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To assess the range and frequency of additional congenital malformations identified among children born alive with CL/P. Analysis of patient-level data from a national registry of cleft births linked to national administrative data of hospital admissions. National Health Service, England. Children born between 2000 and 2012 receiving cleft care in English NHS hospitals. The proportion of children with ICD-10 codes for additional congenital malformations, according to cleft type. The study included 9403 children. Of these 2114 (22.5%) had CL±A, 4509 (48.0%) had CP, 1896 (20.2%) had UCLP, and 884 (9.4%) had BCLP. A total of 3653 (38.8%) children had additional congenital malformations documented in their hospital admission records. The prevalence of additional congenital malformations was greatest among children with CP (53.0%), followed by those with BCLP (33.5%), UCLP (26.3%), and then CL±A (22.2%) (P

Kangha Jung, Mi Hye Park, Duk Kyung Kim, Byung Jun Kim Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South KoreaCorrespondence: Mi Hye ParkDepartment of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 51 Ilwon-Ro, Gangnam-Gu, Seoul 06351, South KoreaTel +82-2-3410-5258Fax +82-2-3410-6626Email dukiduck.park@samsung.comBackground: We evaluated whether the surgical pleth index (SPI) following surgical incision was related to postoperative pain and opioid consumption.Methods: This prospective observational study was performed in 50 patients undergoing laparotomy under sevoflurane-based general anesthesia. We recorded the highest SPI during surgical incision. The postoperative pain with a numerical rating scale (NRS) and opioid consumption during postoperative 24 h were compared in patients who showed SPI over 50 (Group H) or 20– 50 (Group L). The relationship between postoperative opioid consumption and SPI values (pre-incision, post-incision SPI value, change of SPI value, and post-incision SPI minus pre-incision SPI) was evaluated using receiver-operating characteristic analysis.Results: The mean of the highest SPI value during surgical incision was 56 (SD, 12; range, 26– 85). Twenty-nine (63%) patients were included in Group H and 17 (37%) patients in Group L. There was a significant difference in NRS during recovery room stay and on postoperative 24 h in two groups (5 [5, 6] vs 7 [6, 8], p=0.007 and 3.5 [3, 5] vs 5 [5,6], p=0.006, Group L vs Group H). Group H used higher fentanyl via patient control analgesia during postoperative 24 h (573 (253) μg vs 817 (305) μg, p=0.008). A change of pre-incision and post-incision SPI value of 23, which showed the highest sensitivity (67%) and specificity (68%), was defined post hoc as the cut-off for fentanyl consumption during postoperative 24 h ≥ 1000 μg.Conclusion: Our finding suggests that the SPI response to nociceptive stimuli during surgery is closely related to the degree of patient postoperative pain and opioid requirements. This information may be used to provide proper intraoperative analgesia and individual postoperative pain management.Keywords: opioid, postoperative pain, stress response, surgical incision, surgical pleth index

PurposeSince the publication of the Z0011 trial, practice-changing clinical guidelines for breast surgery have been developed. Although recent studies confirmed the feasibility of the Z0011 strategy in Asian populations, there has been no study on the trends of axillary surgery in Asian cohort. This study aimed to investigate the time trend of axillary surgery for breast cancer in Korea and compare it with that in Dutch cohort to understand the impact of the Z0011 trial.MethodsWe collected prospectively constructed data from the nationwide Korean Breast Cancer Registry (KBCR). We identified patients who underwent sentinel node biopsy followed by breast-conserving surgery from 2011 to 2018 and were found to have pathological stage T1-2N1-3M0 disease. Regression analyses were performed to compare the downward trend of axillary lymph node dissection (ALND) in our cohort with that previously reported in a Dutch cohort.Results From KBCR data, 7,478 patients met the inclusion criteria. The proportion of ALND significantly decreased from 2011 (76.6%) to 2018 (47.5%). Multivariate analysis revealed that earlier year at diagnosis, larger tumor size, and lymphatic invasion were associated with a higher odds ratio of performing ALND. Compared to Dutch cohort, the downward trend of ALND in Korea was significantly more gradual (annual percent change: 30.1% vs. 5.8%, P < 0.001).ConclusionsThis study demonstrated a downward trend of ALND in Korean patients with breast cancer. However, the rate of decrease was significantly slower than that in Dutch cohort, indicating the need to spread the Z0011 strategy in Asia.

Tae Young Yeo, Keonyeup Kim, Moon Ho Park Department of Neurology, Korea University Ansan Hospital, Ansan, Republic of KoreaCorrespondence: Moon Ho ParkDepartment of Neurology, Korea University Ansan Hospital, 123 Jeokgeum-ro, Danwon-gu, Ansan-si, Gyeonggi-do 15355, Republic of KoreaTel +82 31 412 5155Fax +82 31 412 5154Email kmmse@naver.comPurpose: The ability to convert scores between cognitive measurements would facilitate the longitudinal assessment of cognition in clinical practice and the comparison and synthesis of cognitive data from international, multicenter, or longitudinal studies. The primary aim of this study was to apply a simple and reliable method for converting scores from the Korean Dementia Screening Questionnaire (KDSQ) to those of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE).Patients and methods: A total of 627 participants, with and without cognitive dysfunction, received both the KDSQ and the IQCODE at the same visit. The scores of both tools were calculated, and equipercentile equating was used to create a method for converting scores from the KDSQ to the IQCODE.Results: KDSQ scores were highly correlated with IQCODE scores (Pearson r = 0.905, P < 0.01). We developed scores for converting the KDSQ to the IQCODE using equipercentile equating and log-linear smoothing. We provide an easy-to-use table that enables the conversion of KDSQ scores to IQCODE scores.Conclusion: We delivered a simple and reliable method for converting scores from the KDSQ to the IQCODE. The conversion score table reported here enables direct and easy comparison of these cognitive measurements in older adults.Keywords: KDSQ, IQCODE, cognition, equation

ObjectivesThe aim of this study was to investigate whether structural and process characteristics of memory assessment services (MASs) are associated with outcomes (changes in patients' health-related quality of life (HRQL), carers' HRQL and carers' burden) over the first 6months following the first appointment.MethodsData from 785 patients referred to 69 MASs and 511 of their lay carers, collected at the first appointment and 6months later. Data on MAS characteristics were collected using a questionnaire at baseline. We used multilevel linear regression models to explore the associations of patients' HRQL and carers' outcomes with structural and process characteristics of MASs. Analyses were conducted on the full sample of patients and carers, and separately on those patients diagnosed with dementia.ResultsNone of the structural (skill mix, workload, volume, provision of clinical assessments and provision of psychosocial support) or process (waiting time, length and number of appointments, anti-dementia drug use and psychosocial interventions use) characteristics included in the analyses were associated with patients' or carers' outcomes at 6months, apart from the presence of allied health professionals (AHPs), which was associated with a DEMQOL score 2.7 points higher. When only those with a diagnosis of dementia were considered, the association with presence of AHPs was no longer observed.ConclusionsApart from involving AHPs, alterations to the way MASs are structured or function appear unlikely to improve their effectiveness in improving patients' and carers' HRQL. It is possible that the characteristics of MASs may influence patients' and carers' experience, but this was not studied. Copyright (c) 2017 John Wiley & Sons, Ltd.

Hae Kook Lee, Jong-Hyun Jeong, Na-Young Kim, Min-hyeon Park, Tae-Won Kim, Ho-Jun Seo, Hyun-Kook Lim, Seung-Chul Hong, Jin-Hee Han Department of Psychiatry, College ofMedicine, The Catholic University of Korea, Seoul, Korea Objectives: Attention-deficit hyperactivity disorder (ADHD) is characterized by inattentive and impulsive behavior. Many ADHD patients reportedly have cognitive dysfunction and sleep problems, including longer sleep latency, lower sleep efficiency, and shorter total sleep time. The purpose of this study was to examine neurocognitive functions and nocturnal sleep parameters in patients with ADHD, using a cognitive function test and actigraphy.Methods: Subjects included 37 male patients with ADHD and 32 controls (7–12 years of age). For each participant, we determined intelligence quotient (IQ) and administered the Matching Familiar Figures Test (MFFT) and 72-hour actigraphy. The relationships between sleep parameters and cognitive functions were assessed.Results: ADHD patients significantly differed from controls in several cognitive functions and sleep variables. In the MFFT, response error rate (P

Min Hae Park,1 Thang Huu Nguyen,2 Anh Thi Ngoc Dang,2 Thoai Dinh Ngo1 1Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, London, UK; 2Research and Metrics Team, Marie Stopes International Vietnam, Ha Noi, Vietnam Objective: To describe medical abortion (MA) practices among private providers in Vietnam. Methods: The study subjects were women (n = 258) undergoing early MA through 12 private providers in Hanoi during February-June 2012. The women were interviewed on the day of their procedure and were followed up by telephone 14 days after mifepristone administration. Results: Of the 258 women in the study, 97% used a regimen of mifepristone plus misoprostol; 80% were instructed to administer misoprostol at home. MA resulted in a complete termination in 90.8% of cases. All women were provided with information on potential complications and were instructed to return for a follow-up visit. We successfully followed up 77.5% (n = 200) of participants by telephone, while nearly two-thirds of women returned to the clinic for a follow-up visit. At follow up, 39.5% of women reported having used a Help line service, while 7% had sought help from a health provider. A high unmet need for postabortion family planning was identified. Conclusion: Follow up of women, postabortion care, and the provision of family planning have been identified as important areas to address for strengthening MA services in the private sector in Vietnam. Keywords: misoprostol, mifepristone, abortion, mhealth, Vietnam

Thoai D Ngo,1,2 Min Hae Park,1 Caroline Free21Research, Monitoring and Evaluation Team, Health System Department, Marie Stopes International, UK; 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UKObjective: Training midlevel providers (MLPs) to conduct surgical abortions and manage medical abortions has been proposed as a way to increase women's access to safe abortion. This paper reviews the evidence that compares the effectiveness and safety of abortion procedures administered by MLPs versus doctors.Methods: A systematic search was conducted of published trials and comparison studies assessing the effectiveness and/or safety of abortion provided by MLPs compared to doctors. The Cochrane Central Register of Controlled Trials, EMBASE, MEDLINE, and Popline were searched. The primary outcomes of interest were: (1) incomplete or failed abortion; and (2) measures of safety (adverse events and complications) of abortion procedures administered by MLPs and doctors. Odds ratios (ORs) and their 95% confidence intervals (CIs) were calculated for each study. Data were synthesized in a narrative fashion.Findings: Five studies were included in this review (n = 8539 women), comprising two randomized controlled trials (RCTs) (n = 3821) and three prospective cohort studies (n = 4718). In total, 4198 women underwent a procedure administered by an MLP, and 4341 women underwent a physician-administered procedure. Studies took place in the US, Nepal, South Africa, Vietnam, and India. Four studies used surgical abortion with maximum gestational ages ranging from 10 to 16+ weeks, while a medical abortion study had gestational ages up to 9 weeks. In RCTs, the effect estimates for incomplete or failed abortion for procedures performed by MLPs compared with doctors were OR = 2.00 (95% CI 0.85–4.68) for surgical abortion, and OR = 0.69 (95% CI 0.34–1.37) for medical abortion. Complications were rare among both provider types (1.2%–3.1%; OR = 1.80, 95% CI 0.83–3.90 for surgical abortions), and no deaths were reported.Conclusion: There were no statistical differences in incomplete abortion and complications for first trimester surgical and medical abortion up to 9 weeks performed by MLPs compared with physicians. Further studies are required to establish more precise effect estimates.Keywords: abortion, misoprostol, manual vacuum aspiration, medical abortion

Thoai D Ngo1, Min Hae Park1, Yuanhong Xiao21Research and Metrics Team, Health System Department, Marie Stopes International, London, UK; 2Research and Metrics Team, Marie Stopes International China, Beijing, ChinaObjective: To compare the effectiveness, in terms of complete abortion, of the World Health Organization (WHO)- and the China-recommended protocol for first-trimester medical abortion.Methods: A retrospective analysis of clinical data from women presenting for first trimester medical abortion between January 2009 and August 2010 at reproductive health clinics in Qingdao, Xi’an, Nanjing, Nanning, and Zhengzhou was conducted. One clinic in Qingdao administered the WHO-recommended protocol (200 mg mifepristone orally followed by 0.8 mg misoprostol buccally 36–48 hours later). Four clinics in the other locations provided the China-recommended procedure (Day 1: 50 mg of mifepristone in the morning, 25 mg in the afternoon; Day 2: 50 mg of mifepristone in the morning, 25 mg in the afternoon; Day 3: 0.6 mg oral misoprostol). Data on reproductive and demographic characteristics were extracted from clinic records, and complete termination was determined on day 14 (post-mifepristone administration).Results: A total of 337 women underwent early medical abortion (167 WHO- and 170 China-recommended procedures). Complete abortion was significantly higher among women who had the WHO protocol than those who received the China protocol (91.0% vs 77.7%, respectively; P < 0.001). Women using the China-recommended protocol were three times more likely to require an additional dose of misoprostol than women using the WHO protocol (21.8% vs 7.8%, respectively; P < 0.001), and had significantly more bleeding on the day of misoprostol administration (12.5 mL vs 18.5 mL; P < 0.001).Conclusion: This clinical audit provides preliminary evidence suggesting the WHO-recommended protocol may be more effective than the China-recommended protocol for early medical abortion. A larger scale study is necessary to compare the methods’ effectiveness and acceptability.Keywords: medical abortion, misoprostol, mifepristone, China, first-trimester termination

Min Hae Park1,2, Thang Huu Nguyen3, Thoai Dinh Ngo1,21Research and Metrics Team, Health System Department, Marie Stopes International; 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; 3Research and Metrics Team, Marie Stopes International Vietnam, Ha Noi, VietnamAbstract: This study describes the dynamics of intrauterine device (IUD) use in Vietnam and implications for family planning services. A retrospective study was conducted among women who received IUD services in 2006–2009 at six commune health stations in three provinces. Women were interviewed about IUD use and switching behaviors. Of 1316 participants, 12.1% had discontinued IUD use at 12 months after insertion, 19.4% at 24 months, and 26.9% at 36 months. The highest rates of discontinuation were among older women and farmers/manual workers. Among 434 women who had an IUD removed, 49% cited health concerns as the main reason. Following removal, 70% switched to another contraceptive method (n = 306); of these, 15% switched to withdrawal, and 12% waited >2 months before adopting a new method. Dissatisfaction with IUD services was associated with high rates of discontinuation. Early discontinuation, delays in adopting new methods, and switching to withdrawal may contribute to unintended pregnancy among commune health station users in Vietnam.Keywords: intrauterine device, contraceptive discontinuation, dissatisfaction

Objectives To evaluate immediate and long-term outcomes of bronchial artery embolisation (BAE) for the treatment of haemoptysis in patients with pulmonary tuberculosis (TB), and to clarify factors that influence recurrence. Design Of 398 patients with haemoptysis who underwent BAE between January 2004 and June 2009, 169 were retrospectively reviewed. All of the patients had either a history of pulmonary TB or a current diagnosis of TB. Follow-up ranged from 1 day to 66 months. Results Haemoptysis was stopped or markedly decreased, with subsequent clinical improvement, in 163 patients (96.4%); in 50 patients symptoms recurred during the follow-up period. Disease activity, aortography and mycetoma showed a statistically significant correlation with recurrence rate. Cumulative non-recurrence rates were 76.1% for 12 months and 51.4% for 40 months. The median non-recurrence time was 41.2 months. Disease activity and mycetoma showed a statistically significant correlation with early recurrence. Only one major complication was observed. Conclusions BAE is a safe and effective treatment option for the control of haemoptysis in TB patients. Disease activity and mycetoma both correlate with higher recurrence rate and early time of recurrence.

Five different kinds of PU foam wound dressings were prepared to investigate their wound healing capability. They include (i) PU+silver sulfadiazine (AgSD), (ii) PU+alginate (Al), (iii) PU+Al+AgSD, (i.v.) PU+hyaluronic acid (HA), and (v) PU+HA+AgSD. Physical properties and in vitro behaviors of AgSD release and fibroblast adhesion on those dressings were evaluated. From the drug release and fibroblast adhesion studies, it was observed that PU foam impregnated with both HA and AgSD shows good drug release behavior and low adhesion of the cells. Furthermore, the HA and AgSD-containing PU foam showed excellent wound healing effect without any inflammation or yellow cluster. The wound size decreased around 77% after 1 week application of that foam dressing onto a rat skin defect.

The objective of this study was to determine alternative meat-quality factors in porcine sera. We investigated serum metabolites from high pH group (HpHG) and low pH group (LpHG) on the basis of pH 24 h of post-mortem muscle (pH24h). The pH24h correlated well with the water holding capacity (WHC) of porcine meat, whereas a strongly negative correlation was observed between pH24h and serum sodium level. For serum metabolites obtained by 1H NMR spectra and PicoTagTM based HPLC, principal components analysis showed clear differences between the HpHG and the LpHG. The 1H NMR spectra of serum metabolites at 600 MHz showed that free amino acids such as alanine, leucine, phenylalanine, and valine were qualitatively higher in the HpHG than in the LpHG. The relative abundance of three amino acids was quantitatively verified by HPLC: Phenylalanine and valine (P

In the UK, 7-10% of the child and adolescent population are currently considered obese according to International Obesity Task Force (IOTF) definitions, and this proportion is expected to rise to 14% over the next 20 years. Childhood obesity is associated with complications including dyslipidemia, insulin resistance, and respiratory problems, and childhood body mass index (BMI) is correlated with BMI in adulthood. However, the ways in which overweight and obesity in early life impact on long-term health are not well understood.This thesis reviews the current evidence for the associations between overweight in childhood and disease outcomes in adulthood, and discusses the limitations of methods that have commonly been used to examine this topic. To investigate the effects of childhood and adolescent overweight on long-term health, pooled data from three British National Birth Cohorts (the 1946 National Survey of Health and Development, 1958 National Child Development Study, and 1970 British Cohort Study) are analysed. The findings of this analysis indicate that being overweight in childhood and adolescence may contribute to increased risk of type 2 diabetes and coronary heart disease, but not hypertension or non-cardiovascular outcomes. Projections from a micro-simulation model show that overweight and obesity in the current UK child population could present a substantial burden in terms of disease prevalence and healthcare costs by the year 2050, and the effects of different obesity interventions on long-term burden are explored.Overweight and obesity in childhood may have important implications for long-term cardiovascular risk, and current trends in childhood obesity prevalence are likely to have a substantial impact on long-term health burden in the UK. Early intervention to reduce overweight in childhood is likely to have an important role in reducing future obesity-related disease burden.

The objective of this study was to evaluate the evidence on whether childhood obesity is a risk factor for adult disease, independent of adult body mass index (BMI). Ovid MEDLINE (1948-May 2011), EMBASE (1980-2011 week 18) and the Cochrane Library (1990-2011) were searched for published studies of BMI from directly measured weight and height in childhood (2-19 years) and disease outcomes in adulthood. Data were synthesized in a narrative fashion. Thirty-nine studies (n 181-1.1 million) were included in the review. There was evidence for associations between childhood BMI and type 2 diabetes, hypertension and coronary heart disease. Few studies examined associations independent of adult BMI; these showed that effect sizes were attenuated after adjustment for adult BMI in standard regression analyses. Although there is a consistent body of evidence for associations between childhood BMI and cardiovascular outcomes, there is a lack of evidence for effects independent of adult BMI. Studies have attempted to examine independent effects using standard adjustment for adult BMI, which is subject to over-adjustment and problems with interpretation. Studies that use more robust designs and analytical techniques are needed to establish whether childhood obesity is an independent risk factor for adult disease.

We report a case with protruding inguinal masses for 6 months, in whom muscular amyloidoma was not suspected before muscle biopsy. On pelvic magnetic resonance imaging (MRI), round masses showing peripheral rim enhancement with gadolinium were observed in iliopsoas and iliacus muscles of both inguinal areas. The same lesions were also observed in gluteus muscles. The biopsy showed Congo red positive materials in a dense fibrous background. Serum and urine electrophoresis showed Bence Jones protein, lambda type. In bone marrow section, myeloma cells were found. Peripheral blood stem cell transplantation (PBSCT) following four cycles of VAD (vincristine, adriamycin, dexamethasone) chemotherapy was performed and the result was satisfactory. Amyloidoma lesions decreased in size and number on the following MRI.

We calculated the differential cross sections as well as the total cross sections for the /sup 7/Be(p,..gamma..)/sup 8/B at low energies in the radiative direct capture model including the E1, M1, and E2 transitions. The astrophysical S factor at the solar temperature of 20 keV is found to be 0.024 keVX which agrees well with a recent measurement by Filippone et al. We show that the d-wave capture plays an important role in determining the magnitude and shape of S(E) at low energies of astrophysical interest.

We consider the problem of color regulation in visual pigments for both bovine rhodopsin (lambda max = 500 nm) and octopus rhodopsin (lambda max = 475 nm). Both pigments have 11-cis-retinal (lambda max = 379 nm, in ethanol) as their chromophore. These rhodopsins were bleached in their native membranes, and the opsins were regenerated with natural and artificial chromophores. Both bovine and octopus opsins were regenerated with the 9-cis- and 11-cis-retinal isomers, but the octopus opsin was additionally regenerated with the 13-cis and all-trans isomers. Titration of the octopus opsin with 11-cis-retinal gave an extinction coefficient for octopus rhodopsin of 27,000 +/- 3000 M-1 cm-1 at 475 nm. The absorption maxima of bovine artificial pigments formed by regenerating opsin with the 11-cis dihydro series of chromophores support a color regulation model for bovine rhodopsin in which the chromophore-binding site of the protein has two negative charges: one directly hydrogen bonded to the Schiff base nitrogen and another near carbon-13. Formation of octopus artificial pigments with both all-trans and 11-cis dihydro chromophores leads to a similar model for octopus rhodopsin and metarhodopsin: there are two negative charges in the chromophore-binding site, one directly hydrogen bonded to the Schiff base nitrogen and a second near carbon-13. The interaction of this second charge with the chromophore in octopus rhodopsin is weaker than in bovine, while in metarhodopsin it is as strong as in bovine.

Özet– Pulmoner hipertansiyon alanındaki önemli gelişmelerden sonra, en önemli görevlerden biri uzun dönem sonuçlarla ilişkili kinik tedavi hedeflerini belirleme gereksinimidir. Modifiye New York Kalp Cemiyeti fonksiyonel sınıf I veya II, 380 metreden fazla 6 dakika yürüme mesafesine ulaşma, ekokardiyografide sağ ventrikül boyutunun ve fonksiyonunun normalleşmesi, B-tip natriüretik peptit düzeyinin azalması ya da normalleşmesi ve sağ atriyal basıncının 8 mmHg’den düşük ve kardiyak indeksin 2,5 L/dk/m2 ’den büyük olması güncel hedeflerdir. Bununla birlikte, egzersiz kapasitesi ve sağ kalp fonksiyonu gibi uzun dönem sonuçlarla daha fazla ilişkili olan parametreleri hedefleyen daha güçlü ve net sınırlarla çizen “eşiğin” daha yüksek tutulması gerektiği açık hale gelmektedir; Özellikle, manyetik rezonans görüntüleme ve BNP/N-terminal pro B tip natriüretik peptit gibi doğru ve noninvaziv olarak sağ ventrikül fonksiyonunu belirleyen testler, temel belirleyiciler ve tedavi hedefleri olarak hizmet etmek için umut verici göstergeler olarak ortaya çıkmaktadır. Ayrıca, sonuçlar üzerine odaklı çalışmalar tek başına hiçbir testin güvenilir bir şekilde uzun vadeli prognostik belirteç olarak kullanılamayacağını ve birleşik tedavi hedeflerinin uzun dönem sonuçlarının daha iyi öngördüreceğini gösterdi. Yeniden düzenlenen tedavi hedeflerinin şunlar olduğu ileri sürülmüştür: Modifiye New York Kalp Cemiyeti fonksiyonel sınıf I veya II, ≥380 ve 440 m arasındaki 6 dakika yürüme mesafesi, kardiyopulmoner egzersiz testi-15 ml/d/kg’dan fazla tepe oksijen tüketim ölçümü ve 45 l/dak’dan az karbondioksit için solunum eşdeğeri, normale yakın BNP değeri, ile normal/normale yakın sağ ventrikül boyut ve fonksiyonlarını gösteren ekokardiyografi ve/veya kardiyak manyetik rezonans görüntüleme ve 8 mmHg’den az sağ atriyal basınçla ve 2,5-3 l/dak/m²’den fazla kardiyak indeksle birlikte sağ ventrikül fonksiyonunun normalleştiğini gösteren hemodinamik parametreler. (J Am Coll Cardiol 2013;62:D73–81) With significant therapeutic advances in the field of pulmonary arterial hypertension, the need to identify clinically relevant treatment goals that correlate with long-term outcome has emerged as 1 of the most critical tasks. Current goals include achieving modified New York Heart Association functional class I or II, 6-min walk distance >380 m, normalization of right ventricular size and function on echocardiograph, a decreasing or normalization of B-type natriuretic peptide (BNP), and hemodynamics with right atrial pressure 2.5 L/dk/m2. However, to more effectively prognosticate in the current era of complex treatments, it is becoming clear that the "bar" needs to be set higher, with more robust and clearer delineations aimed at parameters that correlate with long-term outcome; namely, exercise capacity and right heart function. Specifically, tests that accurately and noninvasively determine right ventricular function, such as cardiac magnetic resonance imaging and BNP/N-terminal pro-B-type natriuretic peptide, are emerging as promising indicators to serve as baseline predictors and treatment targets. Furthermore, studies focusing on outcomes have shown that no single test can reliably serve as a long-term prognostic marker and that composite treatment goals are more predictive of long-term outcome. It has been proposed that treatment goals be revised to include the following: modified New York Heart Association functional class I or II, 6-min walk distance 380 to 440 m, cardiopulmonary exercise test-measured peak oxygen consumption >15 ml/min/kg and ventilatory equivalent for carbon dioxide 2.5 to 3.0 l/min/m2. (J Am Coll Cardiol 2013;62:D73-81) ©2013 by the American College of Cardiology Foundation.

Eukaryotic translation initiation factor 5A (eIF5A) is the only cellular protein that contains the unusual amino acid hypusine [N(ε)-(4-amino-2-hydroxybutyl)lysine]. The role of hypusine formation in the eIF5A protein in the regulation of cell proliferation and apoptosis is addressed in the present review. Moreover, vertebrates carry two genes that encode two eIF5A isoforms, eIF5A-1 and eIF5A-2, which, in humans, are 84% identical. However, the biological functions of these two isoforms may be significantly different. In fact, eIF5A-1 is demonstrable in most cells of different histogenesis, whereas eIF5A-2 protein is detectable only in certain human cancer cells or tissues, suggesting its role as a potential oncogene. In this review we focus our attention on the involvement of eIF5A-1 in the triggering of an apoptotic program and in the regulation of cell proliferation. In addition, the potential oncogenic role and prognostic significance of eIF5A-2 in the prediction of the survival of cancer patients is described. eIF5A-1 and/or the eIF5A-2 isoform may serve as a new molecular diagnostic or prognostic marker or as a molecular target for anti-cancer therapy.