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In this work, an attempt has been made to analyze the shape variations in mediastinum for differentiation of Coronavirus Disease-2019 (COVID-19) and normal conditions in chest X-ray images. For this, the images are obtained from a publicly available dataset. Segmentation of mediastinum from the raw images is performed using Reaction Diffusion Level Set (RDLS) method. Shape-based features are extracted from the delineated mediastinum masks and are statistically analyzed. Further, the features are fed to two classifiers, namely, multi-layer perceptron and support vector machine for differentiation of normal and COVID-19 images. From the results, it is observed that the employed RDLS method is able to delineate mediastinum from the raw chest Xray images. Eight shape features are observed to be statistically significant. The mean values of these features are found to be distinctly higher for COVID-19 images as compared to normal images. Area under the curve of greater than 76.9% is achieved for both the classifiers. It appears that mediastinum could be used as a region of interest for computerized detection and mass screening of the disease.

Abstract Background Diabetes mellitus is the most common metabolic disease globally, while glucose-6-phosphate dehydrogenase deficiency, an X-linked inherited disorder, is the most common erythrocyte enzyme defect. The association between the two in children has been infrequently reported. Case presentation We report the case of a 10-year-old boy of Iraqi descent who presented to our emergency department with new-onset type 1 diabetes mellitus without Diabetic Keto Acidosis. He was treated with subcutaneous insulin and discharged. Eleven days after hospitalization, he was found to be jaundiced during his home visit. Hence, he was referred to the pediatric unit, and his hemoglobin had declined from 130 g/L at the previous admission to 81 g/L. Blood tests revealed low haptoglobin, and his peripheral blood film showed anisocytosis, polychromasia, and occasional red cell fragments suggestive of acute hemolysis. His glucose-6-phosphate dehydrogenase activity was very low, and his subsequent genetic tests confirmed Mediterranean-type glucose-6-phosphate dehydrogenase deficiency. Conclusion Glucose-6-phosphate dehydrogenase deficiency in people with diabetes mellitus has been underreported in the literature so far, and screening of glucose-6-phosphate dehydrogenase deficiency should be considered on diagnosis of diabetes mellitus, especially in boys of African, Mediterranean, or Asian descent.

Objectives Estimating mortality risk in hospitalised SARS-CoV-2+ patients may help with choosing level of care and discussions with patients. The Coronavirus Clinical Characterisation Consortium Mortality Score (4C Score) is a promising COVID-19 mortality risk model. We examined the association of risk factors with 30-day mortality in hospitalised, full-code SARS-CoV-2+ patients and investigated the discrimination and calibration of the 4C Score. This was a retrospective cohort study of SARS-CoV-2+ hospitalised patients within the RECOVER (REgistry of suspected COVID-19 in EmeRgency care) network.Setting 99 emergency departments (EDs) across the USA.Participants Patients ≥18 years old, positive for SARS-CoV-2 in the ED, and hospitalised.Primary outcome Death within 30 days of the index visit. We performed logistic regression analysis, reporting multivariable risk ratios (MVRRs) and calculated the area under the ROC curve (AUROC) and mean prediction error for the original 4C Score and after dropping the C reactive protein (CRP) component.Results Of 6802 hospitalised patients with COVID-19, 1149 (16.9%) died within 30 days. The 30-day mortality was increased with age 80+ years (MVRR=5.79, 95% CI 4.23 to 7.34); male sex (MVRR=1.17, 1.05 to 1.28); and nursing home/assisted living facility residence (MVRR=1.29, 1.1 to 1.48). The 4C Score had comparable discrimination in the RECOVER dataset compared with the original 4C validation dataset (AUROC: RECOVER 0.786 (95% CI 0.773 to 0.799), 4C validation 0.763 (95% CI 0.757 to 0.769). Score-specific mortalities in our sample were lower than in the 4C validation sample (mean prediction error 6.0%). Dropping the CRP component from the 4C Score did not substantially affect discrimination and 4C risk estimates were now close (mean prediction error 0.7%).Conclusions We independently validated 4C Score as predicting risk of 30-day mortality in hospitalised SARS-CoV-2+ patients. We recommend dropping the CRP component of the score and using our recalibrated mortality risk estimates.

Successful renal transplantation (RT) recipients suffer residual muscle weakness, fatigue, and low functional capacity. A safe, feasible, structured, early graded exercise training to improve functional capacity, muscle strength, and fatigue is the need of the hour. The aim of the study is to assess the effectiveness of graded exercise training on the functional capacity, muscle strength, and fatigue after RT. It is a randomized controlled trial conducted at a tertiary care hospital from January 2012 to December 2016. This trial included 104 consented, stable renal transplant recipients without cardiopulmonary/neuromuscular impairment. They received either routine care (51) or graded exercise training (53) for 12 weeks after randomization. The functional capacity, isometric quadriceps muscle strength, and fatigue score were measured at baseline, six, and 12 weeks later to induction. The outcomes of the study and control groups were analyzed using the /-test, Wilcoxon signed-rank test, ANOVA, and Pearson’s correlation. For all analyses, P

Objectives:Ocular tuberculosis is an extrapulmonary tuberculous infection and has varying manifestations which pose a huge challenge to diagnosis and treatment. The purpose of this study is to describe the various clinical manifestations of ocular inflammations due to tuberculosis and to assess the response to treatment following antituberculous therapy (ATT) and corticosteroids in these patients.Materials and Methods:We performed a retrospective analysis of 29 patients with presumed ocular tuberculosis who were started on ATT and completed follow-up of at least 6 months after ATT was initiated. The data collected were: age at presentation, sex, laterality, presence or absence of pulmonary/extrapulmonary tuberculosis, history of exposure to tuberculosis, site of ocular involvement and duration of illness, visual acuity at presentation and at 6-month follow-up, and response to treatment.Results:Most of the patients were of economically productive age, between 21-60 years. This most common presentation in our study population was unilateral nongranulomatous anterior uveitis. In spite of the delay between symptom onset and start of therapy, favorable response was noted in 79.3% of patients at completion of 6 months of ATT. The various reasons for the delay in start of therapy were also evaluated.Conclusion:In this case series, we presented the various ocular manifestations and the difficulties faced in the diagnosis of presumed ocular tuberculosis. Outcomes of ATT were favorable in most of our patients. Thus, the clinician should exercise a very high degree of suspicion and should not withhold a trial of ATT.

In cognitive neuroscience, computational modeling can formally adjudicate between theories and affords quantitative fits to behavioral/brain data. Pragmatically, however, the space of plausible generative models considered is dramatically limited by the set of models with known likelihood functions. For many models, the lack of a closed-form likelihood typically impedes Bayesian inference methods. As a result, standard models are evaluated for convenience, even when other models might be superior. Likelihood-free methods exist but are limited by their computational cost or their restriction to particular inference scenarios. Here, we propose neural networks that learn approximate likelihoods for arbitrary generative models, allowing fast posterior sampling with only a one-off cost for model simulations that is amortized for future inference. We show that these methods can accurately recover posterior parameter distributions for a variety of neurocognitive process models. We provide code allowing users to deploy these methods for arbitrary hierarchical model instantiations without further training.

Introduction: Emergency medicine (EM) organizations such as the Society for Academic Emergency Medicine and the Institute of Medicine have called for more clinical research as a way of addressing thescarcity of research in EM. Previous investigations have examined funding and productivity in EM research, but whether EM researchers preferentially concentrate on certain patient-related topics is notknown. We hypothesized that at least part of the scarcity of EM research is from the tendency of EM researchers, like researchers in other fields, to focus on rarer conditions with higher morbidity or mortality instead of on more common conditions with less acuity. This study compared the frequency of specific medical conditions presenting to emergency departments nationwide with the frequency of emergency physician research on those same conditions.Methods: This study is a structured retrospective review and comparison of 2 databases during an 11-year span. Principal diagnoses made by emergency physicians as reported by the National HospitalAmbulatory Medical Care Survey were compared to all first-author publications by emergency physicians as reported in PubMed between 1996 and 2006. Statistics included correlations and linear regression with the number of emergency department (ED) visits per diagnosis as the independent variable and the number of articles published as the dependent variable.Results: During the study period, there was significant concordance between the frequency of presenting conditions in the emergency department and the frequency of research being performed onthose conditions, with a high correlation of 0.85 (P,0.01). More common ED diagnoses such as injury/poisoning, symptoms/ill-defined conditions, and diseases of the respiratory system accounted for 60.9% of ED principal diagnoses and 50.2% of the total research published in PubMed.Conclusion: Unlike researchers in other fields, emergency physicians investigate clinical problems in almost the exact proportion as those conditions are encountered in the emergency department. The scarcity of EM research does not have to do with a skewed focus toward less common patient problems.

Abstract Objective BLOSUM matrices serve as standard matrices for many protein sequence alignment programs. BLOSUM matrices have been constructed using BLOCKS version5.0 with 27,102 BLOCKS, whereas the latest updated version14.3 has 6,739,916 BLOCKS. We read with interest the research article by Hess et al. (BMC Bioinform 17:189, 2016) on CorBLOSUM, wherein it is argued that an inaccuracy in the BLOSUM code affects the cluster memberships of sequences. They show that replacing the integer based clustering threshold to floating point arguably improves the performances of CorBLOSUM over BLOSUM and RBLOSUM matrices. They compare BLOSUM6214.3 against RBLOSUM69, with relative entropies of 0.2685 and 0.2662 respectively. The present work attempts to repeat the computation to verify the respective analog matrices. Results In our attempt to repeat the computation, we observed that the relative entropy of BLOSUM6214.3 is 0.2360 and BLOSUM5014.3 is 0.1198. As only matrices of similar entropies can be compared, BLOSUM62 can be compared only with RBLOSUM66 and BLOSUM50 can be compared only with RBLOSUM56. We conducted experiments with Astral data sets, and demonstrated the improved accuracy in the coverage. Our results imply that RBLOSUM performs statistically better than CorBLOSUM and BLOSUM matrices.

Background: B12 deficiency is a silent epidemic with serious consequences. Long term use of metformin has been associated with malabsorption of vitamin B12 leading to its deficiency along with increased homocysteine levels. With this background we designed this study to assess the status of vitamin B12 and its markers in type 2 diabetes mellitus patients on metformin therapy who are attending tertiary care hospital in the peripheral area of Pondicherry. Aims and Objective: The current study aims to study the relationship if any, between the glycemic status and the status of Vitamin B12 among T2DM patients on metformin therapy. Materials and Methods: A case control study was done with a sample size of 100 (50 case and 50 control). The patients were selected according to the inclusion criteria and their blood sample were analyzed for the various parameters. The markers of vitamin B12 status are studied among both the control and the patients with T2DM on metformin therapy and compared with their glycaemic status. Results: There is a significant increase in the levels of FBS, HbA1c, insulin and C-peptide in the study group. It was observed that the mean levels of homocysteine and Methylmalonic acid were significantly higher with lower levels of vitamin B12 in patients who were on metformin therapy. Conclusion: There is moderate correlation between the markers of B12 status and levels of fasting blood sugar as well as HbA1C. There is a significant correlation between insulin and C-peptide with the markers of vitamin B12 status.

Abstract Background Amyotrophic lateral sclerosis is a fatal neuromuscular disorder characterized by progressive death of the upper and lower motor neurons in the central nervous system. Patients with this disease die mostly as a result of respiratory failure; however, owing to prolonged survival through assisted ventilation, cardiovascular causes are increasingly responsible for mortality. We report what is to the best of our knowledge the first case of type 2 Brugada syndrome causing ventricular tachyarrhythmia and cardiac arrest in a patient with upper limb onset amyotrophic lateral sclerosis. Case presentation A 48-year-old Caucasian woman with a significant past medical history of papillary thyroid carcinoma status postresection, pulmonary embolism on anticoagulation, and a recent diagnosis of right upper limb-onset amyotrophic lateral sclerosis presented to the emergency department of our hospital with acute on chronic shortness of breath. On further evaluation, she was found to have hypoxic and hypercapnic respiratory failure and was placed on bilevel positive airway pressure ventilation. Her 12-lead electrocardiogram showed sinus rhythm with J-point elevation, saddle-shaped ST segment elevation, predominantly in V1 and V2 with no significant QTc prolongation. No troponin elevation was noted in her laboratory workup. Because she was unable to protect her airway, a decision was made to intubate her. After 1 minute of induction with etomidate and succinylcholine, she went into pulseless ventricular tachycardia and fibrillation requiring three cycles of cardiopulmonary resuscitation with high-quality chest compressions, three doses of epinephrine, and a loading dose of amiodarone prior to return of spontaneous circulation. She was further evaluated by cardiology services and was diagnosed with type 2 Brugada syndrome, for which she was started on quinidine. Her respiratory failure and the drugs she received for intubation likely caused her ventricular tachycardia to occur in conjunction with an underlying Brugada pattern seen on an electrocardiogram. The results of evaluation of her genetic panel for Brugada syndrome were negative. She was subsequently discharged to home in stable condition after a 10-day hospital stay. Conclusions Amyotrophic lateral sclerosis is a progressive neuromuscular disorder with significant mortality. Respiratory failure is the leading cause of death, but lately, owing to increased survival associated with early tracheostomy and positive pressure ventilation, there has been an increasing trend in the identification of cardiovascular causes of mortality, especially arrhythmias, that may need periodic electrocardiographic surveillance.

The pelagic brown macroalga Sargassum supports rich biological communities in the tropical and subtropical Atlantic region, including a variety of epiphytic invertebrates that grow on the Sargassum itself. The thecate hydroid Aglaophenia latecarinata is commonly found growing on some, but not all, Sargassum forms. In this study, we examined the relationship between A. latecarinata and its pelagic Sargassum substrate across a broad geographic area over the course of 4 years (2015–2018). The distribution of the most common Sargassum forms that we observed (Sargassum fluitans III and S. natans VIII) was consistent with the existence of distinct source regions for each. We found that A. latecarinata hydroids were abundant on both S. natans VIII and S. fluitans III, and also noted a rare observation of A. latecarinata on S. natans I. For the hydroids on S. natans VIII and S. fluitans III, hydroid mitochondrial genotype was strongly correlated with the Sargassum substrate form. We found significant population genetic structure in the hydroids, which was also consistent with the distributional patterns of the Sargassum forms. These results suggest that hydroid settlement on the Sargassum occurs in type-specific Sargassum source regions. Hydroid species identification is challenging and cryptic speciation is common in the Aglaopheniidae. Therefore, to confirm our identification of A. latecarinata, we conducted a phylogenetic analysis that showed that while the genus Aglaophenia was not monophyletic, all A. latecarinata haplotypes associated with pelagic Sargassum belonged to the same clade and were likely the same species as previously published sequences from Florida, Central America, and one location in Brazil (São Sebastião). A nominal A. latecarinata sequence from a second Brazilian location (Alagoas) likely belongs to a different species.

Abundance, species diversity, and horizontal distributions of barnacle cyprids offshore of La Jolla, southern California were described from May 2014 to August 2016 to determine how the nearshore barnacle larval assemblage changed before, during, and after the 2015–16 El Niño. The entire water column was sampled at five stations located within one km of shore with water depths of 4, 6, 8, 10, and 12 m during 33 cruises that encompassed the time when El Niño conditions impacted the area. Nearshore temperature and thermal stratification was concurrently measured using a CTD. Six identified cyprid species, including Chthamalus fissus, Pollicipes polymerus, Megabalanus rosa, Tetraclita rubescens, Balanus glandula, and B. trigonus, along with four unknown species, were collected in our samples. DNA barcoding was used to confirm identifications in a subset of the larvae. C. fissus was more than eight times more abundant than any other species, and while abundance varied by species, cyprid density was highest for all species except for M. rosa before and after the El Niño event, and lower during the environmental disturbance. There were significant differences in cross-shore distributions among cyprid species, with some located farther offshore than others, along with variability in cross-shore distributions by season. C. fissus cyprids were closest to shore during spring-summer cruises when waters were the most thermally stratified, which supports previous findings that C. fissus cyprids are constrained nearshore when thermal stratification is high. Relative species proportions varied throughout the study, but there was no obvious change in species assemblage or richness associated with El Niño. We speculate that barnacle cyprid species diversity did not increase at our study site during the 2015–16 El Niño, as it has in other areas during previous El Niño Southern Oscillation events, due to the lack of anomalous northward flow throughout the 2015–16 event.

The clinging jellyfish Gonionemus sp. is a small hydromedusa species known historically from the Swedish west coast but not reported in recent times. This species is thought to be native to the northwest Pacific where it is notorious for causing severe stings in humans and is considered invasive or cryptogenic elsewhere. This year, unlike in the past, severe stings in swimmers making contact with Gonionemus sp. medusae occurred in Swedish waters from a sheltered eelgrass bed in the inner Skagerrak archipelago. To the best of our knowledge, this is only the second sting record of Gonionemus sp. from the Northeast Atlantic—with the first record occurring off the Belgian coast in the 1970s. Stinging Gonionemus sp. medusae have also been recently reported from the northwestern Atlantic coast, where, like on the Swedish coast, stings were not reported in the past. We analyzed sea surface temperature data from the past 30 years and show that 2018 had an exceptionally cold spring followed by an exceptionally hot summer. It is suggested that the 2018 temperature anomalies contributed to the Swedish outbreak. An analysis of mitochondrial COI sequences showed that Swedish medusae belong to the same clade as those from toxic populations in the Sea of Japan and northwest Atlantic. Gonionemus sp. is particularly prone to human-mediated dispersal and we suggest that it is possible that this year’s outbreak is the result of anthropogenic factors either through a climate-driven northward range shift or an introduction via shipping activity. We examined medusa growth rates and details of medusa morphology including nematocysts. Two types of penetrating nematocysts: euryteles and b-mastigophores were observed, suggesting that Gonionemus sp. medusae are able to feed on hard-bodied organisms like copepods and cladocerans. Given the now-regular occurrence and regional spread of Gonionemus sp. in the northwest Atlantic, it seems likely that outbreaks in Sweden will continue. More information on its life cycle, dispersal mechanisms, and ecology are thus desirable.

Hansen’s disease is an important public health problem and it is one of the important cause of disability in patients with nonhealing trophic ulcer in Hansen’s disease, and also the long-term management of these trophic ulcers works out to be very costly. Reduction in the healing time would be a major step in the rehabilitation of these patients. Authors hereby present one such case of chronic plantar ulcer in Hansen’s patient which was refractory to standard treatment like oral and topical antibiotics and daily dressings for more than six years. Hence, Platelet Rich Fibrin Matrix (PRFM) was applied along with adequate rest using Plaster of Paris (POP) cast. The wound was opened and the dried PRFM was cleared from the bed of the wound after 10 days. Procedure was repeated every third week. This led to dramatic healing of the ulcer with a reduction in wound diameter with no noticeable side-effects.

Background: The survival rate after renal transplantation (RT) has improved across the world. Physical activity (PA) remains a way to sustain health benefits after successful RT. But, the PA and quality of life (QOL) after renal transplantation remains underexplored. Methods: This cross-sectional study was done on 63 eligible, consented RT recipients who underwent transplant between 2010 and 2014. The Blood urea, serum creatinine, Physical Activity level (IPAQ) and QOL (RAND 36) were assessed. Results: The PA was found to be low, moderate and high respectively among 28, 24 and 11 subjects. The mean score of PA, physical health (QOL) was 932 ±720, 73.68±10.85 respectively. Physical health QOL positively correlated with PA, negatively with Post RT duration (p

Background: Visually impaired children are unable to maintain good oral hygiene, as their tactile abilities are often underdeveloped owing to their visual disturbances. Conventional brushing techniques are often poorly comprehended by these children and hence, it was decided to evaluate the effectiveness of audio and audio-tactile methods in improving the oral hygiene of these children. Objective: To evaluate and compare the effectiveness of audio and audio-tactile methods in improving oral hygiene status of visually impaired school children. Materials and Methods: In this study, the total study group comprised 48 visually impaired children that were randomly divided into two groups, with one group receiving the audio method and the other group receiving the audio-tactile method. Periodic reinforcement of health education was performed at an interval of 2 months. Re-examination was carried out after 2 months of health education to assess plaque scores. Data were statistically analyzed using paired t-test. Results: There was reduction in plaque scores in audio-tactile group after health education. In the audio-tactile group, the mean plaque scores of pre- and post-health education were 1.28 and 0.95, respectively. The difference was statistically significant (P < 0.001). In audio group, the mean plaque scores of pre- and post-health education were 1.15 and 0.14, respectively. The difference was statistically nonsignificant (P < 0.07). Conclusion: Visually impaired children could maintain an acceptable level of oral hygiene when taught using special customized methods. However, reinforcement at regular intervals is required for the maintenance of oral hygiene.

Staphylococcus aureus, the most common cause of wound infection, produces several exotoxins, including superantigens (SAgs). SAgs are the potent activators of the immune system. Given this unique property, we hypothesized that SAgs produced by S. aureus in wounds would have local, as well as systemic immunologic effects. We tested our hypothesis using a novel staphylococcal skin wound infection model in transgenic mice expressing HLA-DR3. Skin wounds were left uninfected or colonized with S. aureus strains producing SAgs or an isogenic strain not producing any SAg. Animals with wounds challenged with SAg-producing S. aureus had increased morbidity and lower serum IL-17 levels compared to those challenged with the SAg non-producing S. aureus (p = 0.027 and p = 0.032, respectively). At Day 8 following microbial challenge, compared to mice with uninfected wounds, the proportion of Vβ8+CD4+ T cells was increased, while the proportion of Vβ8+CD8+ T cells was decreased only in the spleens of mice challenged with SAg-producing S. aureus (p < 0.001). No such changes were measured in mice challenged with SAg non-producing S. aureus. Lungs, livers and kidneys from mice challenged with SAg-producing, but not SAg non-producing, S. aureus showed inflammatory changes. Overall, SAg-mediated systemic immune activation in wounds harboring S. aureus may have clinical implications.

Introduction: Lung cancer is the pioneer among all the cancers and also the leading cause of cancer related mortality worldwide. In India unlike in western countries most patients are diagnosed at advanced stage (Stage III/Stage IV) which in turn adversely affects the patient prognosis and survival. Studying the proportion of the total lung cancer cases which will present in advanced stage and their clinical, pathological and radiological profile will give us an insight into the problem. Aim: To know the percentage incidence of patients presenting with advanced stage lung cancer (Stage IIIB/Stage IV) and to study the clinical, pathological and radiological profile of these patients along with treatment details and follow-up. Materials and Methods: This was a descriptive retrospective study spanning four years from January 2013 to December 2016. All patients with a histopathological diagnosis of Stage IIIB and Stage IV lung cancer, treated during this period were included. Clinical features, radiological (X-ray and CT) findings, histopathological findings including immunohistochemistry if done, treatment modality and survival were analysed based on the information collected from the medical records. Results: Out of 82 cases diagnosed as advanced stage disease, complete clinical data was available for 67 cases which formed the material for the study. Of 67 patients, 47 were male and 20 were female forming a Male: Female ratio of 2.35:1. The mean age of the patients was 61.3 years. Patients presented with cough (59.7%), chest pain (34.3%) dyspnoea (29.8%), weight loss (17.9%), fever (16.4%), haemoptysis (11.9%). Histologically majority were Adenocarcinoma (ADC) (35.8%) followed by Squamous Cell Carcinoma (SCC) (29.8%) small cell carcinoma (14.92%) and just one case of large cell carcinoma. Forty five cases (64.17%) presented with metastases. The most common site for metastasis was bone followed by brain. Three patients who tested positive for Epidermal Growth Factor Receptor (EGFR) mutation were treated with Erlotinib/Gefitinib. The remaining 64 cases were treated with regimens including combinations of premetrexed, platinum based compounds and etoposide. On follow-up 17 patients died during the course of the treatment. Conclusion: High proportion of lung cancer patients present at advanced stage. This demand for public awareness programs about the smoking hazards, early symptoms and importance of early treatment.

Background: Acute pancreatitis is an inflammation of pancreas associated with reversible pancreatic parenchymal injury. Studies in several countries indicate that the levels of amylase and lipase are usually elevated among patients with acute pancreatitis. Furthermore, hyperlipidemia, mainly high levels of triglycerides, may present in acute pancreatitis. The aim of this study was to determine the levels of serum amylase and lipase as well as their correlation with serum triglyceride level in acute pancreatitis patients. Methods: A retrospective study was conducted on medical records of 48 acute pancreatitis patients in Dr. Hasan Sadikin General Hospital Bandung, Indonesia from 2007to 2011. Data collected from the medical records were age, sex, levels of serum amylase, lipase and triglyceride. The distribution of data was determined using Shapiro-Wilk test. The correlation between serum pancreatic enzyme and triglyceride was analyzed using Spearman-rank test. Results: Most patients had increased levels of serum amylase and lipase in this study. However, no correlation between serum amylase and triglyceride (p-value = 0.312) was found. Furthermore, there was no correlation between serum lipase and triglyceride (p-value = 0.241). Conclusions: The levels of serum amylase and lipase increase in most patients with acute pancreatitis with no significant correlation between serum pancreatic enzymes (amylase and lipase) and triglyceride.

Xp11.2 translocation renal cell carcinomas (TRCCs) are a group of neoplasms with distinct clinical, histopathological appearance, immunohistochemical, and cytogenetic profile. We report a case of Xp11.2 translocation TRCC in an 11-year-old male diagnosed based on immunohistochemistry and fluorescence in situ hybridization.

Here we report a unique trophic interaction between the cryptogenic and sometimes highly toxic hydrozoan clinging jellyfish Gonionemus sp. and the spider crab Libinia dubia. We assessed species–specific predation on the Gonionemus medusae by crabs found in eelgrass meadows in Massachusetts, USA. The native spider crab species L. dubia consumed Gonionemus medusae, often enthusiastically, but the invasive green crab Carcinus maenus avoided consumption in all trials. One out of two blue crabs (Callinectes sapidus) also consumed Gonionemus, but this species was too rare in our study system to evaluate further. Libinia crabs could consume up to 30 jellyfish, which was the maximum jellyfish density treatment in our experiments, over a 24-hour period. Gonionemus consumption was associated with Libinia mortality. Spider crab mortality increased with Gonionemus consumption, and 100% of spider crabs tested died within 24 h of consuming jellyfish in our maximum jellyfish density containers. As the numbers of Gonionemus medusae used in our experiments likely underestimate the number of medusae that could be encountered by spider crabs over a 24-hour period in the field, we expect that Gonionemus may be having a negative effect on natural Libinia populations. Furthermore, given that Libinia overlaps in habitat and resource use with Carcinus, which avoids Gonionemus consumption, Carcinus populations could be indirectly benefiting from this unusual crab–jellyfish trophic relationship.

Introduction: A major challenge when using glass ionomer cement in clinical situation particularly in paediatric dentistry is to overcome the problem of microleakage. Fast or command setting of Type IX glass ionomer cement using external energy source enhances the setting reaction and results in improved initial physical and mechanical properties. Aim: To compare and evaluate the influence of ultrasonic activation, halogen light irradiation and combined effect of both on microleakage of enamel adjacent to Type IX glass ionomer restorations. Materials and Methods: For forty premolar teeth, standard Class V cavities prepared were restored with GC Gold Label Type IX glass ionomer cement in vitro. The specimens were randomly divided into four groups: 1) Control group; 2) halogen group; 3) ultrasonic group; 4) ultrasonic with halogen group. The teeth were kept in distilled water for 24 hours. Teeth were exposed to 1500 thermocycles at temperature of 12°C ±2 and 60°C ±2 with alternate immersion in hot and cold water for one minute. First teeth were immersed in dye solution for four hours and then in developing solution for four hours. The samples were sectioned buccolingually through centre of the restorations and degree of dye penetration was assessed under stereomicroscope and scored. One-Way ANOVA model was constructed followed by post-hoc Tukey’s test for multiple pair wise comparison of mean values. Results: Statistically significant differences were found in microleakage among the four groups (p0.05). Similarly the differences between Ultrasonic plus halogen group and ultrasonic group were not significant (p>0.05). The differences between ultrasonic and halogen group were statistically significant (p

Few studies have evaluated the mortality or quantified the economic burden of community-onset Clostridium difficile infection (CDI). We estimated the attributable mortality and costs of community-onset CDI. We conducted a population-based matched cohort study. We identified incident subjects with community-onset CDI using health administrative data (emergency department visits and hospital admissions) in Ontario, Canada between January 1, 2003 and December 31, 2010. We propensity-score matched each infected subject to one uninfected subject and followed subjects in the cohort until December 31, 2011. We evaluated all-cause mortality and costs (unadjusted and adjusted for survival) from the healthcare payer perspective (2014 Canadian dollars). During our study period, we identified 7,950 infected subjects. The mean age was 63.5 years (standard deviation = 22.0), 62.7% were female, and 45.0% were very high users of the healthcare system. The relative risk for 30-day, 180-day, and 1-year mortality were 7.32 (95% confidence interval [CI], 5.94-9.02), 3.55 (95%CI, 3.17-3.97), and 2.59 (95%CI, 2.37-2.83), respectively. Mean attributable cumulative 30-day, 180-day, and 1-year costs (unadjusted for survival) were $7,434 (95%CI, $7,122-$7,762), $12,517 (95%CI, $11,687-$13,366), and $13,217 (95%CI, $12,062-$14,388). Mean attributable cumulative 1-, 2-, and 3-year costs (adjusted for survival) were $10,700 (95%CI, $9,811-$11,645), $13,312 (95%CI, $12,024-$14,682), and $15,812 (95%CI, $14,159-$17,571). Infected subjects had considerably higher risk of all-cause mortality and costs compared with uninfected subjects. This study provides insight on an understudied patient group. Our study findings will facilitate assessment of interventions to prevent community-onset CDI.

Living organisms in space are constantly exposed to radiation, toxic chemicals or reactive oxygen species generated due to increased levels of environmental and psychological stresses. Understanding the impact of spaceflight factors, microgravity in particular, on cellular responses to DNA damage is essential for assessing the radiation risk for astronauts and the mutation rate in microorganisms. In a study conducted on the International Space Station, confluent human fibroblasts in culture were treated with bleomycin for three hours in the true microgravity environment. The degree of DNA damage was quantified by immunofluorescence staining for γ-H2AX, which is manifested in three types of staining patterns. Although similar percentages of these types of patterns were found between flight and ground cells, there was a slight shift in the distribution of foci counts in the flown cells with countable numbers of γ-H2AX foci. Comparison of the cells in confluent and in exponential growth conditions indicated that the proliferation rate between flight and the ground may be responsible for such a shift. We also performed a microarray analysis of gene expressions in response to bleomycin treatment. A qualitative comparison of the responsive pathways between the flown and ground cells showed similar responses with the p53 network being the top upstream regulator. The microarray data was confirmed with a PCR array analysis containing a set of genes involved in DNA damage signaling; with BBC3, CDKN1A, PCNA and PPM1D being significantly upregulated in both flight and ground cells after bleomycin treatment. Our results suggest that whether microgravity affects DNA damage response in space can be dependent on the cell type and cell growth condition.

We aimed to define characteristics of TB patients in Puducherry and two districts of Tamil Nadu, India and calculate the population attributable fractions (PAF) of TB from malnutrition and alcohol.New smear-positive TB cases were enrolled into the Regional Prospective Observational Research for Tuberculosis (RePORT India) cohort. Census and National Family Health Survey data were used for comparisons.Data were analyzed for 409 participants enrolled between May 2014-June 2016; 307 (75.1%) were male, 60.2% were malnourished (body mass index [BMI]

Mucinous colorectal adenocarcinomas (MCAs) are clinically and morphologically distinct from nonmucinous colorectal cancers (CRCs), show a distinct spectrum of genetic alterations (higher KRAS mutations, lower p53, high MUC2), exhibit more aggressive behavior (more prone to peritoneal dissemination and lymph node involvement) and are associated with poorer response to chemotherapy with limited treatment options. Here, we report the effectiveness of combinatorial targeting of two KRAS-mediated parallel pathways in reducing MUC2 production and mucinous tumor growth in vitro and in vivo. By knockdown of mutant KRAS we show that, mutant KRAS (a) is necessary for MUC2 production in vitro and (b) synergistically engages PI3K/AKT and MEK/ERK pathways to maintain MUC2 expression in MCA cells. These results define a novel and a previously undescribed role for oncogenic KRAS in mucinous cancers. MCA cells were sensitive to MEK inhibition suggesting cellular dependence ('addiction') of KRAS-mutant MCA cells on hyperactivation of the MEK-driven pathway. Interestingly, MCA cells, though initially sensitive, were later resistant to PI3K single agent inhibition. Our studies suggest that this resistance involves dynamic rewiring of signaling circuits mediated through relief of RTK inhibition and MEK-ERK rebound activation. This resistance however, could be overcome by co-targeting of PI3K and MEK. Our studies thus provide a rational basis for MEK- and PI3K-targeted combination therapy for not only KRAS mutant MCA but also for other related mucinous neoplasms that overproduce MUC2 and have a high rate of KRAS mutations such as pseudomyxoma peritonei.

Introduction: The emergency medical services (EMS) system plays a crucial role in the chain of survival for acute myocardial infarction (AMI) and stroke. While regional studies have shown underutilization of the 911 system for these time-sensitive conditions, national trends have not been studied. Our objective was to describe the national prevalence of EMS use for AMI and stroke, examine trends over a six-year period, and identify patient factors that may contribute to utilization. Methods: Using the National Hospital Ambulatory Medical Care Survey-ED (NHAMCS) dataset from 2003-2009, we looked at patients with a discharge diagnosis of AMI or stroke who arrived to the emergency department (ED) by ambulance. We used a survey-weighted χ2 test for trend and logistic regression analysis. Results: In the study, there were 442 actual AMI patients and 220 (49.8%) presented via EMS. There were 1,324 actual stroke patients and 666 (50.3%) presented via EMS. There was no significant change in EMS usage for AMI or stroke over the six-year period. Factors independently associated with EMS use for AMI and stroke included age (OR 1.21; 95% CI 1.12-1.31), Non-Hispanic black race (OR 1.72; 95% CI 1.16-2.29), and nursing home residence (OR 11.50; 95% CI 6.19-21.36). Conclusion: In a nationally representative sample of ED visits from 20003-2009, there were no trends of increasing EMS use for AMI and stroke. Efforts to improve access to care could focus on patient groups that underutilize the EMS system for such conditions. [West J Emerg Med. 2014;15(7):–0.]

Background: Patients with cirrhosis are perceived to be at increased risk for bleeding given the presence of coagulopathy leading to unnecessary head imaging studies. Our aim is to determine the prevalence of intracranial hemorrhage (ICH) in patients with cirrhosis using gold standard autopsy data. Methods: An autopsy-based case control study was performed in a tertiary care hospital with a specialized Liver Unit. Autopsies without both head and abdominal examinations were excluded. Results: Between 1986 and 2003, a total of 679 autopsies were performed. 37 autopsies were excluded and 642 autopsies were available for final review. A total of 21 (4.3%) patients in the cirrhosis group had ICH compared to 12 (7.9%) patients in the control group (p = 0.115). Since Alzheimer’s patients may be at higher risk for ICH given the presence of cerebral amyloid angiopathy, a separate analysis was performed after excluding these patients. The results were similar (4.3% vs. 9.3%, p = 0.061). The prevalence of old strokes (1.2% vs. 13.9%, p