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Introduction: Ensuring access to clean and safe drinking water is crucial, especially in flood-prone regions where the water quality in dug wells can deteriorate due to various physicochemical factors. This research was aimed to measure the effectiveness of natural materials in improving water quality based on physicochemical parameters and to compare water quality before and after treatment in Astambul Subdistrict of Banjar Regency, South Kalimantan Province. Methods: The study involved a survey of 192 private boreholes and dug wells across five villages in the Astambul Subdistrict, with 30 samples selected for detailed analysis. Key physicochemical parameters analyzed included total dissolved solids (TDS), dissolved oxygen (DO), turbidity, and total suspended solids (TSS). TDS, with a standard limit of 50 mg/L, served as a primary water quality indicator. DO, essential for gauging water oxygenation, and was measured as it results from photosynthesis and atmospheric absorption. Turbidity was assessed using a turbidimeter to determine water clarity, and a UV-vis Spectrophotometer 2008 was utilized to measure levels of iron (Fe) and mangasene (Mn). Results and Discussion: The findings demonstrated that coconut shells, husks, and water hyacinths improved water quality across physical and chemical parameters. Statistical analysis using t-tests showed improvements in these parameters after treatment. For example, DO levels increased in multiple villages, with the highest percentage in Kaliukan Village (59.2%) and decreases in turbidity and TSS. Conclusion: The study concluded that coconut shells, husks, and water hyacinths have potential to enhance physicochemical quality of water. [ABSTRACT FROM AUTHOR]

Background: Diabetic retinopathy (DR), a leading cause of vision loss worldwide, is a common complication of type 2 diabetes mellitus (T2DM) driven by chronic hyperglycemia and microvascular damage. Fibroblast growth factor 21 (FGF21) is crucial in blood sugar regulation and has been linked to DR incidence and severity. While some studies suggest that FGF21 levels may contribute to the DR incidence, others propose a protective role. This discrepancy necessitates further analysis, prompting this study to evaluate the association between FGF21 levels and DR incidence and severity in T2DM patients., Methods: A systematic search was conducted through MEDLINE, Web of Science, Scopus, and Embase up to May 2024 for studies evaluating the association between FGF21 and DR incidence and severity. A random-effect model meta-analysis was performed to calculate the pooled standardized mean difference (SMD) and 95% confidence intervals (CI). A univariate meta-regression was performed to analyze factors influencing pooled size estimates. All statistical analyses were performed using STATA 17 software., Result: This systematic review and meta-analysis of 5,852 participants revealed that FGF21 was positively correlated with DR (SMD 3.11; 95% CI [0.92-5.30], p = 0.005) and sight-threatening DR (STDR) incidence (SMD 3.61; 95% CI [0.82-6.41], p = 0.01). There was no significant difference in FGF21 levels in DR vs STDR ( p = 0.79). Subgroup analysis revealed a significant difference in DR incidence between LDL groups, with higher DR incidence in the group with low-density lipoprotein (LDL) levels >100 ( P < 0.00001). Meta-regression revealed no variables significantly influenced the pooled size estimates., Conclusion: A higher level of FGF21 was associated with higher DR and STDR incidence among T2DM patients, highlighting its potential utilization as a biomarker for DR detection and enabling the exploration of FGF21-based treatment strategies. However, variables independently predicting DR among patients with elevated FGF21 levels shall be explored further., Prospero Id: CRD42024559142., Competing Interests: The authors declare that they have no competing interests., (© 2024 Basir et al.)

The application of Scirpus grossus (SG) fiber as a sound absorber is important to reduce the level of noise affected the physical and mental wellbeing of people. The sound absorption coefficient (SAC) and noise reduction coefficient (NRC) of the SG specimen were evaluated based on a typical model-based design using the data analysis with MATLAB. The results showed that SG specimen with a thickness of 20 mm coated with the perforated aluminum sheet (PAS) compared to that without coating can improve the capability of sound absorption by 14% at the frequency of 4000 Hz. SG specimen coated with PAS that has a NRC value of 0.39 can absorb 39% of sound and thus reflects 61% of sound wave while SG specimen without coating that has a NRC value of 0.23 absorbs 23% of sound and can reflect 77% of sound wave. The sound absorption class of D for SG specimen coated with PAS should be better that of E for SG specimen without coating, which permits us to get better understanding on the applications of SG fiber as a sound adsorber in the future., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Cast austenitic stainless steel (CASS) has been widely used for long-term service periods in high-temperature applications. Nonetheless, the behavior of CASS after high-temperature and long-term service is insufficiently researched alongside the microstructural analysis for sigma phase and carbide. Here, intermediate pipe support made from CASS grade HH was investigated after 24 years of service at 700 °C and compared with the solution-treated specimen at 1100 °C for 2 h. The chemical composition was analyzed by optical emission spectroscopy (OES), while the microstructure was observed using optical microscopy and scanning electron microscope (SEM). The confirmation of phase composition and lattice parameters were further analyzed by energy-dispersive X-ray spectroscopy (EDS) and X-ray diffraction spectroscopy (XRD). The mechanical properties were assessed by tensile tests, hardness tests, and impact tests, whereas the corrosion property was analyzed using potentiodynamic polarization. Based on experiment and analysis, the effects of 24 years of exposure on the sigma phase are spheroidization and Cr depletion, and even partial transformation to ferrite. The sigma phase significantly increases the hardness, but Cr depletion slightly reduces the hardness to 96.86 HRB. Meanwhile, the carbide will increase in quantity and develop an irregular interface at long-term high-temperature exposure. Microstructure evolution of the sigma phase and carbide decreased tensile strength to 46%, elongation to 3%, and impact value to 1.6% of the minimum specifications, respectively, while the corrosion rate increased 10 times (about 7.35 μm per year)., Competing Interests: The authors declare no competing interests. PT. Chandra Asri Petrochemical (Tbk) was mentioned in this paper only to describe the contribution of scientific information used in the overall analysis written by the Authors. Any findings or conclusions stated in this paper are of the Authors and do not represent PT. Chandra Asri Petrochemical (Tbk) in any capacity., (© 2023 The Authors.)

Background: Acute coronary syndrome (ACS) is a major cardiovascular problem due to its high hospitalization and mortality rates. One of the risk factors for atherosclerosis that leads to ACS is insulin resistance (IR) which plays a role in the pathogenesis and development of cardiovascular events. This study aims to determine the relationship between IR and in-hospital outcomes in non-diabetic patients with ACS., Methodology: This was a cohort study conducted from January-June 2021. Insulin resistance was assessed using the Admission insulin resistance index (AIRI). This measurement was performed once during the patient's admission, and then the outcome was observed during hospitalization. The observed in-hospital outcomes were composite outcomes; namely, heart failure, arrhythmia, cardiogenic shock, and death. The statistical tests used were ANOVA, independent T and Chi-Square tests. Statistical test results were considered significant if p <0.05., Results: This study included 60 subjects (51 males and 9 females). Analysis revealed that AIRI was higher in patients with composite outcomes (mean 9.97 ± 4.08) than in patients without composite outcomes (mean 7.71 ± 4.06) ( p <0.05); AIRI was higher in patients with heart failure (mean 10.72 ± 3.83) than in patients without heart failure (mean 7.25 ± 3.84) ( p <0.001). Patients with IR had a higher rate of heart failure complications [OR 5.5 95% CI (1.56-19.38) ( p =0.005)]., Conclusion: There is an association between AIRI and composite outcomes. Patients with IR have 5.5 times the risk of developing heart failure., Competing Interests: The authors declared no conflict of interest., (© 2023 Journal of the ASEAN Federation of Endocrine Societies.)

Malaria-associated acute respiratory distress syndrome (MA-ARDS) is a severe complication of malaria that occurs despite effective antimalarial treatment. Currently, noninvasive imaging procedures such as chest X-rays are used to assess edema in established MA-ARDS, but earlier detection methods are needed to reduce morbidity and mortality. The early stages of MA-ARDS are characterized by the infiltration of leukocytes, in particular monocytes/macrophages; thus, monitoring of immune infiltrates may provide a useful indicator of early pathology. In this study, Plasmodium berghei ANKA-infected C57BL/6 mice, a rodent model of MA-ARDS, were longitudinally imaged using the 18-kDa translocator protein (TSPO) imaging agent [ 18 F]FEPPA as a marker of macrophage accumulation during the development of pathology and in response to combined artesunate and chloroquine diphosphate (ART+CQ) therapy. [ 18 F]FEPPA uptake was compared to blood parasitemia levels and to levels of pulmonary immune cell infiltrates by using flow cytometry. Infected animals showed rapid increases in lung retention of [ 18 F]FEPPA, correlating well with increases in blood parasitemia and pulmonary accumulation of interstitial inflammatory macrophages and major histocompatibility complex class II (MHC-II)-positive alveolar macrophages. Treatment with ART+CQ abrogated this increase in parasitemia and significantly reduced both lung uptake of [ 18 F]FEPPA and levels of macrophage infiltrates. We conclude that retention of [ 18 F]FEPPA in the lungs is well correlated with changes in blood parasitemia and levels of lung-associated macrophages during disease progression and in response to ART+CQ therapy. With further development, TSPO biomarkers may have the potential to accurately assess the early onset of MA-ARDS.

Electroactive biomaterials are fascinating for tissue engineering applications because of their ability to deliver electrical stimulation directly to cells, tissue, and organs. One particularly attractive conductive filler for electroactive biomaterials is silver nanoparticles (AgNPs) because of their high conductivity, antibacterial activity, and ability to promote bone healing. However, production of AgNPs involves a toxic reducing agent which would inhibit biological scaffold performance. This work explores facile and green synthesis of AgNPs using extract of Cilembu sweet potato and studies the effect of baking and precursor concentrations (1, 10 and 100 mM) on AgNPs' properties. Transmission electron microscope (TEM) results revealed that the smallest particle size of AgNPs (9.95 ± 3.69 nm) with nodular morphology was obtained by utilization of baked extract and ten mM AgNO 3 . Polycaprolactone (PCL)/AgNPs scaffolds exhibited several enhancements compared to PCL scaffolds. Compressive strength was six times greater (3.88 ± 0.42 MPa), more hydrophilic (contact angle of 76.8 ± 1.7°), conductive (2.3 ± 0.5 × 10 -3 S/cm) and exhibited anti-bacterial properties against Staphylococcus aureus ATCC3658 (99.5% reduction of surviving bacteria). Despite the promising results, further investigation on biological assessment is required to obtain comprehensive study of this scaffold. This green synthesis approach together with the use of 3D printing opens a new route to manufacture AgNPs-based electroactive with improved anti-bacterial properties without utilization of any toxic organic solvents.

The primary Waste Heat Boiler (WHB) in an ammonia plant experienced cap leaking and the outer tube rupture after ten months since the last repair and replacement (total retubing). The leaking cap and the outer tube materials are low carbon steel SA-204 Gr. B and SA-209 Gr. T1a. The inappropriate vertical part of the leaked cap, which is 2.4 mm shorter than the design, might trigger turbulence flow inside the cap and lead to flow-accelerated corrosion (FAC), as suggested by the appearance of wall thinning and horseshoe pattern in the inner surface. This condition is severed by improper cap material selection with low chromium content (0.01%), which is more susceptible to FAC. The local turbulence flow might erode the oxide layer at the cap bottom and accumulate the oxide deposit around the circumference weld joint and the nearest nail spacer in the tube, represented by a thick Fe 3 O 4 deposit. The primary WHB outer tube failure might occur due to the lack of cooling from boiler water because of cap leakage combined with a thick Fe 3 O 4 scale deposit on the nail spacer that causes significant local temperature increases on the failed tube, which resulted in yielding and thin-lip rupture., Competing Interests: The authors declare no conflict of interest., (© 2021 The Author(s).)

Zinc oxide (ZnO) has been considered as one of the potential materials in solar cell applications, owing to its relatively high conductivity, electron mobility, stability against photo-corrosion and availability at low-cost. Different structures of ZnO materials have been engineered at the nanoscale, and then applied on the conducting substrate as a photoanode. On the other hand, the ZnO nanomaterials directly grown on the substrate have been attractive due to their unique electron pathways, which suppress the influence of surface states typically found in the former case. Herein, we review the recent progress of ZnO nanostructured materials in emerging solar cell applications, such as sensitized and heterojunction architectures, including those embedded with promising perovskite materials. The remarkable advancement in each solar cell architecture is highlighted towards achieving high power conversion efficiency and operational stability. We also discuss the foremost bottleneck for further improvements and the future outlook for large-scale practical applications., Competing Interests: There are no conflicts to declare., (This journal is © The Royal Society of Chemistry.)

Surveys of the conditions of termite attack were conducted in two regencies, Pidie and Greater Aceh, Aceh Province, Indonesia (40 houses in each location). Interviews were also conducted with home owners to collect data on the building history; culture, such as daily life in the house; the frequency and intensity of termite attacks; and traditional knowledge for avoiding and/or suppressing termite attacks. We found that 51% of traditional houses were infested by two termite species: Coptotermes gestroi and Nasutitermes matangensis . The lower parts of traditional houses were frequently attacked and severely damaged by termites. Previous land use and the ages of the traditional houses affected the intensity of the termite attacks. Several measures for avoiding and/or suppressing termite attacks on cultural heritage buildings are also proposed.

Background: Lung cancer management is getting more complex due to the rapid advances in all aspects of diagnostic and therapeutic options. Developing guidelines is critical to help practitioners provide standard of care., Methods: The Saudi Lung Cancer Guidelines Committee (SLCGC) multidisciplinary members from different specialties and from various regions and healthcare sectors of the country reviewed and updated all lung cancer guidelines with appropriate labeling of level of evidence. Supporting documents to help healthcare professionals were developed., Results: Detailed lung cancer management guidelines were finalized with appropriate resources for systemic therapy and short reviews highlighting important issues. Stage based disease management recommendation were included. A summary explanation for complex topics were included in addition to tables of approved systemic therapy., Conclusion: A multidisciplinary lung cancer guidelines was developed and will be disseminated across the country., Competing Interests: There are no conflicts of interest.

Epithelioid trophoblastic tumor is a neoplasm of the chorionic-type intermediate trophoblasts. It is considered a rare gestational trophoblastic disease and is frequently misdiagnosed as carcinoma. Extrauterine epithelioid trophoblastic tumor has been reported in multiple anatomical sites. We report a case of a 50-year-old woman who presented with abdominal pain and distension. Her initial β-human chorionic gonatotropin level was 806.7 IU/L. Imaging showed a large complex ovarian mass with peritoneal and subcapsular hepatic deposits as well as pulmonary nodules. Morphological features of the tumor and its immunohistochemical reactivity to CK8/18, CK7, p63, and CD10 were consistent with the diagnosis of an extrauterine epithelioid trophoblastic tumor arising from the ovary. The differential diagnoses, including other ovarian tumors, were ruled out on the basis of morphology and negative immunostaining to a relatively extended panel of antibodies. A prolonged follow up of these cases and the recognition of such rare tumors in unusual sites are crucial to the diagnosing pathologist and treating physician., (© The Author(s) 2015.)

Background: Prophylactic central neck dissection (PCND) for papillary thyroid cancer (PTC) is controversial. Recent publications suggest that the number and size of nodes and the presence of extranodal extension (ENE) are important features for risk stratification of lymph node metastases. We analyzed these features in clinically unapparent nodes that would not otherwise be removed. We also investigated the impact of surgeon experience on the ability to detect metastatic lymph nodes intraoperatively., Methods: Forty-seven patients with well-differentiated PTC, with no preoperative evidence of central metastases, were included in this study. Intraoperatively, clinically apparent disease was determined by inspection and palpation by the senior surgeon and a fellow/senior resident, and recorded in a blinded fashion. Rate of occult metastases based on intraoperative evaluation were tabulated for each group of surgeons. Histopathologic features of occult nodes were analyzed to determine what clinicians would be missing by foregoing a PCND, and how that would have impacted the patient management., Results: The rate of occult metastases, based on senior surgeon assessment, was 26%, and did not differ significantly from fellow/senior resident assessment. The level of agreement between these two surgeon groups was moderate (k=0.665). Analysis of the false negative cases revealed that the size of the largest undetected node ranged from 0.1 to 1.3 cm; 36% of patients with occult metastases demonstrated five or more positive nodes, and 27% showed ENE., Discussion: Clinical assessment based on intraoperative inspection and palpation had poor sensitivity and specificity in identifying metastatic central nodes, regardless of the level of experience of the surgeon. There was moderate agreement between surgeons of different experience levels. Sensitivity improved significantly with larger size of positive nodes, but not with the presence of multiple positive nodes or presence of ENE. In foregoing PCND in this patient population, our results suggest that treating clinicians miss potentially virulent disease with a large number of occult positive central nodes and occult nodes with ENE. This is the first report to address the pathologic features of clinically nonevident central nodes showing a high incidence of clinically relevant, adverse histologic features, as well as the impact of surgeon experience in performing the important intraoperative determination of whether there are clinically evident nodes that require removal.

Oromotor and clinical swallow assessments are routinely performed by speech-language pathologists (SLPs) who see head and neck cancer (HNC) patients. However, the tools used to assess some of these variables vary. SLPs routinely identify and quantify abnormal functioning in order to rehabilitate the patient. However, function in terms of tongue range of motion (ROM) is typically described using a subjective severity rating scale. The primary objective of this study was to gain insight via survey into what variables SLPs consider important in assessing and documenting function after HNC treatment. A second objective was to seek feedback regarding a scale designed by the authors for assessing tongue ROM for this cohort of patients. This survey also was developed to elucidate salient factors that might have an impact on the prognosis for speech and swallow outcomes. Of the 1,816 SLPs who were sent the survey, 292 responded who work with HNC patients. Results revealed that although 95 % of SLPs assess tongue strength, only 13 % use instrumental methods. Although 98 % assess tongue ROM, 88 % estimate ROM based on clinical assessment. The majority of respondents agreed with the utility of the proposed tongue ROM rating scale. Several variables were identified by respondents as having an impact on overall prognosis for speech and swallow functioning. Tracking progress and change in function with treatment can be accomplished only with measurable assessment techniques. Furthermore, a consistent measuring system can benefit patients with other diagnoses that affect lingual mobility and strength.

Objectives: Surgical resection of oral cancer can result in altered speech, swallowing, and quality of life (QOL). To date, the oral outcome variables of tongue strength, tongue and jaw range of motion, and saliva production have not been extensively assessed. This pilot study was done to assess tongue strength along with other oral outcomes and their relationship to performance status for speech, swallowing, and QOL after partial glossectomy. Our aim was to create a norm for what should be considered a normal tongue strength value in this population. We hypothesized that patients with tongue strength of 30 kPa or greater would perform better on the performance status scale and various QOL measures than do patients with tongue strength of less than 30 kPa., Methods: We used a cross-sectional design in this study. The postoperative assessment included 1) Performance Status Scale and Karnofsky Performance Status Scale; 2) oral outcome variables of tongue strength, jaw range of motion. and saliva production; and 3) patient-rated QOL ratings via Eating Assessment Tool, M. D. Anderson Dysphagia Inventory, EORTC-H&N35, and Speech Handicap Index., Results: Patients with tongue strength of at least 30 kPa performed better on the performance status scales and various QOL measures. The cutoff score of 30 kPa for tongue strength measures revealed a trend in predicting performance on the scales and QOL measures., Conclusions: The oral outcome variables correlated with performance status for speech, swallowing, and QOL. We propose a norm for tongue strength in this population, based on the trend seen in this group of patients, as none previously existed. Future studies are under way that incorporate a larger sample size to further validate this norm. Future studies will also examine oral functional outcome measures in a larger population by inclu'ding other oral and oropharyngeal sites to help predict speech and swallow performance status and QOL.

Background: The Saudi population is characterized by high parity and intermarriages that may impact ovarian carcinogenesis. Herein, we analyzed the tumor characteristics and outcomes in Saudi patients with epithelial ovarian cancer (EOC)., Methods: Patients with EOC treated at King Faisal Specialist Hospital and Research Center during 1995-2007 were identified retrospectively through a review of their medical records. Patients' and tumor characteristics were collected including age at diagnosis, marital status, parity, histology, stage, treatment rendered, and follow-up data., Results: One hundred-ninety-three patients with EOC were identified in this cohort. The mean age of the patients was 55 ± 15 years, the mean ± SD body mass index was 27.0 ± 5.6 kg/m, and the median parity was approximately 7.0. Whereas 4 patients reported a family history of cancer, 164 women reported negative family history; and it was unknown in 27 cases. Tumor distribution by International Federation of Gynecology and Obstetrics stage was the following: 12 patients (6.2%) had stage I disease at diagnosis, 1 patient (0.5%) stage II disease, 130 patients (67.4%) stage III disease, 39 patients (20.2%) stage IV disease, and that of 11 patients (5.7%) was unknown. Information on residual disease after surgery was available on 98 patients with optimal debulking (<1 cm) achieved in 61 cases. Median progression-free survival from end of chemotherapy to recurrence/progression was 11.9 months (95% confidence interval, 9.4-15.2). Tumor histology, size of residual disease, and stage at diagnosis were significant prognostic factors. The patients' age, body mass index, tumor histology, and grade had no impact on survival., Conclusions: Patients presenting with advanced-stage disease are higher among Saudis than those reported in global literature. Despite high intermarriage rates, reported family history for related cancers was quite low in this cohort. Notably, this is the first study evaluating EOC in Saudi patients.

Ovarian dysgerminomas are rare entity and account for only about 2% of all malignant ovarian neoplasm. The aim of this study was to evaluate the clinicopathologic characteristics, treatment, long-term survival, and fertility outcome of women diagnosed with ovarian dysgerminoma at our institution. Sixty-five women with histologically proven pure ovarian dysgerminoma were identified in this retrospective study. They were treated at King Faisal Specialist Hospital, Riyadh; Saudi Arabia between 1976 and 2010. The median age was 20 years. The most frequent symptoms at presentation were abdominal pain and abdominal/pelvic mass. Thirty-three patients (50.7%) presented with stage I, 2 (3.1%) had stage II, 22 (33.8%) had stage III, and 4 (6.2%) had stage IV (4 unknown stage). Unilateral oophorectomy was performed in 50 patients (76.9%) while bilateral oophorectomy±hysterectomy was done in 12 patients (18.4%). Three patients had biopsy only. Forty patients (61.5%) received only chemotherapy, and 4 patients (6.2%) received radiotherapy alone. Recurrence was observed in 6 patients (9.2%). With median follow-up of 54 months, the 5-year disease-free survival (DFS) and overall survival (OS) were 88 and 95%, respectively. On univariate analysis, adjuvant chemotherapy was independent better prognostic factor for DFS (HR, 0.09; 95% CI, 0.01-0.84; P=0.034). Of the 50 patients treated with fertility-sparing surgery, 16 patients (32%) achieved pregnancy with 14 live births. Patients with pure ovarian dysgerminoma have excellent long-term outcome. There is no difference at outcome between fertility-sparing and nonconservative surgeries. Adjuvant chemotherapy was associated with significant improvement in DFS. It is possible to maintain good reproductive function after conservative surgery followed by chemotherapy in our series.

Background: Maintenance therapy for non-small cell lung cancer (NSCLC) aims to extend disease control after first-line chemotherapy with active and well-tolerated agents. The utility of continuation maintenance therapy requires further research., Methods: This multicenter, randomized, phase 2 study compared continuation maintenance therapy with pemetrexed (500 mg/m2 every 21 days) and best supportive care (BSC) versus BSC alone in patients with advanced, non-squamous NSCLC who had not progressed after 4 cycles of induction chemotherapy with pemetrexed (500 mg/m2) and cisplatin (75 mg/m2). The primary endpoint was progression-free survival (PFS) from randomization, was analyzed using a Cox model, stratified for the tumor response at the end of induction therapy, at a one-sided alpha of 0.2. Secondary endpoints: response and disease control rates, overall survival (OS), one year survival rates, and treatment-emergent adverse events (TEAEs)., Results: A total of 106 patients commenced induction therapy, of whom 55 patients were randomized to maintenance pemetrexed/BSC (n = 28) or BSC (n = 27). Although the median PFS time for maintenance phase for both arms was 3.2 months, the one-sided p-value for the PFS HR comparison was less than the prespecified limit of 0.2 (HR = 0.76, two-sided 95% confidence interval [CI]: 0.42 to 1.37; one-sided p-value = 0.1815), indicating that PFS was sufficiently long in the pemetrexed/BSC arm to warrant further investigation. Similar PFS results were observed for the overall study period (induction plus maintenance) and when the PFS analysis was adjusted for sex, baseline disease stage, and the ECOG PS prior to randomization. The median OS for the maintenance phase was 12.2 months (95%CI: 5.6 to 20.6) for the pemetrexed/BSC arm and 11.8 months (95% CI: 6.3 to 25.6) for BSC arm. The one-year survival probabilities were similar for both arms for the maintenance phase and the overall study period. Both the induction and continuation maintenance therapies were generally well-tolerated, and similar proportion of patients in each arm experienced at least 1 grade 3/4 TEAE (pemetrexed/BSC, 17.9%; BSC, 18.5%)., Conclusions: Continuation pemetrexed maintenance therapy resulted in promising PFS with an acceptable safety profile in a Middle Eastern population with advanced non-squamous NSCLC and is worthy of further investigation., Trial Registration: NCT00606021.

Background and Objective: Uterine papillary serous cancer (UPSC) represents only 10% of all uterine cancers and is associated with a significantly worse prognosis compared with other histological types of endometrial cancers. It closely resembles the behavior of ovarian carcinoma., Design and Setting: Retrospective study in a referral center covering period from February 1989 to January 2009., Patients and Methods: Eighteen patients who underwent definitive surgery followed by adjuvant therapy-platinum-based chemotherapy, radiotherapy, or both-were reviewed. Median age was 62 years (range, 52-76 years). All patients underwent total abdominal hysterectomy and salpingo-oophorectomy. Positive lymph nodes were found in 4 of 7 patients who underwent lymph node sampling/dissection. Seven patients had stage I/II disease, whereas 11 patients had stage III disease. Six patients received chemotherapy, 5 patients received radiation therapy, while 7 patients received both chemotherapy and radiation therapy., Result: Median follow-up was 27 months. The median survival and relapse-free survival were 33 and 23 months, respectively. Eight patients were alive and free of disease, of whom 5 patients were stage I/II and 4 patients were stage III. Distant metastasis was the most common site of relapse. Early stage (I/II) was associated with significant improvement in relapse-free survival (RFS) and overall survival (OS) (P=.004 and P=.05, respectively). The combined-modality treatment including chemotherapy-radiotherapy showed statistically significant improvement in RFS (P=.012), while the improvement in OS did not reach statistical significance (P=.12)., Conclusion: This study indicates that postoperative combined treatment with chemotherapy and radiation therapy plays a role in the management of UPSC by improving RFS. Distant metastasis remains the major site of relapse. Future studies using combined-modality therapy are needed to improve the outcome in patients with UPSC.

Both Graves' disease and chronic thyroiditis (Hashimoto's thyroiditis) are autoimmune diseases of thyroid gland. Graves' disease is caused by stimulation of TSH receptor located on the thyroid gland by an antibody, which is known as TSH receptor antibody (TRAb). Furthermore, this may lead to hyperplasia and hyperfunction of the thyroid gland. On the contrary, the cause of Hashimoto's thyroiditis is thought due to a TSH stimulation-blocking antibody (TSBAb) which blocks the action of TSH hormone and subsequently brings damage and atrophy to thyroid gland. Approximately 15-20% of patients with Graves' disease had been reported to have spontaneous hypothyroidism resulting from the chronic thyroiditis (Hashimoto's disease). Pathogenesis for chronic thyroiditis following anti-thyroid drug treatment in patients with Graves' disease remains unclear. It has been estimated that chronic thyroiditis or Hashimoto's disease, which occurs following the Graves' disease episode is due to extended immune response in Graves' disease. It includes the immune response to endogenous thyroid antigens, i.e. thyroid peroxidase and thyroglobulin, which may enhance lymphocyte infiltration and finally causes Hashimoto's thyroiditis. We report four cases of chronic thyroiditis (Hashimoto's disease) in patients who have been previously diagnosed with Graves' hyperthyroidism. In three cases, Hashimoto's thyroiditis occurs in 7 to 25 years after the treatment of Grave's disease; while the other case has it only after few months of Grave's disease treatment. The diagnosis of Hashimoto's disease (chronic thyroiditis) was based on clinical manifestation, high TSHs level, positive thyroid peroxidase antibody and thyroglobulin antibody, and supported by positive results of fine needle aspiration biopsy. Moreover, the result of histopathological test has also confirmed the diagnosis in two cases. All cases have been successfully treated by levothyroxine treatment.

Approximately 30 to 40% of patients with advanced lung cancer will develop bone metastases in the course of their disease, resulting in a significant negative impact on both morbidity and survival. Skeletal complications of bone metastases include pain, pathologic fractures, spinal cord compression, and hypercalcemia. Total medical care costs are greater among patients with bone metastases who develop skeletal complications. A randomized phase III trial of the third generation bisphosphonate zoledronic acid has shown clinical benefit in the management of a subgroup of patients with bone metastases from lung cancer. Zoledronic acid treatment was associated with a reduction in both the risk of, and time to, a skeletal-related event. One of the markers of bone resorption, N-telopeptide, is both prognositic for development of skeletal-related events and predictive for benefit from zoledronic acid. In preclinical models, bisphosphonates have also demonstrated antitumor activity and are therefore currently being evaluated in adjuvant trials. Inhibition of the receptor activator of nuclear factor kappa B ligand-RANK pathway can reduce osteoclast-mediated bone resorption, and trials comparing receptor activator of nuclear factor kappa B ligand inhibitors with bisphosphonates are ongoing, including patients with lung cancer. In this article, we review the management of bone metastases and hypercalcemia as well as potential future directions for bone directed therapies in patients with lung cancer.

Primary omental torsion is a rare cause of acute abdominal pain. A case of omental torsion in a 49-year-old woman who presented with clinical features consistent with acute appendicitis is discussed with a review of the literature.