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in the previous issue of critical care , friesecke and colleagues demonstrate that the survival rate of patients with severe lactic acidosis due to metformin accumulation can be strikingly higher than expected based on the initial clinical evaluation . metformin is nowadays the first - line drug of choice for the tre...	metformin is a safe drug when correctly used in properly selected patients . in real life , however , associated lactic acidosis has been repeatedly , although rarely , reported . the term metformin - induced lactic acidosis refers to cases that can not be explained by any major risk factor other than drug accumulati...
in june 2003 , an outbreak of plague emerged in the oran area of algeria ( 4 ) . during the following weeks , a total of 11 confirmed and all cases were bubonic plague ; septicemia and coma later developed in 2 patients . according to national health records , the last outbreak in oran was in 1946 and the last huma...	after an outbreak of human plague , 95 xenopsylla cheopis fleas from algeria were tested for yersinia pestis with pcr methods . nine fleas were definitively confirmed to be infected with y. pestis biovar orientalis . our results demonstrate the persistence of a zoonotic focus of y. pestis in algeria .
the patient - centered scalable national network for effectiveness research ( pscanner ) is a consortium of three existing networks that together constitute a highly diverse patient population with respect to insurance coverage , socioeconomic status , demographics , and health conditions . system characteristics of ...	this article describes the patient - centered scalable national network for effectiveness research ( pscanner ) , which is part of the recently formed pcornet , a national network composed of learning healthcare systems and patient - powered research networks funded by the patient centered outcomes research institute (...
initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney . renovascular hypertension , primary hyperadosteronism and pheocromocytoma are potential diagnosis that must not be forgotten and should be excluded . although rare , chronic pyelonephritis and renal tumors as rennin - producing...	main findings a 25-year - old hypertensive female patient was referred to our institution . initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney . she underwent laparoscopic partial nephrectomy without complications . histopathologic examination revealed a rare juxtaglomerular ...
diseases with symptoms of edema that are encountered a medical institutions vary from internal diseases ( e.g. , kidney , liver , heart , and endocrine diseases ) to orthopedic diseases , central nerve disease , and malignant tumors . generally , edema exceeds a physiological compensatory function to an interstit...	[ purpose ] to develop and verify the reliability of a new practical evaluation method for pitting edema , which uses the depth of the surface imprint as an indicator . [ subjects ] we included 26 inpatients ( 52 legs ) . [ methods ] the subjects were diagnosed with edema , and we verified the inter- and intra ...
western society is currently faced with an increasing incidence of vascular diseases such as hypercholesterolemia and atherosclerosis , mainly as a consequence of unhealthy lifestyle habits , an increase in obesity , and an aging population . vascular diseases and obesity are risk factors for disorders that affect co...	atherosclerosis and apolipoprotein e 4 ( apoe4 ) genotype are risk factors for alzheimer 's disease ( ad ) and cardiovascular disease ( cvd ) . sex differences exist in prevalence and manifestation of both diseases . we investigated sex differences respective to aging , focusing on cognitive parameters in apoe4 and...
	because of their unique electronic properties , cyclic molecular structures ranging from benzene to natural light - harvesting complexes have received much attention . rigid -conjugated templated porphyrin nanorings serve as excellent model systems here because they possess well - defined structures that ca...
environmental variations affect the nutritional composition of food resources . a common example is animals encountering different quality of food depending on a dry or rainy season . this phenomenon is less evident in human agricultural populations , in which efforts are devoted to maintain consistent food resources...	animals thrive in environments where food resources are abundant . while this correlation between population growth and food abundance is well established , much less is known about the influence of diet quality on physiological and developmental programs that support animal reproduction . here we discuss dietary i...
the treatment of orbital floor fractures with silastic sheet was prominent , until the advent of the titanium plate . it was an adequate treatment ; however , it had a tendency to migrate through the skin . diplopia when present for months tends to be difficult to resolve surgically , and what makes this case uniqu...	a 54-year - old male sustained a fractured right orbital floor 33 years ago , which was treated with a silastic implant . his diplopia never resolved , and he presented to us with an acute orbital cellulitis . computerized tomography showed a displaced inferior rectus and entrapment of both inferior and medial rect...
the liver is the largest internal organ in the body and performs many important functions , so it is not surprising that diseases of the liver are a major cause of morbidity and mortality throughout the world . among the most common liver disorders hcv infection is considered a major worldwide public health problem w...	background : hepatitis - c virus ( hcv ) infection is considered a major worldwide public health problem with a global prevalence . maintenance of skin homeostasis requires a delicate balance between proliferation , differentiation , and apoptosis . meanwhile , it is unclear if there is an altered keratinocyte prol...
ligand - gated ion channels ( lgics ) are multimeric membrane proteins that play an important role in fast synaptic transmission and in the modulation of cellular activity . they are involved in many neurological disorders , such as alzheimer s disease , anxiety , epilepsy , and learning and attention deficit , and a...	transcis isomerization of a proline peptide bond is a potential mechanism to open the channel of the 5-ht3 receptor . here , we have used the metadynamics method to theoretically explore such a mechanism . we have determined the free energy surfaces in aqueous solution of a series of dipeptides of proline analogues...
the incidence of hbv or hcv - associated viral hepatitis is increasing , along with the incidence of hepatocellular carcinoma ( hcc ) . however , advances in diagnostic imaging techniques such as ultrasonography , computed tomography ( ct ) , and magnetic resonance imaging ( mri ) now enable early detection and diagn...	radiofrequency ablation has been applied to treat hepatocellular carcinoma , with favorable therapeutic outcomes . nevertheless , practitioners have approached radiofrequency ablation with some reluctance due to the difficulty of identifying isoechoic tumors and recurrent tumors . the aim of the present study is to...
a 49yearold woman suspected of having a right optic neuritis was referred to the neurology department . she had been diagnosed with systemic lupus erythematosus ( sle ) 10 years earlier , and , at the time of presentation , she was receiving azathioprine 50 mg three times a day , prednisone 5 mg daily , and belimumab...	key clinical messageorbital inflammatory pseudotumor is a rare complication of systemic lupus erythematosus . it may present a challenge for differential diagnosis , especially in the context of treatment with hydroxychloroquine , although dosage and duration of the treatment may guide us . although high antibody t...
open surgical repair with graft implantation has been the standard therapy for patients with asymptomatic descending aortic aneurysms larger than 5 - 6.5 cm , while aortic dissections without complications generally have been treated conservatively , . within the last years , new and much less invasive treatment modali...	methods : 21 patients ( 17 men , 4 women ; mean age 66.1 years , range 29 - 90 years ) with 15 true aneurysms , and 6 type b - dissections were treated by implantation of a talenttm endoluminal stentgraft system from february 2000 to july 2003 . in 3 cases it was necessary to overstent the left subclavian artery , in 1...
many potential kidney transplant recipients are unable to receive a live donor transplant due to cross - match or blood type incompatibility . kidney paired donation ( kpd ) increases access to live donor transplantation . from its first realization as an exchange of kidneys between two incompatible donor / recipient...	providing transplantation opportunities for patients with incompatible live donors through kidney paired donation ( kpd ) is an important strategy for easing the crisis in organ availability . kpd is can overcome the barriers when the only living potential donors are deemed unsuitable owing to an incompatibility of b...
many simple rhythmic behaviors are controlled by specialized central pattern generator ( cpg ) networks in the spinal cord or brainstem with intrinsic oscillatory characteristics ( grillner , 2006 ; kiehn , 2006 ) . however , goal - directed upper - limb movements under cortical control can also exhibit rhythmicity ....	summaryupper - limb movements are often composed of regular submovements , and neural correlates of submovement frequencies between 1 and 4 hz have been found in the motor cortex . the temporal profile of movements is usually assumed to be determined by extrinsic factors such as limb biomechanics and feedback delays...
re - methylation of homocysteine ( hcy ) to methionine constitutes one of the most important reactions catalysed in one - carbon metabolism . there are numerous factors that influence hcy level including age , gender , cigarette smoking , alcohol consumption , various medications and polymorphisms in genes encoding e...	accumulating evidence indicates that elevated homocysteine ( hcy ) level occurs in first - episode schizophrenia ( fes ) patients . we included 56 fes patients and 53 healthy controls ( hc ) . plasma level of hcy was significantly higher in fes patients than hc ( p = 0.044 ) . in addition , plasma levels of hig...
square turning is frequently used for corners , and semicircular turning is often used to avoid obstacles during activities of daily living1 . balance is challenged during turning gaits , and this is one of the most common reasons for falls by older adults1 , 2 . many older adults have decreased postural stabil...	[ purpose ] the purpose of this study was to investigate gait velocity and center of mass ( com ) during square and semicircular turning gaits between two groups of elderly people with differing visual acuity . [ subjects ] twenty elderly korean women who could walk independently and who lived in the community ...
ependymomas are rare forms of primary brain tumors , accounting for 37% of all brain tumors [ 1 , 2 ] . ependymomas , composed of neoplastic ependymal cells , are thought to arise from the ependymal cells in the ventricular system . the majority occur infratentorially in the pediatric population , while a smaller f...	ependymomas , tumors of the ependymal cells , are very rare and usually present in the pediatric population . furthermore , there are even rarer variants of ependymomas that can include cellular , papillary , clear cell , and tanycytic subtypes . we present a case of a supratentorial tanycytic ependymoma in an adult ...
malaria accounts for the highest cause of mortality in africa with 90% of the global malaria deaths occurring on this continent . it constitutes 9% of the disease burden to the people of africa and is responsible for 25% of deaths below the age of five years . susceptibility to malaria is increased by up to 3-fold ...	malaria infections undetectable by microscopy but detectable by polymerase chain reaction ( pcr ) ( submicroscopic malaria ) are common in endemic areas like ghana . submicroscopic malaria has been linked with severe pregnancy outcomes as well as contributing to malaria transmission . in this cross - sectional study ...
the assessment of left ventricular mechanical dyssynchrony ( lvd ) using phase analysis of gated myocardial perfusion single - photon emission computed tomography ( spect ) ( mps ) was introduced in 2005 , allowing for the simultaneous assessment of left ventricular ( lv ) perfusion , function , and mechanical dyssynch...	purpose of the study : normal values of cardiac mechanical synchrony parameters in gated myocardial perfusion single - photon emission computed tomography ( gmps ) are well established in literature from the western population . the aim of the study is to establish normal values of mechanical synchrony with gmps in i...
discontinuation of anticoagulated drugs when a minor oral surgery is to be undertaken has been a common practice . multiple studies , however , reported this concept to be associated with high potential risks , and that minor surgeries can be performed safely in anticoagulated patients without interruption of the dru...	objectives : the management of patients receiving oral anticoagulant therapy ( oat ) undergoing minor oral surgeries is controversial . this study was designed to evaluate the correlation between international normalized ratio ( inr ) values and the sufficiency of two different local hemostatic measures in controllin...
overuse tendon injuries , namely , tendinopathies , pose a significant clinical problem in musculoskeletal medicine . the intrinsic pathogenetic mechanisms underlying the development of tendinopathies are largely unknown [ 2 , 3 ] ; however , several model systems have recently implicated proinflammatory cytokines [ ...	the pathogenetic mechanisms underlying tendinopathy remain unclear , with much debate as to whether inflammation or degradation has the prominent role . increasing evidence points toward an early inflammatory infiltrate and associated inflammatory cytokine production in human and animal models of tendon disease . the...
it is accepted that surgical treatment of super superobese patients ( bmi > 60 kg / m ) and high - risk patients with comorbidities , is responsible for an increased risk of postoperative morbidity and mortality after bariatric surgery [ 1 , 2 ] . sleeve gastrectomy is a recently used surgical technique , with an ac...	objective . this prospective study evaluated laparoscopic sleeve gastrectomy for its safety and efficiency in excess weight loss ( % ewl ) in super superobese patients ( bmi > 60 kg / m2 ) . results . thirty patients ( 33 women and 7 men ) were included , with mean age of 35 years ( range 18 to 59 ) . mean pre...
the pas - gaf - phy and pas - gaf fragments from deinococcus radiodurans were expressed in the escherichia coli strain bl21 ( de3 ) and purified by affinity and size - exclusion chromatography . crystallographic data was collected at beamline id23 - 1 of the esrf ( see extended data table 1 ) . time - resolved x - ...	sensory proteins must relay structural signals from the sensory site over large distances to regulatory output domains . phytochromes are a major family of red - light sensing kinases that control diverse cellular functions in plants , bacteria , and fungi.1 - 9 bacterial phytochromes consist of a photosensory core a...
magnetic resonance imaging ( mri ) is one of the major imaging modalities in use today . compared to computed tomography ( ct ) , mri has advantages in imaging soft tissues . however , its relatively long imaging time remains a great challenge for clinical application , often limiting its application . significant ...	undersampling k - space data is an efficient way to speed up the magnetic resonance imaging ( mri ) process . as a newly developed mathematical framework of signal sampling and recovery , compressed sensing ( cs ) allows signal acquisition using fewer samples than what is specified by nyquist - shannon sampling theor...
acceptor systems such as substituted benzenes reveals many interesting processes occurring in electronically excited states . particularly , dual fluorescence of 4-(n , n - dimethylamino)benzonitrile ( dmabn ) in polar solution , consisting of an emission from the lb state and an anomalous red - shifted e...	the structural processes leading to dual fluorescence of 4-(dimethylamino)benzonitrile in the gas phase and in acetonitrile solvent were investigated using a combination of multireference configuration interaction ( mrci ) and the second - order algebraic diagrammatic construction ( adc(2 ) ) methods . solven...
currently , a combination of genetic and environmental factors underlying the development of this disorder is discussed . genetic association and genome - wide association studies revealed several risk genes of schizophrenia , among them are neuregulin1 , disc1 , d - amino - acid oxidase activator ( daoa / g72 ) , zi...	schizophrenia is considered as a neurodevelopmental disorder with genetic and environmental factors playing a role . animal models show that developmental hippocampal lesions are causing disconnectivity of the prefrontal cortex . magnetic resonance imaging and postmortem investigations revealed deficits in the temp...
sensory disturbances in schizophrenia are often described as an inability to filter meaningful sensory stimuli.19 in experimental settings , this filtering inability has been examined most often using auditory evoked potentials to repeated sounds with the main aim of testing the brain s ability to inhibit ( or gate ) i...	sensory gating disturbances in schizophrenia are often described as an inability to filter redundant sensory stimuli that typically manifest as inability to gate neuronal responses related to the p50 wave , characterizing a decreased ability of the brain to inhibit various responses to insignificant stimuli . it impl...
posterior tibial slope that is created during proximal tibial resection in total knee arthoplasty ( tka ) has emerged as an important factor in the biomechanics of the knee joint and postoperative clinical outcome . the common approach is to restore the posterior tibial slope as closely as possible to the anatomical ...	purposethe purpose of this study is to evaluate the effect of change in tibial posterior slope on contact force and ligament stress using finite element analysis.materials and methodsa 3-dimensional finite element model for total knee arthroplasty was developed by using a computed tomography scan . for validation , t...
-chiral ethers are present in many natural products , biologically active molecules and synthetic intermediates.1 therefore , much effort has been directed towards efficient routes to enantiomerically enriched chiral ethers through allylic etherification reactions.2 within this context , there is currently ongoing inte...	gold(i)-catalysed direct allylic etherifications have been successfully carried out with chirality transfer to yield enantioenriched , -substituted secondary allylic ethers . our investigations include a full substrate - scope screen to ascertain substituent effects on the regioselectivity , stereoselectivity and eff...
osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences . osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third ( 35 - 46% ) of cases affecting the b...	introduction : osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences . osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third ( 35 - 46% ) of cases ...
young adult college students in the united states are at a heightened risk for alcohol use problems due to their hazardous patterns of alcohol use [ 14 ] . particularly , among 14000 students from 119 universities , 31% endorsed criteria for alcohol abuse and 6% endorsed criteria for alcohol dependence . however , ...	prior studies have suggested that affect lability might reduce the risk for problematic drinking among sensation seekers by compensating for their deficiencies in emotional reactivity and among individuals high on negative urgency by disrupting stable negative emotions . due to the high prevalence of college drinking ,...
lymphedema ( le ) is a condition in which lymphatic transport is compromised , allowing lymph fluid to accumulate between tissues . the accumulation causes progressive fibrosis between the skin and subcutaneous tissue , and is characterized by non - pitting swelling . this fibrosis and swelling damage lymphoc...	[ purpose ] the aim of this study was to evaluate the effects of proprioceptive neuromuscular facilitation ( pnf ) d2 flexion and breathing exercises in a patient with lymphedema ( le ) . [ subject ] this report describes a 57-year - old woman with le in whom a short - stretch compression bandage ( sscb ) could n...
the growth of home and community - based services ( hcbs ) under medicaid can be traced to the early 1980s when it was found that : a disproportionate percentage of medicaid resources were being used for institutional long - term care ( davidson , 1980 ; grannemann and pauly , 1983 ; holahan , 1975 ; spiegel and podair...	the history and current status of the medicaid home and community - based services waiver program are presented . the article discusses the states ' role in developing and implementing creative alternatives to institutional care for individuals who are medicaid eligible . also described are services that may be pro...
not only is copd a significant cause of morbidity worldwide , but it is also the fourth - leading cause of mortality today and is estimated to be the third - leading cause of death by 2020 . exacerbations of copd are the episodic periods of the disease , characterized by deterioration of respiratory function . ...	objective : because pulmonary embolism ( pe ) and copd exacerbation have similar presentations and symptoms , pe can be overlooked in copd patients . our objective was to determine the prevalence of pe during copd exacerbation and to describe the clinical aspects in copd patients diagnosed with pe.methods:this ...
ultrasound examinations have become the routine technique for the evaluation of the inflammatory changes in the musculoskeletal system in children in the course of systemic inflammatory conditions such as jia . they allow to identify the inflamed structures of the locomotor system such as e.g. joints , bursae , and t...	the application of 3d imaging in pediatric rheumatology helps to make the assessment of inflammatory changes more objective and to estimate accurately their volume and the actual response to treatment in the course of follow - up examinations . additional interesting opportunities are opened up by the vascularity ana...
many people with identifiable psychiatric illness do conflict with the law , often by no fault of their own but because of symptoms of their psychiatric illness and end up in jails . such symptoms include impaired judgment , lack of impulse control , suspiciousness , disinhibition , paranoia , inability to trust othe...	context : the prevalence of psychiatric illness in correctional settings is significantly elevated , with higher than community rates reported for most mental disorders.aims:(1 ) to examine the socio - demographic profile of convicted prisoners . ( 2 ) to evaluate the prevalence of psychiatric disorders in convicted pr...
a 73-year - old diabetic patient presented with a recent - onset visual decline od . 1a ] with mild non - proliferative diabetic retinopathy with no macular edema ; left fundus was normal . optical coherence tomography ( oct ) revealed vitreomacular traction ; central macular thickness ( cmt ) was 630m [ fig . 1b...	a patient underwent successful vitrectomy for macular epiretinal membrane with anatomical and functional improvement . 10 weeks later , there was a recurrence of macular edema with corresponding visual decline . an intravitreal injection of triamcinolone acetonide not only restored the macular anatomy but also impr...
inflammation is receiving an increasing amount of attention for its potential role in the pathogenesis of a variety of disorders , from insulin resistance and type 2 diabetes mellitus ( t2 dm ) to fatty liver and cardiovascular disease ( cvd ) . current evidence shows that c - reactive protein ( crp ) level is a plas...	aims . to examine the association between 4 single nucleotide polymorphisms ( snps ) of peroxisome proliferator - activated receptors ( ppar ) polymorphisms and c - reactive protein ( crp ) level and additional gene - gene interaction . methods . line regression analysis was performed to verify polymorphism associ...
in a recent issue of critical care , parnell and colleagues examined host gene expression changes in whole blood from critically ill patients infected with pandemic h1n1 influenza a infection . the measurable genomic response of the host to influenza may provide important information not only on viral pathogenesis bu...	capturing the host response by using genomic technologies such as transcriptional profiling provides a new paradigm for classifying and diagnosing infectious disease and for potentially distinguishing infection from other causes of serious respiratory illness . this strategy has been used to define a blood - based rn...
dna microarray technology , a powerful tool in functional genome studies , has yet to be widely accepted for extracting disease - relevant genes , diagnosis , and classification of human tumor [ 13 ] . generally , genes are ranked according to their differential expression by analysis of combination of normal and tum...	selection of reliable cancer biomarkers is crucial for gene expression profile - based precise diagnosis of cancer type and successful treatment . however , current studies are confronted with overfitting and dimensionality curse in tumor classification and false positives in the identification of cancer biomarkers ....
with an estimated 70,530 new cases and 14,680 deaths in the united states in 2010 , bladder cancer is the most common malignancy of the urothelium and kidneys . metachronous disease is common , and surveillance for additional tumors is a lifelong challenge in patients with bladder cancer . ct urography ( ctu ) is d...	abstractthe objective of this review article is to learn how to recognize anatomic variants and benign entities that mimic bladder cancer at computed tomography ( ct ) urography . building on recent data that suggest that ct urography can be used to diagnose bladder cancer , recognition of anatomic variants and benig...
bacillus calmette guerin ( bcg ) vaccine , derived from multiple passages of wild - type mycobacterium bovis , has been used in humans since 1921 and is still the only vaccine available against tuberculosis ( 1 ) . approximately , 100 million children routinely receive one or more bcg vaccines in most countries of th...	background : disseminated bacillus calmette guerin ( bcg ) infection is a rare but life threatening complication of bcg vaccination . it has been mainly seen in severe immune deficiency . a precise and rapid diagnosis is crucial for prompt initiation of an aggressive anti - mycobacterial treatment . polymerase ch...
glucagon - like peptide-1 ( glp-1 ) is secreted from the enteroendocrine l cells of the intestinal mucosa and is released into the portal circulation in response to meal ingestion through posttranslational processing of proglucagon by prohormone convertase-1 in its secretory cells . glp-1 enhances insulin secretion...	aim . the relationship between genetic polymorphisms of the glucagon - like peptide-1 ( glp-1 ) receptor ( glp1r ) gene and unresponsiveness to glp-1 analogue treatment in patients with poorly controlled type 2 diabetes mellitus ( dm ) is unclear . methods . thirty - six patients with poorly controlled type 2 dm ...
in the previous issue of critical care we read with great interest a report of the first experimental study of recombinant human activated protein c ( rhapc ) in oleic acid - induced nonseptic acute lung injury ( ali ) in sheep . impairment of the protein c pathway plays a central role in the pathogenesis of sepsis ....	impairment of the protein c pathway plays a central role in the pathogenesis of sepsis . treatment with recombinant human activated protein c ( rhapc ) has been reported to increase survival from severe sepsis . protein c levels also decrease markedly in acute lung injury , of both septic and nonseptic origin . low...
minimally invasive dentistry is an approach that seeks to maintain the patient 's oral health with preventive measures and to treat possible disturbances of health as early as possible and with as little intervention as possible . this requires that caries is detected at an early stage of development and that its sta...	background . a caries lesion causes changes in the optical properties of the affected tissue . currently a caries lesion can be detected only at a relatively late stage of development . caries diagnosis also suffers from high interobserver variance . methods . this is a pilot study to test the suitability of ...
parkinson 's disease ( pd ) is a progressive neurodegenerative disorder affecting 1 - 2% of the elderly population . in addition to the well - known motor problems of pd patients , that are related to nigrostriatal dopamine deficits , also nonmotor symptoms are common . these symptoms strongly affect quality of life ...	besides dopamine - deficiency related motor symptoms , nonmotor symptoms , including cognitive changes occur in parkinson 's disease ( pd ) patients , that may relate to accumulation of -synuclein in the hippocampus ( hc ) . this brain region also contains stem cells that can proliferate . this is a well - regulate...
post - traumatic stress disorder ( ptsd ) is a pathological response to a traumatic event affecting many combat veterans . sleep disturbance , nightmares and insomnia are distressing and often treatment - resistant symptoms of ptsd ( 1 , 2 ) and are also the criteria to diagnose ptsd in the diagnostic and statistical...	backgroundprazosin is significantly effective to reduce sleep disturbance and trauma nightmare in patients with post - traumatic stress disorder ( ptsd ) ; however , results of different studies were evaluated.objectivesthe current randomized clinical trial aimed to assess the effects of prazosin on sleep parameters an...
human mitochondrial sequence data has been used to make various inferences about the origins of modern humans , including a single out of africa dispersion event ( 1,2 ) ( currently the most popular theory for modern human origins ) , multiple dispersions from africa ( 3 ) , and a multi - regional , parallel developme...	with the recent increase in the available number of high - quality , full - length mitochondrial sequences , it is now possible to construct and analyze a comprehensive human mitochondrial consensus sequence . using a data set of 827 carefully selected sequences , it is shown that modern humans contain extremely low le...
we report on a chronic hemiparetic patient whose gait recovery was delayed until healing of an injured corticoreticulospinal tract ( crt ) , which was demonstrated on diffusion tensor tractography ( dtt ) . a 71-year - old female presented with complete paralysis of the right extremities resulting from a spontaneous ...	abstractobjectives : we report on a chronic hemiparetic patient whose gait recovery was delayed until healing of an injured corticoreticulospinal tract ( crt ) , which was demonstrated on diffusion tensor tractography ( dtt).case presentation : a 71-year - old female presented with complete paralysis of the right extre...
the bromodomain ( brd ) family of proteins recognize acetylated - lysine ( kac ) in proteins and represent a set of protein protein interaction modules that are becoming increasingly explored in the field of drug discovery . the bet family of brds is a subset of this larger bromodomain family and is made u...	bromodomains ( brds ) are epigenetic readers that recognize acetylated - lysine ( kac ) on proteins and are implicated in a number of diseases . we describe a virtual screening approach to identify brd inhibitors . key elements of this approach are the extensive design and use of substructure queries to c...
	long - term exposure to high concentrations of lead results in renal dysfunction . during a prospective study of environmental lead and pregnancy outcomes in 1502 women residing in two towns in yugoslavia , we explored whether moderate exposure to lead results in increased rates of proteinuria . the geometric mean bl...
	the aging of the world population is expected to be accompanied by increased pneumococcal pneumonia in older adults . to address this , the community - acquired pneumonia immunization trial in adults ( capita ) , a large , randomized , placebo - controlled trial conducted to assess the 13-valent pneumococcal conjugat...
alkylsilanes are known to self - assemble at the surface of oxide materials . this ability has been widely exploited , for example , to tune the wetting and electronic transport properties of the surface . furthermore , alkylsilanes are often used as coupling agents for attaching organic moieties or nanopar...	the surface functionalization of tio2-based materials with alkylsilanes is attractive in several cutting - edge applications , such as photovoltaics , sensors , and nanocarriers for the controlled release of bioactive molecules . ( 3-aminopropyl)triethoxysilane ( aptes ) is able to self - assemble to form m...
	n - enoxyphthalimides undergo a rh(iii)-catalyzed c h activation initiated cyclopropanation of electron deficient alkenes . the reaction is proposed to proceed via a directed activation of the olefinic c h bond followed by two migratory insertions , first across the electron - deficient alkene and then by...
it dissolves quickly in concentrated acids and in some fluoroalcohols yet its reactivity is low . other relevant properties of this biopolymer are its high molecular weight and porous structure which favors high water absorption [ 1 , 2 ] . on the other hand these associations act as a matrix that interacts with ot...	this research aims to study the production of chitosan from shrimp shell ( litopenaeus vannamei ) of waste origin using two chemical methodologies involving demineralization , deproteinization , and the degree of deacetylation . the evaluation of the quality of chitosan from waste shrimp shells includes parameters fo...
. however , the manifestation of shrinkage due to the polymerization process continues to be a major problem . the composite shrinkage creates stresses within the material at the tooth structure interface , which might manifest clinically as cuspal deflection , which in turn compromises the synergism of the bond at t...	objectives : this study evaluated cuspal deflection in premolar teeth restored with low shrinkable resin composite.materials and methods : a total of 40 human premolars were used for cuspal deflection evaluation in this study . each group was divided into four equal groups according to the type of resin composite and...
radiation treatments , which include external beam radiation , plaque brachytherapy , proton beam radiation , helium ion radiotherapy , and gamma knife radiotherapy,110 may result in long - term damage to the retinal vascular endothelial cells , causing radiation maculopathy in over 50% of eyes undergoing plaque radiot...	purpose : to evaluate the benefits of intravitreal bevacizumab in patients with visually compromising radiation maculopathy following iodine-125 plaque brachytherapy for uveal melanoma.methods:in this institutional review board - approved , consecutive , retrospective study from 20062009 of patients maintaining 20/50 o...
medicine is based on professional virtues such as self - regulation , autonomy authorisation , specialisation , and adherence to an ethical code of practice . the privilege of self - regulation assumes assurance of the competencies of every practicing doctor , which is gained by standards for education and practice ....	background . research has shown that peer - group supervision can strengthen gps ' professionalism , but little is known about the individual learning processes . to establish professionalism beyond professional behaviour , identity and idealism need to be included . the inner attitudinal values of professionalism wi...
juvenile idiopathic arthritis ( jia ) is an autoimmune disease1 whose association with uveitis is established for more than half a century.2,3,4 there are , according to the international league of associations for rheumatologists ( ilar ) , 7 subtypes of jia known as oligoarticular , polyarticular rf( ) , polyarticula...	objectiveto evaluate the characteristics and visual prognosis of juvenile idiopathic arthritis - associated uveitis ( jia).methodsa retrospective review was performed on 56 patients who met the criteria for jia to identify those with uveitis and related complications . patients were referred to and were examined in t...
using cluster sampling , 337 free - living elderly subjects ( 193 females and 144 males ) were entered in a cross - sectional designed study in shiraz ( iran ) . the study population was divided into regional clusters based on regional municipality ; and , a random sample of these clusters was selected . exclusion ...	objectivemalnutrition and depression are highly prevalent in the elderly and can lead to unfavorable outcomes . the aims of the current study were to determine the association between malnutrition and depression and also to find any correlation of depression with some anthropometric indices in free living elderly.met...
obstructive sleep apnea ( osa ) is a common disorder with repetitive upper airway obstruction during sleep resulting in intermittent hypoxia and sleep fragmentation . when untreated , it may cause daytime sleepiness , fatigue , and poor quality of life . positive airway pressure ( pap ) is the first - line treatmen...	backgroundwe addressed the impact of patient education followed by frequent visits on compliance with positive airway pressure ( pap ) treatment in patients with obstructive sleep apnea ( osa ) in a turkish sleep clinic cohort.material/methodsthis single - center , randomized , controlled study was conducted in istanbu...
sarcoidosis is a multisystem inflammatory disease of unknown etiology , pathologically characterized by non - caseating epithelioid granuloma ( 13 ) . a definitive diagnosis of sarcoidosis is still challenging and no gold criteria for diagnosis a set of non - specific clinical features and laboratory findings includi...	background : sarcoidosis is a multisystem inflammatory disease of unknown origin with characterization of small granulomas . angiotensin - converting enzyme ( ace ) is a pathophysiologic marker of sarcoidosis . we present the ace insertion / deletion ( i / d ) polymorphism in correlation with serum ace level in ira...
it is well established , that more than 90% of low - grade malt lymphomas are associated with h. pylori infection1 ) . indeed , the eradication of h. pylori infection has been associated with the regression of gastric malt lymphoma in 70% to 80% of patients2 , 3 ) . additional factors contribute to the development ...	the mucosa - associated lymphoid tissue ( malt ) lymphoma , which was first described in 1983 , is known to be caused by chronic helicobacter pylori ( hp ) infection , which triggers lymphoid infiltration and formation of organized lymphoid tissue . in approximately two thirds of cases of malt , the lymphoma has been...
	the measurement of a deuterium equilibrium isotope effect ( eie ) for the aryl chcl interaction of anion receptor 1h/1d is reported . computations corroborate the results of solution measurements for a small , normal eie in the full complex ( kah / kad = 1.019 0.010 ) . interestingly , isotope effects ...
peach is one of the most well - liked fruits in the world because of their flavor , dietary value , attractive color , and medicinal worth . it is enriched with ascorbic acid , flavonoid , and phenolic compounds , which were considered prime sources for antioxidants [ 1 , 2 ] . however , peaches have a very short s...	peaches ( prunus persica cv . yanhong ) were fumigated with carbon monoxide ( co ) at 0 , 0.5 , 5 , 10 , and 20 mol / l for 2 hours . the result showed that low concentration co ( 0.510 mol / l ) might delay the decrease of firmness and titrable acid content , restrain the increase of decay incidence , and postp...
the history of the initial discovery and characterization of proprotein convertase subtilisin / kexin type 9 ( pcsk9 ) has been well described . the seminal discovery in 2003 by abifadel et al . linked mutations in the gene encoding pcsk9 with autosomal dominant hypercholesterolemia ( adh ) . this finding uncovered a...	even though it is only a little over a decade from the discovery of proprotein convertase subtilisin / kexin type 9 ( pcsk9 ) as a plasma protein that associates with both high and low cholesterol syndromes , a rich body of knowledge has developed , and drugs inhibiting this target have been approved in many markets . ...
oxidized phospholipids ( oxpl ) are generated in vivo as a result of the inflammatory response , mitochondrial respiration , xenobiotic metabolism , and other processes that generate oxidants . the fatty acyl group esterified at the 2 position of glycerophospholipds is mono- or polyunsaturated and is sensitive to oxi...	electrophile - mediated disruption of cell signal - ing is involved in the pathogenesis of several diseases including atherosclerosis and cancer . diffusible and membrane bound lipid electrophiles are known to modify dna and protein substrates and modulate cellular pathways including er stress , antioxidant response ...
respiratory complications are 3 times more common during endotracheal extubation than during tracheal intubation or induction of anaesthesia ( 4.6% vs. 12.6% ) . a smooth tracheal extubation without coughing , bucking or haemodynamic changes is one of the anaesthetic goals during any general anaesthetic procedure esp...	background and aim : exchanging endotracheal tube ( ett ) with classic laryngeal mask airway ( clma ) prior to emergence from anaesthesia is a safe technique to prevent the coughing and haemodynamic changes during extubation . we had compared clma and ambu laryngeal mask ( alm ) during ett / laryngeal mask ( lm ) for...
alzheimer disease ( ad ) , a progressive neurodegenerative disorder , is the most common cause of dementia among the elderly . prevalence increases with age from 1% in the 6064-year age group , to 24 - 33% in those aged > 85 years.1 the neuropathological hallmarks of ad are the presence in the brain of extracellular ...	alzheimer disease is the most common cause of dementia among the elderly , accounting for 60 - 70% of all cases of dementia . the neuropathological hallmarks of alzheimer disease are senile plaques ( mainly containing -amyloid peptide derived from amyloid precursor protein ) and neurofibrillary tangles ( containing h...
colorectal cancer ( crc ) is one of the most common cancers in the world . crcs usually progress from adenomatous polyps , and the morphological and genetic progression of crcs in an adenoma - adenocarcinoma sequence has been well described.1,2 a hyperplastic polyp ( hp ) is the most common histological type found am...	hyperplastic polyposis syndrome ( hps ) is a rare condition characterized by the presence of numerous hyperplastic polyps ( hps ) in the colon and rectum . patients with hps have an increased risk of colorectal cancer . this link is associated with gene mutations , especially b type raf kinase ( braf ) . however , a ...
there are several lower urinary tract dysfunctions ( lutd ) that are more prevalent in women than men including interstitial cystitis , recurrent urinary tract infections , and incontinence [ 1 , 2 ] . the inner most tissue layer of the bladder wall , the mucosa ( urothelium ) , is intimately associated with lower ur...	introduction . there are several bladder dysfunctions that are associated with oxidative stress to the urinary bladder . two experimental models are known to cause this type of bladder damage . the first is direct oxidative damage caused by hydrogen peroxide ( h2o2 ) . the second is oxidative damage caused by i...
ventricular enlargement following head injury is a frequent finding but cases that require shunt operation are relatively rare.2 ) hydrocephalus following traumatic brain injury ( tbi ) or post - traumatic hydrocephalus ( pth ) is not just a ventricular enlargement but an active and progressive disorder of cerebrospina...	objectiveventricular enlargement following head injury is a frequent finding but cases requiring shunt operation are rare . the incidence and developing factors of post - traumatic hydrocephalus ( pth ) have been variously reported , but studies for factors influencing outcomes of shunt operation for pth are rare . t...
the reported frequency of patients with obstructive colon cancer has ranged from 8% to 29% ( 3 ) . left - sided colon malignancies are more prone to obstruct the colon lumen than are the right - sided malignancies . this is because the diameter of the left colon is smaller than that of the right colon . ct is a s...	a broad spectrum of colonic complications can occur in patients with colon cancer . clinically , some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management . the complications of the colon that can be associated with...
allogenic blood transfusion ( abt ) is a life - saving procedure in many clinical situations . however , abt can result in unpredictable clinical consequences and risks despite technical improvements to reduce such problems . a study evaluated transfusion management procedures in elective orthopedic surgeries , par...	erythropoietin combined with parenteral iron sucrose therapy is an alternative to blood transfusion in anemic patients . it was shown to be effective in surgical patients in several previous studies when used in conjunction with other methods . however , there are no guidelines about safety limits in dosage amounts...
by the end of 2011 , more than 90% of the 34 million people infected with hiv worldwide were living in low- or middle - income countries . 16.8 $ billion was invested globally into hiv in 2011 and , in low- and middle - income countries , 89% of the investment was allocated to treatment care and support of hiv infect...	hiv treatment , care , and support programmes in low- and middle - income countries have traditionally focused more on patients remaining in care after the initiation of antiretroviral therapy ( art ) than on earlier stages of care . this study describes the cumulative retention from hiv diagnosis to the achievement ...
attempts have been made to introduce technologies associated with ltp at atmospheric pressure into medical practice for various situations , and ltp s feasibility for use has been demonstrated in hemostasis , wound care , and anti - cancer therapy . translational studies of the basic technology for ltp at atmospheric...	low temperature plasma ( ltp ) coagulation equipment , which avoids causing burn injuries to patients , has been introducing into minimally invasive surgery . the mechanism by which this equipment stops bleeding is to directly occupy the injury with the formed blood clots , and different from the mechanism of the com...
inflammatory myfibroblastic tumor ( imt ) is rare and may be grouped within the family of fibroinflammatory disorders . this tumor affects predominantly children and young adults , but patients of any age and sex can be affected.1 its clinical symptoms are also diverse according to the location of the lesion . a ma...	inflammatory myfibroblastic tumor ( imt ) , also known as inflammatory pseudotumor is unusual , benign solid tumor . this tumor is commonly reported in the lungs but can be present in extrapulmonary sites as well . we present the case of a 7-year - old girl with imt in an unusual location . the patient was admitt...
osteoarthritis ( oa ) is one of the most frequent joint diseases and is a major cause of pain and locomotor disability for people in advanced age . balneotherapy ( bt ) is one of the most commonly used nonpharmacological approaches for oa . bt , in its most general sense , is used for bathing in thermal or mineral ...	background : balneotherapy ( bt ) is a treatment modality that uses the physical and chemical effects of water , including thermomineral , acratothermal , and acratopegal waters . it has many effects on cardiovascular system.aim:the aim of the study is to investigate the effects of 3-week bt on blood pressure of oste...
ion mobility spectrometry ( ims ) has been a tool for the analysis of gases for a long time . famous for their small device size in the centimeter range , their fast response times in the ms range , and their very high sensitivity in the lower ppbv range , ims detectors can be found in a number of quite different loc...	ion mobility spectrometry is a well - known technique for analyzing gases . examples are military applications , but also safety related applications , for example , for protection of employees in industries working with hazardous gases . in the last 15 years , this technique has been further developed as a tool fo...
intramedullary cavernomas ( imc ) are rare lesions especially in children , in whom they represent 1% of all intramedullary lesions . as such , less than 20 symptomatic cases have been reported in the english literature [ 1 , 2 , 6 , 9 , 10 , 16 , 1820 , 2325 ] and predominantly in boys ( table 1 ) . these invaria...	introductionless than 20 children with intramedullary cavernoma ( imc ) have been reported in the english literature ; however , cases with an unfavorable outcome may be underreported . whereas these are predominantly boys , we report two girls who presented with hematomyelia ( one cervical , one thoracic ) and an ac...
transcutaneous electrical nerve stimulation ( tens ) is widely used in western and developed countries to relieve a wide range of painful conditions , including non - malignant acute and chronic pain and pain resulting from cancer and its treatment [ 13 ] . tens can be self administered by patients following simple t...	transcutaneous electrical nerve stimulation ( tens ) refers to the delivery of electrical currents through the skin to activate peripheral nerves . the technique is widely used in developed countries to relieve a wide range of acute and chronic pain conditions , including pain resulting from cancer and its treatment ...
a 40-year - old african american woman with a medical history of anorexia nervosa , depression , and a documented history of iron overload syndrome presented to the emergency department with a self - reported weight loss of 150 lbs , confusion , ambulatory dysfunction , and generalized weakness , all of which progresse...	gelatinous bone marrow transformation ( gmt ) , also known as starvation marrow , represents a rare pathological entity of unclear etiology , in which bone marrow histopathology demonstrates hypoplasia , fat atrophy , and gelatinous infiltration . the finding of gelatinous marrow transformation lacks disease specific...
ssireum is a traditional korean sport in which two athletes hold on to a satba ( a cloth - sash tied around the waist and the thigh of the right leg ) and use strength and various skills to throw their opponent to the ground1 . the weight classifications depend on the level of ssireum such as gyungjang , sojang...	[ purpose ] the purpose of the present study was to elucidate the muscle conditions such as the isokinetic muscle of korean ssireum athletes . [ subjects and methods ] this study enrolled 25 elite ssireum athletes . we measured body composition and peak torque at an angular speed at 60/s using an isokinetic mus...
spinal giant cell tumors ( sgcts ) are locally aggressive benign bone tumors that can occur anywhere along the spine . sgcts account for approximately 2 to 3% of all giant cell tumors ( gcts ) . its incidence is higher in females , the sacral region , and patients aged 20 to 40 years.1 2 sgcts are usually discove...	study design systematic review and meta - analysis . objective to compare the recurrence and perioperative complication rate of en bloc vertebrectomy ( ev ) and intralesional resection ( ir ) in the giant cell tumor of the mobile spine ( sgct ) . methods we systematically searched publications in the pubmed and ...
suction blister epidermal grafting ( sbeg ) is a simple and effective way of surgical repigmentation in cases of vitiligo , especially when areas such as lip and eyelids are involved . the major problem faced during the procedure is the time taken for the formation of blisters . temperature at the suction site is o...	background : suction blister epidermal grafting ( sbeg ) is a simple and effective way of surgical repigmentation in vitiligo . the major problem faced is the time taken for the formation of blisters . temperature at the suction site is one of the factors affecting the blister formation time.aims and objectives : t...
bone scans have become a key tool in assessing musculoskeletal pathology [ 1 , 2 ] . use of single photon emission computerized tomography ( spect ) is becoming more common over the years as well . use of spect allows a three - dimensional assessment of the isotope dispersed in the subjects body , as compared with ...	chronic knee pain is a common complaint among the elderly and appears in 30%40% of the population over the age of 65 . this study was performed in order to evaluate correlation between clinical presentation of chronic knee pain and the imaging findings of spect and planar bone scintigraphy . methods . we prospect...
the thyroid gland ( lat.glandula thyroidea ) is located in the neck in front of the larynx ( lat.larinx ) , and consists of two lobes ( lat.lobus ) connected by narrowing ( lat.isthmus ) . seen from the front has the shape of a letter h or a butterfly with its wings outstretched . thyroid gland is odd endocrine gla...	goal : to investigate the correlation between tsh and hba1c in the treatment of l - thyroxine in the process of glycemic control in patients with subclinical hypothyroidism.patients and methods : the sample consisted of 100 patients , mean age 51.753.23 years , bmi=27.974.52 kg / m2 , with sh ( tsh>4.2 mu / l and norma...
early reperfusion is the modality of choice for treating stemi ( st elevation myocardial infarction ) 2 . primary pci ( percutaneous coronary intervention ) is the preferred method of reperfusion when it can be performed in a timely fashion by experienced operators 3 . there is a significant thrombus burden in near...	key clinical messagemanagement of intracoronary thrombus in patients presenting more than 12 hours after the onset of st elevation myocardial infarction is challenging . we present such a case which had massive thrombus in left anterior descending artery . it was managed successfully with dual antiplatelet agents a...
childhood and adolescent obesity is associated with insulin resistance , abnormal glucose metabolism , hypertension , dyslipidemia , inflammation , liver disease , and compromised vascular function.15 as with obesity , these impairments could track into young adulthood , which increases the risk of cardiometabolic dise...	backgroundchildhood and adolescent obesity is associated with insulin resistance , abnormal glucose metabolism , hypertension , dyslipidemia , inflammation , liver disease , and compromised vascular function . the purpose of this pilot study was to determine the prevalence of cardiometabolic risk factor abnormalities...
with a production surpassing 100 billion liters per year , biofuels have become an important part of the motor fuel consumption in the world , where ethanol continues to be the most common biofuel worldwide . because of its high energy density , ethanol has also been considered one of the most important renew...	the presence of water in biofuels poses the question of how it affects the frictional performance of additives in fuels containing organic substances . to investigate the effect of water on the adsorption of molecules present in fuel and its additives we simulated within the framework of density functional th...
the creation of a hybrid layer or resin - infiltrated dentin - layers ( ridls ) is considered as the most efficient mechanism of adhesion in recent dentin bonding agents ( dbas ) . however , controversy exists regarding the role of collagen fibrils on resin adhesion and sealing efficiency of dbas . nanoleakage , a ...	aims : to assess the deproteinizing effect of bromelain enzyme and compare it with 5% sodium hypochlorite ( naocl ) on shear bond strength before application of the adhesive system.materials and methods : a total of 30 extracted human premolars were divided into three groups , each one consisted of 10 teeth . the occ...
current standards in root canal treatment are based on cleaning and shaping the root canal prior to filling.1 an important innovation that has a major impact on these procedures has been the introduction of rotary nickel - titanium ( niti ) instruments.2,3 a considerable number of rotary niti instruments with particula...	background : this study investigated procedural errors made during root canal preparation with nickel - titanium ( niti ) instruments , using cone beam computed tomography ( cbct ) imaging method.materials and methods : a total of 100 human mandibular molars were divided into five groups ( n = 20 ) according to the nit...
a 64-year - old male patient with a smoking history of 46 pack - years was diagnosed with peripheral tumour of the left upper lobe of the lung and underwent typical left upper lobectomy . as the upper lobe had near the primary tumour slight adhesions to the sixth segment , the upper lobe was resected anatomically and f...	a 64-year - old male patient was diagnosed with 3 consecutive non - small cell lung carcinomas ( nsclc ) . in the current study , we applied whole - genome gene expression analysis to control , primary and locally recurrent cancer , and supposed metastasis samples of a single patient . according to our knowledge , ...
to stent or not to stent is a point debated since long time . this assumes importance in children and infants requiring intervention for ureteropelvic junction obstruction ( upjo ) . although literature supports stentless pyeloplasty , in laparoscopic pyeloplasty particularly , it is a common practice to stent t...	background : access to urethras and ureters of infants may be hazardous and injurious through an endoscopic route . placement and removal of stents in infants requires anaesthesia and access through these small caliber urethras . we describe our technique of placing antegrade splint during a laparoscopic pyeloplasty ...
the incidence in pregnant reproductive age women is reported to be 8 patients per 100 000 per year . the most common cause of primary hyperparathyroidism in pregnancy , as in the general population , is a single adenoma . in 1938 , friedrichsen described symptomatic hypocalcemia in an infant unmasking the mother 's h...	a 7-day - old male infant born to a healthy 33-year - old female at 37 weeks of gestation was brought to the local emergency department ( ed ) with sudden - onset tonic clonic seizures . laboratory testing revealed extreme hypocalcemia ( ionized calcium of 3.2 mg / dl ) and undetectable parathyroid hormone ( pth < 1...
on august 5 , 2011 , a community hospital laboratory contacted the minnesota department of health to submit for identification a bacillus sp . cdc typed the isolate as gt59 using multiple - locus variable - number tandem repeat analysis specific for 8 loci ( 8) . the isolate was related to strains with genotypes ge...	inhalation anthrax occurred in a man who vacationed in 4 us states where anthrax is enzootic . despite an extensive multi - agency investigation , the specific source was not detected , and no additional related human or animal cases were found . although rare , inhalation anthrax can occur naturally in the united st...
there are symptoms common to both chronic heart failure ( chf ) and pulmonary arterial hypertension ( pah ) . pulmonary abnormalities play an important role in the evaluation and prognosis of chf and pah . the differences of pulmonary function in chronic left heart failure and chronic right heart failure are not fu...	backgroundpulmonary abnormalities are found in both chronic heart failure ( chf ) and pulmonary arterial hypertension ( pah ) . the differences of pulmonary function in chronic left heart failure and chronic right heart failure are not fully understood.material/methodswe evaluated 120 patients with stable chf ( 60 wi...
amyotrophic lateral sclerosis ( als ) is a slowly progressive neurodegenerative disorder with no known curative treatments . respiratory insufficiency is a critical problem , and earlier administration of non - invasive ventilation ( niv ) prolongs the survival of als patients ( 1 ) . diaphragm pacing ( dp ) , whic...	respiratory insufficiency is a critical problem in amyotrophic lateral sclerosis ( als ) patients . we herein present the case of an autopsied patient with sporadic als who underwent diaphragm pacing ( dp ) . the pathology showed several localized adhesions with a markedly atrophied diaphragm . a marked loss of m...

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