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Find video protocols related to scientific articles indexed in Pubmed.
A novel recurrent NPM1-TYK2 gene fusion in cutaneous CD30-positive lymphoproliferative disorders.
Blood
PUBLISHED: 10-29-2014
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The cutaneous CD30-positive lymphoproliferative spectrum of disorders (LPD) includes lymphomatoid papulosis (LYP) and primary cutaneous anaplastic large cell lymphoma (ALCL). Chromosomal translocations targeting tyrosine kinases in CD30-positive LPD have not been described. Using whole transcriptome sequencing, we identified a chimeric fusion involving NPM1 (5q35) and TYK2 (19p13) which encodes an NPM1- TYK2 protein containing the oligomerization domain of NPM1 and an intact catalytic domain in TYK2. Fluorescence in situ hybridization revealed NPM1-TYK2 fusions in 2 of 47 (4%) primary cases of CD30-positive LPDs and was absent in other mature T-cell neoplasms (n = 151). Functionally, NPM1-TYK2 induced constitutive TYK2, STAT1, STAT3 and STAT5 activation. Conversely, a kinase-defective NPM1-TYK2 mutant abrogated STAT1/3/5 signaling. Finally, shRNA-mediated silencing of TYK2 abrogated lymphoma cell growth. This is the first report of recurrent translocations involving TYK2 and highlights the novel therapeutic opportunities in the treatment of CD30-positive LPDs with TYK2 translocations.
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Single shot interferogram analysis for optical metrology.
Appl Opt
PUBLISHED: 10-17-2014
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We report a novel constrained optimization method for single shot interferogram analysis. The unknown test wavefront is estimated as a minimum L2-norm squared solution whose phase is constrained to the space spanned by a finite number of Zernike polynomials. Using a single frame from standard phase shifting datasets, we demonstrate that our approach provides a phase map that matches with that generated using phase shifting algorithms to within ?/100??rms error. Our simulations and experimental results suggest the possibility of a simplified low-cost high quality optical metrology system for performing routine metrology tests involving smooth surface profiles.
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[The incredible story about the cesarean section from ancient times till nowadays].
Harefuah
PUBLISHED: 10-08-2014
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During its evolution the cesarean section has meant different things to different people. The indications for it have changed throughout the course of history. From the initial purpose to retrieve an infant from a dead or dying mother in order to bury the child separately from his mother, to contemporary indications. This article strives to follow the roots of this common procedure--starting from the descriptions in the ancient Greek mythology, through the imperial Roman law, aspects of Judaism and the evolution of the procedure throughout modern history. Major improvements in the surgical techniques, the introduction of anesthesia and aseptic procedures contributed to the decline in mortality and morbidity rates. We will attempt to find the etymology for the expression "cesarean section" which has commonly been accounted to Julius Caesar's name, although history denies it. This review takes us on a historical journey, from ancient times to nowadays, in which we follow the course and nature of a procedure being performed daily in thousands of hospitals.
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Hospital accreditation: lessons from low- and middle-income countries.
Global Health
PUBLISHED: 09-04-2014
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The growth of accreditation programs in low- and middle-income countries (LMICs) provides important examples of innovations in leadership, governance and mission which could be adopted in developed countries. While these accreditation programs in LMICs follow the basic structure and process of accreditation systems in the developed world, with written standards and an evaluation by independent surveyors, they differ in important ways. Their focus is primarily on improving overall care country-wide while supporting the weakest facilities. In the developed world accreditation efforts tend to focus on identifying the best institutions as those are typically the only ones who can meet stringent and difficult evaluative criteria.The Joint Learning Network for Universal Health Coverage (JLN), is an initiative launched in 2010 that enables policymakers aiming for UHC to learn from each other's successes and failures. The JLN is primarily comprised of countries in the midst of implementing complex health financing reforms that involve an independent purchasing agency that buys care from a mix of public and private providers [Lancet 380: 933-943, 2012]. One of the concerns for participating countries has been how to preserve or improve quality during rapid expansion in coverage. Accreditation is one important mechanism available to countries to preserve or improve quality that is in common use in many LMICs today.This paper describes the results of a meeting of the JLN countries held in Bangkok in April of 2013, at which the current state of accreditation programs was discussed. During that meeting, a number of innovative approaches to accreditation in LMICs were identified, many of which, if adopted more broadly, might enhance health care quality and patient safety in the developed world.
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Integrated residency training leading to radiology and nuclear medicine board certification: the Arkansas experience.
J Ark Med Soc
PUBLISHED: 09-02-2014
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The pool of qualified nuclear medicine (NM) physicians is declining as fewer choose to enter the specialty. In June 2012, we began developing an integrated categorical residency training position satisfying the requirements of both the American Board of Radiology (ABR) and the American Board of Nuclear Medicine (ABNM). Termed "NuRad," this was listed and filled in the 2013 NRMP match. We found it to be more attractive to qualified applicants than our traditional, three year NM residency. This approach may play a significant role in the future in ensuring the training of physicians expert in NM and molecular imaging.
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Estimating the prevalence and burden of major disorders of the brain in Nepal: methodology of a nationwide population-based study.
J Headache Pain
PUBLISHED: 08-21-2014
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The major disorders of the brain (MDBs), in terms of their prevalence and the burdens of ill health, disability and financial cost that they impose on individuals and society, are headache, depression and anxiety. No population-based studies have been conducted in Nepal.
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Molecular investigations of protriptyline as a multi-target directed ligand in Alzheimer's disease.
PLoS ONE
PUBLISHED: 08-20-2014
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Alzheimer's disease (AD) is a complex neurodegenerative disorder involving multiple cellular and molecular processes. The discovery of drug molecules capable of targeting multiple factors involved in AD pathogenesis would greatly facilitate in improving therapeutic strategies. The repositioning of existing non-toxic drugs could dramatically reduce the time and costs involved in developmental and clinical trial stages. In this study, preliminary screening of 140 FDA approved nervous system drugs by docking suggested the viability of the tricyclic group of antidepressants against three major AD targets, viz. Acetylcholinesterase (AChE), ?-secretase (BACE-1), and amyloid ? (A?) aggregation, with one member, protriptyline, showing highest inhibitory activity. Detailed biophysical assays, together with isothermal calorimetry, fluorescence quenching experiments, kinetic studies and atomic force microscopy established the strong inhibitory activity of protriptyline against all three major targets. The molecular basis of inhibition was supported with comprehensive molecular dynamics simulations. Further, the drug inhibited glycation induced amyloid aggregation, another important causal factor in AD progression. This study has led to the discovery of protriptyline as a potent multi target directed ligand and established its viability as a promising candidate for AD treatment.
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The gastrointestinal manifestation of constitutional mismatch repair deficiency syndrome: from a single adenoma to polyposis-like phenotype and early onset cancer.
Clin. Genet.
PUBLISHED: 08-16-2014
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Data on the clinical presentation of constitutional mismatch repair deficiency syndrome (CMMRD) is accumulating. However, as the extraintestinal manifestations are often fatal and occur at early age, data on the systematic evaluation of the gastrointestinal tract is scarce. Here we describe 11 subjects with verified biallelic carriage and who underwent colonoscopy, upper endoscopy and small bowel evaluation. Five subjects were symptomatic and in six subjects the findings were screen detected. Two subjects had colorectal cancer and few adenomatous polyps (19, 20?years), three subjects had polyposis-like phenotype (13, 14, 16?years), four subjects had few adenomatous polyps (8, 12-14?years) and two subjects had no polyps (both at age 6). Of the three subjects in the polyposis-like group, two subjects had already developed high-grade dysplasia or cancer and one subject had atypical juvenile polyps suggesting juvenile polyposis. Three out of the five subjects that underwent repeated exams had significant findings during short interval. The gastrointestinal manifestations of CMMRD are highly dependent upon age of examination and highly variable. The polyps may also resemble juvenile polyposis. Intensive surveillance according to current guidelines is mandatory.
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Estimating prevalence and burden of major disorders of the brain in Nepal: cultural, geographic, logistic and philosophical issues of methodology.
J Headache Pain
PUBLISHED: 08-15-2014
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Headache, anxiety and depression are major disorders of the brain in terms of their prevalence and the burdens and costs they impose on society. Nationwide population-based studies of these disorders are necessary to inform health policy but, in research-naïve and resource-poor countries such as Nepal, a host of methodological problems are encountered: cultural, geographic, logistic and philosophical.
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Basic ultrasound training can replace chest radiography for safe tube thoracostomy removal.
Am Surg
PUBLISHED: 08-09-2014
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An ultrasound (US) examination can be easily and rapidly performed at the bedside to aide in clinical decisions. Previously we demonstrated that US was safe and as effective as a chest x-ray (CXR) for removal of tube thoracostomy (TT) when performed by experienced sonographers. This study sought to examine if US was as safe and accurate for the evaluation of pneumothorax (PTX) associated with TT removal after basic US training. Patients included had TT managed by the surgical team between October 2012 and May 2013. Bedside US was performed by a variety of members of the trauma team before and after removal. All residents received, at minimum, a 1-hour formal training class in the use of ultrasound. Data were collected from the electronic medical records. We evaluated 61 TTs in 61 patients during the study period. Exclusion of 12 tubes occurred secondary to having incomplete imaging, charting, or death before having TT removed. Of the 49 remaining TT, all were managed with US imaging. Average age of the patients was 40 years and 30 (61%) were male. TT was placed for PTX in 37 (76%), hemothorax in seven (14%), hemopneumothorax in four (8%), or a pleural effusion in one (2%). Two post pull PTXs were correctly identified by residents using US. This was confirmed on CXR with appropriate changes made. US was able to successfully predict the safe TT removal and patient discharge at all residency levels after receiving a basic US training program.
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20 years of leptin: insights into signaling assemblies of the leptin receptor.
J. Endocrinol.
PUBLISHED: 07-25-2014
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Leptin plays a central role in the control of body weight and energy homeostasis, but is a pleiotropic cytokine with activities on many peripheral cell types. In this review, we discuss the interaction of leptin with its receptor, and focus on the structural and mechanistic aspects of the extracellular aspects of leptin receptor (LR) activation. We provide an extensive overview of all structural information that has been obtained for leptin and its receptor via X-ray crystallography, electron microscopy, small-angle X-ray scattering, homology modeling, and mutagenesis studies. The available knowledge is integrated into putative models toward a recapitulation of the LR activation mechanism.
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Sensitivity of epicardial electrical markers to acute ischemia detection.
J Electrocardiol
PUBLISHED: 07-01-2014
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We hypothesize that electrocardiographic measurements from the intramyocardial space contain more sensitive markers of ischemia than those detectable on the epicardium. The goal of this study was to evaluate different electrical markers for their potential to detect the earliest phases of acute myocardial ischemia.
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Human intestinal epithelial cells respond to ?-glucans via Dectin-1 and Syk.
Eur. J. Immunol.
PUBLISHED: 05-27-2014
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Intestinal epithelial cells (IECs) are the first to encounter luminal antigens and may be involved in intestinal immune responses. Fungi are important components of the intestinal microflora. The potential role of fungi, and in particular their cell wall component ?-glucan, in modulating human intestinal epithelial responses is still unclear. Here we examined whether human IECs are capable of recognizing and responding to ?-glucans, and the potential mechanisms of their activation. We show that human IECs freshly isolated from surgical specimens, and the human IEC lines HT-29 and SW480, express the ?-glucan receptor Dectin-1. The ?-glucan-consisting glycans curdlan and zymosan stimulated IL-8 and CCL2 secretion by IEC lines. This was significantly inhibited by a Dectin-1 blockade using its soluble antagonist laminarin. Spleen tyrosine kinase (Syk), a signaling mediator of Dectin-1 activation, is expressed in human IECs. ?-glucans and Candida albicans induced Syk phosphorylation, and Syk inhibition significantly decreased ?-glucan-induced chemokine secretion from IECs. Thus, IECs may respond to ?-glucans by the secretion of pro-inflammatory chemokines in a Dectin-1- and Syk-dependent pathway, via receptors and a signaling pathway described to date only for myeloid cells. These findings highlight the importance of fungi-IEC interactions in intestinal inflammation.
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Transfer of dabigatran and dabigatran etexilate mesylate across the dually perfused human placenta.
Obstet Gynecol
PUBLISHED: 05-09-2014
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To assess the transplacental pharmacokinetics at term of the oral thrombin inhibitor, dabigatran, and its prodrug, dabigatran etexilate mesylate, to estimate fetal drug exposure.
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Investigation of Phosphoproteome in RAGE signaling.
Proteomics
PUBLISHED: 04-28-2014
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Receptor for Advanced Glycation End products (RAGE) is one of the most important factors implicated in diabetes, cardiovascular diseases, neurodegenerative diseases, and cancer. It is a pattern recognition receptor, by virtue of its ability to interact with multiple ligands; RAGE activates several signal transduction pathways through involvement of various kinases, which phosphorylate their respective substrates. Only few substrates have been known to be phosphorylated in response to activation by RAGE (e.g.NF-?B), however it is possible that these kinases can phosphorylate multiple substrates depending upon their expression and localization, leading to altered cellular responses in different cell types and conditions. One such example, Glycogen synthase kinase 3 beta (GSK3?) which is known to phosphorylate glycogen synthase, acts downstream to RAGE and hyperphosphorylates Microtubule Associated Protein Tau (MAPT) causing neuronal damage. Thus, it is important to understand the role of various RAGE activated kinases and their substrates. Therefore, we have reviewed here the details of RAGE activated kinases in response to different ligands and their respective phosphoproteome. Further, we discuss the analysis of the data mined for known substrates of these kinases from PhosphoSitePlus (http://www.phosphosite.org) database, and the role of some of the important substrates involved in cancer, diabetes, cardiovascular diseases and neurodegenerative diseases. In summary, this review provides information on RAGE activated kinases and their phosphoproteome, which will be helpful in understanding the possible role of RAGE and its ligands in progression of diseases. This article is protected by copyright. All rights reserved.
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Structural and mechanistic paradigm of leptin receptor activation revealed by complexes with wild-type and antagonist leptins.
Structure
PUBLISHED: 04-17-2014
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Leptin activates its cognate receptor (LR) to regulate body weight and metabolically costly processes, such as reproduction and immune responses. Despite such benevolent pleiotropy, leptin-mediated signaling has been implicated in autoimmune diseases and breast cancer, thereby rejuvenating interest in leptin antagonism. We present comparative biochemical and structural studies of the LR ectodomain (LRecto) in complex with wild-type and antagonist leptin variants. We show that high-affinity binding of leptin to the cytokine receptor homology 2 domain of LRecto primes interactions with the Ig-domain (LRIg) of another leptin-bound LRecto to establish a quaternary assembly. In contrast, antagonist leptin variants carrying mutations at the LRIg binding site only enable binary complexes with LRecto. Acetylation of free cysteines in LRecto also abrogates quaternary complexes, suggesting a functional role for intrareceptor disulfides. We propose a revised conceptual framework for LR activation whereby leptin activates predimerized LR at the cell surface to seed higher order complexes with 4:4 stoichiometry.
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Clinical orthopedic examination findings in the lower extremity: correlation with imaging studies and diagnostic efficacy.
Radiographics
PUBLISHED: 03-13-2014
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The lower-extremity anatomy is complex and normal function is dependent on intact osteochondral, musculotendinous, and ligamentous structures. Injury may result in pain and functional limitation. Specific clinical tests are used to help isolate and define the pathoanatomy; however, their terminology may be confusing to the radiologist and the diagnostic value of these tests may not be well understood. This article presents an algorithmic approach to evaluation of the hip, knee, and ankle to improve the radiologist's understanding of lower-extremity physical examination. Knowledge of test terminology, clinical utility, and diagnostic accuracy will improve clinical and radiologic correlation. The article reviews the common clinical tests used to evaluate the lower extremity and provides an algorithm to establish a clinical examination road map and rapidly review the clinical utility and study hierarchy of a particular test. The sensitivity and specificity of the clinical tests and magnetic resonance (MR) imaging are reviewed because these parameters vary, and an understanding of the diagnostic utility of both the clinical and imaging tests is important in accurately formulating a definitive diagnosis. The structured algorithmic approach to lower-extremity examination described here, knowledge of test jargon, and familiarity with the diagnostic accuracy of the clinical and MR imaging examinations may help the radiologist focus image search patterns and provide detailed and clinically relevant reports. Online supplemental material is available for this article.
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Clinical orthopedic examination findings in the upper extremity: correlation with imaging studies and diagnostic efficacy.
Radiographics
PUBLISHED: 03-13-2014
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Different orthopedic tests are used to evaluate internal derangements of joints. Radiologic examinations like magnetic resonance (MR) imaging are ordered on the basis of results of these tests to narrow the clinical diagnosis and formulate a treatment plan. Although these tests are clinically useful, the test terminology can be confusing and the significance of the tests not clearly understood. This article helps explain the clinical jargon of tests performed for the major joints of the upper extremity and their proper use and diagnostic value in conjunction with MR imaging. The article presents a structured algorithmic approach to explain the tests. For each joint, a hierarchy of clinical tests is performed, starting with general observation and range of motion, followed by more specific tests tailored to evaluate individual or grouped anatomic structures. MR imaging findings and clinical tests complement each other in making a final diagnosis. However, because of the varied sensitivity and specificity of the clinical tests and MR imaging, it is important to be familiar with their diagnostic value before making clinical decisions. Knowledge of clinical jargon and the proper use and diagnostic value of orthopedic tests can aid in interpretation of radiologic images by focusing search patterns, thus allowing comprehensive evaluation and optimized reporting. It also enhances communication with the orthopedist, thereby helping maintain continuity of care. Online supplemental material is available for this article.
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In vivo Raman spectroscopy of human uterine cervix: exploring the utility of vagina as an internal control.
J Biomed Opt
PUBLISHED: 03-12-2014
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In vivo Raman spectroscopy is being projected as a new, noninvasive method for cervical cancer diagnosis. In most of the reported studies, normal areas in the cancerous cervix were used as control. However, in the Indian subcontinent, the majority of cervical cancers are detected at advanced stages, leaving no normal sites for acquiring control spectra. Moreover, vagina and ectocervix are reported to have similar biochemical composition. Thus, in the present study, we have evaluated the feasibility of classifying normal and cancerous conditions in the Indian population and we have also explored the utility of the vagina as an internal control. A total of 228 normal and 181 tumor in vivo Raman spectra were acquired from 93 subjects under clinical supervision. The spectral features in normal conditions suggest the presence of collagen, while DNA and noncollagenous proteins were abundant in tumors. Principal-component linear discriminant analysis (PC-LDA) yielded 97% classification efficiency between normal and tumor groups. An analysis of a normal cervix and vaginal controls of cancerous and noncancerous subjects suggests similar spectral features between these groups. PC-LDA of tumor, normal cervix, and vaginal controls further support the utility of the vagina as an internal control. Overall, findings of the study corroborate with earlier studies and facilitate objective, noninvasive, and rapid Raman spectroscopic-based screening/diagnosis of cervical cancers.
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Radiology resident recruitment: A study of the impact of web-based information and interview day activities.
Acad Radiol
PUBLISHED: 03-11-2014
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Residency recruitment is a critical and expensive process. A program's Web site may improve recruitment, but little is known about how applicants use program sites or what constitutes optimal content. The importance of an interview day and interactions with a program's residents has been described, but candidate preferences for various activities and schedules have not been widely reported. We investigated contemporary use and perceived utility of information provided on radiology program Web sites, as well as preferences for the interview day experience.
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Effect of frequency tuning on bremsstrahlung spectra, beam intensity, and shape in the 10 GHz NANOGAN electron cyclotron resonance ion source.
Rev Sci Instrum
PUBLISHED: 03-06-2014
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Studies on the effect of the frequency tuning on the bremsstrahlung spectra, beam intensities, and beam shape of various ions have been carried out in the 10 GHz NANOGAN ECR ion source. The warm and cold components of the electrons were found to be directly correlated with beam intensity enhancement in case of Ar(9+) but not so for O(5+). The warm electron component was, however, much smaller compared to the cold component. The effect of the fine tuning of the frequency on the bremsstrahlung spectrum, beam intensities and beam shape is presented.
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Inhibition of early upstream events in prodromal Alzheimer's disease by use of targeted antioxidants.
Curr Aging Sci
PUBLISHED: 03-04-2014
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A link between Alzheimer's disease (AD) and an excess presence of oxidant free radicals in the brain has frequently been reported. It is generally assumed that such oxidative stress and related cellular damage is caused by inflammatory changes in the brain and is consequent to amyloid deposition. This review makes the argument that elevated oxidative stress in AD is an early causal event in the initiation and advancement of this disease. Oxidative stress can be decreased by enhancing antioxidant enzymes through activation of the cytoplasmic transcriptional factor (Nrf2)/ARE (antioxidant response element) pathway, and by dietary and endogenous antioxidant chemicals. Reduction in the binding ability of Nrf2 to ARE lowers antioxidant enzyme levels. Decreased levels of Nrf2 and augmentation of oxidative stress in AD suggest that the ROS-dependent mechanism of activating the Nrf2/ARE pathway has become unresponsive. A combination of agents that can either activate the Nrf2-ARE pathway by ROS-independent mechanisms, or by acting directly as antioxidant chemicals, may be necessary to reduce oxidative stress in AD. Earlier shortcomings of using individual antioxidants may be due to consideration of antioxidants as pharmacological agents, ignoring the fact that individual antioxidants can be transmuted in the highly oxidant milieu that is present in AD. Interactions between various cellular compartments may require simultaneous examination of more than one agent. The clinical utility of such a more integrative method can reveal interactive effects such as those found in nutritional research and this can compensate for any mechanistic shortcomings of simultaneous testing of more than a single agent.
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Passage of nasogastric tube through tracheo-esophageal fistula into stomach: A rare event.
World J Clin Cases
PUBLISHED: 02-16-2014
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Esophageal atresia with tracheo-oesophageal fistula (TEF) occurs in 1 in 3500 live births. Anorectal malformation is found to be associated with 14% of TEF. Esophageal atresia with TEF is a congenital anomaly which classically presents as excessive frothing from the mouth and respiratory distress. Rarely gastric position of the feeding tube in a case of TEF can be obtained delaying the diagnosis of TEF. We had an uncommon situation where a nasogastric tube reached the stomach through the trachea and tracheo-esophageal fistula, leading to misdiagnosis in a case of esophageal atresia with tracheoesophageal fistula. By using a stiff rubber catheter instead of a soft feeding tube for the diagnosis of esophageal atresia and TEF, such situation can be avoided.
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Posterior urethral polyp with type I posterior urethral valves: a rare association in a neonate.
Urology
PUBLISHED: 02-13-2014
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Urethral polyp is a rare cause of bladder outlet obstruction, voiding dysfunction, and hematuria in the pediatric age group. Urethral polyps are rarely associated with other congenital urinary tract anomalies. In this study, we report a case of solitary posterior urethral polyp with type I posterior urethral valve in a 7-day-old neonate presented with urinary retention and deranged renal function. The polyp was diagnosed on cystoscopy. Transurethral resection of the polyp with posterior urethral valve fulguration was performed. Pathologic assessment revealed a fibroepithelial lesion, which was consistent with congenital posterior urethral polyp.
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Direct synthesis of 2-deoxy-?-glycosides via anomeric O-alkylation with secondary electrophiles.
J. Am. Chem. Soc.
PUBLISHED: 02-11-2014
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An approach for direct synthesis of biologically significant 2-deoxy-?-glycosides has been developed via O-alkylation of a variety of 2-deoxy-sugar-derived anomeric alkoxides using challenging secondary triflates as electrophiles. It was found a free hydroxyl group at C3 of the 2-deoxy-sugar-derived lactols is required in order to achieve synthetically efficient yields. This method has also been applied to the convergent synthesis of a 2-deoxy-?-tetrasaccharide.
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Diabetic myonecrosis: likely an underrecognized entity.
Orthopedics
PUBLISHED: 02-01-2014
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Diabetic myonecrosis is a rare complication of long-standing diabetes mellitus that presents as acute onset of swelling and pain of the affected muscles. The differential diagnosis includes cellulitis/pyomyositis, necrotizing fasciitis, neoplasm, and deep venous thrombosis (DVT). Missed diagnoses can lead to unnecessary invasive diagnostic procedures and inappropriate treatment. The diagnosis is established by the clinical presentation and findings on magnetic resonance imaging (MRI) scan. A 30-year-old African-American man presented with a painful mass affecting the medial aspect of the right thigh for several months. Initial laboratory studies showed white blood cell count of 8800 cells/mm(3), D-dimer value of 0.55 µg/mL, HgBA1c level of 15.1%, glucose level of 352 mg/dL, erythrocyte sedimentation rate of 22 mm/h, and C-reactive protein level of 222 mg/L. An MRI scan was obtained, and diabetic myonecrosis was diagnosed and treated. One year later, the patient had similar symptoms of pain in the contralateral thigh. Repeat workup and MRI scan were obtained. The MRI abnormalities originally seen in the right thigh 1 year earlier were present in the left thigh, with complete resolution of the abnormalities seen in the right thigh. Treatment with bed rest and analgesics resulted in symptom resolution. Patients with diabetic myonecrosis typically have no fever, normal white blood cell count, mildly increased erythrocyte sedimentation rate, and elevated C-reactive protein level in 50% of cases. They lack the radiologic signs of fascial enhancement or well-defined, rim-enhancing collections that are seen in necrotizing fasciitis and pyomyositis/abscess. The onset of severe pain and the lack of mass effect on imaging differentiate diabetic myonecrosis from tumor-like conditions such as vascular malformations or soft tissue tumors. Normal D-dimer levels and ultrasound Doppler examination of the extremity help to rule out DVT. The typical MRI scan findings and clinical presentation can lead to the diagnosis of diabetic myonecrosis, allowing the physician to avoid invasive tests, such as muscle biopsy, and to reassure patients that this condition is self-limiting with appropriate treatment.
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Aortic remodeling after thoracic endovascular aortic repair for intramural hematoma.
J. Vasc. Surg.
PUBLISHED: 01-28-2014
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Intramural hematoma (IMH), penetrating atherosclerotic ulcer (PAU), and aortic dissection comprise a spectrum of acute aortic pathologies. Although thoracic endovascular aortic repair (TEVAR) has increasingly been applied to aortic dissection, there is a paucity of data on the anatomic effect of TEVAR for IMH. Our goal was to investigate the extent of aortic remodeling after TEVAR.
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Anti-helminthic drugs in recurrent apthous stomatitis: A short review.
J Pharm Bioallied Sci
PUBLISHED: 01-22-2014
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Recurrent aphthous stomatitis (RAS) is a common mucosal condition producing painful ulcerations in the oral cavity and considerable clinical morbidity. The etiology remains obscure, though local trauma, psychologic stress, hematinic deficiencies and immune dysregulation have been implicated. Though the primary goals of therapy are symptomatic relief of pain, the clinicians are aiming toward reducing the frequency, duration, number of ulcerations and increasing ulcer free periods with systemic drug therapy if topical medications appear ineffective. Levamisole, an antihelminthic drug has been tried with promising results in patients with severe RAS providing long-term benefits.
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Reusable single-port access device shortens operative time and reduces operative costs.
Surg Endosc
PUBLISHED: 01-18-2014
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In recent years, single-port laparoscopy (SPL) has become an attractive approach for performing surgical procedures. The pitfalls of this approach are technical and financial. Financial concerns are due to the increased cost of dedicated devices and prolonged operating room time. Our aim was to calculate the cost of SPL using a reusable port and instruments in order to evaluate the cost difference between this approach to SPL using the available disposable ports and standard laparoscopy.
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Preserving the educational value of call in a diagnostic radiology residency program.
J Am Coll Radiol
PUBLISHED: 01-07-2014
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Our study was designed to determine residents' opinions of the advantages, disadvantages and educational value of a traditional "Tandem Call" (TC) model as compared to night float (NF). Because TC is more representative of adult learning principles and constructivist theory, we hypothesized that resident satisfaction and educational outcomes would demonstrate a preference for, and the educational efficacy of, the TC model.
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Diagnosis, prevalence estimation and burden measurement in population surveys of headache: presenting the HARDSHIP questionnaire.
J Headache Pain
PUBLISHED: 01-02-2014
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The global burden of headache is very large, but knowledge of it is far from complete and needs still to be gathered. Published population-based studies have used variable methodology, which has influenced findings and made comparisons difficult. The Global Campaign against Headache is undertaking initiatives to improve and standardize methods in use for cross-sectional studies. One requirement is for a survey instrument with proven cross-cultural validity. This report describes the development of such an instrument. Two of the authors developed the initial version, which was used with adaptations in population-based studies in China, Ethiopia, India, Nepal, Pakistan, Russia, Saudi Arabia, Zambia and 10 countries in the European Union. The resultant evolution of this instrument was reviewed by an expert consensus group drawn from all world regions. The final output was the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) questionnaire, designed for application by trained lay interviewers. HARDSHIP is a modular instrument incorporating demographic enquiry, diagnostic questions based on ICHD-3 beta criteria, and enquiries into each of the following as components of headache-attributed burden: symptom burden; health-care utilization; disability and productive time losses; impact on education, career and earnings; perception of control; interictal burden; overall individual burden; effects on relationships and family dynamics; effects on others, including household partner and children; quality of life; wellbeing; obesity as a comorbidity. HARDSHIP already has demonstrated validity and acceptability in multiple languages and cultures. Modules may be included or not, and others (eg, on additional comorbidities) added, according to the purpose of the study and resources (especially time) available.
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Synthesis of Pt nanoparticles and their burrowing into Si due to synergistic effects of ion beam energy losses.
Beilstein J Nanotechnol
PUBLISHED: 01-01-2014
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We report the synthesis of Pt nanoparticles and their burrowing into silicon upon irradiation of a Pt-Si thin film with medium-energy neon ions at constant fluence (1.0 × 10(17) ions/cm(2)). Several values of medium-energy neon ions were chosen in order to vary the ratio of the electronic energy loss to the nuclear energy loss (S e/S n) from 1 to 10. The irradiated films were characterized using Rutherford backscattering spectroscopy (RBS), atomic force microscopy (AFM), scanning electron microscopy (SEM), X-ray diffraction (XRD) and high resolution transmission electron microscopy (HRTEM). A TEM image of a cross section of the film irradiated with S e/S n = 1 shows ?5 nm Pt NPs were buried up to ?240 nm into the silicon. No silicide phase was detected in the XRD pattern of the film irradiated at the highest value of S e/S n. The synergistic effect of the energy losses of the ion beam (molten zones are produced by S e, and sputtering and local defects are produced by S n) leading to the synthesis and burrowing of Pt NPs is evidenced. The Pt NP synthesis mechanism and their burrowing into the silicon is discussed in detail.
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Electronic health records and information portability: a pilot study in a rural primary healthcare center in India.
Perspect Health Inf Manag
PUBLISHED: 01-01-2014
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Clinical documentation and health information portability pose unique challenges in urban and rural areas of India. This article presents findings of a pilot study conducted in a primary health center in rural India. In this article, we focus on primary care in rural India and how a portable health record system could facilitate the availability of medical information at the point of care. We followed a geriatric cohort and a maternal cohort of 308 participants over a nine-month period. Physician encounters were entered into a web-based electronic health record. This information was made available to all study participants through a short messaging service (SMS). Additionally, 135 randomly selected participants from the cohort were issued a USB-based memory card that contained their detailed health records and could be viewed on most computers. The dual portability model implemented in the pilot study demonstrates the utility of the concept.
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Plating, nailing, external fixation, and fibular strut grafting for non-union of humeral shaft fractures.
J Orthop Surg (Hong Kong)
PUBLISHED: 12-25-2013
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PURPOSE. To compare various treatment modalities (plating, Ilizarov external fixation, and non-vascular fibular cortical strut grafting) for non-union of humeral shaft fractures. METHODS. Records of 9 women and 26 men aged 24 to 71 (mean, 42) years who presented with non-union of humeral shaft fractures were reviewed. The humeral shaft fractures were secondary to low-energy trauma (n=22) or vehicular accidents (n=13) and involved the proximal (n=9), middle (n=15), and distal (n=11) regions. 13 of the fractures were open. Infection was evident in 8 of the non-unions. For non-unions with infection (n=8), a 2-stage procedure entailing temporary Ilizarov fixation followed by plating was used. For non-unions without infection (n=23), one-stage plating and cancellous bone grafting was used. For non-unions of osteoporotic bone (n=4), one-stage non-vascularised fibular strut grafting was used. Outcome was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. RESULTS. The 35 patients were followed up for a mean of 16 (range, 6-60) months. All achieved bone union except for one (who had persistent infection). Respectively for non-unions with infection, nonunions without infection, and non-unions of osteoporotic bone, the mean times to bone union were 6.5 (range, 4-10), 5 (range, 4-8), and 10 (range, 6-14) months, the mean improvement in DASH score was 30, 43, and 18, and malalignment was noted in 5, 2, and one patient. Three patients had a preoperative radial nerve palsy for which standard tendon transfer was performed 6 weeks after treatment for non-union. CONCLUSION. Compression plating achieved the best results. An external fixator may be used temporarily for infected non-unions. Fibular strut grafting may be used when non-unions warrant additional stability.
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Familial myomatosis cutis et uteri, segmental type 2.
Indian Dermatol Online J
PUBLISHED: 12-19-2013
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Reeds syndrome or familial myomatosis cutis et uteri, an autosomal dominant inherited condition with incomplete penetrance, is characterized by multiple cutaneous and uterine leiomyomas.[1] Uterine leiomyomas usually commence earlier compared to that in the general population and cutaneous leiomyomas may precede, follow or occur concurrently. Few patients may have associated renal cell carcinoma. Herein we report a case of a 50-year-old female with multiple, painful cutaneous leiomyomas and who had undergone hysterectomy owing to large uterine fibroids. Her 18-year-old daughter also has uterine fibroids.
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Metastasis suppressor KISS1 appears to reverse the Warburg effect by enhancing mitochondrial biogenesis.
Cancer Res.
PUBLISHED: 12-18-2013
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Cancer cells tend to utilize aerobic glycolysis even under normoxic conditions, commonly called the "Warburg Effect." Aerobic glycolysis often directly correlates with malignancy, but its purpose, if any, in metastasis remains unclear. When wild-type KISS1 metastasis suppressor is expressed, aerobic glycolysis decreases and oxidative phosphorylation predominates. However, when KISS1 is missing the secretion signal peptide (?SS), invasion and metastasis are no longer suppressed and cells continue to metabolize using aerobic glycolysis. KISS1-expressing cells have 30-50% more mitochondrial mass than ?SS-expressing cells, which is accompanied by correspondingly increased mitochondrial gene expression and higher expression of PGC1?, a master co-activator that regulates mitochondrial mass and metabolism. PGC1?-mediated downstream pathways (i.e. fatty acid synthesis and ?-oxidation) are differentially regulated by KISS1, apparently reliant upon direct KISS1 interaction with NRF1, a major transcription factor involved in mitochondrial biogenesis. Since the downstream effects could be reversed using shRNA to KISS1 or PGC1?, these data appear to directly connect changes in mitochondria mass, cellular glucose metabolism and metastasis.
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Catalytic Stereoselective Synthesis of ?-Digitoxosides: Direct Synthesis of Digitoxin and C1-epi-Digitoxin.
J. Org. Chem.
PUBLISHED: 12-11-2013
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A mild and atom-economic rhenium(V)-catalyzed stereoselective synthesis of ?-d-digitoxosides from 6-deoxy-d-allals has been described. This ?-selective glycosylation was achieved probably because of the formation of corresponding ?-digitoxosides disfavored by 1,3-diaxial interaction. In addition, this method has been successfully applied to the synthesis of digitoxin trisaccharide glycal for the direct synthesis of digitoxin and C1-epi-digitoxin.
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A novel totally internal laparoscopic liver retractor.
Surg Laparosc Endosc Percutan Tech
PUBLISHED: 12-05-2013
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Minimally invasive surgery is still in evolution. Throughout the past two decades numerous devices have been developed to enable safer and faster procedures, including anastomosis creating devices, energy sources, and superior imaging. However, retraction capabilities were put aside and currently, organ laparoscopic retraction is based on standard laparoscopic tools. In the era of minimizing the number of ports and shrinking their size, our aim was to develop internal retraction device that could be placed in the peritoneal cavity through a standard trocar, positioned for adequate retraction, and left in place for the entire procedure. These devices would obviate the need for inserting ports dedicated for retraction only and hence contribute to the reduction of the number of incisions. Herein, we present our initial experience with a novel internal liver retractor.
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Solitary crossed renal ectopia with vesicoureteric reflux presenting with impaired renal function in a neonate.
J Clin Neonatol
PUBLISHED: 11-20-2013
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Solitary crossed renal ectopia (SCRE) is an exceedingly rare anomaly of the urinary tract. So far, only 34 cases have been reported in the literature. It usually presents after infancy. Most of these cases are diagnosed incidentally while patients are undergoing evaluation for associated genitourinary, cardiovascular, hematological or vertebral abnormalities. We report the first case of SCRE presenting in neonatal age with impaired renal function and vesico-ureteric reflux.
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Three-Dimensional Reconstruction of Murine Peyers Patches from Immunostained Cryosections.
Microsc. Microanal.
PUBLISHED: 11-04-2013
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Peyers patches, macroscopic aggregates of lymphoid follicles present throughout the small intestines of humans and other mammals, are considered the gateway through which luminal dietary antigens and microbes are sampled by the mucosal immune system. The cellular make-up of Peyers patch lymphoid follicles is not only complex, but highly dynamic, as there are at least four major cell types that are known to migrate in response to antigenic stimulation. In an effort to capture the complexity and dynamic nature of this specialized tissue, here we report the three-dimensional (3D) reconstruction of immunofluorescent-labeled mouse Peyers patch cryosections. The technology that enabled the stacking and linear blending of serial cryosections was a novel macro for Fiji, the open source image-processing package based on ImageJ. By simultaneously labeling cryosections for surface markers CD45R, CD3, and CD11c, we provide a 3D image as well as quantitative measures of B-cell, T-cell, and dendritic cell populations at steady state and following exposure to the mucosal adjuvant cholera toxin.
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Multi-resolution correlative focused ion beam scanning electron microscopy: Applications to cell biology.
J. Struct. Biol.
PUBLISHED: 10-18-2013
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Efficient correlative imaging of small targets within large fields is a central problem in cell biology. Here, we demonstrate a series of technical advances in focused ion beam scanning electron microscopy (FIB-SEM) to address this issue. We report increases in the speed, robustness and automation of the process, and achieve consistent z slice thickness of ?3nm. We introduce "keyframe imaging" as a new approach to simultaneously image large fields of view and obtain high-resolution 3D images of targeted sub-volumes. We demonstrate application of these advances to image post-fusion cytoplasmic intermediates of the HIV core. Using fluorescently labeled cell membranes, proteins and HIV cores, we first produce a "target map" of an HIV infected cell by fluorescence microscopy. We then generate a correlated 3D EM volume of the entire cell as well as high-resolution 3D images of individual HIV cores, achieving correlative imaging across a volume scale of 10(9) in a single automated experimental run.
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Insertion of flexible neural probes using rigid stiffeners attached with biodissolvable adhesive.
J Vis Exp
PUBLISHED: 10-15-2013
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Microelectrode arrays for neural interface devices that are made of biocompatible thin-film polymer are expected to have extended functional lifetime because the flexible material may minimize adverse tissue response caused by micromotion. However, their flexibility prevents them from being accurately inserted into neural tissue. This article demonstrates a method to temporarily attach a flexible microelectrode probe to a rigid stiffener using biodissolvable polyethylene glycol (PEG) to facilitate precise, surgical insertion of the probe. A unique stiffener design allows for uniform distribution of the PEG adhesive along the length of the probe. Flip-chip bonding, a common tool used in microelectronics packaging, enables accurate and repeatable alignment and attachment of the probe to the stiffener. The probe and stiffener are surgically implanted together, then the PEG is allowed to dissolve so that the stiffener can be extracted leaving the probe in place. Finally, an in vitro test method is used to evaluate stiffener extraction in an agarose gel model of brain tissue. This approach to implantation has proven particularly advantageous for longer flexible probes (>3 mm). It also provides a feasible method to implant dual-sided flexible probes. To date, the technique has been used to obtain various in vivo recording data from the rat cortex.
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Microfabricated polymer-based neural interface for electrical stimulation/recording, drug delivery, and chemical sensing - development.
Conf Proc IEEE Eng Med Biol Soc
PUBLISHED: 10-11-2013
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We present here a microfabricated, multi-functional neural interface with the ability to selectively apply electrical and chemical stimuli, while simultaneously monitoring both electrical and chemical activity in the brain. Such a comprehensive approach is required to understand and treat neuropsychiatric disorders, such as major depressive disorder (MDD), and to understand the mechanisms underlying treatments, such as pharmaceutical therapies and deep brain stimulation (DBS). The polymer-based, multi-functional neural interface is capable of electrical stimulation and recording, targeted drug delivery, and electrochemical sensing. A variety of different electrode and fluidic channel arrangements are possible with this fabrication process. Preliminary testing has shown the suitability of these neural interfaces for in vivo electrical stimulation and recording, as well as in vitro chemical sensing. Testing of the in vitro drug delivery and combined in vivo functionalities this neural interface are currently underway.
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Improved chronic neural stimulation using high surface area platinum electrodes.
Conf Proc IEEE Eng Med Biol Soc
PUBLISHED: 10-11-2013
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We report a novel nano-cluster platinum (NCPt) film that exhibits enhanced performance as an electrode material for neural stimulation applications. Nano-cluster films were deposited using a custom physical vapor deposition process and patterned on a flexible polyimide microelectrode array using semiconductor processing technology. Electrode performance was characterized in vitro using electrochemical impedance spectroscopy and compared with sputtered thinfilm platinum (TFPt) electrodes. We characterized electrode impedance, charge storage capacity, voltage transient properties, and relative surface area enhancement in vitro. Preliminary lifetime testing of the electrode reveals that the NCPt electrodes degrade more slowly than TFPt electrodes. The combination of material biocompatibility, electrochemical performance, and preliminary lifetime results point to a promising new electrode material for neural interface devices.
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Effective use of low-dose computed tomography lung cancer screening.
Curr Probl Diagn Radiol
PUBLISHED: 09-28-2013
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Lung cancer screening programs for high-risk populations using low-dose computed tomography (LDCT) have been shown by a class I clinical trial to reduce lung cancer mortality by 20%. We present an overview of randomized and nonrandomized lung cancer screening trials and review some of the arguments advocating for or against the widespread implementation of such a screening program. Concerns regarding the use of LDCT screening for lung cancer include increased risk from radiation exposure, overdiagnosis of indolent tumors, and high numbers of false-positive results, which may increase patient anxiety and result in unnecessary procedures with potential complications. Current recommendations regarding diagnostic criteria and workup of positive screens as well as the risks and benefits of using LDCT for lung cancer screening are provided.
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Clinical spectrum and molecular basis of recessive congenital methemoglobinemia in India.
Clin. Genet.
PUBLISHED: 09-24-2013
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We report the clinical features and molecular characterization of 23 patients with cyanosis due to NADH-cytochrome b5 reductase (NADH-CYB5R) deficiency from India. The patients with type I recessive congenital methemoglobinemia (RCM) presented with mild to severe cyanosis only whereas patients with type II RCM had cyanosis associated with severe neurological impairment. Thirteen mutations were identified which included 11 missense mutations causing single amino acid changes (p.Arg49Trp, p.Arg58Gln, p.Pro145Ser, p.Gly155Glu, p.Arg160Pro, p.Met177Ile, p.Met177Val, p.Ile178Thr, p.Ala179Thr, p.Thr238Met, and p.Val253Met), one stop codon mutation (p.Trp236X) and one splice-site mutation (p.Gly76Ser). Seven of these mutations (p.Arg50Trp, p.Gly155Glu, p.Arg160Pro, p.Met177Ile, p.Met177Val, p.Ile178Thr, and p.Thr238Met) were novel. Two mutations (p.Gly76Ser and p.Trp236X) were identified for the first time in the homozygous state globally causing type II RCM. We used the three-dimensional (3D) structure of human erythrocyte NADH-CYB5R to evaluate the protein structural context of the affected residues. Our data provides a rationale for the observed enzyme deficiency and contributes to a better understanding of the genotype-phenotype correlation in NADH-CYB5R deficiency.
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Gluteal flap for omphalocele repair in a case of epigastric heteropagus: A novel approach for surgical management.
Indian J Plast Surg
PUBLISHED: 08-21-2013
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Epigastric heteropagus is an extremely rare congenital anomaly, in which there is asymmetrical conjoined twinning, with the parasitic twin attached to the epigastrium. A 2-day-old male, with epigastric heteropagus and omphalocele, was operated in our institution. After excision of the parasitic twin, omphalocele was covered with a gluteal skin flap available from the parasitic twin. Post-operative course was uneventful, except for infection along the edges of the skin flaps, which was managed conservatively. Only 44 cases of epigastric heteropagus twins have been reported previously in world literature. We present a novel surgical approach for the repair of the omphalocele in a case of epigastric heteropagus twins, probably the 45(th) case to be reported in the world literature.
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Improving health system quality in low- and middle-income countries that are expanding health coverage: a framework for insurance.
Int J Qual Health Care
PUBLISHED: 08-19-2013
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Low- and middle-income countries are increasingly pursuing health financing reforms aimed at achieving universal health coverage. As these countries rapidly expand access to care, overburdened health systems may fail to deliver high-quality care, resulting in poor health outcomes. Public insurers responsible for financing coverage expansions have the financial leverage to influence the quality of care and can benefit from guidance to execute a cohesive health-care quality strategy.
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Mesonephric adenocarcinoma (endometrioid type) of endocervix with diffuse mesonephric hyperplasia involving cervical wall and myometrium: an unusual case report.
Indian J Pathol Microbiol
PUBLISHED: 08-09-2013
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Malignant mesonephric tumors are rare variants of cervical adenocarcinoma, derived from remnants of mesonephric ducts and are associated with mesonephric remnants and/or mesonephric hyperplasia. Few cases have been described in literature. We report an unusual case of cervical mesonephric adenocarcinoma of endometrioid type with squamous morules in association with diffuse mesonephric hyperplasia involving the cervical walls and extending into the myometrium.
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The Ability of Healthy Volunteers to Simulate a Neurologic Field Defect on Automated Perimetry.
Ophthalmology
PUBLISHED: 08-07-2013
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To determine if volunteers can simulate and reproduce 3 types of neurologic field defects: hemianopia, quadrantanopia, and central scotoma.
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Kojic Acid vis-a-vis its Combinations with Hydroquinone and Betamethasone Valerate in Melasma: A Randomized, Single Blind, Comparative Study of Efficacy and Safety.
Indian J Dermatol
PUBLISHED: 08-07-2013
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Melasma is a relatively common, acquired symmetric hypermelanosis characterized by irregular light to gray-brown macules involving sun-exposed areas. Kojic acid, with its depigmenting potential due to tyrosinase inhibition and suppression of melanogenesis, has become a vital component of the dermatologists armamentarium against melasma.
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MDCT of abdominopelvic oncologic emergencies.
Cancer Imaging
PUBLISHED: 07-24-2013
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Acute complications arising in abdominopelvic malignancies represent a unique subset of patients presenting to the emergency room. The acute presentation can be due to complications occurring in the tumor itself or visceral or vascular structures harboring the tumor. Multidetector computed tomography (MDCT) is the investigation of choice in the workup of these patients and enables appropriate and timely management. Management of the complication depends primarily on the extent of the underlying malignancy and the involvement of other viscera. The purpose of this article is to depict the imaging features of these complications on MDCT.
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Preparation of novel alginate based anion exchanger from Ulva japonica and its application for the removal of trace concentrations of fluoride from water.
Bioresour. Technol.
PUBLISHED: 07-04-2013
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A green seaweed, Ulva japonica, was modified by loading multivalent metal ions such as Zr(IV) and La(III) after CaCl2 cross-linking to produce metal loaded cross-linked seaweed (M-CSW) adsorbents, which were characterized by elemental analysis, functional groups identification, and metal content determination. Maximum sorption potential for fluoride was drastically increased after La(III) and Zr(IV) loading, which were evaluated as 0.58 and 0.95 mmol/g, respectively. Loaded fluoride was quantitatively desorbed by using dilute alkaline solution for its regeneration. Mechanism of fluoride adsorption was inferred in terms of ligand exchange reaction between hydroxyl ion on co-ordination sphere of the loaded metal ions of M-CSW and fluoride ion in aqueous solution. Application of M-CSW for the treatment of actual waste plating solution exhibited successful removal of fluoride to clear the effluent and environmental standards in Japan, suggesting high possibility of its application for the treatment of fluoride rich waste water.
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Pelvic periprostatic symplastic leiomyoma: an unusual case necessitating a radical surgery.
J Cancer Res Ther
PUBLISHED: 06-18-2013
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Most pelvic smooth muscle tumors are believed to be malignant, leiomyomas are extremely rare; more so in male patients. Very few cases of symplastic leiomyomas have been described in males. We report an extremely unusual case of a soft tissue mass of periprostatic and periseminal vesicle region in a young adult, which necessitated a radical surgery. Histologically, tumor comprised of smooth muscle bundles with numerous bizarre tumor cells which were immunoreactive with smooth muscle actin (SMA), desmin and h-caldesmon. The diagnostic and treatment dilemmas of these unusual tumors are discussed.
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A quality improvement model for the rapid scale-up of a program to prevent mother-to-child HIV transmission in South Africa.
Int J Qual Health Care
PUBLISHED: 05-24-2013
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QUALITY PROBLEM AND ASSESSMENT: In South Africa (SA), non-governmental organizations (NGOs) have a major role in the provision of health services, but they often compete for funding and influence rather than collaborate. The National Department of Health (NDOH) sought to coordinate existing non-governmental organizations (NGOs) to optimize the prevention of mother-to-child HIV transmission (PMTCT) at scale.
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MR evaluation of rectal cancer: current concepts.
Curr Probl Diagn Radiol
PUBLISHED: 05-21-2013
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Magnetic resonance imaging has become more frequently utilized for staging, preoperative planning, and post-neoadjuvant evaluation of rectal cancer. It offers detailed resolution of the layers of the rectal wall, visualization of the mesorectal fascia, and identification of locoregional nodal involvement. Many advances have been made since the original protocols and include the use of phased-array coils, orthogonally obtained images and 3-dimensional sequences, the use of diffusion-weighted and perfusion protocols to better evaluate the tumor before and after neoadjuvant therapy, and the development of techniques to better evaluate metastatic nodes. Magnetic resonance imaging shows similar accuracy to endorectal ultrasound when staging and offers a less invasive technique that is not limited by patient discomfort or decreased luminal size. This article is meant to provide an update on the recent advances in rectal cancer imaging while addressing the controversial issues that exist in staging, technique, and imaging protocol.
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Early outcome after laparoscopic sleeve gastrectomy of type two diabetes mellitus patients with extremely elevated glycated hemoglobin (HbA1c).
Int J Surg
PUBLISHED: 05-02-2013
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Due to high prevalence of type 2 diabetes mellitus (T2DM) and increasing popularity of bariatric and metabolic operations, Surgeons are faced with patients with relatively more severe T2DM disease. High level of glycated hemoglobin (HbA1c) is widely considered as a marker for uncontrolled T2DM. The aim of this study was to explore the correlation between high level of pre-operative HbA1c, peri-operative morbidity and post operative outcome after laparoscopic sleeve gastrectomy.
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Evaluation of Role of Oxidative Stress on Aging in Caenorhabditis elegans: A Brief Review.
Curr Aging Sci
PUBLISHED: 04-19-2013
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Recently the relationship between oxidative stress and aging has been brought into question. It has been suggested that while oxidative events may play a role in the progression of age-related pathologies, it is not relevant to aging processes not involving specific diseases associated with senescence. The evidence in support of this concept is largely based on studies with the roundworm, Caenorhabditis elegans (C. elegans) that has been extensively used as a model system to study aging. This commentary evaluates data derived from C. elegans and documents that the preponderance of evidence from this species supports the role of pro-oxidant events as being a significant contributor to normal aging. Possible reasons for some anomalous findings conflicting with this concept, are discussed.
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Reactive intramammary lymph node mimicking recurrence on MRI study in a patient with prior breast conservation therapy.
J Cancer Res Ther
PUBLISHED: 04-12-2013
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Breast conservative therapy (BCT) is a well accepted form of treatment for patients with early stage breast cancer. The incidence of ipsilateral breast tumor recurrence is higher in patients undergoing BCT than in those patients undergoing Modified Radical Mastectomy (MRM) without any adverse effect on survival. Patients treated with BCT are put on active surveillance using clinical breast examination and mammography. The radiologist reading the follow-up mammograms is on high alert and any neo-density is viewed with suspicion. MRI may be used as a problem solving tool. At such a time, an innocuous intra-mammary node can mimic malignancy on MRI. We want to showcase one such typical example with histological proof and highlight that type III curve may be seen in an intramammary node. Our case also reinforces the utility of second look ultrasound which is a faster, cheaper and easier method for localization and biopsy of abnormalities seen on MRI.
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Isolated mandibular condylar metastases: an uncommon manifestation of recurrent cervical cancer.
J Cancer Res Ther
PUBLISHED: 04-12-2013
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Bone metastases from recurrent cervical cancer is a rare scenario, with commonly involved sites being lumbar spine and pelvic bones report an extremely rare manifestation of cervical cancer recurrence presenting as a painful jaw swelling due to metastasis to the mandibular condyle.
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Using a campaign approach among health workers to increase access to antiretroviral therapy for pregnant HIV-infected women in South Africa.
J. Acquir. Immune Defic. Syndr.
PUBLISHED: 03-22-2013
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In 2010, WHO guidelines modified eligibility criteria for persons living with HIV to start on lifelong antiretroviral therapy. Pregnant HIV-infected women were identified as a priority group. Yet, despite the availability of key resources and medications, antiretroviral treatment rates for pregnant women in South Africa remained low.
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Preexisting epithelial diversity in normal human livers: a tissue-tethered cytometric analysis in portal/periportal epithelial cells.
Hepatology
PUBLISHED: 03-19-2013
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Routine light microscopy identifies two distinct epithelial cell populations in normal human livers: hepatocytes and biliary epithelial cells (BECs). Considerable epithelial diversity, however, arises during disease states when a variety of hepatocyte-BEC hybrid cells appear. This has been attributed to activation and differentiation of putative hepatic progenitor cells (HPC) residing in the canals of Hering and/or metaplasia of preexisting mature epithelial cells. A novel analytic approach consisting of multiplex labeling, high-resolution whole-slide imaging (WSI), and automated image analysis was used to determine if more complex epithelial cell phenotypes preexist in normal adult human livers, which might provide an alternative explanation for disease-induced epithelial diversity. "Virtually digested" WSI enabled quantitative cytometric analyses of individual cells displayed in a variety of formats (e.g., scatterplots) while still tethered to the WSI and tissue structure. We employed biomarkers specifically associated with mature epithelial forms (HNF4? for hepatocytes, CK19 and HNF1? for BEC) and explored for the presence of cells with hybrid biomarker phenotypes. The results showed abundant hybrid cells in portal bile duct BEC, canals of Hering, and immediate periportal hepatocytes. These bipotential cells likely serve as a reservoir for the epithelial diversity of ductular reactions, appearance of hepatocytes in bile ducts, and the rapid and fluid transition of BEC to hepatocytes, and vice versa.
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Single shot high resolution digital holography.
Opt Express
PUBLISHED: 03-14-2013
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We demonstrate a novel computational method for high resolution image recovery from a single digital hologram frame. The complex object field is obtained from the recorded hologram by solving a constrained optimization problem. This approach which is unlike the physical hologram replay process is shown to provide high quality image recovery even when the dc and the cross terms in the hologram overlap in the Fourier domain. Experimental results are shown for a Fresnel zone hologram of a resolution chart, intentionally recorded with a small off-axis reference beam angle. Excellent image recovery is observed without the presence of dc or twin image terms and with minimal speckle noise.
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Radiology education 2.0--on the cusp of change: part 2. eBooks; file sharing and synchronization tools; websites/teaching files; reference management tools and note taking applications.
Acad Radiol
PUBLISHED: 03-05-2013
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Increasing use of smartphones and handheld computers is accompanied by a rapid growth in the other related industries. Electronic books have revolutionized the centuries-old conventional books and magazines markets and have simplified publishing by reducing the cost and processing time required to create and distribute any given book. We are now able to read, review, store, and share various types of documents via several electronic tools, many of which are available free of charge. Additionally, this electronic revolution has resulted in an explosion of readily available Internet-based educational resources for the residents and has paved the path for educators to reach out to a larger and more diverse student population.
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Radiology education 2.0--on the cusp of change: part 1. Tablet computers, online curriculums, remote meeting tools and audience response systems.
Acad Radiol
PUBLISHED: 03-05-2013
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We are in the midst of an evolving educational revolution. Use of digital devices such as smart phones and tablet computers is rapidly increasing among radiologists who now regularly use them for medical, technical, and administrative tasks. These electronic tools provide a wide array of new tools to the radiologists allowing for faster, more simplified, and widespread distribution of educational material. The utility, future potential, and limitations of some these powerful tools are discussed in this article.
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Néel-state to valence-bond-solid transition on the honeycomb lattice: evidence for deconfined criticality.
Phys. Rev. Lett.
PUBLISHED: 02-20-2013
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We study a spin-1/2 SU(2) model on the honeycomb lattice with nearest-neighbor antiferromagnetic exchange J that favors Néel order and competing six-spin interactions Q that favor a valence-bond-solid (VBS) state in which the bond energies order at the "columnar" wave vector K=(2?/3,-2?/3). We present quantum Monte Carlo evidence for a direct continuous quantum phase transition between Néel and VBS states, with exponents and logarithmic violations of scaling consistent with those at analogous deconfined critical points on the square lattice. Although this strongly suggests a description in terms of deconfined criticality, the measured threefold anisotropy of the phase of the VBS order parameter shows unusual near-marginal behavior at the critical point.
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Differential expression of aurora-A kinase in T-cell lymphomas.
Mod. Pathol.
PUBLISHED: 02-15-2013
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Aurora-A is a mitotic kinase implicated in oncogenesis and is known to be overexpressed in B-cell lymphomas and plasma cell myeloma. The expression of Aurora-A kinase (henceforth referred to as Aurora-A) in T-cell lymphomas is not well characterized. In this study, we assessed Aurora-A expression by immunohistochemical analysis in 100 lymphomas encompassing a variety of T-cell lymphomas as categorized in the World Health Organization classification. Aurora-A expression was highest in anaplastic large-cell lymphomas and variably expressed in other types of T-cell lymphomas. In addition, the pattern of Aurora-A expression was predominantly cytoplasmic in ALK-positive anaplastic large-cell lymphoma and was nuclear in ALK-negative anaplastic large-cell lymphoma and other T-cell lymphomas, suggesting altered biochemical mechanisms of Aurora-A nuclear transport in ALK-positive anaplastic large-cell lymphoma. Reverse transcriptase-PCR analysis showed that Aurora-A is more highly expressed in ALK-positive anaplastic large-cell lymphoma than in ALK-negative anaplastic large-cell lymphoma, and is relatively lower in peripheral T-cell lymphomas. Using western blot analysis and the DEL cell line (derived from ALK-positive anaplastic large-cell lymphoma), we showed that Aurora-A expression is decreased after treatment with either MYC or MEK inhibitors, consistent with the MYC and MAP kinase signaling pathways being involved in driving Aurora-A expression; the greatest decrease was observed after MYC inhibition. These findings provide insights into the possible importance of Aurora-A overexpression in anaplastic large-cell lymphoma pathogenesis, and also suggest that Aurora-A inhibition could be a potential therapeutic approach for patients with anaplastic large-cell lymphoma.
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Comparing laparoscopic mesh fixation strength between articulated and non-articulated tack devices.
Minim Invasive Ther Allied Technol
PUBLISHED: 02-04-2013
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The iMESH Tacker™ (IMT) device is a device which simplifies laproscopic hernia repair by enabling an articulation of the device tip. The study compares the strength of mesh fixation between the IMT and another commercial tack (ACT) device - Absorbatack™ (Covidien, Corp, Mansfield, MA, USA).
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Evaluation of HS-CRP and Lipid Profile in COPD.
J Clin Diagn Res
PUBLISHED: 01-29-2013
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Introduction: COPD is a major public health problem. More than 50 % of the patients of COPD die because of some cardiovascular event. Traditionally, the risk of CVD is assessed by the presence of dyslipidaemia. Recently, HS-CRP has emerged as a novel risk factor for the CVD assessment. In this study, we assessed the patients of COPD for CVD with HS-CRP and lipid indicators. Material and Methods: Forty Five diagnosed patients of COPD and 45 age, sex, and BMI matched healthy controls were enrolled for the study after the institutional ethical committees clearance was obtained. The fasting serum samples of the study subjects were evaluated for the lipid profile and HS-CRP. Results: There was no statistical difference in the lipid profile in the two groups, while HS-CRP was significantly raised in the COPD patients. On applying kappa statistics, we found a poor agreement between the lipid parameters and HS-CRP in estimating the risk for CVD. This underlines the independent importance of HS-CRP in the CVD assessment of COPD patients. Discussion: GOLD has described COPD as a systemic chronic inflammatory disease which involves the lung and the distant organs by the emissary of the systemic inflammation, which is also an antecedent to cardiovascular diseases. COPD is a systemic inflammatory disease which is underlined by this study. But the derangement of the lipid indicators is not statistically significant. This suggests the addition of HS-CRP in the assessment of the COPD patients for CVD. This further needs to be ascertained in a large prospective model. Conclusion: COPD is systemic inflammatory disease, but there is hardly any derangement of the lipid indicators.
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