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the evolution of multi - cellular eukaryotic organisms from single - celled ancestors was one of the most significant transitions in the evolution of life on earth . it enabled the emergence of larger and more complex eukaryotes that could resist predation , evolve specialized tissues and higher order biological capa...	we present a perspective on the molecular evolution of the extracellular matrix ( ecm ) in metazoa that draws on research publications and data from sequenced genomes and expressed sequence tag libraries . ecm components do not function in isolation , and the biological ecm system or adhesome also depends on postt...
intervertebral disc degeneration ( idd ) is a highly relevant individual and socioeconomic burden , which is associated to various morphological and functional disturbances . the gradual progression of the disease and the structural features , e.g. , the degradation of proteoglycans with subsequent desiccation of the...	purpose regenerative strategies aim to restore the original biofunctionality of the intervertebral disc . different biomaterials are available , which might support disc regeneration . in the present study , the prospects of success of two hydrogels functionalized with anti - angiogenic peptides and seeded with bon...
age - related macular degeneration ( amd ) is the leading cause of blindness for individuals aged 60 years or older . an estimated 11 million people in the united states suffer with amd , and this number is expected to increase to 22 million individuals by 2050 because of the projected demographic expansion of ...	accumulation of lipofuscin in the retina is associated with pathogenesis of atrophic age - related macular degeneration and stargardt disease . lipofuscin bisretinoids ( exemplified by n - retinylidene - n - retinylethanolamine ) seem to mediate lipofuscin toxicity . synthesis of lipofuscin bisretinoids depends...
the dentigerous cyst initially is always associated with the crown of an impacted , embedded , or unerupted tooth . it develops around the crown of the unerupted tooth by the expansion of the follicle when fluid collects or space occurs between the reduced enamel epithelium and the enamel of an impacted tooth . the...	dentigerous cysts are the most common odontogenic and developmental cysts arising in the jaws . in this article , we report a rare case of dentigerous cyst arising from an unerupted canine which had invaded a part of the maxilla in a 6-year - old child . the clinical features , radiographic presentation , and the tre...
a distinct phenotype within this group is cerebellar ataxia associated with hypogonadotropic hypogonadism ; this association has been found in two diseases , gordon holmes ( ghs ) and boucher neuhauser syndromes . ghs ( mim 212840 ) is a rare phenotype , first described in 1907 by holmes , and comprises adolescence o...	gordon holmes syndrome ( ghs ) is a distinct phenotype of autosomal recessive cerebellar ataxia , characterized by ataxia , dementia , reproductive defects and hypogonadism ; it has been recently found to be associated with rnf216 mutation . we performed whole - exome sequencing and filtered the resulting novel varia...
in malaria endemic areas , factors such as poverty and poor environmental sanitation allow survival and proliferation of malaria vector [ 1 , 2 ] . the emergence and rapid spread of resistance both of the malaria vector ( female anopheles mosquito ) to insecticides and of the pathogenic plasmodia to antimalarial drugs ...	summarybackground and aims.integrated vector control especially use of insecticide - treated bed nets have been reported as effective malaria preventive strategies . this study aimed at documenting factors that influence regular use of insecticide - treated nets in under - fives and impact of vector control methods o...
in recent years , various thermoplastic materials have been developed for the fabrication of no - clasp removable prostheses and complete dentures . the flexural and impact strength of polyamide polymers are higher than those of heat - cured denture base materials.12345 nevertheless , the repair strength of auto - po...	purposepolyamide polymers do not provide sufficient bond strength to auto - polymerized resins for repairing fractured denture or replacing dislodged denture teeth . limited treatment methods have been developed to improve the bond strength between auto - polymerized reline resins and polyamide denture base materials...
functional gastrointestinal disorder ( fgid ) is one of the commonest digestive disease entities , which is characterized by recurrent gastrointestinal symptoms with no identifiable organic pathology . in recent years , a bio - psycho - social pathophysiological model has been implicated for the pathogenesis of fgid ...	functional gastrointestinal disorder ( fgid ) is one of the commonest digestive diseases worldwide and leads to significant morbidity and burden on healthcare resource . the putative bio - psycho - social pathophysiological model for fgid underscores the importance of psychological distress in the pathogenesis of fgid ...
stroke is characterized by a sudden , non - convulsive , focal neurological deficit caused by a brain lesion stemming from a non - traumatic vascular mechanism due to arterial or venous embolism leading to cerebral ischemia or hemorrhage2 . the most common manifestations of stroke are sensory , cognitive and moto...	[ purpose ] the aim of the present study was to evaluate the relationship between upper limb impairment and oral health impact in individuals with hemiparesis stemming from a stroke . [ subjects and methods ] the study subjects were conducted with a sample of 27 stroke survivors with complete or partial hemipares...
as an auditory rehabilitation device , the auditory brainstem implant ( abi ) has been used to treat deafness in individuals with neurofibromatosis type 2 since the first device was implanted in 1979 . in the following years , progressively more effective multichannel abis have been developed to palliate the deficits...	background : the auditory brainstem implants ( abis ) have been used to treat deafness for patients with neurofibromatosis type 2 and nontumor patients . the lack of an appropriate animal model has limited the study of improving hearing rehabilitation by the device . this study aimed to establish an animal model of...
many fungi have yet to be collected and named , and it appears that the number of undescribed species is at least 1.4 million and probably as many as 3 million ( hawksworth 2012a ) . it is anticipated that many of these species are to be found in the tropics , and this poses particular constraints to their formal descr...	access to name - bearing type material can be a particular frustration for those mycologists in the tropics , or working outside established institutions , where the specimens are known to exist but can not be examined . they can be inaccessible because of loans policies and the inability of mycologists to make perso...
the global pharmaceutical industry has grown at a tremendous pace reaching up to $ 956 billion and is expected to rise to nearly $ 1.2 trillion in 2016 , representing a compound annual growth rate of 36 percent the world over ( 1 ) . with this aggressive growth and ever increasing competition the marketing strategies o...	interaction of pharmaceutical companies ( pc ) with healthcare services has been a reason for concern . in medicine , awareness of the ethical implications of these interactions have been emphasized upon , while this issue has not been highlighted in dentistry . this study undertook a cross - sectional rapid assessme...
pituitary adenomas ( pas ) are nonmetastasizing neoplasm which consist adenohypophysial cells . although they usually occur in the sella - turcica , they may occasionally be ectopic . they are relatively common benign neoplasms with different clinical features . according to the who classification in 2004 , endocrine...	background : pituitary adenomas ( pas ) are abnormal benign tumors that develop in the pituitary gland . this study aimed to assess the prevalence of different types of pas with an indication for trans - sphenoidal surgery in a well - defined population referred to loghman hakim hospital during 20012013.subjects and ...
the study was approved by the danish data protection agency ( 2007 - 58 - 0015/local j.nr . register - based studies in which persons can not be identified do not need ethics approval in denmark . all danish citizens are medically covered by a tax - financed system that provides each citizen with equal health care ...	backgrounddata from observational studies have raised concerns about the safety of treatment with antipsychotic agents ( aps ) in elderly patients with dementia , but this area has been insufficiently investigated . we performed a head - to - head comparison of the risk of major adverse cardiovascular events and nonc...
many adolescents often lack strong and stable relationships with their parents or other adults which are necessary to openly discuss reproductive health concerns . therefore , many teenagers do not have access to reliable information regarding their rh needs . in most cultures , parents and family members are an in...	background . open family discussion on reproductive health ( rh ) issues often leads to increased awareness on rh matters and reduces risky behaviors among adolescents . this study was conducted to assess factors affecting parent - adolescent discussion on rh issues in harar , ethiopia . methods . a cross - secti...
increasing data support a role of gut microbiota and dietary ingestion of phosphatidylcholine ( pc or lecithin ) in the pathogenesis of atherosclerosis.1 , 2 pc is the major dietary source of choline , which often is found in the western diet , such as red meat , eggs , and meat products . production of trimethylamin...	backgroundproduction of the proatherogenic metabolite , trimethylamine noxide ( tmao ) , from dietary nutrients by intestinal microbiota enhances atherosclerosis development in animal models and is associated with atherosclerotic coronary artery disease in humans . the utility of studying plasma levels of tmao to ris...
in many real world queueing systems , the server may be unavailable for a random period of time when there is no customer in the waiting line at a service completion instant . this random period of server absence is often called server vacation ; see doshi and tian and zhang . the classical vacation scheme with b...	we study a finite buffer n - policy gi / m(n)/1 queue with bernoulli - schedule vacation interruption . the server works with a slower rate during vacation period . at a service completion epoch during working vacation , if there are at least n customers present in the queue , the server interrupts vacation and other...
the recognition of noise as a serious health hazard as opposed to a nuisance is a recent development and the health effects of hazardous noise exposure are now considered to be an increasingly important public health problem . noise exposure in the workplace is a common reality in qubec ( province of canada ) and worl...	noise exposure in the workplace is a common reality in qubec , canada as it is elsewhere . however , the extent to which noise acts as a causal or contributive factor in industrial work - related accidents has not been studied thoroughly despite its plausibility . this article aims to describe the importance or poten...
	the catalytic asymmetric synthesis of alkyl fluorides , particularly -fluorocarbonyl compounds , has been the focus of substantial effort in recent years . while significant progress has been described in the formation of enantioenriched secondary alkyl fluorides , advances in the generation of tertiary alk...
hyponatremia , characterized by a serum sodium level that is less than 135 meq / l , is one of the most commonly diagnosed electrolyte disorders in clinical medicine1 ) . although sodium deficiency leads to hyponatremia , this condition is more commonly caused by solute dilution resulting from excessive consumption o...	timely diagnosis of hyponatremia is important for preventing potential morbidity and mortality as it is often an indicator of underlying disease . the most common cause of eurvolemic hyponatremia is the syndrome of inappropriate antidiuretic hormone ( siadh ) secretion . recent studies have demonstrated that proinf...
however , the role played by each of several acceleration and loss mechanisms is not yet established observationally [ millan and thorne , 2007 ] . precipitation into the atmosphere is considered to be one of the major electron loss mechanisms , which can completely deplete the radiation belts of electrons during the...	[ 1]previous studies on electromagnetic ion cyclotron ( emic ) waves as a possible cause of relativistic electron precipitation ( rep ) mainly focus on the time evolution of the trapped electron flux . however , directly measured by balloons and many satellites is the precipitating flux as well as its dependence on b...
severity of disease of hospitalized patients has increased over the past decade , and advanced techniques have allowed such patients to stay alive . it is well - known that advances in medicine and biomedical technology have created the likelihood for medical treatment to be continued beyond a point , of which it off...	background and aim : advances in biomedical technology have made medical treatment to be continued beyond a point , at which it does not confer an advantage but may increase the suffering of patients . in such cases , continuation of care may not always be useful , and this has given rise to the concept of limitation...
heart failure ( hf ) is a complex clinical syndrome where the ability of the heart to supply physiological perfusion to organs is impaired , either by acquired or inherited disease . the key biomarker for measuring heart failure is the left ventricular ejection fraction ( lvef ) but a low ejection fraction and hf ar...	heart failure ( hf ) is a major and growing cause of morbidity and mortality . despite initial successes , there have been few recent therapeutic advances . a better understanding of hf pathophysiology is needed with renewed focus on the myocardium itself . a new imaging technique is now available that holds promis...
while aortic valve replacement ( avr ) is the treatment of choice for several aortic valve disorders ; it is important to recognize some complications post this surgical procedure . most importantly , these include valve dehiscence , conduction abnormalities , thrombosis , infective endocarditis , fistulas , and left...	we present a case of a pseudoaneurysm arising from the left ventricular outflow tract / aortic root as a complication of aortic valve surgery . a 45-year - old nigerian female presented to our institution 's emergency department with chest discomfort . she had three bioprosthetic aortic valve replacements in the pr...
the most common organisms causing mucormycosis belong to the genera rhizopus , lichtheimia , and mucor . physicians should maintain a high index of suspicion while encountering nonmycobacterial cavitary lesions not responding to antibiotic therapy . a 44-year - old man presented to us with the chief complaints of o...	cavitary lung lesions have a specific array of differential diagnosis . among rare causes is mucormycosis that should not be overlooked . a high index of suspicion is necessary for a correct diagnosis and aggressive management . it usually occurs in immunosupressed patients . it is a life - threatening , rapidl...
innate immune responses provide four anatomical , physiological , phagocytic , and inflammatory barriers . among these barriers , macrophages produce proinflammatory cytokines and other signaling molecules such as interleukins ( ils ) , tumor necrosis factor ( tnf)- , and prostaglandins ( pgs ) , all of which are ess...	peptide - based therapeutics have received increasing attention in medical research . however , the local delivery of such therapeutics poses unique challenges . self - assembling peptides that use decorated nanofibers are one approach by which these therapeutics may be delivered . we previously found that the se...
intestinal pseudo - obstruction is a clinical syndrome that involves bowel obstruction without any mechanical cause.1 it can be either acute or chronic and may occur in the small bowel or the colon . chronic intestinal pseudo - obstruction ( cip ) usually exhibits a relapsing clinical course and may either be idiopat...	chronic intestinal pseudo - obstruction is a rare clinical syndrome which is characterized by intestinal obstruction without occluding lesions in the intestinal lumen and pregnancy is one of the important aggravating factors . here , we report a case of a woman with intractable intestinal pseudo - obstruction that wa...
it s the most common solid tumor and is responsible for 15% of all cancer - related deaths in childhood . this tumor accounts for more than 7% of malignancies in patients fewer than 15 years of age . nb tumors from these patients are often characterized by deregulation of many key signaling pathways regulating grow...	aim : neuroblastoma ( nb)cells are often used in cancer researches such as glioblastoma cells since they have the potential of high mitotic activity , nuclear pleomorphism , and tumor necrosis . guaiazulene ( gyz 1,4-dimethyl-7-isopropylazulene)is present in several essential oils of medicinal and aromatic plants . ...
, it may be fatal in there is injury caused to the cardiac cavity , an intercostal artery , pulmonary vessels , or intraabdominal organs 2 , 3 . in this situation , invasive management such as emergency surgery and transcatheter arterial embolization ( tae ) may be required 4 , 5 , 6 . however , if there is no seve...	key clinical messagesplenic injury is one of the most critical complications of chest tube insertion and often requires invasive emergency management . however , noninvasive management such as delayed removal of the malpositioned tube may be considered for a stable patient without severe adverse event .
tracheal intubation with the aid of a rigid laryngoscope , although a gold standard in securing a definitive airway , triggers adverse haemodynamic stress response . in instances when the procedure or the patient need not be subjected to endotracheal intubation , which is an invasive technique , the use of supraglott...	background and aims : air - q intubating laryngeal mask airway ( ila ) is used as a supraglottic airway device and as a conduit for endotracheal intubation . this study aims to assess the efficacy of the air - q ila regarding ease of insertion , adequacy of ventilation , rate of successful intubation , haemodynamic r...
this study included 40 cases of lung adenocarcinoma treated with surgery alone or surgery and postoperative adjuvant therapy at our institute between 2000 and 2011 . selected patients had ais , mia , or small adenocarcinoma ( sad ) and no other malignant tumors within five years of their diagnosis of lung adenocarcin...	backgroundnaked cuticle drosophila 1 ( nkd1 ) has been related to non - small cell lung cancer in that decreased nkd1 levels have been associated with both poor prognosis and increased invasive quality.methodsforty cases of lung adenocarcinoma staged as tis or t1a were selected . cases were subclassified into adenoca...
uterine papillary serous carcinoma ( upsc ) is an uncommon but aggressive type of endometrial carcinoma with high recurrence rate and poor survival outcomes . although upsc represents approximately 3% to 10% of the endometrial carcinomas , it accounts for almost 40% of all endometrial cancer - related death . unfortu...	uterine papillary serous carcinoma ( upsc ) is an aggressive form of endometrial cancer characterized by a high recurrence rate and poor prognosis . we report a case of a 58-year - old post - menopausal woman with an abdominal wall metastasis in stage ia upsc . after surgical staging , she did not receive additiona...
the integration of semiconductor quantum dots ( qd ) as active elements in new quantum optoelectronic devices [ 1 - 4 ] requires a precise control in their shape , size and location over the substrate . in this direction , one of them is the use of patterned substrates [ 5 - 9 ] , in which good results on the growth ...	in this work , we study the top surface localization of inas quantum dots once capped by a gaas layer grown by molecular beam epitaxy . at the used growth conditions , the underneath nanostructures are revealed at the top surface as mounding features that match their density with independence of the cap layer thickness...
maggot therapy is categorised as a debridement for chronic infectious wounds using disinfected live maggots for medical use ( herein referred to as maggots ) . since the 1930s , maggot debridement therapy ( mdt ) has been conducted mainly in north america . in japan , first conducted mdt in 2004 and reported the he...	abstractischaemic skin ulcer occurred on the foot of a 73-year - old man who had a history of fulminant myocarditis with severe cardiac dysfunction . we attempted wound bed preparation by maggot debridement therapy and salvaged his limb . it can be one of the adjuvant treatment strategies for critical limb ischaemi...
acute pyelonephritis complicates 1 - 2% of all pregnancies , making it one of the most common medical complications of pregnancy . escherichia coli remains the most common pathogen isolated in acute antepartum pyelonephritis , and ampicillin has been a mainstay of treatment for antepartum pyelonephritis b...	objective . to measure the incidence of ampicillin - resistant uropathogens in acute antepartum pyelonephritis and to determine if patients with resistant organisms had different clinical outcomes . study design . this was a secondary analysis of a prospective cohort study of pregnant women admitted with pyelonephr...
cranial irradiation has been widely used as a therapeutic method treating a wide variety of lesions , particularly neoplasms . though radiation therapy of central nervous system is usually well - tolerated , it does occasionally cause clinically significant long - term toxicity such as late delayed radiation necrosis...	we report a patient who underwent gamma knife radiosurgery to treat recurrent meningioma after microsurgery and thereafter developed secondary malignancy adjacent to the original tumor . a 47-year - old woman had underwent resection of the olfactory groove meningioma . then radiosurgery was done three times over 4 ...
persistent urogenital sinus ( ugs ) is a complex , challenging , and controversial pathology for the pediatric surgeon . it consists of a persistent communication of the genital and urinary tract with the urethra and vagina joined in a single common channel ( cc ) , with the ugs reaching the perineum.1 it can be an i...	persistent urogenital sinus ( ugs ) is a developmental anomaly . it represents one of the most complex problems that a pediatric surgeon may deal with . we report the case of a patient with ugs treated at 3 years of age by anterior sagittal transrectal approach and en bloc sinus mobilization . the procedure was p...
with advances in health care and increasing life expectancy , the population of older adults is increasing in most countries . it is estimated that the population aged 60 years and above will rise from 287 million in 2013 to 417 million in 2050 in the developed world , and from 554 million to 1.6 billion in developin...	in this review , we aim to provide clinical insights into the relationship between surgery , general anesthesia ( ga ) , and dementia , particularly alzheimer s disease ( ad ) . the pathogenesis of ad is complex , involving specific disease - linked proteins ( amyloid - beta [ a ] and tau ) , inflammation , and neuro...
pathophysiological cycles of denervation and impaired reinnervation , the loss of entire motor units , unloading due to prolonged periods of disuse , and excitation - contraction uncoupling may trigger a substantial loss in skeletal muscle mass and function . although considerable interindividual differences exist in...	mitochondria are of central importance for energy generation in skeletal muscles . expression changes or functional alterations in mitochondrial enzymes play a key role during myogenesis , fibre maturation , and various neuromuscular pathologies , as well as natural fibre aging . mass spectrometry - based proteomics ...
diabetes mellitus is one of the most common diseases , with 346 million affected individuals worldwide in 2012 and represents the seventh leading cause of death in the united states . more than twenty percent of patients with type 2 diabetes develop diabetic nephropathy . moreover , clinical studies reported a high p...	the aim of this study was to identify sex - dependent expression of renal transporter mrna in lean and obese zucker spontaneously hypertensive fatty ( zsf1 ) rats and to investigate the interaction of the most altered transporter , organic anion transporter 2 ( oat2 ) , with diabetes - relevant metabolites and drugs . ...
a key and dominant feature of human cancer , including breast cancer , is the heterogeneity evident in the disease . this presents a problem in both understanding the mechanisms of progression and in developing therapeutic options . the development of human breast cancer results in tumors with a wide array of morph...	the heterogeneity of human breast cancer has been well described at the morphological , molecular , and genomic levels . this heterogeneity presents one of the greatest obstacles in the effective treatment of breast cancer since the distinct forms of breast cancer that reflect distinct mechanisms of disease will requ...
given to a long history of substance abuse disorders in the world , it also has remained as a serious problem in recent years . because of some incorrect beliefs and specific geographical conditions , iran has favorable conditions for youth to crave toward substance abuse . based on a study which has conducted in ira...	background : cognitive - behavioral coping approach is known as an effective strategy to preventing relapse . its goal is to forget incompatible behaviors and replaces them with the compatible answers.objectives:this study examines relapse coping strategies in young adults in selected substance abuse treatment center...
malignant glaucoma is a rare but serious condition of secondary angle closure mostly seen after filtration surgery , but it may also occur spontaneously.1 it has also been described after laser iridotomy,2 laser capsulotomy,3 cataract surgery,4 topical miotic therapy,5 and blunt trauma.6 some basic mechanisms of ciliol...	purposeto assess the outcomes of pars plana vitrectomy for the treatment of malignant glaucoma in patients with and without previous filtration surgery.patients and methodsdata of 15 patients developing malignant glaucoma after trabeculectomy ( 60% ) or following ophthalmic interventions other than filtration surgery (...
abdominal tb , a common clinical entity in indian sub - continent can infect the gastrointestinal tract , peritoneum , mesentery , lymph nodes , liver , spleen and pancreas . hepatic tb is usually associated with miliary tb or active pulmonary tb . however , isolated liver tb in the absence of miliary tb is very rare...	tuberculosis ( tb ) presenting as isolated liver mass without clinical evidence of tb is difficult to diagnose preoperatively and is usually mimicked by primary or metastatic carcinoma of the liver . hepatic tb associated with carcinoma colon is a rare association which has very rarely been reported in the literature...
pancreatic ductal adenocarcinoma ( pdac ) is associated with the worst prognosis of all gastrointestinal malignancies , mainly due to late and unspecific symptoms , an aggressive tumor biology , and resistance to most therapies . , these patients were subjected to primary resection ; however , new data suggest that t...	pancreatic ductal adenocarcinoma is a highly aggressive disease , and medical as well as surgical therapeutic options are limited . this article reviews stage dependent treatment options , with a special focus on the current controversy of perioperative treatment regimens in initially borderline resectable or locally...
mycobacterium marinum , a slow - growing mycobacterium , is considered the most common cause of mycobacterial skin infections . the overall incidence is estimated to be 0.27 cases per 100,000 inhabitants , and this number has increased in recent years.1 although mycobacterial infections are more prevalent in immunoco...	background : the incidence of mycobacterium marinum infection has been increasing . first - line antituberculous drugs and other common antibiotics are effective for most cutaneous m. marinum infections ; however , treatment failure still occurs in some rare cases . we report a case of a 70-year - old man with refr...
primary hyperparathyroidism is rarely a part of multiple endocrine neoplasia type 1 ( men-1 ) syndrome with familial occurrence . the genetic background of this syndrome offers a unique opportunity to review a pathomechanism of tumourigenesis that may be also operative in some sporadic tumours . the classic clinica...	primary hyperparathyroidism may occur as a part of an inherited syndrome in a combination with pancreatic endocrine tumours and/or pituitary adenoma , which is classified as multiple endocrine neoplasia type 1 ( men-1 ) . this syndrome is caused by a germline mutation in men-1 gene encoding a tumour - suppressor prot...
an estimated 4.4% of adults in the united states are affected by attentiondeficit hyperactivity disorder ( adhd ) 1 , which is characterized by a persistent pattern of inattention , hyperactivity , and/or impulsivity at all ages 2 . atomoxetine ( atx ) is a selective norepinephrine reuptake inhibitor indicated for th...	summaryaimto compare atomoxetine ( atx ) length of therapy ( lot ) among adults with adhd who reached the recommended dose of 80 mg / day ( atx 80 ) versus those who did not ( atx < 80 ) analyzed separately in patients prescribed atx as monotherapy ( mono ) and in combination with other adhd medications ( combo)....
although the industrial production of polychlorinated biphenyls ( pcbs ) has been banned worldwide under the stockholm convention , pcbs still represent a significant environmental and human health concern . specifically , pcbs continue to be released into the environment from building materials and other sit...	to understand the role of hepatic vs extrahepatic metabolism in the disposition of chiral pcbs , we studied the disposition of 2,2,3,3,6,6-hexachlorobiphenyl ( pcb 136 ) and its hydroxylated metabolites ( ho - pcbs ) in mice with defective hepatic metabolism due to the liver - specific deletion of cytochrome ...
lung cancer is the most common cause of metastasis to the central nervous system ( 1 ) . the brain is also one of the most commonly involved organs in metastases from non - small cell lung cancer ( nsclc ) ( 2 ) . unfortunately , once metastatic brain disease become clinically apparent , the cancer usually has alre...	this study is a retrospective examination of our experiences with patients who underwent treatment of isolated synchronous brain metastases coupled with primary non - small cell lung cancer . from january 1995 to june 2004 , 12 patients presented with isolated synchronous brain metastases coupled with primary non - sma...
	cancer is a worldwide public health concern . identifying carcinogens and limiting their exposure is one approach to the problem of reducing risk . currently , epidemiology and rodent bioassays are the means by which putative human carcinogens are identified . both methods have intrinsic limitations : they are sl...
. clinical features of the disease vary from asymptomatic to symptomatic lymphadenopathy accompanied by fever , malaise and/or weight loss . based on the histological findings cd is divided into two variants the hyaline vascular variant ( hvv ) and the plasma cell variant ( pcv ) . when disease location is consider...	castleman disease ( cd ) is a rare lymphoproliferative disorder of unknown etiology with different clinical manifestations . a previous healthy 50 year - old man was hospitalized for right upper quadrant ( ruq ) abdominal pain . he had jaundice and a 1 cm - sized lymph node in the right supraclavicular area . pan...
trichotillomania is a common impulse control disorder seen in both children and adults characterized by the intense urge to pull out one 's hair which then results in hair loss over the scalp , eyebrows , and/or pubic areas . pulling is often caused or preceded by stress and anxiety which is then relieved after the h...	trichotillomania is a disorder of an impulsive hair pulling that occurs in both adults and children alike . trichotillomania is seen in children and often has other psychiatric comorbidity . here , we present an interesting case of a mother who had trichotillomania and recovered with treatment following which she r...
regional anesthesia is the recommended technique for upper and lower limb surgeries with better postoperative profile . considerable research has been conducted over years in order to determine the ideal local anesthetic ( la ) drug . an ideal drug should have a fast sensory onset , differential offset , with an ea...	background and aims : regional anesthesia is a recommended technique for upper and lower limb surgeries with better postoperative profile . in this , randomized , double - blind study , we evaluated the effectiveness of the addition of dexmedetomidine to varying concentration of levobupivacaine for supra clavicular bra...
the first case of hiv was reported in nepal in 1988 , thereafter , there was a trend for increasing numbers of infections being recorded among specific groups of the population and in the low - risk general population for 20 years . although nepal 's hiv control programme has achieved some progress in reducing the in...	abstractbackground and objectivesnepal has made progress with the control of hiv infection in recent years . there have been changes in epidemiology , programme interventions in different population groups , and changes in policies over the last 10 years , particularly in diagnosis and treatment . therefore , this ...
the term acute coronary syndrome ( acs ) encompasses a range of thrombotic coronary artery diseases , including unstable angina ( ua ) , and both st segment elevation ( stemi ) and non - st segment elevation myocardial infarction ( nstemi ) , mostly induced by local coronary thrombosis as an acute complication of a...	background and objectives : the acute - phase reactant c - reactive protein ( crp ) has been shown to reflect systemic and vascular inflammation and to predict future cardiovascular events . the objective of this study was to evaluate the prognostic value of crp in predicting cardiovascular outcome in patients presen...
general physical examination at age 15 years showed : height 113 cm ( <3 percentile ) , weight 10 kg ( <3 percentile ) , and head circumference 48 cm . he was apparently well up to the age of 18 months , later he developed failure to thrive , loss of hair , prominent eyes and joints , and senile appearance . system...	the hutchinson - gilford progeria ( hgp ) syndrome is an extremely rare genetic condition characterized by an appearance of accelerated aging in children . the word progeria is derived from the greek word progeros meaning prematurely old. it is caused by de novo dominant mutation in the lmna gene ( gene map locus 1...
osteonecrosis of the knee , first reported by ahlback et al.1 ) is characterized by severe pain of sudden onset on the medial side of the knee . the etiology of osteonecrosis has not yet been clearly elucidated , but possible causative factors include sickle cell anemia , gaucher disease , caisson disease , corticost...	osteonecrosis of the femoral condyle is known as an uncommon complication after arthroscopic meniscectomy . the lesion of osteonecrosis can be irreversible , thus early detection of the disease is crucial for treatment . a 50-year - old male patient without known risk factors of osteonecrosis developed increasing kne...
consumers interest in the relationship between diet and health has increased the demand for information about the specific health characteristics of food . it is well known that food can contain ingredients that may have physiological benefits and/or reduce the risk of chronic disease , or even represent significant ...	the bioactive compounds -aminobutyric acid ( gaba ) and biogenic amines ( ba ) , together with protein - free amino acids , were measured by high - performance liquid chromatography in ewe s milk cheeses produced in sardinia with different technological traits . the study included three types of cheese : pecorino sar...
in postmortem studies , dementia with lewy bodies ( dlb ) accounts for 1020% of all cases of dementia and can therefore be regarded as the second most common cause of dementia after alzheimer 's disease ( ad ) . for a definite diagnosis , autopsy is required . however , confirmation of the diagnosis during the patien...	clinically , alzheimer 's disease ( ad ) is by far the most common cause of dementia . criteria for the diagnosis of dementia with lewy bodies ( dlb ) are highly specific but not at all sensitive , which is reflected by the higher number of dlb cases detected histopathologically at autopsy . imaging of dopamine tra...
highly active antiretroviral therapy ( haart ) has improved the prognosis of patients with human immunodeficiency virus ( hiv ) infection by significantly reducing related morbidity and mortality.1,2 early treatment protocols , many of which are still recommended , contain two nucleoside reverse transcriptase inhibitor...	an extended - release formulation of nevirapine ( nvp - xr ) has been developed with the aim of simplifying antiretroviral treatment regimens and improving patients adherence with a single daily intake . the verxve and tranxition clinical trials have demonstrated the noninferiority of nvp - xr compared with nevirapin...
the vagina and cervix are the first lines of physical and immunological defense against sexually transmitted pathogens [ 1 , 2 ] . the presence of potentially pathogenic microorganisms , including protozoans , yeast , bacteria , and viruses , initiate the immune response and result in increased vaginal secretion of i...	objective . to verify the relationship between vaginal ph and human papillomavirus ( hpv ) infection and to measure cytokine levels in endocervical secretions of women with bacterial vaginosis ( bv ) or hpv . methods . 173 women ( 1648 years old ) were enrolled and divided into groups : bv , hpv , and controls . mi...
exaggerated innate immune / inflammatory responses in the brain are now thought to be a common core in the etiology of numerous psychiatric disorders such as depression , ptsd and bipolar disorder ( jones and thomsen , 2013 ) . seemingly unrelated to neuroinflammation , the experience of life stressors is a predisposin...	stress and glucocorticoids ( gcs ) have universally been considered to be anti - inflammatory , however in recent years , stress and gcs have been found to exert permissive effects ( immunological priming ) on neuroinflammatory processes . this phenomenon of priming is characterized by prior stress or gc exposure pot...
in this study of human infections by snv in boulder county , colorado , we identified 2 patients who had trapped rodents for ecologic studies . on june 14 , 2005 , a 24-year - old man was admitted to boulder community hospital with fatigue , headache , fever , and thrombocytopenia ( 70,000 platelets/l ) but without c...	we report 2 cases of sin nombre virus ( snv ) infection in field workers , possibly contracted through rodent bites . screening for antibodies to snv in rodents trapped in 2 seasons showed that 9.77% were seropositive . quantitative real - time pcr showed that 2 of 79 deer mice had detectable titers of snv rna .
thrombotic thrombocytopenic purpura ( ttp ) is a rare acquired or congenital disorder with an annual incidence of six cases per million ( 1 ) . its pathogenesis involves an imbalance between von willebrand factor ( vwf ) multimers and adamts13 . if there is a gene mutation existing congenitally leading to absent or...	thrombotic thrombocytopenic purpura ( ttp ) is a rare multisystem microvascular disorder , which is characterized by pentad of thrombocytopenia , microangiopathic hemolytic anemia , and organ dysfunction due to occlusive thrombi . the proposed pathophysiology involves an imbalance between unusually large von willebra...
records were collected between november 2004 and february 2010 , from 197 client - owned dogs with documented pulmonary edema . we evaluated the records of the first onset of pulmonary edema ( dyspnea , cough and tachypnea ) in dogs with mitral regurgitation , retrospectively . dogs were included , if they had ...	the aim of this study was to evaluate the efficacy of pimobendan with conventional therapies on survival and reocurrence of pulmonary edema in dogs with congestive heart failure ( chf ) caused by myxomatous mitral valve disease ( mmvd ) . records of 197 client - owned dogs from 14 veterinary hospitals were included...
the -adrenergic receptor ( -ar ) plays an essential role in normal physiologic functions and consists of catecholamines and their corresponding receptors , including the - and -ar families . the sympathetic nervous system regulates the body 's fight or flee response through the -adrenergic pathway . increasing ev...	abstract-blockers have been reported to exhibit potential anticancer effects in cancer cell lines and animal models . however , clinical studies have yielded inconsistent results regarding cancer outcomes and cancer risk when -blockers were used . this study investigated the association between propranolol and canc...
paroxysmal nocturnal hemoglobinuria ( pnh ) is an acquired clonal hematopoietic stem cell disorder characterized by a variety of clinical manifestations , including the classic triad of chronic intravascular hemolysis , thrombotic events , and bone - marrow ( bm ) failure . somatic mutation of x - linked gene pig - a...	backgroundcomplement has the potential to provoke severe impairment to host tissues , as shown in autoimmune diseases where complement activation has been associated with diminished cd55 and/or cd59 expression on peripheral blood cell membranes . the aim of this study was to evaluate the presence of cd55- and/or cd59...
copd is associated with significant morbidity and health care costs , and though current pharmacologic treatments have modest benefits , adjunctive pulmonary rehabilitation ( pr ) has been shown to substantially impact patient outcomes.1,2 the minimum recommended duration of therapy for pr is 8 weeks , and successful c...	backgrounddespite known benefits , a significant proportion of patients with copd do not complete pulmonary rehabilitation ( pr ) . little is known regarding which factors promote successful completion of pr.methodswe analyzed data from a prospectively maintained database of subjects with copd who attended a pr progr...
treatment involves excision of the accessory urethra usually through a suprapubic open approach . we report a novel use of extra peritoneal pelvic laparoscopic approach to disconnect accessory urethra from normal urethra in complete urethral duplication . a 10-year - old boy presented with stress incontinence , splay...	we report an extraperitoneal pelvic laparoscopic approach to disconnect accessory urethra from normal urethra in complete urethral duplication . first stage consisted of chordee correction , partial excision of the accessory urethra and glansplasty . in the second stage the remaining accessory urethra was disconnecte...
hepatitis e virus ( hev ) is a major cause of acute viral hepatitis in developing countries ( 1 , 2 ) . the viral genome is represented by a positive - sense single - stranded rna of about 7.2 kb that contains three partially overlapping open reading frames ( orfs ) . orf1 encodes a non - structural protein with di...	backgroundhepatitis e virus ( hev ) , a major cause of acute viral hepatitis in developing countries , has been classified into four main genotypes and a number of subtypes . new genotypes have been recently identified in various mammals , including hev genotype 3 , which has a worldwide distribution . it is widesp...
the progressive loss of height in a motion segment coupled with subluxation of the facet joints leads to changes in biomechanical forces and hypertrophy of the ligamentum flavum and spondylophyte formation around the facet joints . together the combination of a loss of height in the intervertebral space and the appos...	abstractspinal canal stenosis is a dynamic phenomenon that becomes apparent during spinal loading . current diagnostic procedures have considerable short comings in diagnosing the disease to full extend , as they are performed in supine situation . upright mri imaging might overcome this diagnostic gap.this study i...
shivering , a common post - anaesthesia occurrence is defined as an involuntary , repetitive activity of skeletal muscles . the incidence of shivering has been found to be quite high , approximately 40 - 50% in different studies . shivering also increases intraocular and intracranial pressure , and may contribute t...	background and aims : dexmedetomidine ( 2 adrenergic agonist ) has been used for prevention of post anaesthesia shivering . its use for the treatment of post - spinal anaesthesia shivering has not been evaluated . the aim of this study was to evaluate and compare the efficacy , haemodynamic and adverse effects of d...
understanding major adverse events and patient - reported outcomes ( pros ) after acute myocardial infarction ( ami ) is fundamental to improving the quality and effectiveness of health care . with the emergence of validated instruments to measure health status , physical function , and other pros , several observation...	background : despite the rapid growth in the incidence of acute myocardial infarction ( ami ) in china , there is limited information about patients experiences after ami hospitalization , especially on long - term adverse events and patient - reported outcomes ( pros).methods : the china patient - centered evaluative ...
type 2 diabetes ( t2d ) mellitus is a chronic metabolic disease with epidemic proportions . its global prevalence was estimated to be 6.4% worldwide ( 285 million adults in 2010 ) and is predicted to rise to approximately 7.7% ( 439 million ) by 2030 . t2d is a multifactorial disorder resulting from an interactio...	pancreatic cell failure leads to diabetes development . during disease progression , cells adapt their secretory capacity to compensate the elevated glycaemia and the peripheral insulin resistance . this compensatory mechanism involves a fine - tuned regulation to modulate the endoplasmic reticulum ( er ) capacity...
a total of 897 clinical specimens were collected from february 2007 to january 2008 and transported to the national influenza center . two hundred and two samples belonged to children under the age of six from 897 specimens , described above , were selected . then they were tested for influenza virus types and s...	background : respiratory virus infections in children are a leading cause of morbidity and mortality worldwide.methods:a total of 897 clinical specimens were collected from february 2007 to january 2008 and transported to the national influenza center . two hundred and two samples belonged to children under the age o...
	in the present study , the antioxidant activity of successive leaf extracts of dracaena reflexa was investigated using the scavenging activity on 1,1-diphenyl-2-picrylhydrazyl and reducing power by ferric reducing antioxidant power assay . methanol extract was found potent in both the assays . ic50 values of 1,1-di...
sino - nasal undifferentiated carcinoma ( snuc ) is a rare malignancy first described by frierson et al . , as an aggressive neoplasm that was clinico - pathologically distinct from other poorly differentiated malignancies of the nasal cavity and sinuses . snuc is believed to originate from schneiderian epithelium ...	malignant neoplasms of the paranasal sinuses and nasal cavity are rare , comprising only 3% of all head and neck malignancies . this includes both primary sinonasal neoplasms and metastatic disease . we present the case of a patient with a maxillary soft tissue swelling , which proved to be a rare malignant tumor o...
lichen striatus ( ls ) is an uncommon , asymptomatic , self - limiting dermatosis which lasts an average of nine months and usually occurs in children , although it is also rarely seen in adults . it often arises without a clear trigger , but some cases would appear to be related to several possible precipitating eve...	lichen striatus ( ls ) is an uncommon dermatosis of unknown etiology that presents as a continuous or interrupted linear band of pink , tan , red or skin - colored papules in a blaschkoid distribution . the lesions are generally solitary and unilateral , but unusual extensive cases with multiple and bilateral lesions...
gastrinomas are neuroendocrine tumors ( net ) , primarily located in the duodenum or pancreas . gastrin overproduction causes the zollinger - ellison syndrome , which includes ulceration of the gastrointestinal tract , mainly the jejunum , resulting in abdominal pain and diarrhea . the incidence of gastrinomas is 0...	background . gastrinomas are rare functional neuroendocrine tumors causing the zollinger - ellison syndrome ( zes ) . at presentation , up to 25% of gastrinomas are metastasized , predominantly to the liver . embolization of liver metastases might reduce symptoms of zes although a postembolization syndrome can occur ...
mucinous cystic tumors of the ovary rarely contain one or more solid mural nodules in which the histological features differ markedly from the background of benign , borderline or malignant mucinous neoplasms . four varieties of mural nodules have been described , including true sarcomas , sarcoma - like mural nodule...	sarcoma - like mural nodule ( slmn ) is a very uncommon and misleading benign entity which may be associated with benign , borderline or malignant mucinous neoplasm of the ovary . it should be distinguished from other malignant mural nodules with sarcoma , carcinosarcoma or anaplastic carcinoma for proper management ...
in 1987 , researchers hunting for cytotoxic cell surface molecules isolated a cdna from activated cd8 t cells and called it cytotoxic t cell antigen ( ctla)-4 ( 2 ) . genetic studies provided a clue that connected ctla-4 to t cell costimulation : ctla-4 and cd28 both mapped to the same chromosomal neighborhood and sh...	ctla-4 was first identified in 1991 as a second receptor for the t cell costimulation ligand b7 . uncertainties about its biological function plagued the early years after its discovery until 1995 , when it was confirmed to be an inhibitor of t cell responses . ctla-4 has since scored in the clinic as a target for ...
adolescent idiopathic scoliosis ( ais ) is the most common pediatric musculoskeletal disorder that affects the spine and is characterized by a three - dimensional deformity of the spine , and altering coronal and sagittal profiles . brace treatment is the most common non - operative intervention for the prevention of...	backgroundseveral studies have described the differences in electromyographic activity and histological changes of paravertebral muscles in patients with adolescent idiopathic scoliosis ( ais ) . however , there is little knowledge about the muscle volumetric and fatty infiltration imbalance of patients with ais.mate...
participants were employees of the tokyo gas company that supplies natural gas to the tokyo area . all employees received annual health checkups and completed a health questionnaire in accordance with the industrial safety and health law . the participants for this study were 5,984 male employees who had participat...	objectivewhereas single assessments of cardiorespiratory fitness have been shown to predict lower incidence of type 2 diabetes , there are no data on long - term trends in fitness and risk . we investigated the relationship between long - term trends in fitness and the incidence of type 2 diabetes.research design and...
by the end of 20 century , hepatitis c virus ( hcv ) started to emerge as a global threat with around 170 million people infected worldwide1 . the virus is a blood borne pathogen and the high risk group includes patients undergoing blood transfusions , intravenous drug users , renal patients undergoing frequent dialy...	chronic hepatitis c infection poses a major global health predicament and appears to be potent threat to mankind . the treatment in wide use is interferon / ribavirin combination therapy which is generally effective in about 60 - 70 per cent of patients carrying genotype 3 and causes significant morbidity . the res...
in mammalian cells the position of the golgi correlates with that of the microtubule ( mt)-organizing center or centrosome ( kupfer et al . , 1982 ) . disruption of normal mt cytoskeleton dynamics with antibodies or agents such as colchicine and nocodazole that cause mt depolymerization , or paclitaxel , which stabil...	one of the characteristics of the mammalian golgi is its position adjacent to the nucleus . this characteristic is maintained through the action of the microtubule ( mt ) minus end directed motor dynein and mt - associated proteins ( maps ) . recent findings suggest that gmap-210 , a member of the golgin family of...
laparoendoscopic single - site surgery ( less ) in urology was first described by rane et al . . the less approach has been utilized for various indications in adults , including donor nephrectomy , simple nephrectomy , and reconstructions such ureteral reimplantation and pyeloplasty . the safety and efficacy of th...	purposewe report our experience with laparoendoscopic single - site ( less ) urological procedures in children less than 5 years of age.materials and methodsten patients ( 11 procedures ) underwent less through the umbilicus . seven patients underwent nephrectomy and three patients underwent pyeloplasty ( one simulta...
the authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest .	in neurons a well - defined source of signaling ca2 + is the extracellular medium . however , as in all metazoan cells , ca2 + is also stored in endoplasmic reticular compartments inside neurons . the relevance of these stores in neuronal function has been debatable . the orai gene encodes a channel that helps re...
ovarian cancer has the highest fatality - to - case ratio of all gynecologic malignancies [ 1 , 2 ] . this is attributed to the lack of early warning signs and efficacious early detection techniques [ 1 , 3 ] . another problem hindering the successful management of the disease is the paucity in prognostic...	recent reports from our laboratory and others support the seldi proteinchip technology as a potential clinical diagnostic tool when combined with n - dimensional analyses algorithms . the objective of this study was to determine if the commercially available classification algorithm biomarker patterns softw...
the anastomotic complications after primary repair of esophageal atresia ( ea ) are well recognized and can significantly increase the morbidity . the management options for an anastomotic leak ( al ) vary from conservative management to reoperation . a major al may require esophageal diversion that leads to discar...	aims : to investigate the role of feeding jejunostomy ( fj ) in patients of esophageal atresia with anastomotic leak ( al ) to decrease the degree of gastroesophageal reflux ( ger ) and its effect on anastomotic healing.materials and methods : twenty neonates , with major al and severe ger after primary repair were man...
the author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest .	amphibians are important vertebrates in toxicology often representing both aquatic and terrestrial forms within the life history of the same species . of the thousands of species , only two have substantial genomics resources : the recently published genome of the pipid , xenopus ( silurana ) tropicalis , and transcrip...
collision cancers are malignancies in the same organ or anatomical site that comprises at least two different tumor components , with no mixed or transitional area between the two components . , it is known that the prognosis of collision cancer is very poor even after radical resection . herein , we present a case...	herein , we present a case of coexisting neuroendocrine carcinoma and conventional adenocarcinoma ( collision tumor ) in the ampulla of vater , which has seldom been reported in the literature . a 51-year - old man presented with a month history of jaundice . mrcp disclosed about 1.91.8 cm sized heterogeneously enhan...
urate ( uric acid ) is the major inert end product of purine degradation in humans and higher primates in contrast to most other mammals because of the genetic silencing of hepatic enzyme uricase , which is oxidized to water soluble allantoin1 ) , and serum urate concentration is determined by the balance between produ...	renal handling of uric acid mainly occurs in the proximal tubule , and bidirectional transport of urate may involve apical absorption via the urate - anion exchanger ( urat1 ) and basolateral uptake via organic anion transporters ( oat1 and oat3 ) . in rat kidneys , we investigated whether the protein abundance of urat...
one woman is sexually assaulted in canada every minute ( 1 ) . sexual assault is any form of sexual contact without voluntary consent andthat violates a person 's sense of autonomy , control and mastery over their body ( 2 ) . at the university of alberta , recovery from sexual- assault- related posttraumatic stress ...	sexual assault occurs with alarming frequency in canada . the prevalence of posttraumatic stress disorder ( ptsd ) in assault survivors is drastically higher than the national prevalence of the disorder , which is a strong indication that the current therapies for sexual - assault - related ptsd are in need of improv...
born of the prophet muhammad s favorite daughter , fatimah , al - hasan was declared as the legitimate successor of his father , ali ibn - abi - talib ( the last of the caliphs known to arab historians as orthodox ) , in 661 . faced by his rival , muawiyah ibn - abi - sufyan , who had been proclaimed caliph in 660 i...	the puzzle of a mysterious death in the middle ages has been hypothesized in terms of contemporary forensic legal and scientific methods . that al - hasan ibn-ali died in 669 aged just 45 has been forensically analyzed based on written sources that dictate eyewitness accounts of historical events . the report of th...
	when using the mass balance equation to model indoor air quality , the primary assumption is that of uniform mixing . different points in a single compartment are assumed to have the same instantaneous pollutant concentrations as all other points . although such an assumption may be unrealistic , under certain cond...
ecstatic experiences have been reported in every major religion , and psychologists have long advocated research in these areas [ 1 , 2 ] . neuroscience can contribute to these issues by documenting the brain activity of expert meditators , some of whom have trained to enter these states with volitional control . t...	we report the first neural recording during ecstatic meditations called jhanas and test whether a brain reward system plays a role in the joy reported . jhanas are altered states of consciousness ( asc ) that imply major brain changes based on subjective reports : ( 1 ) external awareness dims , ( 2 ) internal verbal...
bronchodilator drugs significantly decrease airway resistance in patients with obstructive lung disease , as well as in patients with acute lung injury [ 2,3,4 ] . in patients with obstructive lung disease ( chronic obstructive pulmonary disease [ copd ] or asthma ) , these drugs are part of the standard therapy ...	the delivery of bronchodilators with metered - dose inhaler ( mdi ) in mechanically ventilated patients has attracted considerable interest in recent years . this is because the use of the mdi has several advantages over the nebulizer , such as reduced cost , ease of administration , less personnel time , reliability...
coronary heart disease ( chd ) and stroke are leading causes of death in the usa and globally . elevated serum low - density lipoprotein ( ldl ) has been identified as a major risk factor for chd.1 epidemiological studies have shown a relationship between dietary cholesterol and chd risk , and early metabolic studies h...	backgroundthis study reviewed epidemiological and experimental evidence on the relationship between egg consumption and cardiovascular disease ( cvd ) risks among type ii diabetes mellitus ( t2 dm ) individuals , and t2 dm risk in nondiabetic subjects.resultsfour of the six studies that examined cvd and mortality and e...
extramammary paget 's disease ( empd ) is a rare cutaneous , intraepithelial adenocarcinoma involving primarily the epidermis but occasionally extending into the underlying dermis which accounts for < 1% of carcinomas in vulva and majority of the patients are postmenopausal females . it presents with a long - standin...	extramammary paget 's disease is a rare cutaneous , intraepithelial adenocarcinoma involving primarily the epidermis but occasionally extending into the underlying dermis . the condition typically presents as a red , velvety , pruritic skin rash of the vulva region which closely mimics a multitude of other , more com...

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