are three postpartum psychiatric disorders such as postpartum blues , depression , and puerperal psychosis is an oversimplification .", "childbirth presents many challenges to the mother such as trauma , sleep deprivation , breastfeeding , and adjustments in relationships and is a major life transition and developmental process .", "the case series of obsessions of infanticide are many . also , posttraumatic stress disorders ( ptsds ) and newer entities such as the morbid preoccupations regarding the childbirth and the disorders of the mother " ], [ "it was usually the 3 postpartum day in case of a normal delivery and the 7 or 8 day in case of a delivery by episiotomy or cesarean section .", "an additional question about obsession of child harm was included while assessing the obsessive compulsive disorder ( ocd ) . in the end , the patients were rated on the global assessment of functioning ( gaf ) .", "then , clinical data were obtained on a similar semistructured proforma comprising items related to patients ' family history of psychiatric illness , history of psychiatric illness , clinical details of delivery , sex of fetus , current episode including onset , duration , and timing of illness , and parity and state of physical health of infant . following this , the mini international neuropsychiatric inventory ( mini ) , a short", ", structured diagnostic interview designed to diagnose dsm - iv and icd-10 psychiatric disorders for multicenter clinical trials and epidemiology studies as well as the first step in outcome tracking in nonresearch clinical settings was administered . in our study ,", "the sociodemographic data were obtained on a semistructured proforma consisting of items relating to patients ' age , social , educational , cultural background , education , and occupation of the spouse .", "then , written consent was taken on the consent form before recruiting them . the study sample consisted of women getting admitted for delivery in the department of obstetrics and gynecology of the study venue .", "after obtaining the approval from the institutional ethics committee , the study was conducted in a tertiary care hospital attached to a medical college at mysore , india , during june december 2011 ." ], [ "association between psychiatric illness and number of children dead ( stillbirths and neonatal deaths ) prior to the present delivery", "pie chart showing psychiatric morbidity pie chart of different psychiatric disorders psychiatric morbidity in study population psychiatric illness detected in the study population was studied for association with education , education of spouse , religion , type of family , occupation , occupation of spouse , antenatal care , consanguinity , order of child , number of dead children before this delivery , number of abortions before this delivery , term of delivery , mode of delivery , planning of pregnancy , and congenital anomalies .", "the study venue provides tertiary care and is a referral center for the district of mysore and the four neighboring districts .", "statistically significant association was seen to be present between psychiatric illness and number of previous stillbirths and dead children before this delivery ( p = 0.045 ) .", "the age range varied from 18 to 35 years with a mean age of 23 4.8 years ." ], [ "this is a cross - sectional hospital - based study in which we assessed the proportion of psychiatric morbidity of postnatal women attending the department of obstetrics and gynecology of the hospital .", "the aim of our study was to assess the proportion and types of psychiatric morbidity and correlates in postpartum women in a tertiary care hospital .", "we found that the psychiatric morbidity was as high as 44% , found in 67 of 152 study subjects .", "however , that study gave the prevalence rates of postnatal blues , postpartum depression , and psychosis ." ], [ "the study reveals that psychiatric comorbidity is very common in the postpartum period and can be detected as early as 1 week after delivery .", "it needs a larger sample with a prospective assessment to generalize the findings of our study .", "the number of dead children ( stillborn and neonatal death ) before the present delivery is a risk factor for psychiatric morbidity during the current pregnancy .", "social phobia identified as a common association , though antepartum , is a new finding and needs further replication .", "the overall psychiatric morbidity was 44% and the most common disorder was depression , seen in 26% women ." ], [], [] ]

[ [ "microdissection , genetic , and inhibitor experiments have been used to define the parts of the spindle that are required for cleavage furrow induction .", "however , recent results suggest that neither cell size nor lack of conservation underlies the variable degree to which the central spindle controls furrow formation , and indicate that this process is controlled by two parallel pathways . in c. elegans embryos , the central spindle is not generally essential for furrow formation .", "indeed , observations in drosophila provide compelling evidence that astral microtubules may not be critical for furrow formation and that the central spindle is necessary and sufficient to induce furrow formation ( fig", "additional evidence supports the notion that the central spindle is involved in furrow formation . in cultured rat cells ," ], [ ", these factors could regulate furrow formation in two ways : they could be positive inducers of furrow formation , or they could inhibit a negative regulator of furrow formation .", "given that both the central spindle and astral microtubules can contribute to induction of cleavage furrows , at least under some circumstances , proteins that localize to these structures are potential clues to the mechanism of furrow induction ." ], [ "there are several factors that concentrate on the central spindle that have been suggested to be inducers of cleavage furrow formation .", "a second potential activator of cleavage furrow formation that could link the central spindle to cleavage furrow formation is the rhogef , pebble .", "both astral microtubules and the central spindle contribute to cortical localization of aurora b ( murata - hori and wang , 2002 ) , presumably due to interactions with incenp and survivin , whose sole function appears to be to activate and localize aurora b. interestingly , aurora b localizes to the central spindle in cells that lack chromosomes ( bucciarelli et al . , 2003 ) , indicating that these subcellular targeting events are independent .", "the association of pebble with centralspindlin might promote the continued ingression of the cleavage furrow by maintaining rhoa in an active state .", "the cortical localization of the abi complex precedes the early stages of cytokinesis ( eckley et al . , 1997 ) ." ], [ "given that there is compelling evidence that microtubules control furrow formation , it is conceivable that modulation of their distribution or properties could control furrow formation . in principle , bundling of microtubules to form the central spindle could quantitatively and/or qualitatively regulate the inhibitory effects of microtubules .", "thus , a second mechanism by which the central spindle could promote furrow formation is by inhibiting this negative regulation .", "central spindle assembly may not only affect the spatial organization of microtubules it could also alter the capacity of microtubules to inhibit contractility by changing the properties of the microtubules .", "thus , binding of centralspindlin to microtubules could induce central spindle assembly and simultaneously prevent the microtubule - dependent inhibition of furrow formation ." ], [ "cleavage furrow induction through local relief from the inhibitory effects of microtubules is an appealing model because it explains how two pathways , spindle elongation and central spindle assembly , could control furrow formation through a common molecular mechanism .", "in addition , it accounts for the fact that the central spindle has a positive ( though nonessential ) role in furrow formation .", "in particular , it is tempting to speculate that the signals discussed here are important for patterning of the cortex in response to a local inhomogeneity in the distribution of microtubules .", "alternatively , contractile ring assembly might be a cooperative process that is self - refining and amplifying .", "it also has predictive value in that local depolymerization of microtubules should induce cleavage furrows ." ] ]

[ [ "is a possible previous step to urinary tract infection , this work was designed to see if there is any difference in papg alleles ' distribution ( especially papg allele ii ) among e. coli vaginal isolates from pregnant and nonpregnant women and also to evaluate the possible ability of papg allele ii isolates to cause pyelonephritis by genotypic analyses of e. coli phylogenetic groups and extraintestinal pathogenic e. coli virulence factors ( expec vfs ) .", "the ability of uropathogenic escherichia coli ( upec ) to adhere to host uroepithelia is an important stage in the successful colonization of the urinary tract and pathogenesis of urinary tract infection ( uti ) ." ], [ " this study included 122 e. coli isolates ( 61 vaginal and 61 fecal isolates ) .", "vaginal isolates ( 23 from pregnant and 38 from nonpregnant women ) were recovered as significant growth from high vaginal swabs collected by gynecologists from pregnant and nonpregnant women ( aged 1845 years ) clinically diagnosed as having symptomatic genital tract infection , without investigating the exact cause of infection ( women with vaginal discomfort , causes of which had not been clarified by gynecological examination ) .", "were recovered from healthy volunteers ( pregnant ( 30 isolates ) and nonpregnant ( 31 isolates ) women , aged 1845 years ) .", "all isolates were screened for the presence of the three papg alleles ( i , ii , and iii ) by a multiplex pcr assay using specific primers ( table 1 ) .", "phylogenetic classification of e. coli isolates was determined using triplex pcr - based phylotyping described by clermont et al . ." ], [ "sixty - one vaginal e. coli isolates from pregnant and nonpregnant women were surveyed for papg alleles as predisposing factor to pyelonephritis .", "papg vaginal isolates clustered in groups b2 ( 78.2% ) and d ( 21.7% ) , whereas all of the fecal isolates clustered in group d. except for sfa / foc , for all the studied vfs ' genes ( table 5 ) , papg vaginal isolates did not differ significantly in comparison with papg fecal isolates . also pregnant and nonpregnant", "papg allele ii was the most prevalent allele among both vaginal ( 32.7% ) and fecal ( 3.2% ) isolates , whereas other alleles were found only among vaginal isolates ( 1.6% for alleles", "papg \n isolates were further genotyped for e. coli phylogenetic groups and expec vfs ' genes ( table 5 ) .", "in addition , the mean of vfs ' gene possession was 3.5 ( range from 2 to 5 ) .", "pregnant and nonpregnant women 's vaginal isolates were papg allele ii , respectively ( table 4 ) . \n" ], [ "here in this work , the vast majority of papg allele ii vaginal isolates clustered in group b2 and much less in group d , and most of them were positive for fimh , papc , iucc , and hly , and about half of them were positive for sfa / foc ( table 6 ) .", "so , it can be concluded that vaginal colonization by papg allele ii e. coli is possibly one of the predisposing factors of both pregnant and nonpregnant women to pyelonephritis , but its potential is modified by other factors especially host factors .", "all papg allele ii isolates in this work were positive for both papc and fimh and about half of them were positive for papc , fimh , and sfa / foc .", "pregnant women 's isolates did not differ significantly from those of nonpregnant in possession of papg allele ii ( 39.1% versus 28.9% ) , whereas both ( 32.7% ) differed significantly ( p 0.05 ) in comparison with fecal isolates ( 3.2% ) ( table 4 ) . also papg allele ii isolates did not differ significantly from each other regarding the phylogenetic groups and expec vfs ' genotypes ' distribution ( tables 5 and 6 ) this indicates that both pregnant and nonpregnant women have the same chance to get pyelonephritis in accordance with this work 's proposal , although , previous studies found that acute pyelonephritis is more common in pregnant than in nonpregnant women [ 11 , 31 ] which means that physiological differences seem to be the critical determinants of predisposition to this infection due to stasis of urine and bacteriuria in the urinary tract caused by relative obstruction . the vaginal ecosystem and especially lactobacillus , as well as intestinal populations of e. coli , coitus and the physiological and anatomical conditions of the urinary tract also play a major role in the pathogenesis of urinary tract infections . " ] ]

[ [ "its radius of care extends far into the amazonian region , where the most intense fighting between rebel groups , cocaine traffickers , and government forces has taken place for over 40 years . in this setting , tbi is exceptionally common , but few resources have been devoted to neurologic care in the hospital .", "the objective of this study was to evaluate the outcomes of patients with stbi treated with a strategy of early cranial decompression ( ecd ) as a damage control procedure ( dc ) .", "trauma remains as a public health problem and generates a significant burden on healthcare systems in latin american countries . in colombia in particular ,", "nuh has one computed tomography ( ct ) and one magnetic resonance imaging machine and did not have continuous access to advance neuro - monitoring .", "the incidence of stbi has been reported at 200 cases per 100,000 people worldwide . according to the world health organization 's study on the global burden of disease in 2010 ,", "the hospital at which this study was conducted , neiva university hospital ( nuh ) , is a 504-bed , level i trauma center and tertiary referral hospital in southern colombia .", "thus , this is an appropriate location to study the effects of a dc procedure that may be implemented in a timely manner without the extensive use of already limited resources ." ], [ "this is a descriptive observational study of head trauma patients , who were managed with ecd as a dc approach in nuh between february 2009 and february 2013 .", "the patient outcomes were evaluated according to the glasgow outcome scale ( gos ) at 12 months postinjury . based on the gos score , a dichotomous variable divided into", "the analysis of clinical , demographic , and imaging variables was performed for patients who had tbi and were operated with an ecd .", "patients were evaluated using the gos in both the outpatient clinic and by phone interview .", "documentary review of medical records by data recording was performed using an intake form that included epidemiological , clinical , surgical , and outcomes data .", "approval from the nuh , quality improvement office and the institutional review board of nuh was obtained prior to conducting this study .", "all of the patients included in the study were operated in less than 12 h post - trauma ." ], [ "this is a descriptive observational study of head trauma patients , who were managed with ecd as a dc approach in nuh between february 2009 and february 2013 .", "approval from the nuh , quality improvement office and the institutional review board of nuh was obtained prior to conducting this study .", "the patient outcomes were evaluated according to the glasgow outcome scale ( gos ) at 12 months postinjury . based on the gos score , a dichotomous variable divided into", "classic scale scoring was used ( 1 = dead , 2 = vegetative state , 3 = severe disability , 4 = moderate disability , and 5 = good recovery ) .", "patients were evaluated using the gos in both the outpatient clinic and by phone interview .", "( gos 4 or 5 ) , and unfavorable ( gos 13 ) groups was created ." ], [ "additional criteria include age 18 years old , severe head trauma ( glasgow coma score 8 on arrival or head abbreviated injury scale 3 ) and icd-10 diagnostic codes of s-00 to s-09 or t-00 to t-14 .", "all of the patients included in the study were operated in less than 12 h post - trauma .", "we excluded patients with severe extracranial traumatic injuries , patients who do not receive a decompressive craniectomy , and patients operated after 12 h posttrauma ." ], [ "tbi : traumatic brain injury , er : emergency room , eb : excess of base , asdh : acute subdural hematoma , edh : epidural hematoma , ich : intracranial hemorrhage , mdls : midline shift , cd : cranial decompression , icu : intensive care unit , sbp : sistolic blood pressure , hobe : head of the bed elevation , ab : antibiotic", "surgical criteria for the procedure included : obliteration of the basal cisterns , midline shift of > 0.5 cm , acute subdural hematoma wider than 1 cm , epidural hematomas of > 30 cc in volume , or intracerebral hemorrhage of > 50 cc in volume [ figure 1 ] .", "early decompression included a > 12 cm by 12 cm hemispheric craniectomy either with or without dural closure ." ], [ "postoperative care includes sedation for at least 5 days with midazolam and fentanyl , 7.5% hypertonic saline in boluses every 6 h for 48 h and control ct at 24 h after surgery .", "antibiotic and anti - convulsive prophylaxis was used in penetrating injuries [ figure 1 ] ." ], [ "documentary review of medical records by data recording was performed using an intake form that included epidemiological , clinical , surgical , and outcomes data .", "variables such as glasgow coma scale at the emergency room , type of trauma , the severity of injuries , ct scan findings including the presence of hematoma , midline shift , and the compression of the basal cisterns were included .", "the analysis of clinical , demographic , and imaging variables was performed for patients who had tbi and were operated with an ecd .", "measures of central tendency and dispersion for continuous variables were calculated including frequencies and proportions for categorical variables .", "the student 's t - test was used to compare continuous variables , and pearson chi - square test was used for categorical variables" ], [ "at nuh , 156 patients were admitted with a diagnosis of stbi between february 2009 and february 2013 , but only 106 were managed under ecd with all the inclusion criteria [ table 1 ] . at 12 months postsurgery , a favorable clinical outcome ( gos 45 ) was found in 70 patients ( 66.1% ) , while an unfavorable clinical outcome ( gos 13 ) was found in 36 patients ( 33.9% ) ( p = 0.0001 ) .", "of the 36 patients with an unfavorable outcome , mortality ( gos = 1 ) was observed in 27 , with an overall rate of 25.4% .", "70.1% ( 20 ) of the patients who die , were patients admitted for penetrating brain injury .", "the average length of stay in the icu for the patients with a favorable gos ( 45 ) was 12.96 2.67 days while the group with an unfavorable gos ( 13 ) spent an average of 26.71 5.35 days in the icu ( p = 0.0002 ) .", "clinical characteristics of patients with stbi admitted to nuh clinical and demographic characteristics of patients with stbi the factors that were associated with an unfavorable neurologic outcome were the following injury severity score ( iss ) > 35.62 ( 95% confidence interval [ ci ] , 35.645.8 ) , subdural hematoma at the first ct , closed basal cisterns , and unreactive pupils upon emergency room arrival . in [ table 3 ] , significant findings were analyzed for both groups .", "cranioplasty was performed in most of the cases with autologous bone in a mean period between 1 and 3 months after the initial decompression ." ], [ "continuous neuromonitoring in the icu is not an option ; however , the results obtained using edc as dc therapy reflected a better neurological outcome in patients with severe head injury .", "many of these factors have also been described in other studies that recommend ecd as a dc therapy for stbi , but our study findings need to be highlighted in a context of few resources for neuromonitoring and an aggressive surgical care as an option due to this resource limitation . the only available study of ecd in low resources environment includes the analysis of 10 patients in a teaching hospital in africa . at present , the management of patients with stbi should be aggressive from the moment they arrive at the emergency department ; different management protocols can be used help increase survival and reduce hospital time for these patients . in our study , hospital stay was significantly shorter for the group of patients with a favorable neurological outcome at 12 months from injury .", "ecd has been cataloged as an important option to improve survival and reduce disability associated with tbi .", "in addition , the results of these studies show high variability in patient age , type of surgery , and time to initiation of edc surgery . despite this , in many parts of the world ecd surgery as dc therapy has begun to play a critical role as management for neurotrauma ." ], [ "twelve months outcome of patients with stbi managed with ecd in a neuromonitoring limited resource university hospital in colombia shows an important survival rate with favorable clinical outcome measure with gos .", "authors are supported by the nih - fic grant # r21tw009332 awarded to meditech foundation ( col ) and the university of pittsburgh ( usa ) ." ], [ "authors are supported by the nih - fic grant # r21tw009332 awarded to meditech foundation ( col ) and the university of pittsburgh ( usa ) ." ], [] ]

[ [ "we \n investigate ni nanoparticles ( nps ) deposited on a polished \n yttria - stabilized zirconia ( ysz ) substrate as sofc model anode by \n surface sensitive x - ray diffraction methods .", "the nio formed \n during oxidation grows epitaxially with repect to the ni nanoparticles . \n from the measured particle heights and widths ,", "the energy of adhesion , \n which is an important quantity with respect to the nanoparticles \n sintering stability , is determined .", "we find that ni nanoparticles grow with two very distinct \n orientations on ysz(111 ) , in contrast to mgo(100 ) .", "this \n raises the question how smaller particles in the size regime from \n 310 nm , as typically encountered on the anodes of sofcs behave \n when in contact with a solid electrolyte ." ], [ "the \n experiments presented in the following were performed at the \n mpi beamline of the ngstrm - quelle \n karlsruhe ( anka ) using an x - ray energy of 10 kev .", ", only the as - prepared nps were structurally characterized , \n and after the in situ synchrotron experiment , the sample was investigated \n by atomic force microscopy ( afm ) in air . in a second experiment on \n sample ii", "the ni nps were grown with a substrate temperature \n of 623 k at a growth rate of 0.2 nm / min resulting in a nominal 3 nm \n of deposited material .", "here , we present results from two such growth \n runs with different samples , named sample i and sample ii hereafter . \n for sample i", ", we conclude that each of these processing steps \n does not result in any significant atomic relaxations of the substrate .", "x - ray data consist \n of x - ray reflectivity , extensive reciprocal space mapping , and crystal \n truncation rod ( ctr ) data . in addition , ex situ atomic force microscopy \n ( afm ) measurements were performed in air once the synchrotron experiments \n had finished ." ], [ "after oxidation , the width distribution \n of the metallic core of the partially oxidized particles has become \n asymmetric and peaks at around 9 nm ( filled white ) .", "( a ) small nps oxidize comparatively faster and burn up \n completely , whereas at the same time , an oxide skin has formed on \n larger nps and the core is still metallic .", "it has been observed that during the oxidation of a ni(111 ) \n single - crystal surface under identical conditions as used in this \n work , a nio skin of approximately 2 nm forms after approximately 14 \n h. therefore , it seems reasonable to \n assume that for the oxidation time investigated here , at most , only \n one single outermost layer of ni atoms , which constitute the top facets , \n form an ultrathin nickel oxide .", "the occurrence of two distinct np growth directions can be \n related to a difference in interfacial binding which either could \n originate from a lateral chemical inhomogeneity of the ysz substrate \n or a kinetically trapped state . also a size dependence can not be ruled \n out which is difficult to investigate due to the inherent size distribution \n of the nps after growth via thermal deposition . at a temperature of 573 k , the \n nps were exposed to molecular oxygen at a pressure of 10 pa for approximately 35 min , after which the oxygen was pumped off \n again .", "the oxidation behavior of the \n nps belonging to or2 has not been \n followed in situ , but the overall changes in height and width , as \n listed in table 3 , \n are very similar to those of or1 .", "the intensity loss on the metal \n ni bragg peaks is about 50% , very similar to that of the peaks belonging \n to or1 ." ], [ "nickel nps \n were grown in uhv by pvd using an electron beam evaporator \n with a nominal average height of approximately 4 nm at substrate temperatures \n of 623 k. x - ray diffraction revealed that two distinct np orientations \n form ; there is no random orientational growth which would give rise \n to powderlike diffraction patterns .", "instabilities around the ideal ratio of fuel and oxygen \n levels can lead to the formation of nio , which is known to lower the \n sofc performance and lifetime by stress development , lowering of the \n metal triple phase boundary density , and mechanical failure .", "a possible adsorption of the hydrocarbons on the nps is thus concluded not to affect the structure of the nps .", "the results obtained here can be discussed in relation to real \n sofcs , in particular with respect to the so - called redox cycling ( i.e. , \n the oxidation reduction process of ni ) . during sofc operation ," ], [ "x - ray diffraction revealed \n two distinct orientations of ni nanoparticles \n grown in uhv by mbe : -oriented particles and ones with their \n planes tilted by 41.33 from the surface normal . a combination \n of diffraction line width analysis , x - ray reflectivity , and afm delivered \n information on the average np height and width .", "annealing \n the nps in uhv to 923 k led to the observation of sintering : most \n significantly , their average height increased and the data also indicate \n an increase in average width . this sinterering process does not lead \n to a significant shape change from just after growth .", "these sizes were used \n to determine the energy of adhesion to be in the range of 1.42.2 \n jm , whereby particles that have a more round shape \n are more weakly bound than those that have a flatter geometry .", "exposure to \n methane at 10 pa at a temperature of 573 k did \n not show any structural changes . however , oxidation at 10 pa of o2 at the same temperature led to the formation \n of expitaxial nio on the -oriented particles .", "an oxidation mechanism \n is postulated , which is based on a preferentially faster burn up rate \n for small particles and the formation of an oxide skin around larger \n ones ." ] ]

[ [ ". therefore , our investigation aimed at an efficient screening program , using an experimental and computational(16 ) approach to complement and validate the results and comprehensively characterize all ra solid - state forms at ambient conditions . the experimental screen was based on manual solution crystallizations of the compound in a variety of solvents and crystallization conditions , sublimation and moisture sorption experiments . the thermodynamic and kinetic stability of the solid - state forms were ascertained by hot - stage microscopy , differential scanning calorimetry , thermogravimetic analysis , and solvent - mediated transformation studies .", "the present study deals with the solid - state of -resorcylic acid ( 2,4-dihydroxybenzoic acid , ra , figure 1 ) , a small organic molecule exhibiting molecular flexibility and the ability to form different hydrogen bonding motifs .", "vibrational spectroscopy ( mid infrared and raman ) and x - ray diffractometry ( powder and single crystal ) were employed to determine the structural features of the phases . however , as neither high - throughput methodologies or other widely applied screening strategies(19 ) guarantee all possible forms will be found , we supported and complemented our manual screen with computational crystal structure prediction ( csp ) . by contrasting the thermodynamically feasible crystal structures with the experimentally observed ones , we discuss the factors that control crystallization and polymorphism of ra ." ], [ "we have named the polymorphs according to the kofler notation using roman numerals in the order of the melting points ( i.e. , the highest melting is named form i ) and flagged the thermodynamically stable form at room temperature with the symbol . form ii was either prepared by slow crystallization from numerous solvents , including n - butanol , n - propanol , i - propanol , acetonitrile , ethyl methyl ketone , ethyl acetate , or by solvent - mediated transformation of any ra form , using water - free solvents that did not form a solvate .", "the single crystal structures of hh , sdmso , and the pyridinium salt were solved by direct methods using the program package wingx(23 ) ( sir2004(24 ) and shelxl97(25 ) ) .", "the dioxane hemisolvate ( sdx ) , dimethyl formamide 0.75-solvate ( sdmf - ii ) , and the dimethylsulfoxide hemisolvate ( sdmso ) were prepared from ii by solvent - mediated transformation experiments in the respective solvent , the acetic acid monosolvate ( saa ) by fast crystallization ( cooling a hot saturated solution in acetic acid to ca . 8 c ) .", "sorption and desorption cycles covered the 1090% rh range in 10% steps and the 010% range in 5% steps .", "finally , the dimethyl formamide hemisolvate ( sdmf - i ) was obtained as an intermediate desolvation product of the sdmf - ii solvate . every crystallization or solvent - assisted grinding experiment with pyridine resulted in the formation of the pyridinium salt.(22 ) for hot - stage thermomicroscopic ( htm ) investigations a reichert thermovar polarization microscope equipped with a kofler hot stage ( reichert , a ) was used .", "crystallization conditions included solvent evaporation , fast and slow cooling crystallization , precipitation with a miscible antisolvent , vapor diffusion , and solvent - mediated transformation . in total ," ], [ "the solvent screening program resulted in a new ra polymorph ( form i ) , a new monohydrate ( mh ) , and five new solvates , namely acetic acid ( saa ) , dioxane ( sdx ) , dmso ( sdmso ) , and two dmf solvates ( sdmf - i and sdmf - ii ) .", "moisture sorption isotherm of ra performed at 25 c showing a moisture sorption cycle of anhydrous ra to hh and a desorption cycle of hh to a polymorphic mixture of forms i and ii .", "the lack of any crystal structures varying the conformation of the intramolecular h - bond , involving the o - oh proton and c = o oxygen , is consistent with the experimental cocrystals , solvates , including hydrates and modifications.(7 ) experimentally , only conformations closely related to conf_p1 and conf_p2 , or a mix of the two , were observed , with the largest deviation of up to 10 in the position of the p - oh proton from planarity .", "all low - energy structures ( figure 13 ) form one intra- and two intermolecular hydrogen bonds . the majority of computed crystal structures exhibit the experimentally observed r22(8 ) acid dimer ( d ) , but there are also acid catemer ( c ) , coohoh chain ( ch ) , and the combination of d and ch structures . the two experimental anhydrates were found to correspond to the lowest - energy structures within the two lowest energy groups of structures , with form i being the global minimum .", "the calculations also showed that there was no barrier in this crystal structure to the proton moving by 30 from the lowest energy planar conformation .", "the reproduction of form ii was excellent , given the neglect of thermal effects in our model , with an optimal root - mean square overlay of all non - hydrogen atoms in a 15 molecule coordination cluster ( rmsd15)(56 ) of 0.16 ." ], [ "unfortunately , we were not able to grow single crystals suitable for structure determination for all solid - state forms . from the ir and raman spectra , it could be assumed that in all phases the ra molecules are dimerized , as the symmetric (c = o ) band appeared in the region 16751625 cm .", "we can not exclude the possibility that the formation of the dimer motif is kinetically favored in all the crystallization conditions we have explored , hence ruling out the formation of catemers during our screening experiments .", "the relative stability of the catemeric structures on the crystal energy landscape may be overestimated by the computational model .", "the anhydrate crystal energy landscape showed that the two known forms are the most likely polymorphs ." ], [ "-resorcylic acid represents another organic molecule exhibiting a complex solid - state behavior , that is , polymorphism , salt , and solvate ( hydrate ) formation .", "thus , the consistency between the experimental and computational techniques used in this study adds confidence that the practically most important -resorcylic acid solid - state forms at ambient conditions have been characterized , showing the value of calculating the crystal energy landscape as part of the screening process .", "the experimental search has resulted in seven new solid - state forms ( anhydrate , monohydrate , and five solvates ) , in addition to the previously known , and structurally characterized anhydrate ii and hemihydrate hh.(8 ) we found no evidence for a triclinic polymorph ( zzzeeu(6 ) ) or a hydrate showing a water / acid stoichiometry greater than 1:1.(64 ) before we can answer the question how exhaustive should a polymorph screen be ? , perhaps we must add a supplementary question , namely , ", "however , recognizing that it is impractical to sample all possible nucleation and growth conditions for a given molecule , we can conclude that as a minimum , a polymorph screen should include sufficient diversity to at least find the thermodynamically most stable polymorph ( non solvated ) and hydrate form(s ) as well as those thermodynamically unstable forms that show sufficient kinetic stability at ambient conditions ( termed metastable forms ) to enable them to be isolated and identified ." ] ]