Search

At the invitation of the director of The National Eye Center, Kaduna, Nigeria and The Makkah Eye Hospital of Khartoum, Sudan I visited both these institutions to teach phacoemulsification surgery to their aspiring surgeons on Visalis 100 (Carl Zeiss Meditec, Germany). This article highlights the experience of teaching phacoemulsification surgery in foreign African countries like Nigeria and Sudan. In Nigeria I had the opportunity to give training in both wet lab and live surgery settings whereas in Sudan only hands-on live surgery. Sudan being an Islamic nation pigs are not slaughtered there and hence no pig eyes. Goat eyes differ significantly from human eyes and hence have almost no value in wet lab teaching. The training program included theoretical discussions, wet lab, surgery and finally discussions related to the days' surgery. It became clear that quality of learning depends on three main factors. Thorough understanding of theory and observation of senior surgeons in operation room Good wet lab and finally doing the surgery oneself in step by step manner. Dedicated teachers and instructors can make all the difference. The learning curve also significantly shortens if the trainees are exposed to all types of cataract surgery like ECCE, SICS and phacoemulsification surgery. The main problem faced by those surgeons who have done only ECCE/SICS is that they are not used to handling microscope and instruments in both hands at the same time. Hence I strongly recommend them wet lab where they can sit and practice using both hands and feet and microscope simultaneously and in coordinated fashion.

Glaucoma represents a progresive multifactorial optic neuropathy characterised by retinal ganglion cell loss and atrophy of the optic nerve its main cause being high intraocular pressure. [1,2] Trabeculectomy is the most used surgical method when it comes to the majority of the ophthalmologists which is why knowing and managing the intraoperative and postoperative complications well is very important. [3]

The identification and biopsy of the sentinel lymph node has become a standard method of treatment for stage I and II breast cancer in the last decades, taking into account the fact that the management of the axilla in patients with breast cancer has evolved from the routine lymphadenectomy to a selective attitude, based on the histopathological evaluation of the sentinel lymph node, as well as on the tumor and on the patients’ characteristics. Since the introduction of the method into clinical practice, in 1994, different methods of identification have been used (radioisotope injection, vital blue dye, or, more recently, lipophilic contrast agent for ultrasound visualization or paramagnetic nanoparticles (NPs) or the method of indocyanine green fluorescence), each presenting certain limits, but the radioisotopic method proving the most accurate. Moreover, during the development of the method, beside the standard indications specific for T1 or T2 breast tumor, without clinical or imagistic axillary adenopathies, their extension to a series of other particular situations such as the following, has been tried: ductal carcinoma in situ, multicentre tumors, after excisional biopsy or tumors preoperatively treated by neoadjuvant chemotherapy. The aim of the paper is to present the progress made regarding the current stage in the use of sentinel lymph node technique in breast cancer, while mentioning the established indications, as well as the ones that are still debating and need further studies. Likewise, the cases in which the axillary lymph node dissection remains the major indication for treatment of the axilla, in patients with early stage breast cancer, will be discussed.

Esophageal cancer represents one of the most aggressive digestive tumors, with a survival rate at 5 years of only 10%. Globally, during the last three decades, there has been an increasing incidence of the esophageal cancer, approx. 400,000 new esophageal cancers being currently diagnosed annually. This represents the eighth leading cause of cancer incidence and the sixth leading cause of cancer death overall. Taking into account the population’s global aging and thus, the increase in the number of patients who will not bear surgery, PCT and radiation, or the fact that they do not want it especially because of deficiencies and associated pathology, the endoscopic ablative techniques with palliation purposes represent the alternative. If we refer to the Western Europe countries and North America, we notice an increase of esophageal adenocarcinoma rate versus squamous cancer. As for the Asian region, referring in particular to China and Japan, 9 out of 10 esophageal cancers are squamous cell carcinomas. For at least half of the patients with EC (esophageal cancer) there is no hope of healing because of the advanced regional malignant invasion (T3-4, N+, M+) with no chemo and radiotherapy response, poor preoperative patients’ conditions or systemic metastasis. The low life expectancy does not justify the risky medical procedures, the goal of the therapy consisting in the improvement of the quality of life by eliminating dysphagia (reestablishing oral feeding) which represents the most common complication of EC, the respiratory tract complication caused by eso-tracheal fistulas or by eliminating chest pain. To treat dysphagia, which is the main target of palliation, combined methods like endoscopic, chemo and radio-therapy, can be used, each one with indications, benefits and risks. Abbreviations: SEPS = self expanding plastic stent, SREMS = self expanding metal stent, EBRT = Endoscopic brachy radiotherapy, EUS = Ultra sound endoscopy, CT = Computer tomograph, UGE = Upper gastro endoscopy, PET-CT = Positron Emission Tomography, APC = argon plasma coagulation, PDT = photo dynamic therapy, PCT = Poli-chemotherapy, RT = Radio-therapy

Breast cancer represents a major public health problem, being the highest incidence neoplasia in females in Romania. The most important step in the treatment of this neoplasia is the surgical procedure; the biggest problem associated with this form of treatment in these patients is pain-related. Pain is a complex symptom with an impact on quality of life and psychology of cancer patient and can only be monitored verbally and subjectively. Consequently, the purpose of our work is to identify some biochemical parameters involved in the events cascade associated with inflammation and pain in breast cancer female patients, monitored in dynamics of anesthesia and surgical procedure. Measurements of lipid peroxides, ceruloplasmin and immune circulating complexes in mentioned dynamics have been performed. The recorded values are in concordance with the inflammatory processes and pain intensity, thus we can allege that these measurements can complete the pain-associated clinical picture in female breast cancer patients.

Oligo-anovulation, hyperandrogenism and insulin resistance characterizes polycystic ovary syndrome (PCOs). Metformin is the oldest insulin sensitizer used in the management of type 2 diabetes mellitus. In PCOs, metformin decreases the serum lipids, androgen and insulin; induces ovulation and regular menstrual cycle; increases the pregnancy rate.

There is a wide documentary material regarding the upper dental disease influencing the state of the maxillary sinus. This article tries to show that the relation is a two-way one.

Introduction.Over the past years, there has been an increasing interest in involving the cancer patients in the decision making regarding the therapy management due to several factors. The most important aspect to be taken into consideration is the principle of patient autonomy. More and more patients have become interested in making informed decisions regarding their therapy options and physicians need to be able to provide data on the aspect. Some patient-physician models have been proposed and used for 40 years now. Still, the debate is very important for most of the physicians due to the shifts in the approach. Materials and methods. To really express the concerns that the authors address, the case of a head and neck cancer patient and the possible dialogues with the physician were presented. Each type of communication model with the patient is very important because nowadays, intrications between the four are likely to occur. There are legal aspects that need to be taken into consideration such as the informed consent, the ethical and moral aspects. Conclusions The possibility of individualized oncological therapy for the cancer patient leads to different decisions for both the patient and the physician. The decision making process involves the patient at different levels. Legal implications tend to affect the healthiness of the dialogue between the physician and the cancer patient and might be a key-point in the further development of the ethical aspects.

The teaching practices inventory characterizes the teaching methods used in university science and mathematics courses, including the extent of use of research-based teaching practices. Data from many courses across five departments are presented., We have created an inventory to characterize the teaching practices used in science and mathematics courses. This inventory can aid instructors and departments in reflecting on their teaching. It has been tested with several hundred university instructors and courses from mathematics and four science disciplines. Most instructors complete the inventory in 10 min or less, and the results allow meaningful comparisons of the teaching used for the different courses and instructors within a department and across different departments. We also show how the inventory results can be used to gauge the extent of use of research-based teaching practices, and we illustrate this with the inventory results for five departments. These results show the high degree of discrimination provided by the inventory, as well as its effectiveness in tracking the increase in the use of research-based teaching practices.

This study compared the effectiveness of three different methods of implementing active-learning exercises in an introductory biology course. The results suggest that individual writing should be implemented as part of active learning whenever possible and that instructors may need training and practice to become effective with active learning., We investigated some of the key features of effective active learning by comparing the outcomes of three different methods of implementing active-learning exercises in a majors introductory biology course. Students completed activities in one of three treatments: discussion, writing, and discussion + writing. Treatments were rotated weekly between three sections taught by three different instructors in a full factorial design. The data set was analyzed by generalized linear mixed-effect models with three independent variables: student aptitude, treatment, and instructor, and three dependent (assessment) variables: change in score on pre- and postactivity clicker questions, and coding scores on in-class writing and exam essays. All independent variables had significant effects on student performance for at least one of the dependent variables. Students with higher aptitude scored higher on all assessments. Student scores were higher on exam essay questions when the activity was implemented with a writing component compared with peer discussion only. There was a significant effect of instructor, with instructors showing different degrees of effectiveness with active-learning techniques. We suggest that individual writing should be implemented as part of active learning whenever possible and that instructors may need training and practice to become effective with active learning.

Acute pancreatitis is a serious disease. Many clinical and laboratory prognostic scores for the severity of acute pancreatitis have been proposed over the years. The aim was to identify the biological factors of prognostic severity. The study was prospective, including a four-year period between 2007 and 2010. 103 patients were diagnosed with severe acute pancreatitis and treated in a surgical clinic in Bucharest. 58 were males, accounting for 56.31%, and 45 were women, 43.69% respectively. Numerous biochemical analyses of blood, especially the number of leukocytes, glucose, urea and bilirubin were monitored. They proposed generic profiles for patients with severe acute pancreatitis. Conclusions: There is no single biological prognostic factor, but a combination of different markers may contribute to a more precise prediction of severity, as confirmed by international literature.

This article reviews some of the recent data concerning Consultation-Liaison Psychiatry in a general hospital. As the organic medical conditions have a major impact on the one's quality of life and self-awareness as an ill-person, very often a psychiatric disorder appears as co-morbidity. It is the responsibility of the psychiatrist to recognize and to treat these psychiatric conditions, and also to develop good work-relationships with the patients and the clinical team.

Combination therapy with pegylated interferon alfa (PEG-IFN alfa) and the nucleoside analogue ribavirin is the current standard of care in patients infected with hepatitis C virus (HCV). Patients with HCV genotype 1 have a much less favorable response to therapy and are treated for 12 months, compared with patients infected with genotypes 2 and 3, in whom a 6-month course of therapy is sufficient. If viremia is present after 6 months, additional therapy has a negligible benefit, and treatment should be stopped in all patients regardless of the viral genotype. With HIV coinfection, all patients with a response to therapy at the end of 6 months should receive an additional 6 months of combination therapy regardless of the genotype. Patients with acute HCV infection should be treated for 6 months. The addition of protease inhibitors to the combination of PEG-IFN alfa and ribavirin is becoming the new standard of care for the treatment of chronic HCV infection. Regimens that include a protease inhibitor significantly improve sustained virologic response rates in patients with genotype 1 HCV infection.

Background: Hypogonadotropic hypogonadism (HH) is characterized by inappropriately low serum concentration of LH (luteinizing hormone) and FSH (follicle-stimulated hormone) in the setting of hypogonadism. A number of pathologic processes cause Hypogonadotropic hypogonadism but it can also occur as a part of various congenital syndromes. Objectives. To characterize the morphotypes and the hormonal profile of the HH patients enrolled in the COST Action BM1105 within “C.I. Parhon” National Institute of Endocrinology from May 2012 onward. Methods. The eligible patients were selected by using a general protocol that included: a detailed familial and personal history; a clinical evaluation focusing on genital development; a hormonal evaluation that aimed to exclude the acquired causes of HH and to characterize the basal/stimulated (triptoreline) profile of gonadotropins; a DNA extraction for genetic studies. Results: We examinated the medical records of patients admitted in our institute with the diagnosis of hypogonadotropic hypogonadism from May 2012 onward. There were 19 patients: 12 males and 7 females, age at diagnosis 28.03±11.45 years (13.4-56 years). The phenotypic expressions were variable and the hormonal evaluation showed low values of basal and stimulated gonadotropins. Conclusions: Although hypogonadotropic hypogonadism is a rare disease, the monospeciality profile of National Institute of Endocrinology enable the enrolment of a high number of patients in order to create clinical guidelines for evaluation/diagnosis and for treating GnRH deficient patients.

Osteoarthritis is the most common joint disorder and a major cause of disability with a major socio-economic impact. In these circumstances is very important to understand its pathogenesis. Although previous research focused primarily on changes in the articular cartilage, more recent studies have highlighted the importance of the subchondral bone, synovium, menisci, ligaments, periarticular muscles and nerves. Now osteoarthritis is viewed as a multifactorial disease affecting the whole joint. Abbreviations: TNF-α – tumor necrosis factor alpha, IL-1 – interleukin -1, IL-6 – interleukin-6, COMP- cartilage oligomeric matrix protein, BSP - bone sialoprotein, MRI - magnetic resonance imaging, NTx - cross-linked N-telopeptide of type I collagen, CTx – C-telopeptide-cross-linked collagen type I, TGF-β – transforming growth factor beta, MMPs- matrix metaloproteinases, VEGF-vascular endothelial growth factor, bFGF - basic fibroblast growth factor.

The following article by Barba (2012a) addresses Neuringer's proposal that variability is an operant dimension of behavior, that is, that variability can be reinforced, extinguished, and brought under stimulus control, just like any other response property (e.g., Denney & Neuringer, 1998; Morgan & Neuringer, 1990; Neuringer, 1986, 2009; Page & Neuringer, 1985). Barba confines his argument to methodological considerations: He points out that the measures that have been used to assess Neuringer's proposal have been indirect and do not resolve the question one way or the other. Specifically, he argues that, in the relevant studies, the response properties on which reinforcement was contingent were not the same as the properties that were used as measures of variability. Thus, he holds that Neuringer's proposal remains in doubt until this methodological discrepancy is addressed. Neuringer has supported his proposal with a long program of research over several decades, with pigeons, rats, and college students. In every case, variability in behavior increased when reinforcement contingencies were applied. This empirical finding is not in doubt. Moreover, it has practical applications, particularly for populations in which behavioral variability is limited. However, although the empirical findings appear to be robust, Neuringer's interpretation of them has been controversial on grounds other than those offered by Barba. As Holth (2012a) pointed out, Conceptually, the idea of an operant class that consists of, or includes, all sorts of novel instances is problematic because such a class would have no defining criteria to permit the counting of instances, or even to specify where an instance of novel behavior starts or ends. (p. 88) Thus, although the data show variability in behavior, it isn't clear what the units of analysis are. Most studies of variability have investigated sequences of behavior, in which variability is found in patterns of elementary responses that are not, themselves, novel. (Exceptions include studies of extinction, e.g., Antonitis, 1951; Notterman, 1959; and studies of variations in response topography, e.g., Pryor, Haag, & O'Reilly, 1969; but see Holth, 2012a, for an alternative view.) Can variability in the sequencing of elementary units be considered a dimension of operant behavior, or is a more fundamental interpretation possible? This problem is not unique to Neuringer's proposal. Generalized operants raise the same problem and occasion an analogous controversy. Because Barba's paper, and the topic of variability-as-operant generally, evoked a wide range of thoughtful remarks from the reviewers, we solicited commentaries from five experts on the conceptual foundations of behavior. Their articles offer the reader a wide range of opinions on Barba's target article, Neuringer's proposal, and some of the fundamental conceptual topics that are raised by the controversy. Neuringer (2012) ably defends his proposal on conceptual, methodological, and empirical grounds, and Holth (2012b), with reference to his own work on the topic, offers a contrary opinion on the same grounds. Machado and Tonneau (2012) challenge the premise of Barba's argument, but they offer an interpretation of the research on variability in terms of differential extinction and reinforcement that does not require that variability itself be an operant. Marr (2012) points out that variability should not be confused with randomness and raises questions, challenging to all points of view, about how a science of behavior can decide on units of analysis, dependent variables, and levels of analysis with such a slippery topic. Barba (2012b) concludes the set by responding to the other commentaries and returning to his suggestion that questions about the operant nature of variability can be answered only when dependent variables and reinforcement criteria are the same. In approaching the set of articles, perhaps the reader will find it helpful to consider some hypothetical cases. How, in general, do we decide whether something is an operant? How do we settle on a definition? The question is as old as behavior analysis itself. In “The Generic Nature of the Concepts of Stimulus and Response,” Skinner (1935) wrestled with the question and offered an empirical solution: Define your units in such a way that the relation between behavior and its controlling variables, so defined, is most orderly. This requires exhaustive parametric research, and in practice, most researchers simply use well-tested experimental procedures or leave the matter of conceptual units to common sense. But consider the following cases: A research team reinforces “weight loss.” They can measure it precisely, and they discover that it is sensitive to reinforcement, punishment, and extinction procedures, and that it can be brought under stimulus control. In this case the dependent variable, as measured, is not behavior at all but an outcome of behavior. Following Skinner's maxim, they would vary their definitions and presumably discover that even more variance could be accounted for by studying the behavior that mediates weight loss and the many conditioned reinforcers that attend such a complicated set of events. A research team reinforces rapid heart beats. They too find that it is sensitive to the full range of behavioral procedures. Moreover, unlike the first team's dependent variable, theirs is behavior. But continued investigation reveals that the experimental subjects get up and run around when the contingency is in effect. When running is controlled for, the remaining effect on heart rate is absent, or very weak. The point of these implausible scenarios is that the sensitivity of a variable to behavioral procedures is not, by itself, sufficient for us to determine that something is an operant if there are other behavioral events that mediate that sensitivity. Might variability be mediated in some analogous way? One possibility, noted by Neuringer himself, is that variable behavior might be “strategic.” An experimental subject who is aware that his behavior is reinforced on a Lag 4 schedule could obtain every reinforcer by repeatedly cycling through the same four responses. An experimental subject asked to generate random numerals might recite telephone numbers, birth dates, time of day, mathematical constants, and so on. Strategic behavior of that sort might be possible for verbal adults, but it is implausible in pigeons and rats. However, a program of research by Machado has investigated the effect of local contingencies on variability and has shown, among other things, that differential reinforcement of various rates of switching behavior affects measures of variability in systematic ways (e.g., Machado, 1989, 1997). The foregoing remarks are intended to illustrate the formidable problem of determining when something is an operant, particularly when it is an atypical case. Perhaps the concept of the operant, like other natural categories, has fuzzy boundaries, and at those boundaries we may have to make do with a degree of uncertainty. Whatever the resolution of the claim that variability is an operant may be, variability is of fundamental importance to a science of behavior, just as it is to evolutionary biology. Repeated cycles of variation and selection offer a powerful and parsimonious explanation of both biological and behavioral adaptations to changing contingencies. Both evolution and shaping illustrate differential selection of some candidates from pools of variants (Pringle, 1951; Skinner, 1953, 1981). The scope of such accounts is limited by the selection contingencies themselves (not all programs of contingencies occur in nature) but a second constraint is imposed by sources of variation, because without variation, neither evolution nor shaping could occur. Ultimately, variation is the origin of all behavior.

Stimuli that precede aversive events are typically less preferred than stimuli that precede nonaversive events. It has recently been demonstrated that stimuli that follow less preferred events may become favored more than stimuli that follow more preferred events. This phenomenon has been investigated under a variety of names, most commonly, within-trial contrast and state-dependent valuation. Although this effect has been replicated, there have been several failures to replicate and it is still little understood. This paper reviews and summarizes the literature on within-trial contrast and state-dependent valuation. Procedural variations across studies are identified and discussed. The two current models that explain the phenomenon are then outlined and the limitations of each model are described. A third explanation is offered that incorporates the concept of motivating operations. Last, the predictions of all three models are compared.

Several recent studies have explored what Michael (e.g., 1982) termed the value-altering effect and the behavior-altering effect of motivating operations. One aspect of the behavior-altering effect that has garnered no recent attention involves changes in stimulus control produced by motivating operations. To call attention to this aspect of the behavior-altering effect, we herein review 11 studies that are concerned with the influence of varying levels of food or water deprivation on stimulus generalization. These studies suggest that motivating operations influence stimulus control (a) by changing the evocative strength of not just an established discriminative stimulus, but also of stimuli that are physically similar to it; (b) by changing the range of stimuli that evoke the operant in question; and (c) by exerting these effects in a graded fashion. These findings are potentially of conceptual and applied significance, and it appears that further research examining how motivating operations alter stimulus control, including some studies suggested herein, is warranted.

Ever since Skinner (1945) suggested how so-called “subjective” terms could be brought under the control of private stimuli, behavior analysts have debated the nature and role of private events in a natural science of behavior. In this issue, the debate continues with the target article by Baum and commentaries by five prominent behavioral theoreticians. Specifically, Baum (2011a) argues that it is futile to speculate about private events because, behavior, by its very nature, is extended in time and, thus, we are only tempted to “posit private events … when an activity is viewed in too small a time frame, obscuring what the activity does” (p. 185). In other words, a molar approach to understanding behavior precludes any consideration of private events because such events occur on too small a scale and, thus, are not necessary to understand behavior.

The aim of this paper is to examine specific features of modern individualistic societies that contribute to “emotions” and “cognitions” becoming a matter of privacy. Although some behavior analysts identify emotions and cognitions as “private events,” we argue with Skinner (1945) that cognitions and emotions are relations among events and that their origin is in public events in the contingencies of reinforcement maintained by other people. Guided by Elias (1939/ 1996), we suggest that the shift from feudal economies to market economies involved the increasing individualization of society’s members. This individualizing process includes the socially maintained contingencies that bring some verbal responses under control of private stimulation and reduce the magnitude of some verbal responses to a covert level. Behavioral relations in which either stimuli or responses (or both) cannot be observed by others set the stage for a concept of “privacy.” Changes in societal contingencies that gave rise to individualization and the attribution of privacy to cognitions and emotions are suggested to include the following: (a) increasing frequency of individual consequences that have no apparent or direct relevance to the group; (b) increasing numbers of concurrent contingencies and choice requirements; (c) conflicts between immediate and delayed consequences for the individual; and (d) conflicts between consequences for the individual and for the group.

Joseph V. Brady (1922–2011) created behavior-analytic neuroscience and the analytic framework for understanding how the external and internal neurobiological environments and mechanisms interact. Brady's approach offered synthesis as well as analysis. He embraced Findley's approach to constructing multioperant behavioral repertoires that found their way into designing environments for astronauts as well as studying drug effects on human social behavior in microenvironments. Brady created translational neurobehavioral science before such a concept existed. One of his most lasting contributions was developing a framework for ethical decision making to protect the rights of the people who participate in scientific research.

Previous descriptions of incomplete longitudinal fractures and fatigue injury of the proximopalmar aspect of the third metacarpal bone (McIII) have focused on diagnostic imaging findings, especially in racehorses.To document the case details, clinical features, response to diagnostic analgesia, diagnostic imaging findings and follow-up data in a large group of horses with an incomplete longitudinal fracture or fatigue injury of the proximopalmar medial aspect of the McIII.Horses were included in the study if pain was localised to the proximopalmar aspect of the metacarpal region, with radiological evidence of an incomplete longitudinal fracture or generalised increased radiopacity in the proximopalmar medial aspect of the McIII, or focal increased radiopharmaceutical uptake (IRU) in the proximopalmar aspect of the McIII. Age, breed, gender, height, bodyweight, work discipline, work history, duration of lameness, clinical signs and responses to diagnostic analgesia were recorded. Radiographic and scintigraphic images were assessed subjectively and objectively.There were 55 horses representing a broad spectrum of ages and work disciplines, 73% of which had radiological abnormalities. The majority had no localising clinical signs, although 73% of horses with radiological abnormalities showed a characteristic pattern of lameness. Lameness was generally worse in straight lines than in circles. Increased radiopharmaceutical uptake ranged from mild to intense in the lame limb; 14% of nonlame limbs had mild IRU. Of horses for which long-term follow-up was available, 98% returned to full athletic function.Incomplete longitudinal fractures and fatigue injury of the proximopalmar medial aspect of the McIII may occur in horses of many types and sports disciplines, and are not confined to immature performance horses. They should be considered an important differential diagnosis for proximal metacarpal region pain.

L. Benjamin Wyckoff’s seminal contributions to both psychological theory and application are the subject of this review. Wyckoff started his academic career as a graduate student at Indiana University, where he developed the observing-response procedure under the guidance of B. F. Skinner and C. J. Burke. At the University of Wisconsin—Madison, Wyckoff refined his mathematical theory of secondary reinforcement. This theory was the impetus for his creation of an electronic simulation of a rat running a T maze, one of the first “computer models” of learning. Wyckoff next went to Emory University, leaving there to help create two of the most successful companies dedicated to the advancement of programmed instruction and teaching machines: Teaching Machines, Inc. and the Human Development Institute. Wyckoff’s involvement in these companies epitomizes the application of basic behavior-analytic principles in the development of technology to improve education and human relationships. The emergent picture of Wyckoff is that of a man who, through his research, professional work in educational applications of behavioral principles, and active involvement in the civil rights movement of the 1960s, was strongly committed to applying behavioral science to positively influence human behavior change.

From recent commentaries about the role of basic behavior scientists in translational research, I distill some advice to young investigators who seek to apply their basic science training to translational studies. Among the challenges are (a) devising use-inspired research programs that complement, and are not redundant with, existing efforts in basic and applied behavior analysis; and (b) making tactical decisions, such as the selection of methods and collaborators, based on the research topic rather than, necessarily, the existing traditions in behavioral research. Finally, it must be recognized that although use-inspired basic research has the potential to attract support to basic laboratories and contribute to “saving the world,” neither of these outcomes is guaranteed. I discuss the relative risks for basic scientists who proceed with use-inspired basic research rather than ignore such translational questions.

The most important known metabolic complication of the newborns from diabetic mothers, including diabetes type 1 and 2 and gestational diabetes, is the postnatal hypoglycemia. If unrecognized and undiagnosed, hypoglycemia in this particular high-risk group can determine severe neurological lesions and even death, in a significantly higher proportion than those from the general population. The present paper brings arguments for the crucial importance of screening for post-natal hypoglycemia in the early hours after birth, and discusses the management strategies and the topics that still remain in debate.

Despite the global effort to control the spread of HIV and AIDS, the number of HIV-infected people continues to increase worldwide. The failure of present prevention strategies, which rely principally on the modification of behavioral practices that put individuals at risk of getting the infection, and the lack of effective anti-HIV drugs have given an impetus to the search for a better way in the prevention and control of the epidemic. It was observed and scientifically documented that efforts related to prevention have to be adapted, constantly monitored and readapted in relation to results from periodical surveys. They also have to be well sustained over a sufficiently long period of time (years). Under these assumptions, in order to evaluate the knowledge and perception/attitudes of the students in the University of Medicine, we developed a questionnaire that we presented for completion, for example, to medical students at the end of their first year of study. The gathered data conducted us to the assumption that information regarding HIV transmission is not yet internalized in order to determine specific practices, and attitudes are more related to perceptions and beliefs than to facts. An active, responsible, adult day to day responsibility could increase the protection against HIV transmission. A limitation of our study was represented by the reduced number of participants (96) and the lack of correlation between attitudes and knowledge, between students in different years of study and over time. It is our intention to continue this research and provide more complete data in the nearest future.

Thymoglobulin has a proven safety and efficacy profile both as treatment of acute rejection and as induction therapy in organ transplantation. The most common adverse events associated with Thymoglobulin are cytokine release syndrome, thrombocytopenia, and lymphopenia. Results of early studies showed an increased rate of cytomegalovirus disease associated with Thymoglobulin treatment, but recent studies indicate that routine administration of modern antiviral prophylaxis can reduce this risk. More research comparing Thymoglobulin with basiliximab will help individualize regimens by matching the choice of induction agent with the risk profile of each transplant recipient. The proven efficacy and safety profile of Thymoglobulin provides an excellent starting point for future investigations.[50] Horse ATG (hATG) or Thymoglobulin + Cyclosporine are an efficacious treatment for aplastic anemia. Due to its higher potency Thymoglobulin may be superior to hATG, but further studies are required for confirmation.[38] GvHD prophylaxis with Thymoglobulin may result in less acute and chronic GvHD, lower TRM, improved survival and quality of life in myeloablative or reduced intensity conditioning protocols in patients receiving hematopoietic stem cells from related or unrelated donors. Attributable to its polyclonal nature, Thymoglobulin provides multifaceted immunomodulation suggesting that its use should be included in the immunosuppressant therapeutic armamentarium to help reduce the incidence of organ rejection and GvHD,[5] and for treatment of aplastic anemia.

In the genesis of dental-maxillary anomalies both morphologic factors (of proven genetic origin) and functional factors (as added ethio-pathogenic elements) are incriminated. From this point of view, Class II/2 malocclusion, presents two morphologic factors whose genetic origin is certain and upon which functional factors have minor influence. These are: the morphology of the teeth and alveolar process in the anterior region of the maxilla and the type of rotation. The combination of the two generates a broad range of deep bite case variants.

The aim of this paper is to determine the possibilities of modern radiofrequency (RF) technology and the usefulness of abdominal and thoracic parenchymatous organs in surgery. Investigation was made on 17 patients with 125 RF energy realized cycles (an average of 7,35 per one pt.) and the average time heating coagulative necrosis of 42,6 minutes (maximum to 80 minutes). There was one complication (pleural effusion) in a patient with RF treatment of 5 metastases colorectal carcinoma (MCRC) and synchronous right hemicolectomy. There were no other complications either to close or to distant to the organs. The urgent need of RF technology was in the case of a patient with iatrogenic rupture of spleen, treated by radiofrequency coagulation (RFC) with documented preservation of the whole organ. Most of the patients with MCRC (64%) were intraoperatively treated with a combination of radiofrequency ablation (RFA) and radiofrequency assisted resection (RFAR) of the liver with success in 95% of the cases. In the surgery of echinococcal liver cyst located deep, in the parenchyma, RFA were used for scolicidal purpose, and for hepatotomy. In the treatment of lung malignancies RF technology was reserved for nonsurgical candidates suffering from NSCLC, but also for surgical patients as a palliative measure in the treatment of local symptoms related to non-resectable primary and secondary tumors, presenting an aggressive tumor growth on the thoracic wall and the great vessels, with the possibility of reducing the number of explorative thoracotomy.

Since the first description of uterine artery embolisation for the treatment of symptomatic fibroids of the uterus in 1994, this minimally invasive procedure has been increasingly performed in many countries. Transcatheter embolisation of the uterine arteries feeding large fibroids is a minimally invasive technique. This paper presents the combined endovascular and surgical therapy in the treatment of uterine fibroma. The purpose of this therapy is saving the reproductive function of the uterus even in cases with very large fibromas or located in areas with difficult access, in which hysterectomy would have been needed. The therapy has a high rate of success, it is accompanied by disappearance of the symptoms and it has a low risk of intra- and post-operatory complications. The first step is the embolisation of uterine arteries – a safe therapy of uterine fibroma. The procedure eliminates the risk of post-miomectomy relapse through the symultaneous devascularisation of all fibroma nodules, even of the very small ones which are unapparent clinically or imagistically. The post-embolisation surgical intervention is undertaken in conditions of operative comfort, with minimal bleeding; it eliminates the need for blood transfusions and diminishes the duration of intervention. Three representative cases where this therapy has been successfully applied are presented in this article. The embolisation of the uterine arteries represents an efficient therapy of the uterine fibroma, with very good results noted in the speciality literature.

Retroperitoneal tumors, whether primary or resulting from the metastasis of other tumors, are a real challenge for the surgeon, as regards their diagnosis and treatment. They are relatively rare, under 0.2 % of the total number of tumors. The clinical examination of retroperitoneal tumors is uncharacteristic and misleading, consisting mainly in palpation of the tumor proper and in pain. The other signs and symptoms often result from the affected neighboring organs. The imagistic investigations used in diagnosing retroperitoneal tumors are ecography, intravenous pielography, computed tomography, MRI, PET/CT. The main treatment is the surgical one, consisting either in the total or partial excision of the tumor, or in biopsic material samples with a view to making a histopathologic diagnosis. Post-operatory evolution depends mainly on the thoroughness of the surgical treatment, that is the complete excision of the tumor, which increases the chances of survival, while lowering the risk of relapse.

The aim of this general article is to present an overview of the current knowledge about composition and structural changes and also about specific biomechanical alterations related to vitality loss or endodontic therapy. For a long time, these issues have been controversially approached from a clinical standpoint and are therefore still confusing for many practitioners. Vitality loss or endodontic procedures seem to induce only negligible changes in hard dental tissue moisture. Physico-chemical properties of dentin can be modified by some of the endodontic chemical products used for chemo-mechanical debridement. On the other hand, tooth biomechanical behavior is affected, since tooth strength is reduced proportionally to coronal tissue loss, due to either pre-existent carious/non-carious lesions or cavity acces preparation, besides restorative procedures. The related literature shows the lack of accepted clinical standards and consensus regarding the optimal way of approaching the specific tooth biomechanics following endodontic therapy.

Cranial traumas have different particularities in infants, toddlers, preschool child, school child and teenagers. The assessment of these cases must be individualized according to age. It is completely different in children that in adults. Trauma scales, very useful in grading the severity and predicting outcome in traumatic brain injury, used in adults must be adapted in children. Children have age-related specificity and anatomic particularities, for each of this period of development. Neurotrauma scales, specific for infants and children, such as Pediatric Coma Scale, Children’s Coma Score, Trauma Infant Neurological Score, Glasgow Coma Scale, Liege Scale are reviewed, as well as neurotrauma outcome scales, like Glasgow Outcome Scale, modified Rankin score, KOSCHI score and Barthel Index. The authors present these scales in an exhaustive manner for thoroughgoing pediatric neurotrauma standards.

Mutations in adenomatous polyposis coli (APC) gene have not been previously characterized among Romanian patients with colorectal cancer (CRC). We initiate this study to detect the mutations in APC gene in blood and tumor samples collected from 16 patients (10 men and 6 women) and blood samples from 21 first and second degree relatives of the patients. For this the presence of mutations in exons 6, 7, 12, 13, 14 as well as in regions B, L and W of exon 15 was investigated using PCR multiplex. In the same time, we have searched for 5 bp deletions at codon 1061 of APC gene by PAGE and SSCP methods. These methods allowed us to evidence identification of the presence of mutations in samples from 7 individuals. In one patient, was detected a deletion of exon 13th of APC gene both in DNA extracted from blood and tumor samples. Multiple deletions (e.g. in exon 6, 12, and in 15L and 15W regions) in DNA extracted from the tumor sample were detected, but not in DNA probe obtained from blood cells. We can speculate that these mutations are an example of genomic instability accompanying the malignancy. Till now, no mutation affecting 1061 codon of APC gene was identified in the patients investigated in our study.

The introducing of reconstructive microsurgery has meant not only the addition of microsurgical microscopes and instruments, but a change, a progress towards a new concept, the concept of the microsurgical reconstruction of tissues. The microscope and the instruments themselves are only a means of utilizing this new concept to good effect since the mere use of the microscope and of the instruments according to the old concept of tissue reconstruction cannot be considered to be reconstructive microsurgery. From December 1979 through to December 2005, more than 3.000 patients with peripheral nerve lesions were operated on by the same microsurgeon, the author Doina Ionescu-Dumitrescu. The conclusions are based on the following: • A huge amount of work involved in carrying out microsurgical reconstructions of over 7,500 peripheral nerves in over 3,000 patients, 1,800 of which were nerve transplants for defects of peripheral nerves of the extremities, for posttraumatic brachial plexus paralyses (91), for replantations and/or revascularizations following partial or complete amputations of the extremities (24 out of which 23 successful) or for free transfers of functional composite tissues (53). For a more accurate picture of such an effort one should consider the operation time that these types of reconstruction involve: between 3 and 12 hours for each patient under general anaesthesia and for both the anaesthetist and the microsurgeon. • Experimental microsurgery on rabbit ears • The results of the histopathological examination of 500 postoperative neuromas of peripheral nerves repaired traditionally • The Moberg test • Pre, intra and postoperative monthly observations of the patients until their full recovery according to the criteria set by the International Reconstructive Microsurgery Society (postoperative intervals of 6-12-24 months) • Taking pictures and recording pre, intra and postoperative stages • The patients’ professional, social and familial reintegration • The patients’ state of mind; level of cooperation • Comparing results with those of classic and palliative repairs • Comparing the data resulting from this experience with the information provided by the specialist literature of the world • Completing the internationally defined reconstructive procedures with the personal ones, to produce a new concept The introducing of reconstructive microsurgery has meant not only the addition of microsurgical microscopes and instruments, but a change, a progress towards a new concept, the concept of the microsurgical reconstruction of tissues. The microscope and the instruments themselves are only a means of utilizing this new concept to good effect since the mere use of the microscope and of the instruments according to the old concept of tissue reconstruction cannot be considered to be reconstructive microsurgery. From December 1979 through to December 2005, more than 3.000 patients with peripheral nerve lesions were operated on by the same microsurgeon, the author Doina Ionescu-Dumitrescu. The conclusions are based on the following: • A huge amount of work involved in carrying out microsurgical reconstructions of over 7,500 peripheral nerves in over 3,000 patients, 1,800 of which were nerve transplants for defects of peripheral nerves of the extremities, for posttraumatic brachial plexus paralyses (91), for replantations and/or revascularizations following partial or complete amputations of the extremities (24 out of which 23 successful) or for free transfers of functional composite tissues (53). For a more accurate picture of such an effort one should consider the operation time that these types of reconstruction involve: between 3 and 12 hours for each patient under general anaesthesia and for both the anaesthetist and the microsurgeon. • Experimental microsurgery on rabbit ears • The results of the histopathological examination of 500 postoperative neuromas of peripheral nerves repaired traditionally • The Moberg test • Pre, intra and postoperative monthly observations of the patients until their full recovery according to the criteria set by the International Reconstructive Microsurgery Society (postoperative intervals of 6-12-24 months) • Taking pictures and recording pre, intra and postoperative stages • The patients’ professional, social and familial reintegration • The patients’ state of mind; level of cooperation • Comparing results with those of classic and palliative repairs • Comparing the data resulting from this experience with the information provided by the specialist literature of the world • Completing the internationally defined reconstructive procedures with the personal ones, to produce a new concept

One of the national objectives in "Healthy People 2000" is for members of the public to increase their consumption of fruits and vegetables to five or more servings daily. The National Cancer Institute (NCI) began a nationwide campaign to achieve this objective in 1991. As part of this campaign, the NCI funded nine research studies in 1993. These projects are implementing and evaluating community-based programs designed to increase fruit and vegetable consumption among different segments of the population in Alabama, Arizona, Georgia, Louisiana, Maryland, Massachusetts, Minnesota, North Carolina, and Washington. The settings for these projects include the Special Supplement Food Program for Women, Infants, and Children (WIC Programs), churches, worksites, and schools. The projects are led by multidisciplinary teams and entail extensive collaboration among academic, governmental, private sector, and voluntary agencies within each State. The projects represent a model public health paradigm for conducting this type of research.

Mortality, cardiovascular risk factors, and diet were compared in Tianjin province, People's Republic of China; in North Karelia Province, Finland; and in the United States as a whole. People in Tianjin received 7 percent of their energy intake from saturated fats, whereas people in the United States received 13 percent and those in North Karelia received 20. The mean blood cholesterol levels for men were 158 milligrams per deciliter (mg per dl) for Tianjin, 216 mg per dl for the United States, and 241 mg per dl for North Karelia. The smoking prevalence among men was highest in Tianjin (66 percent), followed by the United States (42 percent) and Finland (36 percent). The differences among mortality rates for the three locales were less pronounced among women than among men. Age-standardized total mortality for women was highest for Tianjin and lowest in North Karelia. The reverse was true for men. Age-standardized total mortality for men was lowest in Tianjin and highest in North Karelia. Age-standardized ischemic heart disease mortality for men was lowest in Tianjin (99 per 100,000) and highest in North Karelia (730 per 100,000). For women, the corresponding figures were 83 per 100,000 in Tianjin and 164 per 100,000 in North Karelia. Although salt intake was higher in Tianjin than in North Karelia, the blood pressure was on average lower in persons from Tianjin than in those from North Karelia. The stroke mortality rate in Tianjin, however, was much higher than in either Finland or the United States. The strong discrepancy in stroke mortality relative to prevalence of hypertension and salt intake raises the issue of the etiology of stroke in Tianjin. Recently it has been reported that hemorrhagic stroke may be more common among people whose blood cholesterol level is very low and blood pressure level high. This joint condition may be relatively common in Tianjin and calls for longitudinal and case-control studies to clarify the relationships among these factors in Tianjin.

The serum concentrations of the aminoglycosides neomycin, kanamycin and streptomycin were determined after intravenous (iv) and intramuscular (im) administration. These values were then related to the minimum inhibitory concentrations (MIC) of a number of equine pathogenic bacteria to determine the duration of therapeutic serum concentrations of the aminoglycosides in the horse. Pharmacokinetic analysis of the data using neomycin as the example revealed a mean (+/- sd) peak serum concentration of 23.2 +/- 10.2 micrograms/ml present at 30 mins, and at 8 h the serum concentration was 2.8 +/- 0.8 micrograms/ml. From the pharmacological analysis of concentration-time data it was shown that neomycin was very rapidly absorbed from the im injection site, with an absorption half-time of 0.16 +/- 0.05 and was well absorbed (systemic availability was 73.7 +/- 26.9 per cent). A peak tissue level, which represented 40 per cent of the amount of drug in the body, was obtained at 32 mins after injection of the drug. At 8 h, the fractions of the dose in the central and peripheral compartments of the model were 1.5 per cent and 2.5 per cent respectively, and 96 per cent was the cumulative amount eliminated up to that time. Based on the MIC values of the majority of isolates of Corynebacterium equi, and only a few isolates of Klebsiella pneumoniae, Escherichia coli, Salmonella typhimurium and Streptococcus equi, one would expect a serum concentration of more than 2 micrograms neomycin/ml up to 8 h following im dosage (10 mg/kg) to be therapeutically effective.

The orientation towards one of the marketing policies with a major impact in organizations providing healthcare services, requires a careful analysis of the needs and aspirations of customers, targeting those patients whose needs the service organization can achieve through the existing resources at the respective health facility, finding the most effective way of achieving benefits associated with reduced costs to maximizing profits, placing the offers for medical services required by the patients on the market, as well as promptly reacting and acting to the changes of health services market which is constantly evolving through a flexible organizing and functioning structure, connected to the financial needs of the patients.

The study was designed to determine the chemical composition and antimicrobial properties of the essential oil of Thymus vulgaris cultivated in Romania. The essential oil was isolated in a yield of 1.25% by steam distillation from the aerial part of the plant and subsequently analyzed by GC-MS. The major components were p-cymene (8.41%), γ-terpinene (30.90%) and thymol (47.59%). Its antimicrobial activity was evaluated on 7 common food-related bacteria and fungus by using the disk diffusion method. The results demonstrate that the Thymus vulgaris essential oil tested possesses strong antimicrobial properties, and may in the future represent a new source of natural antiseptics with applications in the pharmaceutical and food industry.

In autoimmune conditions affecting the central and peripheral CNS as well as in multiple sclerosis (MS), the inflammatory syndrome is present with the onset of this disease. The present paper aimed to highlight the inflammatory syndrome based on the leukergia test, the total blood viscosity test, blood filterability test as well as on other tests. The early instituting of the therapeutic plasmapheresis beneficially modified the clinical status, the biological and pathophysiological behavior of the patient’s illness. Objective of the paper: The aim was to highlight the importance, advantages, and pathophysiological changes after therapeutic plasmapheresis in five cases, in patients hospitalized with the diagnosis of multiple sclerosis. Material and method: In order to emphasize the inflammatory syndrome, the determination of leukergia assay, the total blood viscosity test and the blood filterability test were added to regular examinations, conducted on the batch of patients included in the study. Results and discussions: As a result of using therapeutic plasmapheresis, the inflammatory parameters in patients with multiple sclerosis improved beneficially as it was proven by the values of inflammatory tests before and after plasmapheresis. Conclusions: In the treatment of multiple sclerosis, plasmapheresis proved to be a medical method that significantly reduced autoimmune inflammatory “installed” syndrome.

Burning mouth syndrome (BMS) is defined as a chronic pain condition characterized by a burning sensation in the clinically healthy oral mucosa. It is difficult to diagnose BMS because there is a discrepancy between the severity, extensive objective pain felt by the patient and the absence of any clinical changes of the oral mucosa. This review presents some aspects of BMS, including its clinical diagnosis, classification, differential diagnosis, general treatment, evolution and prognosis.

The injury of the esophageal epithelium may be determined by the reflux of the gastric acid in the esophagus. Barrett's esophagus (BE) is characterized by the replacement of the normal squamous epithelium with the columnar epithelium, when the healing of the lesion occurs. According to some studies, the incidence of the esophageal adenocarcinoma in patients with BE is of about 0,5% per year. The term Barrett's esophagus is subjected to interpretation nowadays, so it lacks the clarity needed for the clinical and scientific communication on the subject of columnar metaplasia of the esophageal mucosa. The major pathogenetic factor in the development of BE is represented by the reflux disease. The cellular origin of BE is controversial and it represents an issue that needs to be resolved because it will have implications in the putative molecular mechanisms underlying the metaplastic process. The epigenetic or genetic changes, which alter protein expression, function, and/ or activity, in post-mitotic cells to drive transdifferentiation or in stem/ progenitor cells such that they are reprogrammed to differentiate into columnar rather than squamous cells, are driven by the inflammatory environment created by chronic reflux. In order to be able to develop better therapeutic strategies for the patients with this disease, an increasing interest in understanding the pathogenesis of BE at the cellular and molecular level presents these days.