Evaluating the benefits of machine learning for diagnosing deep vein thrombosis compared to gold standard ultrasound- a feasibility study.

BACKGROUND: This study evaluates the feasibility of remote deep venous thrombosis (DVT) diagnosis via ultrasound sequences facilitated by ThinkSono Guidance, an artificial intelligence (AI)-app, for point-of-care ultrasound (POCUS). AIM: The aim is to assess the effectiveness of AI-guided POCUS conducted by non-specialists in capturing valid ultrasound images for remote diagnosis of DVT. DESIGN & SETTING: Over a 3.5-month period, patients with suspected DVT underwent AI-guided POCUS conducted by non-specialists using a handheld ultrasound probe connected to the app. These ultrasound sequences were uploaded to a cloud-dashboard for remote specialist review. Additionally, participants received a formal DVT scans. METHOD: Patients underwent AI-guided POCUS using handheld probes connected to the AI-app, followed by formal DVT scans. Ultrasound sequences acquired during the AI-guided scan were uploaded to a cloud-dashboard for remote specialist review, where image quality was assessed, and diagnoses were provided. RESULTS: Among 91 predominantly elderly female participants, 18% of scans were incomplete. Of the rest, 91% had sufficient quality, with 64% categorised by remote clinicians as "compressible" or "incompressible." Sensitivity and specificity for adequately imaged scans were 100% and 91%, respectively. Notably, 53% were low risk, potentially obviating formal scans. CONCLUSION: ThinkSono Guidance effectively directed non-specialists, streamlining DVT diagnosis and treatment. It may reduce the need for formal scans, particularly with negative findings, and extend diagnostic capabilities to primary care. The study highlights AI-assisted POCUS potential in improving DVT assessment.

Doppler ultrasound surveillance of recently formed haemodialysis arteriovenous fistula: the SONAR observational cohort study.

Background: Arteriovenous fistulas are considered the best option for haemodialysis provision, but as many as 30% fail to mature or suffer early failure. Objective: To assess the feasibility of performing a randomised controlled trial that examines whether, by informing early and effective salvage intervention of fistulas that would otherwise fail, Doppler ultrasound surveillance of developing arteriovenous fistulas improves longer-term arteriovenous fistula patency. Design: A prospective multicentre observational cohort study (the 'SONAR' study). Setting: Seventeen haemodialysis centres in the UK. Participants: Consenting adults with end-stage renal disease who were scheduled to have an arteriovenous fistula created. Intervention: Participants underwent Doppler ultrasound surveillance of their arteriovenous fistulas at 2, 4, 6 and 10 weeks after creation, with clinical teams blinded to the ultrasound surveillance findings. Main outcome measures: Fistula maturation at week 10 defined according to ultrasound surveillance parameters of representative venous diameter and blood flow (wrist arteriovenous fistulas: ≥ 4 mm and > 400 ml/minute; elbow arteriovenous fistulas: ≥ 5 mm and > 500 ml/minute). Mixed multivariable logistic regression modelling of the early ultrasound scan data was used to predict arteriovenous fistula non-maturation by 10 weeks and fistula failure at 6 months. Results: A total of 333 arteriovenous fistulas were created during the study window (47.7% wrist, 52.3% elbow). By 2 weeks, 37 (11.1%) arteriovenous fistulas had failed (thrombosed), but by 10 weeks, 219 of 333 (65.8%) of created arteriovenous fistulas had reached maturity (60.4% wrist, 67.2% elbow). Persistently lower flow rates and venous diameters were observed in those fistulas that did not mature. Models for arteriovenous fistulas' non-maturation could be optimally constructed using the week 4 scan data, with fistula venous diameter and flow rate the most significant variables in explaining wrist fistula maturity failure (positive predictive value 60.6%, 95% confidence interval 43.9% to 77.3%), whereas resistance index and flow rate were most significant for elbow arteriovenous fistulas (positive predictive value 66.7%, 95% confidence interval 48.9% to 84.4%). In contrast to non-maturation, both models predicted fistula maturation much more reliably [negative predictive values of 95.4% (95% confidence interval 91.0% to 99.8%) and 95.6% (95% confidence interval 91.8% to 99.4%) for wrist and elbow, respectively]. Additional follow-up and modelling on a subset (n = 192) of the original SONAR cohort (the SONAR-12M study) revealed the rates of primary, assisted primary and secondary patency arteriovenous fistulas at 6 months were 76.5, 80.7 and 83.3, respectively. Fistula vein size, flow rate and resistance index could identify primary patency failure at 6 months, with similar predictive power as for 10-week arteriovenous fistula maturity failure, but with wide confidence intervals for wrist (positive predictive value 72.7%, 95% confidence interval 46.4% to 99.0%) and elbow (positive predictive value 57.1%, 95% confidence interval 20.5% to 93.8%). These models, moreover, performed poorly at identifying assisted primary and secondary patency failure, likely because a subset of those arteriovenous fistulas identified on ultrasound surveillance as at risk underwent subsequent successful salvage intervention without recourse to early ultrasound data. Conclusions: Although early ultrasound can predict fistula maturation and longer-term patency very effectively, it was only moderately good at identifying those fistulas likely to remain immature or to fail within 6 months. Allied to the better- than-expected fistula patency rates achieved (that are further improved by successful salvage), we estimate that a randomised controlled trial comparing early ultrasound-guided intervention against standard care would require at least 1300 fistulas and would achieve only minimal patient benefit. Trial Registration: This trial is registered as ISRCTN36033877 and ISRCTN17399438. Funding: This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: NIHR135572) and is published in full in Health Technology Assessment; Vol. 28, No. 24. See the NIHR Funding and Awards website for further award information.

For people with advanced kidney disease, haemodialysis is best provided by an 'arteriovenous fistula', which is created surgically by joining a vein onto an artery at the wrist or elbow. However, these take about 2 months to develop fully ('mature'), and as many as 3 out of 10 fail to do so. We asked whether we could use early ultrasound scanning of the fistula to identify those that are unlikely to mature. This would allow us to decide whether it would be practical to run a large, randomised trial to find out if using early ultrasound allows us to 'rescue' fistulas that would otherwise fail. We invited adults to undergo serial ultrasound scanning of their fistula in the first few weeks after it was created. We then analysed whether we could use the data from the early scans to identify those fistulas that were not going to mature by week 10. Of the 333 fistulas that were created, about two-thirds reached maturity by week 10. We found that an ultrasound scan 4 weeks after fistula creation could reliably identify those fistulas that were going to mature. However, of those fistulas predicted to fail, about one-third did eventually mature without further intervention, and even without knowing what the early scans showed, another third were successfully rescued by surgery or X-ray-guided treatment at a later stage. Performing an early ultrasound scan on a fistula can provide reassurance that it will mature and deliver trouble-free dialysis. However, because scans are poor at identifying fistulas that are unlikely to mature, we would not recommend their use to justify early surgery or X-ray-guided treatment in the expectation that this will improve outcomes.

Real-world evidence on the effectiveness and safety of gliclazide MR 60 mg in Bangladeshi patients with Type II diabetes during fasting: a sub-analysis from the global DIA-RAMADAN study.

Aim: Many Muslims with Type II diabetes (T2DM) fast during Ramadan, which can put them at increased risk of hypoglycemia. This sub-analysis of the global DIA-RAMADAN study assessed the effectiveness and safety of gliclazide modified release (MR) 60 mg in the Bangladeshi cohort. Materials & methods: DIA-RAMADAN was an international, prospective, observational study conducted in adult T2DM patients intending to fast and receiving gliclazide MR 60 mg once daily for ≥90 days before Ramadan. Dosing was switched from morning to evening at the start of Ramadan. The primary outcome was the proportion of patients with ≥1 symptomatic hypoglycemic event. Secondary outcomes included changes between inclusion (V0) and end of study visit (V1) in glycated hemoglobin (HbA1c), body weight and fasting plasma glucose (FPG). Results: Among the 98 Bangladeshi patients, 80 (81.6%) were at moderate/low-risk (category 3) for fasting and 18 (18.4%) were high-risk (category 2), as per International Diabetes Federation and Diabetes and Ramadan International Alliance (IDF-DAR) guidelines. Gliclazide MR was being prescribed as monotherapy to 59 (60.2%) patients and in combination with metformin to 39 (39.8%). There was no incidence of severe hypoglycemic events. Mean (±SD) HbA1c change from V0 was -0.1 ± 0.8% (p = 0.159). Mean (±SD) changes in FPG and body weight were -0.8 ± 39.7 mg/dl (p = 0.876) and -0.0 ± 1.5 kg (p = 0.810), respectively. Conclusion: In a real-world setting, this sub-analysis in Bangladeshi patients shows that patients with T2DM treated with gliclazide MR 60 mg can fast safely during Ramadan with a very low risk of hypoglycemia, while maintaining glycemic control and body weight.

Inter-observer Variability in the Analysis of CO-RADS Classification for COVID-19 Patients.

During the early stages of the pandemic, computed tomography (CT) of the chest, along with serological and clinical data, was frequently utilized in diagnosing COVID-19, particularly in regions facing challenges such as shortages of PCR kits. In these circumstances, CT scans played a crucial role in diagnosing COVID-19 and guiding patient management. The COVID-19 Reporting and Data System (CO-RADS) was established as a standardized reporting system for cases of COVID-19 pneumonia. Its implementation necessitates a high level of agreement among observers to prevent any potential confusion. This study aimed to assess the inter-observer agreement between physicians from different specialties with variable levels of experience in their CO-RADS scoring of CT chests for confirmed COVID-19 patients, and to assess the feasibility of applying this reporting system to those having little experience with it. All chest CT images of patients with positive RT-PCR tests for COVID-19 were retrospectively reviewed by seven observers. The observers were divided into three groups according to their type of specialty (three radiologists, three house officers, and one pulmonologist). The observers assessed each image and categorized the patients into five CO-RADS groups. A total of 630 participants were included in this study. The inter-observer agreement was almost perfect among the radiologists, substantial among a pulmonologist and the house officers, and moderate-to-substantial among the radiologists, the pulmonologist, and the house officers. There was substantial to almost perfect inter-observer agreement when reporting using the CO-RADS among observers with different experience levels. Although the inter-observer variability among the radiologists was high, it decreased compared to the pulmonologist and house officers. Radiologists, house officers, and pulmonologists applying the CO-RADS can accurately and promptly identify typical CT imaging features of lung involvement in COVID-19.

Effects of herbal supplements on milk production quality and specific blood parameters in heat-stressed early lactating cows.

The present study explored the influence of supplemental herbal mixtures on cow milk production, quality, and blood parameters in dairy cows under high ambient temperatures. Thirty Holstein cows were randomly assigned into three experimental groups of 10 each. The first control group was supplied with the commercial basal diet, whereas two treatment groups were provided with the commercial basal diet supplemented with 50 and 100 g/head/day of the herbal mixture, respectively. The results showed that the mixture of herbal supplementation did not influence weekly milk production. Milk total fat, triglyceride, and total protein values were not affected (p < 0.05) in cows fed on basal diets supplemented with herbal mixture; however, milk cholesterol was decreased significantly by 100 mg/head/day of the herbal mixture. On the other hand, lactose has increased significantly by adding 100 mg/head/day of herbal mixture. Furthermore, the total cholesterol level in serum was decreased by adding 100 mg/head/day of the herbal mixture, while plasma prolactin, cortisol, GOT, and GPT were unaffected. Regarding fatty acids (C18, C18:1 (c9), 18:1 (c11), 18:2 (c9, c12), 18:2 (t9, t12), and CLA (c9, t11)), there was no significant variation between the groups. Meanwhile, both C19:00 and 18:3 (c6, c9, and c12) were noticeably higher (p < 0.05) in the group that received 100gm, followed by 50 mg, compared to the control. In conclusion, the supplement with a herbal mixture positively affected milk quality by decreasing total cholesterol and increasing lactose, milk fatty acid profile by increasing unsaturated fatty acids content, and plasma cholesterol levels.

Laparoscopic antireflux surgery for refractory gastroesophageal reflux disease: long-term clinical outcomes.

Persistent symptoms despite adequate Proton Pump Inhibitors (PPI) treatment are described in up to 40% of patients with Gastroesophageal Reflux Disease (GERD). The efficacy of Laparoscopic Antireflux Surgery (LARS) in PPI non-responder patients is still unclear. This observational study aims to report the long-term clinical outcomes and predictors of dissatisfaction in a cohort of refractory GERD patients submitted to LARS. Patients with preoperative refractory symptoms and objective GERD evidence submitted to LARS between 2008 and 2016 were included in the study. Primary endpoint was overall satisfaction with the procedure, secondary endpoints were long-term GERD symptom relief and endoscopic findings. Univariate and multivariate analyses were performed to compare satisfied and dissatisfied patients, in order to identify preoperative predictors of dissatisfaction. A total of 73 refractory GERD patients who underwent LARS were included in the study. At a mean follow-up of 91.2 ± 30.5 months, the satisfaction rate was 86.3%, with a statistically significant reduction in typical and atypical GERD symptoms. Causes of dissatisfaction were severe heartburn (6.8%), gas bloat syndrome (2.8%), and persistent dysphagia (4.1%). Multivariate analysis showed that a number of Total Distal Reflux Episodes (TDRE) > 75 was a predictive factor of long-term dissatisfaction after LARS while a partial response to PPI was a protective factor against dissatisfaction. LARS guarantees a high level of long-term satisfaction for selected refractory GERD patients. An abnormal TDRE at 24 h-multichannel intraluminal impedance-pH monitoring and the lack of response to preoperative PPI were predictors of long-term dissatisfaction.

One Year Clinical Evaluation of White Spot Lesions with Newly Introduced Resin Modified Glass-Ionomer in Comparison to Resin Infiltration in Anterior Teeth: a split mouth randomized controlled clinical trial from Egypt / Avaliação clínica de um ano de lesões de mancha branca com iônomo de vidro modificado por resina recentemente introduzido em comparação à infiltração de resina em dentes anteriores: um ensaio clínico controlado randomizado de boca dividida do Egito

Objective: to compare the clinical performance of newly introduced resin modified glass ionomer varnish (Clinpro™ XT) versus resin infiltration in treatment of post-orthodontic white spot lesions. Material and Methods: Six participants (70 teeth) were enrolled with post-orthodontic white spot lesions. Randomization was performed according to patient selection for the sealed envelope containing which half will receive the control (resin infiltration (ICON, DMG) and the other will receive the intervention (resin modified glass-ionomer cement varnish (Clinpro™ XT, 3M)). Follow up was done after 1 day, 1 week, 1 month, and 3 months, 6 months and 12 months. The color was assessed by spectrophotometer while the degree of demineralization was measured by Diagnodent pen 2910. Patient satisfaction was assessed using (VAS) Visual analogue scale Results:Regarding color change, significant improvement in lightness for ICON group, while Clinpro™ XT group, the change was insignificant. The demineralization data revealed significant decrease in demineralization with resin infiltration after immediate application. Clinpro™ XT showed also significant decrease after immediate assessment and significant increase in demineralization in 6 and 12 months. Conclusion: Resin infiltration can be considered more as an alternative treatment rather than fluoride varnish. Clinpro™ XTis considered as a preventive protocol, provided that renewal application is needed after 3 months (AU)

Objetivo: comparar o desempenho clínico do recém-introduzido verniz de ionômero de vidro modificado por resina (Clinpro ™ XT) com a infiltração de resina no tratamento de lesões de manchas brancas pós-ortodônticas. Material e Métodos: Seis participantes (70 dentes) foram inscritos com lesões pós-ortodônticas de manchas brancas. A randomização foi realizada de acordo com a seleção do paciente para o envelope lacrado contendo qual metade receberá o controle (infiltração de resina (ICON, DMG) e a outra metade receberá a intervenção (verniz de cimento de ionômero de vidro modificado por resina (Clinpro ™ XT, 3M)). O acompanhamento foi feito após 1 dia, 1 semana, 1 mês e 3 meses, 6 meses e 12 meses. A cor foi avaliada por espectrofotômetro, enquanto o grau de desmineralização foi medido pela caneta Diagnodent 2910. A satisfação do paciente foi avaliada usando (VAS) Escala visual analógica. Resultados: Em relação à mudança de cor, houve uma melhora significativa na luminosidade para o grupo ICON, enquanto o grupo Clinpro ™ XT, a mudança foi insignificante. Os dados de desmineralização revelaram diminuição significativa da desmineralização com infiltração de resina após a aplicação imediata. O grupo Clinpro ™ XT também mostrou diminuição significativa após avaliação imediata e aumento significativo na desmineralização em 6 e 12 meses. Conclusão: A infiltração de resina pode ser considerada mais como uma alternativa de tratamento do que o verniz fluoretado. O Clinpro ™ XT é considerado um protocolo preventivo, uma vez que a renovação é necessária após 3 meses. (AU)

Clinical Outcome of Treatment of Diaphyseal Fractures of Humerus Treated by Titanium Elastic Nails in Adult Age Group.

INTRODUCTION: Humerus shaft fracture is one of the most common injuries to the musculoskeletal system, which are managed both conservatively and surgically. There are pitfalls, advantages and disadvantages in each method. The individual fracture analysis determines the therapeutic options. AIM: To assess the clinical outcome of treatment of diaphyseal fractures of humerus treated by Titanium elastic nail in adult age group by DASH scoring. MATERIALS AND METHODS: It was a prospective study of 20 cases of diaphyseal fracture of humerus admitted to Era's Lucknow Medical College and Hospital between October 2014 and September 2015 treated with close reduction and internal fixation with titanium elastic nail. Functional outcome was evaluated using DASH scoring system and radiological outcome was evaluated by serial radiographs. The data was processed with SPSS software version 16.0 (Chicago, inc. USA) and it was summarized in proportion and percentage. RESULTS: In our series of 20 patients, 17 were males and three were females. Most of the patients were between 30-50 years of age (mean 38 years). Most common mode of injury, side of involvement, level of fracture and fracture type were road traffic accidents (60%), right side (53.3%) and mid one third (75%), transverse (60%) respectively. So, in 65% of the patients, there was no disability of arm shoulder and hand as DASH score was within normal range and in 15% of the patients the disability was mild to moderate as scoring was slightly higher than normal and in 20% the disability was severe as the DASH score could not be calculated because of non union. CONCLUSION: Elastic nail fixation require very minimal soft tissue dissection and being a close reduction, the biology of the fracture is also not disturbed and the chances of nerve injury are much less and as the non union was seen in oblique and spiral fracture type hence it should be used with caution or else other alternative methods of fixation should be used.

[The nursing role in field amputation]. / Rôle infirmier dans l'amputation de dégagement.

Field amputation is a surgical procedure which consists in removing one or several limbs of a victim to extricate them from rubble and evacuate them to a hospital. A last resort, it is a rarely-performed procedure, carried out primarily in disaster medicine. A team which worked in Haiti after the 2010 earthquake reports on one such clinical situation.

Cytotoxic activity and phytochemical analysis of Arum palaestinum Boiss

Objective: To evaluate the in vitro cytotoxic activity of the fractionated extract as well as isolated compounds of Arum palaestinum Boiss. ( A. palaestinum) (black calla lily), and to identify the volatile components which may be responsible for the potential antitumor activity. Methods: A. palaestinum was collected from its natural habitats and subjected to phytochemical analysis for separation of pure compounds. In vitro cytotoxic activity was investigated against four human carcinoma cell lines Hep2, HeLa, HepG2 and MCF7 for the fractionated extract and isolated compounds. While, the diethyl ether fraction was subjected to GC-MS analysis as it exhibited the most potent cytotoxic effect to evaluate the active constituents responsible for the cytotoxic activities. Results: Four flavonoid compounds were isolated (luteolin, chrysoeriol, isoorientin, isovitexin) from the diethyl ether and ethyl acetate. The extracts and the pure isolated compounds showed a significant high antiproliferative activity against all investigated cell lines. The GC-MS analysis revealed the separation and identification of 15 compounds representing 95.01% of the extract and belonging to different groups of chemical compounds. Conclusions: The present study is considered to be the first report on the cytotoxic activities carried out on different selected fractions and pure compounds of A. palaestinum to provide evidences for its strong antitumor activities. In addition, chrysoeriol and isovitexin compounds were isolated for the first time from the studied taxa.

A new antioxidant stilbene and other constituents from the stem bark of Morus nigra L.

A new stilbene, 2',3,4',5,5'-pentahydroxy-cis-stilbene (1), along with 13 known compounds, resveratrol (2), oxyresveratrol (3), norartocarpetin (4), kuwanon C (5), morusin (6), cudraflavone A (7), kuwanon G (8), albafurane C (9), mulberrofuran G (10), 3-O-acetyl-α-amyrin (11), 3-O-acetyl-ß-amyrin (12) ursolic acid-3-O-acetate (13) and uvaol (14), were isolated from the barks of Morus nigra. Compounds 2, 8, 10, 12 and 14 are reported for the first time from this plant. The isolated compounds were elucidated by means of 1D and 2D NMR, UV, IR and MS, as well as by comparison with the literature data. The isolated compounds and the different extracts were evaluated for their potential antioxidant activity using 2,2'-azino-bis-(3-ethylbenzthiazoline-6-sulfonic acid)(+) radical-scavenging capacity assay and compared with ascorbic acid. The new stilbene (1) exhibited remarkable antioxidant capacity with IC50 of 4.69 µM.

Effects of a novel curcumin derivative on insulin synthesis and secretion in streptozotocin-treated rat pancreatic islets in vitro.

BACKGROUND: Hyperglycemia induces activation of the c-Jun N-terminal kinase (JNK) pathway, which suppresses insulin gene expression and reduces DNA binding of pancreatic and duodenal homeobox factor (PDX)-1. This study aims to investigate the effects of a novel curcumin derivative (NCD) on JNK signaling pathway on insulin synthesis and secretion in streptozotocin (STZ)-treated rat pancreatic islets in vitro. METHODS: Isolated rat pancreatic islets were divided into five groups: untreated control group; group treated with NCD (10 µM); group exposed to STZ (5 mM); group treated with NCD (10 µM) and then exposed to STZ (5 mM); and group exposed to STZ (5 mM) and then treated with NCD (10 µM). The pancreatic islets from all groups were used for DNA fragmentation assays and quantitative assessments of the JNK, Pdx1, glucose transporter-2 (GLUT2), heme oxygenase (HO)-1, transcription factor 7-like 2 (TCF7L2), and glucagon-like peptide (GLP)-1 gene expression levels. The intracellular calcium, zinc, and the phosphorylated and total JNK protein levels were assessed. The insulin (secreted/total) and C-peptide levels were examined in islet culture medium. RESULTS: NCD protected pancreatic islets against STZ-induced DNA damage, improved total insulin (P = 0.001), secreted insulin (P = 0.001), and C-peptide levels (P = 0.001), normalized mRNA expressions of insulin, Pdx1, and GLUT2 (P = 0.0001), and significantly elevated calcium and zinc levels (P = 0.0001). All effects were significant when islets were treated with NCD before STZ (P = 0.05). JNK gene overexpression and JNK protein levels induced by STZ were significantly inhibited after NCD treatment of islets ( P = 0.0001). NCD-treated islets showed significantly elevated gene expressions of HO-1, TCF7L2, and GLP-1 (P = 0.0001), and these upregulated gene expressions were more significantly elevated with NCD treatment before STZ than after STZ (P = 0.05). CONCLUSIONS: NCD improved insulin synthesis and secretion in vitro in isolated pancreatic islets treated with STZ through inhibition of the JNK pathway, up-regulation of the gene expressions of HO-1, TCF7L2, and GLP-1 and enhancing effects on calcium and zinc levels.

The effects of supercritical carbon dioxide processing on progesterone dispersion systems: a multivariate study.

The aim of this work was to investigate the effects of supercritical carbon dioxide (SC-CO(2)) processing on the release profiles of progesterone (PGN) and Gelucire 44/14 dispersion systems. A fractional factorial design was conducted for optimization of the particles from gas-saturated suspension (PGSS) method and formulation parameters and evaluating the effects of three independent responses: PGSS process yield, in vitro dissolution extent after 20 min (E(20)) and t (1/2) for prepared PGN dispersion systems. The experimental domain included seven factors measured at two levels to determine which factors represent the greatest amount of variation, hence the most influence on the resulting PGN dispersion systems. Variables tested were temperature (A) and pressure (B) of the supercritical fluid, sample loading (C), SC-CO(2) processing time (D), sonication (E), drug-to-excipient ratio (F) and orifice diameter into the expansion chamber (G). The analysis of variance showed that the factors tested had significant effects on the responses (p value <0.05). It was found that the optimum values of the PGSS process are higher pressure (186 bar), higher temperature (60°C), a longer processing time (30 min) and lower PGN-to-excipient ratio of 1:10. The corresponding processing yield was 94.7%, extent of PGN dissolution after 20 min was 85.6% and the t (1/2) was 17.7 min. The results suggest that Gelucire 44/14-based dispersion systems might represent a promising formulation for delivery of PGN. The preparation of PGN-loaded Gelucire 44/14 dispersion systems from a PGSS method can be optimized by factorial design experimentation.

A case of cellulitis of the hands caused by a predatory bird attack

Many species have been drastically affected by rapid urbanization. Harris's hawks from their natural habitat of open spaces and a supply of rodents, lizards and other small prey have been forced to change their natural environment adapting to living in open spaces in sub- and peri-urban areas. Specific areas include playgrounds, parks and school courtyards. The migration of this predatory species into these areas poses a risk to individuals, and especially the children are often attacked by claws, talons and beaks intentionally or as collateral damage while attacking rodent prey. In addition, the diverse micro-organisms harbored in the beaks and talons can result in wound infections, presenting a challenge to clinical management. Here we would like to present a case of an 80-year-old man with cellulitis of both hands after sustaining minor injuries from the talons of a Harris's hawk and review the management options. We would also like to draw attention to the matter that, even though previously a rarity, more cases of injuries caused by birds of prey may be seen in hospital settings.

Scientific overview of the CSCI-CITAC 2009 conference.

From September 21st-23rd 2009, the Clinical Investigator Trainee Association of Canada - Association des cliniciens-chercheurs en formation du Canada (CITAC-ACCFC) and the Canadian Society for Clinician Investigators (CSCI), held their annual conference in Ottawa. Participants included clinician investigators and trainees from across the country. The conference featured many excellent guest speakers including this year's recipient of the Henry G. Friesen International Prize in Health Research, Sir John Bell. There were several forums focusing on professional development, with topics such as "sustaining the clinician investigator in Canada", "succeeding as a clinician investigator", and "collaborating internationally with MD+ trainees", alongside networking opportunities to help establish relationships with potential mentors and collaborators. Further, the CSCI-CITAC annual conference featured some of the cutting edge research that MD+ trainees throughout Canada are engaged in. Trainees presented their research either at the Young Investigators Forum poster session or at the oral plenary. This scientific overview aims to highlight some of the research presented by trainees at the annual conference. The broad themes of scientific interest included topics from both basic science and clinical research. In this article, we summarize some of the major research questions that are being investigated by clinician-investigator trainees in the following areas: neurological sciences, cell biology, medicine, immunology, obstetrics, gynecology, neonatology, orthopedics, rheumatology, and public health.

Serotonin syndrome in the perioperative period.

Herein, we report a patient treated preoperatively with multiple psychiatric medications who developed serotonin syndrome (SS) during the perioperative period. SS was diagnosed using the Hunter Criteria (use of multiple serotonergic drugs preoperatively, hypertonia, and spontaneous clonus) and was presumed to have been triggered by the combination of perioperative and intraoperative serotonergic medications. It is essential that perioperative physicians, especially anesthesiologists, understand the risk factors, clinical scenario, and treatment of SS.

Human papillomavirus type 18 variants: histopathology and E6/E7 polymorphisms in three countries.

In cervical cancer, human papillomavirus type 18 (HPV 18) and HPV 16 are predominantly related to adenocarcinomas (ADCs) and squamous cell carcinomas (SCCs), respectively. Here, we studied whether the geographically distributed HPV intratypic variants are also associated with histologically different tumors. A total of 44 HPV 18-positive and 91 HPV 16-positive cervical carcinomas from Indonesian, Surinamese and Dutch patients were histologically classified using hematoxilin and eosin, periodic acid Schiff plus and Alcian Blue staining. Samples were sequenced and intratypic variants were classified into the known phylogenetic branches. The Asian Amerindian HPV 18 variant was observed in 56% of ADCs compared to 15% of SCCs (p < 0.006). The African HPV 18 variant was exclusively found in SCCs. By sequencing the HPV 18 E6 and E7 open reading frames, we found predicted amino acid changes only in 8 samples. Two amino acid changes were consistent throughout the African branch. In HPV 16-positive tumors, we did not find a specific linkage between intratypic variants and histopathology. We conclude that HPV 18 intratypic variants are differentially associated with adenocarcinoma and squamous cell carcinoma of the cervix. The findings described here stress the biologic significance of intratypic HPV variants and might help explaining differences in the pathogenesis of cervical ADCs and SCCs.

Human papillomavirus type 16 E6, E7, and L1 variants in cervical cancer in Indonesia, Suriname, and The Netherlands.

OBJECTIVE: Human papillomavirus type 16 (HPV 16) has several intratypic variants, and some are associated with enhanced oncogenic potential. For risk determination as well as for future vaccine development, knowledge about variants is important. Regarding the geographical distribution of HPV variants and the lack of data from Indonesia and Suriname, we studied the prevalence of HPV 16 variants in cervical cancer in these high incidence countries. Data were compared with The Netherlands, a low-risk country. METHODS: DNA samples from 74 formalin-fixed paraffin-embedded HPV 16-positive cervical carcinomas from Indonesia (Java, N = 22), Suriname (N = 25), and The Netherlands (N = 27) were amplified using primers specific for the E6, E7, and part of the L1 regions. Products were sequenced and analyzed. RESULTS: A specific Javanese variant, with mutations 666A in E7 and 6826T in L1, was found in 73% of the Indonesian samples, 56% having an additional mutation in the E6 open reading frame (ORF; 276G), giving the predicted amino acid change N58S. This Javanese variant was also found in three Surinamese samples, which reflects what could be expected from migration of Javanese people to Surinam. Other non-European variants were identified in Indonesian, Surinamese, and Dutch samples in 14%, 28%, and 19%, respectively. CONCLUSION: The majority of the HPV 16-positive cervical cancers in Indonesia are caused by a specific intratypic variant that was rarely found before in other countries.