- Secunderabad, Andhra Pradesh, India
- Herbert Publications was established in 2011 and embrace gold open access journal publishing dedicated to provide a r... moreHerbert Publications was established in 2011 and embrace gold open access journal publishing dedicated to provide a rapid access to quality (single blinded) peer-reviewed journals covering all disciplines widely in life sciences, medical research, chemistry alongside technology and management.(Herbert Publications was established in 2011 and embrace gold open access journal publishing dedicated to provide a rapid access to quality (single blinded) peer-reviewed journals covering all disciplines widely in life sciences, medical research, chemistry alongside technology and management.)edit
Background: Salmonella enterica serovar Typhimurium SL 1344 migrates on moist surfaces by swarming motility. S. enterica serovar Typhimurium synthesized osmoregulated periplasmic glucans (OPG) using opgGH bicistronic operon under low... more
Background: Salmonella enterica serovar Typhimurium SL 1344 migrates on moist surfaces by swarming
motility. S. enterica serovar Typhimurium synthesized osmoregulated periplasmic glucans (OPG) using
opgGH bicistronic operon under low osmolarity conditions (<70 mMos Mol l-1). OPG were not detected
when cells were grown in swarm motility-promoting media which were typically iso- or hyperosmotic
(>400 mMos Mol l-1).
Findings: We observed that an opgGH-deletion mutant was defective in swarm motility. Swarm motility
was complimented by a plasmid bearing a wild type copy of opgGH. Since synthesis of OPG is below
the detection limits at medium osmolarity >400 mMos Mol l-1 the requirement of opgGH operon for
swarm motility appears counter intuitive. We observed that in wild-type cells, transcripts of opgGH
genes remained high even at 600 mMos Mol l-1, the highest osmolarity at which swarm motility occurred.
Truncated and in-frame deletion copies of opgGH (carrying deletions in transmembrane domains) as well
as plasmid expressing catalytically dysfunctional active site of OpgH (OpgHD346G, D348G) failed to restore
swarm motility.
Conclusions: Thus full-length opgGH gene products were needed to support swarm motility even though
no OPG synthesis was detected in swarm motility growth media. The requirement of OPG for swarm
motility appears to be indirect, since in the opgGH mutant, several class-II and -III flagella regulatory
genes were down-regulated specifically under swarm growth conditions. It is postulated that the lack of
OPG results in cells incapable of transducing surrounding environmental stimuli, possibly due to increased
transcript levels of cyclic di-GMP (secondary messenger) modulator gene (ydiV) in the opgGH mutant
under swarm growth conditions.
motility. S. enterica serovar Typhimurium synthesized osmoregulated periplasmic glucans (OPG) using
opgGH bicistronic operon under low osmolarity conditions (<70 mMos Mol l-1). OPG were not detected
when cells were grown in swarm motility-promoting media which were typically iso- or hyperosmotic
(>400 mMos Mol l-1).
Findings: We observed that an opgGH-deletion mutant was defective in swarm motility. Swarm motility
was complimented by a plasmid bearing a wild type copy of opgGH. Since synthesis of OPG is below
the detection limits at medium osmolarity >400 mMos Mol l-1 the requirement of opgGH operon for
swarm motility appears counter intuitive. We observed that in wild-type cells, transcripts of opgGH
genes remained high even at 600 mMos Mol l-1, the highest osmolarity at which swarm motility occurred.
Truncated and in-frame deletion copies of opgGH (carrying deletions in transmembrane domains) as well
as plasmid expressing catalytically dysfunctional active site of OpgH (OpgHD346G, D348G) failed to restore
swarm motility.
Conclusions: Thus full-length opgGH gene products were needed to support swarm motility even though
no OPG synthesis was detected in swarm motility growth media. The requirement of OPG for swarm
motility appears to be indirect, since in the opgGH mutant, several class-II and -III flagella regulatory
genes were down-regulated specifically under swarm growth conditions. It is postulated that the lack of
OPG results in cells incapable of transducing surrounding environmental stimuli, possibly due to increased
transcript levels of cyclic di-GMP (secondary messenger) modulator gene (ydiV) in the opgGH mutant
under swarm growth conditions.
Research Interests:
Background : The aim of this study was to investigate the independent impact of maternal childhood abuse history (MCAH), after controlling for maternal past, current parenting, and paternal past parenting, and maternal mental health... more
Background
: The aim of this study was to investigate the independent impact of maternal childhood abuse
history (MCAH), after controlling for maternal past, current parenting, and paternal past parenting, and
maternal mental health (MMH) on the attachment problems of children living in mother-child homes in
Japan.
Methods
: A self-administered questionnaire survey was conducted among mothers (N=306) staying in
83 mother-child homes in Japan to assess mothers’ and fathers’ maltreatment toward their children before
moving into the homes, mothers’ current maltreatment, MMH and MCAH in relation to their children’s
(N=310) attachment problems.
Results
: MCAHs were significantly and independently associated with children’s attachment problems after
controlling for maternal past, current maltreatment, and paternal past maltreatment. Among covariates,
MMH, especially dissociation, was independently significantly associated with children’s attachment
problems.
Conclusions
: The finding that MCAH has a significant impact on children’s attachment problems,
independent of parental maltreatment, suggests inter-generational continuity of child maltreatment.
: The aim of this study was to investigate the independent impact of maternal childhood abuse
history (MCAH), after controlling for maternal past, current parenting, and paternal past parenting, and
maternal mental health (MMH) on the attachment problems of children living in mother-child homes in
Japan.
Methods
: A self-administered questionnaire survey was conducted among mothers (N=306) staying in
83 mother-child homes in Japan to assess mothers’ and fathers’ maltreatment toward their children before
moving into the homes, mothers’ current maltreatment, MMH and MCAH in relation to their children’s
(N=310) attachment problems.
Results
: MCAHs were significantly and independently associated with children’s attachment problems after
controlling for maternal past, current maltreatment, and paternal past maltreatment. Among covariates,
MMH, especially dissociation, was independently significantly associated with children’s attachment
problems.
Conclusions
: The finding that MCAH has a significant impact on children’s attachment problems,
independent of parental maltreatment, suggests inter-generational continuity of child maltreatment.
Research Interests:
Researchers have long been interested in traditional forms of intelligence for predicting personal and profession life successes, however such dimensions have not been largely successful as they oftentimes miss the social component of... more
Researchers have long been interested in traditional forms of intelligence for predicting personal and
profession life successes, however such dimensions have not been largely successful as they oftentimes miss
the social component of human interaction. To capture this absence, researchers have proposed a new type
of intelligence, which has been coined emotional intelligence. The purpose of this article was to provide a
brief review how concepts of emotional intelligence have emerged in the previous 30 years, and to discuss
the potential application emotional intelligence has in public health research and practice. This article will
review three proposed models of emotional intelligence (ability, personality, and mixed), with corresponding
measurements. In addition, the current state of research on how emotional intelligence has been related
with risk factors related to the most prevalent chronic diseases will be summarized. Suggestions for future
research and practice are presented.
profession life successes, however such dimensions have not been largely successful as they oftentimes miss
the social component of human interaction. To capture this absence, researchers have proposed a new type
of intelligence, which has been coined emotional intelligence. The purpose of this article was to provide a
brief review how concepts of emotional intelligence have emerged in the previous 30 years, and to discuss
the potential application emotional intelligence has in public health research and practice. This article will
review three proposed models of emotional intelligence (ability, personality, and mixed), with corresponding
measurements. In addition, the current state of research on how emotional intelligence has been related
with risk factors related to the most prevalent chronic diseases will be summarized. Suggestions for future
research and practice are presented.
Research Interests:
Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed labour, which is a major cause results from prolonged, neglected labour. The partograph as recommended by the World Health Organization is... more
Maternal mortality ratio averages 230 per 100,000 live births in developing countries. Obstructed labour,
which is a major cause results from prolonged, neglected labour. The partograph as recommended by the
World Health Organization is a graphical tool used to monitor the progress of the first stage of labour,
thereby preventing prolonged labour. The partograph has been in use in Ghana since 1989. The study was
conducted to ascertain the proportion and correct use of the partograph in monitoring labours in 4 hospitals
in a metropolitan area of Ghana. Partograph use for labour monitoring averaged 54% in this study. Midwives
formed 90% of birth attendants. For the progress of labour, parameters were monitored to standard in
55-60% of cases. Parameters pertaining to fetal well being were correctly monitored in 30-50%. Maternal
well being was monitored to standard in 40% of cases. Apgar scores at 1 and 5 minutes did not differ whether
parameters were recorded to standard or not. We conclude from our study that almost half of labour cases
were not monitored with the partograph. In those that were monitored with the partograph monitoring to
standard was done in 40-60%. Birth attendants either lack the skill in charting the partograph to standard
protocols or do not appreciate the use of the partograph in monitoring the progress of labour. In resource-
limited centres in the developing world the use of the partograph to monitor the progress of labour cannot be
overemphasized. Skilled attendants at deliveries must therefore be given regular updates on the proper use of
the partograph during labours.
which is a major cause results from prolonged, neglected labour. The partograph as recommended by the
World Health Organization is a graphical tool used to monitor the progress of the first stage of labour,
thereby preventing prolonged labour. The partograph has been in use in Ghana since 1989. The study was
conducted to ascertain the proportion and correct use of the partograph in monitoring labours in 4 hospitals
in a metropolitan area of Ghana. Partograph use for labour monitoring averaged 54% in this study. Midwives
formed 90% of birth attendants. For the progress of labour, parameters were monitored to standard in
55-60% of cases. Parameters pertaining to fetal well being were correctly monitored in 30-50%. Maternal
well being was monitored to standard in 40% of cases. Apgar scores at 1 and 5 minutes did not differ whether
parameters were recorded to standard or not. We conclude from our study that almost half of labour cases
were not monitored with the partograph. In those that were monitored with the partograph monitoring to
standard was done in 40-60%. Birth attendants either lack the skill in charting the partograph to standard
protocols or do not appreciate the use of the partograph in monitoring the progress of labour. In resource-
limited centres in the developing world the use of the partograph to monitor the progress of labour cannot be
overemphasized. Skilled attendants at deliveries must therefore be given regular updates on the proper use of
the partograph during labours.
Research Interests:
Introduction : Lichen sclerosus (LS) is a site, gender and age specific disease that affects the vulvar region of menopausal women. The menopausal transition is characterized by physiologic changes that impact basic processes, such as... more
Introduction
: Lichen sclerosus (LS) is a site, gender and age specific disease that affects the vulvar region
of menopausal women. The menopausal transition is characterized by physiologic changes that impact basic
processes, such as weight, sleep and drug clearance. Our current pharmacopeia includes drugs that target
basic metabolic processes such as cholesterol, sex steroidogenesis and the gut microbiome. Introduction of
drugs engages complex pathways that govern bile salt metabolism and the provision of sex steroid substrate.
We hypothesized that lichen sclerosus in the vulva may represent an off target effect of pharmaceutical
alteration of sex steroid substrate in some women. We compared biometric and drug data in women with
lichen sclerosus with an age matched control group without disease.
Methods
: 43 women with lichen sclerosus underwent chart review to determine BMI, Fitzpatrick level, and
pharmaceutical burden. This data was compared to 106 randomly selected age matched controls. Logistic
regression was adjusted for age, BMI and Fitzpatrick photo typing. The statistical software was R version
3.0.1. Cases were defined as those with diagnosis claims for lichen sclerosus and were obtained from electronic
records in a single private practice.
Results
: Proton pump inhibitors were noted in 12/43 women (28%) cases and 15/106 (14%) controls: p=0.048,
(confidence interval CI=-0.01 to 0.287), adjusted p value 0.33; Hormone therapy 5/43 cases (12%), 26/106
(25%) controls: p value 0.078, (CI=-0.25 to 0.002), adjusted p value 0.02. Antihypertensive medications 17/43
(40%) cases, 29/106 (27%) controls, p value 0.14, (CI=-0.047 to 0.29), adjusted p value 0.8. Statins 16/43 cases
(37%), 28/106 controls (26%); p=0.19, (CI=-0.05 to 0.27), adjusted p value 0.89. Average age among cases was
63, average age in the control group was 61. Average BMI was 27.5 in the case group, 23.6 in the control
group. Logistic regression analysis was adjusted for age, BMI and Fitzpatrick phototyping.
Conclusions
: Borderline statistical significance was seen with proton pump inhibitors and hormone
replacement therapy (HRT). The significance seen with proton pump inhibitors went away with adjustment
for Fitzpatrick, age and BMI. The significance seen with HRT withstood adjustment, with the control group
featuring more women on hormone replacement therapy than the case group.
: Lichen sclerosus (LS) is a site, gender and age specific disease that affects the vulvar region
of menopausal women. The menopausal transition is characterized by physiologic changes that impact basic
processes, such as weight, sleep and drug clearance. Our current pharmacopeia includes drugs that target
basic metabolic processes such as cholesterol, sex steroidogenesis and the gut microbiome. Introduction of
drugs engages complex pathways that govern bile salt metabolism and the provision of sex steroid substrate.
We hypothesized that lichen sclerosus in the vulva may represent an off target effect of pharmaceutical
alteration of sex steroid substrate in some women. We compared biometric and drug data in women with
lichen sclerosus with an age matched control group without disease.
Methods
: 43 women with lichen sclerosus underwent chart review to determine BMI, Fitzpatrick level, and
pharmaceutical burden. This data was compared to 106 randomly selected age matched controls. Logistic
regression was adjusted for age, BMI and Fitzpatrick photo typing. The statistical software was R version
3.0.1. Cases were defined as those with diagnosis claims for lichen sclerosus and were obtained from electronic
records in a single private practice.
Results
: Proton pump inhibitors were noted in 12/43 women (28%) cases and 15/106 (14%) controls: p=0.048,
(confidence interval CI=-0.01 to 0.287), adjusted p value 0.33; Hormone therapy 5/43 cases (12%), 26/106
(25%) controls: p value 0.078, (CI=-0.25 to 0.002), adjusted p value 0.02. Antihypertensive medications 17/43
(40%) cases, 29/106 (27%) controls, p value 0.14, (CI=-0.047 to 0.29), adjusted p value 0.8. Statins 16/43 cases
(37%), 28/106 controls (26%); p=0.19, (CI=-0.05 to 0.27), adjusted p value 0.89. Average age among cases was
63, average age in the control group was 61. Average BMI was 27.5 in the case group, 23.6 in the control
group. Logistic regression analysis was adjusted for age, BMI and Fitzpatrick phototyping.
Conclusions
: Borderline statistical significance was seen with proton pump inhibitors and hormone
replacement therapy (HRT). The significance seen with proton pump inhibitors went away with adjustment
for Fitzpatrick, age and BMI. The significance seen with HRT withstood adjustment, with the control group
featuring more women on hormone replacement therapy than the case group.
Research Interests:
A 16-year-old boy with Marfan syndrome was scheduled for open-heart surgery for dilated aortic sinuses of Valsalva. Preoperative cardiac catheterization with left ventricular angiography demonstrated bulging at the junction of the... more
A 16-year-old boy with Marfan syndrome was scheduled for open-heart surgery for dilated aortic sinuses
of Valsalva. Preoperative cardiac catheterization with left ventricular angiography demonstrated bulging at
the junction of the mitral annulus with an appearance like ‘a swim ring’. Transthoracic echocardiography
showed severe mitral prolapse with the mitral valve leaflets rising toward the left atrium and stretching of
the chordae tendineae. ECG-gated contrast CT revealed that this bulging was not the left ventricle itself
but the interspace between the base of the left ventricle and mitral valve leaflets. This bulging disappeared
after mitral valve plasty with an annuloplasty ring. This unusual finding might herald chordae tendinae
rupture in Marfan syndrome
of Valsalva. Preoperative cardiac catheterization with left ventricular angiography demonstrated bulging at
the junction of the mitral annulus with an appearance like ‘a swim ring’. Transthoracic echocardiography
showed severe mitral prolapse with the mitral valve leaflets rising toward the left atrium and stretching of
the chordae tendineae. ECG-gated contrast CT revealed that this bulging was not the left ventricle itself
but the interspace between the base of the left ventricle and mitral valve leaflets. This bulging disappeared
after mitral valve plasty with an annuloplasty ring. This unusual finding might herald chordae tendinae
rupture in Marfan syndrome
Research Interests:
Background: In children supracondylar fracture of the humorous is one of the most common fractures in the first decade of life. This study was conducted to establish the efficacy and the accuracy of a new own method for measuring the... more
Background: In children supracondylar fracture of the humorous is one of the most common fractures in the first decade of life. This study was conducted to establish the efficacy and the accuracy of a new own method for measuring the Trochleocapitellar index (TCI) in the management of supracondylar humeral fracture in children versus Baumann’s angle.
Methods: This study made on base AP elbow radiograms and clinical charts of 54 children that were treated due to supracondylar fracture of the elbow. Cases included were of either gender with age range from four to 13 years with a supracondylar fracture presenting within 72 hours of the reduction.
Outcome measures: Two measure roentgen logic modalities studied for comparison: Baumann’s angle and TCI were taken into consideration when examining the AP roentgenograms (immediately after the reduction and during 1-3 months thereafter).
Results: During 1-3 months after the reduction Baumann’s angle modality gave normal results in 51 (94.4%), valgus result in one (1.9%) and varus result in two (3.7%) patients. While TCI showed normal results in 31 (57.4%), valgus result in one (1.9%) and varus results in 22 (40.7%) patients. Correlation was found between the measurements of the normal Baumann’s angle and normal TCI immediately after fracture reduction (r=0.75, p<0.001) and on the period between one to three months follow-up (r=0.54, p<0.001). TCI was found as more accurate for detection of cubitus varus.
Conclusions: Authors recommends post reduction measurement of the TCI in supracondylar fractures to determine the adequacy of reduction.
Methods: This study made on base AP elbow radiograms and clinical charts of 54 children that were treated due to supracondylar fracture of the elbow. Cases included were of either gender with age range from four to 13 years with a supracondylar fracture presenting within 72 hours of the reduction.
Outcome measures: Two measure roentgen logic modalities studied for comparison: Baumann’s angle and TCI were taken into consideration when examining the AP roentgenograms (immediately after the reduction and during 1-3 months thereafter).
Results: During 1-3 months after the reduction Baumann’s angle modality gave normal results in 51 (94.4%), valgus result in one (1.9%) and varus result in two (3.7%) patients. While TCI showed normal results in 31 (57.4%), valgus result in one (1.9%) and varus results in 22 (40.7%) patients. Correlation was found between the measurements of the normal Baumann’s angle and normal TCI immediately after fracture reduction (r=0.75, p<0.001) and on the period between one to three months follow-up (r=0.54, p<0.001). TCI was found as more accurate for detection of cubitus varus.
Conclusions: Authors recommends post reduction measurement of the TCI in supracondylar fractures to determine the adequacy of reduction.
Research Interests:
Background: Undiagnosed CD may lead to unstable blood glucose levels, weight loss, growth failure, osteopenia. The primary objective of the study was to review CD screening practices in one center, describe symptoms at the time of... more
Background: Undiagnosed CD may lead to unstable blood glucose levels, weight loss, growth failure,
osteopenia. The primary objective of the study was to review CD screening practices in one center, describe
symptoms at the time of diagnosis, and implement screening guidelines. The secondary objective was to
carry out an educational intervention, to review practices after screening guidelines were established.
Methods: A total of 532 charts of patients with T1D treated in our center from 2007-2009 were
reviewed. Data collected included times of screenings for CD, results of serologic tests, symptoms, and
intestinal biopsy results. Two hundred and fifty charts from 2010-2012 were reviewed after an educational
intervention with the same group of physicians.
Results: After the educational intervention to encourage implementation of screening guidelines, there was
a statistically significant reduction in the interval between the diagnosis of T1D and first screening for CD.
The majority were diagnosed in the first year after T1D diagnosis, only 30% were symptomatic.
Conclusion: Our results suggest that patients with T1D should be screened within the first several months
after diagnosis, on an annual basis thereafter, even in the absence of gastroenterologic symptoms of CD.
This will allow early dietary intervention and reduce morbidities in this high-risk population.
osteopenia. The primary objective of the study was to review CD screening practices in one center, describe
symptoms at the time of diagnosis, and implement screening guidelines. The secondary objective was to
carry out an educational intervention, to review practices after screening guidelines were established.
Methods: A total of 532 charts of patients with T1D treated in our center from 2007-2009 were
reviewed. Data collected included times of screenings for CD, results of serologic tests, symptoms, and
intestinal biopsy results. Two hundred and fifty charts from 2010-2012 were reviewed after an educational
intervention with the same group of physicians.
Results: After the educational intervention to encourage implementation of screening guidelines, there was
a statistically significant reduction in the interval between the diagnosis of T1D and first screening for CD.
The majority were diagnosed in the first year after T1D diagnosis, only 30% were symptomatic.
Conclusion: Our results suggest that patients with T1D should be screened within the first several months
after diagnosis, on an annual basis thereafter, even in the absence of gastroenterologic symptoms of CD.
This will allow early dietary intervention and reduce morbidities in this high-risk population.
Research Interests:
The inflammatory process underlying chronic obstructive pulmonary disease (COPD) may be caused by tobacco smoke (TS) exposure. Previous studies show that epoxyeicosatrienoic acids (EETs) possess promising anti-inflammatory properties,... more
The inflammatory process underlying chronic obstructive pulmonary disease (COPD) may be caused
by tobacco smoke (TS) exposure. Previous studies show that epoxyeicosatrienoic acids (EETs) possess
promising anti-inflammatory properties, therefore stabilization of EETs and other fatty acid epoxides
through inhibition of soluble epoxide hydrolase (sEH) was investigated in mouse models of acute and subchronic
inflammation caused by TS exposure. During the entire TS exposure, the potent sEH inhibitor
1-(1-methylsulfonyl-piperidin-4-yl)-3-(4-trifluoromethoxy-phenyl)-urea (TUPS) was given via drinking
water. To assess drug target engagement of TUPS, a tandem mass spectrometry method was used for
bioactive lipid profiling of a broad range of fatty acid metabolites, including EETs, and their corresponding
diols (DHETs) derived from arachidonic acid, as well as epoxides and diols derived from other fatty acids.
Several, but not all, plasma epoxide/diol ratios increased in mice treated with sEH inhibitor, compared to
non-treated mice, suggesting a wider role for sEH involving more fatty acid precursors besides arachidonic
acid. This study supports qualitative use of epoxide/diol ratios explored by bioactive lipid profiling to
indicate drug target engagement in mouse models of TS exposure relevant to COPD, which may have
ramifications for future therapeutic interventions of sEH.
by tobacco smoke (TS) exposure. Previous studies show that epoxyeicosatrienoic acids (EETs) possess
promising anti-inflammatory properties, therefore stabilization of EETs and other fatty acid epoxides
through inhibition of soluble epoxide hydrolase (sEH) was investigated in mouse models of acute and subchronic
inflammation caused by TS exposure. During the entire TS exposure, the potent sEH inhibitor
1-(1-methylsulfonyl-piperidin-4-yl)-3-(4-trifluoromethoxy-phenyl)-urea (TUPS) was given via drinking
water. To assess drug target engagement of TUPS, a tandem mass spectrometry method was used for
bioactive lipid profiling of a broad range of fatty acid metabolites, including EETs, and their corresponding
diols (DHETs) derived from arachidonic acid, as well as epoxides and diols derived from other fatty acids.
Several, but not all, plasma epoxide/diol ratios increased in mice treated with sEH inhibitor, compared to
non-treated mice, suggesting a wider role for sEH involving more fatty acid precursors besides arachidonic
acid. This study supports qualitative use of epoxide/diol ratios explored by bioactive lipid profiling to
indicate drug target engagement in mouse models of TS exposure relevant to COPD, which may have
ramifications for future therapeutic interventions of sEH.
Research Interests:
Background: Approximately 30% of overweight/obese children display an adverse lipid profile. While weight loss is the commonly prescribed intervention, success in treatment has been limited. The substantial involvement of lipid metabolism... more
Background: Approximately 30% of overweight/obese children display an adverse lipid profile. While
weight loss is the commonly prescribed intervention, success in treatment has been limited. The substantial
involvement of lipid metabolism by skeletal muscle suggests resistance training has the potential to improve
lipid profile even in the absence of weight loss, although investigations in the pediatric population are
limited. The objective of this study was to investigate the effect of an 8-week resistance training program
on lipid profile in overweight/obese peri-pubertal boys.
Methods: 8 overweight/obese, peri-pubertal boys (ages 10-12) were randomized to either a control (n=3)
or resistance training (n=5) group. The resistance training protocol included 7 exercises consisting of 3
sets with 10-15 repetitions to fatigue 3 days per week for 8-weeks. Fasting blood draw, strength testing
and DXA were performed at baseline and 8-weeks for evaluation of lipid profile, strength, and body
composition, respectively.
weight loss is the commonly prescribed intervention, success in treatment has been limited. The substantial
involvement of lipid metabolism by skeletal muscle suggests resistance training has the potential to improve
lipid profile even in the absence of weight loss, although investigations in the pediatric population are
limited. The objective of this study was to investigate the effect of an 8-week resistance training program
on lipid profile in overweight/obese peri-pubertal boys.
Methods: 8 overweight/obese, peri-pubertal boys (ages 10-12) were randomized to either a control (n=3)
or resistance training (n=5) group. The resistance training protocol included 7 exercises consisting of 3
sets with 10-15 repetitions to fatigue 3 days per week for 8-weeks. Fasting blood draw, strength testing
and DXA were performed at baseline and 8-weeks for evaluation of lipid profile, strength, and body
composition, respectively.
Research Interests:
Purpose: To determine the incidence and impact of pelvic pain, pelvic organ prolapse, urinary and colorectal distress and quality of life by birth mode for women in the chronic postpartum period. Study design: Cross-sectional... more
Purpose: To determine the incidence and impact of pelvic pain, pelvic organ prolapse, urinary and
colorectal distress and quality of life by birth mode for women in the chronic postpartum period.
Study design: Cross-sectional correlational design utilizing purposive sampling of (n=21) female
postpartum subjects ages 18-45.
Background: Caesarean Section (CS) incidence is reported at 32% nationwide, well above the recommended
safe rate of 10% (WHO). Literature is not clear regarding role of birth mode in postpartum symptoms
including: pelvic pain, colorectal distress, pelvic organ prolapse, and quality of life.
Methods: Data collection took place after IRB approval from Andrews University. Each subject who agreed
to volunteer for the study and met the inclusion criteria completed (1) Health History Questionnaire, (2) SF-
36, and (3) Pelvic Floor Distress Inventory.
Result: Incidence reports of UI were 80% in CS and 50% in the NVD group. The CS reported significantly
higher mean scores for PFIQb, UDI, POPDI and CRADI. Age was negatively correlated with CRADI
and pain (Chi-square=7.02, p=0.030). NVD reported a significantly higher quality of life (as measured by
the SF-36) in general and mental health compared to published norms and CS (p<0.05). BMI showed a
significant moderate correlation (r=0.682, p<0.001) with pelvic organ prolapse.
Conclusion: Our study found significant increased incidence and impact of UI, CRADI, POPDI and
PFIQb symptoms and a decrease in QOL in CS compared to NVD. Age showed significant correlation with
colorectal symptoms and BMI showed significant relationship to pelvic organ prolapse.
colorectal distress and quality of life by birth mode for women in the chronic postpartum period.
Study design: Cross-sectional correlational design utilizing purposive sampling of (n=21) female
postpartum subjects ages 18-45.
Background: Caesarean Section (CS) incidence is reported at 32% nationwide, well above the recommended
safe rate of 10% (WHO). Literature is not clear regarding role of birth mode in postpartum symptoms
including: pelvic pain, colorectal distress, pelvic organ prolapse, and quality of life.
Methods: Data collection took place after IRB approval from Andrews University. Each subject who agreed
to volunteer for the study and met the inclusion criteria completed (1) Health History Questionnaire, (2) SF-
36, and (3) Pelvic Floor Distress Inventory.
Result: Incidence reports of UI were 80% in CS and 50% in the NVD group. The CS reported significantly
higher mean scores for PFIQb, UDI, POPDI and CRADI. Age was negatively correlated with CRADI
and pain (Chi-square=7.02, p=0.030). NVD reported a significantly higher quality of life (as measured by
the SF-36) in general and mental health compared to published norms and CS (p<0.05). BMI showed a
significant moderate correlation (r=0.682, p<0.001) with pelvic organ prolapse.
Conclusion: Our study found significant increased incidence and impact of UI, CRADI, POPDI and
PFIQb symptoms and a decrease in QOL in CS compared to NVD. Age showed significant correlation with
colorectal symptoms and BMI showed significant relationship to pelvic organ prolapse.
Research Interests:
St. Jude Medical (SJM) bileaflet mechanical valves were approved by the Food and Drug Administration in 1977. The SJM valve design consists of two semicircular leaflets which pivot on hinges. Compared to other mechanical heart valve... more
St. Jude Medical (SJM) bileaflet mechanical valves were approved by the Food and Drug Administration
in 1977. The SJM valve design consists of two semicircular leaflets which pivot on hinges. Compared to
other mechanical heart valve prostheses such as ball and cage and tilting disk prosthetic valves, it provides
good central flow, the leaflets open completely, and the pressure drop across the valve is trivial. However,
non-physiological hemodynamics around these valves may lead to red blood cells lysis and therombigenic
complications. Also, the regurgitation-flow inSJM valves is almost twice that of the native valves in the
aortic position. In this study, we suggest a new design for the stent (housing) of SJM valves in which 15%
ovality is applied to the stent whereas its perimeter remains constant. In a pilot study, the hemodynamic
performance of the proposed design is analyzed in the closing phaseand compared to that of conventional
SJM models. Results show that while the elliptic SJM model offers a shorter closing phase (9.7% shorter),
the regurgitation flow remains almost unchanged. In other words, even though the dynamic response of the
valve is improved, the regurgitation flow is not decreased. Thus, a more efficient effective orifice area (EOA)
is shown to be provided by the proposed model. The preliminary calculations presented in this study justify
an improved hemodynamics of elliptic SJM valves compared to conventional models; the proposed design
shows promise and merits further development.
in 1977. The SJM valve design consists of two semicircular leaflets which pivot on hinges. Compared to
other mechanical heart valve prostheses such as ball and cage and tilting disk prosthetic valves, it provides
good central flow, the leaflets open completely, and the pressure drop across the valve is trivial. However,
non-physiological hemodynamics around these valves may lead to red blood cells lysis and therombigenic
complications. Also, the regurgitation-flow inSJM valves is almost twice that of the native valves in the
aortic position. In this study, we suggest a new design for the stent (housing) of SJM valves in which 15%
ovality is applied to the stent whereas its perimeter remains constant. In a pilot study, the hemodynamic
performance of the proposed design is analyzed in the closing phaseand compared to that of conventional
SJM models. Results show that while the elliptic SJM model offers a shorter closing phase (9.7% shorter),
the regurgitation flow remains almost unchanged. In other words, even though the dynamic response of the
valve is improved, the regurgitation flow is not decreased. Thus, a more efficient effective orifice area (EOA)
is shown to be provided by the proposed model. The preliminary calculations presented in this study justify
an improved hemodynamics of elliptic SJM valves compared to conventional models; the proposed design
shows promise and merits further development.
Research Interests:
Background: We developed and validated an algorithm to evaluate pure red cell aplasia (PRCA) incidence in chronic hepatitis C (CHC) patients in a large observational database. Methods: We conducted a retrospective study using the... more
Background: We developed and validated an algorithm to evaluate pure red cell aplasia (PRCA) incidence
in chronic hepatitis C (CHC) patients in a large observational database.
Methods: We conducted a retrospective study using the HealthCore Integrated Research DatabaseSM
(HIRD) in which we identified CHC patients and followed them forward to identify PRCA occurrences.
Possible PRCA cases were identified based on a medical claim for aplastic anemia (ICD-9-CM 284.8x or
284.9x) with a claim for bone marrow biopsy in the prior 30 days. Medical records were requested and
reviewed by an Adjudication Committee (AC) to confirm PRCA case status. The positive predictive value
(PPV) and 95% confidence interval (CI) for the PRCA algorithm were estimated based on adjudication
results.
Results: A total of 36,164 CHC patients were identified yielding 25 suspected PRCA cases. Medical records
were obtained and reviewed for 17 cases. Of these 17 cases, none were confirmed as PRCA (PPV: 0.0%; 95%
CI 0.0-19.5%). Estimated confirmed PRCA incidence was 0.0/1,000 person-years (95% CI 0.00-0.05/1,000
person-years).
Conclusions: Automated case definitions for PRCA performed poorly in identifying PRCA in CHC patients,
limiting our ability to estimate PRCA incidence. PRCA in CHC patients is rare and difficult to study using
large automated databases.
in chronic hepatitis C (CHC) patients in a large observational database.
Methods: We conducted a retrospective study using the HealthCore Integrated Research DatabaseSM
(HIRD) in which we identified CHC patients and followed them forward to identify PRCA occurrences.
Possible PRCA cases were identified based on a medical claim for aplastic anemia (ICD-9-CM 284.8x or
284.9x) with a claim for bone marrow biopsy in the prior 30 days. Medical records were requested and
reviewed by an Adjudication Committee (AC) to confirm PRCA case status. The positive predictive value
(PPV) and 95% confidence interval (CI) for the PRCA algorithm were estimated based on adjudication
results.
Results: A total of 36,164 CHC patients were identified yielding 25 suspected PRCA cases. Medical records
were obtained and reviewed for 17 cases. Of these 17 cases, none were confirmed as PRCA (PPV: 0.0%; 95%
CI 0.0-19.5%). Estimated confirmed PRCA incidence was 0.0/1,000 person-years (95% CI 0.00-0.05/1,000
person-years).
Conclusions: Automated case definitions for PRCA performed poorly in identifying PRCA in CHC patients,
limiting our ability to estimate PRCA incidence. PRCA in CHC patients is rare and difficult to study using
large automated databases.
Research Interests:
Background: Malaria has been a major public health problem in sub-Saharan Africa. Malaria parasitaemia among pregnant women is associated with adverse maternal and fetal complications. The objective of this study was to determine the... more
Background: Malaria has been a major public health problem in sub-Saharan Africa. Malaria parasitaemia
among pregnant women is associated with adverse maternal and fetal complications. The objective of this
study was to determine the prevalence of malaria parasitaemia among asymptomatic women at booking
and to ascertain their packed cell volume (PCV) at Garki Hospital, Abuja, Nigeria.
Materials and methods: This was a cross-sectional descriptive study of 659 pregnant women recruited
consecutively at the time of booking for antenatal care. Thick film microscopy and thin film for malaria
parasites were performed for all the women. PCV assessment was done using the micro centrifuge method
and comparison was made between women with and without parasitaemia. Descriptive statistics was also
done.
Results: A total of 700 were initially counseled but only 659 gave consent and participated in the study,
given a rate of 94%. The gestational age at first booking ranged between 8-37 weeks. Prevalence of
malaria parasitaemia was 38.8%. Majority of the women had mild parasitaemia and there was statistical
significant difference between mild, moderate and severe parasitaemia. About 53.8% of primigravidae and
18.7% multigravidae were anaemic at booking. The Probability of a woman aged<30 years having malaria
parasitaemia is four times (81.3%) more than those aged>31 years (18.8%). Those with tertiary education
constituted the largest group in the Study (67.2%) and there was association between low parasitaemia and
higher level of education.
Conclusion: Asymptomatic women with malaria parasitaemia and anaemia are common at booking visit.
Public enlightenment on malaria prevention and female education may greatly reduce high level of malaria
parasitaemia and anaemia among this obstetric population. We recommend screening policy for malaria
parasitaemia at booking.
among pregnant women is associated with adverse maternal and fetal complications. The objective of this
study was to determine the prevalence of malaria parasitaemia among asymptomatic women at booking
and to ascertain their packed cell volume (PCV) at Garki Hospital, Abuja, Nigeria.
Materials and methods: This was a cross-sectional descriptive study of 659 pregnant women recruited
consecutively at the time of booking for antenatal care. Thick film microscopy and thin film for malaria
parasites were performed for all the women. PCV assessment was done using the micro centrifuge method
and comparison was made between women with and without parasitaemia. Descriptive statistics was also
done.
Results: A total of 700 were initially counseled but only 659 gave consent and participated in the study,
given a rate of 94%. The gestational age at first booking ranged between 8-37 weeks. Prevalence of
malaria parasitaemia was 38.8%. Majority of the women had mild parasitaemia and there was statistical
significant difference between mild, moderate and severe parasitaemia. About 53.8% of primigravidae and
18.7% multigravidae were anaemic at booking. The Probability of a woman aged<30 years having malaria
parasitaemia is four times (81.3%) more than those aged>31 years (18.8%). Those with tertiary education
constituted the largest group in the Study (67.2%) and there was association between low parasitaemia and
higher level of education.
Conclusion: Asymptomatic women with malaria parasitaemia and anaemia are common at booking visit.
Public enlightenment on malaria prevention and female education may greatly reduce high level of malaria
parasitaemia and anaemia among this obstetric population. We recommend screening policy for malaria
parasitaemia at booking.
Research Interests:
The occurrence of perinuclear anti-neutrophilic cytoplasmic antibodies (p-ANCA) in pulmonary fibrosis has been reported in a number of small studies, however, the appearance of p-ANCA in already established idiopathic pulmonary fibrosis... more
The occurrence of perinuclear anti-neutrophilic cytoplasmic antibodies (p-ANCA) in pulmonary fibrosis
has been reported in a number of small studies, however, the appearance of p-ANCA in already established
idiopathic pulmonary fibrosis (IPF), predating the manifestations of vasculitis has not been widely
appreciated. We report 2 cases with radiographic evidence of established IPF where p-ANCA was negative
at the time of diagnosis and became positive during the course of the disease, for a variable period of time,
prior to the subsequent development of systemic vasculitis. Our cases suggest a possible rationale for serial
p-ANCA measurements in patients with pulmonary fibrosis even in the absence of features suggestive of
vasculitis. Furthermore, the required frequency of ANCA measurement in the absence of clinical features
of vasculitis is unknown. Larger studies with repetitive p-ANCA measurement in tandem with ongoing
clinical assessment for vasculitis are required to assess the prevalence of ANCA and to confirm our
observation.
has been reported in a number of small studies, however, the appearance of p-ANCA in already established
idiopathic pulmonary fibrosis (IPF), predating the manifestations of vasculitis has not been widely
appreciated. We report 2 cases with radiographic evidence of established IPF where p-ANCA was negative
at the time of diagnosis and became positive during the course of the disease, for a variable period of time,
prior to the subsequent development of systemic vasculitis. Our cases suggest a possible rationale for serial
p-ANCA measurements in patients with pulmonary fibrosis even in the absence of features suggestive of
vasculitis. Furthermore, the required frequency of ANCA measurement in the absence of clinical features
of vasculitis is unknown. Larger studies with repetitive p-ANCA measurement in tandem with ongoing
clinical assessment for vasculitis are required to assess the prevalence of ANCA and to confirm our
observation.
Research Interests:
A congenital malformation of the bronchial tree, known as bronchial cyst, is mostly found in the mediastinum or lung. Intracardiac bronchogenic cysts are quite rare and only two cases of right ventricular bronchogenic cyst have so far... more
A congenital malformation of the bronchial tree, known as bronchial cyst, is mostly found in the
mediastinum or lung. Intracardiac bronchogenic cysts are quite rare and only two cases of right
ventricular bronchogenic cyst have so far been reported. We herein report a case in which a cyst developed
in the right ventricle of a 65-year-old Japanese male who presented with aphasia due to cerebral infarction
and pulmonary embolism. The cyst was successfully removed and the patient successfully recovered
following surgery.
mediastinum or lung. Intracardiac bronchogenic cysts are quite rare and only two cases of right
ventricular bronchogenic cyst have so far been reported. We herein report a case in which a cyst developed
in the right ventricle of a 65-year-old Japanese male who presented with aphasia due to cerebral infarction
and pulmonary embolism. The cyst was successfully removed and the patient successfully recovered
following surgery.
Research Interests:
Background: The purpose of this study was to review key differences between necrotizing soft tissue infections (NSTI) and Fournier’s Gangrene (FG) in demographics, comorbidities, laboratory findings, cost, and clinical course. Methods:... more
Background: The purpose of this study was to review key differences between necrotizing soft tissue
infections (NSTI) and Fournier’s Gangrene (FG) in demographics, comorbidities, laboratory findings, cost,
and clinical course.
Methods: The burn registry of a Level 1 trauma and burn center in Lubbock, Texas was used to identify
and retrospectively review medical records of patients with NSTIs and FG from 2003 to 2012. Bivariate
analysis on the FG subgroup was performed and compared to all other NSTI using Fisher’s exact test for
proportions and Student’s t-test to compare continuous variables with equal variance assumed. A p<0.05
was considered to be significant.
Results: We found that 133 patients met inclusion criteria. Analysis of data revealed that FG had longer
length of hospital stay (p=0.02) and an increased number of operations performed (p=0.01) than other
NSTIs. There was also a higher association with diabetes in FG (p=0.03) and polymicrobial infections
(p=0.01). Intravenous drug abuse was found to be more associated with NSTIs compared to FG (p=0.03).
Conclusion: Our study showed that FG patients have longer length of hospital stay, lower hemoglobin
levels, and increased number of operations. NSTIs were more likely to be associated with intravenous drug
abuse. There is no difference in rates of mortality between the two groups.
infections (NSTI) and Fournier’s Gangrene (FG) in demographics, comorbidities, laboratory findings, cost,
and clinical course.
Methods: The burn registry of a Level 1 trauma and burn center in Lubbock, Texas was used to identify
and retrospectively review medical records of patients with NSTIs and FG from 2003 to 2012. Bivariate
analysis on the FG subgroup was performed and compared to all other NSTI using Fisher’s exact test for
proportions and Student’s t-test to compare continuous variables with equal variance assumed. A p<0.05
was considered to be significant.
Results: We found that 133 patients met inclusion criteria. Analysis of data revealed that FG had longer
length of hospital stay (p=0.02) and an increased number of operations performed (p=0.01) than other
NSTIs. There was also a higher association with diabetes in FG (p=0.03) and polymicrobial infections
(p=0.01). Intravenous drug abuse was found to be more associated with NSTIs compared to FG (p=0.03).
Conclusion: Our study showed that FG patients have longer length of hospital stay, lower hemoglobin
levels, and increased number of operations. NSTIs were more likely to be associated with intravenous drug
abuse. There is no difference in rates of mortality between the two groups.
Research Interests:
Background: Encrustation of urinary catheters is a frequent problem in patients with long-term indwelling catheters colonised with urease-positive bacteria such as Proteus mirabilis. Catheter blockage may follow catheter encrustation,... more
Background: Encrustation of urinary catheters is a frequent problem in patients with long-term indwelling
catheters colonised with urease-positive bacteria such as Proteus mirabilis. Catheter blockage may follow
catheter encrustation, potentially leading to systemic infection. Prevention of encrustation is difficult and
avoidance of recurrence often unsuccessful. One possible preventative strategy is to use a catheter with an
antimicrobial surface and development and assessment of such a surface was the aim of this research.
Methods: Initial experiments assessed the antimicrobial activity of silicone impregnated with plant-derived
antimicrobials and triclosan using agar diffusion. The longevity of activity of each antimicrobial silicone
was examined over a period of 11 weeks following soaking individual pieces of antimicrobial silicone in
an artificial urine solution before using agar diffusion to test remaining antimicrobial activity. Live/Dead
staining of bacteria colonising the surface of each antimicrobial silicone was employed to determine the
bactericidal properties of each antimicrobial silicone. Selected antimicrobial silicones were subsequently
evaluated for their ability to prevent catheter encrustation in an in vitro bladder model.
Results: Results showed that antimicrobial activity was obtained using 1% triclosan-impregnated silicone
and that this antimicrobial activity was long-lasting (up to 11 weeks). Use of a dip coat silicone formulation,
containing 0.2% triclosan, proved effective at delaying catheter encrustation with P. mirabilis metabolites
in vitro. In 8 out of 13 independent experiments using dip-coated catheters, no catheter blockage occurred
over 7 days, whilst all control catheters blocked during this period. Only on one occasion was delayed
encrustation not evident with the treated catheters.
Conclusions: In summary, a dip-coat silicone containing triclosan proved effective in preventing in vitro
catheter encrustation caused by P. mirabilis infection. Further studies with triclosan silicone dip coat
formulation are warranted, including those that investigate potential host cell toxicity and long-term
benefits following its application to indwelling urinary catheters in clinical settings.
catheters colonised with urease-positive bacteria such as Proteus mirabilis. Catheter blockage may follow
catheter encrustation, potentially leading to systemic infection. Prevention of encrustation is difficult and
avoidance of recurrence often unsuccessful. One possible preventative strategy is to use a catheter with an
antimicrobial surface and development and assessment of such a surface was the aim of this research.
Methods: Initial experiments assessed the antimicrobial activity of silicone impregnated with plant-derived
antimicrobials and triclosan using agar diffusion. The longevity of activity of each antimicrobial silicone
was examined over a period of 11 weeks following soaking individual pieces of antimicrobial silicone in
an artificial urine solution before using agar diffusion to test remaining antimicrobial activity. Live/Dead
staining of bacteria colonising the surface of each antimicrobial silicone was employed to determine the
bactericidal properties of each antimicrobial silicone. Selected antimicrobial silicones were subsequently
evaluated for their ability to prevent catheter encrustation in an in vitro bladder model.
Results: Results showed that antimicrobial activity was obtained using 1% triclosan-impregnated silicone
and that this antimicrobial activity was long-lasting (up to 11 weeks). Use of a dip coat silicone formulation,
containing 0.2% triclosan, proved effective at delaying catheter encrustation with P. mirabilis metabolites
in vitro. In 8 out of 13 independent experiments using dip-coated catheters, no catheter blockage occurred
over 7 days, whilst all control catheters blocked during this period. Only on one occasion was delayed
encrustation not evident with the treated catheters.
Conclusions: In summary, a dip-coat silicone containing triclosan proved effective in preventing in vitro
catheter encrustation caused by P. mirabilis infection. Further studies with triclosan silicone dip coat
formulation are warranted, including those that investigate potential host cell toxicity and long-term
benefits following its application to indwelling urinary catheters in clinical settings.
Research Interests:
Background: The demographic profile of heart failure (HF) is important to understand for its effective management and liver dysfunction has got prognostic impact on its outcome. We aimed to look for the demographic profile of HF and find... more
Background: The demographic profile of heart failure (HF) is important to understand for its effective
management and liver dysfunction has got prognostic impact on its outcome. We aimed to look for the
demographic profile of HF and find out the predictive role of model for end-stage liver disease-XI (MELDXI)
score such that its prognostic implications in HF could be determined in the western Nepal.
Methods: Among 264 consecutive hospitalized HF patients, demographic profile was recorded prospectively
and the patients were followed up till 3 months with recording of the composite end-points, which were
defined as adverse outcomes measured in terms of all-cause death and hospital re-admission. The MELD-XI
score was calculated as 11.76 (loge creatinine)+5.112 (loge total bilirubin)+9.44 and its predictive role in the
adverse outcomes in HF was determined.
Results: Among 264 patients, the causes of HF were ischemic (29.5%), hypertensive (24.6%), dilated
cardiomyopathy (21.6%), cor-pulmonale (15.5%) and valvular (8.7%), and 27.7% patients had adverse outcomes
(re-admission 20.1% and all-cause death 7.6%). The prevalence of history of hypertension and diabetes in
HF was 54.2% and 14.8%, respectively. The overall mean MELD-XI score was 10.8 (±2.1; range 6.3-18.8);
the mean score was <10 in patients with no adverse outcome, >13 in patients with adverse outcome and >15
in patients who died. In univariate analysis, the MELD-XI score was found to be a significant predictor of
adverse outcomes in HF with adjusted R2 of 0.928 (P<0.001). The logistic regression analysis showed that the
adverse outcome of HF could be predicted by the combination of MELD-XI score, ejection fraction, New York
Heart Association functional class and age (Nagelkerke’s pseudo R2 0.935) with beta coefficient of MELD-XI
being 3.79 (p<0.001) and that of ejection fraction being -0.19 (P 0.009); the Hosmer-Lemshow test showed p
value of 1.0 (chi-square value of 0.494) indicating the goodness of fit for our logistic regression model. The
area under receiver operating curve of MELD-XI score for adverse outcomes in HF was 0.993 (P<0.001).
Conclusion: Ischemic and hypertensive heart diseases were the common causes of HF in western region of
Nepal. The MELD-XI score was an excellent predictor of hospital re-admission and all-cause death in the
patients of HF and could be an important prognostic tool in the patients of HF. Further study with a large
sample is required to establish the predictive role of increased MELD-XI score on adverse outcome of HF.
management and liver dysfunction has got prognostic impact on its outcome. We aimed to look for the
demographic profile of HF and find out the predictive role of model for end-stage liver disease-XI (MELDXI)
score such that its prognostic implications in HF could be determined in the western Nepal.
Methods: Among 264 consecutive hospitalized HF patients, demographic profile was recorded prospectively
and the patients were followed up till 3 months with recording of the composite end-points, which were
defined as adverse outcomes measured in terms of all-cause death and hospital re-admission. The MELD-XI
score was calculated as 11.76 (loge creatinine)+5.112 (loge total bilirubin)+9.44 and its predictive role in the
adverse outcomes in HF was determined.
Results: Among 264 patients, the causes of HF were ischemic (29.5%), hypertensive (24.6%), dilated
cardiomyopathy (21.6%), cor-pulmonale (15.5%) and valvular (8.7%), and 27.7% patients had adverse outcomes
(re-admission 20.1% and all-cause death 7.6%). The prevalence of history of hypertension and diabetes in
HF was 54.2% and 14.8%, respectively. The overall mean MELD-XI score was 10.8 (±2.1; range 6.3-18.8);
the mean score was <10 in patients with no adverse outcome, >13 in patients with adverse outcome and >15
in patients who died. In univariate analysis, the MELD-XI score was found to be a significant predictor of
adverse outcomes in HF with adjusted R2 of 0.928 (P<0.001). The logistic regression analysis showed that the
adverse outcome of HF could be predicted by the combination of MELD-XI score, ejection fraction, New York
Heart Association functional class and age (Nagelkerke’s pseudo R2 0.935) with beta coefficient of MELD-XI
being 3.79 (p<0.001) and that of ejection fraction being -0.19 (P 0.009); the Hosmer-Lemshow test showed p
value of 1.0 (chi-square value of 0.494) indicating the goodness of fit for our logistic regression model. The
area under receiver operating curve of MELD-XI score for adverse outcomes in HF was 0.993 (P<0.001).
Conclusion: Ischemic and hypertensive heart diseases were the common causes of HF in western region of
Nepal. The MELD-XI score was an excellent predictor of hospital re-admission and all-cause death in the
patients of HF and could be an important prognostic tool in the patients of HF. Further study with a large
sample is required to establish the predictive role of increased MELD-XI score on adverse outcome of HF.
Research Interests:
Suicide continues to be a world-wide problem. For every suicide there are many more suicide attempts and acts of deliberate self-harm. The Emergency Department (ED) of the public hospital is at the forefront of an increasing presentation... more
Suicide continues to be a world-wide problem. For every suicide there are many more suicide attempts and
acts of deliberate self-harm. The Emergency Department (ED) of the public hospital is at the forefront of an
increasing presentation rate of patients in the acute phase of mental illness or suicide risk, requiring specialised
mental health risk assessment. Little is known of mental health patient views about their experience in the
ED, yet consumer views are seen as an important factor in measuring the quality of psychiatric assessment
and treatment. This paper sets out to examine consumer experiences of psychiatric assessment in the ED.
Twenty participants, assessed in one of three public hospital EDs in Melbourne, Australia, following a
suicide or deliberate self-harm (DSH) attempt, completed an anonymous online mixed method questionnaire.
Participants reported an overall improvement in mood and expressed a positive view of the quality of service
from the ED psychiatric team. Most helpful to participants was being listened to, not feeling judged, and
having time to talk. What they found unhelpful was the lack of a private area for assessment, feeling ‘labelled’,
and at times a lack of individual focus. What became apparent during this study was the difficulty in recruiting
participants. A more direct-approach design to encouraging consumers to participate may increase response
rates, however, privacy and power dynamics would pose an ethical challenge. Even though participation rate
was low, the preliminary message from these ED consumers is still useful in formulating the beginnings of an
important conversation with this group.
acts of deliberate self-harm. The Emergency Department (ED) of the public hospital is at the forefront of an
increasing presentation rate of patients in the acute phase of mental illness or suicide risk, requiring specialised
mental health risk assessment. Little is known of mental health patient views about their experience in the
ED, yet consumer views are seen as an important factor in measuring the quality of psychiatric assessment
and treatment. This paper sets out to examine consumer experiences of psychiatric assessment in the ED.
Twenty participants, assessed in one of three public hospital EDs in Melbourne, Australia, following a
suicide or deliberate self-harm (DSH) attempt, completed an anonymous online mixed method questionnaire.
Participants reported an overall improvement in mood and expressed a positive view of the quality of service
from the ED psychiatric team. Most helpful to participants was being listened to, not feeling judged, and
having time to talk. What they found unhelpful was the lack of a private area for assessment, feeling ‘labelled’,
and at times a lack of individual focus. What became apparent during this study was the difficulty in recruiting
participants. A more direct-approach design to encouraging consumers to participate may increase response
rates, however, privacy and power dynamics would pose an ethical challenge. Even though participation rate
was low, the preliminary message from these ED consumers is still useful in formulating the beginnings of an
important conversation with this group.
Research Interests:
Abstract Background: Cyclic AMP influences many facets of signaling in vascular smooth muscle cells (VSMCs) including those mediated by protein kinase A (PKA) and those operating through exchange proteins activated by cAMP (EPACs).... more
Abstract
Background: Cyclic AMP influences many facets of signaling in vascular smooth muscle cells (VSMCs) including those mediated by protein kinase A (PKA) and those operating through exchange proteins activated by cAMP (EPACs). Activation of EPACs has been suggested to promote VSMC migration and to increase arterial neointima development; however, the molecular mechanisms of EPACs in VSMCs still remain unclear. The goal of this study was to identify mechanisms of action of EPACs related to vascular growth, and the hypothesis was that EPACs operate via distinct, kinase-mediated mechanisms to control VSMC migration and proliferation.
Methods and results: Using a wounding scrape injury on confluent rat primary VSMCs, the direct EPAC activator CPT transiently stimulated migration after 6 hours followed by inhibition of migration after 16 hours which persisted through 22 hours. This prolonged and stable inhibition of cell migration by EPAC was potentiated by pharmacologic blockade of MAPK, PI3K, Rac, PKC or PKG. In-Cell Western analysis on intact adherent cells was then used to identify differential phosphorylation of the actinregulatory protein vasodilator-activated serum phosphoprotein (VASP), as VASPSer157 and VASPser239 have been suggested as respective readouts of PKA and PKG and to have capacities to regulate cell growth. CPT (10μM) alone had no effect on either phosphoVASP species, but in the presence of a PKA inhibitor VASPser239 phosphorylation was significantly elevated. Involvement of focal adhesion proteins implicated in cell motility (focal adhesion kinase (FAK), paxillin (PAX)), were then assessed with/without EPAC stimulation. CPT increased PAX expression but failed to markedly alter FAKTyr397 phosophorylation. Finally, CPT alone had minimal effects on VSMC proliferation yet along with blockade of Rac, PI3K or MAPK or following direct activation of PKA proliferation was significantly decreased.
Conclusions: These data confirm that PKA and EPAC work cooperatively to primarily inhibit VSMC migration likely through mechanisms largely independent of VASP. Multiple kinases appear to be involved in this EPAC regulation of VSMC migration. Collectively these data suggest that EPAC regulates migration of VSMCs in time- and concentration-dependent manner, yet its precise mechanisms of action and its full influence on cellular proliferation remain to be fully characterized.
Background: Cyclic AMP influences many facets of signaling in vascular smooth muscle cells (VSMCs) including those mediated by protein kinase A (PKA) and those operating through exchange proteins activated by cAMP (EPACs). Activation of EPACs has been suggested to promote VSMC migration and to increase arterial neointima development; however, the molecular mechanisms of EPACs in VSMCs still remain unclear. The goal of this study was to identify mechanisms of action of EPACs related to vascular growth, and the hypothesis was that EPACs operate via distinct, kinase-mediated mechanisms to control VSMC migration and proliferation.
Methods and results: Using a wounding scrape injury on confluent rat primary VSMCs, the direct EPAC activator CPT transiently stimulated migration after 6 hours followed by inhibition of migration after 16 hours which persisted through 22 hours. This prolonged and stable inhibition of cell migration by EPAC was potentiated by pharmacologic blockade of MAPK, PI3K, Rac, PKC or PKG. In-Cell Western analysis on intact adherent cells was then used to identify differential phosphorylation of the actinregulatory protein vasodilator-activated serum phosphoprotein (VASP), as VASPSer157 and VASPser239 have been suggested as respective readouts of PKA and PKG and to have capacities to regulate cell growth. CPT (10μM) alone had no effect on either phosphoVASP species, but in the presence of a PKA inhibitor VASPser239 phosphorylation was significantly elevated. Involvement of focal adhesion proteins implicated in cell motility (focal adhesion kinase (FAK), paxillin (PAX)), were then assessed with/without EPAC stimulation. CPT increased PAX expression but failed to markedly alter FAKTyr397 phosophorylation. Finally, CPT alone had minimal effects on VSMC proliferation yet along with blockade of Rac, PI3K or MAPK or following direct activation of PKA proliferation was significantly decreased.
Conclusions: These data confirm that PKA and EPAC work cooperatively to primarily inhibit VSMC migration likely through mechanisms largely independent of VASP. Multiple kinases appear to be involved in this EPAC regulation of VSMC migration. Collectively these data suggest that EPAC regulates migration of VSMCs in time- and concentration-dependent manner, yet its precise mechanisms of action and its full influence on cellular proliferation remain to be fully characterized.
Research Interests:
Short report Open Access Marsha B. Novick 1†* , Erik Lehman 2† and Ronald J. Williams 3† Abstract Background : Summertime is particularly problematic for obese youth, as this unstructured time typically shows accelerated weight gain. We... more
Short report Open Access Marsha B. Novick 1†* , Erik Lehman 2† and Ronald J. Williams 3† Abstract Background : Summertime is particularly problematic for obese youth, as this unstructured time typically shows accelerated weight gain. We hypothesized that obese adolescents participating in a pilot summer camp program, developed in partnership with the Boy Scouts of America, would demonstrate significant weight loss and improvement of metabolic parameters. Methods : Obese and overweight adolescent males between ages 13 and 18 were eligible for enrollment. BMI (kg/m²) and additional anthropometric and metabolic measurements were measured at the start and end of the 4 week camp. Results : Thirteen participants enrolled and ten participants with the mean age of 16.1 years finished camp. Among these ten participants, BMI decreased by 9.1% (40.2±13.0 kg/m² vs. 36.5±12.0 kg/m²; p<0.001). Waist circumference decreased by 7.4% (48.4±9.6 cm vs. 44.9±9.4 cm; p<0.001), and fasting glucose levels decreased by 23.1% (84 mg/dL vs. 62 mg/dL; p=0.001). Conclusions : BMI and metabolic parameters significantly improved after 4 weeks of camp. Partnering with the Boy Scouts of America is an innovative approach to creating a summer weight management camp for adolescents
Research Interests:
Background: The responses to the use of neuromuscular electrical stimulation (NMES) technique, once or twice a day, are not well described in literature. In this direction, we measured the biomechanical properties and morphological... more
Background: The responses to the use of neuromuscular electrical stimulation (NMES) technique, once or twice a day, are not well described in literature. In this direction, we measured the biomechanical properties and morphological responses of NMES, applied once or twice a day to the gastrocnemius muscle of female rats after cast immobilization in comparison with both sham control and immobilized control groups. Methods: Eighty Female Wistar rats (Body mass±SDg; 210±10g) were divided into five groups: Control (CG); Immobilized (IG); Immobilized then freed (IFG); Immobilized and subjected to NMES once a day (1ESIG) and another twice a day (2ESIG). All groups that suffered cast immobilization were kept in a shortened position for fourteen days, and then NMES was applied once or twice a day for ten consecutive days. The assessments included the mechanical properties of load and elongation at the limit of proportionality, as well as the resilience obtained from the load versus elongation graph. The crosssectional area (CSA), the different fiber type proportions and the perimisial connective area were measured. Results: There was restoration of load at the limit of proportionality (LLP), but not resilience, in the 1ESIG and 2ESIG, as well as restoration of atrophy (CSA) of type I (TIF), type IIad (TIIadF) and type IId (TIIdF) fibers in the 1ESIG, but not in the 2ESIG. An induction of the TIIcF proportions in the 1ESIG and 2ESIG, and a reduction of the TIIad in the 1ESIG were verified. Conclusions: The muscle remobilization intensity can, influence the recovery responses postimmobilization either positively or negatively, for it was observed that NMES once a day can recover most mechanical (except resilience) and structural parameters of gastrocnemius muscle after casting, whereas twice daily, promoted deleterious effects to the much clearer muscles. Moreover, the animals` free movement allowed them to identify their own mobilization limits, which did not cause neither mechanical nor structural overload in the evaluated muscles.
Research Interests:
Liriodendron tulipifera L., is a wide-spread, fast-growing pioneering tree species native to eastern North America. Commonly known as yellow-poplar, tulip tree, or tulip-poplar, the species is valued, both ecologically and economically.... more
Liriodendron tulipifera L., is a wide-spread, fast-growing pioneering tree species native to eastern North America. Commonly known as yellow-poplar, tulip tree, or tulip-poplar, the species is valued, both ecologically and economically. It is perhaps the most commonly used utility hardwood in the USA, and is planted widely for reforestation and, in varietal forms, as an ornamental. Although most seedlings used for reforestation today derive from collections in natural populations, two known seed orchards, established from plus-tree selections, i.e. superior phenotypes, in the 1960’s and 1970’s have been used for local and regional planting needs in Tennessee and South Carolina. However, very little is known about the population genetics of yellow-poplar nor the genetic composition of the existing seed orchards. In this study, 194 grafted yellow-poplar trees from a Clemson, SC orchard and a Knoxville, TN orchard were genetically characterized with 15 simple sequence repeat (SSR) markers developed from expressed sequence tags (ESTs). Of the 15 EST-SSR markers, 14 had a polymorphic information content (PIC) of at least 0.5. There was no significant difference between the Clemson and Knoxville orchards in average effective number of alleles (5.93 vs 3.95), observed and expected heterozygosity (Ho: 0.64 vs 0.58; He: 0.74 vs 0.70), Nei’s expected heterozygosity (0.74 vs 0.58), or Shannon’s Information index (1.84 vs 1.51). The larger Clemson orchard exhibited a significantly greater number of observed alleles than the Knoxville orchard (15.3 vs7.4). Overall, substantial genetic diversity is captured in the Clemson and Knoxville orchards.
Research Interests:
Background: B-cell chronic lymphocytic leukemia is the most frequent leukemia in the western world while T-cell large granular lymphocytic leukemia with cytotoxic (CD8+/CD3+CD4- ) immunophenotype is rare. There is much ongoing interest... more
Background: B-cell chronic lymphocytic leukemia is the most frequent leukemia in the western world while
T-cell large granular lymphocytic leukemia with cytotoxic (CD8+/CD3+CD4-
) immunophenotype is rare.
There is much ongoing interest regarding the interaction between T cells and B-cell chronic lymphocytic
leukemia cells.
Methods: Peripheral blood and bone marrow samples from a 72 year-old-man with a simultaneous presence
of these two types of leukemia were examined and analyzed by conventional morphology, flow cytometry,
immunohistochemistry, chromosomal study, and molecular studies.
Results: Flow cytometric analysis of the bone marrow aspirate documented B-cell chronic lymphocytic
leukemia, CD3+ CD8+ T-cell large granular lymphocytic leukemia, and demonstrated the presence of three
subpopulations of CD8+ T-cells with transitional immunophenotypes between that of benign and malignant
CD8+ T-cells.
Conclusions: We report the first case of simultaneous presence of B-cell chronic lymphocytic leukemia and
T-cell large granular lymphocytic leukemia with cytotoxic (CD8+/CD3+/CD4-
) immunophenotype. The
simultaneous presence of together with the three immunophenotypically different subpopulations of CD3+
CD8+ T-cells indicated an ongoing stepwise malignant transformation of large granular lymphocytes late
in the 9-year-course of B-cell chronic lymphocytic leukemia. We propose that chronic antigenic stimulation
by B-cell chronic lymphocytic leukemia cells and immune deficiency inherent to B-cell chronic lymphocytic
leukemia additionally augmented by treatment with fludarabine, may cause development of T-cell large
granular lymphocytic leukemia.
T-cell large granular lymphocytic leukemia with cytotoxic (CD8+/CD3+CD4-
) immunophenotype is rare.
There is much ongoing interest regarding the interaction between T cells and B-cell chronic lymphocytic
leukemia cells.
Methods: Peripheral blood and bone marrow samples from a 72 year-old-man with a simultaneous presence
of these two types of leukemia were examined and analyzed by conventional morphology, flow cytometry,
immunohistochemistry, chromosomal study, and molecular studies.
Results: Flow cytometric analysis of the bone marrow aspirate documented B-cell chronic lymphocytic
leukemia, CD3+ CD8+ T-cell large granular lymphocytic leukemia, and demonstrated the presence of three
subpopulations of CD8+ T-cells with transitional immunophenotypes between that of benign and malignant
CD8+ T-cells.
Conclusions: We report the first case of simultaneous presence of B-cell chronic lymphocytic leukemia and
T-cell large granular lymphocytic leukemia with cytotoxic (CD8+/CD3+/CD4-
) immunophenotype. The
simultaneous presence of together with the three immunophenotypically different subpopulations of CD3+
CD8+ T-cells indicated an ongoing stepwise malignant transformation of large granular lymphocytes late
in the 9-year-course of B-cell chronic lymphocytic leukemia. We propose that chronic antigenic stimulation
by B-cell chronic lymphocytic leukemia cells and immune deficiency inherent to B-cell chronic lymphocytic
leukemia additionally augmented by treatment with fludarabine, may cause development of T-cell large
granular lymphocytic leukemia.
Research Interests:
Oral cancer, ranking sixth in the cancer incidence worldwide, is one of the most common neoplasms. Preneoplastic or premalignant (precancerous) lesions are lesions that can potentially transform into malignancy in a variety of tissues,... more
Oral cancer, ranking sixth in the cancer incidence worldwide, is one of the most common neoplasms. Preneoplastic or premalignant (precancerous) lesions are lesions that can potentially transform into malignancy in a variety of tissues, including the oral cavity. Such oral lesions may be caused by tobacco use, exposure to the human papillomavirus and chewing of the betel nut. These substances contain carcinogens and/or tumor promoters. The mucosa of the oral cavity is covered with squamous epithelium and is relatively resistant to injury. However, exposure to these substances can cause the mucosa to undergo changes. The changes are usually initiated by a leukoplakic patch. While some leukoplakic patches recover and resolve, others progress to squamous cell carcinoma with or without invasion. Other premalignant lesions include oral submucous fibrosis, which is a potentially malignant condition caused by the abuse of the betel nut. Understanding the histology, premalignant states and molecular mechanisms of oral carcinogenesis may facilitate the development of novel strategies for the prevention and treatment of oral cancer. In addition, early detection is of critical importance to improve the survival rates of patients with oral cancer. In this review, we will summarize these aspects of oral cancer development, beginning from the histology of the oral cavity.
Research Interests:
Transverse vaginal septum is a rare condition that results from abnormalities in the vertical fusion between the vaginal components of the Mullerian ducts and the urogenital sinus. Associated menouria as a result of a fistulous connection... more
Transverse vaginal septum is a rare condition that results from abnormalities in the vertical fusion between the vaginal components of the Mullerian ducts and the urogenital sinus. Associated menouria as a result of a fistulous connection of the vagina with the bladder is even rarer. A case is presented of a 22 year old unmarried woman who in addition to presenting with primary amenorrhea, complete transverse vaginal septum and cyclic hematuria, also had unilateral renal agenesis and a corrected congenital imperforate anus. A surgical correction is described as well as simple measures during follow-up that ensured non-contracture of the excision site. The fistulous connection between the bladder and upper vagina closed spontaneously. The patient has since been having normal menses for the past 15 months with no associated hematuria. The vagina has remained patent since. We conclude that for cases of transverse vaginal septum associated with menouria excision of the septum that ensures normal outflow of menstrual blood is sufficient to facilitate spontaneous closure of the fistulous connection between the bladder and vagina.
Research Interests:
Manual therapies are frequently recommended to improve post-surgical scar pliability, e.g., its elasticity and glide capacity with respect to the underlying tissue. A significant percentage of scars are pathological, causing pain,... more
Manual therapies are frequently recommended to improve post-surgical scar pliability, e.g., its elasticity and glide capacity with respect to the underlying tissue. A significant percentage of scars are pathological, causing pain, functional/psychological disorders, or cosmetic damage. Hence, early identification of a pathological post-surgical scar is crucial for prompt treatment so as to optimize and evaluate outcome. Scar assessment tools provide data on objective parameters as the basis for planning treatment. While the published literature contains many reviews on validated tools for post-surgical scar assessment, none specifically analyzes tools for use in the rehabilitative setting. The aim of this focused review was thus to illustrate the tools-instruments, scales and questionnaires-validated to assess post-surgical scar pliability in rehabilitation. A literature search was conducted on articles published in journals indexed by PubMed before October 15, 2014. The literature search produced 72 papers, 6 of which met our inclusion criteria. These 6 articles deal with the validation of 5 different tools to assess post-surgical scar. Three are devices aimed to assess different pliability characteristics: Adheremeter (degree of scar adherence), Cutometer (elasticity), and Tissue Ultrasound Palpation System (scar thickness). The other two are rating scales developed for general scar assessment (Vancouver Scar Scale, and Patient and Observer Scar Assessment Scale). As the efficacy of manual therapy on post-surgical scar is still debated, it is desirable that in the future increasing use be made of validated tools as outcome measures of the rehabilitation treatment.
Research Interests:
Background: Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disease of the central nervous system that most commonly afflicts children and young adults and may be rarely seen in renal transplant patients. Most cases... more
Background: Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disease of the central nervous system that most commonly afflicts children and young adults and may be rarely seen in renal transplant patients. Most cases resolve with medical management; however, in some instances, the initial episode may evolve into a fulminant illness with malignant cerebral edema and elevated intracranial pressure that can result in a herniation syndrome with possible fatal consequences. Immediate relief of intracranial pressure is a priority and medical therapies alone may not suffice or may be precluded by compromised renal function.
Case description: A case is presented of fulminant ADEM in a pediatric renal transplant patient associated with intracranial hypertension and an acute herniation syndrome with rapid neurological decline that was effectively treated with a decompressive craniectomy. The procedure was life-saving and resulted in a favorable outcome without inflicting any additional morbidity.
Conclusion: Decompressive craniectomy is an effective way to rapidly reduce intracranial pressure in patients with malignant cerebral edema associated with fulminant ADEM and rapid neurological decline.
Keywords: ADEM, cerebral edema, herniation, renal transplant, craniectomy
Case description: A case is presented of fulminant ADEM in a pediatric renal transplant patient associated with intracranial hypertension and an acute herniation syndrome with rapid neurological decline that was effectively treated with a decompressive craniectomy. The procedure was life-saving and resulted in a favorable outcome without inflicting any additional morbidity.
Conclusion: Decompressive craniectomy is an effective way to rapidly reduce intracranial pressure in patients with malignant cerebral edema associated with fulminant ADEM and rapid neurological decline.
Keywords: ADEM, cerebral edema, herniation, renal transplant, craniectomy
Research Interests:
We reviewed 1,152 patients with bleeding gastric ulcer treated at our institution between 1987 and 2011. Of these, 1,026 patients (89.1%) underwent endoscopic hemostasis. Forrest classification for bleeding ulcers in these cases was as... more
We reviewed 1,152 patients with bleeding gastric ulcer treated at our institution between 1987 and 2011. Of these, 1,026 patients (89.1%) underwent endoscopic hemostasis. Forrest classification for bleeding ulcers in these cases was as follows: Ia, 188 patients (18.3%); Ib, 114 patients (11.1%); and IIa, 665 patients (64.8%). Endoscopic treatment proved successful in 1,023 patients (99.7%), including 70 patients (6.8%) who experienced re-bleeding. There were 19 deaths (1.9%), and 3 patients (0.3%) underwent surgical procedures. No surgical procedures were performed after 1994.
Keywords: Hemorrhagic gastric ulcer, endoscopic hemostasis, upper gastrointestinal hemorrhage, heater probe coagulation
Keywords: Hemorrhagic gastric ulcer, endoscopic hemostasis, upper gastrointestinal hemorrhage, heater probe coagulation
Research Interests:
Abstract Cellular Schwannoma (CS) is a well-recognized morphological variant of schwannoma, which has been reported in many usual and unusual sites. We herein report a rare case of a bulky, retroperitoneal cellular schwannoma showing... more
Abstract
Cellular Schwannoma (CS) is a well-recognized morphological variant of schwannoma, which has
been reported in many usual and unusual sites. We herein report a rare case of a bulky, retroperitoneal
cellular schwannoma showing challenging radiological and morphological features. Due to large size
and ill-defined margins at CT examination a malignant soft tissue tumor (sarcoma) was suggested. At
histological examination high cellularity and co-existence of several growth patterns, such as fascicular,
storiform and herringbone patterns, contributed to make difficult its recognition as schwannoma. The
present case emphasizes the possibility that retroperitoneal CS can represent a potential diagnostic pitfall
of malignancy. Awareness of the possibility that this unusual variant of schwannoma may occur in the
retroperitoneum is crucial to avoid potential confusion with malignant tumors, especially when evaluating
small biopsies.
Keywords: Cellular schwannoma, retroperitoneum, imaging, sarcoma, immunohistochemistry
Cellular Schwannoma (CS) is a well-recognized morphological variant of schwannoma, which has
been reported in many usual and unusual sites. We herein report a rare case of a bulky, retroperitoneal
cellular schwannoma showing challenging radiological and morphological features. Due to large size
and ill-defined margins at CT examination a malignant soft tissue tumor (sarcoma) was suggested. At
histological examination high cellularity and co-existence of several growth patterns, such as fascicular,
storiform and herringbone patterns, contributed to make difficult its recognition as schwannoma. The
present case emphasizes the possibility that retroperitoneal CS can represent a potential diagnostic pitfall
of malignancy. Awareness of the possibility that this unusual variant of schwannoma may occur in the
retroperitoneum is crucial to avoid potential confusion with malignant tumors, especially when evaluating
small biopsies.
Keywords: Cellular schwannoma, retroperitoneum, imaging, sarcoma, immunohistochemistry
Research Interests:
Abstract The authors describe a case of congenital lobar emphysema in child at the age of 45 days and discuss the clinical manifestations as well as the features of histological diagnostic of the disease. This case is of particular... more
Abstract
The authors describe a case of congenital lobar emphysema in child at the age of 45 days and discuss the
clinical manifestations as well as the features of histological diagnostic of the disease. This case is of particular
interest because of the rarity of the pathology as well as the fact that congenital lobar emphysema developed
as a result of combination of two anomalies of the bronchi: mucosal folding and muscular layer hypoplasia.
Keywords: Congenital lobar emphysema, clinical manifestation, muscular layer hypoplasia, lung
malformation
The authors describe a case of congenital lobar emphysema in child at the age of 45 days and discuss the
clinical manifestations as well as the features of histological diagnostic of the disease. This case is of particular
interest because of the rarity of the pathology as well as the fact that congenital lobar emphysema developed
as a result of combination of two anomalies of the bronchi: mucosal folding and muscular layer hypoplasia.
Keywords: Congenital lobar emphysema, clinical manifestation, muscular layer hypoplasia, lung
malformation
Research Interests:
Abstract Adipose-derived stem cells are a kind of mesenchymal stem cells which have a higher frequency in the adipose tissue and can be harvested by minimally invasive procedures. These cells are able to differentiate into other cells... more
Abstract
Adipose-derived stem cells are a kind of mesenchymal stem cells which have a higher frequency in the
adipose tissue and can be harvested by minimally invasive procedures. These cells are able to differentiate
into other cells outside their lineage such as neuron, neurotrophic factor secreting cells and Schwann cells.
Many of the identified neurotrophic factors such as brain-derived neurotrophic factor, nerve growth factor,
and glial cell line-derived neurotrophic factor can be produced by adipose-derived stem cells. In addition,
these cells when differentiated into neurotrophic factor secreting cells are able to secrete a significantly
high level of these factors. Neurotrophic factors have a significant role in cellular processes include cell
proliferation, differentiation and maturation. This article reviews the in vitro differentiation of adiposederived
stem cells into neural lineage cells and clinical application.
Keywords: Adipose-derived stem cells, neurogenic differentiation, schwann cells, neurotrophic factor
secreting cells
Adipose-derived stem cells are a kind of mesenchymal stem cells which have a higher frequency in the
adipose tissue and can be harvested by minimally invasive procedures. These cells are able to differentiate
into other cells outside their lineage such as neuron, neurotrophic factor secreting cells and Schwann cells.
Many of the identified neurotrophic factors such as brain-derived neurotrophic factor, nerve growth factor,
and glial cell line-derived neurotrophic factor can be produced by adipose-derived stem cells. In addition,
these cells when differentiated into neurotrophic factor secreting cells are able to secrete a significantly
high level of these factors. Neurotrophic factors have a significant role in cellular processes include cell
proliferation, differentiation and maturation. This article reviews the in vitro differentiation of adiposederived
stem cells into neural lineage cells and clinical application.
Keywords: Adipose-derived stem cells, neurogenic differentiation, schwann cells, neurotrophic factor
secreting cells
Research Interests:
Abstract Background: Autoimmune pancreatitis (AIP) can present as pancreatic mass mimicking malignancy. However, it has specific histomorphology and immunohistology which in clinical context can be diagnostic. Aim: To retrospectively... more
Abstract
Background: Autoimmune pancreatitis (AIP) can present as pancreatic mass mimicking malignancy.
However, it has specific histomorphology and immunohistology which in clinical context can be
diagnostic.
Aim: To retrospectively analyze pancreatic resections done for pancreatic head masses to identify
cases of autoimmune pancreatitis.
Methods: Hematoxylin and eosin stained slides of pancreatic resections (n-142) done for pancreatic
masses (2004-2012) were reviewed. Immunohistochemistry for IgG4 was done in cases suggestive
of AIP. As controls, 30 pancreatic carcinomas (n-30) and plasma cells rich chronic pancreatitis (n-
25) were stained with IgG4. Clinical records were retrieved.
Results: There were 5/142 cases (3.5%) of autoimmune pancreatitis among pancreatic resections done
for presumed pancreatic tumors. There were 3 females and 2 males and age range was 35-65 (mean
51). Presenting symptoms were painless jaundice (n-4), with adult onset diabetes (n-1) and feature of
gastric outlet obstruction (n-1). Histomorphology of all the five masses was of Type I autoimmune
pancreatitis showing lobulocentric plasma cell rich inflammation and storiform fibrosis. IgG4
positive plasma cells (>10 per high power field) in all the cases diagnosed as autoimmune pancreatitis;
though few IgG4 positive plasma cells were positive in controls. Venulitis and veno-oblitrative changes,
neural hyperplasia, neuritis were present in all. Serum IgG4 levels done immediately after surgeries
in three patients were elevated.
Conclusion: Incidence of autoimmune pancreatitis in pancreatic resections done for pancreatic
masses is 3.5%. All the five cases were of Type 1 autoimmune pancreatitis with significant number
of IgG4 positive plasma cells using >10 positive cells per high power field as cut off.
Keywords: Autoimmune, IgG4 positive plasma cells, pancreatitis, pancreatic masses
Background: Autoimmune pancreatitis (AIP) can present as pancreatic mass mimicking malignancy.
However, it has specific histomorphology and immunohistology which in clinical context can be
diagnostic.
Aim: To retrospectively analyze pancreatic resections done for pancreatic head masses to identify
cases of autoimmune pancreatitis.
Methods: Hematoxylin and eosin stained slides of pancreatic resections (n-142) done for pancreatic
masses (2004-2012) were reviewed. Immunohistochemistry for IgG4 was done in cases suggestive
of AIP. As controls, 30 pancreatic carcinomas (n-30) and plasma cells rich chronic pancreatitis (n-
25) were stained with IgG4. Clinical records were retrieved.
Results: There were 5/142 cases (3.5%) of autoimmune pancreatitis among pancreatic resections done
for presumed pancreatic tumors. There were 3 females and 2 males and age range was 35-65 (mean
51). Presenting symptoms were painless jaundice (n-4), with adult onset diabetes (n-1) and feature of
gastric outlet obstruction (n-1). Histomorphology of all the five masses was of Type I autoimmune
pancreatitis showing lobulocentric plasma cell rich inflammation and storiform fibrosis. IgG4
positive plasma cells (>10 per high power field) in all the cases diagnosed as autoimmune pancreatitis;
though few IgG4 positive plasma cells were positive in controls. Venulitis and veno-oblitrative changes,
neural hyperplasia, neuritis were present in all. Serum IgG4 levels done immediately after surgeries
in three patients were elevated.
Conclusion: Incidence of autoimmune pancreatitis in pancreatic resections done for pancreatic
masses is 3.5%. All the five cases were of Type 1 autoimmune pancreatitis with significant number
of IgG4 positive plasma cells using >10 positive cells per high power field as cut off.
Keywords: Autoimmune, IgG4 positive plasma cells, pancreatitis, pancreatic masses
Research Interests:
Background: In this paper we report the prevalence of copy number aberration events at various stages (subclasses) of breast cancer as assessed by two different statistical methods, GISTIC, a well-known method to identify significant... more
Background: In this paper we report the prevalence of copy number aberration events at various stages (subclasses) of breast cancer as assessed by two different statistical methods, GISTIC, a well-known method to identify significant somatic copy-number alterations in a given set and GISDIP: Genomic Identification of Significant Differences in Progression, a newly developed numerical algorithm described here to compare different sets.
Methods: GISTIC assesses significant aberrations towards whole genomic location for each stage and GISDIP assesses significant difference towards whole genomic location for two stages pair-wise.
Results: We compare GISDIP with the original GISTIC by a simulation study. Comparing with the focal/broad regions obtained by GISTIC, GISDIP can directly illustrate significantly different regions between different stages. We then performed experimental data analyses and identified all significant aberrations at each stage of breast cancer using GISTIC and identified the peaks significant for each stage/tumour category. Then we applied GISDIP to identify the significant differences between the tumour size categories in progression. The significance was assessed by permuting the data across all samples in all stages. The statistically significant copy number aberrations specific for the various stages are presented here by both statistics on a set of 530 cases (validation set). The same analysis was performed in subsets of cases according to ER-status. The genes located in the identified regions were investigated by applying network analysis and the list for genomic loci related to allele-specific disparity.
Conclusions: Our method indicates significant particular regions related to difference of copy number aberration between different stages. The particular biological characteristics for network analysis on estimated regions are summarized.
Keywords: DNA copy number alteration, breast cancer, computational algorithm, permutation, false discovery rate, allele-specific disparity
Methods: GISTIC assesses significant aberrations towards whole genomic location for each stage and GISDIP assesses significant difference towards whole genomic location for two stages pair-wise.
Results: We compare GISDIP with the original GISTIC by a simulation study. Comparing with the focal/broad regions obtained by GISTIC, GISDIP can directly illustrate significantly different regions between different stages. We then performed experimental data analyses and identified all significant aberrations at each stage of breast cancer using GISTIC and identified the peaks significant for each stage/tumour category. Then we applied GISDIP to identify the significant differences between the tumour size categories in progression. The significance was assessed by permuting the data across all samples in all stages. The statistically significant copy number aberrations specific for the various stages are presented here by both statistics on a set of 530 cases (validation set). The same analysis was performed in subsets of cases according to ER-status. The genes located in the identified regions were investigated by applying network analysis and the list for genomic loci related to allele-specific disparity.
Conclusions: Our method indicates significant particular regions related to difference of copy number aberration between different stages. The particular biological characteristics for network analysis on estimated regions are summarized.
Keywords: DNA copy number alteration, breast cancer, computational algorithm, permutation, false discovery rate, allele-specific disparity
Research Interests:
Objectives: The aim of this study was to identify and quantify likeness and difference in parent response to anxiety scale, dental knowledge, parent-child communication, and parental dental history. The objective is to determine if... more
Objectives: The aim of this study was to identify and quantify likeness and difference in parent response to anxiety scale, dental knowledge, parent-child communication, and parental dental history. The objective is to determine if relationships exist with these parameters and the need for analgesia and/or sedation in their children.
Methods: A survey-based quality analysis was performed between June 2012 and May 2013 on 126 consecutive parents/guardians of children receiving nitrous oxide administration during dental care within CareSouth Carolina’s Division of Dental Medicine Pediatric Dental Clinic (CSCDM).
Results: A total of 126 questionnaires were completed by the legal guardians of pediatric patients seen for dental care during the administration of nitrous oxide. The mean Corah’s Anxiety Scale score corresponds to moderate anxiety. The mean score for the dental knowledge quiz was 2.98±1.13 out of 5 (59.6%). The majority of parents responded that they discussed a previous dental visit with their child and 41.1% described that visit to their child with negative connotations. A total of 50% of parents reported having a bad dental experience.
Conclusions: The results revealed a shared anxiety with dental care. Pediatric anxiety and fear of dental care is multifactorial and the parents have a significant role in its development. Parents of patients that required referral for a deeper form of sedation may have higher anxiety scores, lower dental knowledge scores, and be more likely to describe a previous dental visit as negative. The communication process between the child-patient and parent can include negative connotations.
Methods: A survey-based quality analysis was performed between June 2012 and May 2013 on 126 consecutive parents/guardians of children receiving nitrous oxide administration during dental care within CareSouth Carolina’s Division of Dental Medicine Pediatric Dental Clinic (CSCDM).
Results: A total of 126 questionnaires were completed by the legal guardians of pediatric patients seen for dental care during the administration of nitrous oxide. The mean Corah’s Anxiety Scale score corresponds to moderate anxiety. The mean score for the dental knowledge quiz was 2.98±1.13 out of 5 (59.6%). The majority of parents responded that they discussed a previous dental visit with their child and 41.1% described that visit to their child with negative connotations. A total of 50% of parents reported having a bad dental experience.
Conclusions: The results revealed a shared anxiety with dental care. Pediatric anxiety and fear of dental care is multifactorial and the parents have a significant role in its development. Parents of patients that required referral for a deeper form of sedation may have higher anxiety scores, lower dental knowledge scores, and be more likely to describe a previous dental visit as negative. The communication process between the child-patient and parent can include negative connotations.
Research Interests:
Aim: The study is to establish basic epidemiological characteristics of patients hospitalized in the Czech Republic with a diagnosis of toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS). Material and methods: This is a... more
Aim: The study is to establish basic epidemiological characteristics of patients hospitalized in the Czech Republic with a diagnosis of toxic epidermal necrolysis (TEN) and Stevens-Johnson syndrome (SJS).
Material and methods: This is a retrospective multicenter study including hospitalized patients in the Czech Republic in the period from 1st January 1994 to 31st December 2010. The basic condition for inclusion in the study is TEN (L512) or SJS (L511) as the primary diagnosis according to International Classification of Diseases 10th version (ICD–10). The two diseases have similar clinical presentations, but have different nosological codes, which were retrieved from our database. Information was obtained from a central data depository-Department of Health Information and Statistics (National Registry of hospitalized patients).
Results: A total of 626 patients were hospitalized in our followed period. Of these, 163 patients were hospitalized with toxic epidermal necrolysis and 463 patients with Stevens-Johnson syndrome. The overall M:F ratio in the sample was 1:1.15. In the group of patients with TEN M:F ratio was 1:1.31 and in the SJS group M:F ratio was 1:1.11. The mean incidence in the period in patients with TEN was 0.93 cases/million inhabitants per year. In patients with SJS, the average incidence was 2.64 cases/million inhabitants per year. The average age was 39.2 years, in patients with TEN it was 40.1 years (SD±21.5) and in patients with SJS 38.4 years (SD±11.98). The average length of hospitalization was 11.3 days. In patients with TEN, the average length of hospitalization was slightly higher (11.8 days (SD±3.11)) when compared with SJS group (10.7 days (SD±6.48)). From the total of 626 patients, 54 patients died. Of these, it was 47 patients with TEN and 7 patients with SJS.
Conclusion: In a retrospective study confirms that SJS and TEN are rare diseases and their incidence in the Czech Republic closer to the results of most large epidemiological studies.
Keywords: Toxic epidermal necrolysis, stevens-Johnson syndrome, inhabitants, Czech Republic
Material and methods: This is a retrospective multicenter study including hospitalized patients in the Czech Republic in the period from 1st January 1994 to 31st December 2010. The basic condition for inclusion in the study is TEN (L512) or SJS (L511) as the primary diagnosis according to International Classification of Diseases 10th version (ICD–10). The two diseases have similar clinical presentations, but have different nosological codes, which were retrieved from our database. Information was obtained from a central data depository-Department of Health Information and Statistics (National Registry of hospitalized patients).
Results: A total of 626 patients were hospitalized in our followed period. Of these, 163 patients were hospitalized with toxic epidermal necrolysis and 463 patients with Stevens-Johnson syndrome. The overall M:F ratio in the sample was 1:1.15. In the group of patients with TEN M:F ratio was 1:1.31 and in the SJS group M:F ratio was 1:1.11. The mean incidence in the period in patients with TEN was 0.93 cases/million inhabitants per year. In patients with SJS, the average incidence was 2.64 cases/million inhabitants per year. The average age was 39.2 years, in patients with TEN it was 40.1 years (SD±21.5) and in patients with SJS 38.4 years (SD±11.98). The average length of hospitalization was 11.3 days. In patients with TEN, the average length of hospitalization was slightly higher (11.8 days (SD±3.11)) when compared with SJS group (10.7 days (SD±6.48)). From the total of 626 patients, 54 patients died. Of these, it was 47 patients with TEN and 7 patients with SJS.
Conclusion: In a retrospective study confirms that SJS and TEN are rare diseases and their incidence in the Czech Republic closer to the results of most large epidemiological studies.
Keywords: Toxic epidermal necrolysis, stevens-Johnson syndrome, inhabitants, Czech Republic
Research Interests:
An innovative micro-scale liquid desiccant dehumidification system is numerically investigated. The liquid desiccant dehumidification unit employs a counter-flow low-cost and efficient heat and mass exchange core, improving the thermal... more
An innovative micro-scale liquid desiccant dehumidification system is numerically investigated. The liquid desiccant dehumidification unit employs a counter-flow low-cost and efficient heat and mass exchange core, improving the thermal performance and eliminating desiccant carryover with the process air. An environmentally friendly, non-corrosive, nontoxic and chemically stable HCOOK potassium formate liquid desiccant solution was employed in the unit. A set of governing differential equations was established for the dehumidification system operation allowing the development of a numerical model to predict and simulate the energy performance and various output parameters of the dehumidifier. A numerical case study was considered for a micro-liquid desiccant dehumidification system using potassium formate and a dehumidification and cooling capacity of around 11.32 kW was attained with about 59% humidity effectiveness and 62% enthalpy effectiveness. In addition, a parametric study was performed to investigate the effect of various operational parameters on the overall performance of the liquid desiccant dehumidifier. Utilizing the developed numerical model, it was shown that the dehumidifier effectiveness is directly proportional to the intake air temperature, intake air relative humidity and liquid desiccant flow rate where the effectiveness is inversely proportional to the intake air velocity and the heat exchanger air channel height.
Keywords: Dehumidification, liquid desiccant, counter-flow, potassium formate, heat and mass exchange, effectiveness
Keywords: Dehumidification, liquid desiccant, counter-flow, potassium formate, heat and mass exchange, effectiveness
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Background: Heart rate variability (HRV) is an effective way to estimate heart rate (HR) autonomic regulation. In some cardiovascular diseases increased sympathetic activity (low frequency spectral power of HRV) was shown to be an... more
Background: Heart rate variability (HRV) is an effective way to estimate heart rate (HR) autonomic regulation. In some cardiovascular diseases increased sympathetic activity (low frequency spectral power of HRV) was shown to be an unfavorable risk factor which could be downregulated by beta-blockers. There are only few data on If-blocker ivabradine impact on HRV parameters and direct comparison between betablockers and ivabradine in relation to HRV was not conducted. The purpose of the study was to compare the impact of If-blocker ivabradine and metoprolol tartrate on autonomic control of nervous system HR control in patients with stable angina pectoris.
Methods: Effects of ivabradine 7.5 mg and 50 mg metoprolol tartrate HRV were estimated in 33 patients with angina pectoris in the open-labeled randomized, controlled, crossover design and acute pharmacological test study. HRV was determined for 10 minutes in supine position before and after 4h the each test drug according to randomization.
Results: Equal negative chronotropic impact for ivabradine and metoprolol was shown, the effect increased with HR upraise and was positively correlated with baseline HR. Both ivabradine and metoprolol produced downregulating effect of sympathetic tone, but the effect of ivabradine was more significant. However, metoprolol decreased the total power parameter and the value of adaptation.
Conclusions: In patients with angina pectoris If-blocker ivabradine downregulation of sympathetic status in comparison with beta-blocker metoprolol tartrate effect was firstly shown.
Methods: Effects of ivabradine 7.5 mg and 50 mg metoprolol tartrate HRV were estimated in 33 patients with angina pectoris in the open-labeled randomized, controlled, crossover design and acute pharmacological test study. HRV was determined for 10 minutes in supine position before and after 4h the each test drug according to randomization.
Results: Equal negative chronotropic impact for ivabradine and metoprolol was shown, the effect increased with HR upraise and was positively correlated with baseline HR. Both ivabradine and metoprolol produced downregulating effect of sympathetic tone, but the effect of ivabradine was more significant. However, metoprolol decreased the total power parameter and the value of adaptation.
Conclusions: In patients with angina pectoris If-blocker ivabradine downregulation of sympathetic status in comparison with beta-blocker metoprolol tartrate effect was firstly shown.
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Objectives: The aim of this study was to measure the occurrence of acute exacerbations of asthma at an Emergency Health Facility for the period 2010-12, and to describe its spatial distribution using ARC GIS 10.0 (ESRI). Design: The... more
Objectives: The aim of this study was to measure the occurrence of acute exacerbations of asthma at an Emergency Health Facility for the period 2010-12, and to describe its spatial distribution using ARC GIS 10.0 (ESRI).
Design: The study design is an observational cross sectional study in which cases of acute exacerbations of asthma treated at an Emergency Department of a semi rural 24hr health facility were reviewed. The address of each patient was geocoded and mapped.
Setting: An emergency health facility offering 24x7 service.
Participants: All patients who met the criteria for an acute exacerbation of asthma during the period 2010-12.
Main outcome measures: The occurrence and geographic distribution of asthma presenting for rescue therapy.
Results: The number of cases of acute exacerbations asthma increased in each consecutive year. Spatially, while the geographical distribution of cases was diffuse we identified a cluster (Valencia). Using spatial overlay there was a correlation with temperature and humidity.
Conclusions: Over the three year period 2010-2012 there was an increase in the occurrence of acute exacerbations of asthmatic requiring emergency care, emphasizing that Asthma is still an important Public Health challenge.
Keywords: Asthma, GIS, emergency admissions, trends
Design: The study design is an observational cross sectional study in which cases of acute exacerbations of asthma treated at an Emergency Department of a semi rural 24hr health facility were reviewed. The address of each patient was geocoded and mapped.
Setting: An emergency health facility offering 24x7 service.
Participants: All patients who met the criteria for an acute exacerbation of asthma during the period 2010-12.
Main outcome measures: The occurrence and geographic distribution of asthma presenting for rescue therapy.
Results: The number of cases of acute exacerbations asthma increased in each consecutive year. Spatially, while the geographical distribution of cases was diffuse we identified a cluster (Valencia). Using spatial overlay there was a correlation with temperature and humidity.
Conclusions: Over the three year period 2010-2012 there was an increase in the occurrence of acute exacerbations of asthmatic requiring emergency care, emphasizing that Asthma is still an important Public Health challenge.
Keywords: Asthma, GIS, emergency admissions, trends
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Background: An altered pain perception is a common clinical feature in patients with depressive disorders. However, the question of how listening to music influences pain perception in subjects with depression has not yet been studied.... more
Background: An altered pain perception is a common clinical feature in patients with depressive disorders. However, the question of how listening to music influences pain perception in subjects with depression has not yet been studied.
Aims: The aim of the study was to test the hypothesis that music reduces the severity of pain in patients with depressive disorders. For the investigation the tonic heat pain model was used as it is suitable to simulate chronic pain.
Methods: Repeated measurement design on n=20 patients with a depressive disorder (mean age 49±14 years). Subjective pain ratings were assessed two times without and once with music, each trial lasted 5 minutes with measurements taken every minute.
Results: Under the influence of music the patients showed significantly reduced pain ratings compared to the trial without music (p<0.05). Conclusions: The use of music appears to be effective on pain symptomatology in patients suffering from depressive disorders. Further studies are warranted to examine the use of music within a therapeutic context.
Keywords: Music, pain, depression, tonic heat, therapy
Aims: The aim of the study was to test the hypothesis that music reduces the severity of pain in patients with depressive disorders. For the investigation the tonic heat pain model was used as it is suitable to simulate chronic pain.
Methods: Repeated measurement design on n=20 patients with a depressive disorder (mean age 49±14 years). Subjective pain ratings were assessed two times without and once with music, each trial lasted 5 minutes with measurements taken every minute.
Results: Under the influence of music the patients showed significantly reduced pain ratings compared to the trial without music (p<0.05). Conclusions: The use of music appears to be effective on pain symptomatology in patients suffering from depressive disorders. Further studies are warranted to examine the use of music within a therapeutic context.
Keywords: Music, pain, depression, tonic heat, therapy
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Periodontal disease has been associated as a co-contributor for cardiovascular disease. Inflammatory markers such as lipoprotein-associated phospholipase A2 (Lp-PLA2) demonstrate an increased risk of heart attack and ischemic stroke. It... more
Periodontal disease has been associated as a co-contributor for cardiovascular disease. Inflammatory markers such as lipoprotein-associated phospholipase A2 (Lp-PLA2) demonstrate an increased risk of heart attack and ischemic stroke. It is not known to what extent treating periodontal disease may affect changes in Lp-PLA2 levels. This case report discussed treating patients periodontal conditions with the Perio Protect Method (PPM) and evaluating systemic Lp-PLA2 levels, before, during and after periodontal treatment. This pilot study demonstrates that treating the patient’s periodontal conditions resulted in decreasing the periodontal markers and lowering the Lp-PLA2 levels and these findings may be important as an adjunct of cardiovascular treatment.
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Background: Longitudinal clinical trial has measurements at successive occasions, and unavailability of patient at a scheduled visit causes missingness in expected full sequence of the measurements. Missing data is a major concern during... more
Background: Longitudinal clinical trial has measurements at successive occasions, and unavailability of patient at a scheduled visit causes missingness in expected full sequence of the measurements. Missing data is a major concern during the conduct of a clinical trial. It has been noted that missing data are not handled properly during final analysis which may considerably bias the results of analysis, reduce the power of the study and lead to invalid conclusions. A promising approach to handle this problem is to impute the missing values.
Methods: Multiple imputation (MI) methods provide a useful strategy to deal with the data sets with missing values, where missing values are filled in by estimate and the resulting data sets are analyzed by complete data methods. Statistical methods to address missingness have been actively pursued in recent years. This paper has attempted to provide a description of missing data mechanism and various imputation techniques for missing data analysis in longitudinal clinical trials. Further, the appropriateness of multiple imputation methods has been discussed under moderate to large proportion of missingness in a simulated clinical trial data, by comparing the various performance measures derived through intensive simulation procedure.
Results: For moderate proportion (~20 & 30%) of missingness MI-regression method scored minimum bias and MSE with increase in the sample size. However, other methods did not improve much despite increased sample size. For large proportion (50%) of missing data, MI-regression and MI-propensity score methods were close in performance but MI-regression method performed significantly well with increased number of subjects in the dataset.
Conclusions: Present investigation showed that MI-regression method is most appropriate for the analysis of data in presence of missingness with discussed sample size and missingness mechanism. Overall, the study findings will help researchers having limited knowledge of statistical methodology to choose a multiple imputation method accordingly, so that achieved estimates will be more precised.
Keywords: Missing data, missing mechanism, longitudinal data, multiple imputation
Methods: Multiple imputation (MI) methods provide a useful strategy to deal with the data sets with missing values, where missing values are filled in by estimate and the resulting data sets are analyzed by complete data methods. Statistical methods to address missingness have been actively pursued in recent years. This paper has attempted to provide a description of missing data mechanism and various imputation techniques for missing data analysis in longitudinal clinical trials. Further, the appropriateness of multiple imputation methods has been discussed under moderate to large proportion of missingness in a simulated clinical trial data, by comparing the various performance measures derived through intensive simulation procedure.
Results: For moderate proportion (~20 & 30%) of missingness MI-regression method scored minimum bias and MSE with increase in the sample size. However, other methods did not improve much despite increased sample size. For large proportion (50%) of missing data, MI-regression and MI-propensity score methods were close in performance but MI-regression method performed significantly well with increased number of subjects in the dataset.
Conclusions: Present investigation showed that MI-regression method is most appropriate for the analysis of data in presence of missingness with discussed sample size and missingness mechanism. Overall, the study findings will help researchers having limited knowledge of statistical methodology to choose a multiple imputation method accordingly, so that achieved estimates will be more precised.
Keywords: Missing data, missing mechanism, longitudinal data, multiple imputation
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Introduction: The study aimed to explore the impact of the use of music in the everyday life of those dependent on substance abuse. Methods: A psychiatric population (n=190; 111 female; mean age of 37.4±13.3 years) was examined using the... more
Introduction: The study aimed to explore the impact of the use of music in the everyday life of those dependent on substance abuse.
Methods: A psychiatric population (n=190; 111 female; mean age of 37.4±13.3 years) was examined using the IAAM (inventory for the assessment of activation and arousal modulation through music) to measure the situation-dependent everyday life use of music, the SKI (self-concept inventory) for personality dimensions and the GAF score (Global assessment of functioning). Group differences of patients with and without substance abuse were assessed.
Results: Substance abuse was identified in 28 patients (14.7%). Patients of this group showed a lower functioning level (p=0.045) and reported they listened more to music for relaxation (p=0.018) and cognitive problem solving (p=0.047), more under the influence of psychotropic drugs (p<0.003) and–after the onset of the mental disorder–more to loud music (p=0.005) than patients without substance abuse (n=162).
Discussion and conclusion: Psychiatric patients with substance abuse use music particularly to reduce negative emotions compared to psychiatric patients without substance abuse. This result can be discussed on the basis of the reward system which is influenced by both psychotropic substances as well as by music. The results have a substantial relevant clinical impact and therapeutic conclusions have been drawn. Further studies are warranted.
Keywords: Music, emotion modulation, mental disorders, addiction disorders, cognition, arousal, reward system
Methods: A psychiatric population (n=190; 111 female; mean age of 37.4±13.3 years) was examined using the IAAM (inventory for the assessment of activation and arousal modulation through music) to measure the situation-dependent everyday life use of music, the SKI (self-concept inventory) for personality dimensions and the GAF score (Global assessment of functioning). Group differences of patients with and without substance abuse were assessed.
Results: Substance abuse was identified in 28 patients (14.7%). Patients of this group showed a lower functioning level (p=0.045) and reported they listened more to music for relaxation (p=0.018) and cognitive problem solving (p=0.047), more under the influence of psychotropic drugs (p<0.003) and–after the onset of the mental disorder–more to loud music (p=0.005) than patients without substance abuse (n=162).
Discussion and conclusion: Psychiatric patients with substance abuse use music particularly to reduce negative emotions compared to psychiatric patients without substance abuse. This result can be discussed on the basis of the reward system which is influenced by both psychotropic substances as well as by music. The results have a substantial relevant clinical impact and therapeutic conclusions have been drawn. Further studies are warranted.
Keywords: Music, emotion modulation, mental disorders, addiction disorders, cognition, arousal, reward system
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The UK food chain was responsible for 18% of the total UK energy use and produced 32% of the country’s greenhouse gas (GHG) emissions in 2011. The holistic food chain is estimated to produce around 15Mt of post-farm gate food waste,... more
The UK food chain was responsible for 18% of the total UK energy use and produced 32% of the country’s greenhouse gas (GHG) emissions in 2011. The holistic food chain is estimated to produce around 15Mt of post-farm gate food waste, corresponding to 15% of overall food purchases. The UK Waste and Resources Action Programme (WRAP) estimates that post-farm gate food waste is responsible for more than 20MtCO2e emissions, making 12% of total direct food chain emissions. The majority of post-farm gate food waste comes from households (7.2Mt) and the manufacturing sector (3.2Mt). This waste is largely disposed to landfill. The agricultural sector was found to account for approximately 90Mt of organic material waste, mostly in the form of manures and slurries. In addition to contributing to GHG emissions, wastes also depict a financial and resource flow weakness in the economy. As a result, the UK government is actively promoting energy recovery from waste, particularly through Anaerobic Digestion (AD) systems. This paper explores the energy generation potential of food-chain wastes (i.e., food and manure/slurry wastes) employed in AD systems to produce biogas, which is in turn used in combinations of Combined Heat and Power (CHP) and Organic Rankine Cycle (ORC) systems to generate power. Future scenarios on the amount of wastes are developed, and the relative potential of the technologies are investigated. The addition of ORC system with conventional CHP systems have shown to increase the electricity generation potential, at the expense of heat generation. The impacts of the implementation of these technologies are determined from observable trends in the literature, and are intended to be illustrative rather than predictive. For the case of this paper, the ‘Gas Turbine CHP with High-Grade ORC’ has shown the highest energy generation potential upto 2050 for the UK economy.
Keywords: Food chain wastes, anaerobic digestion systems, renewable energy technology, biogas
Keywords: Food chain wastes, anaerobic digestion systems, renewable energy technology, biogas
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End-of-life tires constitute one of the biggest environmental concerns in terms of environmental pollution and resources conservation. This study aims to determine the best proportion of reclaimed rubber and crumb rubber to be added as... more
End-of-life tires constitute one of the biggest environmental concerns in terms of environmental pollution and resources conservation. This study aims to determine the best proportion of reclaimed rubber and crumb rubber to be added as part of the constituents used in the manufacturing of three different tire parts (tread, side wall, and inner liner) in order to produce standard products from a mix of both recycled and original ingredients. Batches were prepared into which reclaimed rubber and crumb rubber were added to the formulation of three different tire parts, in addition to one batch as reference according to the original formulation. Batches were analyzed according to national and international standards to select the optimum percentage that can be introduced in new tire formulation preparations. Results revealed that reclaimed rubber could be used as 15 parts per hundred rubber (phr) in radial tread compound and as 25 phr in either radial side wall or radial inner liner compounds. As for crumb rubber, results showed that it could be used as 10, 20 and 25 phr in radial tread, radial side wall or radial inner liner compounds respectively. Incorporating higher amounts of either reclaimed or crumb rubber would lead to violating the standards specified in vulcanized rubber tension property test and in oscillating disk cure meter test. Savings in raw material and in energy resulting from the use of reclaimed rubber was calculated: As concerns raw materials, adding 15 phr reclaimed rubber to the tread formulation would save about 7.7% of each of Styrene Butadiene Rubber (SBR), Polybutadiene and carbon black. Adding 25 phr reclaimed rubber to the side wall formulation would save about 12.8% of each of natural rubber, Polybutadiene and carbon black. Adding 25 phr reclaimed rubber to the inner liner formulation would save about 13% of each of natural rubber, SBR and carbon black. Regarding energy conservation, use of reclaimed rubber in new tires would result in a total energy conservation of 6393GJ/year. In addition to the raw material and energy conservation, the process was found to be cost-effective.
Keywords: Crumb rubber, inner liner, reclaimed rubber, side wall, tire recycling, tread
Keywords: Crumb rubber, inner liner, reclaimed rubber, side wall, tire recycling, tread
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The supplementary motor area (SMA-proper) is important for the programming and execution of motor, speech, and other elaborative functions. Unilateral SMA syndrome is well described. We present two patients who underwent resection of a... more
The supplementary motor area (SMA-proper) is important for the programming and execution of motor, speech, and other elaborative functions. Unilateral SMA syndrome is well described. We present two patients who underwent resection of a large parasagittal meningioma in proximity to the SMA-proper in both hemispheres. Following surgery, these patients developed akinetic mutism; the maximal clinical deficit was not immediately evident, but manifested at 48 hours and 1 week respectively. Both patients showed complete recovery of neurological function but the process was slow. Initial return to near normal function was noted at approximately 3 months with a specific pattern; return of strength was first noted in the upper extremities followed by the lower extremities and speech and cognitive function was the last to recover. The unique occurrence of akinetic mutism secondary to bilateral SMA involvement by parasagittal meningiomas of the posterior frontal region is rare. We discuss the clinical and neuropsychological outcomes in these patients along with an analysis of the possible underlying neurophysiological mechanisms of this unique phenomenon.
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Background: Women with breast cancer are at increased risk for the development of osteoporosis and skeletal fractures, as consequences of aromatase inhibition or chemotherapy-induced ovarian failure. We investigated the effect of adjuvant... more
Background: Women with breast cancer are at increased risk for the development of osteoporosis and skeletal fractures, as consequences of aromatase inhibition or chemotherapy-induced ovarian failure. We investigated the effect of adjuvant chemotherapy on biochemical markers of bone formation and resorption as well as on bone mineral density (BMD) of non-metastatic breast cancer (NMBC) postmenopausal Egyptian women.
Methods: We followed 100 newly diagnosed women with T1-3 N0-2 M0 breast cancer, who had a mean age (±SD) of 55.06±8.78 year, before and after receiving 6-cycles of CAF chemotherapy treatment protocol. All participant women were subjected to blood biochemical analysis for determining serum levels of: erythrocyte sedimentation rate, calcium, alkaline phosphatase (ALP), bone specific alkaline phosphatase (S.ALP), Osteocalcin, carboxytelopeptide of collagen type I (CTx-I), 25-Hydroxyvitamin D, Parathyroid Hormone (PTH) and tumor marker CA15-3. Segmental and total BMD were also investigated using Dual X-ray Absorptiometry technique.
Results: We found ALP, S.ALP, and CTx-I levels were significantly lower (p<0.001), while PTH levels to be significantly higher for all women after chemotherapy as compared to their initial state before chemotherapy. Both segmental and total BMD, and consequently T- and Z-Scores after chemotherapy were significantly (p<0.01) lower than their levels before chemotherapy. We developed prediction mathematical formulae for spine, pelvis and total BMD for all women before and after chemotherapy.
Conclusions: Adjuvant chemotherapy is responsible for decreasing both biochemical markers of bone formation and resorption as well as for decreasing segmental and total BMD in NMBC postmenopausal Egyptian women. We believe the mathematical formulae developed on basis of the two individual variables Age and BMI can be useful for assisting the clinician to frequently monitor bone health status of breast cancer patients in similar conditions.
Methods: We followed 100 newly diagnosed women with T1-3 N0-2 M0 breast cancer, who had a mean age (±SD) of 55.06±8.78 year, before and after receiving 6-cycles of CAF chemotherapy treatment protocol. All participant women were subjected to blood biochemical analysis for determining serum levels of: erythrocyte sedimentation rate, calcium, alkaline phosphatase (ALP), bone specific alkaline phosphatase (S.ALP), Osteocalcin, carboxytelopeptide of collagen type I (CTx-I), 25-Hydroxyvitamin D, Parathyroid Hormone (PTH) and tumor marker CA15-3. Segmental and total BMD were also investigated using Dual X-ray Absorptiometry technique.
Results: We found ALP, S.ALP, and CTx-I levels were significantly lower (p<0.001), while PTH levels to be significantly higher for all women after chemotherapy as compared to their initial state before chemotherapy. Both segmental and total BMD, and consequently T- and Z-Scores after chemotherapy were significantly (p<0.01) lower than their levels before chemotherapy. We developed prediction mathematical formulae for spine, pelvis and total BMD for all women before and after chemotherapy.
Conclusions: Adjuvant chemotherapy is responsible for decreasing both biochemical markers of bone formation and resorption as well as for decreasing segmental and total BMD in NMBC postmenopausal Egyptian women. We believe the mathematical formulae developed on basis of the two individual variables Age and BMI can be useful for assisting the clinician to frequently monitor bone health status of breast cancer patients in similar conditions.
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Collective evidence points to a prominent role of stress in cancer growth and metastasis. Despite these results an etio-pathogenetic role has not been widely accepted. Reasons of controversies are the coexistence in stressed patients of... more
Collective evidence points to a prominent role of stress in cancer growth and metastasis. Despite these results an etio-pathogenetic role has not been widely accepted. Reasons of controversies are the coexistence in stressed patients of high risk habits, the sample size, the heterogeneity and the retrospective origins of these studies. Experimental data and clinical observations argue about the possibility of an interaction between psychosocial events and tumours. However the number of involved variables and the long period of observation prevent with current technologies the definition of causal versus chaotic sequences of this hypothetical relationship. Psychotherapy may help to face up to stressful events, but its role e remains uncertain. Stress works through sympathetic nervous system and hypothalamic– pituitary–adrenal axis activation, along with related hormones, that have functionally and biologically significant impacts on the tumor microenvironment. This paper collects evidences through the hypothesis of correlation between stress, psychological factors and cancer focusing both on psychology and on molecular biology. Knowledge on stress induced neuroendocrine dynamics in the tumor microenvironment might allow the development of integrated pharmacological and bio-behavioral strategies to create more successful cancer therapies.
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An overview of the recent advances in the state-of-the-art holographic recoding media dedicated to the dynamic holography display is presented in this paper. Unlike the traditional holographic media, those materials enable the holograms... more
An overview of the recent advances in the state-of-the-art holographic recoding media dedicated to the dynamic holography display is presented in this paper. Unlike the traditional holographic media, those materials enable the holograms to be updatable rather than permanent like before. Over the past few years, a number of material recipes for this use have been disclosed and can be mainly divided into four classesphotorefractive/photochromic polymers and photorefractive/photochromic liquid crystals. Focusing on five key material properties related to the display application, including diffraction efficiency, applied electric field, recording intensity, rise time and memory, the important findings as well as the underlying mechanisms are unraveled with in-depth discussion. Moreover, a comparison of the four classes of materials is provided, followed by a projection of the potential challenges.