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The Impact of Smoking on Rheumatoid Arthritis Activity
No full textIntroduction: The Rheumatoid arthritis (RA) is a chronic, inflammatory, systemic disease that is usually the most evident and commonly manifested on diarthrosis joints. The initial etiological factors that trigger the immune-inflammatory response still remains unknown. RA is result of the simultaneous influence of genetic risk factors, external factors and changes in immune system.Objective: The goal of this study was to determine the mutual correlation between smoking and RA activities expressed by the quantitative values of laboratory and disease activity parameters.Material and Method: The open clinical retrospective study included 100 RA patients stages from I to IV aged from 21 to 77 ys. There were 85 (85%) females and 15 (15%) males selected by randomization. The study analysed: age, gender, smoking, duration of smoking, sedimentation rate (ESR), rheumatoid factor (RF), C-Reactive Protein (CRP) anti-cyclic citrullinated peptide (anti-CCP) antibodies and X-ray. Statistical analyses was done with SPSS software, Student's t-test and chi-square test.Results: The quantitative values of laboratory parameters are directly related with the smoking period. All inflammatory markers were increased in both groups, but more elevated in smoker's group. The only statistical significance was found in anti-CCP where this test was significantly higher compared to non-smokers. There was no statistical significance in the onset of disease, gender, ESR, CRP, RF, and radiological changes between two groups, although smokers had some more higher values.Conclusion: Smoking plays significant role in RA activity and leads to longer duration of symptoms and increased disability. All inflammatory markers were increased in both groups, but more elevated in smoker's group, with the only significancy in anti-CCP level. The cessation of smoking should be part of disease management proccess
Comparison of Two Biodegradable Polymer Coated, Drug-Eluting Coronary Stents Paclitaxel vs. Sirolimus, with 6-Years Clinical Follow-Up: BIOPRESS (BIOdegradable Polymer REgistry Smt Stents) Infinnium vs. Supralimus
No full textBackground: The safety and efficacy of drug-eluting stents has been shown in randomized trials, but some controversy exists regarding which stent, sirolimus-eluting or paclitaxel-eluting is more effective in unselected real-world patients. Therefore, we investigated, long term safety and efficacy of paclitaxel-eluting stents (PES) compared to sirolimus-eluting stents (SES) when used without restriction in unselected real-world patients.Methods: We created a prospective, open label, non-randomized, multicenter registry and analyzed data on a consecutive series of all patients who presented to our institution with symptomatic coronary artery disease between July-2004 and June-2006 and who were treated with the Infinnium® PES or the Supralimus® SES. All enrolled patients were divided into two groups based on stent type. By outpatient clinic visit and telephone interview, we obtained up to 6-years clinical outcomes including death, myocardial infarction (MI), stent thrombosis (ST), target lesion revascularization (TLR), target vessel revascularization (TVR), and major adverse cardiac events (MACE, the composite of cardiac death, TLR, TVR and ST).Results: In total, 571 patients were treated with either the Infinnium® PES (n=276) or the Supralimus® SES (n=295). Baseline clinical and angiographic characteristics were almost similar in the two groups. The six-year clinical follow-up was completed in 529 patients (92.6%). Total 1.4% in-hospital major adverse cardiac event (MACE) were recorded (1.8% Infinnium® PES vs. 1.0% Supralimus® SES) with 99% procedural success. At 6-years, all-cause death was significantly lower in Supralimus® SES group than in Infinnium® PES group (3.1% vs. 6.9%, p=0.03). The incidence of cardiac death (4.3% vs. 2.7%, p=0.29), TLR (3.6% vs. 3.7%, p=0.95, TVR (4.0% vs. 2.4%, p=0.27) and ST (2.5 vs. 1.0, p=0.17) was more frequent in the Infinnium® PES group compare to Supralimus® SES group, but it did not reach statistical significance.Conclusion: The long-term follow-up of 6-years, demonstrated the safety and efficacy of both Infinnium® PES and Supralimus® SES biodegradable polymer coated drug-eluting stents (Sahajanand Medical Technologies Pvt. Ltd., Surat, India) in real-world practice. Also superiority of Supralimus® SES proved on long term follow-up with complex lesions
Hemostasis Values, Growth and Intercellular Adhesion Factors in Evaluation of the Extent of Tumor Spread in Urinary Bladder Cancer Patients
No full textTo evaluate the extent of tumor spread in urinary bladder cancer patient blood, factors of hemocoagulation, angiogenesis and intercellular adhesion were measured. The study enrolled 555 patients with nonmuscular invasion bladder cancer, 382 with muscular invasion and 110 clinically healthy persons.The concentration of the vascular endothelial growth factor, intercellular adhesion molecules, fibrinogen, D-dimers was found to be significantly higher in the blood of cancer patients than in the control group. The mean level of the investigated hemostasis parameters for invasive and metastatic bladder cancer is significantly higher than that for localized nonmuscular invasion cancer. The data presented can be used by clinicians as an additional criterion for discerning patients with an increased metastatic potential and justification of treatment strategy
Activation of Neurons in the Rat Medulla Following a Gag Reflex Stimulus
No full textDespite the fact that a number of individuals present with a hypersensitive gag reflex, research in this area has been limited to clinical applications. An animal model that describes the neurologic underpinnings of the gag reflex has not been reported. Thus, the objective of the current study was to localize activated neurons in the rat medulla and to investigate their neurochemistry following mechanostimulation to the posterior pharyngeal wall eliciting a gag reflex response. Activated neurons, determined using c-fos immunohistochemistry, were observed in subnuclei of the nucleus tractus solitarius (NTS) and motor regions such as dorsal motor vagus, hypoglossal, and nucleus ambiguus. The lateral and dorsal paragigantocellular nuclei and the medial rostral ventrolateral nucleus involved in bitter taste processing, also showed robust activation. Tyrosine hydroxylase and/or choline acetyltransferase immunoreactivity was localized in many activated neurons. The results of the present study provide the first documentation of activated neurons and preliminary neurochemistry in brainstem nuclei that are unique to mechanostimulation to the posterior pharyngeal wall. Our results support postulated medullary structures involved with the gag reflex and propose new regions to be added to the circuitry model. Further, our results reveal an activation pattern within the NTS unique to the gag reflex
Benefits and shortcomings of cochlear implantation in children: Parental reports from India
No full textObjective: The aim of the study was to understand the rationale for choosing cochlear implantation as a rehabilitation option and the benefits and shortcomings of cochlear implants in children as reported by their parents.  Method: Ninety parents of children with cochlear implants from various parts of India completed open-ended questionnaires. Results: The main reasons for choosing cochlear implantation include: no benefit from hearing aids, the expectation that children would have better hearing and develop age appropriate speech and language. Most of the participants reported benefits of cochlear implantation in a home setting but not in school and other social settings. Most participants reported shortcomings in a home setting but only less than half reported in school and other social settings.  Conclusions: Not all respondents reported benefits and shortcomings in all settings, particularly school and other social settings. This may raise some questions about knowledge of parents about what to expect from their child’s performance with a cochlear implant in different settings
Referential Choice in the Narratives of Italian Speakers with Klinefelter Syndrome
No full textKlinefelter Syndrome (KS) is a genetic disorder characterized by an uneven neuro-linguistic profile. Whereas cognitive abilities appear to be within the normal range, KS patients often show poor linguistic abilities and language-based learning disorders. Although it has been proposed that KS can be considered a genetic model of language impairment, it is not yet well established whether speakers with KS are impaired in specific psycholinguistics aspects, such as reference production. The choice of an adequate referential expression (whether a full noun phrase, a null or overt pronoun, etc.) involves the use of memory mechanisms to represent the characters and actions involved, but also the ability to judge the attention and the knowledge of the hearer.The present work focuses on KS speakers’ ability to report a story based on a Sylvester and Tweety cartoon (Arnold et al., 2009). We examine the ability to choose an appropriate referent (overt pronouns vs. null pronoun vs. full noun phrase) made during a narrative by Italian adolescents and young adults with KS (n = 8) and age-matched typically developing controls. In addition, we administered to each participant a full battery of cognitive and linguistic tests.Overall our results indicate that the correct use of referential expressions did not appear to be significantly predicted by the cognitive level of the speakers. Therefore the ability to choose an appropriate referential expression is preserved in KS whereas receptive vocabulary and comprehension skills are significantly lower as compared to controls
A New Operative Telesurgical System: Telelap Alf-X - Experimental Study on Animal Model
No full textObjective: To report the first surgical thoracic major procedure performed using a new robotic telesurgical device (TELE-LAP ALF-X) in the ovine model.Materials: The new operative-system has two innovative peculiarities: tactile perception (similar to tactile feedback of thoracoscopy) and eye tracking (the immediate and perfect synchronization between the surgeon eyes and the Robot-camera).Results: After a careful setting of the robotic device, we have performed a lower-right lobectomy under complete robotic-assistance. The operative time was similar to the traditional thoracoscopy. In particular after the resection of inferior pulmonary ligament, we have isolated and closed firstly the lower pulmonary vein, then the bronchus followed by the arterial branches. The vascular and bronchial resections as well as the completion of the fissure were performed with standard endoscopic staplers introduced through an utility 4cm-sized incision. The specimen was placed in an endoscopic retrieval-bag and removed through the minithoracotomy. Finally, albeit the limitations due to different anatomical landmarks, a mediastinal lymph nodal dissection was also completed. Overall operation time was 180 minutes (with estimated blood loss of 100ml). The cooperation between the “first-operator†(placed at computer-console) and the “second-operator†(placed at the surgical-theatre) was optimal and no technical difficulties occurred.Conclusions: According to this first experimental experience, we may assume that robotic thoracic procedures, using Tele-Lap Alf-X system, could be technical feasible in the ovine model. Although more “in vivo†experimental data are needed, we believe that robot-assisted telesurgery approach could be reasonable an innovative contribution in the near future also in human model
Constitutional Delay of Growth and Puberty: the Patient’s Perspective
No full textIntroduction: Constitutional delay of growth and puberty (CDGP) is a common cause of psychosocial upset among adolescents and their families. Concerns about reduced final height often urge patients to ask for urgent treatment rather than to wait for observation.Aim: The main objective is to evaluate the concerns, knowledge, understanding, and expectations of a group of children with CDGP and their families. Secondary objective is to study the auxological and socioeconomic characteristics of the patients.Patients and Methods: Forty nine patients with CDGP were included. Fifteen were followed for two years, and seven until final height. Patients and parents completed a designed question sheet to identify their concerns, knowledge, expectations from treatment, and willingness to follow up for observation. Socioeconomic standard scoring and anthropometric evaluation were performed.Results: 59.2% presented because of the concern of the whole family. There was a delay of 1.8 years between the time when patients were concerned about short stature and/or delayed puberty and presentation to clinic The delay was greatest in patients who stopped following up. Twenty seven patients (55.1%) were of low socioeconomic background, 17 (34.7%) were medium low, and 5 (10.2%) were medium high. 69.4% of patients were concerned about their height, not puberty. Two thirds were not convinced that shortness was not due to growth hormone deficiency and that treatment if needed would be sex hormones. 69.4% were not convinced to follow up without treatment.Conclusion: Short stature rather than late puberty is usually the reason for consultation in CDGP. Incomplete understanding of the condition among families and dissatisfaction with the treatment options available remains a problem even after detailed explanation. Extra effort is needed to raise the awareness and avoid the adverse psychosocial sequels in patients with CDGP
Oral Ciclopsorin in Steroid Refractory, Acute, Severe Ulcerative Colitis
No full textPatients with curatively resected gastric cancer patients with positive peritoneal wash cytology are called P0/Cy1 status. The aim of the present study is to verify the survival benefit of the comprehensive treatment for patients with P0/Cy1 status.Twenty gastric cancer patients were diagnosed as P0/Cy1 by laparoscopy or laparotomy, and were treated with a comprehensive treatment consisting of neoadjuvant intraperitoneal/systemic chemotherapy (NIPS), cytoreductive surgery (CRS) consisting of gastrectomy with lymph node dissection and peritonectomy, intraoperative hyperthermic intraperitoneal chemotherapy (HIPEC) and postoperative systemic chemotherapy. At the second look laparotomy, the peritoneal wash cytology became negative in 15 patients. No grade 3, 4, 5 complications were experienced after second look operations for CRS. Median follow-up time is 3.7 years. Eight patients died of recurrence, but the other 21 patients are alive without recurrence. Five-year survival rate was 42%.The present study demonstrated the efficacy and safety of the comprehensive treatment on the gastric cancer patients in P0/Cy1 status. Â
Software Engineering Applications in Gastroenterology
No full textSoftware engineering enables the construction of reliable services, which in the field of medicine can be regarded as crucial components of today’s clinical practice. This paper focuses on software engineering applications in the field of gastroenterology and presents the state of the art in this field as well as challenges for future research. It reviews a broad spectrum of applications with emphasis on endoscopic imaging. The advances in the latter are dominant, with hundreds of scientific contributions in the last quinquennium to be driven mainly by the technological revolution of wireless capsule endoscopy (WCE). However, there is still a long way for research before resolving the related open issues in practice