Short Communication

The effects of alcohol taxation and pricing policies on vodka sales in Russia

Razvodovsky YE

Background: The majority of aggregate econometric studies indicate that higher taxes and real prices on alcohol significantly reduce the alcohol consumption.

Objectives: To estimate the effects of recent alcohol taxation and pricing policies on vodka sales per capita in Russia.

Methods: Trends in the affordability of vodka, excise tax rates on vodka, real and minimum price of vodka and per capita vodka sales between 2010 and 2015, were compared.

Results: A Pearson’s correlation analysis suggests a positive and statistically significant association between the affordability of vodka and per capita vodka sales. The association between vodka sales and excise tax rates on vodka, the real price of vodka and minimum price of vodka was negative.

Conclusions: These findings indicate that pricing policy has potential to reduce binge drinking of vodka in Russia.

Review Article

Nano-formulations for Ophthalmic Treatments

Mahima John and Rajesh N Gacche*

Ocular disorders encompass a multitude of diseases that are unique in their cause, therapy and degree of severity. Due to distinctive morphology of the eye, efficient ocular drug delivery has proven to be a difficult task. Current treatments of ophthalmological diseases include the usage of both intrusive as well as nonintrusive methods such as injections, eye drops, ointments, gels etc. The current state of the art drug delivery methods are associated with low bioavailability and therefore nanotechnology based drug delivery approached are evolving as for improving the therapeutic index of currently used drugs against variety of ocular disorders. This review highlights the recent developments in nano-formulations for ophthalmic treatment and also offers discussions towards the future prospectus of nano-formulations in the mainstream of ophthalmic diseases.

Case Report

Brachial Plexus Schwannoma: Report of 4 cases with Intralesional Enucleation

Jennette SY Chan* and Josephine WY Ip

Brachial plexus tumours are rare. It comprises of only 5% of all tumours of upper limb [1]. The two most common brachial plexus region tumors are schwannomas and neurofibromas [2 4].Both are benign and arise from the nerve sheath. XiaotianJia et al., published a large case series of 143 patients with primary brachial plexus tumors in 2016. In his series, there are 119 schwannoma and 12 neurofibromas [3]. Schwannomas are most frequently found in the head and neck region, which comprises 25% of all Schwannomas. There are only about 5% of schwannomas present as brachial plexus tumours [5].

The most common clinical presentation of primary brachial plexus tumor includes palpable mass, pain, numbness or paresthesias, weakness etc. [3-6], Brachial plexus schwannoma can present as neck mass, axillary mass, supraclavicular mass or apical lung mass [7-10]. On CT, most schwannomas are iso-dense relative to brain parenchyma. Calcification or areas of hemorrhage are rare and the enhancement pattern is typically homogeneous. On MRI, schwannomas are iso-intense to hypo-intense on T1-weighted MRI and enhance with gadolinium [11,12]. Malignant transformation of schwannoma is very rare, but it has been reported in literature [13]. Outcome of surgical removal of brachial plexus schwannoma has been reported to be satisfactory [14].


Stemness of Mesenchymal Stem Cells

Tong Ming Liu*

Mesenchymal stem cells (MSCs) are multipotent adult stem cells that can
self-renew and differentiate into a variety of cell types including chondrocytes, osteocytes and adipocytes.MSCs reside in bone marrow, adipose tissues, cord blood, peripheral blood, placenta, Wharton’s jelly, fetal liver and lung among others. MSCs represent one of the most promising stem cells for regenerative medicine due to their multipotency, immunoprivileged properties and easy expansion in vitro. So far, MSCs are already in various phases of clinical application [1-4]. Their most immediate use is in the orthopedic context due to the clear demonstration of their ability to differentiate into bone and cartilage [5-8]. It has been 5 decades since Friedenstein et al described clonal and plastic adherent stromal cells from bone marrow in the 1960s [9,10]. Although there are a handful of genes suggesting possible MSC stemness markers, the molecular basis underlying MSC stemness, especially the key transcription factor to MSC stemness, is still poorly understood.

There are several reasons for poor understanding of MSC stemness. First of all, the heterogeneity of MSCs greatly hamper in-depth MSC study. Variations exist among MSCs from different sources and culture conditions, even fast and slow growing CFU-derived MSCs from the same patient also display differences [11,12]. So far, the factors that affect the heterogeneity of the MSC population is still largely unknown. Secondly, the limited lifespan of MSCs increases the difficulty to study MSCs, especially in case of large number of cells needed. Like other adult stem cells, MSCs undergo the replicative senescence after only a finite number of times in culture. At around passage 10, MSCs demonstrate morphological abnormalities, enlargement, attenuated expression of specific surface markers, and ultimately proliferation arrest [13,14]. In the meanwhile, MSCs reduce differentiation potential during prolonged in vitro culture [15]. The limited lifespan of MSCs also greatly compromises the therapeutic application of human MSCs due to limitation in cell number. Thirdly, little is known about MSC niche. Stem cell niche is a specific microenvironment, in which stem cells are able to self- renew and maintain the undifferentiated state. So far, the MSC niche remains poorly understood.

Research Article

Association between bh4/bh2 ratio and Albuminuria in Hypertensive Type -2 Diabetic patients

Jose Aviles-Herrera, Karla C Arana-Pazos, Leonardo Del Valle-Mondragon, Carolina Guerrero-García and Alberto Francisco Rubio-Guerra*

Endothelial dysfunction and inflammation play a key role in the pathophysiology of diabetic nephropathy; Tetrahydrobiopterin (BH4) is an essential cofactor for nitric oxide synthase, when BH4 is reduced to dihydrobiopterin (BH2), endothelial dysfunction is induced.

Purpose: The aim of this study is to evaluate the relationship between the levels of biopterins with albuminuria in type-2 diabetic hypertensive patients.

Methods: We studied 30 hypertensive type-2 diabetic patients in whom biopterins levels were measured by reverse phase high performance liquid chromatography with fluorescence detection. Additionally, 24 h urinary albumin excretion was also measured (nephelometry). The levels of biopterins and albuminuria were correlated with the Pearson correlation coefficient.

Results: We did not find a significantly correlation between biopterins levels and albuminuria, However, we found a significantly inverse correlation (R= -0.498, p<0.005) between the BH4/BH2 ratio and albuminuria.

Conclusion: Our results suggest that the BH4/BH2 ratio instead of biopterins levels may be a marker of nephropathy in hypertensive type-2 diabetic patients.

Research Article

Role of Accessory Right Inferior Hepatic Veins in evaluation of Liver Transplantation

Awais Ahmed, Abdu Hafeez Baig*, Mirza Akmal Sharif, Umair Ahmed and Raj Gururajan

Purpose: The purpose of the study is to access the prevalence of accessory right inferior hepatic veins and their relevant significance in liver transplantation.

Materials and Methods: A retrospective study was done in which the CT of 82 potential liver transplant candidates between January 2012 and March 2013 were reviewed. The presence of the accessory right inferior hepatic vein was examined; the diameters of the accessory inferior hepatic veins and the distance between the point where they open into the inferior vena cava on the coronal plane and to the right hepatic vein-inferior vena cava junction was measured.

Results: Out of 82 patients, 42 (51%) had accessory right inferior hepatic veins. Right accessory inferior hepatic veins larger than 3 mm were detected in 23 (28%) patients. The distance of these veins to the right hepatic vein-inferior vena cava junction was more than 4 cm in 13 (15%) patients.

Conclusion: The precise preoperative knowledge of accessory right inferior hepatic veins is essential in living donor liver transplantation.

Research Article

Prospective Clinical Study to Find out Epidemiology of Xerophthalmia in Children in a Tertiary Care Centre in India

Deepak Mishra*, Megha Gulati, Prashant Bhushan, Nilesh Mohan and Bibhuti Sinha P

Objective: To study the epidemiology of xerophthalmia in children 2-6 years of age in North India.

Methods: A prospective clinical study was done at two tertiary care centers of North India between 2010 to 2016, Cases were selected from routine OPD and children less than 6 years of age were examined by an ophthalmologist. Diagnosis and classification of Xerophthalmia was done according to WHO classification. All the data recording demographic profile, socioeconomic status, other health problems etc were recorded in a fixed proforma. Data was analyzed by SPSS version 16.

Findings: Two thousand nine hundred forty six cases were included in the study after satisfying inclusion and exclusion criteria. The prevalence of night blindness was estimated to be 2.93% (95% Confidence Interval [CI]: 2.53-3.33) among children between 2 and 6 years of age. Xerophthalmia prevalence was 4.43% (95% CI: 4.19-4.67). Prevalence was more in girls than boys and higher in low socioeconomic status.

Conclusion: Vitamin A deficiency is recognized to be a severe public health problem leading to corneal opacity and childhood blindness in most of the areas of North India.

Short Communication

Maternal thyroid dysfunction and neonatal cardiac disorders

Ahmed RG*

The normal levels of thyroid hormones (THs; thyroxine, T4 & 3,5,3′-triiodo-Lthyronine, T3) are necessary for the normal development [1-48], particularly the fetal and neonatal cardiac growth and development [49].The actions of THs are facilitated genomically by thyroid receptors (TRs, α and β) and non-genomically at the plasma membrane, in the cytoplasm and in cellular organelles [4,49-55], by stimulation of Na+, K+, Ca2+ and glucose transport, activation of protein kinase C (PKC), protein kinase A (PKA) and mitogen activated and protein kinase (ERK/MAPK) [4]. In addition, the transport of T4 and T3 in and out of cells is controlled by several classes of transmembrane TH-transporters (THTs) [56], including members of the organic anion transporter family (OATP), L-type amino acid transporters (LATs), Na+/Taurocholate cotransporting polypeptide (NTCP), and monocarboxylate transporters (MCTs) [4,49,57,58]. Adding additional complexity, the metabolism of T4 and T3 is regulated by 3 selenoenzyme iodothyronine deiodinases (Ds: D1, D2 and D3) [59-61]. On the other hand, the congenital hypothyroidism can cause the following [49,62-64], (1) congenital heart diseases; (2) diastolic hypertension; (3) reduced cardiac output, stroke volume and a narrow pulse pressure; (4) dilatation and overt heart failure; (5) elevation in the systemic vascular resistance [65-68]. Similarly, the chronic hyperthyroidism can cause the following [49,64]: (1) cardiac hypertrophy; (2) increase in the cardiomyocyte (CM) length rather than width; (3) noticeable diminution in systemic vascular resistance; (4) elevation in the cardiac contractility; (5) systolic hypertension; (6) increase in the cardiac output, venous volume return, blood volume and pulse pressure; and (7) reduction in the systemic vascular resistance [49,69]. T3-therapy can induce DNA synthesis and cardiomyocyte proliferation, and improve the cardiac contractility; though, this action is as still unidentified [49,70-74].

Mini Review

Neuro-ophthalmological emergency disorders: A general view

Burak Turgut*, Feyza Calis Karanfil and Fatos Altun Turgut

Neuro-ophthalmological emergency disorders usually occur with symptoms of visual loss, diplopia, ocular motility impairment and anisocoria. In this mini-review, we aim to take look the common neuro-ophthalmological emergency disorders. The delayed diagnosis of the neuro-ophthalmological emergencies puts the patient at risk of death or blindness. If these are well-known, the discrimination and management of these emergency conditions will be easier. 

Research Article

Synthesis, Radioiodination and Biological distribution of 5-(5-(tributylstannyl) benzofuran-2-yl) pyridin-2-amine as an amyloid imaging agent

Atteyat A Labib* and Mohsen B Challan

In this work an efficient method developed for the synthesis of 125I-benzofuran-2-yl) pyridin-2-amine (125IBPA), followed by radioiodination with 125I by using Chloramine-T at pH 8. The reaction proceeds within 10 min at room temperature (20-25°C). The radiochemical yield determined by Thin-Layer Chromatography (TLC) using hexane:ethyl acetate (1:6 v/v) and the purity analyzed by high-performance liquid chromatography using a reversed-phase RP18column and acetonitrile:0.1 M ammonium bicarbonate (pH 7.5) (1:1) as the mobile phase at a flow rate of 1 ml×min−1. The radiochemical yield using aH2O2 oxidant found equal to 96.5% with a radiochemical purity of 125I-BPA of over 96.5%. The biodistribution data in normal mice indicated a high initial uptake of 6.54±0.10 (% ID/g±SD) in the brain within 30 min post-injection. These results promote a further the use of 125I-BPA as a novel agent for brain imaging.

Short Communication

Brain response in some systemic immune condition-Toxicological aspects

Luisetto M*

From biomedical literature “autism disorder are involved in young patient, that we have abnormalities (Imaging, histology) in some brain areas, and a comples symptomatology. Genetic and environment can produce some unbalances in brain grow and immunitary situation is involved. Apoptotic signal contribute in brain growth and immunologic shock can unbalance the environment producing abnormalities”.

We can see that some pharmacological molecules are been introduced in therapy in some brain pathologies with a specific mechanism: modulating the immune systems. We can see that some systemic immune modifications can unbalance this systems producing pharmacological effect in local place (as Brain). We can observe this phenomena like a kind of toxicity that can be deeply investigate to discover new Pharmacological strategies.

Aim of this work is to observe this kind of pathologies under a specific immune-toxicological aspect. We think that in this field are needed deeply new approach in order to adequately focus this kind of disorder. A different way to set this kind of pathologies can help in searching new pharmacological strategies.

Case Report

Failure to Autopsy: The Otto Warmbier Case

Steven A Koehler* and Victor W Weedn

Coroner and medical examiner offices are charged with the medicolegal investigation of deaths to determine the cause and manner of death. We describe the recent high-profile case of Otto Warmbier, who tragically died shortly after his return in a coma from North Korea and in which the coroner failed to conduct a complete autopsy, and failed to satisfy the needs of the local, national, and international communities.

Medico legal death investigation offices, including both medical examiner and coroner offices, have a legal responsibility and duty to investigate deaths in the public interest for public safety and public health purposes. Although, they serve the families of the deceased as they can, their raison d’être and priority is service to the greater public good. Thus, they may conduct investigations and even autopsies over the objections of the next-of-kin. Full investigations include a complete forensic autopsy. The utilitarian public interest should, within the constraints of the office resources, drive the decision of whether to autopsy or not. Failure to autopsy can sometimes constitute a breach of faith that the public entrusts in these offices. Empirically, this seems to be a greater problem in coroner jurisdictions than in medical examiner offices. Specifically, we believe the recent case of Otto Warmbier is such a case.

Case Report

Hepato-Pulmonary syndrome and Porto-Pulmonary Hypertension: Rare combination cause of Hypoxemia in patient with end-stage renal failure on Hemodialysis and hepatitis C Induced Decompensated Cirrhosis

Awad Magbri*, Mariam El-Magbri and Eussera El-Magbri

The case is that of 83 year-old African American man with hypertension, hepatitis C induced decompensated cirrhosis with ascites, end-stage renal disease (ESRD) on hemodialysis, fluid overload with peripheral edema and chronic hypotension. The patient was referred to the dialysis access center of Pittsburgh, PA for evaluation of his prolonged bleeding from the left upper arm brachial-basilic arterial-venous fistula (BBAVF).

On examination, he was found to be severely hypoxic with oxygen saturation of 80-92 mm Hg. Chest was clear on auscultation. Abdominal examination showed hepatosplenomegaly with ascites. Extremities showed 3+ peripheral edema bilaterally. His chest x-ray showed cardiomegaly with clear lung fields. His laboratory workup showed, WBC of 3.4, RBC 3.69, MCH 31.2, MCHC 32, and platelets 104 K/L. Chemistry showed Na 134, Cl 99, CO2 24, Total protein 7.2 with albumin of 2.9. SGOT was high at 44, vitamin D 42. Laboratory data were also indicative of chronic liver disease with bilirubin of 2.8, INR of 1.2, and albumin of 2.9, and platelet count of 104. Immunology for Hepatitis B Ag was negative, Hepatitis B Ab was 22 H, Hepatitis C Ab was positive. Arterial blood gas analysis showed PaO2 of 54 mmHg while breathing room air.

Case Report

Catamenial pneumothorax: Presentation of an uncommon Pathology

Rui Haddad*, Caterin Arevalo and David Nigri

The catamenial pneumothorax is defined as the accumulation of air in the pleural cavity that appears in women infrequently and spontaneously with various clinical presentations. Actually, it is considered as an extremely rare entity with few cases described in the literature, that is the reason why the etiology is still discussed. However, a strong association with thoracic endometriosis syndrome has been found. We want to emphasize how the importance of conducting a diagnosis and having a timely management would improve the quality of life of the patient and give a better prognosis of the disease. Thus, a case report of a 38-year-old female patient who was receiving hormone therapy as a treatment for abdominal endometriosis and repetitive pneumothorax was presented. In the video-assisted thoracoscopy we saw diaphragmatic lesions and pneumothorax during the perioperative and postoperative period. Emphasize the importance of a detailed inspection of each intrathoracic organ during the surgical procedure, we also showed how the intraoperative pleurodesis, the placement of a mesh on the diaphragm and the continuity of the hormonal treatment, seems to be an effective therapy to prevent recurrences and have a better control of the disease.

Case Report

Giant Lipoma Anterior Neck: A case report

Gowri Sankar M, Manu CB* and Arun Alexander

Lipoma is a benign mesenchymal tumor with a thirteen percent incidence in head and neck region. Posterior triangle is the most common location while anterior neck lipoma is a rare one. Giant lipomas >10cm have been reported in different parts of the body but rarely in the anterior neck. Giant lipomas of the neck can present as a cosmetic disfigurement or can produce pressure symptoms. Most lipomas do not pose any difficulty in diagnosis. Surgical excision remains the treatment of choice. We here present a case of giant anterior neck lipoma. 

Review Article

The Role of Omega-3 Essential Fatty Acids in Dry Eye Disease

William J Faulkner*

One of every four visits to eye care professionals is for dry eye disease which affects an estimated 7-34% of Americans [1].Knowledge regarding etiology and treatments has advanced exponentially in the last 20 years. As recently as 1997, in the mega textbook Cornea, it was stated “The mechanism for lacrimal gland dysfunction in this condition is unclear” [2]. A recent study entitled “The Dry Eye Workshop ll Report”, defines dry eye as “a multifactorial disease of the ocular surface characterized by a loss of homeostasis of the tear film and accompanied by ocular symptoms in which tear film instability and hyperosmolarity, ocular surface inflammation, and damage and neurosensory abnormalities play etiological roles” [3]. A 2003 study regarding the morbidity ratings of dry eye showed utility assessments for moderate and severe dry eye were parallel to historical reports for more severe (class lll/ lV) angina [4]. The tear film is responsible for the greatest optical power of any ocular surface, since the greatest change in the index of refraction occurs between the air and the tear film [5]. Double pass retinal imaging shows increased light scatter in dry eye patients which can decrease retinal image quality 20-40% [5]. Ophthalmologists now understand the critical necessity to normalize the ocular surface prior to cataract surgery; otherwise, they risk an unhappy patient with a less than ideal visual result. Increased use of electronic devices, such as smart phones, tablets, and computers, by youth in the last ten years has resulted in a broader age range of dry eye patients, to now include adolescents and teens. A study of urban school age children showed that 8.2% had dry eye (vs 2.8% in a rural group), presumably due to high incidence of smart phone use.6 In fact, with cessation of phone use for four weeks, dry eye resolved completely in 100% of subjects [6]. Only two FDA approved dry eye medications are available: cyclosporine ophthalmic emulsion, 0.05%, (approved in 2003) and lifitegrast, 5%, (approved in 2016), both of which require chronic treatment. The focus of this discussion involves an emerging paradigm in treating ocular surface disease: a nutraceutical containing omega-3 essential fatty acids.


Short term effect of Intravenous Intermittent Iron Infusion versus Bolus Iron Infusion on Iron parameters in Hemodialysis patients

Iman Ibrahim Sarhan, Hussein Sayed Hussein, Islam Omar Elshazly* and Mahmoud Salah Hassan

Intravenous iron is used in combination with erythropoi esis-stimulating agents to treat the anemia of hemodialysis patients, however, there is variety in the dose and the frequency. So we compare bolus intravenous iron administration protocol vs an intermittent intravenous iron infusion protocol for 3 months in a single blinded design that was conducted on 30 patients randomized into 2 matching groups. Iron parameter, hemoglobin level, and CRP were monitored before and at the end of study. Patients with end stage renal disease on regular hemodialysis with iron deficiency anemia can be treated with intravenous iron administration either by the protocol of divided doses of IV iron through the sessions of hemodialysis or by giving the total dose of iron needed as a single large dose on only one session of hemodialysis, obtaining the same outcome in correction of iron parameters in treatment of iron deficiency anemia.

Case Report

It is not invisible! A case report of 2 patients with scalp Lichen Planopilaris mimicking Androgenic Alopecia

Sorbellini Elisabetta, Pinto Daniela, Marzani Barbara and Fabio Rinaldi*

Lichen Planopilaris is known as the form of Lichen Planus typical of the scalp. It is classified as a lymphatic disease and is characterized by chronic inflammation which leads to cicatricial alopecia. Its causes are not yet well characterized but its etiology seems to strongly correlates with infection, sensitization and pollution. A clear and objective diagnosis of Lichen Planopilaris is not simple but the evolution and strongly negative outcomes on scalp of people affected by, pose the need of an early diagnosis. 

In this work we report the case of a 27-year-old male and a 54-year-old female, respectively, in which a correct diagnosis of Lichen Planopilaris, followed the incorrect previous ones, was made by means of dermatoscopy and histopathological analysis, decisive tools for the diagnosis of this kind of pathology.

Research Article

Lifestyle Diseases and the Hair Growth Cycle: A multidisciplinary approach using Nourkrin® with Marilex®, a proteoglycan replacement therapy, for anagen induction and maintenance

Thom E* and Thom EW

Multiple studies have investigated the relationship between androgenetic alopecia and cardiovascular disease, including studies that have identified elevated rates of cardiovascular disease in patients with vertex hair loss, vertex and frontal hair loss, early onset hair loss and rapidly progressive hair loss. In addition, increased risks for hypertension, excess weight, abnormal lipids, insulin resistance, carotid atheromatosis and death from diabetes or heart disease have been reported in this population. Studies investigating an association between androgenetic alopecia and metabolic syndrome have yielded conflicting findings. Distinct guidelines for the detection and prevention of cardiovascular disease in individuals with androgenetic alopecia have not been established. In addition to the traditional risk factors for developing cardiovascular disease, included in the definition of the metabolic syndrome, several skin diseases have recently been shown to be markers of conditions relating to the patient’s overall health. Physicians should be aware of the possible connection between relatively frequent skin diseases, such as psoriasis and hair growth disruptions, including androgenetic alopecia and female pattern hair loss and cardiovascular disease. This review is concentrated on the association between insulin resistance, type 2 diabetes, abdominal fat, cardiovascular disease and hair growth disruptions as an early indicator of these underlying conditions. We have investigated the importance of robust primary clinical treatment measures to address the manifestation of hair loss due to a disruption caused by metabolic syndrome as an effective means to alleviate further stress induced hair loss, which can exacerbate the underlying cause.

Research Article

Intraepidermal Injections of Autologous Epidermal Cell Suspension: A new promising approach to Dermatological Disorders. Preliminary Study

Elisa Borsani, Luigi Fabrizio Rodella, Elisabetta Sorbellini, Rita Rezzani, Daniela Pinto, Barbara Marzani, Giovanna Tabellini, Mariangela Rucco and Fabio Rinaldi*

Regenerative medicine is a modern approach of dermatological treatment, using Epidermal Cells of the interfollicular epidermis (ESCs) for their effect in skin regeneration in chronic ulcers and burns, melanoma, vitiligo, junctional epidermolysis bullosa.Intraepidermal injections of autologous epidermal cell suspension can be a new and very promising treatment for many other cutaneous disorders as non-scarring alopecia (Alopecia Areata, Androgenic Alopecia) or scarring alopecia (Lichern Plano Pilaris alopecia, Discoid Lupus Erithematosus alopecia), anti-aging therapies. The intraepidermal injection of an autologous epidermal cell suspension is a simple, fast and safe surgical procedure: a small, thin portion of the epidermis of the patient undergoes a treatment where a suspension with all the cells collected from the epidermis and cultured for 7 days is injected into the skin. Our preliminary study shows that a suspension contains a significant number of viable cells that survive at day 7 in culture.

Our research is ongoing and is focusing on the typing of the different cells in the suspension and evaluation of the presence and the nature of stem cells.

Review Article

Role of polyamine metabolism in plant pathogen interactions

Magda Pal* and Tibor Janda

Polyamines are aliphatic amines found in all living cells, and they are necessary for several fundamental cell processes. Their protective role against various abiotic stress factors has been reported in different plant species,while the mechanism by which polyamines act during plant-microbe interaction is still poorly understood. The several types of the interactions between the plants and the microbes outline a divers and complex picture of the action mechanisms. The present review focuses on this aspect of the mode of action of polyamines and polyamine metabolism during biotroph and necrotroph interactions between plants and pathogens. It seems that apoplastic metabolism of polyamines of the host and the accumulation of H2O2 as a result of polyamine catabolism play important signalling role in plant-pathogen interactions. The manipulation of the members of the polyamine-induced signalling pathways could increase the host plant resistance to biotic stresses.

Research Article

Numerical Simulation of Thrombotic Occlusion in Tortuous Arterioles

Zhi-Gang Feng*, Miguel Cortina, Jennifer KW Chesnutt and Hai-Chao Han*

Tortuous microvessels alter blood flow and stimulate thrombosis but the physical mechanisms are poorly understood. Both tortuous microvessels and abnormally large platelets are seen in diabetic patients. Thus, the objective of this study was to determine the physical effects of arteriole tortuosity and platelet size on the microscale processes of thrombotic occlusion in microvessels. A new lattice-Boltzmann method-based discrete element model was developed to simulate the fluid flow field with fluid-platelet coupling, platelet interactions, thrombus formation, and thrombotic occlusion in tortuous arterioles. Our results show that vessel tortuosity creates high shear stress zones that activate platelets and stimulate thrombus formation. The growth rate depends on the level of tortuosity and the pressure and flow boundary conditions. Once thrombi began to form, platelet collisions with thrombi and subsequent activations were more important than tortuosity level. Thrombus growth narrowed the channel and reduced the flow rate. Larger platelet size leads to quicker decrease of flow rate due to larger thrombi that occluded the arteriole. This study elucidated the important roles that tortuosity and platelet size play in thrombus formation and occlusion in arterioles. 

Case Report

Addiction to self-strangulation: a case-report

Aurely Ameller*, Yann Le Strat, Marion Cadranel, Celine Portalier and Caroline Dubertret

Introduction: DSM-5 mentions autoerotic asphyxia in the paraphilic disorders section, as a specifier for the diagnostic of sexual masochism disorder. Strangulation activities have also been observed in the “choking game”. The term “strangulation activity” is considered as more appropriate than “choking game”. While sharing a same behavior, autoerotic asphyxia and non auto-erotic strangulation activities might represent a very distinct pattern of disorders. We describe here a case report of a 25-year old male internship student who has practiced manual self-strangulation up to 40 times a day since adolescence. In the examination of this case we identify individual clinical aspects of this case in a process-based holistic case conceptualization.

Case description: The patient is a 25 years old male with a post-graduate degree who presented with a recent history of poor work performance and work-related stress during an internship. He has a concomitant history of both ketamine and cannabis use disorders, and reports urges to self-strangulate, sometimes specifically avoiding contact with friends engage in this behavior and that he has never attempted to discontinue self-strangulation. Neuropsychological assessment found a cognitive functioning below that expected given his educational level. Our intervention consists of a 3-weeks cognitive and motivational therapy program in addiction unit with associated abstinence.

Conclusion: Autoerotic asphyxia is a behavior observed not only in the context of sexual masochism disorder, but also as a specific addictive behavior, in the absence of sexual arousal, possibly as a result of emotional dysregulation.

Case Report

Near Complete Response to 177Lu- PSMA-DKFZ-617 Therapy in a Patient with Metastatic Castration Resistant Prostate Cancer

Madhav Prasad Yadav, Sanjana Ballal and Chandrasekhar Bal*

Prostate specific membrane antigen, a type II transmembrane protein is an excellent target for the radionuclide therapy in advanced prostate cancer patients due to its high expression in the prostate cancer cells.We present the case of a 69-year old man with advanced metastatic castration resistant prostate cancer. In view of rising serum PSA levels despite hormonal and chemotherapy, we decided to perform a 68Ga-PSMA-HBED-CC PET/CT scan (prostate specific membrane antigen). It revealed intense radiotracer uptake in the prostate, lymph nodes and multiple skeletal sites. Five cycles of 177Lu-PSMA-DKFZ-617 radioligand therapy were administered in the patient followed by an intrim 68Ga-PSMA-HBED-CC PET/CT. Intrim 68Ga-PSMA-HBED-CC PET/CT scan demonstrated a near complete remission of disease with a corresponding decrease in the sPSA levels. During the follow-up duration of 12 months, the patient did not develop haematological, kidney and liver toxicity during the course of treatment and follow-up. 177Lu-PSMA-DKFZ-617 is a promising therapeutic option in metastatic castration resistant prostate cancer (mCRPC) patients.

Research Article

Influence of Vitamin E on the Disposition Kinetics of Florfenicol after single and multiple oral administrations in Broiler Chickens

Fatma Ibrahim Abo El-Ela*, Hossny Awad El-Banna, Manal B El-Deen and Tohamy MA

Investigation the influences of vitamin (vit) E over a period of 5 days on the pharmacokinetics of florfenicol after single and multiple oral administrations in broiler chickens. Total of 12 broiler chickens had been taken single and multiple oral administrations of florfenicol (30 mg/kg) alone or pre-treated with vit E (2 mg/kg). The serum concentrations of florfenicol were determined using microbiological assay with Bacillus subtilis (ATCC 25922) as a tested microorganism. The mean serum concentrations of florfenicol alone were markedly lower when compared with florfenicol pre-treated with vit E after single and multiple dosing. The peak serum concentrations (Cmax) were 5.9±0.46, 7.48±0.3 ug/ml, absorption half-life (t0.5ab) of 0.51±0.06, 0.71±0.1 h and elimination half-life (t0.5el) of 2.72±0.34, 3.34±0.5 after single florfenicol alone and florfenicol pre-treated with vit E respectively. While, after multiple dosing, (Cmax) were 7.4±0.3, 8.04±0.3 ug/ml, (t0.5ab) 0.82±0.04, 0.81±0.04 h and (t0.5 el) 3.77±0.2, 4.52±0.7 h after multiple dosing of florfenicol alone and florfenicol pre-treated with vit E respectively. In conclusion Vit E alter the disposition kinetics of florfenicol after single and multiple oral administrations as, vit E allows prolongation of the duration of action for more 24 and 48 h of the drug concentration in the serum indicated by prolonged elimination half-lives and MRT reflecting the importance of this combination for the drug duration in serum but the increase in the serum concentration of florfenicol increasing its efficacy not toxicity as florfenicol of wide safety margin so, it’s advisable for poultry farms owners to use this combinations.

Research Article

Quantification of the pressures generated during insertion of an epidural needle in labouring women of varying body mass indices

Wee MYK*, Isaacs RA, Vaughan N, Dubey VN and Parker B

Objective: The primary aim of this study was to measure pressure generated on a Tuohy needle during the epidural procedure in labouring women of varying body mass indices (BMI) with a view of utilising the data for the future development of a high fidelity epidural simulator. High-fidelity epidural simulators have a role in improving training and safety but current simulators lack a realistic experience and can be improved.

Methods: This study was approved by the National Research Ethics Service Committee South Central, Portsmouth (REC reference 11/SC/0196). After informed consent epidural needle insertion pressure was measured using a Portex 16-gauge Tuohy needle, loss-of-resistance syringe, a three-way tap, pressure transducer and a custom-designed wireless transmitter. This was performed in four groups of labouring women, stratified according to BMI kg/m2: 18-24.9; 25-34.9; 35-44.9 and >=45. One-way ANOVA was used to compare difference in needle insertion pressure between the BMI groups. A paired t-test was performed between BMI group 18-24.9 and the three other BMI groups. Ultrasound images of the lumbar spine were undertaken prior to the epidural procedure and lumbar magnetic resonance imaging (MRI) was performed within 72h post-delivery. These images will be used in the development of a high fidelity epidural simulator.

Results: The mean epidural needle insertion pressure of labouring women with BMI 18-24.9 was 461mmHg; BMI 25-34.9 was 430mmHg; BMI 35-44.9 was 415mmHg and BMI >=45 was 376mmHg, (p=0.52).

Conclusion: Although statistically insignificant, the study did show a decreasing trend of epidural insertion pressure with increasing body mass indices.

Mini Review

Lipid-induced cardiovascular diseases

Sumeet Manandhar, Sujin Ju, Dong-Hyun Choi and Heesang Song*

Cardiovascular diseases are the leading cause of death worldwide. There are many evidences that the dysfunctioning lipotoxicity is the one of major factors of cardiovascular diseases such as, atherosclerosis, hypertension, and coronary heart disease. Obesity and diabetes increase circulating lipids that are likely with more generation of toxic intermediates, which leading to the complications associated with cardiovascular diseases. Indeed, lipotoxicity is a metabolic syndrome caused by abnormal lipid accumulation, which leads to cellular dysfunction and necrosis. Here we review the factors that induced pathogenesis of cardiovascular diseases by lipid accumulation and the mechanisms underlying the lipotoxicity.