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on the basis of mechanism - driven
reaction design , a pd - catalyzed
nucleophilic fluorination of aryl bromides and iodides has been developed .
the method exhibits a broad substrate scope , especially with respect
to nitrogen - containing heteroaryl bromides , and proceeds with minimal
formation of the corresponding reduction products .
a facilitated ligand
modification process was shown to be critical to the success of the
reaction . | Supplementary Material |
|
funding for travel or speaker honoraria : ( 1 ) istanbul ms days , novartis pharmaceuticals , speaker honoraria payment to mayo clinic . no personal compensation .
( 2 ) invited professor program , biogen - boston , speaker honoraria payment to mayo clinic . no personal compensation .
other activities : grant review for the national multiple sclerosis society . research support , commercial entities : dr .
orhun h. kantarci receives research support from the european regional development fund ( fnusaicrc cz.1.05/1.1.00/02.0123 ) , the national multiple sclerosis society , and has given a scientific presentation at a meeting supported by teva pharmaceuticals but has received no personal fees or personal compensation for this activity ( all compensation for consulting activities paid directly to mayo clinic ) nor has spoken about the specific medications involving this company .
kejal kantarci ( spouse ) serves on the data safety monitoring board of takeda global research and development center , inc . , and the data monitoring boards of pfizer inc . and janssen alzheimer immunotherapy and is funded by the nih ( r01 ag040042 [ pi ] , r21 ns066147 [ pi ] , p50 ag44170/project 2 [ pi ] , p50 ag16574/project 1 [ pi ] , r01 ag11378 [ co - i ] , u19 ag10483 [ co - i ] u01 ag042791 [ co - i ] ) and minnesota partnership for biotechnology and medical genomics ( po03590201 [ pi ] ) .
kejal kantarci serves on the data safety monitoring board of takeda global research and development center , inc . , and the data monitoring boards of pfizer inc .
and janssen alzheimer immunotherapy and is funded by the nih ( r01 ag040042 [ pi ] , r21 ns066147 [ pi ] , p50 ag44170/project 2 [ pi ] , p50 ag16574/project 1 [ pi ] , r01 ag11378 [ co - i ] , u19 ag10483 [ co - i ] u01 ag042791 [ co - i ] ) and minnesota partnership for biotechnology and medical genomics ( po03590201 [ pi ] )
kejal kantarci serves on the data safety monitoring board of takeda global research and development center , inc .
janssen alzheimer immunotherapy and is funded by the nih ( r01 ag040042 [ pi ] , r21 ns066147 [ pi ] , p50 ag44170/project 2 [ pi ] , p50 ag16574/project 1 [ pi ] , r01 ag11378 [ co - i ] , u19 ag10483 [ co - i ] u01 ag042791 [ co - i ] ) and minnesota partnership for biotechnology and medical genomics ( po03590201 [ pi ] ) .
research support , foundations and societies : 20062009 multiple sclerosis society for support in multiple sclerosis research unrelated to this publication ; 20082009 mayo foundation cr20 award for support in multiple sclerosis research unrelated to this publication ; 20092011 hilton foundation support in multiple sclerosis research unrelated to this publication . | before the genomics technology revolution allowed us to do genome - wide science , genetics research relied on our limited knowledge about a subject to generate hypothesis and candidate genes to study . despite the level of naivet , several associations with susceptibility to a complex disease such as multiple sclerosis ( ms ) were discovered . of these ,
hla - drb1 and il7r1 stand out as being confirmed and refined early by the genome - wide association studies ( gwas ) that followed.2 despite the expense and gargantuan efforts , these gwas have successfully led to the discovery of more than 100 additional genes , albeit with smaller effect sizes , that contribute to ms susceptibility.3 this list keeps growing , but it comes with no surprise that most of these genes identified the immune system as one large candidate for ms susceptibility . | STUDY FUNDING
DISCLOSURE |
the generation of genetic mutants in caenorhabditis elegans has long relied on the selection of mutations in large - scale screens .
directed mutagenesis of specific loci in the genome would greatly speed up analysis of gene function . here , we adapt the crispr / cas9 system to generate mutations at specific sites in the c. elegans genome . | Supplementary Material |
|
as a service to our authors and readers , this journal provides supporting information supplied by the authors .
such materials are peer reviewed and may be reorganized for online delivery , but are not copyedited or typeset .
technical support issues arising from supporting information ( other than missing files ) should be addressed to the authors .
| abstractanalytical methods that enable visualization of nanomaterials derived from solution selfassembly processes in organic solvents are highly desirable . herein , we demonstrate the use of stimulated emission depletion microscopy ( sted ) and single molecule localization microscopy ( smlm ) to map living crystallizationdriven block copolymer ( bcp ) selfassembly in organic media at the subdiffraction scale .
four different dyes were successfully used for singlecolour superresolution imaging of the bcp nanostructures allowing micelle length distributions to be determined in situ .
dualcolour smlm imaging was used to measure and compare the rate of addition of red fluorescent bcp to the termini of green fluorescent seed micelles to generate block comicelles .
although wellestablished for aqueous systems , the results highlight the potential of superresolution microscopy techniques for the interrogation of selfassembly processes in organic media . | Supporting information |
there is an increasing concern amongst the women and girls about the appearance of their external genitalia . many women and adolescent girls present with labia hypertrophy .
a young girl presenting with labia hypertrophy is quite unusual . a child with severe hypertrophy of bilateral labia minora
patient a , youngest of six female siblings , was born at term in a hospital through the lower segment caesarean section . at 8 years of age , she noticed progressive increasing size of labia , which caused her pain while prolonged sitting , walking and daily activities .
the increased size of labia affected her psychologically as she considered herself abnormal among her siblings .
she disclosed the enlargement to her elder sister almost after 6 months of noticing it , and the patient consulted the plastic surgery clinic at the age of 8 years . on clinical examination ,
her labia minora was found to be thickened and enlarged more than 5.5 cm from the free edge of the labia majora with associated hypertrophy of the clitoral hood [ figures 1 and 2 ] ( type 6 : franco 's classification ; severe hypertrophy : ricci and pardo classificatio ) [ tables 1 and 2 ] .
pre - operative view of labia minora hypertrophy size of labia minora measuring 5.5 cm in its width franco classification of labia minora hypertrophy ricci and pardo classification of labia minora hypertrophy for surgical correction on work - up , her hormonal assay revealed no abnormality .
her thyroid profile , serum luteinizing hormone , serum follicle - stimulating hormone , serum testosterone and serum estradiol levels were within normal limits .
skin and subcutaneous tissues in the labia minora were found to be hyperplastic . extended linear excision was performed which included excision of hypertrophied clitoral hood [ figures 3 and 4 ] .
after 24 h , the patient was advised to clean the genitalia with application of antiseptic ointment .
linear excision of labia minora and clitoral hood reduction immediate post - operative result ( a and b ) post - operative result after two weeks with good aesthetic appearance histological examination showed acanthosis and chronic non - specific inflammation of underlying dermis [ figure 6a and b ] .
( a and b ) histological picture illustrating mild acanthosis with mild chronic non - specific inflammation with congestion ( 40 , h and e )
hodgkinson and hait first described labia minora hypertrophy in 1984 ; though description regarding circumcision of labia minora and clitoris has been mentioned vaguely in many old scriptures .
juvenile labia minora hypertrophy [ jlmh ] is a less common clinical condition and becomes rarer in a developing country like india where social taboos and customs are stringently enforced in the common lives . in such milieu ,
jlmh cases are detected only when symptoms significantly affect a patient 's functional and psychological well - being .
hence , whenever a surgeon in a developing country like india diagnoses a jlhm patient , it should be addressed properly , and relevant procedure should be carried out to relieve the patient from distressing symptoms .
although no standard consensus has been established yet to classify labia minora hypertrophy ; many do exist depending on the size and severity of the hypertrophy [ tables 1 and 2 ] .
arbitrary landmarks taken in these measurements make it difficult to diagnose hypertrophy on a standard scale .
some have measured size from midline horizontally , and some have measured from free edge .
. surgical decision should largely be dependant on labia size as well as symptoms addressed by the patient .
a number of studies have been published in context to labia minora hypertrophy and their management , but only a few have addressed the occurrence of hypertrophy in adolescent age and most of their patients fall in 2040 age group .
although age is not a criterion for labiaplasty , most of the surgeons refrain from doing it at an early age .
our patient was an 8-year - old when she noticed labial hypertrophy , which is rare .
all the relevant investigations , including hormonal assays and usg were normal suggestive of an idiopathic , isolated and abnormal morphology of the labia .
the size of the labia minora as well as presenting symptoms should be taken into account , while planning labiaplasty in any age group , especially in adolescents .
a better classification system for labia minora hypertrophy and standardization regarding functional and cosmetic labiaplasty need to be established in this era of ever increasing vulvovaginal surgeries . | labia minora hypertrophy is a relatively uncommon surgical entity being popularised in the realm of vulvovaginal plastic surgeries .
apart from the unaesthetic appearance of the hypertrophied minora , these cases are also associated with itching , hygiene problem , pain while sitting down , sports activities , difficulty in wearing tight clothing , bleeding and discomfort while or after sexual intercourse , social embarrassment , insecurity and psychological diminution of confidence and self - esteem . in a country like india , due to sociocultural reasons
, patients hesitate to consult a doctor for such deformities .
most of the patients suffer in silence for years .
although common in the west , very few surgeons in the country perform this simple and rewarding surgery . here , we are presenting a case of premenarchal juvenile labia minora hypertrophy ( jlmh ) in an 8-year - old child .
labial hypertrophy in this age group is uncommon .
we were unable to find hypertrophy of labia minora in the eight - year - old child on english literature search . | INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION
Financial support and sponsorship
Conflicts of interest |
both interstitial granulomatous dermatitis ( igd ) and palisaded neutrophilic granulomatous dermatitis ( pngd ) are rare disorders typically associated with systemic autoimmune conditions .
they probably represent different aspects of a disease spectrum encompassing the concept of autoimmunity - related granulomatous dermatitis ( argd ) .
the present case shows that the clinicopathological correlation in argd does not always clearly fit with the classical presentations of igd or pngd .
a number of autoimmune conditions are associated with cutaneous symptoms . interstitial granulomatous dermatitis ( igd )
the typical clinical presentation corresponds to a linear rope present on the trunk and axillae . on histopathological examination ,
igd is characterized by a sparse palisaded histiocytic infiltrate with little neutrophilic debris and eosinophils associated with a necrobiotic aspect of the collagen matrix . in the literature
, there is some overlap between igd and palisaded neutrophilic granulomatous dermatitis ( pngd ) .
lesions of pngd typically correspond to papules occasionally admixed with small crusts on the elbows .
other related disorders include rheumatoid papules , churg - strauss granuloma , superficial ulcerating rheumatoid necrobiosis , necrobiotic granuloma , palisading granuloma , cutaneous extravascular necrotizing granuloma , and rheumatoid neutrophilic dermatitis . here ,
a 61-year - old woman presented with skin lesions over the elbows and the left thenar region .
they corresponded to erythematous and discrete hyperkeratotic papules which had been present for a few weeks ( fig .
immunohistochemistry revealed the presence of cd3 + t lymphocytes predominating in the perivascular area ( fig .
they were associated with cd68 + and mac387 + histiocytes as well as factor xiiia+ dermal dendrocytes ( dd1 ) .
the pattern of dd1 distribution was similar to that of cd68 + histiocytes ( fig .
it was characterized by the elevation of anti - smooth muscle antibodies ( 1:160 ) and antinuclear antibodies ( 1:1,280 ) .
there were no detectable antibodies directed against nuclear antigens , keyhole limpet hemocyanin and mitochondria .
hepatitis b and c serologies were negative . at the time of presentation , the patient 's liver tests were in the normal range .
however , they recurred a few months later , and some other lesions appeared on the thighs .
in some cases , there is a mismatch between the clinical presentation and the histopathological patterns of igd and pngd .
indeed , these two conditions possibly represent a continuum or progression of a single disease process corresponding to autoimmunity - related granulomatous dermatitis ( argd ) [ 6 , 8 ] .
the clinical associations between argd , autoimmune disease and lymphoproliferative disorders have been intermixed between both igd and pngd diagnoses in the literature [ 6 , 9 , 10 , 11 , 12 , 13 , 14 ] .
it is acknowledged that the inflammatory cell infiltrate is sparse to moderate in igd , while pngd has a dense neutrophilic and interstitial histiocytic infiltrate .
only a single case of igd with autoimmune hepatitis association has been reported so far .
some other autoimmune comorbidities including arthritis , antiphospholipid syndrome [ 18 , 19 ] and hematologic malignancy have been reported in association with igd .
in addition , interstitial granulomatous drug reactions have been linked to tnf inhibitors , ace inhibitors , diuretics [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ] and soy products in food . | aimboth interstitial granulomatous dermatitis ( igd ) and palisaded neutrophilic granulomatous dermatitis ( pngd ) are rare disorders typically associated with systemic autoimmune conditions .
they probably represent different aspects of a disease spectrum encompassing the concept of autoimmunity - related granulomatous dermatitis ( argd).case reporta 61-year - old woman presented with argd and autoimmune hepatitis .
the clinical presentation suggested pngd , while histopathology was consistent with igd.discussionthe association of argd with autoimmune hepatitis is apparently a rare event .
the present case shows that the clinicopathological correlation in argd does not always clearly fit with the classical presentations of igd or pngd . | Aim
Case Report
Discussion
Introduction
Case Report
Discussion
Disclosure Statement |
abnormal variation of the posterior corneal curvature may occur in two forms : the generalized posterior keratoconus , characterized by an regular increase of the curvature of the entire posterior corneal surface has , and the circumscribed posterior keratoconus , in which a localized paracentral or central posterior corneal indentation is seen . in the generalized form , the corneal stroma typically remains clear .
in contrast , the circumscribed posterior keratoconus shows stromal opacities overlying the localized anterior ectasia of the posterior surface , which may occupy the full stromal thickness .
circumscribed posterior keratoconus is usually bilateral and sporadic , but familial cases have been also documented . despite the anterior protrusion in some cases ,
the 60-year - old white male of mediterranean origin presented for a cataract extraction on his left eye . visual acuity was 20/25 in the right eye and light perception in the left eye due to cataract formation .
the patient denied history of injury , reporting only a bilateral ocular infection in childhood was reported .
slitlamp examination revealed a bilateral paracentrally localized depression of the posterior curvature measuring 3 mm in diameter .
there was scarring in the overlying corneal stroma ( figures 1 , 2 , and 3 ) .
the posterior depression was clearly detectable using ultrasound biomicroscopy ( humphrey , zeiss , oberkochen ) ( figure 5 ) and slit - scanning topography analysis ( orbscan , bausch and lomb ) ( figure 6 ) .
corneal thickness measured 450 m within the lesion and 540 m in the adjacent healthy cornea using the orbscan system .
the refractive power of both the posterior and anterior corneal curvature was 50 to 56 diopters within the paracentral area .
following phacoemulsification and posterior chamber lens implantation visual acuity increased to 20/50 in the left eye .
the clinical and topographic findings in this patient are consistent with the paracentral keratoconus posterior circumscriptus .
this is the first report on ultrasound biomicroscopy to visualise the local anterior bulging of the posterior corneal surface with concomitant thinning of the stroma .
light microscopy of this abnormality has shown focal disorganization of basal epithelium and basement membrane , a replacement of bowman 's layer by fibrous tissue , a thinned stroma with an irregular arrangement of the central collagen lamellae , and a variable appearance of descemet 's membrane with posterior excrescences indentating the vacuolated endothelium correspond to the corneal guttae seen in specular reflection .
iron deposits are present in the basal and suprabasal epithelium , corresponding to the brownish epithelial line observed clinically , indicating an irregularity of the anterior corneal surface .
visualisation of the posterior keratoconus using corneal topography analysis has been reported so far in a few cases [ 7 , 8 ] .
the light microscopy findings suggest an early pathogenic mechanism probably originated in the fifth or sixth month of gestation .
it is classified as one of the anterior chamber cleavage anomalies ( mesenchymal dysgenesis ) , as there are other anterior segment and systemic developmental abnormalities , as well as melanin depositions surrounding the posterior depression and iridocorneal adhesions . however , not all cases share this phenomenon . acquired cases occur and are usually associated with trauma [ 9 , 10 ] .
the mechanism in such cases involves an oblique penetrating injury with splitting of the inner corneal layers .
differential diagnosis also includes congenital disorders as peter 's anomaly and congenital hereditary endothelial dystrophy but they are usually found in new borns .
inflammation process as perforated corneal ulcer may also be taken into consideration , but it is usually unilateral . in most of the cases of posterior keratoconus
the vision is not affected , rarely it may be associated with other ocular abnormalities as polar cataract , lenticonus , and ectopia lentis . | this paper documents a rare nonprogressive developmental disorder bilateral circumscribed posterior keratoconus in a 60-year - old man referred for a cataract surgery . for the first time
ultrasound biomicroscopy was used to visualise the local anterior bulging of the posterior corneal surface with concomitant thinning of the stroma . the amount of localized posterior depression , corneal thickness and the refractive power of both the posterior and anterior corneal curvature were measured using slit - scanning topography analysis ( orbscan ) . | 1. Introduction
2. Case Report
3. Discussion |
transition
metal dichacogenides represent a unique class of two - dimensional layered
materials that can be exfoliated into single or few atomic layers .
tungsten diselenide ( wse2 ) is one typical example with
p - type semiconductor characteristics .
bulk wse2 has an
indirect band gap ( 1.2 ev ) , which transits into a direct band
gap ( 1.65 ev ) in monolayers .
monolayer wse2 , therefore ,
is of considerable interest as a new electronic material for functional
electronics and optoelectronics .
however , the controllable synthesis
of large - area wse2 atomic layers remains a challenge .
the
studies on wse2 are largely limited by relatively small
lateral size of exfoliated flakes and poor yield , which has significantly
restricted the large - scale applications of the wse2 atomic
layers . here , we report a systematic study of chemical vapor deposition
approach for large area growth of atomically thin wse2 film
with the lateral dimensions up to 1 cm2 .
microphotoluminescence
mapping indicates distinct layer dependent efficiency .
the monolayer
area exhibits much stronger light emission than bilayer or multilayers ,
consistent with the expected transition to direct band gap in the
monolayer limit .
the transmission electron microscopy studies demonstrate
excellent crystalline quality of the atomically thin wse2 .
electrical transport studies further show that the p - type wse2 field - effect transistors exhibit excellent electronic characteristics
with effective hole carrier mobility up to 100 cm2 v1 s1 for monolayer and up to 350
cm2 v1 s1 for few - layer
materials at room temperature , comparable or well above that of previously
reported mobility values for the synthetic wse2 and comparable
to the best exfoliated materials . | Supplementary Material |
|
the present study examines the dose - response relationship for 2,3,7,8-tetrachlorodibenzo - p - dioxin ( tcdd ) promotion of histologic and biochemical parameters by using a two - stage model for hepatocarcinogenesis in female sprague - dawley rats initiated with a single intraperitoneal dose of 175 mg of diethylnitrosamine ( den)/kg body weight at 70 days of age . starting 2 weeks after initiation
, treatment groups of 8 - 10 rats were given tcdd by gavage in corn oil once every 2 weeks for 30 weeks .
doses were 3.5 , 10.7 , 35.7 , and 125 ng tcdd / kg body weight / day .
a significant body weight reduction was present in the noninitiated group that received 125 ng tcdd .
relative liver weight was statistically increased in initiated rats treated with > or = 10.7 ng tcdd and in noninitiated rats treated with > or = 35.7 ng tcdd .
histopathologic evidence of cytotoxicity was dose - related in all tcdd - treated groups .
there was a statistically significant dose response in the bromodeoxyuridine ( brdu ) s - phase labeling index ( li ) in the den - initiated rats ( p < 0.01 ) and a marginally significant trend in the saline - treated rats ( p = 0.10 ) , but proliferating cell nuclear antigen s - phase li and growth fraction within altered hepatic foci showed no increase . among the den - initiated groups
there was a significant increase in glutathione s - transferase altered hepatic foci stereological parameters in the 125 ng tcdd group .
this study demonstrates that dose - response relationships for tcdd 's effects on cell proliferation growth of altered hepatic foci are different from previously reported effects on p450 gene expression , indicating that different biological or biochemical responses may exhibit different dose - response relationships.(abstract truncated at 250 words)imagesfigure 1.figure 1.figure 1.figure 1.figure 1.figure 2.figure 3.figure 4.figure 5.figure 6.figure 7 . | Images |
|
at the end of december 1993 and also at the end of january 1995 , the river meuse , one of the major rivers in europe , flooded and river banks were inundated .
we investigated the possible health risks of exposure to heavy metal concentrations in river bank soils resulting from the flooding of the river meuse at the end of 1993 .
soil and deposit samples and corresponding aerable and fodder crops were collected and analyzed for heavy metals .
although the soils of the floodplain of the river meuse appeared severely polluted mainly by cd and zn , the heavy metal concentrations in the crops grown on these soils were within background ranges .
incidentally , the legal standard for cd as endorsed by the commodities act was exceeded in wheat crops .
the main exposure pathways for the general population were through the consumption of food crops grown on the river banks and through the direct ingestion of contaminated soils . for estimating potential human exposure in relation to soil pollution
, we used a multiple pathway exposure model . for estimating the actual risk , we determined metal contents of vegetables grown in six experimental gardens . from this study
, it can be concluded that there is a potential health risk for the river bank inhabitants as a consequence of pb and cd contaminations of the floodplain soils of the river meuse , which are frequently inundated ( averaged flooding frequency once every 2 years).imagesfigure 1figure 2 | Images |
|
the ability to three - dimensionally interweave biological tissue with functional electronics could enable the creation of bionic organs possessing enhanced functionalities over their human counterparts .
conventional electronic devices are inherently two - dimensional , preventing seamless multidimensional integration with synthetic biology , as the processes and materials are very different . here
, we present a novel strategy for overcoming these difficulties via additive manufacturing of biological cells with structural and nanoparticle derived electronic elements . as a proof of concept
, we generated a bionic ear via 3d printing of a cell - seeded hydrogel matrix in the precise anatomic geometry of a human ear , along with an intertwined conducting polymer consisting of infused silver nanoparticles .
this allowed for in vitro culturing of cartilage tissue around an inductive coil antenna in the ear , which subsequently enables readout of inductively - coupled signals from cochlea - shaped electrodes .
the printed ear exhibits enhanced auditory sensing for radio frequency reception , and complementary left and right ears can listen to stereo audio music .
overall , our approach suggests a means to intricately merge biologic and nanoelectronic functionalities via 3d printing . | Supplementary Material |
|
we sequenced 8 melanoma exomes to identify novel somatic mutations in metastatic melanoma .
focusing on the map3k family , we found that 24% of melanoma cell lines have mutations in the protein - coding regions of either map3k5 or map3k9 .
structural modelling predicts that mutations in the kinase domain may affect the activity and regulation of map3k5/9 protein kinases .
the position of the mutations and loss of heterozygosity of map3k5 and map3k9 in 85% and 67% of melanoma samples , respectively , together suggest that the mutations are likely inactivating . in vitro kinase assay
shows reduction in kinase activity in map3k5 i780f and map3k9 w333x mutants .
overexpression of map3k5 or map3k9 mutant in hek293 t cells reduces phosphorylation of downstream map kinases .
attenuation of map3k9 function in melanoma cells using sirna leads to increased cell viability after temozolomide treatment , suggesting that decreased map3k pathway activity can lead to chemoresistance in melanoma . | Supplementary Material |
|
switches between different phenotypes and their underlying states of gene transcription occur as cells respond to intrinsic developmental cues or adapt to changing environmental conditions .
post - translational modification of the master regulatory transcription factors that define the initial phenotype is a common strategy to direct such transitions .
emerging evidence indicates that the modification of key transcription factors by the small polypeptide ubiquitin plays a central role in many of these transitions1 , 2 .
however , the molecular mechanisms by which ubiquitination regulates the switching of promoters between active and inactive states are largely unknown .
ubiquitination of the yeast transcriptional repressor 2 is necessary to evoke the transition between mating - types3 , and here , we dissected the impact of this modification on 2 dynamics at its target promoters .
the ubiquitination of 2 does not alter dna occupancy by depleting the existing pool of the transcription factor , despite its well - characterized function in directing repressor turnover .
rather , 2 ubiquitination plays a direct role in the rapid removal of the repressor from its dna targets .
this disassembly of 2 from dna depends on the ubiquitin - selective aaa - atpase cdc48 .
our findings expand the functional targets of cdc48 to active transcriptional regulatory complexes in the nucleus , a far broader role than previously anticipated .
these data reveal an ubiquitin - dependent extraction pathway for dismantling transcription factor - dna complexes and provide an archetype for the regulation of transcriptional switching events by ubiquitination . | Supplementary Material |
|
distance between two genes was defined as the number of base pairs between their gene midpoints .
relative distance refers to the distance of a tsg or a noncancer gene from an oncogene divided by the radius distance .
the gene labels were randomly shuffled 10,000 times to generate new positions of oncogenes , tsgs and noncancer genes for the calculation of p - value .
gene density is the number of tsgs or noncancer genes in a radius of specified distance divided by the radius distance .
average density is the total number of all tsgs or noncancer genes on a particular chromosome divided by the length of that chromosome .
a tumor types with cna profiles obtained by whole - genome sequencing were included in the present study . level 3
distance between two genes was defined as the number of base pairs between their gene midpoints .
relative distance refers to the distance of a tsg or a noncancer gene from an oncogene divided by the radius distance .
the gene labels were randomly shuffled 10,000 times to generate new positions of oncogenes , tsgs and noncancer genes for the calculation of p - value .
gene density is the number of tsgs or noncancer genes in a radius of specified distance divided by the radius distance .
average density is the total number of all tsgs or noncancer genes on a particular chromosome divided by the length of that chromosome .
a tumor types with cna profiles obtained by whole - genome sequencing were included in the present study . | abstractfocal copy number gains or losses are important genomic hallmarks of cancer .
the genomic distribution of oncogenes and tumor - suppressor genes ( tsg ) in relation to focal copy number aberrations is unclear .
our analysis revealed that the mean distance of tsgs from oncogenes was significantly shorter than that of noncancer genes , suggesting that oncogenes and tsgs tend to be in close physical proximity in the human genome .
such relationship was conserved in mouse and drosophila .
pan - cancer analysis using data from the cancer genome atlas indicated that oncogenes without a nearby tsg are more prone to amplification . in conclusion
, our study provides evidence for the nonrandom distribution of oncogenes and tsgs across different species .
our data also support that the existence of a neighboring tsg can suppress amplification of an oncogene , shedding new light on a previously unappreciated protective mechanism of tsgs . | Materials and Methods
Calculation of Gene Distance and Permutation Test
Calculation of Normalized Gene Density
Focal CNA Data
Supplementary Material
Author Contributions
Supplementary Material |
it is incidentally found in autopsy specimens and surgical specimens with cryptorchidism and testicular germ cell tumor .
this non - neoplastic lesion is usually seated in the mediastinum and septal part of the rete testis .
it may present as a very small lesion detected in microscopic examination or a solid - cystic mass lesion which is macroscopically evident . in microscopic evaluation
cryptorchidism was unilateral and the other testis was normal . there were no clinical or endocrine abnormalities .
the testis measured 4 2.5 2.2 cm in size and there was no tumoral lesion in gross examination . on the cut section close to the testis parenchyma , there was a gland like tubular structures .
some of these were in back - to - back position with little intervening stroma .
the testicular parenchyma was comprised of seminiferous tubules that had sertoli cells only and no spermatozoa ( fig .
ema ( novocastra ; 1/150 , clone gp 1.4 , newcastle , united kingdom ) and pankeratin ( novocastra ; 1/150 , clone ae1/ae3 , newcastle , united kingdom ) immunohistochemical stains were performed for diagnosis .
adenomatous hyperplasia of the rete testis is a benign lesion which can appear at any time during life and was first described by nistal et al .
.
it is important to recognize tumor - like lesions of the rete testis to make an accurate differential diagnosis whether the lesion is benign or malign .
ahrt etiology is not well understood yet but there seem to be associated conditions such as cryptorchidism , some kidney diseases , and germ cell tumors .
our case was cryptorchid and seminiferous tubules near the lesion were lined by only sertoli cells and had no spermatozoa .
the authors reported an adult case with ahrt in unilateral testis with no luminal spermatozoa .
there are different cases such as prostate adenocarcinoma or embryonal carcinoma together with ahrt in the literature [ 6 , 7 ] .
the true epithelial proliferation with gland - like or papillary proliferations replacing normal epithelium , continuous architecture of normal rete testis with adenomatous hyperplasia and lack of signs of malignancy are the proper diagnostic criteria for ahrt . in our case
the differential diagnosis should include adenoma , papillary adenoma , primary and metastatic adenocarcinoma and rete testis cystic transformations with epithelial metaplasia .
clinical history , localization , histologic features and immunohistochemistry are criteria for differentiating these lesions .
complete surgical resection is the proposed therapy for ahrt cases and no report for recurrence has been identified . in conclusion ,
adenomatous hyperplasia of the rete testis is a rare lesion that can be confused with malignancy and should be remembered in the differential diagnosis of rete testis lesions . | there are several tumor - like lesions and miscellaneous neoplasms of the rete testis .
we present a case with adenomatous hyperplasia of the rete testis ( ahrt ) .
the patient was 24 years old with undescended testis and was referred to our hospital .
there were no clinical or endocrine abnormalities .
cryptorchidism was unilateral and the other testis was normal .
right orchiectomy was performed and sent to the pathology laboratory for examination .
morphologic and immunohistochemistry findings confirmed the diagnosis of ahrt in this case .
the patient 's postoperative course continues uneventfully .
ahrt is a rare lesion and can be confused with malignancy .
it is incidentally detected in microscopic investigation .
it may present as a very small lesion detected in microscopic examination or a solid - cystic mass lesion which is macroscopically evident . clinical history ,
localization , histologic features and immunohistochemistry are criteria for differentiating these lesions.we present this rare case for both surgeons and pathologists due to its importance as it can be confused with malignancy . | Introduction
Case presentation
Discussion
None |
teiser relies on calculating mutual information values between whole - genome measurements and millions of predefined structural motifs .
the decoy / scrambled experiments and sirna knock - downs were performed using lipofectamin 2000 reagent ( invitrogen ) . for hybridizations , we used human 444k whole - genome human arrays ( agilent ) . isolation and identification of rna - binding proteins were based on previously published protocols .
full methods and any associated references are available in the online version of the paper at www.nature.com/nature . | decoding post - transcriptional regulatory programs in rna is a critical step in the larger goal to develop predictive dynamical models of cellular behavior . despite recent efforts13 , the vast landscape of rna regulatory elements
remain largely uncharacterized .
a longstanding obstacle is the contribution of local rna secondary structure in defining interaction partners in a variety of regulatory contexts , including but not limited to transcript stability3 , alternative splicing4 and localization3 .
there are many documented instances where the presence of a structural regulatory element dictates alternative splicing patterns ( e.g. human cardiac troponin t ) or affects other aspects of rna biology5 .
thus , a full characterization of post - transcriptional regulatory programs requires capturing information provided by both local secondary structures and the underlying sequence3,6 .
we have developed a computational framework based on context - free grammars3,7 and mutual information2 that systematically explores the immense space of small structural elements and reveals motifs that are significantly informative of genome - wide measurements of rna behavior .
the application of this framework to genome - wide mammalian mrna stability data revealed eight highly significant elements with substantial structural information , for the strongest of which we showed a major role in global mrna regulation . through biochemistry , mass - spectrometry , and in vivo
binding studies , we identified hnrpa2b1 as the key regulator that binds this element and stabilizes a large number of its target genes . ultimately , we created a global post - transcriptional regulatory map based on the identity of the discovered linear and structural cis - regulatory elements , their regulatory interactions and their target pathways .
this approach can also be employed to reveal the structural elements that modulate other aspects of rna behavior . | Methods Summary
Supplementary Material |
mechanical systems are used in buildings to provide conditioned air , dissipate thermal loads , dilute contaminants , and maintain pressure differences .
the characteristics of these systems and their operations h implications for the exposures of workers to environmental tobacco smoke ( ets ) and for the control of these exposures .
this review describes the general features of building ventilation systems and the efficacy of ventilation for controlling contaminant concentrations .
ventilation can reduce the concentration of ets through dilution , but central heating , ventilating , and air conditioning ( hvac ) can also move air throughout a building that has been contaminated by ets .
an understanding of hvac systems is needed to develop models for exposures of workers to ets.imagesfigure 1figure 2figure 3 | Images |
|
emphysematous cholecystitis ( ec ) is an uncommon variant of acute cholecystitis , which is caused by secondary infection of the gallbladder wall with gas - forming organisms [ 15 ] .
the mortality rate of ec is as high as 25% because of its high complication rate [ 2 , 5 ] due to gangrene , gallbladder perforation , pericholecystic abscess and bile peritonitis .
emergency surgical intervention is necessary for ec treatment for which open cholecystectomy has traditionally been performed [ 1 , 35 ] . here
a 78-year - old male was admitted to our hospital for an investigation of vertigo .
after admission , he developed fever and abdominal distention . a chest x - ray in the up - right position and abdominal computed tomography ( ct )
the chest x - ray showed the presence of gas within the gallbladder and in its wall ( fig . 1 ) .
the ct scan revealed emphysematous changes in the gallbladder wall and air within the gallbladder ( fig .
the patient was referred to the department of surgery and emergent surgery was performed .
figure 1:up - right chest x - ray demonstrating air in the gallbladder ( arrow ) and in its wall ( arrowheads ) .
figure 2:(a and b ) abdominal computed tomographic scans of axial and coronal views revealing emphysematous changes in the gallbladder wall and air in the gallbladder .
up - right chest x - ray demonstrating air in the gallbladder ( arrow ) and in its wall ( arrowheads ) .
( a and b ) abdominal computed tomographic scans of axial and coronal views revealing emphysematous changes in the gallbladder wall and air in the gallbladder . based on the hemodynamically stable status of the patient , we selected a laparoscopic approach .
exploration of the abdominal cavity revealed gangrene and necrosis of the gallbladder . to facilitate the resection , we initially punctured the gallbladder using a percutaneous needle to extract bile .
although there was significant adhesion , we were able to safely dissect the calot 's triangle and detected a cystic duct and artery .
his postoperative course was uneventful . a bile culture obtained during surgery revealed clostridium perfringens , enterobacter cloacae and enterococcus faecalis as the causative organisms .
ec is an uncommon variant of acute cholecystitis characterized by potentially high mortality and morbidity because of a high incidence of gangrene or perforation .
garcia et al . reviewed 20 cases of ec and reported that the mortality rate was as high as 25% and the morbidity rate as high as 50% .
emergent surgical intervention for ec is indicated with cholecystectomy as the definitive treatment , although percutaneous cholecystostomy for critically ill patients presents another option [ 1 , 4 , 5 ] .
bouras et al . reported that the laparoscopic approach for ec can be considered a safe procedure .
owing to the advances of laparoscopic surgery , it has allowed to perform emergency cholecystectomy .
our patient was hemodynamically stable ; therefore , we selected the laparoscopic approach , which was successfully and safely completed .
the causative organisms of ec include c. perfringens , escherichia coli and species of the genera staphylococcus , streptococcus , pseudomonas and klebsiella [ 15 ] .
ec is associated with diabetes mellitus and primarily affects males , as in the present case .
the symptoms of ec are almost the same as those of acute cholecystitis , including right upper quadrant pain , nausea , vomiting and low - grade fever [ 2 , 4 ] .
a prompt diagnosis of ec is essential and plain abdominal x - rays or ultrasound can be diagnostically useful with a sensitivity of up to 95% .
however , contrast - enhanced abdominal ct scans may offer more information . in our patient ,
a chest x - ray in the up - right position detected air in the gallbladder wall and an abdominal ct revealed typical presentation of ec .
emergency intervention is indicated and the laparoscopic approach can be considered a safe and effective method in hemodynamically stable patients . | emphysematous cholecystitis ( ec ) is an uncommon variant of acute cholecystitis , which is caused by secondary infection of the gallbladder wall with gas - forming organisms .
the mortality rate of ec is still as high as 25% .
emergency surgical intervention is indicated .
open cholecystectomy has been traditionally accepted as a standard treatment for ec .
we present a case of ec successfully treated by laparoscopic surgery .
laparoscopic cholecystectomy for ec is considered to be safe and effective when indicated . | INTRODUCTION
CASE REPORT
DISCUSSION
CONFLICTS OF INTEREST |
the causes of pulmonary embolism can be venous thromboembolism , and nonthrombotic embolism like septic , fat , air , amniotic fluid and tumour embolism .
tumour embolism to lungs can arise from cancers of breast , stomach , liver , kidney and rarely from choriocarcinoma .
choriocarcinoma is a malignant , trophoblastic cancer , belonging to the malignant end of the spectrum in gestational trophoblastic disease , which can occur following molar pregnancy , ectopic pregnancy , abortion and even normal pregnancy [ 2 , 3 ] .
choriocarcinomas spread via blood and lymphatics with early haematogenous spread to lungs , resulting in pulmonary embolism , pulmonary oedema , pulmonary hypertension or acute respiratory distress syndrome . in a young female presenting with persistent shortness of breath , cough and chest pain ,
the possibility of metastatic pulmonary embolism should be considered as surgery and chemotherapy can cure the choriocarcinoma metastasizing to the lungs .
a 25-year - old lady was admitted in the pulmonology ward with the diagnosis of pneumonia .
the patient had presented with a history of progressive shortness of breath , chest pain and persistent cough with occasional haemoptysis .
she had a history of being treated with antibiotics and anti - tb drugs in outpatient basis .
since her symptoms were persistent and her general condition was deteriorating , she was admitted to the ward . on examination , she had crepitations in bilateral chest and an oxygen saturation of only 80% .
cect chest was done , which revealed pulmonary embolus occluding the main pulmonary artery , and right and left pulmonary arteries ( fig . 1 ) .
serum beta - human chorionic gonadotrophin ( hcg ) level was found to be significantly high .
she was managed further with chemotherapy ( emaco regimen ) with excellent response to the treatment .
figure 3:histopathological image showing the trophoblastic elements . a ct scan image showing thrombus in the pulmonary artery .
women in the reproductive age group with lung metastasis present with dyspnoea , chest pain , cough and haemoptysis . as the diagnosis can always be misleading and patient might be treated in the line of pneumonia or tuberculosis , it is very essential to have a high index of suspicion .
surgery is indicated in patients with haemodynamic instability and those with massive tumour burden occluding main pulmonary and branch pulmonary arteries .
so , chemotherapy should be initiated as soon as the diagnosis is strongly suspected or confirmed .
pulmonary embolism due to choriocarcinoma should always be suspected in a reproductive age woman presenting with intractable shortness of breath . | pulmonary embolism carries a significant morbidity and mortality .
metastatic choriocarcinoma presenting as pulmonary embolism is a rare event . here , we report a case of a 25-year - lady with a history of worsening shortness of breath for 4 months who was treated as a case of pneumonia and tuberculosis . owing to the worsening condition ,
she had a contrast enhanced computed tomography ( cect ) chest done and was diagnosed to have pulmonary embolism .
she underwent pulmonary embolectomy .
the histopathological examination of the embolus revealed it to be metastatic choriocarcinoma .
she showed a good response to chemotherapy .
metastatic choriocarcinoma should be considered as a differential diagnosis in females presenting with pulmonary embolism . | INTRODUCTION
CASE REPORT
DISCUSSION
CONFLICT OF INTEREST STATEMENT |
for the self - assembling process , a solution containing 10 nm scaffold strand , 50 nm of each staple strand ( reverse - phase cartridge purified , bioneer inc . ) , 5 mm tris + 1 mm edta ( ph 7.9 at 20 c ) , 16 mm mgcl2 was heated to 80 c for 4 min , cooled down to 60c over the course of 80 min , and cooled further down to 24 c over the course of 72 h. the folded objects were electrophoresed on a 1.5% agarose gel containing 45 mm tris borate + 1 mm edta and 11 mm mgcl2 at 70 v for 3 h. to prevent the origami structures from denaturation during electrophoresis , the gel - box was cooled in an ice - water bath .
the gel - band containing the structures was physically extracted from the gel and run through spin columns ( freezensqueeze spin columns , biorad ) at 5000 rcf .
the dna tensegrity objects were then imaged with tem after negative staining with uranyl formate on a fei tecnai t12 biotwin at 80 kv .
a 12-helix bundle kite with four springs of equal length ( 300 nt ) was designed such that the restriction site for ecori is located in one of the 300-nt spring regions . the assembled kites with a double - stranded region at the ecorri restriction site ( gaattc + 10 bases or more overhang on both sides of the sequence )
were incubated for one hour with the enzymes ( 20 l of 10 nm scaffold , 80 nm each staple , 1xneb - buffer 2 , 20 units of enzyme , new england biolabs , inc . ) . uncut and cut tensegrity kites were electrophoresed on a 1.5% agarose gel .
the gel - bands were physically extracted and imaged with tem after negative staining with uranyl formate .
for the self - assembling process , a solution containing 10 nm scaffold strand , 50 nm of each staple strand ( reverse - phase cartridge purified , bioneer inc . ) , 5 mm tris + 1 mm edta ( ph 7.9 at 20 c ) , 16 mm mgcl2 was heated to 80 c for 4 min , cooled down to 60c over the course of 80 min , and cooled further down to 24 c over the course of 72 h. the folded objects were electrophoresed on a 1.5% agarose gel containing 45 mm tris borate + 1 mm edta and 11 mm mgcl2 at 70 v for 3 h. to prevent the origami structures from denaturation during electrophoresis , the gel - box was cooled in an ice - water bath .
the gel - band containing the structures was physically extracted from the gel and run through spin columns ( freezensqueeze spin columns , biorad ) at 5000 rcf .
the dna tensegrity objects were then imaged with tem after negative staining with uranyl formate on a fei tecnai t12 biotwin at 80 kv .
a 12-helix bundle kite with four springs of equal length ( 300 nt ) was designed such that the restriction site for ecori is located in one of the 300-nt spring regions .
the assembled kites with a double - stranded region at the ecorri restriction site ( gaattc + 10 bases or more overhang on both sides of the sequence ) were incubated for one hour with the enzymes ( 20 l of 10 nm scaffold , 80 nm each staple , 1xneb - buffer 2 , 20 units of enzyme , new england biolabs , inc . ) .
the gel - bands were physically extracted and imaged with tem after negative staining with uranyl formate . | tensegrity or tensional integrity is a property of a structure that relies on a balance between components that are either in pure compression or in pure tension for its stability [ 1,2 ] .
tensegrity structures exhibit extremely high strength - to - weight ratios and great resilience , and are therefore widely used in engineering , robotics and architecture [ 3,4 ] . here
we report nanoscale , prestressed , three - dimensional tensegrity structures in which rigid bundles of dna double helices resist compressive forces exerted by segments of single - stranded dna that act as tension - bearing cables .
our dna tensegrity structures can self - assemble against forces up to 14 pn , which is twice the stall force of powerful molecular motors such as kinesin or myosin [ 5,6 ] .
the forces generated by this molecular prestressing mechanism can be employed to bend the dna bundles or to actuate the entire structure through enzymatic cleavage at specific sites .
in addition to being building blocks for nanostructures , tensile structural elements made of single - stranded dna could be used to study molecular forces , cellular mechanotransduction , and other fundamental biological processes . | Methods
Folding and purification of Prestressed DNA Tensegrity structures
Ligand-induced mechanical actuation of the 12-helix-bundle kite
Supplementary Material |
e - cadherin immunohistochemistry in foci of subpleural lipogranulomatous inflammation shows positive staining only in pneumocytes . | a 9-year - old , female , spayed , domestic longhaired cat presented to the ohio state university veterinary medical center oncology service with a 6-month history of changes in behavior and weight loss . the owner reported that the cat had become abnormally unfriendly and would growl or hiss when touched .
the cat also had gait changes , manifested by left hind limb weakness , difficulty walking up stairs , and occasionally losing balance and falling down stairs .
the cat was examined by its regular veterinarian and had abdominal radiographs , cbc , and biochemistry profile performed , which did not detect any abnormalities . on physical examination ,
the cat was underweight with an estimated body condition score ( bcs ) of 1/5 .
neurologic examination revealed a very dull mentation , severe generalized muscle atrophy , and a slow , reluctant , and crouched gait .
cranial nerve examination revealed no abnormalities .
there was absence of conscious proprioception in all limbs .
a forebrain lesion was suspected .
the cat was examined 8 days later because of progressive signs of neurologic disease .
the cat was obtunded and had a right head turn with a mild right head tilt .
the gait showed proprioceptive / right vestibular ataxia with knuckling of both thoracic limbs on ambulation , a crouched posture , and a splaying outward of the left thoracic limb .
there was a decreased menace response bilaterally that was worse on the left and decreased nasal sensation bilaterally .
spinal reflexes were normal in all limbs .
neurolocalization was to the right - forebrain with possible brainstem involvement .
an abdominal ultrasound was then performed at the owner s request to investigate the gastrointestinal tract as a possible explanation for the weight loss , but no abnormalities were identified . | Supplementary Material |
hybridization is a controversial topic in coral reef ecology
1 ,
2 . while small numbers of hybrid embryos can be produced in a few species
in vitro
, the evidence for hybrids in the field is often equivocal because the genetic techniques used for corals can not distinguish between hybridization and incomplete lineage sorting
.
in fact , only one of the over 1300 species in the order is generally accepted to be unequivocally of hybrid origin :
acropora prolifera
1 ,
5 . nonetheless , hybridization is often invoked as a source of evolutionary novelty in the order
scleractinia
6 ,
7 . here , we report an incidental observation on the potential for hybridization between two closely related scleractinian corals species in the family fungiidae ,
ctenactis echinata and
ctenactis crassa .
these species are sympatric , often dominating large multi - specific assemblages of fungiid corals throughout the central indo - pacific
.
colonies of these species are superficially very similar (
figure 1a and b ) but can readily be distinguished by the shape of the costal dentitions
.
both species are gonochoric , that is each colony is either male or female , and reproduce by broadcast spawning , releasing gametes into the water column for fertilization
(
figure 1c and d ) . at our study site on sesoko island ( 2638'13.00"n ; 12751'56.24"e ) ,
okinawa , japan , spawning occurs following the full moons from july to august
.
furthermore , both species release gametes at the same time
and consequently there is the potential for hybridization . in the days before the predicted date of spawning in july 2013 , we collected four colonies of
c. echinata and six colonies of
c. crassa , to produce larvae for other experiments .
coral species in the family fungiidae , such as these colonies of
fungia repanda , are gonochoric broadcast spawners : each individual releases either eggs (
c ) or sperm (
d ) into the water column where fertilization takes place ( arrows indicate gametes ) . while the species are relatively easy to identify , determining the sex of each individual prior to spawning is impossible without destructive sampling to expose the gametes .
consequently , we placed each individual in a separate 20 l bucket containing sea water in the open air at approximately 20:00 h in order to sex each individual once gametes had been released .
on the night of 27 july between 22:30 and 23:30 h three
c. echinata and five
c. crassa spawned revealing that the three spawning
c. echinata were female , while four
c. crassa were females and one was a male .
the size of the eggs of each species at the time of release was distinct with a range in maximum diameter of 244266 m in
c. echinata and 133155 m in
c. crassa .
in contrast to earlier work on
c. echinata
, we saw no symbiotic algae in the eggs of either species .
we collected approximately 5000 eggs from the three
c. echinata females and mixed them with sperm from the
c. crassa male .
as a positive control we mixed eggs from the four
c. crassa females with the
c. crassa sperm .
approximately 100 eggs were observed under a stereo - dissecting microscope for cleavage , indicating fertilization , every 2 to 6 h over the next 24 h. at no point did we observe cleavage in the cross between species indicating that no hybrid embryos were produced .
in contrast , over 90% of
c. crassa eggs in the positive control were fertilized within 2 h. we conclude that despite synchrony in the time of gamete release between these two closely related sympatric species there appears to be strong pre - zygotic mechanism to avoid hybridization . while our observations are preliminary and in only one direction ( i.e. we did not cross
c. echinata males with
c. crassa females ) we predict that hybridization between these species is unlikely .
this observation adds to a growing body of evidence indicating strong pre - zygotic barriers to hybridization in many scleractinian corals
11
13 . | hybridization is often cited as a potential source of evolutionary novelty in the order
scleractinia .
while hybrid embryos can be produced
in vitro , it has been difficult to identify adult hybrids in the wild . here , we tested the potential for hybridization between two closely related species in the family fungiidae .
we mixed approximately 5000 eggs of
ctenactis echinata with sperm from
ctenactis crass .
no hybrid embryos were produced .
this observation adds to a growing body of evidence for pre - zygotic barriers to hybridization in corals and challenges the claim that hybridization is a major source of evolutionary novelty in the order . | Observation |
additional supporting information may be found in the online version of this article : video s1 .
this video runs at three frames per second : 96 sec . of running video time
distal podomeres detach from tp of tc , and their presence guides the elongation and migration of tp belonging to other tc , as preliminary stages in the formation of a complex multi - cellular network . for supplementary materials on tc , please see http://www.telocytes.com .
please note : wiley - blackwell are not responsible for the content or functionality of any supporting materials supplied by the authors .
any queries ( other than missing material ) should be directed to the corresponding author for the article . | abstracttelocytes ( tc ) are interstitial cells with telopodes ( tp ) .
these prolongations ( tp ) are quite unique : very long ( several tens of micrometres ) and very thin ( 0.5 m ) , with moniliform aspect : thin segments ( podomeres ) alternating with dilations ( podoms ) . to avoid any confusion , tc were previously named interstitial cajal - like cells ( iclc ) .
myocardial tc were repeatedly documented by electron microscopy , immunohistochemistry and immunofluorescence .
tc form a network by their tp , either in situ or in vitro . cardiac tc are ( completely ) different of classic fibroblasts or fibrocytes .
we hereby present a synopsis of monitoring , by time - lapse videomicroscopy , of tp network development in cell culture .
we used a protocol that favoured interstitial cell selection from adult mouse myocardium .
videomicroscopy showed dynamic interactions of neighbour tc during the network formation . during their movement ,
tc leave behind distal segments ( podomeres ) of their tp as guiding marks for the neighbouring cells to follow during network rearrangement . | Supporting Information |
a 44-year - old woman presented to the emergency room with shortness of breath and thoracic pain radiating to the left arm and shoulder .
her vital signs showed a blood pressure of 158/102 mmhg , a pulse rate of 135 beats / min , a normal temperature and oxygen saturation of 100% on room air and no signs of heart failure . laboratory research revealed an elevated troponin t of 0.18 g
/ l , a creatinine kinase of 170 u / l and ck - mb of 17.9
non - significant coronary abnormalities were found by coronary angiogram . left ventriculogram showed akinetic wall motion abnormality in posterolateral and diaphragmatic wall segments , and a hypokinetic apex ( fig . 1 ) .
medical treatment with furosemide , anticoagulants and an ace inhibitor was started . on the ecg ,
negative t waves evolved combined with prolonged qt duration ( fig . 2 ) .
1left ventriculogram with wall motion abnormalities in the distal segments and normal wall motion in basal segments comparative to stress - induced cardiomyopathy . a systolic phase , b diastolic phasefig .
2ecg at admission ( a ) with slight st elevation in v2 and 16 h after admission ( b ) with negative t waves in the right precordial leads ,
i and avl with prolonged qt duration left ventriculogram with wall motion abnormalities in the distal segments and normal wall motion in basal segments comparative to stress - induced cardiomyopathy . a systolic phase , b diastolic phase ecg at admission ( a ) with slight st elevation in v2 and 16 h after admission ( b ) with negative t waves in the right precordial leads , i and avl with prolonged qt duration the patient appeared to have had a previous incidence of thyrotoxicosis ( graves disease ) in 2002 .
her current thyroid function confirmed a toxic state with a thyroid - stimulating hormone ( tsh ) of < 0.05 mu / l and free thyroxin ( t4 ) of > 100
pmol / l and tri - iodothyronine ( t3 ) of 26 pmol / l .
six days after treatment with propylthiouracil and propanolol , her heart rate reduced to 80 beats / min and the sequential echocardiogram showed an improvement of her systolic left ventricular function ( fig . 3 ) . magnetic resonance imaging measured a left ventricular ejection fraction of 52% .
3transthoracic echocardiogram with return of normal systolic function after initiating medical treatment transthoracic echocardiogram with return of normal systolic function after initiating medical treatment
hyperthyroid patients can present with angina symptoms and abnormal ecgs in the absence of coronary artery disease .
a myocardial infarction can be induced due to increased demand . a hypertrophic heart due to an increase in cardiac protein synthesis is also seen .
forfar et al . discovered that hyperthyroid patients have an elevated ejection fraction at rest but experience significant declines during exercise , also known as hyperthyroid cardiomyopathy .
we speculate that a surge of catecholamine release during physical stress in combination with a reduced ejection fraction caused by the thyrotoxicosis state resulted in severe left ventricular dysfunction .
after initialising medical treatment the symptoms were reduced and the left ventricular function returned to normal with borderline left ventricular hypertrophy remaining . in this case report
we demonstrate a combination of reversible cardiomyopathy related to stress ( tako tsubo ) and thyrotoxicosis that resolved completely with medical treatment . | we report on a 44-year - old woman presenting with chest pain and dyspnoea without previous stress - related events . by means of echocardiography
severe left ventricular dysfunction and wall motion abnormalities resembling stress - induced cardiomyopathy ( tako tsubo ) were seen .
laboratory investigation revealed thyrotoxicosis and elevated cardiac markers .
six days after starting medical treatment , complete restoration of the left ventricular function was observed .
the transient left ventricular dysfunction was induced by thyrotoxicosis resembling stress - induced cardiomyopathy that resolved completely after medical treatment . | Case report
Conclusion |
accidents with a pneumatic nail gun , which has been used in the construction industry , have increased.2 ) however , reports on management of a patient with a nail gun injury to the cranium are rare
. the authors report on a case of a patient treated with simple retraction after small skin and prophylactic antibiotic administration .
a 56-year - old man had five nail gun - shots due to attempted suicide and was transferred to the emergency room . on his physical examination ,
his mental status was drowsy and there was no neurological deficit except for nails on his cranium . in his past history , there was no psychological background , however , he used to drink often and became depressed . on plain skull radiography ,
five nails were found ( figure 1a ) . among the five nails , two penetrated glabella .
two nails were located in the right parietal bone and another was located in the left parietal bone . due to the head of the nail , the direction was confined to the outer table of the skull .
in addition , a subarachnoid hemorrhage was observed on brain computed tomography ( ct)(figure 1b ) .
all procedures were performed in the operating room under general anesthesia in order to treat the emergent condition as rapidly as possible .
the nail head was located beneath the scalp and tightly attached to the skull , it was not visible from the outside . a small incision to advance a forceps and a rongeur was necessary , and
, all nails were removed successfully ( figure 1c ) . during the period of conservative management
antibiotics including vancomycin , ceftriaxone , and metronidazole were administered for two weeks and carbamazepine was administered for a week .
conventional angiography was performed , and there was no vascular invasion or newly formed fistula ( figure 1d ) .
head injury by pneumatic nail gun injury is rare , and there have been some case reports on management , treatment . according to lee and park,4 ) the speed of the launched nail and presence of the nail head are important determinants of the extent of nail gun related head injuries
. if major artery or sinuses are not involved , extraction from the nail head could be the main treatment .
ct is typically the first - line radiologic examination in the emergency room for head - injured patients . in general , ct shows excellent details in bone and average value in soft tissue . failure to recognize cerebral damage following penetrating brain injuries ,
especially when there is retained foreign body , can lead to serious life - threatening complications.1 ) in addition , because involvement of the large vessels is critical to determining the operative strategy , vascular integrity should be evaluated with ct angiography or ct enhanced image in the initial evaluation in the emergency room . in this case , nails were removed by a small scalp incision due to the fact that major artery or sinuses were not involved . if this is not the case , management would be direct ligation or vascular bypass surgery . despite many controversies regarding use of prophylactic antibiotics , the authors believe that broad spectrum antibiotics are appropriate for patients with penetrating brain injury since
it is also recommended that antibiotics should be started as soon as possible.3 ) post - traumatic epilepsy is a major cause of disability and inadequate social integration .
although there is no prospective study to indicate the efficacy of prophylactic anti - epileptic medication following a traumatic brain injury , it has been recommended that patients be covered for about the first week after injury with a medication such as phenytoin or carbamazepine.5 )
in the patient with head injury by pneumatic nail gun , the first evaluation should focus on the shape of the nail head and vascular integrity from simple x - ray and ct .
if the nail head is confined to the depth of skull penetration , cautious extraction of the nail head can be performed without postoperative complication and early start of prophylactic antibiotics can be the next treatment . | a 56-year - old man had five nail gun - shots on his skull due to attempted suicide and was transferred to the emergency room . because the nail head played a role as a brake , the launched nail made a hole in the skull but did not entirely pass through it .
if major artery or sinuses are not involved , cautious retrieval after a small scalp incision can be performed and prophylactic antibiotics be administered for treatment . | Introduction
Case Report
Discussion
Conclusion |
the ability
of core shell nanowires to overcome existing
limitations of heterostructures is one of the key ingredients for
the design of next generation devices .
this requires a detailed understanding
of the mechanism for strain relaxation in these systems in order to
eliminate strain - induced defect formation and thus to boost important
electronic properties such as carrier mobility . here
we demonstrate
how the hole mobility of [ 110]-oriented ge
si core
shell
nanowires can be substantially enhanced thanks to the realization
of large band offset and coherent strain in the system , reaching values
as high as 4200 cm2/(vs ) at 4 k and 1600 cm2/(vs ) at room temperature for high hole densities of 1019 cm3 .
we present a direct correlation of ( i ) mobility ,
( ii ) crystal direction , ( iii ) diameter , and ( iv ) coherent strain ,
all of which are extracted in our work for individual nanowires .
our
results imply [ 110]-oriented ge
si core
shell nanowires
as a promising candidate for future electronic and quantum transport
devices . | Supplementary Material |
|
a 24 y / o single , educated , mother is hesitant to have her 12 mo daughter vaccinated for measles , mumps and rubella ( mmr ) due to concerns of her developing autism .
student objectives : to discuss the actual risks and benefits of the mmr vaccine and to debunk the link the between the mmr vaccine and autism by describing recent medical literature on the topic .
a 7 y / o boy has been having more frequent asthma exacerbations and his divorced parents are arguing in the office over the situation and both are potentially at fault .
student objectives : to manage the interview effectively keeping the patient s interest and not the parental issues at the center of the discussion .
a 16 y / o healthy female ( or male ) , from a middle - class background , comes to the office for a sports physical .
the patient s social history is significant for increasing marijuana use , occasional sexual intercourse , and brief periods of depression in her past .
student objectives : to gain the trust of the patient and to complete a thorough psychosocial history with interventional guidance as appropriate . | as medical students enter the role of physician , clinical outcomes not only rely on their mastery of clinical knowledge , but also on the effectiveness in which they can communicate with patients and family members . while students typically have
numerous opportunities to practice clinical communication with adult patients , such practice in pediatric settings is limited .
this study examines if simulated patient ( sp ) encounters strengthen third - year medical students communication skills during the pediatrics clerkship . during 2011 - 2013 ,
three sp encounters ( comprising 3 pediatric scenarios ) were incorporated into a pediatrics clerkship at one united states medical school to give students a safe venue to practice advanced communication with observation and direct feedback .
third - year medical students engaged in the scenarios and received both written and oral feedback from an evaluator observing the encounter . with irb approval , students self - perceived confidence and abilities at performing the advanced communication skills were measured using an eightitem , likert scale questionnaire administered pre and post the sp encounter .
pre- and post - questionnaires ( n=215 ; response rate , 96% ) analyzed using a wilcoxon - matched pairs signed - rank test demonstrated statistically significant increases in students perception of their confidence and abilities regarding their performance ( p<0.05 ; bonferroni correction , p<0.006 ) .
there was an increases in student confidence and self - perceived ability in : first , communicating with children and family members of young patients ; second , managing confrontational situations involving parents ; third , performing a thorough psychosocial history with an adolescent ; and fourth , using evidence based medicine to motivate parents . | SUPPLEMENTARY MATERIAL
Case #1. MMR vaccination
Case #2. Parental conflict
Case #3. Adolescent psychosocial history |
( 1 ) patients may report dysuria , intermittency , haematuria , frequency , hesitancy , nocturia or sudden termination of voiding .
a 62 year old lady presented to the hospital with a swelling in her right thigh .
she had a past history of myelomeningocele spina bifida which had been closed at birth .
she suffered from urinary incontinence and had been managed with long term suprapubic catheters for 20 years .
she had required a vesicolithotomy via a midline incision and a vaginal hysterectomy 13 years previously .
initial examination revealed a swollen right thigh and a calcified mass protruding through the skin in the right groin .
a strong smell of urine was noted although it was thought that this was secondary to a leakage from around the site of her supra pubic catheter .
laboratory data demonstrated normal renal function , a raised c - reactive protein and normal white cell count .
due to her swollen right leg a deep vein thrombosis was excluded with an ultrasound scan and negative d dimer and plain radiographs of her right hip and pelvis were requested .
a urology opinion was sought , initially , with regard to management of the suprapubic catheter . on closer examination ,
urine was noted to be leaking not from the suprapubic site but around the calcified mass in the right groin and a diagnosis of vesicocutaneous fistula was made .
her radiographs demonstrated two urinary calculi ( fig 1 ) and she went on to have an abdominal computed topography scan ( fig 2 ) which confirmed the diagnosis of a vesicocutaneous fistula .
plain radiographs demonstrating two bladder calculi ct demonstrating the two bladder calculi pointing towards the right groin vesicolithotomy was performed removing the calculi by enlarging the fistulous opening .
( fig 3 ) two calculi measuring 40 mm 43 mm 30 mm and 43 mm 50 mm 33 mm were extracted .
4 ) the suprapubic catheter was changed and the fistula was left open and urine leakage continued to decrease in quantity until the fistula tract closed .
intraoperative view of the bladder calculi emerging through the vesicocutaneous fistula into the right groin the two bladder calculi following extraction
urological complications are often a major source of morbidity for these patients . ( 5 ) abnormal bladder sensation and function combined with sphincter dysnergia predispose the spina bifida patient to urinary stasis , recurrent urinary tract infections , stone formation and renal function impairment .
( 5 ) management of the problem can be difficult and may include the use of anti - cholinergics , intermittent self catheterisation ( isc ) , supra pubic catheterisation or surgical intervention to allow urinary diversion .
( 6 ) increased fluid intake , weekly changes of indwelling catheters if isc is not possible and regular ultrasonic screening , to pick up stone formation at an early stage , may help reduce the burden of these problems .
( 2 - 4 ) predisposing factors to bladder stone formation include urinary stasis , bladder outflow obstruction urinary stasis , recurrent urinary tract infections and foreign bodies within the bladder ( 1 ) , all of which can be seen in spina bifida patients . in our case
the added sensory abnormalities secondary to spina bifida left the bladder calculus undiagnosed until it had formed the vesicocutaneous fistula .
good control of the predisposing factors can dramatically reduce the risk of developing bladder calculi , but especially in cases where this is difficult , a high index of suspicion , regular urological review and timely uss can prevent the development of both the bladder calculus and its complications . | we present a rare case of a vesicocutaneous fistula secondary to two large bladder calculi in a patient with spina bifida .
a 62 year old lady presented with swelling of her right thigh and a calcified mass protruding through the subcutaneous tissues of her right groin .
urine was seen to be draining from around the area and plain radiographs and a computed topography ( ct ) scan confirmed the presence of two bladder calculi with a vesicocutaneous fistula .
vesicolithotomy was performed and the fistula tract left to close spontaneously .
worldwide this is only the fourth case of a bladder calculus causing a vesicocutaneous fistula . | INTRODUCTION
CASE REPORT
DISCUSSION |
pityriasis amiantacea ( pa ) is a scalp disorder presenting with thick , silvery / yellowish , asbestos - like scales wrapping around and binding down tufts of hair .
it is typically considered to be a reactive condition to several inflammatory diseases , which may affect the scalp , mainly including psoriasis , atopic dermatitis and seborrheic dermatitis . however , although rarely , pa may be the presenting clinical pattern of dermatophyte infection ( pa - like tinea capitis ) , thus emphasizing the importance of ruling out / confirming the possibility of tinea capitis when dealing with a case of pa we here describe for the first time the usefulness of dermoscopy as a supportive diagnostic tool in an instance of pa - like tinea capitis .
a 9-year - old girl presented with a five - week history of a progressively worsening , asymptomatic , scaling patch on the scalp .
her past medical history was unremarkable and there was no personal or family history of atopic diathesis and skin diseases .
physical examination showed thick , adherent , whitish , asbestos - like scales on the right parietal region of the scalp , surrounding and binding the hair ( figure 1a ) ; no other significant skin , nail or mucosal finding was evident .
dermoscopic examination ( performed with dermlite dl3 x10 ; 3gen , san juan capistrano , ca , usa ) revealed diffuse white scales and compact white keratotic material adhering to tufts of hair ( asbestos - like scaling ) without erythema ( figure 1b ) ; interestingly , several hairs displayed a question mark or
( hair shaft bent at more than one point ) appearance ( figure 1b ) . as such dermoscopic findings may be found in tinea capitis [ 37 ] , we decided to carry out a direct microscopic examination of 10% koh preparation of the scales scraped from the scalp , which showed septate branching hyphae .
specimens were also cultured on conventional sabouraud s dextrose agar medium , with evidence of microsporum canis growth after three weeks , thus confirming the diagnosis of tinea capitis .
the patient was treated with oral griseofulvin ( 15 mg / kg once daily ) with complete resolution of the clinical picture after eight weeks of therapy .
clinical distinction between pa due to inflammatory noninfectious diseases and pa - like tinea capitis is a challenging task , with a significant likelihood of diagnostic errors / delays and prescription of inappropriate therapies . over the last few years
, dermoscopy has been showed to be a useful auxiliary instrument for the recognition of several hair disorders [ 89 ] , particularly dermatophyte infections [ 37 ] . indeed , beside nonspecific findings ( broken and dystrophic hairs , black dots , scaling , erythema , etc .
) , tinea capitis may display peculiar dermoscopic features such as comma hairs , corkscrew hairs , zigzag hairs , interrupted ( morse code - like ) hairs , elbow - shaped
hairs and question mark hairs [ 37 ] . regarding the present instance , even though we observed dermoscopic findings that may be commonly seen in pa , i.e. , diffuse white scaling and the characteristic compact white keratotic material adhering to a tuft of hair ( asbestos - like scales ) , dermoscopy turned out to be very helpful in suspecting tinea infection by showing the aforementioned zigzag and question mark hairs .
in fact , although such features ( or similar findings ) may be rarely found in other hair disorders ( e.g. , zigzag hairs in trichorrhexis nodosa , alopecia areata and monilethrix , and question mark hairs in alopecia areata ) [ 37 ] , they are typically not visible in classic pa . in conclusion , even though the final diagnosis relies on mycological testing , dermoscopy might come in very handy for raising the suspicion of tinea capitis presenting with a pa - like appearance by showing peculiar dermoscopic findings ( e.g. , as shown in this case , zigzag and question mark hairs ) , which are typically not detectable in instances of pa due to inflammatory diseases . obviously , further studies on larger groups of patients are needed to confirm our observations . | clinical distinction between pityriasis amiantacea - like tinea capitis and pityriasis amiantacea due to noninfectious inflammatory diseases is a troublesome task , with a significant likelihood of diagnostic errors / delays and prescription of inappropriate therapies .
we report a case of pityriasis amiantacea - like tinea capitis with its dermoscopic findings in order to highlight the usefulness of dermoscopy in improving the recognition of such a condition . | Introduction
Case report
Discussion |
wild type cd1 embryos were harvested , staged and stained by wholemount in situ hybridization using established methods , .
measurement of palates before dissection and after staining confirmed that no significant shrinkage occurred ( data not shown ) .
palatal explants were cultured ( 37c , 5% co2 ) using the trowell technique in dmem ( sigma ) , 20 u / ml pen - strep ( gibcobrl ) , 10% fbs ( gibcobrl ) , 50 mm transferrin ( sigma ) and 150 g / ml ascorbic acid ( sigma ) . for cutting and inhibitor experiments ,
serum - free advanced d - mem / f12 ( gibcobrl ) supplemented as above , was used .
su5402 ( calbiochem ) was diluted in medium from 10 mm in dmso stock ; cyclopamine ( sigma ) from 20 mg / ml - ethanol stock .
explants placed in a minimum volume of pbs in wells cut into 1% agarose were digitally imaged under a stereo dissecting microscope and measurements made using the ruler in imagej ( from the nih imagej website ) calibrated with a micrometer slide .
dimensions of fixed material were within 8% of those of fresh , unfixed material ( data not shown ) .
simulations of reaction - diffusion patterning were performed using the javascript in ref with the parameters du=0.03 , d u=0.02 , a u=0.1 , b u=0.06 , c u=0 , fmax=0.2 , dv= 0.06 , d v=0.5 , a v=0.1 , b v=+0 , c v=0.2 , gmax=0.5 .
wild type cd1 embryos were harvested , staged and stained by wholemount in situ hybridization using established methods , .
measurement of palates before dissection and after staining confirmed that no significant shrinkage occurred ( data not shown ) .
palatal explants were cultured ( 37c , 5% co2 ) using the trowell technique in dmem ( sigma ) , 20 u / ml pen - strep ( gibcobrl ) , 10% fbs ( gibcobrl ) , 50 mm transferrin ( sigma ) and 150 g / ml ascorbic acid ( sigma ) . for cutting and inhibitor experiments , serum - free advanced d - mem / f12 ( gibcobrl ) supplemented as above ,
su5402 ( calbiochem ) was diluted in medium from 10 mm in dmso stock ; cyclopamine ( sigma ) from 20 mg / ml - ethanol stock .
explants placed in a minimum volume of pbs in wells cut into 1% agarose were digitally imaged under a stereo dissecting microscope and measurements made using the ruler in imagej ( from the nih imagej website ) calibrated with a micrometer slide .
dimensions of fixed material were within 8% of those of fresh , unfixed material ( data not shown ) .
simulations of reaction - diffusion patterning were performed using the javascript in ref with the parameters du=0.03 , d u=0.02 , a u=0.1 , b u=0.06 , c u=0 , fmax=0.2 , dv= 0.06 , d v=0.5 , a v=0.1 , b v=+0 , c v=0.2 , gmax=0.5 . | we present direct evidence of an activator - inhibitor system in the generation of the regularly spaced transverse ridges of the palate .
we show that new ridges , or rugae , marked by stripes of sonic hedgehog ( shh ) expression , appear at two growth zones where the space between previously laid - down rugae increases .
however , inter - rugal growth is not absolutely required : new stripes still appear when growth is inhibited .
furthermore , when a ruga is excised new shh expression appears , not at the cut edge but as bifurcating stripes branching from the neighbouring shh stripe , diagnostic of a turing - type reaction - diffusion mechanism .
genetic and inhibitor experiments identify fibroblast growth factor ( fgf ) and shh as an activator - inhibitor pair in this system .
these findings demonstrate a reaction - diffusion mechanism likely to be widely relevant in vertebrate development . | Supplementary Material
Methods
Generation of embryos
Explant culture
Imaging, measuring and simulations |
pellagra is a nutritional disorder secondary to niacin deficiency .
the classical triad is dermatitis , diarrhea , and dementia .
we report the case of a young girl with hypermobility - type ehlers danlos syndrome who exhibited the classical pellagra symptoms , despite apparent adequate nutritional intake .
her condition resolved after oral niacin supplements were administered .
although this association has not previously been recognized , an inherited connective tissue disorder may be related to the appearance of pellagra . | Conflict of interest and funding |
|
in december 2011 , a 51-year - old woman was admitted to our hospital due to massive hemoptysis .
she had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times .
the patient s vital signs were stable . on chest examination , decreased breathing sound and crackle were audible in the right lower lung field .
a chest x - ray showed patchy consolidation in the right lower lung ( fig .
1a ) . a computed tomography scan of the chest showed a small nodule , ground glass appearance , and consolidation around the nodule in the lateral basal segment of the right lower lobe ( fig
we performed an operation for the differential diagnosis between the possibility of a malignancy or life - threatening , massive hemoptysis . under general anesthesia with a double lumen endotracheal tube , we resected the right lower lobe through a posterolateral thoracotomy at the sixth intercostal space . in the operation field ,
we could palpate a round , hard mass 2.03.0 cm in the lateral basal segment of the right lower lobe .
the resected specimen consisted of the right lower lobe , weighed 177.5 g , and was sized 11.511.23.0 cm . on multiple serial sections , a cavity lesion measuring approximately 2.02.5 cm was identified ( fig .
histopathological examination confirmed it to be a vegetable foreign body , and clumps of actinomyces , indicating actinomycosis , were present within the abscess cavity ( fig .
actinomycosis is a chronic , suppurative pulmonary infection usually caused by actinomyces israelii , which is present in the oropharynx of humans .
pulmonary infection with species of actinomyces is uncommon , and usually results from aspiration of oropharyngeal secretions in those with chronic dental infections , extension from a cervicofacial infection , or hematogenous spread from a distant source .
bronchial involvement , a rare form of thoracic actinomycosis , has been reported to be associated with foreign bodies .
the first report of endobronchial pulmonary actinomycosis induced by a foreign body was the case of a spanish patient in 1991 , when a chicken bone was aspirated . according to chouabe et al .
, eleven cases of pulmonary actinomycosis secondary to endobronchial foreign body aspiration have been described .
most cases have occurred in middle - aged males with known risk factors such as a chronic debilitated state and poor dentition .
the main symptoms include cough , fever , expectoration of yellow pus , chest pain , and weight loss .
chest computed tomography shows a thickened bronchial wall , dense pulmonary alveolar opacity , atelectasis , pleural effusion , bronchiectasis , lymphadenopathy , or a radiopaque foreign body .
obstructive endoluminal masses have been found on bronchoscopy , but the actual foreign bodies are not easily detected in some cases . in the present case ,
usually the foreign body is likely to have become a host for subsequent actinomyces contamination once the patient had developed poor dentition .
mucosal breaches secondary to foreign body impaction must occur for actinomyces species to colonize and cause a marked granulomatous inflammatory reaction .
we could find only one case of pulmonary actinomycosis induced by a vegetable foreign body .
our case represents a very rare pathogenesis of pulmonary actinomycosis , which is an important disease in the differential diagnosis of a pulmonary mass . | a 51-year - old woman visited our hospital with massive hemoptysis .
she had suffered from recurrent hemoptysis for five years and had undergone bronchial artery embolization many times .
the patient had a history of pulmonary tuberculosis and bronchiectasis .
chest radiography showed consolidation around the nodule in the lateral basal segment of the right lower lobe .
we successfully performed a right lower lobectomy .
the histological study of the resected specimen showed a vegetable foreign body and clumps of actinomyces , indicating actinomycosis , which was suggested to be the cause of the hemoptysis .
this was a very rare case of hemoptysis caused by a vegetable foreign body and actinomycosis . | CASE REPORT
DISCUSSION |
real - time measurement
of intracellular ph in live cells is of great
importance for understanding physiological / pathological processes
and developing intracellular drug delivery systems .
we report here
the first use of nanoscale metal organic frameworks ( nmofs )
for intracellular ph sensing in live cells .
fluorescein isothiocyanate
( fitc ) was covalently conjugated to a uio nmof to afford f - uio nmofs
with exceptionally high fitc loadings , efficient fluorescence , and
excellent ratiometric ph - sensing properties . upon rapid and efficient
endocytosis
, f - uio remained structurally intact inside endosomes .
live cell imaging studies revealed endo- and exocytosis of f - uio and
endosome acidification in real time .
fluorescently labeled nmofs thus
represent a new class of nanosensors for intracellular ph sensing
and provide an excellent tool for studying nmof cell interactions . | Supplementary Material |
|
we
present a chemical method to selectively tag and enrich thymine
modifications , 5-formyluracil ( 5-fu ) and 5-hydroxymethyluracil ( 5-hmu ) ,
found naturally in dna .
inherent reactivity differences have enabled
us to tag 5-fu chemoselectively over its c modification counterpart ,
5-formylcytosine ( 5-fc ) .
we rationalized the enhanced reactivity of
5-fu compared to 5-fc via ab initio quantum mechanical calculations .
we exploited this chemical tagging reaction to provide proof of concept
for the enrichment of 5-fu containing dna from a pool that contains
5-fc or no modification .
we further demonstrate that 5-hmu can be
chemically oxidized to 5-fu , providing a strategy for the enrichment
of 5-hmu .
these methods will enable the mapping of 5-fu and 5-hmu
in genomic dna , to provide insights into their functional role and
dynamics in biology . | Supplementary Material |
|
after one year of preparatory work a model of cooperation for patients with chronic wounds was implemented in the hospital krankenhaus gttlicher heiland in june 2009 .
principals of the project are the vienna health insurance and vienna 's medical association , the practical implementation lies mainly in the responsibility of the krankenhaus gttlicher heiland. this project is arranged for the duration of two years ; within this time an integrative model of medical care involving hospital , doctors in the extramural sector and the medical mobile nursing care will be implemented .
dr . viktor grablowiz ( chief of the surgery department in krankenhaus gttlicher heiland ) show , how such an approach of an integrative wound management can reduce treatment time by 50% . | description of projectafter one year of preparatory work a model of cooperation for patients with chronic wounds was implemented in the hospital krankenhaus gttlicher heiland in june 2009 .
principals of the project are the vienna health insurance and vienna 's medical association , the practical implementation lies mainly in the responsibility of the krankenhaus gttlicher heiland. this project is arranged for the duration of two years ; within this time an integrative model of medical care involving hospital , doctors in the extramural sector and the medical mobile nursing care will be implemented.resultsfirst experience reports of prim .
dr .
viktor grablowiz ( chief of the surgery department in krankenhaus gttlicher heiland ) show , how such an approach of an integrative wound management can reduce treatment time by 50% . | Description of project
Results |
ovarian cancer is the leading cause
of death among women with gynecological
malignancies .
acquired resistance to chemotherapy is a major limitation
for ovarian cancer treatment .
we report here the first use of nanoscale
metal organic frameworks ( nmofs ) for the co - delivery of cisplatin
and pooled small interfering rnas ( sirnas ) to enhance therapeutic
efficacy by silencing multiple drug resistance ( mdr ) genes and resensitizing
resistant ovarian cancer cells to cisplatin treatment .
uio nmofs with
hexagonal - plate morphologies were loaded with a cisplatin prodrug
and mdr gene - silencing sirnas ( bcl-2 , p - glycoprotein [ p - gp ] , and survivin )
via encapsulation and surface coordination , respectively .
nmofs protect
sirnas from nuclease degradation , enhance sirna cellular uptake , and
promote sirna escape from endosomes to silence mdr genes in cisplatin - resistant
ovarian cancer cells .
co - delivery of cisplatin and sirnas with nmofs
led to an order of magnitude enhancement in chemotherapeutic efficacy in vitro , as indicated by cell viability assay , dna laddering ,
and annexin v staining .
this work shows that nmofs hold great promise
in the co - delivery of multiple therapeutics for effective treatment
of drug - resistant cancers . | Supplementary Material |
|
however , the complexity of ill - health , which is socially constructed by individuals , health personnel and health authorities have motivated the search for other forms to approach knowledge .
to discuss the complementarities of qualitative and quantitative research methods in the generation of knowledge .
the purpose of quantitative research is to measure the magnitude of an event , to make predictions , develop causal explanations . to achieve this
it uses a pre - established design based on hypothesis and theories , conducts extensive data collection to a statistical sample and develops statistical data analysis .
quantitative research objectives can be to establish the incidence or prevalence of a health problem ; the health personnel degree of adherence to a new intervention ; or , the users level of satisfaction with a service .
its design is open , flexible and circular , data collection is intensive and based on a purposive sample and results will be achieved through inductive analysis .
qualitative research allows to explore aspects thought as known , understands differences in personnel opinions and practice in front of new interventions or users opinion on services utilization .
quantitative and qualitative methods are different research approaches , that not only provide complementary knowledge that contributes to gaining better understanding of a problem or situation , but that can be used in a combined way , to approach a new research area , to develop instruments and to interpret results . | introductionresearch in the area of health has been traditionally dominated by quantitative research . however , the complexity of ill - health , which is socially constructed by individuals , health personnel and health authorities have motivated the search for other forms to approach knowledge.aimto discuss the complementarities of qualitative and quantitative research methods in the generation of knowledge.contentsthe purpose of quantitative research is to measure the magnitude of an event , to make predictions , develop causal explanations . to achieve this
it uses a pre - established design based on hypothesis and theories , conducts extensive data collection to a statistical sample and develops statistical data analysis .
quantitative research objectives can be to establish the incidence or prevalence of a health problem ; the health personnel degree of adherence to a new intervention ; or , the users level of satisfaction with a service .
qualitative research aims at understanding what exists from social actors perspectives .
its design is open , flexible and circular , data collection is intensive and based on a purposive sample and results will be achieved through inductive analysis .
qualitative research allows to explore aspects thought as known , understands differences in personnel opinions and practice in front of new interventions or users opinion on services utilization.conclusionquantitative and qualitative methods are different research approaches , that not only provide complementary knowledge that contributes to gaining better understanding of a problem or situation , but that can be used in a combined way , to approach a new research area , to develop instruments and to interpret results . | Introduction
Aim
Contents
Conclusion |
we studied the effects of weight loss and non - weight - bearing exercise ( swimming ) on blood and organ lead and essential metal concentrations in rats with prior lead exposure .
nine - week - old female sprague - dawley rats ( n = 37 ) received lead acetate in their drinking water for 2 weeks , followed by a 4-day latency period without lead exposure .
rats were then randomly assigned to one of six treatment groups : weight maintenance with ad libitum feeding , moderate weight loss with 20% food restriction , and substantial weight loss with 40% food restriction , either with or without swimming .
blood lead concentrations were measured weekly .
the rats were euthanized after a 4-week period of food restriction , and the brain , liver , kidneys , quadriceps muscle , lumbar spinal column bones , and femur were harvested for analysis for lead , calcium , copper , iron , magnesium , and zinc using atomic absorption spectrophotometry .
both swimming and nonswimming rats fed restricted diets had consistently higher blood lead concentrations than the ad libitum controls .
rats in the substantial weight loss group had higher organ lead concentrations than rats in the weight maintenance group .
rats in the moderate weight loss group had intermediate values .
there were no significant differences in blood and organ lead concentrations between the swimming and nonswimming groups .
organ iron concentrations increased with weight loss , but those of the other metals studied did not .
weight loss also increased hematocrits and decreased bone density of the nonswimming rats .
the response of lead stores to weight loss was similar to that of iron stores because both were conserved during food restriction in contrast to decreased stores of the other metals studied .
it is possible that weight loss , especially rapid weight loss , could result in lead toxicity in people with a history of prior excessive lead exposure.imagesfigure 1figure 2figure 3figure 4figure 5 | Images |
|
dna methylation ( 5-methylcytosine ,
5mc ) plays critical biological
functions in mammals and plants as a vital epigenetic marker .
the
ten - eleven translocation dioxygenases ( tet1 , 2 , and 3 ) have been found
to oxidize 5mc to 5-hydroxymethylcytosine ( 5hmc ) and then to 5-formylcytosine
( 5fc ) and 5-carboxylcytosine ( 5cac ) in mammalian cells .
we report
herein three mushroom tet homologues from coprinopsis cinerea that can mediate 5mc oxidation .
specifically , one homologue ( cc1g_05589 ,
cctet ) shows similar activity to its mammalian tet homologues .
biochemically ,
cctet actively converts 5mc to 5hmc , 5fc , and 5cac under natural conditions
( ph 7.0 ) .
interestingly , cctet also converts the majority of 5mc to
5fc under slightly acidic ( ph 5.8 ) and neutral conditions .
kinetics
analyses of the oxidation by cctet under neutral conditions indicate
that conversion of 5mc to 5hmc and 5hmc to 5fc are faster than that
of 5fc to 5cac , respectively .
our results provide an example of a
tet homologue in a non - mammalian organism that exhibits full 5mc - to-5cac
oxidation activity and a slight preference to producing 5fc .
the preferential
accumulation of 5fc in the in vitro oxidation reactions
under both neutral and acidic conditions may have biological implications
for 5mc oxidation in fungi species . | Supplementary Material |
|
termine et al
. first demonstrated that sequential dissociative extraction and fractionation procedures with protease inhibitors could provide a convenient approach for the study of mineral compartment constituents .
the primary extraction regimen used 4 m guanidine hcl to remove most of the protein from the nonmineralized phase of bone .
subsequently , edta - guanidine was used to remove the mineral - phase components .
these methods discriminate on the basis of physical - chemical association with a mineral phase rather than on the specific gene products of a particular cell . in the present discussion emphasis
is directed at a group of divalent cation binding proteins isolated from the mineral compartment of bone .
the localization , synthesis , and chemical characteristics of osteonectin , bone sialoproteins i and ii , and bone acidic glycoprotein-75 are discussed and offered as possible sites for perturbation by the environment with lead exposure.imagesfigure 1.figure 2.figure 2.figure 2.figure 3.figure 3.figure 3.figure 3 . | Images |
|
the richest uranium ore bodies ever discovered ( cigar lake and mcarthur river ) are presently under development in northeastern saskatchewan .
this subarctic region is also home to several operating uranium mines and aboriginal communities , partly dependent upon caribou for subsistence . because of concerns over mining impacts and the efficient transfer of airborne radionuclides through the lichen - caribou - human food chain , radionuclides were analyzed in tissues from 18 barren - ground caribou ( rangifer tarandus groenlandicus ) .
radionuclides included uranium ( u ) , radium ( 226ra ) , lead ( 210pb ) , and polonium ( 210po ) from the uranium decay series ; the fission product ( 137cs ) from fallout ; and naturally occurring potassium ( 40k ) .
natural background radiation doses average 2 - 4 msv / year from cosmic rays , external gamma rays , radon inhalation , and ingestion of food items .
the ingestion of 210po and 137cs when caribou are consumed adds to these background doses .
the dose increment was 0.85 msv / year for adults who consumed 100 g of caribou meat per day and up to 1.7 msv / year if one liver and 10 kidneys per year were also consumed .
we discuss the cancer risk from these doses .
concentration ratios ( crs ) , relating caribou tissues to lichens or rumen ( stomach ) contents , were calculated to estimate food chain transfer .
the crs for caribou muscle ranged from 1 to 16% for u , 6 to 25% for 226ra , 1 to 2% for 210pb , 6 to 26% for 210po , 260 to 370% for 137cs , and 76 to 130% for 40k , with 137cs biomagnifying by a factor of 3 - 4 .
these crs are useful in predicting caribou meat concentrations from the lichens , measured in monitoring programs , for the future evaluation of uranium mining impacts on this critical food chain.imagesfigure 1figure 2figure 3figure 4figure 5figure 6figure 7figure 8figure 9 | Images |
|
guajadials c - f ( 14 ) , four sesquiterpenoid - based meroterpenoids with unprecedented skeletons were isolated from the leaves of psidium guajava .
their structures and relative configurations were established by extensive spectroscopic analysis . a possible biosynthetic pathway for 14 was also proposed .
supplementary material is available for this article at 10.1007/s13659 - 012 - 0102 - 4 and is accessible for authorized users . | abstractguajadials c - f ( 14 ) , four sesquiterpenoid - based meroterpenoids with unprecedented skeletons were isolated from the leaves of psidium guajava .
their structures and relative configurations were established by extensive spectroscopic analysis .
a possible biosynthetic pathway for 14 was also proposed.graphical abstractelectronic supplementary materialsupplementary material is available for this article at 10.1007/s13659 - 012 - 0102 - 4 and is accessible for authorized users . | Abstract
Graphical abstract
Electronic Supplementary Material
Electronic supplementary material |
ashy dermatosis is a hypermelanotic disorder of the idiopathic variety characterized by bluish - grey macules in healthy individuals .
it is a controversial entity and is sometimes considered as a variant of lichen planus .
etiology of ashy dermatosis is mostly unknown and it usually affects the face , arms , neck , and trunk .
ashy dermatosis usually has a symmetrical distribution but cases with unilateral presentation have also been observed .
lichen planus pigmentosus , occupational dermatosis with hyperpigmentation , drug - related dermatoses , universal acquired melanosis , and familial progressive hyperpigmentation are the common entities confounding diagnosis .
our case was a 20 year - old indian male who presented with slowly progressive , diffuse darkening of the face , arms , neck , and trunk seen over the last two years [ figures 1 and 2 ] .
he had no previous history of skin diseases and was not on any kind of medication during this two - year period .
laboratory investigations suggested normal blood counts , blood glucose level , normal liver and kidney function test and normal acth stimulation ( sensitive ) test results .
bluish black discoloration of face , chest , and upper extrimity bluish black discoloration of neck and back oral mucous membrane and palate are not involved
it has been a controversial topic that has showed a tendency to appear mostly in dark colored individuals and also in asians .
confusion also arises because the disease is also known by many different names like erythema dyschromicum perstans and lichen planus pigmentosus .
others have suggested that ashy dermatosis presents clear clinical characteristics but that histopathological findings are not specific .
our differential diagnoses revolved around lichen planus pigmentosus , occupational dermatosis with hyperpigmentation , drug - related dermatoses , universal acquired melanosis , allgrove 's syndrome , dermatomyositis , and familial progressive hyperpigmentation syndrome .
absence of occupational exposure ruled out occupational dermatosis with hyperpigmentation ; dermatomyositis is a condition of muscle weakness , and allgrove syndrome is characterized by alacrima , achalasia , and acth insensitivity .
but the patient did not show any of these symptoms and signs . a normal creatinine phosphokinase ( cpk ) level ruled out the chances of dermatomyositis , and a normal barium meal x - ray and acth sensitivity test ruled out allgrove syndrome .
the patient had not taken any drugs in this period.so drug - related dermatosis was ruled out .
the histopathological study was not conclusive enough to differentiate from lichen planus pigmentosus but the absence of pruritus , the lack of involvement of the oral mucosa , and the bluish - black discoloration in our patient , a dark colored indian in his second decade of life support our diagnosis in favor of ashy dermatosis of the idiopathic variety .
the only treatment in this condition resulting in considerable improvement in pigmentation is clofazimine at a dose of 100 mg three times per week for three to five months . | we present here the case of a young indian male with slowly progressive , diffuse darkening of the face , arms , neck , and trunk .
the patient was not taking any medication and there was no history of any previous skin disease and the mucous membrane was not involved .
these findings are consistent with a diagnosis for ashy dermatosis of unknown etiology . | Introduction
Case Report
Discussion |
research conducted since 1980 in relation to inheritance patterns and dna testing of major genes for prolificacy has shown that major genes have the potential to significantly increase the reproductive performance of sheep flocks throughout the world .
mutations that increase ovulation rate have been discovered in the bmpr-1b , bmp15 and gdf9 genes , and others are known to exist from the expressed inheritance patterns although the mutations have not yet been located . in the case of bmp15 , four different mutations have been discovered but each produces the same phenotype .
the modes of inheritance of the different prolificacy genes include autosomal dominant genes with additive effects on ovulation rate ( bmpr-1b ; lacaune ) , autosomal over - dominant genes with infertility in homozygous females ( gdf9 ) , x - linked over - dominant genes with infertility in homozygous females ( bmp15 ) , and x - linked maternally imprinted genes ( fecx2 ) .
the size of the effect of one copy of a mutation on ovulation rate ranges from an extra 0.4 ovulations per oestrus for the fecx2 mutation to an extra 1.5 ovulations per oestrus for the bmpr-1b mutation .
a commercial dna testing service enables some of these mutations to be used in genetic improvement programmes based on marker assisted selection . | None |
|
protein dynamics on the micro- to millisecond time scale
is increasingly
found to be critical for biological function , as demonstrated by numerous
nmr relaxation dispersion studies .
methyl groups are excellent probes
of protein interactions and dynamics because of their favorable nmr
relaxation properties , which lead to sharp signals in the 1h and 13c nmr spectra . out of the six different methyl - bearing
amino acid residue types in proteins
, methionine plays a special role
because of its extensive side - chain flexibility and the high polarizability
of the sulfur atom .
methionine is over - represented in many protein
protein
recognition sites , making the methyl group of this residue type an
important probe of the relationships among dynamics , interactions ,
and biological function . here
we present a straightforward method
to label methionine residues with specific 13chd2 methyl isotopomers against a deuterated background .
the resulting
protein samples yield nmr spectra with improved sensitivity due to
the essentially 100% population of the desired 13chd2 methyl isotopomer , which is ideal for 1h and 13c spin relaxation experiments to investigate protein dynamics
in general and conformational exchange in particular .
we demonstrate
the approach by measuring 1h and 13c cpmg relaxation
dispersion for the nine methionines in calcium - free calmodulin ( apo - cam ) .
the results show that the c - terminal domain , but not the n - terminal
domain , of apo - cam undergoes fast exchange between the ground state
and a high - energy state .
since target proteins are known to bind specifically
to the c - terminal domain of apo - cam , we speculate that the high - energy
state might be involved in target binding through conformational selection . | Supplementary Material |
|
we report a case of 18-year - old boy who presented with vomiting , backache , and fever for 1-month , diagnosed to have anaplastic large cell lymphoma of urinary bladder with hypercalcemia and metastatic calcification in multiple viscera .
his computed tomography scan was suggestive of soft tissue lesion in the urinary bladder and multiple lytic skeletal lesions .
bone scan showed unusual visceral uptake in lungs , liver , spleen , and myocardium in addition to osseous lesions .
the clinical laboratory test revealed functional impairment of visceral organs .
the patient died 3 months later . | Financial support and sponsorship
Conflicts of interest |
|
primary ovarian failure ( pof ) is a syndrome composed of amenorrhea , estrogen deficiency and follicular stimulating hormone ( fsh ) of menopausal ranges in young women . in this article
a 29-year old woman with a history of primary amenorrhea attended hospital with full term pregnancy .
she had experienced a few episodes of withdrawal bleeding on hormonal treatment initially and she had conceived spontaneously .
this case was presented to emphasize the real chances of spontaneous conceptions due to intermittent and unpredictable ovarian function in patients with poi .
nevertheless , egg donation is still considered the best option for infertility in such women .
fuller albright first described a condition he termed primary ovarian insufficiency ( poi ) in 1942 when he reported a syndrome of amenorrhea , estrogen deficiency and menopausal follicular stimulating hormone ( fsh ) levels in young women ( 1 ) .
herein , we report such a case that had primary amenorrhea and presented with full term pregnancy .
a 29-year - old woman attended antenatal out - patient department of north eastern indira gandhi regional institute of health and medical sciences ( neigrihms ) , shillong , meghalaya , india with full term pregnancy in october 2009 .
she gave a very interesting history of primary amenorrhea with a few episodes of withdrawal bleeding upon hormonal treatment in the past .
for the past 3 4 years she had not been receiving any treatment and had remained amenorrhoeic . after 4 years of marriage , she went to a local doctor for nausea and vomiting and , to her surprise , her urine pregnancy test was positive .
her expected date of delivery ( edd ) was calculated from the first trimester ultrasound , which confirmed the gestational maturity . on examination ,
, uterus was found to be in the form of a full - term pregnancy .
the fetus was in cephalic presentation and fetal heart rate ( fhr ) was 136 beats per minute and regular . per vaginal examination revealed a closed internal os with soft , short and central cervix .
caesarean section was performed on maternal request and a healthy male baby weighing 2.5 kg was delivered .
primary ovarian insufficiency has varied manifestations of amenorrhea , oligomenorrhea or dysfunctional uterine bleeding . overall , approximately 10% of women with poi present with primary amenorrhea ( 2 , 3 ) .
a similar case of spontaneous pregnancy has been reported in a 27-year old woman with hypergonadotropic ovarian failure ( 4 ) .
we suspected her to be a case of primary ovarian insufficiency on the basis of history alone and in the absence of any laboratory test of increased fsh , since we admitted her for the first time in full term pregnancy .
this case was reported to emphasize the real chances for a spontaneous conception because of the intermittent and unpredictable ovarian function in these patients .
primary ovarian insufficiency occurs in only 1% of women it can still result in spontaneous pregnancy in 5 - 10% of the cases .
women with poi should be educated on the nature of the disease and the current research efforts .
it is important to be aware of the condition and the options for future treatment . | introductionprimary ovarian failure ( pof ) is a syndrome composed of amenorrhea , estrogen deficiency and follicular stimulating hormone ( fsh ) of menopausal ranges in young women . in this article
, we report a case of primary amenorrhea that presented with full term pregnancy.case presentationa 29-year old woman with a history of primary amenorrhea attended hospital with full term pregnancy .
she had experienced a few episodes of withdrawal bleeding on hormonal treatment initially and she had conceived spontaneously .
subsequently , she had uneventful pregnancy and caesarean delivery on maternal request.conclusionthis case was presented to emphasize the real chances of spontaneous conceptions due to intermittent and unpredictable ovarian function in patients with poi .
nevertheless , egg donation is still considered the best option for infertility in such women . | Introduction
Case Presentation
Conclusion
Introduction
Case Presentation
Discussion
Conclusion |
neuropsychiatric manifestations are included : p0 eripheral neuropathy , myeloneuropathy , cerebellar ataxia , optic atrophy , mood disorders , psychosis , personality changes , loss of memory , depression , dementia , confusion and more rarely reversible manic and schizoferniform status and obsessive compulsive disorder ( ocd).[18 ] psychiatric manifestations of b12 deficiency seldom precede anemia.[68 ] we present a case of b12 deficiency in which ocd precedes anemia .
a 29-year - old female came with anxiety and history of ocd since 11 years ago .
general blood chemistries including thyroid function tests , liver function tests , renal function tests , cbc diff , hemoglobin level and iron profile had been performed 5 months ago and all were in normal ranges [ table 1 ] , but further investigations in recent visit showed mild anemia ( hb=11.8 g / dl , mcv=89 fl ) and markedly diminished serum cobalamine level to < 30 pg / ml and also iron deficiency with significant decreased ferritin level to 1.28 ng / ml [ table 2 ] .
laboratory findings of first visit laboratory findings of the recent visit the association between b12 deficiency and iron deficiency in this case was our explanation to her normocytic anemia .
diagnosis of b12 deficiency with ocd manifestation and concurrent iron deficiency was made and parenteral b12 and oral iron replacement therapy initiated .
in this 29-year - old female , ocd was the early manifestation of b12 deficiency .
although , it was rarely reported , but psychiatric and mood disorders may be the first manifestation of b12 deficiency and precede anemia.[68 ] we recommend checking serum b12 and folate level in any case with psychiatric disorder such as ocd , even in the absence of anemia and other hematologic manifestations of b12 and/or folate deficiencies .
b12 replacement therapy can resolve symptoms of psychiatric disorders in patients with b12 deficiency.literature review shows that patients with ocd have dysregulation in serotoninergic system and efficacy of serotonin reuptake inhibitors ( sris ) in the treatment of ocd was demonstrated.[912 ] neurotransmitters ( dopamine , serotonin and melatonin ) are necessary for a normal balanced mood , emotions and also sleeping .
folic acid and vitamin b12 act as cofactors in synthesis of neurotransmitters such as serotonin and norepinephrine .
although it is rare but psychiatric manifestations of b12 deficiency may precede anemia as we saw in this case . | b12 acts as a cofactor in synthesis of neurotransmitters such as serotonin and dopamine , thus b12 deficiency affects mood , emotions and sleeping and can lead to psychiatric disorders .
psychiatric manifestations of b12 deficiency are varied .
they seldom precede anemia .
we want to present a case of b12 deficiency which was presented with obsessive compulsive disorder . | INTRODUCTION
CASE REPORT
RESULT
DISCUSSION |
the birth of a baby with a tail can cause tremendous psychological disturbance to the parents .
isolated case reports of various types of human tails have been described in the literature .
the main features and imaging findings of six patients have been summarised in table 1 .
the plain radiographs showed spina bifida in three patients at l 5 and s 1 .
summary of main features and imaging findings of all patients other than patient number 5 ( lumbar lipomeningomyelocele ) , all other patients underwent surgical excision .
the parents of patient number 5 refused to give consent for the operation and the patient was lost to follow - up . on histopathological examination ,
the specimen of sacrococcygeal teratoma showed mature tissues that included bones , cartilage , fat and neural tissues , whereas other tails showed mature adipose tissue , blood vessels and nerves .
a vestigial tail describes a remnant of a structure found in embryonic life or in ancestral forms . during the 5 to 6 week of intrauterine life
it contains adipose tissue , connective tissue , central bundles of striated muscle , blood vessels and nerves and is covered by skin .
it can move and contract and occurs twice as often in males as in females .
none of our patients showed any movement of the tail . unlike the tail of other vertebrates , human tails do not contain vertebral structures .
the additional lesions found with pseudo tails are lipomas , teratomas , chondromegaly and gliomas , and there may be elongated parasitic fetus .
human tail usually occurs in the lumbosacral region , but it has also been reported in the cervical region .
teratoma in the human tail has also been reported . in a review series of 48 skin - covered lumbosacral masses
the preoperative assessment includes a complete clinical examination including neurology , plain radiographs of the spine and computed tomography or magnetic resonance imaging .
an occult spinal lesion has been reported in around 50% of the cases . in another review by lu ,
tail in the midline of lumbar region tail in the left side of the buttock , away from the midline tail in the midline of lumbar region tail in the midline of lumbar region tail in the midline of lumbar region ( lipomyelomeningocele ) sacrococcygeal teratoma with tail , away from the midline | human tail is a curiosity , a cosmetic stigma and presents as an appendage in the lumbosacral region .
six patients of tail in the lumbosacral region are presented here to discuss the spectrum of presentation of human tails .
the embryology , pathology and treatment of this entity are discussed along with a brief review of the literature . | INTRODUCTION
CASE REPORT
DISCUSSION |
in order to assess the abilities of alveolar macrophages ( ams ) to phagocytize adsorbent - adsorbate complexes , rat ams were incubated in vitro with two carbon blacks that have 15-fold differences in specific surface areas ( astm classification n339 less than black pearls 2000 ) sorbed with 0.5 and 1.0 monolayer coverages of a polar and semi - polar adsorbate ( acrolein and benzofuran , respectively ) .
one - half monolayer coverages of n339 with either adsorbates significantly suppressed the phagocytosis of the carbon black , whereas one monolayer coverage did not .
neither adsorbate at either coverages affected the phagocytosis of black pearls 2000 .
the capacity of macrophages to phagocytize a subsequent particle challenge via the fc - membrane receptor was quantified following treatment of the macrophages with the carbon black - adsorbate complexes .
treatment of the macrophages with carbon black n339-adsorbates complexes at both coverages impaired fc - receptor - mediated phagocytosis , whereas no effect was observed when the carbon black was black pearls 2000 .
the results of this study indicate that the surface properties of the particles , the chemical properties of the chemical pollutants , and the interactions between particles and pollutants play a major role in defining the biological effect of particle - pollutant complexes.imagesfigure 2 . | Images |
|
this genus comprises of gram - negative , strictly - aerobic , non - fermenting , non - fastidious , non - motile , catalase - positive , oxidase - negative bacteria with dna g + c content of 39.0% to 47.0% . according to euzeby 's list of prokaryotic names with standing in nomenclature ( http://www.bacterio.cict.fr/a/acinetobacter.html )
acinetobacter guillouiae proposed by nemec et al . was isolated from sewage - containing gas - work effluent and shares characteristics corresponding to those of the genus acinetobacter .
a. guillouiae strain msp 4 - 18 , isolated from a mangrove soil sample from parangipettai ( 1130n , 7947e ) , tamil nadu , india , was grown on tryptic soya agar medium ( tsa ; himedia ) at 30 c .
genomic dna was extracted from 36 hour old culture using zr fungal / bacterial dna miniprep as per manufacturer 's instructions .
amplification and sequencing of 16s rrna was performed as described by mayilraj et al . .
identification was confirmed using 16s rrna sequencing . to determine the phylogenetic relationship of strain msp4 - 18 ,
the 16s rrna sequence consisting of 1502 bp was compared with those of type strains of species of related genera and identification of phylogenetic neighbors and the calculation of pairwise 16s rrna gene sequence similarities were achieved using the eztaxon server and aligned using mega version 5.0 .
bootstrap analysis was performed to assess the confidence limits of the branching ( fig . 1 ) .
the genome of a. guillouiae msp 4 - 18 was sequenced using the illumina - hiseq 1000 technology .
sequencing resulted in 26,685,818 paired - end reads ( insert size of 350 bp ) with a length of 101 bp .
a total of 26,465,246 high - quality reads with approximately 550 coverage were assembled with clcbio wb6 ( word size 40 and bubble size 60 ) to obtain 94 contigs ( n50 , 128,068 bp ) of 4,848,959 bp and average g + c content of 38.0% .
the functional annotation was carried out by rast ( rapid annotation using subsystem technology ) , fig .
2 shows the subsystem distribution of a. guillouiae strain msp 4 - 18 , trna was predicted by trnascan - se 1.23 and rrna genes by rnammer 1.2 .
the genome contains 3 rrna genes ( 5s-23s-16s ) and 69 aminoacyl - trna synthetase genes .
a total of 4543 coding regions ( 2294 genes transcribed from the positive strand and 2249 from the negative strand ) were found in the genome , of which 3052 ( 67% ) could be functionally annotated .
the genome coding density is 83% with an average gene length of 883 bp .
the annotated genome has 106 genes responsible for resistance to antibiotic and toxic compounds including 13 genes for mdr efflux pumps .
sixty five genes are involved in oxidative stress , 12 in osmotic stress , 15 for heat shock and several others for response to various other stresses , to make a total of 107 genes responsible for stress response in this organism .
the functional comparison of the genome sequences available on the rast server revealed the closest neighbors of a. guillouiae msp 4 - 18 as acinetobacter baumanii ab0057 ( score 502 ) followed by a. baumanii aye ( score 500 ) , acinetobacter johnsonii sh046 ( score 494 ) and a. baumanii acicu ( score 494 ) .
the a. guillouiae msp 4 - 18 whole genome shot gun ( wgs ) project which has been deposited at ddbj / embl / genbank under the project accession asqg00000000 of the project ( 01 ) has the accession number asqg01000000 and consists of sequences asqg01000001asqg01000094 .
the authors declare that there is no conflict of interest on any work published in this paper . | the genus acinetobacter consists of 31 validly published species ubiquitously distributed in nature and primarily associated with nosocomial infection .
we report the 4.8 mb genome of acinetobacter guillouiae msp 4 - 18 , isolated from a mangrove soil sample from parangipettai ( 1130n , 7947e ) , tamil nadu , india .
the draft genome of a. guillouiae msp 4 - 18 has a g + c content of 38.0% and includes 3 rrna genes ( 5s , 23s , 16s ) and 69 aminoacyl - trna synthetase genes . | Direct link to the data
Nucleotide sequence accession number
Conflict of interest |
development of methods to evaluate certain classes of polycyclic aromatic compounds ( pac ) detected in complex mixtures to which humans are exposed would greatly improve the diagnostic potential of 32p - postlabeling analysis .
identification of dna adduct patterns or specific exposure - related marker adducts would strengthen associations between observed dna adducts and exposures to different environmental pollutants ( e.g. , kerosene , cigarette smoke , coke oven , and diesel ) .
we have compared diesel - modified dna adduct patterns in various in vitro and in vivo rodent model systems and compared them to dna reactive oxidative and reductive metabolites of 1-nitropyrene .
the formation of nitrated polycyclic aromatic hydrocarbon ( nitrated pah ) dna adducts , derived from the metabolism of diesel extract constituents , was enhanced relative to other pah - derived dna adducts via xanthine oxidase - catalyzed nitroreduction .
these adducts were detectable only by the butanol extraction version of the postlabeling analysis .
five major dna adducts were detected in human lymphocytes treated in vitro with diesel extract .
a major adduct detected in human lymphocytes treated in vitro with diesel extract comigrated with a major adduct detected in lymphocyte dna treated with benzo[a]pyrene ( bap ) alone . other adducts that co - migrated with the major bap - derived adducts were detected in skin and lung dna isolated from rodents topically treated with ( 50 mg ) diesel extract and the major adduct detected in calf thymus dna treated with rat liver s9 and diesel particle extract .
postlabeling of lung dna isolated from rodents exposed via lung inhalation for 24 months to diesel combustion emissions resulted in the formation of a major nuclease - p1-sensitive dna adduct that did not co - migrate with the major bap - diol epoxide adduct.(abstract truncated at 250 words)imagesfigure 1 .
afigure 1 .
bfigure 1 .
cfigure 2.figure 3 . | Images |
|
the authors present a case of giant ureteric calculus highlighting the importance of plain film radiograph in the assessment of children with suspected renal tract calculi .
ultrasonography demonstrated left hydronephrosis and a 2 cm echogenic area with acoustic shadow in the proximal ureter , consistent with a ureteric calculus .
plain radiography astonishingly revealed a large 7 cm radio - opaque shadow in the line of the left ureter extending from the left pelvi - ureteric junction to the mid - ureter , and a second 4 cm opacity in the left distal ureter ( fig 1 ) .
plain abdominal radiograph demonstrating large opacity extending from the left pelvi - ureteric junction to the mid ureter , and a smaller opacity in the distal ureter .
a dmsa scan showed split renal function of 30% on the left side and 70% on the right .
the left distal ureter was identified using an extraperitoneal approach through a left iliac fossa incision .
the distal calculus was extracted through a longitudinal ureteric incision . as it was not possible to retrieve the proximal stone through this incision
the proximal ureteric calculus measured 6.5 x 1.8 cm and weighed 7991 milligrams ( fig 2 ) .
ureteric calculi removed from the proximal ( left ) and distal ( right ) ureter .
it was composed of 85% magnesium ammonium phosphate ( struvite ) and 15% carbonate apatite .
the uk incidence of urolithiasis in children has been estimated to be two per million per annum ( 1 ) .
giant. renal tract calculi commonly present with renal colic , haematuria , urinary tract infections or lower urinary tract symptoms .
giant ureteric calculi have been reported to present with urinary tract infection and retention of urine ( 2,3 ) .
they can however be asymptomatic and progress silently , as was characterised by our case , where the giant calculus was discovered incidentally .
current practice reflects evidence that ultrasonography is more sensitive than plain radiography in detecting renal tract calculi in children ( 4,5 ) .
however , ultrasonography is less sensitive in detecting and characterising ureteric stones than plain radiography .
a combination of ultrasonography and plain radiography has therefore been recommended as the standard assessment .
ultrasonography does not always accurately characterise ureteric calculi and if a plain radiograph had not been performed , the extent of the calculus would not have been appreciated and a different course of management may have been undertaken .
the management of giant ureteric calculi entails removal of the calculus or nephroureterectomy depending on kidney function .
the authors wish to emphasise the importance of including a plain abdominal radiography in the pre - operative assessment of ureteric calculus in children . | giant ureteric calculi are extremely rare in children .
we present a case of a child who was originally admitted for observation following non - accidental injury and had an episode of painless haematuria as an inpatient .
ultrasonography demonstrated left hydronephrosis and a 2 cm echogenic area in the proximal ureter .
a plain abdominal radiograph surprisingly revealed two left ureteric calculi , one 7 cm and the other 4 cm in length .
stone extraction was achieved using an open left ureterolithotomy and pyelolithotomy . | INTRODUCTION
CASE PRESENTATION
DISCUSSION |
salt bridges are known to play an
essential role in the thermodynamic
stability of the folded conformation of many proteins , but their influence
on the kinetics of folding remains largely unknown .
here , we investigate the effect of glu - arg salt bridges on the kinetics
of -helix folding using temperature - jump transient - infrared
spectroscopy and steady - state uv circular dichroism .
we find that
geometrically optimized salt bridges ( glu and arg+ are spaced four peptide units apart , and the glu / arg order
is such that the side - chain rotameric preferences favor salt - bridge
formation ) significantly speed up folding and slow down unfolding ,
whereas salt bridges with unfavorable geometry slow down folding and
slightly speed up unfolding .
our observations suggest a possible explanation
for the surprising fact that many biologically active proteins contain
salt bridges that do not stabilize the native conformation : these
salt bridges might have a kinetic rather than a thermodynamic function . | Supplementary Material |
|
tarantula is a large spider which usually be found in tropical and subtropical areas , but recently has become as pets in worldwide ( 1 ) .
consequently , it is more likely that emergency physicians encounter with patients that hurt with these spiders .
they are nonaggressive arthropods that if to be forced to defend themselves , flick their needle - like abdominal hair at the target and may rarely bite ( 2 ) .
though tarantulas may look scary , most of their species are relatively harmless , just a few cases may be dangerous to humans ( 1 ) .
their attacks generally do not cause general manifestation , however there are some case reports in this regard ( 3 , 4 ) . here , an unusual presentation of tarantula bite was reported .
a 40-year - old man referred to the emergency department ( ed ) with severe colicky periumbilical pain , which was non - positional and radiated to both legs .
the patient did not have recent trauma history , except heavy lifting , and also any positive past medical history . on admission time
, tachycardia of 110/minute revealed a sinus tachycardia on 12 lead electrocardiogram ( ecg ) and hypertension of 220/110 mmhg in the right arm and 190/100 mmhg in the left arm . on physical examination ,
straight leg raising ( slr ) test did not aggravate the pain and all other systems were normal too .
with suspicion of large vessel insult abdominal sonography , chest radiography ( cxr ) and double contrast enhanced computed tomography ( ct ) were performed , all reported as normal .
after ruling out above - mentioned critical impressions , with attention to the history of heavy lifting , herniated disk was suspected so that magnetic resonance imaging ( mri ) was requested in which no abnormalities were found . during all these examinations , despite palliative treatments , the patient had severe pain without improvement .
unfortunately , the patient was discharged against medical advice and admitted again after 24 hours with right leg swelling and erythema . in this time , the patient was exposed and several bite - like sites were surprisingly found on his right leg .
tarantulas usually flick their hair at the target , so the most clinical presentations of biting are local allergic reactions including irritation , pruritus , edema , and erythema .
if the flicked hair takes place in eye , can result in redness and keratitis .
their bite usually sense as mild pain similar to a pinprick , but can cause severe pain , muscle spasms , local swelling , and numbness or even arthritis ( 3 , 4 ) . in spite of all above - mentioned , there is no properly documented case of permanent deficit or death following the tarantula bite ( 5 ) .
such severe symptoms almost always belong to other spiders like black widow spider ( 6 ) .
surprisingly , our case had some of these symptoms in spite of being bitten by tarantula .
therefore , we would consider that tarantula bite can mimic symptoms of black widow spider envenomation .
laboratory tests and imaging studies are not helpful for evaluation and management ( 7 ) .
in the case of tarantula bite , washing the site with soap and water and applying a cool compress or even an ice cube can reduce the local symptoms .
treatment in the ed is usually conservative and involves administration of antihistamines , corticosteroids , and analgesics ( 8) . although no specific treatment exists , it has been suggested that calcium supplements may be beneficial to relieve the muscle spasms ( 4 ) .
there is no report of recurrent or delayed reaction yet , so except for rare cases of anaphylaxis , all patients can be discharged after symptom resolution .
all authors passed four criteria for authorship contribution based on recommendations of the international committee of medical journal editors . | tarantulas have recently become as pets in most parts of the world that increased the probability of encountering emergency physicians with patients hurt with these spiders .
their attacks usually do not cause general manifestation , however there are some case reports in this regard . here ,
a 40-year - old man was reported who was referred to the emergency department with severe periumbilical pain that radiated to both legs and diagnosed as a victim of tarantula bite .
such symptoms usually are belonging to other spiders like black widow spider , but it seems that tarantula can mimic them in some cases , too . | Introduction:
Case Report:
Discussion:
Conflict of interest:
Funding support:
Authors contributions: |
a practical catalytic
method for enantioselective addition
of an allene unit to aldimines is disclosed .
transformations are promoted
by an in - situ - generated b - based catalyst that is derived from a simple ,
robust , and readily accessible ( in multigram quantities ) chiral aminoalcohol .
a range of aryl- , heteroaryl- , and alkyl - substituted homoallenylamides
can be obtained in 6691% yield and 84:16 to > 99:1 enantiomeric
ratio through reactions performed at ambient temperature and in the
presence of 0.13.0 mol% of the chiral catalyst and a commercially
available allenylboron reagent .
the catalytic protocol does not require
strict anhydrous conditions , can be performed on gram scale , and promotes
highly selective addition of an allenyl unit ( vs a propargyl group ) .
the utility of the approach is demonstrated through development of
succinct approaches to syntheses of anisomycin and epi - cytoxazone . | Supplementary Material |
|
as a service to our authors and readers , this journal provides supporting information supplied by the authors .
such materials are peer reviewed and may be re - organized for online delivery , but are not copy - edited or typeset . technical support issues arising from supporting information ( other than missing files ) should be addressed to the authors | we describe a new platform to identify structure - switching dna beacon aptamers , which detect small molecules in a specific manner . by clonally amplifying a dna library designed to fluoresce in response to binding events onto microbeads ,
aptamer beacons can be selected by stringent fluorescence - assisted sorting .
we validated this method by isolating known and novel anti - steroid aptamers from two separate dna libraries that were structurally enriched with three - way junctions .
importantly , aptamers were retrieved in only a few ( three ) rounds of selection by this approach and did not require further optimization , significantly streamlining the process of beacon development . | Supporting Information |
using dental implants for prosthetic rehabilitation of the edentulous maxilla has become a routine dental procedure . however , low quality of the posterior maxillary bone and a highly pneumatised maxillary sinus can compromise an implant 's survival12 .
implant migration into the maxillary sinus can be caused by inexperienced practitioners , unexpected perforations during sinus floor elevation , application of heavy force during implant insertion , and dental implant placement without sinus floor elevation of an excessively pneumatised maxillary sinus3 .
if this condition is inadequately treated , the implants can displace to deeper craniofacial cavities , causing infection , tissue necrosis , and adverse reactions to foreign bodies4 .
treatment of implant migration into the maxillary sinus includes the classic caldwell - luc operation and the endoscopic approach via the nose5 . in this case report
, we will discuss a dental implant that disappeared following its migration into the left maxillary sinus .
a 53-year - old male patient was referred to us for retrieval of a displaced dental implant that had migrated into his left maxillary sinus .
three months before his referral , the patient underwent a surgical procedure where eight dental implants were inserted to rehabilitate his fully edentulous maxilla .
1 ) using sinus floor elevation , implants placed in the left and right first molar areas were inserted simultaneously .
three months postoperatively , the patient 's dentist administered a panoramic radiograph and discovered that one of the implants had migrated into the patient 's left antrum.(fig .
2 ) the patient 's medical and family history was not remarkable , and intraoral examination showed no signs or symptoms of oroantral fistula . after administering computed tomography imaging to localize the implant , we discovered no foreign body in the maxillary sinus.(fig .
3 ) due to the small size of the migrated implant ( 3.4 mm in diameter and 8 mm in length ) and the absence of oroantral fistula , we believe that the implant left the maxillary sinus via the ostium .
thoracic and abdominal radiographs were taken for aspiration risk of the implant but no radiopaque objects within the patient 's body were detected .
similarly , a six - month follow - up of the patient proved to also be uneventful.(fig .
although complications are uncommon , dental implant migration into the maxillary sinus can occur due to inexperienced operators , high pneumatisation of the sinus , and low bone density in the posterior maxilla6 . although implant migration into the maxillary sinus is usually symptomless , it can cause infections that affect the paranasal sinuses and oroantral communications .
implants that have migrated into the paranasal sinuses may also cause sinusitis and adverse reactions to foreign bodies7 . migrated dental implants can primarily be diagnosed using three - dimensional computed tomography but can also be observed on panoramic radiographs and lateral or frontal cephalograms .
retrieval of migrated implants can be achieved via standard caldwell - luc operations , transoral functional endoscopic sinus surgeries ( fess ) , and transnasal fess4 .
some advantages of endoscopic removal of foreign bodies from the atrium include low morbidity , rapid recovery periods , and possible treatment of the affected paranasal cavities4 . for instance ,
kitamura and zeredo6 describe a case report where a migrated dental implant was removed endoscopically via semilunar hiatus . in their report ,
access to the maxillary sinus via semilunar hiatus was cited to be undemanding . to our knowledge , this is the first report of a dental implant that migrated into the maxillary sinus and left the sinus cavity without further treatment . because the patient claimed to have experienced no sensation of swallowing the implant , we believe that the dental implant may have left the antrum via the ostium while the patient was sleeping . therefore , this complication may create the risk of foreign body aspiration and life - threatening conditions . in conclusion
, foreign bodies in the maxillary sinus should be retrieved as soon as possible to avoid infections , maxillary sinusitis , and the potential risk of foreign body aspiration . | migration of dental implants into the maxillary sinus is uncommon . however
, poor bone quality and quantity in the posterior maxilla can increase the potential for this complication to arise during implant placement procedures .
the aim of this report is to present a dental implant that migrated into the maxillary sinus and disappeared .
a 53-year - old male patient was referred to us by his dentist after a dental implant migrated into his maxillary sinus .
the displaced implant was discovered on a panoramic radiograph taken five days before his referral . using computed tomography
, we determined that the displaced dental implant was not in the antrum .
there was also no sign of oroantral fistula .
because of the small size of the displaced implant , we think that the implant may have left the maxillary sinus via the ostium . | I. Introduction
II. Case Report
III. Discussion |
woolly hair nevus is a rare condition , characterized by unruly and tightly coiled hair , which is not genetically determined .
a 5-year - old girl child presented with abnormal patch of hair since 2 years of age .
her parents noticed a single patch of curling and coiling of hair along with altered texture over the left side of scalp .
her parents felt the patch to be unruly and unsightly and hence attempted repeated tonsuring . in spite of this
, we noticed a solitary circumscribed patch of size 64 cm located over the left frontoparietal region of scalp .
the hair over the patch had an altered texture , was lighter in color , thinner , tightly coiled , and curled giving an unkempt appearance [ figure 1 ] .
based on the above findings , we arrived at a diagnosis of localized woolly hair nevus .
a well - circumscribed patch of tightly coiled woolly hair hpe of scalp showing normal hair follicle and appendages
woolly hair is characterized by tightly coiled hair occurring over the entire scalp or part of it in an individual of non - african origin .
it is a nevoid condition characterized by a circumscribed patch of unruly and curled hair with an altered texture .
this condition may be associated with melanocytic or epidermal nevi , mongolian spots elsewhere on the skin .
ocular defects like persistent pupillary membrane , retinal defects , and precocious puberty have also been associated .
woolly hair nevus is not associated with cardiac abnormalities as in carvajal or naxos disease in which desmoplakin and plakoglobin mutations are known to occur , respectively .
our patient presented with an isolated woolly hair nevus without any associations , which has been reported very rarely .
however , this patient must be followed up regularly to detect any cardiac defects which may present later . | woolly hair nevus is a rare non - hereditary focal condition characterized by unruly and tightly coiled hair .
it can appear in childhood or adolescence and may be associated with epidermal or melanocytic nevus .
patients presenting with woolly hair must be examined completely to rule out cardiofaciocutaneous and noonan syndrome . | INTRODUCTION
CASE REPORT
DISCUSSION |
we report a genome - wide association study to iron status .
we identify an association of snps in tpmrss6 to serum iron ( rs855791 , combined p = 1.51020 ) , transferrin saturation ( combined p = 2.21023 ) , and erythrocyte mean cell volume ( mcv , combined p = 1.11010 ) .
we also find suggestive evidence of association with blood haemoglobin levels ( combined p = 5.3107 ) .
these findings demonstrate the involvement of tmprss6 in control of iron homeostasis and in normal erythropoiesis . | Supplementary Material |
|
exposure to disinfection by - products ( dbps ) of drinking water is multiroute and occurs in households serviced by municipal water treatment facilities that disinfect the water as a necessary step to halt the spread of waterborne infectious diseases .
biomarkers of the two most abundant groups of dbps of chlorination , exhaled breath levels of trihalomethanes ( thms ) and urinary levels of two haloacetic acids , were compared to exposure estimates calculated from in - home tap water concentrations and responses to a questionnaire related to water usage .
background thm breath concentrations were uniformly low .
strong relationships were identified between the thm breath concentrations collected after a shower and both the thm water concentration and the thm exposure from a shower , after adjusting for the postshower delay time in collecting the breath sample .
urinary haloacetic acid excretion rates were not correlated to water concentrations .
urinary trichloroacetic acid excretion rates were correlated with ingestion exposure , and that correlation was stronger in a subset of individuals who consumed beverages primarily within their home where the concentration measurements were made .
no correlation was observed between an average 48-hr exposure estimate and the urinary dichloroacetic acid excretion rate , presumably because of its short biological half - life .
valid biomarkers were identified for dbp exposures , but the time between the exposure and sample collection should be considered to account for different metabolic rates among the dbps .
further , using water concentration as an exposure estimate can introduce misclassification of exposure for dbps whose primary route is ingestion due to the great variability in the amount of water ingested across a population.imagesfigure 1figure 2figure 3figure 4figure 5figure 6 | Images |
|
photosystem
ii ( psii ) offers a biological and sustainable route
of photochemical water oxidation to o2 and can provide
protons and electrons for the generation of solar fuels , such as h2 .
we present a rational strategy to electrostatically improve
the orientation of psii from a thermophilic cyanobacterium , thermosynechococcus elongatus , on a nanostructured
indium tin oxide ( ito ) electrode and to covalently immobilize psii
on the electrode .
the ito electrode was modified with a self - assembled
monolayer ( sam ) of phosphonic acid ito linkers with a dangling carboxylate
moiety .
the negatively charged carboxylate attracts the positive dipole
on the electron acceptor side of psii via coulomb interactions .
covalent
attachment of psii in its electrostatically improved orientation to
the sam - modified ito electrode was accomplished via an amide bond
to further enhance red - light - driven , direct electron transfer and
stability of the psii hybrid photoelectrode . | Supplementary Material |
|
a working classification about the interrelationship of nine individual dental specialties with forensic odontology was formulated , and a detailed review about the relationship of these dental specialties with forensic odontology was ascertained .
the main objective of this study is to find the relationship of forensic odontology with various dental specialties in the articles published in the journal of forensic odonto - stomatology from 2005 to 2012 .
all of the protocols for this study were performed in accordance with the declaration of helsinki .
the author has no known conflict of interest associated with the study and there has been no significant financial support for this work that could have influenced its outcome .
a total of 16 issues of journal of forensic odonto - stomatology from 2005 to 2012 were analyzed .
this was available on the journal website http://www.iofos.eu/jfosonline2.html ( last accessed on 2013 dec 30 ) .
the article contents were scrutinized based on the relationship of forensic odontology with other dental specialties .
the contents of the published articles were categorized into nine individual dental specialty articles based on the new working classification proposed for forensic odontology .
the dental specialties considered were oral pathology and microbiology , oral medicine and radiology , oral and maxillofacial surgery , pedodontics , periodontics , conservative dentistry and endodontics , prosthodontics , orthodontics and finally community dentistry .
the section on editorial , book review and conference proceedings in journal of forensic odonto - stomatology were excluded from the study .
the relationship of forensic odontology with various dental specialties in the articles published in the journal of forensic odonto - stomatology from 2005 to 2012 is summarized in table 1 .
the relationship of forensic odontology with various dental specialities in the articles published in the journal of forensic odonto - stomatology from 2005 to 2012
there is a paucity of information about the relationship of forensic odontology with various dental specialties in the articles published in the journal of forensic odonto - stomatology . regarding the relationship with various dental specialties , the maximum number of published articles were related to oral medicine and radiology ( 20 ) and community dentistry ( 20 ) , followed by orthodontics ( 18 ) , prosthodontics ( 15 ) , and oral pathology and microbiology ( 8) , pedodontics ( 7 ) , oral and maxillofacial surgery ( 4 ) and conservative dentistry and endodontics ( 3 ) .
two articles dealing with forensic anthropology were excluded from the study since it has no relationship with dental specialties based on the new working classification for forensic odontology . in a recent study done on publication trends of a forensic odontology journal from india , regarding the relationship of forensic odontology with various dental specialties ,
the maximum numbers of published articles were related to oral medicine and radiology ( 30 ) , followed by oral pathology and microbiology ( 16 ) , prosthodontics ( 14 ) , and orthodontics ( 10 ) and community dentistry ( 5 ) . regarding the relationship of forensic odontology with various dental specialties ,
the maximum number of published articles were related to oral medicine and radiology in both journals ( journal of forensic odonto - stomatology and journal of forensic dental sciences ) . among the articles published in journal of forensic odonto - stomatology , mass disasters ( 10 ) and
bite mark analysis ( 10 ) followed by sexual dimorphism ( 8) and dental fraud and malpractice ( 8) followed by craniofacial superimposition ( 6 ) and identification ( 6 ) form the major attraction of the contributors . in journal of forensic dental sciences ,
cheiloscopy ( 12 ) followed by palatal rugoscopy ( 9 ) , sexual dimorphism ( 6 ) and cephalometrics ( 4 ) form the major attraction of the contributors .
in journal of forensic dental sciences , the two dental specialties such as oral and maxillofacial surgery and periodontics were untouched over 4 years publication . under periodontics
specialty , the editorial board should include articles about age estimation using periodontosis ( gum recession ) , root transparency and root length and identification using gingival morphology and pathology and thickness and widening of periodontal ligament and pathology and status of alveolar bone .
the main limitation of this study is that the data is taken from only one journal to study the relationship of forensic odontology with various dental specialties .
to sum up , this paper has tried to evaluate the new working classification proposed for forensic odontology based on its relationship with other dental specialties . | background : there is a paucity of information about the relationship of forensic odontology with various dental specialties in the articles published in the journal of forensic odonto - stomatology .
this study aimed to find the relationship of forensic odontology with various dental specialties in the articles published in the journal of forensic odonto - stomatology from 2005 to 2012 over an 8-year period.methods:bibliometric analysis was performed using web - based search during december 2013.results:out of the total 97 published articles , the maximum number of published articles were related to oral medicine and radiology ( 20 ) and community dentistry ( 20 ) , followed by orthodontics ( 18 ) , prosthodontics ( 15 ) , and oral pathology and microbiology ( 8) , pedodontics ( 7 ) , oral and maxillofacial surgery ( 4 ) and conservative dentistry and endodontics ( 3 ) . among the articles published in journal of forensic odonto - stomatology , mass disasters ( 10 ) and bite mark analysis ( 10 ) , followed by sexual dimorphism ( 8) and dental fraud and malpractice ( 8) , followed by craniofacial superimposition ( 6 ) and identification ( 6 ) form the major attraction of the contributors.conclusion:this paper has tried to evaluate the new working classification proposed for forensic odontology based on its relationship with other dental specialties . | INTRODUCTION
METHODS
RESULTS
DISCUSSION
CONCLUSION |
sodium bromate and potassium bromate are strong oxidants that are widely used in hair permanent wave neutralizers , reagents of printing or dyeing and other chemical processes .
hair wave permanent neutralizing solutions typically contain 2 - 10% sodium or potassium bromate , which are colorless , odorless and tasteless .
clinical manifestations of bromate intoxication include vomiting , diarrhea , central nervous system symptoms , oliguric or non - oliguric acute renal failure , hemolytic anemia , and deafness .
hearing impairment is rather common and is usually rapidly progressive , bilateral , and of severe to profound sensorineural type of hearing loss ( snhl ) .
although many investigators have studied the characteristics of hearing impairment , cochlear implantation ( ci ) after bromate intoxication has been rarely documented .
we hereby present a case of successful ci in bromate - induced bilateral sudden total deafness .
she had accidentally ingested a cold wave neutralizer . within one hour after the ingestion , she developed nausea , vomiting , and diffuse abdominal pain .
her past history included hypertension , left hemiparesis due to previous brain hemorrhage and infarction and depressive disorder . upon arrival in the emergency room of a local hospital , she received intravenous hydration and furosemide injection .
one day later , she was referred to our hospital with decreased urinary output and reduced mental state .
four days after admission , her kidney function was normalized and mentality was recovered to an alert state .
1b ) and v - wave was not detectable at 90 db in the auditory brainstem response .
she was diagnosed as having bromate - induced sudden deafness and steroid was administered systematically for a week with tapering for another week .
nucleus 24re was implanted without any intra - operative problems and the neural response telemetry showed satisfactory values .
six months after the implant , ci - aided pta showed a threshold of 30 db ( fig .
, she comprehended 70% of the sentences , 85% of the words and 68% in the korean version of the central institute for the deaf test .
hearing problems may be diagnosed with a delay after bromate intoxication due to other life - threatening symptoms such as acute renal failure which generally occurs within 1 hour after the ingestion . however , the onset of bromate - induced hearing loss is actually rapid , occurring within 4 - 16 hours of ingestion . like many other ototoxins ,
the degree of hearing impairment is severe to profound , and is irreversible in most cases .
since they are usually transient , loop diuretics including furosemide are ototoxic in themselves . in the present case , the patient received furosemide during the primary treatment , which may have aggravated the ototoxic effects of bromate .
previous studies using guinea pigs and sodium bromate demonstrated severe collapse of the reissner 's membrane , hair cell degeneration and damage of the stria vascularis .
the ototoxicity may be ascribed to a decrease in enzyme activities which leads to damage of the stria vascularis with degenerative changes in outer hair cells
on the other hand , dizziness associated with bromated - induced vestibulotoxicity is not common .
the dizziness could be secondary to other systemic toxicities such as lightheadedness or general malaise .
to our knowledge , there has only been one report in the english literature of ci performed in patients deafened due to bromated - ingestion . in this case , the diagnosis of hearing loss was delayed for at least 6 months after bromate ingestion . in our case ,
deafness was diagnosed right after the recovery of consciousness and the intervention with ci was done 3 months after the diagnosis . in both cases , the outcome of ci was good .
other potential drugs with ototoxicity should be avoided and early monitoring of hearing level is needed . | despite the well - established nature of bromate - induced ototoxicity , cochlear implantation after bromate intoxication has been rarely documented . we hereby present a case of a 51-year - old female deafened completely after bromate ingestion .
her hearing was not restored by systemic steroid treatment and hearing aids were of no use .
a cochlear implantation was performed on her right ear 3 months after the bromate ingestion . in bromate intoxication cases , early monitoring of hearing level
is necessary and other drugs with potential ototoxicity should be avoided .
the outcome of cochlear implantation was excellent in this case of bromate - induced deafness . | Introduction
Case Report
Discussion |
a 6yearold male was brought to our emergency department having sustained an accidental penetrating injury to zone 1 of the neck with a sickle . on examination , there was a foreign body sickle ( fig .
1 ) with its wooden handle as an entry point at the right submandibular region with no active bleeding and without evidence of vascular or neurological injuries .
the sickle had serrated part on its concave surface and blunt part on its curvature .
2 . what is the superior limit of foreign body piercing the neck in this patient ?
penetrating neck injury can be life threatening because of the increased risk of injury to the vital structures such as blood vessels , airway , cervical spines , and nerves which are present in such a small confined area 1 .
the foreign body may be providing tamponade effect on a major blood vessel so it should not be blindly pulled out until radiological evaluation 2 .
our patient initially has undergone plain xray of the neck as a means of costeffective investigation . but from xray alone , it was not possible to find the accurate information regarding the relation of foreign body with the adjacent vital structures .
computed tomography scan can be helpful to know the extent of the injury sustained by the patient with penetration of neck with sharp objects such as sickle , knife , broken glasses , metallic and wooden foreign bodies . in this case
, the computed tomography showed the metallic foreign body penetrating the soft tissue of neck on right side reaching the opposite side orbit .
intraoperatively , the foreign body was found to be penetrated to floor of mouth , involving dorsum of tongue and soft palate , then entered into left nasal cavity , piercing the middle turbinate , and finally entered into left orbital cavity lying posterior , that is , very close to the orbital apex ( fig . 2 , 3 , 4 ) .
coronal view of ct scan showing the entry point and the extent of foreign body .
axial view of ct scan showing metallic foreign body in left orbit . correlating the radiological and clinical finding ,
although xray plain film is a costeffective investigation method in the case of metallic foreign body penetrating the neck , one should not rely alone on it , as it can not reveal status of neurovascular structures lying adjacent to foreign body in an anatomically important area such as head and neck region .
ct scan is a definitive imaging technique which yields important information and makes interpretation easy .
so , it must be taken before planning the removal of foreign body in operation theater . | key clinical messagect scan is the most important investigation in patients with penetrating neck injury in which it can show the extent of internal injury which may be overlooked . without ct scan being performed , one should not try to remove foreign body by just pulling blindly , as it can injure vital structures . | Introduction
Discussion and Outcome
Take Home Message
Conflict of Interest
Authorship |
although fish in natural populations may carry high body burdens of both organic and inorganic mercury , the effects of this divalent metal on such lower vertebrates is poorly understood . in this report , inorganic mercury in the form of mercuric chloride ( hgcl2 )
is shown to produce both high - dose inhibition and low - dose activation of leukocytes in a marine teleost fish , sciaenops ocellatus .
concentrations of inorganic mercury > or = 10 microm suppressed dna synthesis and induced rapid influx of radiolabeled calcium , as well as tyrosine phosphorylation of numerous cellular proteins . lower concentrations ( 0.1 - 1 microm ) of hgcl2 that activated cell growth also induced a slow sustained rise in intracellular calcium in cells loaded with the calcium indicator dye fura-2 , but did not produce detectable tyrosine phosphorylation of leukocyte proteins .
these studies support the possibility that subtoxic doses of hgcl2 may inappropriately activate teleost leukocytes , potentially altering the processes that regulate the magnitude and specificity of the fish immune response to environmental pathogens.imagesfigure 1.figure 2.figure 3.figure 4.figure 5.figure 6.figure 7 . | Images |
|
biliary obstruction is preferentially managed by endoscopic retrograde cholangiopancreatography ( ercp ) . however , after ercp failed , alternatives include percutaneous transhepatic drainage , surgery and more recently , endoscopic ultrasonography ( eus)-guided hepaticogastrostomy .
the limitation of this technique is that the drainage is restricted to the left side .
the aim of this study is to describe a new method of drainage of both hepatic ductal systems by hepaticogastrostomy in patients with hilar obstruction .
nine prospectively patients were included , all with hilar obstruction ( metastasis of a pancreatic adenocarcinoma n = 4 , cholangiocarcinoma n = 1 , gallbladder cancer n = 2 and metastasis from a pancreatic neuroendocrine tumor n = 2 ) .
a total of four patients had previously whipple surgery and the others five had duodenal involvement by the tumor .
the topography of the stenosis varied from bismuth type 2 ( n = 7 ) and hilar infiltration in the others two .
the first one consisted in a transgastric eus - guided puncture of the left - side bile duct with a 19 gauge needle , insertion of a 0.0035 inch guide wire which was positioned at the right biliary tree crossing the bile bifurcation . after a dilatation with 6 fr cystotome ,
a non - covered self - expandable metal stent was placed communicating the right and left biliary ducts .
finally , a second stent , partially covered , was inserted at the left biliary duct , with the distal part inside the previously stent and the proximal edge positioned at the stomach .
successful drainage was observed in seven patients , two of them presented abdominal pain during the first 72 h. one patient developed sepsis and death 7 days after the procedure and the other one had drainage failure .
this pilot study shows the feasibility of this new technique to drain the right biliary duct in patients with hilar obstruction , with few major complications rates . | introduction : biliary obstruction is preferentially managed by endoscopic retrograde cholangiopancreatography ( ercp ) .
however , after ercp failed , alternatives include percutaneous transhepatic drainage , surgery and more recently , endoscopic ultrasonography ( eus)-guided hepaticogastrostomy .
the limitation of this technique is that the drainage is restricted to the left side .
the aim of this study is to describe a new method of drainage of both hepatic ductal systems by hepaticogastrostomy in patients with hilar obstruction.results : nine prospectively patients were included , all with hilar obstruction ( metastasis of a pancreatic adenocarcinoma n = 4 , cholangiocarcinoma n = 1 , gallbladder cancer n = 2 and metastasis from a pancreatic neuroendocrine tumor n = 2 ) .
a total of four patients had previously whipple surgery and the others five had duodenal involvement by the tumor .
the topography of the stenosis varied from bismuth type 2 ( n = 7 ) and hilar infiltration in the others two .
all of them were submitted a three - step drainage .
the first one consisted in a transgastric eus - guided puncture of the left - side bile duct with a 19 gauge needle , insertion of a 0.0035 inch guide wire which was positioned at the right biliary tree crossing the bile bifurcation . after a dilatation with 6 fr cystotome ,
a non - covered self - expandable metal stent was placed communicating the right and left biliary ducts .
finally , a second stent , partially covered , was inserted at the left biliary duct , with the distal part inside the previously stent and the proximal edge positioned at the stomach .
successful drainage was observed in seven patients , two of them presented abdominal pain during the first 72 h. one patient developed sepsis and death 7 days after the procedure and the other one had drainage failure .
jaundice was reduced significatively in seven patients and a chemotherapy was started in 6/7 patientsconclusion : this pilot study shows the feasibility of this new technique to drain the right biliary duct in patients with hilar obstruction , with few major complications rates . | Introduction:
Results:
Conclusion: |
a 52-year - old korean female visited seoul veterans hospital with a complaint of acute pain and gingival swelling on the right mandibular molar region .
on palpation , bilateral buccal bony expansion was noted on the posterior mandible and maxilla ( fig .
1 ) . she had a complete denture , however her denture was out of use due to the gingival swelling and pain .
panoramic radiograph showed diffuse , lobular , and irregularly shaped radiopacities or cotton - wool appearance throughout the alveolar process of both quadrants of the maxilla and mandible .
multiple sclerotic masses with radiolucent borders were found in the maxilla and mandible , confined within the alveoli at the level corresponding to the roots of the teeth , above the inferior alveolar canal ( fig .
cone beam computed tomography ( cbct ) ( kavo 3d exam , kavo , biberach , germany ) images also revealed large radiopaque shadow extending into the mandible and maxilla .
the bucco - lingual aspects of the lesions could be visualized on the cbct images , which demonstrated the relationship of the bony lesions to the cortical plates in the bucco - lingual dimension .
some lesions appeared larger and connected with the buccal and lingual cortical plates . on the parasagittal reformatted images at this level ,
the radiographic appearance varied from radiolucent to mixed lesions or rather radiopaque masses . under local anesthesia , incision and surgical curettage was performed on the right mandibular posterior area . irregular bony defects and inflammatory fibrous tissue were seen in the operation field .
histological finding of this lesion showed the formations of dense sclerotic calcified cementum - like masses .
the lesion was composed of cementum - like substances characterized by islands of calcified deposits and areas of loose fibro - collagenous stroma , which showed the evidence of proliferation .
the patient of the present case has been followed up over the last 12 month and fcod has remained asymptomatic .
exuberant fibro - osseous lesions occurring in multi - quadrants of the jaws were designated as gigantiform cementomas or familial multiple cementomas in the first edition of the world health organization 's histological typing of odontogenic tumor , jaw cysts and allied lesions.11 however , the etiopathogenesis has not been clear .
our case was diagnosed with fcod based on the clinical , histologic , and radiographic features .
fcod should be differentiated from paget 's disease , chronic diffuse osteomyelitis , and gardner 's syndrome .
paget 's disease is polyostotic and shows the raised alkaline phosphatase level which is not a consistent feature of fcod .
it is a primary inflammatory condition of mandible with cyclic episodes of unilateral pain and swelling .
fcod is a reactive , non - neoplastic process confined to tooth - bearing areas of the jaws that is found most frequently in middle - aged and older black women .
melrose et al reported a study of 34 cases of such lesions , of which 32 were black women ( in a predominantly caucasian population ) with mean age of 42 years.12 the definite female gender predilection of the condition is unclear.2,3 in the present case , the patient was a 52-year - old korean female ; it was rare in regard to the race and gender .
fcod may be familial with an autosomal dominant inheritance pattern . however , there were only few examples in the literatures in which the familial pattern had been confirmed.10,13,14 in this case , the patient 's mother and twin daughters had similar lesions in the jaw , and they were diagnosed with familial gigantiform cementoma in other clinic , however the lesions were focal without pain and any other symptom .
conventional radiograph , which exhibit multi - quadrant diffuse radiopaque masses in the tooth - bearing areas of the jaws , plays an important role in the diagnosis for asymptomatic fcod patients .
the ct findings of the lesion have been previously reported.10 axial ct images clearly showed the location and extent of the lesion , especially in the maxilla .
the expansion of the cortical bone was clearly evaluated on the ct images even though it was slight .
extraction is not recommended due to the poor socket healing from the impaired blood circulation in the affected area of the bone .
extensive surgical resection and saucerization are proposed as treatment options when lesions become extensive and symptomatic.15,16 in this case , surgical resection and saucerization were performed due to the symptoms of the pain and gingival swelling on the edentulous area . | cemento - osseous dysplasias are a group of disorders known to originate from periodontal ligament tissue and involve , essentially , the same pathological process .
they are usually classified into three main groups : periapical , florid , and focal cemental dysplasias depending on their extent and radiographic appearances .
radiographically , florid cementoosseous dysplasia ( fcod ) appears as dense , lobulated masses , often symmetrically located in various regions of the jaws .
the best management for the asymptomatic fcod patient consists of regular recall examinations with prophylaxis .
the management of the symptomatic patient is more difficult . a case of fcod occurring in a 52-year - old edentulous korean female
is reported which is rare with regard to race and sex . | Case Report
Discussion |
diabetes is a common chronic disease that is characterized by impaired insulin secretion and insulin resistance .
psychiatric disorders frequently occur in type 2 dm patients and about 15% of the diabetic patients are susceptible to depression . in iranian traditional medicine ( itm )
, the relationship between diabetes and depression is mentioned and special attention to their psychiatric problems is considered in the treatment of diabetes .
this study is a descriptive review according to available iranian traditional medicine literature such as canon compared with modern medicine by using pubmed and scopus databases .
in itm , diabetes is divided into warm and cold categories where the warm type is more common .
emotions such as anger and grief can play an important role in creating the warm or cold diabetes , respectively . in modern medicine
, several studies found that the odds of depression in the diabetic group were more than the non - diabetic comparison group . on the other hand ,
depression may have a role in the pathogenesis of dm with stimulation of the hypothalamic
pituitary adrenal axis , which results in increased cortical level and blood glucose , eventually progressing to diabetes .
evidence in modern medicine suggests that diabetes and depression can be a risk or exacerbating factor to each other . in itm ,
the theory of association between depression and diabetes is more highlighted than modern medicine , which is mentioned since more than 1000 years ago .
it seems that emphasis on the treatment of depression in diabetic patients may have significant effects in the course of their disease . | background : diabetes is a common chronic disease that is characterized by impaired insulin secretion and insulin resistance . it is considered an urgent public - health issue because of its epidemic perspective .
depression is a highly prevalent disease with a lifetime prevalence of 17% .
individuals with depression experience reduced functioning and decreased quality of life .
psychiatric disorders frequently occur in type 2 dm patients and about 15% of the diabetic patients are susceptible to depression . in iranian traditional medicine ( itm ) ,
the relationship between diabetes and depression is mentioned and special attention to their psychiatric problems is considered in the treatment of diabetes.methods:this study is a descriptive review according to available iranian traditional medicine literature such as canon compared with modern medicine by using pubmed and scopus databases.results:in itm , diabetes is divided into warm and cold categories where the warm type is more common .
emotions such as anger and grief can play an important role in creating the warm or cold diabetes , respectively.in modern medicine , several studies found that the odds of depression in the diabetic group were more than the non - diabetic comparison group . on the other hand ,
depressed mood was associated with an increase of developing type 2 diabetes .
depression may have a role in the pathogenesis of dm with stimulation of the hypothalamic
pituitary adrenal axis , which results in increased cortical level and blood glucose , eventually progressing to diabetes.conclusion:evidence in modern medicine suggests that diabetes and depression can be a risk or exacerbating factor to each other . in itm ,
the theory of association between depression and diabetes is more highlighted than modern medicine , which is mentioned since more than 1000 years ago .
it seems that emphasis on the treatment of depression in diabetic patients may have significant effects in the course of their disease . | Background:
Methods:
Results:
Conclusion: |
the cytotoxicity of a high purity cornish kaolinite toward mouse peritoneal macrophages in vitro was examined .
the material was cytotoxic towards these cells , the activity could be decreased substantially by pretreating the dust with poly(2-vinylpyridine n - oxide ) .
pretreatment of the dusts with poly(acrylic acid ) had a small effect on cytotoxicity , but combinations of the polymer treatments virtually abolished the material 's biological activity towards macrophages .
these studies indicated that the cytotoxicity of kaolinite is not due to its flakelike morphology.imagesfigure 1 . | Images |
|
on the day of surgery , all donor tissues are dissected in the operating room prior to the start of the first dsaek surgery .
dissection is performed using a microkeratome ( altk cbm ; moria japan kk , tokyo , japan ) equipped with a 300 m head .
after microkeratome - dissection , the donor - endothelial lamella ( with the repositioned , dissected cap ) is transferred to a punching system , and cut with an 8.0 mm diameter punch ( barron donor cornea punch ; katena products inc , denville , nj ) .
the busin glide surface is then wetted with several drops of balanced salt solution ( figure 2a ) .
after the composite of donor - endothelial lamella and microkeratome - dissected cap is punched out , several drops of dispersive ophthalmic viscosurgical device are placed onto the endothelial surface ( figure 2b ) .
next , hydrodissection of the potential space between the donor - endothelial lamella and the microkeratome - dissected cap is carefully performed , using ophthalmic irrigation solution ( bss plus ; alcon , fort worth , tx ) to enable smooth detachment of these two lamellae ( figure 2d ) .
this technique enables smooth detachment of the composite , without causing the formation of any wrinkles or folds ( figure 2e ) .
the donor lamella is then pulled into the busin glide opening , using a 25-gauge anterior - capsular forceps ( cat # mf801l ; inami co , ltd , tokyo , japan ) ( figure 2f ) .
we reported herein a modified surgical technique , prewetting of the glide , and hydrodissection of the donor lamella aimed at optimizing the use of the busin glide for dsaek surgery .
hydrodissection of the donor lamella enables the smooth detachment of the composite of donor - endothelial lamella and microkeratome - dissected cap on the busin glide without the formation of any wrinkles or folds .
this technique is quite useful when the dsaek is performed using pre - cut tissue , as these tissues are usually distributed with the cap adhered to the dissected stromal bed . in ten out of ten consecutive cases
, we saw that simply dragging donor - endothelial lamella directly onto the glide caused macroscopic wrinkling or folding of the donor lamella .
it has been shown previously with in vitro vital dye staining9 that folding of the donor endothelial lamella resulting from the forceps manipulation can cause endothelial cell damage .
we too , have preliminary vital dye staining data ( not shown here ) that wrinkling or folding of the donor lamella as it is dragged onto the busin glide causes endothelial cell damage . to date
, we have used this modified technique in more than 50 consecutive dsaek cases , and no wrinkles or folds were caused during loading of the donor lamella onto the busin glide .
furthermore , prewetting of the glide enabled quite smooth pull - through of the donor lamella in all cases .
we strongly believe that this technique eliminates additional endothelial - cell loss caused by wrinkle formation , during donor manipulation .
however , care should be exercised in using viscoelastic materials over the graft , especially on the stromal side , because of the increased risk of donor dislocation . currently , these modifications are our preferred endothelial keratoplasty technique during busin glide use . | we describe a modified technique for loading donor corneal endothelial lamella onto a busin glide without causing wrinkles , as part of the procedure of descemet - stripping automated endothelial keratoplasty . briefly , after punching out a composite of the donor - endothelial lamella and a microkeratome - dissected cap , several drops of dispersive ophthalmic viscosurgical device are placed onto the endothelial surface .
the busin glide surface is then wetted with several drops of balanced salt solution .
after the composite is transferred onto the busin glide , hydrodissection of the potential space between the donor - endothelial lamella and the microkeratome - dissected cap is carefully performed to enable smooth detachment of these two lamellae . whereas simply dragging the donor - endothelial lamella directly onto the glide can cause wrinkling or folding of the donor lamella , this technique enables smooth detachment of the composite without wrinkle or fold formation , and results in less endothelial cell damage . | Surgical technique
Discussion |
persistent cloaca is defined as a defect in which rectum ; vagina and urinary tract meet and fuse into a single common channel .
this is a rare anomaly seen exclusively in girls with an incidence of 1 in 50,000 live births and accounts for 10% of all anorectal malformations in females .
it is a complex malformation with a wide spectrum of severity and remains a difficult reconstructive challenge .
achieving bowel and urinary control , as well as normal sexual function are the main management issues , whereas malignancy is rarely of concern in this group of patients .
although cloacogenic tumors of anorectum , bladder , and vulva are reported , which are mainly adenocarcinomas ; development of squamous cell carcinoma of bladder in patients with cloacal malformation is unknown .
a 36-year - old married female having two children , both delivered by caesarian section , presented to us with complaints of urinary frequency , urgency , and urge incontinence associated with low - grade fever .
she had history of recurrent urinary tract infections ( uti ) since childhood and had received multiple courses of antibiotics .
she had been diagnosed as having a persistent cloaca and had undergone multiple cutback procedures at birth . on pelvic examination ,
ultrasound abdomen showed a mass lesion in urinary bladder [ figure 1 ] . computed tomography ( ct ) abdomen and pelvis with
three dimensional reconstruction confirmed the presence of persistent cloaca , a large mass in the bladder with infiltration into the pubic bones [ figure 2 ] with uterus didelphys and rectum crossing between the two uteri and opening into the bladder base [ figure 3 ] .
cystoscopy revealed a large solid , sessile growth arising from dome and anterior wall of urinary bladder , rectum opening just distal to bladder neck and two cervical openings posteriorly .
cold cup biopsy from growth revealed a moderately differentiated squamous cell carcinoma ( scc ) .
ultrasonogram abdomen showed a mass lesion in urinary bladder ct scan with 3d reconstruction shows the presence of persistent cloaca contrast enhanced ct scan abdomen and pelvis showing uterus didelphys and rectum crossing between the two uteri and opening into the bladder base with a diagnosis of squamous tumor with persistent cloaca , radical cystectomy and urinary diversion were planned .
intraoperatively , we found a 15 cm pouch colon along with a large tumor involving anterior wall of bladder , infiltrating the pubic bones .
pelvic exenteration , standard bilateral pelvic lymph node dissection , pubectomy , and wet colostomy were performed .
operative time was 6 hours with 1200 cc blood loss and the patient received 2 units of packed cell transfusion .
postoperative course was uneventful except for a small incision disruption which was managed with secondary suturing .
she was started on adjuvant methotrexate and platin - based combination chemotherapy but finally lost to follow up .
cloacogenic tumors i.e. , tumors arising from remnants of cloacal membrane have been reported in the anorectum , vulva , bladder , and vagina .
most of these are adenocarcinomas and less commonly of transitional cell origin . squamous cell carcinoma arising from cloaca
to best of our knowledge , this is probably the first case of squamous cell carcinoma of urinary bladder occurring in a patient with persistent cloacal anomaly .
the reason for recurrent uti in our patient may be fecal contamination of urinary tract due to persistent cloaca .
studies from john hopkins institute have shown that history of uti is an important risk factor ( risk ratio = 1.6 , confidence interval ( ci ) = 1.4 - 1.8 ) for development of scc .
these are : i ) production of excess nitrites by bacteria , ii ) conversion of nitrites into nitrosamines , and iii ) increased absorption of carcinogens through bladder mucosa because of inflammation .
development of malignancy in patients with cloacal malformations is exceedingly rare but a possibility should be kept in mind , particularly while treating recurrent and unexplained utis in a patient with persistent cloaca .
taking all treatment perspectives together , the most serious problem is the lack of any histological or clinical data allowing a reliable prognosis of future bladder growth and long - term storage and voiding function after birth . | a rare case of squamous cell carcinoma of bladder occurring in a 36-year - old female with persistent cloacal anomaly who presented with frequency , urgency , dysuria , and recurrent urinary tract infection is reported .
contrast enhanced computed tomography with three dimensional reconstruction showed presence of bladder tumor and persistent cloaca .
she underwent pelvic exenteration and wet colostomy .
histopathologic findings revealed locally advanced moderately differentiated squamous cell carcinoma . | INTRODUCTION
CASE REPORT
DISCUSSION |
the reaction of a manganese(v)oxo
porphyrinoid complex with the lewis acid b(c6f5)3 leads to reversible stabilization of the valence tautomer
mniv(o)(-radical cation ) .
the latter complex , in
combination with b(c6f5)3 , reacts
with aro
h substrates via formal hydrogen - atom transfer and
exhibits dramatically increased reaction rates over the mnv(o ) starting material . | Supplementary Material |
|
methods and any associated references are available in the online version of the paper at http://www.nature.com / naturemedicine/. note :
supplementary information
is available on the nature medicine website . | cancer stem cells ( cscs ) or tumor progenitor cells are involved in tumor progression and metastasis1 .
micrornas ( mirnas ) regulate both normal stem cells and cscs25 and mirna dysregulation has been implicated in tumorigenesis6 .
cscs in many tumors , including cancers of the breast7 , pancreas8 , head and neck9 , colon10,11 , small intestine12 , liver13 , stomach14 , bladder15 , and ovary16 have been identified using adhesion molecule cd44 , either individually or in combination with other marker(s ) .
prostate cancer ( pca ) stem / progenitor cells with enhanced clonogenic17 and tumor - initiating and metastatic18,19 capacities are also enriched in the cd44 + cell population , but whether mirnas regulate the cd44 + pca cells and pca metastasis remains unclear . here
we show , through expression analysis , that mir-34a , a p53 target2024 , was under - expressed in cd44 + pca cells purified from xenograft and primary tumors .
enforced expression of mir-34a in bulk pca cells inhibited clonogenic expansion and tumor development .
mir-34a re - expression in cd44 + pca cells blocked whereas mir-34a antagomirs in cd44 pca cells promoted tumor regeneration and metastasis .
systemically delivered mir-34a inhibited pca metastasis and extended animal survival . of significance , cd44 was identified and validated as a direct and functional target of mir-34a and cd44 knockdown phenocopied mir-34a over - expression in inhibiting pca regeneration and metastasis .
our study reveals mir-34a as a critical negative regulator of cd44 + pca cells and establishes a strong rationale for developing mir-34a as a novel therapeutic against prostate cscs . | METHODS
Supplementary Material |
90408028 to ct zhang and 10747150 to f gao ) . funding for open access charge | the genome of sorangium cellulosum has recently been completely sequenced , and it is the largest bacterial genome sequenced so far . in their report , schneiker et al .
( in complete genome sequence of the myxobacterium sorangium cellulosum , nat .
biotechnol . ,
2007 , 25 , 12811289 ) concluded that in the absence of the gc - skew inversion typically seen at the replication origin of bacterial chromosomes , it was not possible to discern the location of oric. in addition , the complete genome of microcystis aeruginosa nies-843 has also been recently sequenced , and in this report , kaneko et al .
( in complete genomic structure of the bloom - forming toxic cyanobacterium microcystis aeruginosa nies-843 , dna res . ,
2007 , 14 , 247256 ) concluded that there was no characteristic pattern , according to gc skew analysis. therefore , oric locations of the above genomes remain unsolved . using ori - finder , a recently developed computer program , in both genomes , we have identified candidate oric regions that have almost all sequence hallmarks of bacterial orics , such as asymmetrical nucleotide distributions , being adjacent to the dnan gene , and containing dnaa boxes and repeat elements . | Funding |
ccdc 1435933 ( 1 a ) , 1435934 ( 2 a ) and 1435935 ( 2 b ) contain the supplementary crystallographic data for this paper .
as a service to our authors and readers , this journal provides supporting information supplied by the authors .
such materials are peer reviewed and may be reorganized for online delivery , but are not copyedited or typeset .
technical support issues arising from supporting information ( other than missing files ) should be addressed to the authors . | abstractthe synthesis of heteroatom analogues of the cyclopentadienyl anion cp is a fascinating and challenging field of research .
the replacement of methine moieties by phosphorus is well investigated for the synthesis of mono , tri and pentaphospholyl ligands . on the other hand ,
arsenic derivatives are rare and 1,2,4triarsolyl and tetraarsolyl salts are unknown . herein , we report on the synthesis of cs[e3c2(trip)2 ] ( 1 a : e = p ; 1 b : e = as ; trip=2,4,6triisopropylphenyl ) and cs[e4c(trip ) ] ( 2 a : e = p ; 2 b : e = as ) . compound 1 b represents the first 1,2,4triarsolyl and 2 b the first tetraarsolyl anion .
all salts are obtained in onepot syntheses using e(sime3)3 , 2,4,6triisopropylbenzoyl chloride and csf .
the products 1 a2 c4h8o2 , 2 aet2o and 2 b3 c4h8o2 were characterized by xray structural analysis , which revealed planar heterocycles .
nucleusindependent chemical shifts ( nics ) confirmed the aromaticity of these anions .
notably , compound 2 aet2o is only the second tetraphospholyl ligand which is structurally characterized . | Supporting Information
Supporting information |
an
efficient method for the construction of csp2csp3 bond in a regio- and stereoselective fashion involving 1,3-terminal
dienes , enol triflates / nonaflates , and sodium formate under pd(0)-catalysis
is described .
the three component assembly allows trapping of a -allyl
intermediate , after the initial migratory insertion of the diene ,
by a hydride source that leads to structurally complex and synthetically
challenging tri- and tetrasubstituted alkene building blocks . | Supplementary Material |
|
intranodal schawnomas are extremely rare and just a few cases have been described before . clinical presentation comprises a symptomatic mass in several anatomical regions , but they can also be found during analysis of surgical specimens resected for other reasons . the report is based on the case of an 80-year - old patient who was underwent to right hemicolectomy for an adenocarcinoma .
an 80-year - old female patient , with personal history of intellectual development retardation , without other associated pathologies . besides she had been diagnosed with right colon adenocarcinoma , during the study of anemia .
the extension study with thoracoabdominal computed tomography scan showed no signs of local or distant disease from the primary tumor .
histopathological analysis of the surgical specimen revealed the confirmation of a low - grade adenocarcinoma , infiltrating perintestinal fat without evidence of serosa affectation ( t3 ) .
for the rest of the specimen examination , 12 perintestinal lymph nodes were observed , 10 of them with normal macroscopic and microscopic characteristics .
the two others instead showed whitish coloring and increased consistency , highly suspicious of involvement of primary adenocarcinoma , with a total size of 7 mm .
the second , however , was microscopically constituted by a spindle cell proliferation without atypia , mitosis or necrosis , displacing the normal lymphatic tissue toward periphery ( fig .
we also had positive result after immunohistochemical study for vimentin and protein s100 , and a negative one for actin , desminia , cd34 and cd117 , all of this was compatible with intranodal schwannoma ( fig .
2 ) .
figure 1:mesenteric node tumor microscopically constituted by a spindle cell proliferation without atypia , mitosis or necrosis , displacing the normal limphatic tissue toward periphery .
figure 2:positive result after immunohistochemical study for vimentin and protein s100 , compatible with intranodal schwannoma .
mesenteric node tumor microscopically constituted by a spindle cell proliferation without atypia , mitosis or necrosis , displacing the normal limphatic tissue toward periphery .
positive result after immunohistochemical study for vimentin and protein s100 , compatible with intranodal schwannoma .
lymphatic affectation ( within lymph nodes ) is extremely rare and poorly described in the literature .
the lesions to beware of in the differential diagnosis are : metastatic tumor cells , including spindle cell sarcoma , spindle cell carcinoma and melanomas . among the benign lesions ,
the most important distinction must be made with the miofibroblastoma , whose characteristics include hemorrhage focuses and areas of starry arranged collagen .
while miofibroblastomas show a positivity result for actin immunohistochemistry , they do not do it for s100 protein , whose positivity is strongly linked to the schwannomas . in our case ,
it was reported just one case before by piana , of mesenteric lymph node affectation by schawnnoma in a piece of colonic resection .
remaining reports describe tumors located in retroperitoneal nodes , thoracic region , groin location or neck mass relative to growth lymph nodes [ 210 ] . in our case , as in the rest of the consulted case reports , lymph node involvement by schwannoma , could not be identified until the histopathological analysis are completed , either preoperative extension studies or macroscopic study of the surgical specimen , could suspect lymph node involvement by this tumor , because , there are not specific characteristics that could make it suspicious .
it is also noteworthy that such lymph node involvement occurred in a different one from the affected by adenocarcinoma metastasis .
intranodal schawnomas are extremely rare and < 12 cases have been previously described in the literature . the origin of those remains unknown ; therefore , as far as our review is concerned , there are not currently theories that could explain lymphatic localization . on the other hand , we have to notice that this type of diagnosis , although anecdotal by its infrequency , highlights the importance of correct microscopic evaluation of lymphatic tissue , included in the pieces of surgical , beyond their macroscopic appearance , because it has not only diagnostic importance , as in our case , but also implications in staging and subsequent treatment if malignant lesions are present . | abstractintranodal schawnomas are extremely rare .
just a few cases have been described before .
clinical presentation comprises not only symptomatic mass in several anatomical body parts , but also , they can be found during analysis of surgical specimens resected for other reasons . the report is based on the case of an 80-year - old patient who underwent to right hemicolectomy for an adenocarcinoma .
the histopathologic analysis revealed one mesenteric intranodal schwannoma in the surgical specimen .
the diagnosis was confirmed by immunohistochemistry with positive result for vimentin and s100 protein .
less than 12 cases have been reported in the literature before .
the findings pointed out our patient as , one of these few reported with such diagnosis . | INTRODUCTION
CASE REPORT
DISCUSSION |
as
part of our ongoing effort to expand the scope of cross - coupling
reactions of alkyl electrophiles , we have pursued a strategy wherein
the nucleophilic coupling partner includes a pendant olefin ; after
transmetalation by such a substrate , if -migratory insertion
proceeds faster than direct cross - coupling , an additional carbon carbon
bond and stereocenter can be formed . with the aid of a nickel / diamine
catalyst ( both components are commercially available ) , we have established
the viability of this approach for the catalytic asymmetric synthesis
of 2,3-dihydrobenzofurans and indanes .
furthermore , we
have applied this new method to the construction of the dihydrobenzofuran
core of fasiglifam , as well as to a cross - coupling with a racemic
alkyl electrophile ; in the latter process , the chiral catalyst controls
two stereocenters , one that is newly generated in a -migratory
insertion and one that begins as a mixture of enantiomers . | Supplementary Material |
|
lipomas are the most common benign mesenchymal tumors developing in any location where fat is normally present .
the etiology of lipomas is uncertain and the tumors mainly affect the region of the trunk , shoulders , neck , and axilla .
involvement of the oral cavity is rare , with lipomas corresponding to less than 4.4% of all benign oral soft tissue tumors .
they commonly present as slow - growing asymptomatic lesions with a characteristic yellow color and soft , doughy feel in the buccal mucosa , floor of the mouth and tongue in the fourth and fifth decades , and generally with no gender predilection .
oral lipomas can occur in various anatomic sites including the major salivary glands , buccal mucosa , lip , tongue , palate , vestibule , and floor of mouth .
although benign in nature , their progressive growth may cause interference with speech and mastication due to tumor 's dimension .
a 10-year - old female patient reported with a chief complaint of swelling on left cheek .
the swelling was first noticed two years ago , which showed slow continuous gradual enlargement .
intraoral examination revealed a pinkish , well - defined oval swelling measuring 2.5 3 cm present in the left buccal mucosa [ figure 1 ] . on palpation , the swelling was soft , fluctuant , non - tender , mobile , and the margins were slippery under the palpating finger .
the lesion was excised under local anesthesia and the excised tissue was sent for histopathological examination [ figures 2 and 3 ] .
showing fibrolipoma of left buccal mucosa buccal mucosa after surgical resection of the lesion microscopic examination revealed adipose tissue with compressed blood vessels embedded within dense collagen fibers .
the overlying epithelium was 8 to 10 layers thick , atrophic , parakeratinized and stratified squamous type .
correlating with the clinical and histopathological examination , the excised lesion was suggestive of fibrolipoma [ figure 4 ] .
histologic appearance of fibrolipoma [ h & e , 10 ] postoperative healing of buccal mucosa
the first description of oral lipoma was provided in 1848 by roux in a review of alveolar masses which he referred it as a yellow epulis .
the lipoma is a very common benign tumor of adipose tissue , but its presence in the oral and oropharyngeal region is relatively uncommon with a prevalence rate of only 1/5000 adults .
fibrolipoma is a microscopic variant of lipoma characterized by a significant fibrous component intermixed with lobules of fat cells .
the consistency of this lesion varies from soft to firm , depending on the quantity and distribution of fibrous tissue and the depth of the tumor .
the tumor has been reported to be more frequent in the buccal mucosa and buccal vestibule , and it also shows a slight predominance in females . in our case ,
fregnani et al . collected several cases and diagnosed 45.7% cases as lipomas and 39.1% cases as fibrolipomas .
hereditary , fatty degeneration , hormonal basis , trauma , infection , infarction , and chronic irritation are probable representative theories to elucidate the pattern of a lipoma .
the most common of these is the fibrolipoma , characterized by a significant fibrous component intermixed with the lobules of fat cells .
the spindle cell lipoma is another variant that demonstrates variable amount of uniform appearing spindle cells in conjunction with a more typical lipomatous component .
intramuscular lipomas are often more deeply situated and have an infiltrative growth pattern that extends between skeletal muscle bundles .
this tumor can be life threatening due to obstruction of upper airway by virtue of its size as sudden asphyxia death has been reported in a case of esophageal fibrolipoma .
lesions outside the oral cavity could show greater recurrence rates after surgical excision , but intraoral intramuscular lipomas , although not well - limited , rarely show recurrence if completely excised .
most of lipomas develop in the subcutaneous tissues but deeper tissues may be involved as well .
the complete resection should be emphasized , which is the key factor to avoid recurrence . | the lipoma is a very common benign tumor of adipose tissue , but its presence in the oral and oropharyngeal region is relatively uncommon .
fibrolipoma , a histological variant of lipoma , mostly affect the buccal mucosa and causes functional and cosmetic disabilities .
hence , accurate histopathological examination of lipomas is important for a correct treatment plan .
this article describes a case of 10 year old girl with fibrolipoma of the buccal mucosa with a relevant review of tumors . | Introduction
Case Report
Discussion
Conclusion |
author do not report any financial or personal links with other persons or organizations , which might affect negatively the content of this publication and/or claim authorship rights to this publication . | it is estimated that 3.4% of patients qualified for cholecystectomy due to cholelithiasis have a coexisting choledocholithiasis . for decades ,
endoscopic ascending retrograde cholangiopancreatography has been the golden diagnostic standard in cases of suspected choledocholithiasis .
the method is associated with a relatively high rate of complications , including acute pancreatitis , the incidence of which is estimated to range between 0.74% and 1.86% .
the mechanism of this ercp - induced complication is not fully understood , although factors increasing the risk of acute pancreatitis , such as sphincter of oddi dysfunction , previous acute pancreatitis , narrow bile ducts or difficult catheterization of vater 's ampulla are known .
it has been suggested to discontinue the diagnostic endoscopic retrograde ascending cholangiopancreatography and replace it with endoscopic ultrasonography due to possible and potentially dangerous complications .
endoscopic ultrasonography has sensitivity of 94% and specificity of 95% regardless of gallstone diameter , as opposed to magnetic resonance cholangiography .
however , both of these parameters depend on the experience of the performing physician .
the use of endoscopic ultrasonography allows to limit the number of performed endoscopic retrograde cholangiopancreatography procedures by more than 2/3 . ascending endoscopic retrograde cholangiopancreatography combined with an endoscopic incision into the vater 's ampulla followed by a mechanical evacuation of stone deposits from the ducts still remains a golden standard in the treatment of choledocholithiasis . despite some limitations such as potentially increased treatment costs as well as the necessity of the procedure to be performed by a surgeon experienced in both endoscopic retrograde cholangiopancreatography as well as endoscopic ultrasonography ,
the diagnostic endoscopic ultrasonography followed by a simultaneous endoscopic retrograde cholangiopancreatography aimed at gallstone removal is the most efficient diagnostic and therapeutic management scheme in cases of suspected choledocholithiasis . | Conflict of interest |
within influenza viral particles , the intricate balance between host cell binding and sialic acid receptor destruction is carefully maintained by the hemagglutinin ( ha ) and neuraminidase ( na ) glycoproteins , respectively .
a major outstanding question in influenza biology is the function of a secondary sialic acid binding site on the na enzyme . through a series of brownian dynamics ( bd ) simulations of the avian n1 , human pandemic n2 , and currently circulating pandemic ( h1)n1 enzymes , we have probed the role of this secondary sialic acid binding site in the avian n1 subtype .
our results suggest that electrostatic interactions at the secondary and primary sites in avian na may play a key role in the recognition process of the sialic acid receptors and catalytic efficiency of na .
this secondary site appears to facilitate the formation of complexes with the na protein and the sialic acid receptors , as well as provide ha activity to a lesser extent .
moreover , this site is able to steer inhibitor binding as well , albeit with reduced capacity in n1 , and may have potential implications for drug resistance or optimal inhibitor design .
although the secondary sialic acid binding site has previously been shown to be nonconserved in swine na strains , our investigations of the currently circulating pandemic h1n1 strain of swine origin appears to have retained some of the key features of the secondary sialic acid binding site .
our results indicate possible lowered ha activity for this secondary sialic acid site , which may be an important event in the emergence of the current pandemic strain . | Supplementary Material |
|
the intestinal absorption of the nephrotoxic environmental pollutant cadmium increases markedly when iron stores are depleted . this may be mediated by an up regulation of the recently identified mucosal transporter dmt1 ( nramp2 or dct1 ) for divalent cations .
we tested whether the highly increased iron absorption in hereditary hemochromatosis ( hh ) was accompanied by an enhanced absorption of cadmium and lead .
cadmium and lead in blood and iron status markers were determined in 21 nonsmoking subjects with hh genetically tested for the hfe mutations and in 21 nonsmoking controls matched for age and sex . in subjects with hh on maintenance phlebotomy treatment , blood concentrations of cadmium , but not lead , were significantly higher than in paired controls .
there was a strong age - independent positive association between blood cadmium and the number of years of phlebotomy treatment .
blood lead showed a similar but less pronounced consequence of treatment .
all hh subjects with lower blood cadmium than the corresponding controls had either no mutation in the hfe gene , were not phlebotomized , or were phlebotomized for only a limited time .
our findings indicate that the treatment rather than the disease increased the cadmium uptake in homozygous hh .
further studies are needed to confirm whether the disease decreased cadmium absorption and whether the absorption was dependent on the genotype.imagesfigure 1figure 2 | Images |
|
excessive sweating is a medical condition in which a person sweats much more than needed . the medical name of this disorder is hyperhidrosis known as a common dermal problem that affects people of all ages and leads to negative impact on the quality of life . during the last decades
, several studies have shown that in many cases of hyperhidrosis there is no evidence of systemic disease .
therefore , most treatments are temporary and symptomatic therapy . according to iranian traditional medicine ( itm ) ,
this study has reviewed itm textbooks , such as canon of medicine and exir - e - azam as well as scientific references and databases of modern medicine ( isi , pubmed , etc . ) with specific keywords .
in modern medicine , hyperhidrosis has been defined as an abnormal excessive sweating , which is either primary ( idiopathic ) or secondary to other systemic diseases such as hyperthyroidism , neurological condition or heart disease .
current modalities for treatment are topical anti - perspiration , iontophoresis , botox injection ( botulinum toxin type a ) and eventually thoracic sympathectomy as the last therapeutic modalities . from the viewpoint of the iranian traditional medicine as a holistic doctrine ,
hyperhidrosis etiologies include overfilled and repletion of body due to the accumulation of humors , excessive intake of food , excessive dilated skin pores , vigorous exercise , or physical activity .
therefore , therapeutic plan for hyperhidrosis was based on its cause , which includes reduction in the amount of food , increasing physical activity , purging the body from the excess humors and adjustment in temperament .
hyperhidrosis is not an important or dangerous disorder ; however , due to the negative impact on quality of life and failure to achieve perfect answer in modern medicine treatments it seems that the recommendations of iranian traditional medicine will be helpful to control this disorder . | background : excessive sweating is a medical condition in which a person sweats much more than needed . the medical name of this disorder is hyperhidrosis known as a common dermal problem that affects people of all ages and leads to negative impact on the quality of life . during the last decades
, several studies have shown that in many cases of hyperhidrosis there is no evidence of systemic disease .
therefore , most treatments are temporary and symptomatic therapy . according to iranian traditional medicine ( itm ) ,
different approaches are mentioned for hyperhidrosis.methods:this study has reviewed itm textbooks , such as canon of medicine and exir - e - azam as well as scientific references and databases of modern medicine ( isi , pubmed , etc . ) with specific keywords .
contents and related concepts were classified and results prepared.results:in modern medicine , hyperhidrosis has been defined as an abnormal excessive sweating , which is either primary ( idiopathic ) or secondary to other systemic diseases such as hyperthyroidism , neurological condition or heart disease .
current modalities for treatment are topical anti - perspiration , iontophoresis , botox injection ( botulinum toxin type a ) and eventually thoracic sympathectomy as the last therapeutic modalities.from the viewpoint of the iranian traditional medicine as a holistic doctrine , hyperhidrosis etiologies include overfilled and repletion of body due to the accumulation of humors , excessive intake of food , excessive dilated skin pores , vigorous exercise , or physical activity .
therefore , therapeutic plan for hyperhidrosis was based on its cause , which includes reduction in the amount of food , increasing physical activity , purging the body from the excess humors and adjustment in temperament.conclusion:hyperhidrosis is not an important or dangerous disorder ; however , due to the negative impact on quality of life and failure to achieve perfect answer in modern medicine treatments it seems that the recommendations of iranian traditional medicine will be helpful to control this disorder . | Background:
Methods:
Results:
Conclusion: |
the type 1 boston keratoprosthesis ( kpro ) is a poly ( methyl methacrylate ) device that has gained acceptance in many types of end - stage corneal diseases as a viable surgical option.13 the kpro is assembled using a carrier donor tissue , and its optics afford excellent visual acuity and field of vision4 assuming that the alignment of the kpro is optimized .
centration of the kpro is determined during preparation of the donor carrier tissue and host trephination .
the manufacturer s recommended steps for kpro preparation involve punching the donor with an 8.5 mm or greater diameter followed by a 3-mm central punch .
we have found that centration of the kpro in the carrier tissue can be difficult using this procedure , and we present a modification for minimizing centration error .
the center of the donor carrier tissue is marked using a surgical marker , and a 3-mm central punch is performed using the centration mark ( figure 1a ) .
. the 3-mm - diameter punched tissue is removed , and the edge is inspected .
an appropriate outer diameter punch size is selected , which should be at least 8.5 mm diameter if possible , and a disposable barron corneal punch ( katena eye instruments , denville , nj ) is typically used .
the donor carrier tissue is placed on the punch block and the 3-mm hole is centered between the vacuum holes of the punch block ( figure 1b ) , and the vacuum is engaged .
the punch is then carefully performed , and the kpro is assembled and sutured to the host rim ( figure 1c ) .
the type 1 boston kpro is a viable therapeutic option for many end - stage corneal diseases that are poor candidates for traditional penetrating keratoplasty , and the reported visual results of the kpro have been good.2,3 the assembly of the kpro involves preparation of a carrier tissue with two punches that are ideally concentric .
we have found difficulty in creating concentric punches using this technique ( figure 2 ) , and we believe that punching the central 3-mm hole first and then using this hole to center within the barron corneal punch s four vacuum ports affords much better control . if the manufacturer s recommendations are followed and the outer punch is performed first , then the free - hand 3-mm dermatologic punch must be placed perfectly for a concentric result .
the optical performance of the kpro on an optical bench using a 3-mm pupil and precise alignment was evaluated and found to produce a sharp , crisp image with a tight point - spread function.4 the optical cylinder , under these optimized alignment conditions , produced scattered ghost images when the 3-mm pupil was widened to 10 mm .
if the alignment of the kpro is suboptimal with the cylinder off - axis from the fovea , then the projected image will most likely be further degraded .
we believe the centration of the kpro in the donor carrier and host cornea is integral for optimal alignment of the cylinder and minimization of scatter and other optical phenomena .
our technique of punching the 3-mm inner hole first and then centering the outer punch on this hole relieves much centration uncertainty in kpro preparation .
in addition to the optical advantages of optimizing centration , suturing to the host rim is much easier with better distribution of tension when the kpro is centered .
we have not found any limitations or problems from this simple modification of kpro assembly . | the type 1 boston keratoprosthesis preparation requires a 3-mm central punch and an 8.5 mm or larger punch in the carrier tissue .
these punches are ideally concentric , but we have found difficulty in achieving concentric punches when the larger punch is performed first .
we present a modification in the preparation procedure to help minimize centration error . | To the editor
Technique description
Discussion |
values of ( kcat / km)gap for triosephosphate
isomerase - catalyzed reactions
of ( r)-glyceraldehyde 3-phosphate and kcat / khpikga for reactions of the substrate pieces glycolaldehyde
and hpo32 have been determined for wild - type
and the following tim mutants : i172v , i172a , l232a , and p168a ( tim
from trypanosoma brucei brucei ) ; a
208-tgag for 208-yggs loop 7 replacement mutant ( l7rm , tim from chicken
muscle ) ; and , y208 t , y208s , y208a , y208f and s211a ( yeast tim ) .
a
superb linear logarithmic correlation , with slope of 1.04 0.03 ,
is observed between the kinetic parameters for wild - type and most
mutant enzymes , with positive deviations for l232a and l7rm .
the unit
slope shows that most mutations result in an identical change in the
activation barriers for the catalyzed reactions of whole substrate
and substrate pieces , so that the two transition states are stabilized
by similar interactions with the protein catalyst .
this is consistent
with a role for dianions as active spectators , which hold tim in a
catalytically active caged form . | Supplementary Material |
|
the use of the waterpipe , or shisha , for smoking tobacco is an old tradition in the eastern mediterranean region that goes back centuries .
this habit is relatively rare in singapore , a country with a predominantly chinese population .
carbon monoxide ( co ) poisoning can be notoriously deceptive and non - specific in its initial presentation to the emergency department ( ed ) .
its correct diagnosis and eventual management require a high level of suspicion on the part of the emergency physician ( ep ) .
our patient was a 19-year - old gentleman of saudi descent who was a student in singapore and had no past medical history of note .
he had been having dinner with a friend at a restaurant 4 h prior to presentation and had been smoking shisha at that time .
collateral information from his friend revealed that he had been smoking shisha with three other friends and had hit his occiput after a fall .
his vital signs revealed a temperature of 36.7c , blood pressure of 108/61 , pulse rate of 99/min and pulse oximetry reading of 99% on room air .
physical examination revealed that he was alert and orientated to time , place and person .
bedside capillary blood sugar was 5.1 mmol / l , and the baseline electrocardiogram was normal .
the initial working diagnosis was that of stable head injury and a few other possible explanations for the dizziness , including cardiac arrhythmias , transient hypoglycemic episode , viral illness and substance overdose .
he was scheduled for computed tomography ( ct ) of the brain . however , a carboxyhemoglobin ( cohb ) level was taken in view of the shisha smoking .
he was immediately transferred to the critical monitoring area and put on 100% oxygen via a non - rebreather mask .
a bedside arterial blood gas on high flow oxygen revealed respiratory alkalosis with ph of 7.441 , pco2 of 37.3 mmhg and po2 of 501 mmhg .
he was admitted to the medical high dependency unit ( mdu ) for further monitoring and management .
he was placed on 100% oxygen for the next 46 h while he was in the mdu , and his dizziness resolved .
he was discharged 2 days post - admission with a follow - up date for psychometric testing and neurological review at the outpatient clinic .
this case highlights the challenge to emergency physicians regarding the timely diagnosis of co poisoning , a highly treatable condition .
the non - specific neurological complaints can mimic many illnesses , such as viral illness or stable head injury .
it binds to hemoglobin 200300 times more tightly than oxygen , forming cohb . as such
, it inhibits the release of oxygen from hemoglobin to peripheral tissues , causing tissue hypoxia .
the half life of cohb is 4 to 5 h in a person breathing room air and changes to 60 min in the presence of 100% oxygen at sea level . as such
, our index patient would have been symptomatic for a prolonged period of time if the initial suspicion of co poisoning had not been made and he had been managed as a person with stable head injury .
shisha smoking is one form of waterpipe smoking among others , including hookah , nargileh and arguileh .
shisha smoking is relatively rare in singapore , but is common in the mediterranean regions , according to a who report .
the report stated that the overall prevalence of shisha smoking in egypt was estimated at 10% from a national survey in 2002 focusing on hypertension , obesity and diabetes in such smokers .
it has been estimated that smoke exposure could be as much as 100200 cigarettes per session .
co poisoning is difficult to diagnose in the ed as its presenting symptoms are usually non - specific .
undoubtedly , a history of potential co exposure is the most reliable indicator of poisoning .
eps should have a high index of suspicion , even though the exposure can be exotic , as in this case .
it is important to realize that when dizziness occurs in co poisoning , it usually corresponds to a caboxyhemoglobin level of 20% and above , a level considered to be at least moderately severe . making a diagnosis in a timely fashion can expedite the management of such patients . | carbon monoxide poisoning has been reported as a result of exposure to various sources of smoke , such as car exhaust fumes , home water heaters and tobacco smoke .
we describe a case of symptomatic , moderately severe carbon monoxide ( co ) poisoning in a young mediterranean man after smoking a waterpipe , or shisha .
this case highlights the importance of considering carbon monoxide exposure in patients presenting with non - specific neurological symptoms to the emergency department ( ed ) . | Introduction
Case report
Discussion |
a 31-year - old female patient consulted to our outpatient clinic because of a mass protruding from her right nipple . on her breast examination , an 8 mm prolapsed mass was seen on the right breast areola ( figure 1 ) . during physical examination
any abnormality was not detected on other parts of the breast , and her left breast . from her personal and family medical history
her breast ultrasonographic ( us ) examination demonstrated an avascular , hypoechoic prolapsed solid mass measuring 8x5 mm which filled the areolar region completely .
based on physical , and us examination findings surgery was planned with the initial diagnosis of intraductal papilloma .
the prolapsed mass , minimal portion of the overlying areolar skin and communicating ductus were totally excised under local anesthesia .
histopathological examination of the specimen revealed intraductal papilloma without atypical dysplasia ( figure 2 ) .
any postoperative complication did not develop , and any recurrence was not seen during 2 years of follow - up .
intraductal papillomas ( ip ) are benign tumours which develop as a result of papillary proliferation of the ductal epithelium .
its incidence is 2 - 3% , and it is seen between 30 , and 77 years of age .
central type is a solitary ip which settles in the subareaolar region , and it is observed in perimenauposal women .
peripheral type is situated on the proximal parts of the laciferous ducts of young female patients and tends to be multiple .
however , the patient consulted to the physician at an earlier stage because of the protruding characteristics of the mass .
although it is generally localized in the breast tissue , and subareolar region , in our case , it protruded from the nipple of the patient .
intramammary masses are detected by us , and the diagnosis is conclusively confirmed by biopsy .
radiological imaging techniques are helpful in establishing the diagnosis , however for the discrimination between benign , and malign lesions core needle biopsy should be performed .
treatment of intraductal papillomas consists of total excision . since the mass lesion of our patient was protruding , total excision was performed both for diagnosis , and treatment . if intramammary ip lesion can be located using radiological techniques , then excision , without needle biopsy is recommended .
core biopsy is recommended for cases with radiologically suspect malignancy or in the presence of microcalcification , and distorted tissue ultrastructure . if small papillary lesions can be totally excised , and histopathologic examination does not reveal any evidence of atypia , then the patient can be followed up with us , and mammographic monitorization . in the differential diagnosis , nipple adenoma , and papillary lesion , paget s disease , eczematous dermatitis , and pyogenic granuloma
histopathological differentiaton of the excised mass can be achieved . if untreated , papillary lesion of the nipple also protrudes .
paget s disease , and eczema can be discriminated from other lesions with their characteristic cutaneous incrustrations .
ip prolapsed from the nipple is a rarely seen abnormality . for its diagnosis , and treatment , | intraductal papillomas ( ip ) are benign papillary lesions caused by proliferation of mammary ductal epithelium .
ip occurs in the breast tissue .
prolapse of ip from nipple can be rarely seen .
ips are generally treated with total excision .
a 31-year - old female patient was admitted to our clinic because of a protruded lesion from the nipple of her right breast . on her breast examination ,
an 8 mm- prolapsed mass was seen on the areola of her right breast .
breast ultrasonography showed no other lesions in the breast .
the patient was operated with initial diagnosis of ip .
the prolapsed mass , the overlying nipple skin and related ductus were totally excised under local anesthesia .
histopathological examination of the specimen revealed intraductal papilloma without atypical dysplasia .
herein , we are presenting a rarely encountered case of ip prolapsed from the nipple of a female patient . | CASE REPORT
DISCUSSION |
tooth carving is an important practical preclinical exercise in the curriculum in indian dental education setup .
it forms the basis of introduction to tooth anatomy , morphology and occlusion of primary and permanent teeth through practical approach .
it requires enormous time and manpower to master the skill .
therefore , there is an imminent necessity to incorporate computer - based learning of the art of tooth carving for effective teaching and efficient student learning .
this will ensure quality time to be spent on other academic and research activities by students and faculty in addition to adding value as a teaching aid . | Financial support and sponsorship
Conflicts of interest |
|
these extrahepatic lesions are most commonly found in the lungs , lymph nodes , and bones .
there have been reports of extrahepatic lesions found in urogenital sites , such as the kidneys , testes , and bladder [ 24 ] .
we encountered a patient with a metastatic hcc lesion presenting as a tender right inguinal mass .
to the best of our knowledge , this case represents the first such report in the english language literature .
a 57-year - old man was referred to our urology out - patient department from a gastrointestinal doctor because of a tender inguinal mass that had become progressively larger over the previous one and half months .
the patient had a past history of hcc ( underwent radiofrequency ablation in july 2004 and transcatheter arterial chemoembolization in november 2004 ) , hepatitis b virus infection , rightside inguinal hernia ( status postherniorrhaphy in 2007 ) , a cholecystectomy in 2000 , and a vasectomy in the 1990s .
he noticed a painful hard mass in the right inguinal area one and half months prior to visiting our department .
physical examination revealed a 2 2 centimeter hard , movable , tender mass in the right inguinal area .
an excision biopsy was performed , and the pathological report revealed tumor cells with abundant amphophilic to pale eosinophilic cytoplasm , round nuclei , mitosis , and focal necrosis , and the cells were hep par 1 positive as determined by immunohistochemical staining ( figure 1 ) .
due to a persistent , painful sensation in the right inguinal area , removal of the right inguinal metastatic mass was arranged . during inguinal exploration
a right radical orchiectomy was performed because the tumor could not be freed from the spermatic cord .
the pathological report showed multiple metastatic hcc tumor nodules and tumor emboli in the lymphatic and blood vessels of the spermatic cord and peritesticular soft tissue ( figure 2 ) .
hcc is commonly seen in taiwanese hospitals due to high incidence of hepatitis b and c in taiwan .
most documented extrahepatic metastatic lesions have been found in the lungs followed by the lymph nodes , bones , and adrenal glands , but there are cases of distal metastasis to the genitourinary system , such as the kidneys and bladder [ 1 , 3 , 4 ] .
similar to other metastatic lesions , the clinical presentation of extrahepatic metastatic lesions depends on their location and the affected areas .
presentations include hematuria , flank pain , and testicular pain ; these signs and symptoms are very similar to those of other common genitourinary diseases [ 14 ] . in our case , this patient presented with a painful inguinal mass . when patients present with an inguinal mass , we need to take into consideration several differential diagnoses ranging from benign to malignant lesions .
malignant tumors , including primary tumors and metastases , are extremely rare [ 68 ] .
painless scrotal or lower inguinal mass was the most common clinical presentation in the metastatic spermatic cord tumors .
the metastatic spermatic cord tumors could be misdiagnosed as hydrocele , hernia , and testis tumor . when a tumor is found in the inguinal area in patients with a history of malignancy or peritoneal carcinomatosis ,
retrograde extension through the vas deference and transperitoneal seeding had been reported . in this case
a metastatic tumor originating from hcc was confirmed after excision biopsy . according to the national comprehensive cancer network clinical practice guideline for metastatic hcc , only sorafenib ( for child - pugh class a or b ) , supportive care , or clinical trials
because of persistent pain in the inguinal area and progressive enlargement of the tumor , a radical orchiectomy was performed .
what kind of treatment is suitable for tumor emboli in the surgical margin of the spermatic cord ? according to previous reports , palliative radiation therapy has been used to treat hcc with brain and bone metastasis with successful symptom control .
hawkins and dawson showed that radiation therapy can prolong survival for hcc patients with portal vein thrombus . because of the lack of a standard treatment for metastatic lesions of hcc , we used radiation therapy for local control , and no recurrence was found after 6 months . in conclusion , we report the first case of metastatic hcc in the spermatic cord , which presented as a painful inguinal mass .
palliative radiation therapy is a choice for the treatment of metastatic hcc with tumor emboli in the surgical margin . | most spermatic cord masses are benign , and malignant spermatic cord tumors are uncommon .
spermatic cord metastases originating from hepatocellular carcinoma ( hcc ) have not been previously reported in the english language literature as determined by a pubmed search .
we report a male patient who presented with a painful palpable mass in the right inguinal area .
the patient was diagnosed with hcc in 2004 and undertook a nonsurgical approach to control the cancer .
a radical orchiectomy was performed , and the pathological report showed metastatic hcc in the spermatic cord .
the patient received palliative radiation therapy because of a positive surgical margin .
no recurrence was noted after 6 months of followup . | 1. Introduction
2. Case Report
3. Discussion |
initiation of an multimodal , customer focused service network across the service sectors for multimorbid patients : for example the hard - of - hearing .
the lack in accessibility of services , flexibility of appointments and handicap - oriented communication skills often prevents the geriatric patient from partaking in the medical services offered . the geriatric hearcare service and its care for the hard - of - hearing outlines the possibilities of an integrated , multimodal setting at all levels of care for these patients .
the scientific evaluation of > 2000 hard - of - hearing patients in geriatric care from 2002 to 2008 .
upon standardized admission patients are screened for a history in hard - of - hearing . organised and accompanied by a specially trained hearcare - nurse , a patient with a possible auditive decline
is then seen by an ent and hearing - aid technician for examination and audiometry . the patient is then seen by an neuropsychologist for a cognitive evaluation . after these tests , documented by the hearcare - nurse ,
the patient and his next - of - kin are informed of the outcome , the treatment options and follow - up in the out - patient setting .
the integration of services across sectors of care and the provided co - ordination leads to a higher degree of customer satisfaction , a lesser rate of cases of hard - of - hearing missed and better continuity in care on a long - term basis . | purposeinitiation of an multimodal , customer focused service network across the service sectors for multimorbid patients : for example the hard-of-hearing.contextthe lack in accessibility of services , flexibility of appointments and handicap - oriented communication skills often prevents the geriatric patient from partaking in the medical services offered . the geriatric hearcare service and its care for the hard - of - hearing outlines the possibilities of an integrated , multimodal setting at all levels of care for these patients.data sourcethe scientific evaluation of > 2000 hard - of - hearing patients in geriatric care from 2002 to 2008.case descriptionupon standardized admission patients are screened for a history in hard - of - hearing . organised and accompanied by a specially trained hearcare - nurse , a patient with a possible auditive decline is then seen by an ent and hearing - aid technician for examination and audiometry .
the patient is then seen by an neuropsychologist for a cognitive evaluation .
after these tests , documented by the hearcare - nurse , the patient and his next - of - kin are informed of the outcome , the treatment options and follow - up in the out - patient setting.conclusion and discussionthe integration of services across sectors of care and the provided co - ordination leads to a higher degree of customer satisfaction , a lesser rate of cases of hard - of - hearing missed and better continuity in care on a long - term basis . | Purpose
Context
Data source
Case description
Conclusion and discussion |
nine children and their mother were exposed to vapors of metallic mercury .
the source of the exposure appears to have been a 6-oz vial of mercury taken from a neighbor 's home .
the neighbor reportedly operated a business preparing mercury - filled amulets for practitioners of the afro - caribbean religion santeria . at diagnosis , urinary mercury levels in the children ranged from 61 to 1,213 microg / g creatinine , with a geometric mean of 214.3 microg / m creatinine .
all of the children were asymptomatic . to prevent development of neurotoxicity
, we treated the children with oral meso-2,3-dimercaptosuccinic acid ( dmsa ) . during chelation ,
the geometric mean urine level rose initially by 268% to 573.2 microg mercury / g creatinine ( p<0.0005 ) . at the 6-week follow - up examination after treatment , the geometric mean
urine mercury level had fallen to 102.1 microg / g creatinine , which was 17.8% of the geometric mean level observed during treatment ( p<0.0005 ) and 47.6% of the original baseline level ( p<0.001 ) .
thus , oral chelation with dmsa produced a significant mercury diuresis in these children .
we observed no adverse side effects of treatment .
dmsa appears to be an effective and safe chelating agent for treatment of pediatric overexposure to metallic mercury.imagesfigure 1 | Images |
|
hellp syndrome represents a severe form of preeclampsia , presenting with hemolysis , elevated liver enzymes , and low platelet count .
visual symptoms can be present in up to 25% of patients with preeclampsia , usually in the form of decreased visual acuity .
retinal detachment is a rare , but the well - document cause of visual loss in patients with preeclampsia and eclampsia .
it is observed in < 1% of patients with preeclampsia , specially in the patients with severe hypertension . in women with preeclampsia and eclampsia , coexistence of hellp syndrome
point - of - care ocular ultrasonography allows for bedside detection of ocular pathologies such as retinal detachment , globe rupture , lens dislocation , and vitreous hemorrhage . here
, we report a case or retinal detachment in a patient with hellp syndrome , which was detected at the bedside by an intensivist , using ocular ultrasonography .
a 26-year - old female , para 2 and gravida 3 , presented with the history of 2 days of swelling of whole body , headache , and blurring of vision associated with decreased urine output .
her liver enzymes and lactate dehydrogenase were raised , platelet count was 55,000 per ml , and urine examination revealed 4 plus albuminuria and hematuria .
emergency lower segment cesarean section was performed , and the patient was transferred to the intensive care unit .
an intensivist , trained in bedside focused ultrasonography , performed ocular ultrasound ( using high frequency linear probe ; frequency range of 613 mhz ; micromaxx ; sonosite , usa ) , which revealed a linear hyperechoic membrane floating off the posterior globe , with the medial end attached to the margin of optic nerve head , which was suggestive of retinal detachment [ figure 1 ] .
she was started on injection glyceryl trinitrate , along with amlodipine 10 mg 12 hourly , prazosin 2.5 mg 12 hourly , metoprolol 50 mg 12 hourly , clonidine 100 mcg 12 hourly , and methyldopa 500 mg 6 hourly . with these drug combinations ,
blood pressure was controlled ( 130/80 mm hg ) and glyceryl trinitrate was tapered and stopped after 24 h. the patient underwent four sessions of hemodialysis for acute kidney injury .
renal function and liver function gradually improved . a linear hyperechoic membrane floating off the posterior globe ( marked by white arrow ) , with the medial end attached to the margin of optic nerve head , suggestive of retinal detachment the patient was explained about the favorable prognosis . with the supportive care ,
ocular ultrasound repeated after 7 days showed regression of retinal detachment [ figure 2 ] .
after another 1 week , she had complete recovery of vision . resolving retinal detachment ( marked by white arrow )
. retinal vascular changes , usually in the form of spasm and narrowing of retinal vessels , occur in up to 40%100% of patients with preeclampsia / eclampsia syndrome .
arteriolar vasospasm affecting the retinal pigment epithelium leads to breakdown of blood - retinal barrier .
subsequent leakage of protein and fluids from the capillaries , into the subretinal space , causes retinal detachment .
the combination of microangiopathic hemolysis , hypoalbuminemia , and severe hypertension further contributes to the pathophysiology of retinal detachment .
bedside ultrasound by a trained physician has been shown to be reliable and accurate for the diagnosis of retinal detachment .
. the incidence of retinal detachment in these conditions can be much higher than actually detected . in our patient ,
early initiation of aggressive supportive care was coupled with favorable prognostication of visual outcome to the patient .
the progressive improvement of vision correlated with both the ophthalmoscopic evidence of resolution of retinal detachment and sonographic appearance of resolution .
to conclude , bedside ocular sonography can be a valuable and easily available tool for early detection of retinal detachment in patients with preeclampsia / eclampsia / hellp syndrome , presenting with visual symptoms . | retinal detachment is a rare , but well - known cause of visual impairment in patients with hemolysis , elevated liver enzymes , and low platelet count ( hellp ) syndrome . with supportive care ,
patients usually improve , with complete recovery of vision .
bedside ultrasonography of the orbit can be helpful for early detection of retinal detachment in these patients . here , we present a case of hellp syndrome presenting with severe visual symptoms .
retinal detachment was detected with point - of - care ocular sonography , which was confirmed with ophthalmoscopic examination .
the patient was reassured of the favorable prognosis .
early initiation of aggressive supportive care was followed by progressive improvement of vision , which correlated with sonographic evidence of resolution of detachment .
her vision recovered completely in 2 weeks . | Introduction
Case Report
Discussion
Conclusion
None
Financial support and sponsorship
Conflicts of interest |
s. le g. and b.k.f . are supported by the intramural research program of the national cancer institute , national institutes of health .
k.j.p . was supported by the homing plus/2012 - 6/12 grant of the foundation for polish science and the national science center , poland ( grant 2011/01/d / nz1/03478 ) . | replication of retroviruses and transposition of endogenous retroelements exploits a unique mechanism of post - transcriptional regulation as a means of exporting their incompletely - spliced mrnas ( which serve as both the genomic rna and the template for protein synthesis ) .
following discovery of the rev response element ( rre ) that mediates nucleocytoplasmic export of the full - length and singly - spliced human immunodeficiency virus type 1 ( hiv-1 ) genome , equivalent cis - acting regulatory elements have been characterized for both complex and simple retroviruses and retroelements , together with the obligate viral and host proteins with which they interact .
the exception to this is the gammaretrovirus family of simple retroviruses , exemplified by reticuloendotheliosis virus ( rev ) , murine leukemia virus ( mlv ) and xenotropic mlv - related retrovirus ( xmrv ) . in this commentary
, we discuss our recent data that reported structural and functional data on the mlv / xmrv post - transcriptional regulatory element ( designated the pte ) .
the pte was characterized by a highly - structured region of multiple stem - loops ( sl1 sl7 ) overlapping the pro and 5 portion of the pol open reading frames , comprising a bipartite export signal whose structures are separated by 1400 nt . in addition , structural probing suggested that sl3 nucleotides were involved in pseudoknot formation . these data ,
when compared with rna transport elements of complex retroviruses ( hiv ) and simple murine retrotransposons ( musd ) , collectively present an emerging picture that long - range tertiary interactions are critical mediators of their biological function . | Disclosure of Potential Conflicts of Interest
Funding |
we
report the discovery of hd5-cd , an unprecedented c2-symmetric -barrel - like covalent dimer of the
cysteine - rich host - defense peptide human defensin 5 ( hd5 ) .
dimerization
results from intermonomer disulfide exchange between the canonical
-defensin cysii
cysiv ( cys5cys20 ) bonds located at the hydrophobic
interface .
this disulfide - locked dimeric assembly provides a new element
of structural diversity for cysteine - rich peptides as well as increased
protease resistance , broad - spectrum antimicrobial activity , and enhanced
potency against the opportunistic human pathogen acinetobacter
baumannii . | Supplementary Material |
|
this is an unusual case of a 42-year - old gentleman , admitted to the intensive treatment unit ( itu ) following an attempted suicide .
he was observed to develop significant polyuria following admission to itu and this polyuria resolved when propofol was stopped with no further treatment .
this is a rare occurrence of this side effect with this drug , considering how frequently it is used
. it may be the case that it occurs more frequently than is known about at present since it may be under - reported , which is why we feel this case report and the discussion it may stimulate are important .
a 42-year - old man with a known psychiatric history was admitted in the morning to itu for respiratory and circulatory support following a mixed overdose .
he had taken 50 mg of ramipril , 150 mg of olanzapine , and 200 mg of citalopram .
he had taken no alcohol , paracetamol , aspirin , or recreational drugs and had not suffered any head injury .
on itu he was sedated with 120 mg / h infusion of propofol 1% . in the afternoon
, he was noted to be polyuric with a urine output greater than 500 ml / h and his urine was noted to be progressively more dilute [ figure 1 ] .
catheter bag showing progressively more dilute urine since admission urine and serum osmolarity were measured .
the following morning , sedation was stopped and he was extubated successfully . shortly thereafter , urine concentration returned to normal .
medline was used to perform searches with combinations of the term diabetes insipidus and the drugs taken in overdose .
there were no results found for a medline search of ramipril and diabetes insipidus or
citalopram and diabetes insipidus . the search diabetes insipidus and olanzapine gave three results : one case report detailing the case of a 17-year - old who had taken an overdose of olanzapine and developed cranial diabetes insipidus whilst in itu ; a case report of a patient treated for diabetes insipidus secondary to lithium in a patient also taking olanzapine ; and a pilot study of the use of olanzapine in a palliative care setting in which one of the 24 patients developed diabetes insipidus .
olanzapine is well absorbed via the oral route and its half - life is approximately 33 h , making it highly unlikely to be the culprit in our case where the polyuria resolved completely less than 36 h following ingestion of the overdose .
on reviewing the notes , it was found that the resolution of the polyuria seemed to occur shortly after sedation with propofol was stopped
. a further search of diabetes insipidus and propofol was performed .
this found one case report linking the use of propofol as an anesthetic with diabetes insipidus .
the mechanism of action of propofol ( 2 , 6-diisopropylphenol ) as an anesthetic is not fully understood , but it enhances gaba ( gamma - aminobutyric acid)-mediated inhibition of adh ( anti - diuretic hormone / arginine vasopressin ) release in rats , which is a potential mechanism for transient neurogenic diabetes insipidus in humans .
the onset of the action of propofol is 30 s and its action is short - lived .
the case report linking olanzapine and diabetes insipidus does not state what sedation was used whilst the patient was on itu .
this case report shows that it is possible for propofol to induce polyuria in humans as it does in animal studies .
why this does not occur more frequently , given how commonly propofol is used in the itu setting , is unclear and should be the subject of further investigation .
it is possible that the use of other drugs in conjunction with propofol may have led to the under - recognition of the association with propofol .
propofol is often used for the induction of anesthesia rather than maintenance , so polyuria may be less pronounced with smaller doses , attributed to other drugs or to the administration of iv fluids intra - operatively . | case report detailing the occurrence of diabetes insipidus in a 42-year - old man admitted to the intensive treatment unit ( itu ) following an overdose .
whilst on itu , he was sedated with propofol .
cessation of treatment with propofol coincided with resolution of the polyuria .
animal studies suggest a theoretical mechanism for propofol as the causative agent , but this phenomenon is not commonly seen in humans . | INTRODUCTION
CASE REPORT
DISCUSSION
CONCLUSION |
lupus panniculitis ( lp ) occurs in 3% of the patients with cutaneous lupus erythematosus .
it primarily affects subcutaneous tissues of the face and the proximal areas of the limbs , leading to residual atrophy .
lp may lead to major aesthetic sequelae that severely decrease quality of life ( even during good long - term control of the autoimmune processes ) . given the condition 's low prevalence , treatment strategies in lp
only 1 case of lipofilling has been reported with a follow - up period limited to 12 months . here ,
we report on the strikingly good aesthetic outcomes , the long - term quality - of - life benefits , and the safety of lipofilling in 2 patients with lp - associated subcutaneous atrophy .
patient 1 ( a 13-year - old boy ) was referred for an ill - defined subcutaneous inflammatory nodule on the chin . a histopathological examination revealed a marked lymphocytic infiltrate ( in superficial and deep tissues ) with juxtafollicular involvement , prompting us to diagnose lp .
treatment with hydroxychloroquine for 18 months led to the complete disappearance of inflammatory signs but resulted in a cup - shaped lipoatrophy and facial asymmetry .
patient 2 ( a 32-year - old female ) had been monitored over a 6-year period for systemic lupus erythematosus with positive antinuclear and anti - double - stranded dna antibodies . during treatment with hydroxychloroquine , she presented with subcutaneous inflammatory lesions on the thighs and cheeks .
a diagnosis of lp was confirmed by histopathological examination of a skin biopsy according to the criteria by peter and su .
the initial response to oral prednisone was good , but the patient became steroid dependent .
a series of steroid - sparing agents was then administered ( including thalidomide , cyclophosphamide , and azathioprine ) .
four weekly intravenous infusions of rituximab ( 375 mg / m ) , which were repeated 1 year later , led to complete remission , although atrophic scarring in malar areas persisted . following a request from both patients for correction of the aesthetic sequelae , we chose to use lipofilling .
briefly , 10 ml of fat were collected via a 2-mm incision below the umbilicus .
next , fat cells were injected into the submental ( patient 1 ) or malar ( patient 2 ) areas using coleman needles .
there were no complications , and the positive aesthetic outcome was maintained 3 years after the procedure with no signs of the recurrence of lp ( fig 1 ) .
the dermatology quality of life index decreased from 16 before lipofilling to 0 six months thereafter ( patient 1 ) .
lipofilling is a well - established technique widely used in the rejuvenation of the aging face and in iatrogenic lipoatrophy [ 7 , 8 ] .
this technique was also used successfully in some cases of linear scleroderma en coup de sabre .
most of the common side effects of lipofilling are not severe . nevertheless , it is critical for surgeons to have a firm knowledge of the vascular anatomy because some cases of irreversible blindness have been reported .
the good response of patient 2 to rituximab suggests that the efficacy of rituximab as a salvage therapy for treatment - refractory lp should be assessed in prospective trials . along with a previous report
, the 2 present cases suggest that lipofilling is effective for treating the atrophic scars that result from permanent alterations of the subcutaneous fatty tissue in lp .
moreover , the short- and long - term absence of any signs of lupus relapse or postsurgical complications is encouraging .
the lipofilling procedure appears to be very safe when performed in patients with stable disease and thus paves the way for prospective , larger - scale studies in patients with completely controlled autoimmune disorder .
these long - term , controlled trials will be able to accurately assess the benefit - risk ratio of lipofilling in lp and other immune - related subcutaneous scarring conditions . | lupus panniculitis is a rare manifestation of cutaneous lupus erythematosus , which may lead to major aesthetic sequelae with a severe impact on patients quality of life .
we report 2 cases supporting the short- and long - term efficacy and safety of lipofilling in the treatment of lupus panniculitis - induced atrophy .
these observations pave the way for prospective , larger - scale studies in patients with scarring lupus panniculitis , provided that the autoimmune pathogenic process is in complete , stable remission . | Introduction
Case Presentations
Discussion
Statement of Ethics
Disclosure Statement |
darier disease ( dd ) is a rare , autosomal dominant , inherited acantholytic dermatosis caused by a mutation in the atp2a2 gene on chromosome 12 .
the diagnosis of dd is suggested by the clinical findings of a persistent eruption of greasy hyperkeratotic papules and plaques usually occurring over seborrheic areas as well as distinctive nail abnormalities .
numerous treatments such as topical corticosteroids , topical retinoids , topical 5-fluorouracil , diclofenac sodium 3% gel , dermabrasion and laser therapy have reportedly been used for the treatment of dd , with limited success .
systemic retinoids , including acitretin , isotretinoin and alitretinoin , are the most effective treatment for dd .
however , their use is limited by potential deleterious side effects . considering the recently reported efficacy of doxycycline for hailey - hailey disease , an inherited acantholytic skin disorder pathogenetically similar to dd , we report the case of a patient with extensive dd who showed a dramatic response to oral doxycycline monotherapy .
a 77-year - old patient with a 57-year history of dd was referred to our department for a severe exacerbation of dd that was recalcitrant to conventional topical treatments , including emollients , topical corticosteroids and topical mupirocin ointment .
physical examination revealed malodorous eroded hyperkeratotic papules and plaques on the axillae , groin , perineum and lower back ( fig .
classical nail changes , which included white and red longitudinal bands , were present . the mucosa was not affected .
a skin biopsy specimen from a lower back lesion showed characteristic histopathological findings consistent with a diagnosis of dd ( fig .
2 ) . a therapeutic regimen of oral doxycycline ( 100 mg / day ) was started .
the skin lesions showed marked improvement and were in complete remission after 1 month ( fig .
3 ) . the patient was maintained on a half - dose therapy ( 50 mg / day ) and did not experience any relapse within 3 months of follow - up .
dd is caused by mutations in the atp2a2 gene that encodes the sarcoplasmic / endoplasmic reticulum calcium atpase 2 ( serca2 ) , which is a calcium pump .
serca2 plays a central role in cellular calcium homeostasis and actively transports calcium ions from the cytosol into the lumen of the endoplasmic reticulum in order to maintain a low cytoplasmic calcium level .
the molecular mechanisms by which specific atp2a2 mutations alter the function of the serca2 protein and cause acantholysis ( loss of cell - to - cell adhesion ) and dyskeratosis ( premature and abnormal keratinization ) , the histological hallmarks of dd , remain unclear . as a consequence of the loss of serca2 calcium transport , darier keratinocytes display depleted endoplasmic reticulum calcium stores .
in addition to their antibiotic potential , tetracyclines and their analogues exhibit anti - inflammatory properties by inhibiting granulocyte chemotaxis and secretion .
interestingly , matrix metalloproteinase 9 and its inhibitor , tissue inhibitor of metalloproteinase 1 , have been shown to be involved in dd and hailey - hailey disease .
tetracyclines bind divalent metal cations and circulate in blood plasma primarily as calcium and magnesium chelators .
furthermore , once chelated , tetracyclines can act as ionophores that are capable of transporting bound calcium and magnesium through lipophilic phases , such as cellular membranes , and delivering ions into intracellular compartments .
after intracellular incorporation , calcium can act as a secondary messenger and affect pathways , such as those involved in secretory processes , receptor activation or inhibition , cell division and metabolic reactions .
it can be hypothesized that these chelation properties can affect the release of calcium from storage organelles such as sarcoplasmic / endoplasmic reticulum and act on the molecular mechanisms involved in the disruption of calcium homeostasis in darier keratinocytes , leading to the clinical symptoms of the disease . due to its non - antibiotic properties and favorable safety profile compared to oral retinoids
further studies are warranted to confirm these findings and to assess the efficacy of oral doxycycline in the treatment of dd . | darier disease ( dd ) is a rare dominantly inherited genodermatosis characterized by loss of intercellular adhesion ( acantholysis ) and abnormal keratinization .
dd is often difficult to manage .
numerous treatments have reportedly been used for the treatment of dd , with limited success .
systemic retinoids are considered the drug of choice for treating dd .
however , their use is limited by potential deleterious side effects . considering the recently reported efficacy of doxycycline for hailey - hailey disease , an inherited acantholytic skin disorder pathogenetically similar to dd , we report the case of a patient with extensive dd who showed a dramatic response to oral doxycycline monotherapy . | Introduction
Case Report
Discussion
Statement of Ethics
Disclosure Statement |
blue nevus is an acquired benign melanocytic nevus described as a blue or blue - black , firm papule , nodule or plaque - like lesion occurring on the skin and mucous membranes .
malignant blue nevus is rare , and a common blue nevus rarely needs a differential diagnosis from malignant melanoma .
although a melanocytic nevus with a satellite lesion is usually suggestive of a peripherally disseminating malignant melanoma , very few cases of blue nevus with satellite lesions have been reported thus far [ 1 , 2 , 3 , 4 , 5 , 6 ] . to our knowledge , this is the seventh case of a blue nevus with satellitosis .
a healthy 24-year - old japanese man was referred to our hospital with a blue - black skin lesion on his left forearm . as confirmed by the patient
, this lesion had developed after he accidentally pricked his forearm with a pencil 13 years earlier .
physical examination revealed a 10 7-mm , blue - black nodule with an irregular border , which was accompanied by 12-mm guttate macular satellite lesions ( fig .
dermoscopic examination showed a homogeneous , blue - white structure in the absence of any other dermoscopic structures ( fig .
an excisional biopsy was performed with the suspicion of a common blue nevus versus a malignant melanoma .
the lesion was excised with a 3-mm margin of surrounding normal skin down to the level of the superficial fascia .
we recognized a black - colored restiform structure in the dermis during the operation and added another 3-mm margin . in the histopathological examination of the excised lesion ,
nevus cells were dispersed in the dermis , and hyperpigmented , spindle - shaped melanocytes infiltrated among the collagen bundles ( fig .
there were no features suggestive of malignancy , such as cytological atypia , atypical mitoses or necrosis .
common blue nevi are usually solitary , blue - black , dome - shaped papules , and are not difficult to diagnose .
however , in a very small number of cases [ 1 , 2 , 3 , 4 , 5 , 6 ] , including our case , a blue nevus can be accompanied by satellite lesions .
this is when the physician needs to differentially diagnose it from malignant melanoma , especially the nodular type . under a dermatoscope
, a blue nevus usually shows a typical steel - blue , homogeneous coloration generated by the presence of heavily pigmented melanocytes in the dermis , in the absence of any other dermoscopic structure .
however , a recent study showed that a wide spectrum of local dermatoscopic features ( whitish , scar - like depigmentation , dots / globules , peripheral streaks or vessels ) may also be observed in blue nevi
. in such cases , clinical and dermatoscopic distinction from a malignant melanoma may be difficult , or impossible , and surgical excision is necessary .
kang and chung reported that nevus cells aggregated densely around the blood vessels in the main papule , and also in the satellite lesions , suggesting that nevus cells may spread along the perivascular space to manifest clinically as guttate or linear satellite lesions . in our case ,
periappendageal and perivascular concentrations of nevus cells were observed in the main papule as well as in the satellite lesions .
clinically , we recognized a black - colored restiform structure in the dermis during the operation .
these findings suggest that blue nevus cells could infiltrate along the perivascular area in the dermis and form multiple satellite lesions . in conclusion
, we suggest that a blue nevus should be considered as a differential diagnosis when a locally disseminating malignant melanoma is suspected . | malignant blue nevus is rare , and a common blue nevus rarely needs a differential diagnosis from malignant melanoma .
although a melanocytic nevus with a satellite lesion is usually suggestive of a peripherally disseminating malignant melanoma , very few cases of blue nevus with satellite lesions have been reported thus far . to our knowledge , this is the seventh case of a blue nevus with satellitosis .
periappendageal and perivascular concentrations of the nevus cells were observed in the main papule as well as in the satellite lesions .
these findings suggest that blue nevus cells could infiltrate along the perivascular area in the dermis and form multiple satellite lesions .
blue nevus should be considered as a differential diagnosis when a locally disseminating malignant melanoma is suspected . | Introduction
Case Presentation
Discussion |
the skin and lung tissues from sencar mice used as part of the environmental protection agency 's ( epa 's ) carcinogenesis testing matrix were examined .
this study included sencar mice used in three different short - term bioassay protocols in which the skin papilloma assay was used to identify initiators , promoters , and complete carcinogens . also included
were the pathology findings from sencar mice used in the combined bioassay in which the skin assay and the lung adenoma assay were conducted simultaneously .
the gross and microscopic features of treatment - associated and spontaneous lesions of the skin and lung of the sencar mouse used in these studies are defined and the lesions most commonly observed are described . generally , gross observations and microscopic findings in both the skin and lung tissues were poorly correlated .
although there are several definite criteria on which gross interpretations of the various skin and lung lesions can be made , with the exception of pedunculated squamous cell papillomas and the classic squamous cell carcinomas , the various lesion types had a wide variety of clinical presentations that severely compromised the accuracy of gross diagnosis .
further , in the case of benign skin neoplasms , malignant transformation of these tumors most often occurred at the base of the lesion and was initially hidden from gross observation . as a result ,
approximately 50% of the neoplasms interpreted clinically as benign tumors ( papillomas and keratoacanthomas ) were actually malignant neoplasms .
moreover , many lesions determined grossly to be nontumorous were in fact found to be neoplastic when examined microscopically .
the sencar mouse was found to be more responsive in the lung adenoma assay than other strains examined with exception of the strain a. although accurate interpretation of the lung lesions in the sencar was compromised by nonneoplastic treatment - associated and/or spontaneous lesions , the feasibility of using the sencar skin and lung as target tissues in two - stage combined carcinogenesis studies merits further consideration.imagesfigure 1.figure 2.figure 3.figure 4.figure 5.figure 6.figure 7.figure 8.figure 9.figure 10.figure 11.figure 12.figure 13.figure 14.figure 15.figure 16.figure 17 . | Images |