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Basal cell carcinoma (BCC) is one among the most prevalent malignant neoplasms that has exhibited a notable surge in global incidence over recent decades. This slow-growing malignancy is typified by its localized invasiveness while demonstrating an exceedingly rare metastatic proclivity. It predominantly afflicts the sun-exposed skin of aging individuals, with a heightened predilection for the maxillofacial region. Scraping cytology offers numerous benefits, including the potential for an earlier diagnosis and the absence of scarring, as opposed to a biopsy. The cytodiagnosis of BCC proves to be straightforward with various techniques, making it highly advantageous in an outpatient environment as a swift diagnostic method when planning a surgical excision. Our study sought to scrutinize the clinicopathological facets of BCC within the maxillofacial region. We compared advanced cytological techniques for diagnosis, including scraping, scratching, and imprinting using Papanicolau and Diff-Quick stains. In addition, we evaluated the therapeutic effectiveness of diode lasers operating at wavelengths of 940nm and 980n. A retrospective analysis was undertaken, encompassing facial BCC lesions smaller than 2.5 cm in diameter that underwent treatment through diode laser ablation between September 2021 and August 2023 at Ramadi Teaching Hospital and a private clinic in Ramadi City, Iraq. Among the cohort of 48 patients with BCC, a majority (58%) were 50 years of age or older, with a predominance of males (62%). The mean duration of lesion existence exceeded 4 months. The anatomical region most commonly involved was the middle 1/3 of the face, accounting for 34% of cases. Intriguingly, the therapeutic approach of diode laser ablation yielded exceptional esthetic and functional outcomes, which were consistently observed throughout the follow-up period post-healing. The occurrence of complications following diode laser ablation was relatively infrequent. This investigation revealed that cytological examination is easily conducted, eliminating the need for local anesthesia, saving time, being more cost-effective than a conventional biopsy, and delivering swift diagnoses. The process of smear-taking for cytology is well-tolerated, inflicting minimal trauma or discomfort on the patient. BCC predominantly afflicts elderly males and most frequently affects the middle third of the face. Notably, nodular BCC emerged as the prevailing histological subtype. The use of diode laser ablation exhibited a commendable track record, producing exemplary functional and esthetic outcomes over a 6-month follow-up period.

Background: Islam and Muslims are underrepresented in the medical literature and the influence of physician's cultural beliefs and religious values upon the clinical encounter has been understudied. Objective: To elicit the perceived influence of Islam upon the practice patterns of immigrant Muslim physicians in the USA. Design: Ten face-to-face, in-depth, semistructured interviews with Muslim physicians from various backgrounds and specialties trained outside the USA and practising within the the country. Data were analysed according to the conventions of qualitative research using a modified grounded-theory approach. Results: There were a variety of views on the role of Islam in medical practice. Several themes emerged from our interviews: (1) a trend to view Islam as enhancing virtuous professional behaviour; (2) the perception of Islam as influencing the scope of medical practice through setting boundaries on career choices, defining acceptable medical procedures and shaping social interactions with physician peers; (3) a perceived need for Islamic religious experts within Islamic medical ethical deliberation. Limitations: This is a pilot study intended to yield themes and hypotheses for further investigation and is not meant to fully characterise Muslim physicians at large. Conclusions: Immigrant Muslim physicians practising within the USA perceive Islam to play a variable role within their clinical practice, from influencing interpersonal relations and character development to affecting specialty choice and procedures performed. Areas of ethical challenges identified include catering to populations with lifestyles at odds with Islamic teachings, end-of-life care and maintaining a faith identity within the culture of medicine. Further study of the interplay between Islam and Muslim medical practice and the manner and degree to which Islamic values and law inform ethical decision-making is needed.

BackgroundAcute isolated posterior cerebral artery occlusions (aPCAOs) were excluded or under-represented in major randomized trials of mechanical thrombectomy (MT). The benefit of MT in comparison to intravenous tissue plasminogen activator (alteplase; IV-tPA) alone in these patients remains controversial and uncertain.MethodsWe performed a systematic search of PubMed, MEDLINE, and EMBASE databases for articles comparing MT with or without bridging IV-tPA and IV-tPA alone for aPCAO using keywords (‘posterior cerebral artery’, ‘thrombolysis’ and ‘thrombectomy’) with Boolean operators. Extracted data from patients reported in the studies were pooled into groups (MT vs IV-tPA alone) for comparison. Estimated rates for favorable outcome (modified Rankin scale score 0–2), symptomatic intracranial hemorrhage (sICH), and mortality were extracted.ResultsSeven articles (201 MT patients, 64 IV-tPA) were included, all retrospective. There was no statistically significant difference between pooled groups in median age, median presentation National Institutes of Health Stroke Scale (NIHSS) score, PCAO segment, and median time from symptom onset to puncture or needle. The recanalization rate was significantly higher in the MT group than the IV-tPA group (85.6% vs 53.1%, p<0.00001). Odds ratios for favorable outcome (OR 1.5, 95% CI 0.8 to 2.5), sICH (OR 1.1, 95% CI 0.2 to 5.5), and mortality (OR 1.4, 95% CI 0.5 to 3.6) did not significantly favor any modality.ConclusionsWe found no significant differences in odds of favorable outcome, sICH, and mortality in MT and IV-tPA in comparable aPCAO patients, despite superior MT recanalization rates. Equipoise remains regarding the optimal treatment modality for these patients.

The Woven EndoBridge (WEB) device is a barrel-shaped nitinol mesh deployed within the aneurysmal sac. The absence of metallic mesh in the aneurysm’s parent vessel lumen obviates the need for potent antiplatelet therapy, making this device appealing for acutely ruptured aneurysms not amenable to clipping or coiling. To assess the literature regarding WEB treatment of these aneurysms, we performed a comprehensive systematic search of PubMed, MEDLINE, and EMBASE databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Keywords were combined with Boolean operators to increase search sensitivity and specificity (‘woven endobridge device’ AND ‘ruptured’). Nine studies comprising 377 acutely ruptured aneurysms were included. Overall, 82.7% were wide-necked, 85.9% were located in the anterior circulation, and 26.9% of patients presented with poor subarachnoid hemorrhage grade. Intraprocedure and postprocedure complications occurred in 8.4% (95% CI 3.6% to 13.3%) and 1% (95% CI 0% to 2%), respectively. The post-treatment rebleeding rate was 0%. Rates of adequate occlusion (complete occlusion to neck remnant) and retreatment at last follow-up were 84.8% (95% CI 73% to 96.6%) and 4.5% (95% CI 2.2% to 6.8%), respectively. The favorable outcome rate (modified Rankin Scale score 0–2) was 62.2% (95% CI 53% to 71.4%); mortality was 13.6% (95% CI 9.7% to 17.6%). WEB treatment of acutely ruptured aneurysms results in high adequate occlusion rates, low perioperative complication rates, no rebleeding, and low recurrence requiring retreatment. This device is promising for acutely ruptured aneurysms not amenable to clipping or coiling, considering the lower need for antiplatelet regimens during the procedure or follow-up.

Background Transradial access for neurointerventions offers advantages of fewer access-site complications, reduced procedure time, and greater patient comfort over transfemoral access. Data about transradial access for flow diversion are limited. We share our early experience with transradial access for flow diversion in a relatively large case series.Methods Consecutive patients who underwent Pipeline embolization device (Medtronic) deployment via transradial access were included in the study, irrespective of location and laterality of the intracranial aneurysm. The cases were performed between July 2016 and October 2019. Demographics, aneurysm characteristics, and procedure-related details (including catheter systems used) were recorded and statistically evaluated.Results Thirty-five transradial flow diversion procedures were attempted in 32 patients, of which 33 procedures were successful. In two cases involving left common carotid artery and internal carotid artery access, guide catheter herniation into the aortic arch led to abandonment of transradial access in favor of transfemoral access. The most common aneurysm locations in the transradial access procedures were the posterior communicating artery (n= 7), ophthalmic artery (n= 7), and superior hypophyseal artery (n= 7). Most transradial access procedures (66.7%) were performed using a biaxial catheter system. 6-French Benchmark (Penumbra) and Phenom 27 (Medtronic) were the most commonly utilized guide- and microcatheters, respectively. One patient had intraprocedural subarachnoid hemorrhage. No access-site complications occurred.Conclusion This study demonstrates safety and feasibility of transradial access for Pipeline embolization device deployment and shows the versatility of this approach for different catheter systems. Tortuosity and acute angulation of the left common carotid artery and internal carotid artery were associated with approach failure.

BackgroundFew studies have compared technical success and effectiveness of transradial access (TRA) versus transfemoral access (TFA) for mechanical thrombectomy (MT) for acute ischemic stroke (AIS). We compared the two approaches for technical success, effectiveness, and outcomes.MethodsWe retrospectively compared TRA with TFA for AIS MT at our institute. We additionally performed a systematic review and meta-analysis of studies describing the use of TRA alone or in comparison with TFA for MT. Primary outcomes included rate of successful reperfusion (thrombolysis in cerebral infarction (TICI) >2b), number of passes, access-site complications, and 3- month mortality and favorable functional outcomes (modified Rankin Scale (mRS) score 0–2).ResultsA total of 222 consecutive patients (TRA=93, TFA=129) were included in our case series. The rate of successful reperfusion was significantly higher for the TFA cohort (91.4% vs 79.6%, P=0.01) with lower mean number of passes (1.8±1.2 vs 2.4±1.6, P=0.014). Three-month mortality in the TFA group was lower (22.1% vs 40.9% for the TRA cohort (P=0.004), with a higher rate of favorable functional outcomes (51.3% vs 34.1%, P=0.015). A meta-analysis of 10 studies showed significant heterogeneity in rates of successful reperfusion (57.1% to 95.6%, heterogeneity=67.55%, P=0.001). None of the previous comparative studies reported 3-month mortality and functional outcomes.ConclusionsThis case series demonstrate a higher successful reperfusion rate, fewer passes, lower 3-month mortality, and improved 3-month functional outcomes with TFA. The systematic review highlights the inadequacy of existing evidence. Prospective comparative studies are needed before a ‘radial-first’ approach can be adopted for stroke intervention.

BackgroundThere are no reports that describe complete flow control using concurrent transient rapid ventricular pacing or intravenous (IV) adenosine and afferent arterial balloon flow arrest to aid transvenous embolization of cerebral arteriovenous malformations (AVM). We describe our experience with the use of this technique in patients undergoing transvenous AVM embolization.MethodsConsecutive patients in whom transvenous embolization was attempted at our institute between January 2017 and July 2019 were included. Anatomical AVM features, number of embolization stages, technique of concurrent transient rapid ventricular pacing and afferent arterial balloon flow arrest, complications, and clinical and radiological outcomes were recorded and tabulated.ResultsTransvenous AVM embolization was attempted in 12 patients but abandoned in two patients for technical reasons. Complete embolization was achieved in 10 patients, five of whom had infratentorial AVMs. All 10 had a single primary draining vein. Rapid ventricular pacing was used in nine cases; IV adenosine injection was used in one case to achieve cardiac standstill. Complete AVM nidus obliteration was achieved with excellent neurologic outcome in nine cases, with transvenous embolization alone in two cases, and with staged transarterial followed by transvenous embolization in the others. Two patients developed hemorrhagic complications intraprocedurally. One patient was managed conservatively and the other operatively with AVM excision and hematoma evacuation; both made an excellent recovery without any neurologic deficits at 3 months.ConclusionComplete flow control using concurrent transient rapid ventricular pacing with afferent arterial balloon flow arrest technique is safe and feasible for transvenous embolization of select AVMs.

BackgroundRadial access has become popular among neurointerventionalists because it has favorable risk profiles compared with femoral access. Difficulties in accessing or navigating the radial artery have been viewed as a reason to convert to femoral access, but ulnar artery access may prevent complications associated with transfemoral procedures.ObjectiveTo evaluate the safety and feasibility of ulnar access for neurointerventions and diagnostic neuroangiographic procedures.MethodsConsecutive patients who underwent diagnostic angiography or neurointerventional procedures via ulnar access between July 1, 2019 and April 15, 2020 were included. Data recorded were demographics, procedure indication, devices, technique, and complications. Descriptive analysis was performed.ResultsUlnar artery access was obtained for 21 procedures in 18 patients (mean age 70.3±7.8 years; nine men). Procedures included 13 diagnostic angiograms and eight neurointerventions (3 left middle meningeal artery embolization, 1 of which was aborted; 2 carotid artery stenting; 2 angioplasty; 1 mechanical thrombectomy for in-stent thrombosis). A right-sided approach with ultrasound guidance was used for all cases except one. Indications included small caliber radial artery (n=9), radial artery occlusion (n=10), and radial artery preservation for potential bypass (n=2). A 5-French slender sheath was used for diagnostic angiography; a 6-French slender sheath was used for neurointerventions. No case required conversion to femoral access. Two patients had minor hematomas after the procedure; one other had ulnar artery occlusion on 30-day ultrasonography.ConclusionUlnar access is safe and feasible for diagnostic and interventional neuroangiographic procedures. It provides a useful alternative to radial access, potentially avoiding complications associated with femoral access.

ABSTRACTConcrete pedestals under bridge bearing are sources of high stress zones that exhibit complex damage mechanisms under serviceability limit states. These damages are hard to detect and repair; however, if not treated early, they can lead to twisted or slant bridge girders with potential safety risks to the vehicles. With a view to understand the structural responses of these pedestals, a three-dimensional nonlinear explicit finite element modelling method has been developed and reported in this paper. The nonlinearity of the materials and the contact interaction between the bearing and the pedestal has been accounted for the model. It is shown that the model is capable of predicting the localised damages to the concrete pedestals comparable to those occur in the field. It is also shown that the sharp edges of the concrete pedestal are vulnerable to severe damages due to tensile stress singularities; modifying the shape of the edges appears prudent.

Background Controversy exists regarding the optimum number of flow diverters for the treatment of intracranial aneurysms. We explored the effect of the number of Pipeline embolization devices (PEDs; Medtronic, Dublin, Ireland) deployed on rates of aneurysm occlusion and complications.Methods Consecutive patients who underwent saccular intracranial aneurysm treatment solely with the PED were included in this retrospective study. Computed tomographic, magnetic resonance, or digital subtraction angiographic images at 6 and 12 months and last follow-up (>12 months) were reviewed for aneurysm occlusion. Complication and retreatment rates were recorded and analyzed statistically.Results The study included 141 aneurysm treatments in 119 patients. A single PED was deployed in 105 cases, two PEDs in 31 cases, and three PEDs in 5 cases (total = 182 devices). Six-month angiographic data were available for 103 patients. Occlusion rates were 67.1% for single-PED cases and 90.0% for cases with > 1 PED (p = 0.028). The 12-month occlusion rate (follow-up available for 132) for single-PED cases was 74.7% compared to 91.7% for multiple-PED cases (p = 0.04). On multivariate analysis, number of PEDs was an independent predictor of aneurysm occlusion at 12 months (odds ratio 6.3, 95% confidence interval 1.8–22.8, p = 0.005). Thromboembolic complication rates were the same in the single- and multiple-PED treatment groups (2.8%). The retreatment rate was higher in patients treated with a single PED (16.2% vs. 0%, p = 0.01).Conclusions Deployment of > 1 Pipeline embolization device was associated with higher intracranial aneurysm occlusion and lower retreatment rates. No significant difference was found in complication rates.

In this work, the cast solutions manufacturing approach was applied to prepare a PVA/TiO2composite, which is made of titanium dioxide (TiO2) and polyvinyl alcohol (PVA). The energy dispersive X-ray (EDX), atomic force microscope (AFM), and Fourier transform infrared (FTIR) methods were employed to indicated the successful preparations of the composites. Moreover, the XRD and SEM methodologies were employed to investigate the impact of ion bombardment on the structural characteristics and surface morphology of the composite PVA/TiO2. The prepared films were irradiated with oxygen beam at fluencies; 0.3 × 1017, 0.6 × 1017, and 0.9 × 1017ions cm−2. The ion beam increases the surface roughness of the PVA/TiO2from 17 nm for the un-bombarded up to 25 nm for highly irradiated one, as indicated and measured by AFM images. The dielectric behavior of the pure and bombarded films were measured at the frequency of 50 Hz–6 MHz. The results reveal that the dielectric properties of PVA/TiO2films were significantly modified by the oxygen beam bombardment. The results of the research pave the way for potential applications of irradiated PVA/TiO2nanocomposite sheets in various forms of energy storage as capacitors and batteries.

BackgroundMiddle meningeal artery (MMA) embolization is an emerging therapy for the resolution of subacute or chronic subdural hematoma (CSDH). CSDH patients are often elderly and have several comorbidities. We evaluated our experience with transradial access (TRA) for MMA embolization using predominantly Onyx under conscious sedation.MethodsData for consecutive patients who underwent transradial MMA embolization for CSDH during a 2-year period (2018–2019) were analyzed from a single-center, prospectively-maintained database. Patient demographics, comorbidities, ambulatory times, subdural hematoma resorption status, and guide catheter type were recorded. Conversion to femoral access and complication rates were also recorded. Univariate and multivariate analyses were performed.ResultsForty-six patients (mean age, 71.7±14.4 years) were included in this study. Mean CSDH size was 14±5.5 mm. Most (91.3%) TRA embolizations were performed with 6-French 0.071-inch Benchmark guide catheters (Penumbra). MMA embolization was successful in 44 patients (95.7%) (including two cases of TRA conversion). Twenty-one (48%) patients had a severe Charlson Comorbidity Index (>5). Symptomatic improvement was noted in 39 of 44 patients (88.6%). Mean length of stay was 4±3 days. Patients were ambulated immediately postprocedure. At mean follow-up (8±4 weeks), 86.4% of patients had complete or partial CSDH resolution. Persistent use of antiplatelet agents after the procedure was associated with failed or minimal CSDH resorption (5 of 6, 83.3% vs 9 of 38 23.7% with complete or near-complete resolution; P=0.009).ConclusionTransradial Onyx MMA embolization under conscious sedation is safe and effective for CSDH treatment. TRA may be especially useful in elderly patients with numerous comorbidities.

Cancer management is associated with serious side-effects due to the harmful nature of radiation and chemotherapy on the body cells. These side-effects have necessitated the need for diversifying the alternative or complementary sources of cancer therapy. Natural products have been on the front line as alternative sources of anticancer agents and have attracted much attention in recent times. In this study, the anticancer activity of Hypsizygus tessellatus(white var.) caps (also known as Bunapi shimeji) extracted with acetone and ethyl acetate was evaluated in vitro against MDA-MB-231 and MCF-7 (breast cancer cell lines) and MCF-10a (Vero or normal breast cells). Likewise, the free radical scavenging and metal reducing activities of the extract were evaluated through in vitro chemical-based methods. Furthermore, the phytochemical compositions of the extracts were determined through LC–MS-QTOF-assisted mass spectroscopy. The results of this study indicated that acetone fraction had better radical scavenging activity against DPPH (IC50= 0.76 mg/mL) and H2O2(IC50= 0.84 mg/mL) than ethyl acetate fraction against DPPH (IC50= 1.10 mg/mL) and H2O2(IC50= 1.26 mg/mL) (p < 0.05). Additionally, the acetone fraction was observed to have more antiproliferative effects against MCF-7 (IC50= 0.051–0.055 mg/mL) and MDA-MB-231 (IC50= 0.122–0.131 mg/mL) compared to the ethyl acetate fraction against MCF-7 (IC50= 0.075–0.096 mg/mL) and MDA-MB-231 (IC50= 0.161–0.164 mg/mL) (p < 0.05). Both extracts generally had less effect on MCF-10a cells. Thus, these results suggested that Bunapi shimeji caps is a potential good natural source of anticancer agents.

Mushrooms are rich in pharmacologically-important phytochemicals with reported medicinal values. In this study, the antibacterial activity of Flammulina velutipes(Enoki), Hypsizygus tessellatus(brown (Buna shimeji) and white (Bunapi shimeji) variants) stem extracts prepared with different solvents (water, methanol, acetone, and ethyl acetate) was investigated against Escherichia coli(E. coliATCC 25922), Serratia marscenscens(S. marscenscensATCC14756), Bacillus subtilis(B. subtilisATCC 23857), and Staphylococcus aureus(S. aureusATCC 25923). Their antioxidant activities were evaluated using radical scavenging assays of 1,1-diphenyl-2-picrylhydrazyl (DPPH), hydrogen peroxide (H2O2) and ferric reducing power (FRP). The water extracts of Enoki, Buna shimeji, and Bunapi shimeji showed bacterial growth inhibition in a concentration-dependent manner. From the obtained results, all the Enoki extracts showed a significant inhibition of the gram positive bacterial species (E. coliand S. marcescens> 68%) and a reduced inhibition of the gram negative bacterial species (B. subtilisand S. aureus< 45%, p < 0.05) after 24 h of incubation, while water extracts of Buna shimeji showed a significantly lower bacterial growth inhibition (< 60%) against all the studied bacteria. Bunapi shimeji extract inhibited S. marscenscens, E. coli, B. subtilis, and S. aureusby 54, 67, 46, and 44%, respectively. Methanol, acetone and ethyl acetate extracts showed significantly lower antibacterial activities (p < 0.05) compared to water extracts. Similarly, water extracts of Enoki, Bunapi shimeji and Buna shimeji showed significant antioxidant activities using DPPH (67.37 ± 0.01, 66.30 ± 0.18 and 42.44 ± 0.18%, respectively), hydrogen peroxide (67.87 ± 0.000, 45.52 ± 0.160 and 52.08 ± 0.000% respectively), and FRP (0.891 ± 0.001, 0.413 ± 0.001 and 0.491 ± 0.001, respectively) at the concentration of 1 mg/mL, compared to their respective methanol, acetone and ethyl acetate fractions. Upon LC-MS analysis of the most potent fraction (Enoki water extract), several phenolic compounds were identified, of which chromogenic acid, Methyl-5-O-caffeoylquinate, Kukoamine A, Kushenol K, Methyl Kushenol C, Glabrol, Sanggenon J, Corylin, and Moracenin C were confirmed. The antioxidant activities of the water extracts of Enoki, Buna shimeji and Bunapi shimeji correlated with their total phenolic and flavonoid contents, which were (166.56 ± 1.50, 108.13 ± 0.32 and 116.71 ± 0.01 µg gallic acid equivalent (GAE)/mg, respectively) and (96.33 ± 0.03, 82.18 ± 0.20 and 91.37 ± 0.15 µg quercetin equivalent (QE)/mg, respectively). Collectively, the study results have shown the studied mushrooms as potential natural sources of pharmacological agents.

Metabolically obese but normal weight (MONW) is associated with higher risk of type 2 diabetes, dyslipidemia, and hypertension. The aim of this study was to evaluate the association of metabolic syndrome components with MONW in each sex in Iranian population. This cross-sectional study was performed on 417 normal weight subjects in Qazvin, Iran between September 2010 and April 2011. MONW was defined by insulin resistance (IR) using the homeostatic model assessment (HOMA). Cut off point for IR was defined as the lower limit of top quintile of HOMA-IR values in normal weight population without any metabolic risk factors. Data were analyzed using Ttest, Mann–Whitney Utest, and multi-variant logistic regression analysis. Of 417 subjects, 44.3 % were female. The prevalence of MONW was 33.8 % in men and 39.8 % in women. Triglycerides levels were significantly higher in both men and women with MONW. Waist circumference was significantly higher in men with MONW, while high-density lipoprotein cholesterol levels were significantly lower in women with MONW. In logistic regression analysis, hypertriglyceridemia in women (OR 3.398; 95 % CI 1.306–8.846) and waist circumference (per 5 cm increment) in men (OR 1.653; 95 % CI 1.279–2.136) had independent association with MONW. Association of metabolic syndrome components with MONW is different in men and women. Waist circumference had an independent association with IR in men but not in women. IR and its complications should be considered in lean women with hypertriglyceridemia.

Human cells homozygous for rare loss-of-expression (LOE) TYK2 alleles have impaired, but not abolished, cellular responses to IFN-α/β (underlying viral diseases in the patients) and to IL-12 and IL-23 (underlying mycobacterial diseases). Cells homozygous for the common P1104A TYK2 allele have selectively impaired responses to IL-23 (underlying isolated mycobacterial disease). We report three new forms of TYK2 deficiency in six patients from five families homozygous for rare TYK2 alleles (R864C, G996R, G634E, or G1010D) or compound heterozygous for P1104A and a rare allele (A928V). All these missense alleles encode detectable proteins. The R864C and G1010D alleles are hypomorphic and loss-of-function (LOF), respectively, across signaling pathways. By contrast, hypomorphic G996R, G634E, and A928V mutations selectively impair responses to IL-23, like P1104A. Impairment of the IL-23–dependent induction of IFN-γ is the only mechanism of mycobacterial disease common to patients with complete TYK2 deficiency with or without TYK2 expression, partial TYK2 deficiency across signaling pathways, or rare or common partial TYK2 deficiency specific for IL-23 signaling.

Most previous studies of living kidney donors have been retrospective and have lacked suitable healthy controls. Needed are prospective controlled studies to better understand the effects of a mild reduction in kidney function from kidney donation in otherwise healthy individuals.

A new series of pyrano-chromene and pyrimido pyrano-chromene derivatives were synthesized starting from 2-amino-4-(1-naphthyl)-5-oxo-4H,5H-pyrano[3,2-c]chromene-3-carbonitrile (6). The structures of the synthesized compounds were elucidated by spectral data. Compounds 6-11, 13-15 and 18 have been selected for an inhibitory activity screening against HIV-1 and HIV-2 in MT-4 cells.

This study explored the association between long-term epilepsy surgery outcome and changes in depressive symptoms.

There are no effective antivirals currently available for the treatment of flavivirus infection in humans. As such, the identification and characterization of novel drug target sites are critical to developing new classes of antiviral drugs. The flavivirus NS5 N-terminal capping enzyme (CE) is vital for the formation of the viral RNA cap structure, which directs viral polyprotein translation and stabilizes the 5′ end of the viral genome. The structure of the flavivirus CE has been solved, and a detailed understanding of the CE–guanosine triphosphate (GTP) and CE–RNA cap interactions is available. Because of the essential nature of the interaction for viral replication, disrupting CE–GTP binding is an attractive approach for drug development. The authors have previously developed a robust assay for monitoring CE–GTP binding in real time. They adapted this assay for high-throughput screening and performed a pilot screen of 46 323 commercially available compounds. A number of small-molecule inhibitors capable of displacing a fluorescently labeled GTP in vitro were identified, and a second functional assay was developed to identify false positives. The results presented indicate that the flavivirus CE cap-binding site is a valuable new target site for antiviral drug discovery and should be further exploited for broad-spectrum anti-flaviviral drug development.

To report National Cancer Institute (NCI) experience in managing various benign and malignant renal tumors with nephron sparing surgery (NSS), and to assess its safety and feasibility.

Background:Infection by mosquito-borne flaviviruses (family Flaviviridae) is increasing in prevalence worldwide. The vast global, social and economic impact due to the morbidity and mortality associated with the diseases caused by these viruses necessitates therapeutic intervention. There is currently no effective clinical treatment for any flaviviral infection. Therefore, there is a great need for the identification of novel inhibitors to target the virus lifecycle. Discussion:In this article, we discuss structural and nonstructural viral proteins that are the focus of current target validation and drug discovery efforts. Both inhibition of essential enzymatic activities and disruption of necessary protein–protein interactions are considered. In addition, we address promising new targets for future research. Conclusion:As our molecular and biochemical understanding of the flavivirus life cycle increases, the number of targets for antiviral therapeutic discovery grows and the possibility for novel drug discovery continues to strengthen.

Microwave (MW) irradiation has been used in each step for the transformation of acyl glycines 2 to 6-benzyl-3-thioxo-2,3,4,5-tetrahydro-1,2,4-triazin-5-one (7a), and its 4-phenyl derivatives 7b and 7c. The oxazolone 3a was also transformed to phenylpyruvic acid 5, whose thiosemicarbazone 6 can be cyclized to 7a under MW. Methylation of 7c gave the respective S- and / or N-methylated derivatives, 8 and 9, based on the reaction conditions.

Electrical resistivity of the unplasticized poly(vinyl chloride) copolymer (UPVC) films irradiated with high-energy proton beams was studied with reference to a control sample, as a function of both ion energy and ion dose. Upon irradiation with beam energy ranging from 25 up to 37 MeV and at a beam fluence of 0.225×10¹⁰ ion cm^-2, the room-temperature resistivity of the insulating films decreased by four orders of magnitude from its original value. Furthermore, using 25 MeV proton beams over a wide range of fluence (10¹¹-10¹⁵ cm^-2), the room-temperature resistivity of the films decreased by only three orders. Then, the dependence of the resistivity ρ(T) on the ion energy and fluence was also observed as the temperature T was progressively increased up to 373 K. The observed behaviour of ρ(T) agrees with the charge transport model, consistent with a hopping mechanism in the polymer. In addition, the changes in the ac electrical resistivity of the irradiated UPVC films have been measured within the temperature range (293-373 K) and at different frequencies (100 kHz-3 MHz).

By utilizing the peculiarities of superquadratic and subquadratic functions, we give the extensions for multidimensional inequalities of Hardy-type with general kernel. We use some algebraic inequalities such as the Minkowski inequality, the refined Jensen inequality, and the Bernoulli inequality to prove the essential results in this paper. The performance of the superquadratic functions is reliable and effective to obtain new dynamic inequalities on time scales. By utilizing special kernels, we also acquire numerous examples and implementations of the related inequalities.

In this article, some fractional Hardy-Leindler-type inequalities will be illustrated by utilizing the chain law, Hölder’s inequality, and integration by parts on fractional time scales. As a result of this, some classical integral inequalities will be obtained. Also, we would have a variety of well-known dynamic inequalities as special cases from our outcomes when α=1.

The literature demonstrates a favorable first pass effect with balloon-guide catheter (BGC) for mechanical thrombectomy. An 8F BGC is routinely used with femoral access. We present the first video report of 8F BGC advanced through the radial artery using a sheathless technique (video 1). An approximately 70-year-old patient presented with left-sided hemiplegia, neglect, and dysarthria. A CT angiogram demonstrated right M1 occlusion, and the patient underwent urgent mechanical thrombectomy. Radial approach was preferred owing to patient history of anticoagulation. A 6F Sim Select intermediate catheter was used to minimize the step off as the 8F BGC was advanced into the radial artery over an 035 exchange-length Advantage Glidewire. A skin nick over the Glidewire Advantage facilitated the introduction of the 8F BGC into the radial artery. Standard mechanical thrombectomy using a combination of stent retriever and aspiration catheter (Solumbra technique) was performed, and thrombolysis in cerebral infarction 3 recanalization was achieved after a single pass. The National Institutes of Health Scale score improved from 12 to 4, with mild left facial droop, dysarthria, and decreased speech fluency. The patient was discharged from the hospital on postoperative day 2. Ultrasound should be used for immediate assessment of radial artery size and conversion to femoral access without delay if the radial artery is less than 2.5 mm.[Figure]

N-butyl 2-cyanoacrylate (nBCA) is a fast-acting liquid adhesive that polymerizes when it comes in contact with blood anions. We present the principles of nBCA preparation and delivery for tumor embolization of a right convexity meningioma in a patient who presented with a 6-month history of word-finding difficulty and memory loss video 1. Angiography of the middle meningeal artery showed a hairpin turn that was not negotiable with a number of different microwires, including the Synchro-2, Chikai 014 and Balt hybrid 008 wire. Due to the tortuous hairpin turn, the microcatheter position was distal to the tumor blush for the convexity meningioma. Given the distal microcatheter position, we opted for nBCA as the liquid embolic of choice for tumor embolization. The time of polymerization for nBCA may be delayed using glacial acetic acid, which makes nBCA ideal when the microcatheter is in a distal position relative to the target location for embolization. The patient underwent successful embolization using nBCA and was taken for a right frontal craniotomy for resection of the meningioma the next day. The intraoperative blood loss was 100 mL and the postoperative MRI showed gross total resection. The patient had an uncomplicated hospital course and was discharged home on post-procedure day 3.[Figure]

BackgroundThe purpose of this cross-sectional study was to determine the percentage of the US population with 60 min ground or air access to accredited or state-designated endovascular-capable stroke centers (ECCs) and non-endovascular capable stroke centers (NECCs) and the percentage of NECCs with an ECC within a 30 min drive.MethodsStroke centers were identified and classified broadly as ECCs or NECCs. Geographic mapping of stroke centers was performed. The population was divided into census blocks, and their centroids were calculated. Fastest air and ground travel times from centroid to nearest ECC and NECC were estimated.ResultsOverall, 49.6% of US residents had 60 min ground access to ECCs. Approximately 37.7% (113 million) lack 60 min ground or air access to ECCs. Approximately 84.4% have 60 min access to NECCs. Ground-only access was available to 77.9%. Approximately 738 NECCs (45.4%) had an ECC within a 30 min drive.ConclusionNearly one-third of the US population lacks 60 min access to endovascular stroke care, but this is highly variable. Transport models and planning of additional centers should be tailored to each state depending on location and proximity of existing facilities.

Reaction of D-erythro-2,3-hexodiulosono-1,4-lactone-2,3-bis(phenylhydrazone) (2) with an iodine, triphenylphosphine and imidazole mixture afforded the furo[3,2-c]pyridazine derivative 11. Condensation of 6-bromo-6-deoxy-D-erythro-2,3-hexodiulosono-1,4-lactone with phenylhydrazine gave the bishydrazones 6, and 8 or the furo[3,2-c]pyridazine (11) depending on the reaction conditions. The lactone ring in 11 could be opened by treatment with alkali to give the pyridazine derivative 9. Lactonization of the later with simultaneous acetylation by acetic anhydride afforded the lactone derivative 14. Alkali treatment of 6 gave the pyrazolindione derivative 13 that gave upon reation with HBr/AcO H the dibromide 15. The assigned structures were based on spectral analysis. The activity of compounds 11 and 14 against hepatitis B virus has been studied.

ABSTRACT: Because surfactant protein (SP) mRNA levels in rat fetuses are increased by maternal dexamethasone (dex) treatment and decreased in streptozotocin-induced diabetic (STZ-DB) pregnancy, we investigated the in vivo effects of dex on SP gene expression in STZ-DB pregnancy. The mRNA levels of SP (SP-A, SP-B, SP-C) were assessed in d 18 and 20 fetuses by Northern blot analysis, and nuclear run-on assays were performed with lung nuclei from d 20 fetuses (term = 22 d). Our findings indicate: 1) dex causes a greater increase in SP-A and SP-B mRNA levels in d 18 (12–16-fold) compared with day 20 (4–6-fold) fetuses (p < 0.05) in normal and STZ-DB pregnancy; 2) a 2–3-fold increase in SP-C mRNA levels was observed in response to dex in d 18 and 20 fetuses; 3) the increase in transcription of SP-A and SP-B in d 20 fetuses after dex is 68 and 60%, respectively, of the increase in their mRNA levels whereas in STZ-DB, the decrease in transcription compared with mRNA levels is 3.67-fold for SP-A and 2.42 fold SP-B; and 4) changes in SP-C transcription in either in vivo model, dex-treated or STZ-DB, correspond well with changes in mRNA levels. Together, these findings indicate that dex can enhance SP expression in STZ-DB immature lungs and support differential regulation of fetal SP genes in the models studied.

The clinical features of' 78patients with SLE seen in Cairo and Glasgow are reviewed. Raynaud's phenomenon was recorded more frequently here than in previous series. The value of serial measurements of anti-DNA antibodies, C3and C4in the management of SLE is discussed. Although antibodies to native DNA paralleled the disease course in only a minority of SLE patients anti-DNA antibodies were present during all major SLE exacerbations and could be diagnostically useful. Serious systemic infections complicating the management of SLE patients could occur and their diagnosis is discussed.

Two hundred and fifty of 323 laparoscopically sterilized patients had hysterosalpingographic (HSG) follow-up. A Foley catheter was used in hysterosalpingography. Of these patients, 3.6 per cent demonstrated fistula; 1.2 per cent were found to have round ligament burns, and 0.618 per cent became pregnant. Mechanism of fistula formation, prevention, and management is discussed. The incidence of intrauterine pregnancy and ectopic pregnancy after laparoscopic sterilization is discussed, and the literature is reviewed. Based on these data, it is concluded that HSG follow-up is helpful in teaching institutions and where the laparoscopic sterilization is carried out by inexperienced operators. Routine HSG follow-up is not recommended.