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metaplastic breast cancer ( mbc ) is a rare malignancy characterized by the histologic presence of two or more cellular types , commonly a mixture of epithelial and mesenchymal components [ 16 ] . mbc represents 0.251% of breast cancers diagnosed annually [ 1 , 7 , 8 ] . due to its relative rarity and heterogeneous...	metaplastic breast cancer ( mbc ) is a malignancy characterized by the histologic presence of two or more cellular types , commonly a mixture of epithelial and mesenchymal components . mbc is rare relative to invasive ductal carcinoma ( idc ) , representing less than 1% of all breast cancers . other than a lower ra...
worldwide , tumours account for the majority of cases of large bowel obstruction with diverticular disease and volvulus accounting for the remainder . volvulus commonly affects the sigmoid , caecum and transverse colon in the decreasing order of frequency with caecal volvulus accounting for < 1% of causes of large bo...	caecal volvulus is a rare cause of intestinal obstruction , with the bascule subtype accounting for < 10% of all cases of caecal volvulus . it is associated with significant morbidity and mortality if left undiagnosed . we present the case of a 58-year - old female who presented to our surgical department with symp...
budd - chiari syndrome ( bcs ) is a hepatic venous outflow obstruction at any level from the small hepatic veins to the junction of the inferior vena cava ( ivc ) and the right atrium . thrombosis of the hepatic veins is the most common cause of bcs in western countries , whereas membranous obstruction of the ivc or ...	endovascular stenting is accepted as an effective treatment for patients with budd - chiari syndrome ( bcs ) . we herein present a case of successful endovascular treatment . a 46-year - old woman , who was followed up for 10 years after a diagnosis of bcs , showed progression progressive of liver cirrhosis and deter...
recent studies have revealed an association between lower pre - dialysis serum sodium levels and increased all - cause and cardiovascular mortality in haemodialysis ( hd ) patients [ 1 , 2 ] . in these studies , hyponatraemia was also associated with low serum albumin , low body mass index and high interdialytic weig...	backgroundlow serum sodium ( na ) has been associated with decreased body mass index and increased cardiovascular mortality in haemodialysis ( hd ) patients . we examined the relationship between serum na and selected nutritional parameters of protein energy wasting that are not affected from the hydration status in ...
elearning is concerned with the learning activities , resource access , communication , and assessment undertaken in an online environment . this type of learning environment normally uses a range of information and communication technologies ( icts ) accessible via computer or mobile devices . the purpose of this ...	backgroundthe use of information and communication technology ( ict ) in health professional education is increasing rapidly . health professional educators need to be responsive to health professionals information and communication technological needs ; however , there is a paucity of information about educators att...
highly charged ( trivalent and tetravalent ) metal ions are of great interest in both supramolecular , biomolecular , and rare - earth chemistry . some of these serve as the coordination center that performs structural , catalytic , or electron - transfer functions , while others are well - known biotoxins . fo...	highly charged metal ions act as catalytic centers and structural elements in a broad range of chemical complexes . the nonbonded model for metal ions is extensively used in molecular simulations due to its simple form , computational speed , and transferability . we have proposed and parametrized a 12 - 6 ...
entropy is a key property to understand a wide variety of physical , chemical , and biochemical phenomena . however , the estimation of absolute entropies and entropy differences from computer simulations is a long - standing problem and one of the current challenges in computational chemistry . the calculation of ...	the convergence properties of the absolute single - molecule configurational entropy and the correction terms used to estimate it are investigated using microsecond molecular dynamics simulation of a peptide test system and an improved methodology . the results are compared with previous applications for systems of d...
various causes of intractable hiccups have been reported ; however , to the best of our knowledge , there are no previous reports of either intractable hiccups due to esophageal candidiasis in an immunocompetent adult or improvement following antifungal therapy . an esophagogastroduodenos - copy revealed several whit...	introductionvarious causes of intractable hiccups have been reported ; however , to the best of our knowledge , there are no previous reports of either intractable hiccups due to esophageal candidiasis in an immunocompetent adult or improvement following antifungal therapy.case presentationan 87-year - old man presente...
natural killer / t - cell ( nk / t - cell ) lymphoma is a rare fast - growing lymphoma arising from the lining of the nose or upper airway . a 26-year - old young female presented with nasal obstruction , bloody discharge and swelling of the nasal skin and right lower eyelid . biopsy from the soft tissue seen in the ...	natural killer / t - cell ( nk / t - cell ) lymphoma is a rare condition , which presents as necrotic , granulomatous lesions involving the nose and the upper respiratory tract . the condition usually has an aggressive clinical course . the predominant subtype of nk / t - cell lymphoma noted in asian population is ...
eumycetoma is a chronic , relentlessly progressive , granulomatous subcutaneous disease caused by a true fungus . it commonly occurs in the extremities , the foot being the most common site of involvement . cranial involvement has only rarely been reported[24 ] and is often due to direct extension from the paranasa...	cranial eumycetoma ( ce ) due to direct inoculation of madurella grisea into the scalp is extremely rare . we describe a case of ce caused by direct inoculation of m. grisea with the characteristic mri findings of the dot - in - circle sign and a conglomeration of multiple , extremely hypointense dots .
orthodontic forces generate cellular and molecular responses , resulting in tooth movement . a difference in the expression pattern of bone modeling markers and histological changes is reasonable assuming that molecular changes in the compression zone are different than those in the tension zone of the periodontal liga...	objectivethe objective of this study is to investigate the expression and concentration of ligand receptor activator of nfkb ( rankl ) and osteoprotegerin ( opg ) in human periodontal ligament ( hpdl ) with orthodontic forces of different magnitudes.methodsright premolars in 32 patients were loaded with 4 oz or 7 oz of...
according to the diagnostic and statistical manual of mental disorders , developmental coordination disorder ( dcd ) refers to those children whose acquisition and execution of motor skills is substantially below their age and opportunities for learning . the coordination problems are expressed in slow and inaccurate...	developmental coordination disorder ( dcd ) is often called a motor learning deficit . the question addressed in this paper is whether improvement of motor skills is just a matter of mere practice . without any kind of intervention , children with dcd do not improve their motor skills generally , whereas they do im...
the process of immunomodulation is of utmost importance for sustaining the immune homeostasis in the organism , and detailed knowledge about the precise mechanisms of this process can bring about a better and more efficient therapy of the autoimmune diseases . regulation of the immune response is accomplished by a nu...	mesenchymal stem cells ( mscs ) are a new and promising tool for therapy of autoimmune disorders . in recent years their possibility to take part in the modulation of the immune response is discussed . the exact mechanisms for immunoregulation realized by mscs are not clear yet , but interactions with other immunoreg...
two classes of proteins play important roles in dna segregation : topoisomerases and structural maintenance of chromosome ( smc ) complexes . dna replication introduces positive ( + ) supercoiling ahead of the replication fork , and rotation of the forks leads to interlinking of the two sister chromosomes , generatin...	summarythe type ii topoisomerase topoiv , which has an essential role in escherichia coli chromosome decatenation , interacts with mukbef , an smc ( structural maintenance of chromosomes ) complex that acts in chromosome segregation . we have characterized the intracellular dynamics of individual topoiv molecules an...
dermatophytes are the most common organisms infecting keratinized structures such as skin , hair , and nails , and their ability to degrade keratin is believed to be a major virulence factor . a correlation between keratinolytic activity and pathogenesis has been proposed because dermatophytes secrete a battery of endo...	in fungi , ambient ph sensing involves the activation of the pal / pacc signalling pathway . in the dermatophyte trichophyton rubrum , ph - dependent secretion of keratinases , which are major virulence determinants , is affected by disruption of the pacc gene . here , the transcription profiling of the genes codin...
glucometers , which employ the glucose dehydrogenase pyrroloquinoline quinone ( gdh - pqq ) are known to produce falsely high recordings of capillary glucose in the presence of interfering substances like maltose and galactose . the food and drug administration ( fda ) did recommend that these meters should not be us...	we report a 2-month - old child with galactosemia and falsely high glucose readings with a glucometer using mutant variant of quinoprotein glucose dehydrogenase ( mutq - gdh ) chemistry . potentially fatal hypoglycemia could have been induced in the child if insulin infusion had been initiated as per glycemic managem...
approximately 2 billion people have latent infection , 8 million would develop active tuberculosis annually , and 2 - 3 million would die due to tuberculosis . with this resurgence , cases with extrapulmonary tuberculosis approximately 10 - 11% of extrapulmonary tuberculosis involves joints and bones , which is appro...	introduction . current therapeutic regimens with first - line antitubercular agents are associated to a high rate of adverse effects which could cause pronounced changes in collagen 's contents and structure . investigation of these changes is very important for optimization of antitubercular therapy and minimizati...
the obesity epidemic currently facing the developed world [ 1 , 2 ] is increasing the number of people affected by preventable causes of disability . this epidemic has an impact on the field of rehabilitation as interventions need to be adapted for people with obesity and new approaches need to be developed for peopl...	obesity and its relation to quality of life are multifaceted . the purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants . a model of weight - related qualit...
rotational atherectomy ( ra ) is an irreplaceable modality for heavily calcified lesions in current percutaneous coronary intervention ( pci). since incomplete stent expansion is a well - known predisposing factor for further instent restenosis and thrombosis , lesion preparation using ra prior to stent deployment in b...	entrapment of the burr within calcified lesion is an uncommon , but serious complication during rotational atherectomy and usually needs surgical retrieval . we report a case series of this complication and also review the possible mechanisms , such as kokesi phenomenon or insufficient pecking motion with decreased r...
one challenge in primary care in germany is the treatment of older patients who consult their general practitioners ( gps ) with multiple health and associated everyday problems [ 13 ] . shared decision making ( sdm ) is a particular communication strategy in the doctor - patient dialogue with medical decisions being t...	background . this qualitative study aims to gain insight into the perceptions and experiences of older patients with regard to sharing health care decisions with their general practitioners . patients and methods . thirty - four general practice patients ( 70 years ) were asked about their preferences and experienc...
recent interest to semiconductor quantum dots ( qds ) is conditioned by new physical properties of these zero - dimensional objects , which are conditioned by size - quantization ( sq ) effect of the charge carriers ( ccs ) [ 1 - 3 ] . such new structures were obtained by means of interrupted growth of qds within sem...	in framework of the adiabatic approximation the energy states of electron as well as direct light absorption are investigated in strongly oblate and strongly prolate ellipsoidal quantum dots ( qds ) at presence of electric and magnetic fields . analytical expressions for particle energy spectrum are obtained . the ...
	new methods and strategies for the direct functionalization of c h bonds are beginning to reshape the fabric of retrosynthetic analysis , impacting the synthesis of natural products , medicines , and even materials1 . the oxidation of allylic systems has played a prominent role in this context as possibly the most ...
breast cancer has become a major focus of worldwide attention due to the increase in incidence over the past decades . in brazil , it is an important public health problem , being the most common neoplasm among women and the leading cause of death from cancer in this population group . in 2014 , 57,120 new cases were...	purpose . to assess the quality of life ( qol ) as a predictor of volume reduction in women undergoing complex physical therapy ( cpt ) for lymphoedema following breast cancer . methods . clinical trial in 57 women undergoing cpt . results . at baseline , in measuring quality of life for the eortc qlq - c30 questionn...
high circulating calcitonin levels are associated with medullary thyroid carcinoma . however , several other neuroendocrine tumors ( nets ) can also release calcitonin , including pheochromocytomas , neuromas and lung , breast , prostate , and colorectal carcinomas . calcitonin - secreting pancreatic endocrine tumors...	abstractcalcitonin is the hallmark of medullary thyroid carcinoma . however , extrathyroidal neuroendocrine tumors can also release calcitonin.we report 2 cases of calcitonin - secreting pancreatic tumors found in asymptomatic patients with thyroid nodules referred to our center within 11 months.case 1 : a man initia...
myxomas are the most common type of cardiac tumors , and approximately 75% of these tumors originate in the left atrium and 15% to 20% in the right atrium , with only less than 10% arising from the right and left ventricles . however , the incidence of myxomas in the great vein is extremely rare , and a thorough review...	myxomas are the most common benign cardiac tumors . myxomas are more common in the left heart chamber than the right side chamber . an extracardiac origin presenting as a right atrial mass is very rare . we present a case of myxoma originating in the superior vena cava ( svc ) in a 24-year - old man , who underwe...
anemia has been shown to be the most frequent hematological abnormality in hiv - infected patients globally [ 1 , 2 ] . even among those initiating antiretroviral therapy ( art ) , anemia has been demonstrated to be a strong risk factor for disease progression and subsequent death [ 15 ] independent of cd4 count and ...	among those with hiv , anemia is a strong risk factor for disease progression and death independent of cd4 count and viral load . understanding the role of anemia in hiv treatment is critical to developing strategies to reduce morbidity and mortality . we conducted a prospective analysis among 10,259 hiv - infected a...
clinically significant unexpected antibodies are capable of causing hemolytic transfusion reactions secondary to accelerated destruction of a significant proportion of transfused red blood cells ( 1 ) . therefore , screening for unexpected antibodies should be part of all pretransfusion testing , with antibody identi...	we evaluated the clinical usefulness of simultaneous liss / coombs and nacl / enzyme testing using the gel method for screening and identification of unexpected antibodies in 15,014 samples . when unexpected antibodies were detected by either screening test , those antibodies were identified using both the liss / coo...
cyclin - dependent kinase inhibitors have the potential to induce cell cycle arrest and apoptosis in cancer cells . roscovitine , a potent and selective inhibitor of cdk2 and cdc2 , has demonstrated selective inhibition of cdk enzymes over related kinases . it has been reported that roscovitine does cause not only ...	the antitumor activity of roscovitine was tested in four cervical carcinoma cells : c33a , hce-1 , hela , and siha . the effects of roscovitine on atp lite assay , cell cycle , and apoptosis were assessed . the sub - g1 dna content occurred great increasing , and this indicates that apoptosis was induced quickly in...
	modern man is chronically exposed to lead in the biosphere at levels several orders of magnitude higher than the natural level that once existed . there is much concern about the possible adverse effects of this population - wide , low - level lead exposure , particularly on the developing organism , wherein the cent...
dendritic spines are small protrusions that serve as a postsynaptic site for the 90% of the excitatory synapses in the cns . different kinds of dendritic spines were described based on their shape and their actin content in adult rat brains . mushroom dendritic spines have stalks with a clear head differentiation , s...	perinatal asphyxia ( pa ) affects the synaptic function and morphological organization . in previous works , we have shown neuronal and synaptic changes in rat neostriatum subjected to hypoxia leading to long - term ubi - protein accumulation . since f - actin is highly concentrated in dendritic spines , modificati...
the ovary itself is a highly vascularized organ but vascular tumors of the female genital tract , especially those arising in the ovary , are very rare , not exceeding 60 . these neoplasms have been reported in different ages ranging from infancy to 81 years.though most of these lesions are small and detected only in...	introductionhaemangioma of ovary is a rare tumour.presentation of casewe report an ovarian haemangioma which presented as an acute abdomen due to an adnexal mass.discussionwe report an ovarian haemangioma which presented as an acute abdomen due to an adnexal mass . haemangiomas have been reported in other organs but ...
pneumoconiosis is a chronic pulmonary disease caused by the accumulation of small ( 0.5- to 5-um ) dusts in the lungs , which leads to inflammation and fibrosis in the air sacs . the function of the lungs worsens with the disease progress , and the patients show dyspnea , coughing , sputum , and chest pains . in part...	the purpose of this study was to examine the effects of walking exercise through a 6-min walking test on subjective dyspnea , pulmonary function test , arterial blood gas analysis , and activities of daily living to provide base data for the nursing intervention of pneumoconiosis patients . the subjects were pneumoco...
newtonian ideas helped us to understand solid matter and moving objects found in the earth 's gravitational field . einstein , however , through his renowned equation e = mc , determined that energy and matter are dual expressions of the same universal substance ( 1 ) . a slowly vibrating substance is referred to a...	chromotherapy is a method of treatment that uses the visible spectrum ( colors ) of electromagnetic radiation to cure diseases . it is a centuries - old concept used successfully over the years to cure various diseases . we have undertaken a critical analysis of chromotherapy and documented its scientific evolution...
in 2002 , paulhus and williams1 described the personality construct of the dark triad ( dt ) , and since then , dt has been attracting increasing attention.2 dt consists of three dimensions : machiavellianism ( a manipulative , self - centered , immoral , and calculative attitude ) , narcissism ( exaggerated self - lov...	objectivethe dark triad ( dt ) describes a set of three closely related personality traits : machiavellianism , narcissism , and psychopathy . mental toughness ( mt ) refers to a psychological construct combining confidence , commitment , control , and challenge . high mt is related to greater physical activity ( pa ...
common sites of breast cancer metastases include regional lymph nodes , bones , liver , lungs and brain . metastatic breast and lung cancers are the most common non - traumatic causes of brachial plexopathy , after radiation induced fibrosis . because one of the major lymphatic drainage of the breast is through the a...	we report a case of a 56-year - old woman diagnosed with infiltrating ductal carcinoma of the left breast , who had undergone left modified radical mastectomy followed by radiotherapy and adjuvant chemotherapy . fdg pet - ct showed metastatic brachial plexopathy with intra - spinal and extra - axial brain metastasis ...
acute migratory polyarthritis , then known as acute articular rheumatism was the first manifestation described simultaneously in 1605 , in france from guilleaume de baillou and in england by thomas sydenham . the following year he described the disorder of movement ( st vitus dance ) that is now called sydenham s c...	background : acute rheumatic fever and its sequels , rheumatic heart diseases , remain major unsolved preventable health problems in kosovo population , particularly among the disadvantages indigenous albanian and egyptians people . in kosovo , despite of performing secondary prophylaxis with benzathine penicillin , ...
ghana and other countries in sub - saharan africa ( ssa ) are experiencing an epidemic of cardiovascular diseases propelled by rapidly increasing rates of hypertension . a reciprocal or bidirectional relationship has been postulated for hypertension and end - stage chronic kidney disease ( esckd ) . hypertension is...	the surge in prevalence of chronic noncommunicable diseases like hypertension and chronic kidney disease has been linked with modifiable lifestyle practices and increased body fat . this study sought to compare the association between different modifiable lifestyle practices , adiposity indices , renal function param...
fatigue , best defined as difficulty in initiating or sustaining voluntary activities , is a common symptom of various illnesses and even occurs in healthy individuals [ 24 ] . in japan , in contrast , long - term fatigue ( chronic fatigue ) is sometimes irreversible , and the compensation mechanisms that are useful ...	summarybackgroundexposure to a warm environment has been reported to be effective for recovery from mental fatigue . however , there have been no reports examining the effects of a pellet stove on recovery from mental fatigue . the purpose of this study was to examine the effects of a pellet stove on recovery from ...
it demonstrates an elastotic degeneration of the collagen as a result of excessive ultraviolet exposure . majority of pterygium occurs in the nasal side , but it is not uncommon to encounter double - head pterygium in the pterygium belt pterygium can affect vision by causing tear film instability , inducing cornea...	purpose . the study aims to compare the long - term outcome of conjunctival autograft ( cau ) and mitomycin c ( mmc ) in double - head pterygium surgery . methods . this is a follow - up study of a comparative interventional trial . thirty - nine eyes of the 36 patients with double - head pterygium excision in th...
a 25-year - old systemically healthy male patient presented with complaints of severe photophobia , redness , discharge , pain and severe swelling of the lids in the left eye , since two days . past history was significant for a boil on the lower eyelid , two days ago . on examination , the best - corrected ...	we report a 25-year - old systemically healthy male who presented with periocular necrotizing fasciitis ( nf ) in the left eyelid . this was associated with the presence of immunologically mediated marginal kerato - conjunctivitis , in the same eye . this potentially dangerous lid infection and the associat...
metabotropic glutamate receptors , members of the g protein - coupled receptor superfamily , are widely distributed throughout the central nervous system ( cns ) on neuronal and glial cells . during the past two decades , a body of scientific evidence has accumulated indicating that metabotropic glutamate receptors pla...	metabotropic glutamate receptor 5 ( mglur5 ) negative allosteric modulators ( nams ) may play a role in some psychiatric disorders such as anxiety and depression . the pharmacokinetic profile and pharmacodynamics effects of mglur5-nams have been previously reported . we performed a post hoc analysis of pharmacologi...
rhabdomyosarcoma ( rms ) is a malignant tumor of striated muscle origin and derives from primitive mesenchyme that retains its capacity for skeletal muscle differentiation . the combined use of chemoradiotherapy and surgery improves the survival rate significantly , namely up to 5 years . we report on a 42-year - o...	abstractwe report a patient who presented to the ent service complaining of nasal obstruction , exophthalmos , edema and ipsilateral facial congestion . imaging studies revealed an aggressive noncalcified solid mass centered in the left nasoethmoidal region and heterogeneous avid enhancement following contrast media ...
renal transplant candidates present immune dysregulation , caused by chronic uremia followed by renal replacement therapy . recently , uremia was reported to influence cytokine synthesis . while the immune response shift is well described in the literature , still it is not clear whether the pretransplant chronic inf...	renal transplant candidates present immune dysregulation , caused by chronic uremia . the aim of the study was to investigate whether pretransplant peripheral blood gene expression of immune factors affects clinical outcome of renal allograft recipients . methods . in a prospective study , we analyzed pretransplant...
inclusion criteria were that subjects 1 ) had type 1 diabetes for at least 1 year , 2 ) were between the ages of 21 and 70 , 3 ) drove a minimum of 6,000 miles a year , and 4 ) either reported no driving mishaps ( no collisions , citations , or automatic driving where they drove from point a to b with no recollection o...	objectivecollisions are more common among drivers with type 1 diabetes than among their nondiabetic spouses . this increased risk appears to be attributable to a subgroup of drivers with type 1 diabetes . the hypothesis tested is that this vulnerable subgroup is more at risk for hypoglycemia and its disruptive effe...
ssc ) is a chronic , multifactorial disease which was first described by goetz . the disease can run either a chronic or violent course which depends on the degree of internal organs dysfunction . literature data point out that small and large blood vessel disturbances and fibrosis development play a ke...	fibrosis of oesophagus , lungs , heart , and kidney in the course of systemic sclerosis ( ssc ) may lead to dysfunction of the above organs or even patients death . recent studies point out the role of angiogenesis and fibrosis disturbances in the pathogenesis of ssc . heart fibrosis is one of the most impo...
patients with growth hormone ( gh ) deficiency who have a history of abnormal birth injury such as breech delivery occasionally show an atrophic anterior lobe of the pituitary gland , the formation of an ectopic posterior lobe at the median eminence , and a thin or absent pituitary stalk on brain magnetic resonance ima...	we herein report a 31-year - old japanese woman with evolving hypopituitarism due to pituitary stalk transection syndrome . she had a history of short stature treated with growth hormone ( gh ) in childhood and had hypothyroidism and primary amenorrhea at 20 years old . levothyroxine replacement and recombinant folli...
infectious diseases caused by flaviviruses are major concerns in the public health community , particularly those that are drug - resistant or resistant to antibody - mediated neutralization . however , the basic mechanism by which mutations in antigenic proteins lead to evasion of antibody neutralization is ...	mutations in the epitopes of antigenic proteins can confer viral resistance to antibody - mediated neutralization . however , the fundamental properties that characterize epitope residues and how mutations affect antibody binding to alter virus susceptibility to neutralization remain largely unknown . to addr...
h - ns is an abundant global regulator of transcription and a determinant of nucleoid structure in many bacteria ( 1,2 ) . this protein is primarily a repressor acting both as a selective silencer of specific genes or regions of the chromosome and also more locally in concert with other transcription factors within a...	the global transcriptional regulator h - ns selectively silences bacterial genes associated with pathogenicity and responses to environmental insults . although there is ample evidence that h - ns binds preferentially to dna containing curved regions , we show here that a major basis for this selectivity is the prese...
endothelial cells ( huvec passage 46 ; clonetics , walkersville , md ) were grown to confluence , then stimulated with plasminogen activation inhibitor-1 ( pai-1 , 10 ng / ml ; american diagnostica inc . , supernatant was collected 3 hours after stimulation and centrifuged ( 145 g , 8 minutes ) to remove cell debris ...	backgroundendothelium - derived microparticles ( emps ) are submicron vesicles released from the plasma membrane of endothelial cells in response to injury , apoptosis or activation . we have previously demonstrated emp - induced acute lung injury ( ali ) in animal models and endothelial barrier dysfunction in vitro ...
aqueous dispersions of micrometer - sized droplets of thermotropic liquid crystals ( lcs ) provide versatile platforms for the design of stimuli - responsive soft matter systems . the responsiveness of these droplet - based lc systems to various types of stimuli results from the fine scale of energetics that ...	we report a study of the wetting and ordering of thermotropic liquid crystal ( lc ) droplets that are trapped ( or caged ) within micrometer - sized cationic polymeric microcapsules dispersed in aqueous solutions of surfactants . when they were initially dispersed in water , we observed caged , nearly spher...
isolated hemihyperplasia ( ih , omim 23500 ) is most succinctly defined as asymmetric regional body overgrowth because of an underlying abnormality of cell proliferation in individuals without any other underlying diagnosis . there are no widely accepted criteria for defining ih as distinct from normal growth variati...	isolated hemihyperplasia , formerly termed isolated hemihypertrophy , is a congenital overgrowth disorder associated with an increased risk for embryonal tumors , mainly wilms tumor and hepatoblastoma . this practice guideline will set forth the diagnostic criteria and tumor screening recommendations for children wit...
reproductive applications of laparoscopy have broadened to include various diagnostic , reconstructive , and ablative operations . a major concern at laparoscopy remains intraabdominal adhesions , which may predispose a patient to access - related injury and can make the dissection of vital structures difficult , lea...	objective : abdominal wall adhesions at laparoscopy may predispose infertile patients to access - related injuries and increase the complexity of the procedure . we have observed concern from referring physicians regarding the safety of surgical laparoscopy in infertile patients who previously underwent surgery becau...
the primary goal of endodontic therapy is to make the root canal system devoid of micro - organisms . this can be achieved by thorough biomechanical preparation , along with effective debridement and disinfection protocols . the use of various intracanal irrigants and medicaments are essential to control microbial ...	aim : the objective of the study was to determine the neutralizing effect of proanthocyanidin ( grape seed extract ) and lycopene ( tomato extract ) on reactive oxygen species ( ros ) generated by the mixture when used as an intracanal medicament . the study also evaluated the effect of proanthocyanidin and lycopene ...
synthesis of new catalysts is critical for modern synthetic chemistry , but catalyst discovery is commonly based on time - consuming and frustrating trial - and - error protocols . to address this issue , many combinatorial approaches to accelerate the process have been developed.[1 , 2 } however , combinatorial cata...	the first example of a bifunctional organocatalyst assembled through dynamic covalent chemistry ( dcc ) is described . the catalyst is based on reversible imine chemistry and can catalyze the morita baylis hillman ( mbh ) reaction of enones with aldehydes or n - tosyl imines . furthermore , these dynamic catalyst...
detailed clinical and social data were collected by case managers for all tb patients undergoing treatment in london on july 1 , 2003 . analyses were restricted to pulmonary patients 1560 years of age ( n = 970 ) . we used univariate analyses to compare the characteristics of crack cocaine users , other hard - drug...	we hypothesize that crack cocaine is independently associated with smear - positive tuberculosis ( tb ) . in a case control study of tb in london , 19 ( 86% ) of 22 crack cocaine users with pulmonary tb were smear positive compared with 302 ( 36% ) of 833 non drug users . respiratory damage caused by crack cocaine...
erythroderma is a well - recognized entity in the adult age group , but there are few studies on erythroderma in the pediatric age group . it is an uncommon , yet striking entity in children with an incidence of 0.11% . psoriasis affects 0.71% of the population under 18 and psoriatic erythroderma accounts for 1.4% ...	erythroderma in children is an uncommon , yet striking entity with an incidence of 0.11% . psoriatic erythroderma accounts for 1.4% of psoriasis cases in children . follicular psoriasis is an underdiagnosed variant of psoriasis , with only about 15 cases reported till date , characterized by scaly follicular papule...
despite the directly observed treatment short course ( dots ) strategy , tuberculosis ( tb ) is still a major public health problem in the world ( 1 ) . according to the world health organization ( who ) , about 8 to 8 million people annually are diagnosed with tb , diabetes is a debilitating disease that impairs the...	background : diabetes mellitus ( dm ) due to suppressive effect on cellular immunity can impact on progression of tuberculosis ( tb).objectives : the aim of this study was to investigate the impact of dm on the epidemiological , clinical and para clinical aspects of pulmonary tb.patients and methods : the information o...
the hernia sac passes through the obturator foramen , following the path of the obturator nerves and muscles . here we present a typical case of obturator hernia which was diagnosed by spiral ct preoperatively and the emergency operation was performed successfully . a 78-year - old woman was sent to our emergency d...	obturator hernia is a rare pelvic hernia with incidence of 1% . it 's a significant cause of intestinal obstruction in emaciated elderly women . delayed diagnosis and surgical intervention contributed to its relatively high morbidity and mortality . we present a typical case of obturator hernia with positive howshi...
in food processing plants , residues of all kinds chemical , biological , organic , or inorganic inevitably accumulate on the surfaces of equipments in contact with food . attachment of undesirable microorganisms to these surfaces is a source of concern , since this can result in product contamination leading to seri...	the adhesion of aeromonas hydrophila , escherichia coli o157:h7 , salmonella enteritidis , and staphylococcus aureus to hydrophobic and hydrophilic surfaces in cultures with different phs ( 6 , 7 , and 8) was studied . the results indicated that the type of material had no effect on the attachment capacity of microor...
low back pain ( lbp ) is a common condition , with 28.1% of adults in the us reporting to have experienced lbp within the previous 3 months.1 the prevalence of chronic lbp has increased from 3.9% in 1992 to 10.2% in 2006.2 national estimates of direct costs for chronic lbp in the us have been between $ 12.2 billion and...	introductionlow back pain is common and treatment costly with substantial lost productivity and lost wages in the working - age population . chronic low back pain originating in the sacroiliac ( si ) joint ( 15%30% of cases ) is commonly treated with nonoperative care , but new minimally invasive surgery ( mis ) opti...
	this study compared susceptibility to respiratory morbidity in a cohort of 9-year - old children exposed congenitally and postnatally to environmental tobacco smoke ( ets ) to susceptibility in a cohort of unexposed children . the epidemiologic study included 1129 children : 594 boys and 535 girls attending the secon...
a 31-year - old woman presented with a 6-month history of diarrhea , hyperglycemia requiring insulin , weight loss and a 2-month history of icterus and jaundice . laboratory evaluation revealed elevated liver function tests including alanine aminotransferase ( alt ) of 456 iu / l , aspartate aminotransferase ( ast ) ...	pancreatic neuroendocrine tumors ( pnets ) are relatively rare tumors that arise in the endocrine cells of the pancreas . historically , somatostatin analogues have been used in this disease primarily for symptom control and , to a limited extent , disease stability . more recently , sunitinib and everolimus have b...
cancer is one of the most common causes , which results in morbidity and mortality today , further , more than 10 million new cases and more than 6 million deaths occur each year worldwide . in india , oral squamous cell carcinoma ( oscc ) although tobacco and alcohol are the main etiologic factors in three - fourth ...	aims : the aim of this study is to evaluate the expression of human papilloma virus ( hpv ) in oral squamous cell carcinoma ( oscc ) and to correlate the association of hpv in histological grades of oscc using p16 ( p16ink4a ) immunohistochemistry ( ihc).subjects and methods : this study consists of 30 histological dia...
rhabdomyosarcoma ( rms ) is the most common soft tissue sarcoma in children , with the second peak of bimodal age distribution at adolescence . the head and neck , genitourinary system , trunk , and extremities are most commonly involved . rms in the genitourinary system represents 25% of all adolescent cases of rm...	abstractalthough the second peak of the age distribution of rhabdomyosarcoma ( rms ) is at adolescence , renal rms is extremely rare at this age group . this tumor is indistinguishable from other renal tumors based on clinical and imaging findings , and the diagnosis relies on histology and immunohistochemical staini...
in 1952 , wilson1 coined the term " necrotizing fasciitis " ( nf ) for the necrotizing soft tissue infections in which the fascia and tissue death are invariably involved . nf is an infection that spreads along the fascial planes causing subcutaneous tissue death with relative sparing of skin and underlying muscles ,...	necrotizing fasciitis ( nf ) is an infection that spreads along the fascial planes , causing subcutaneous tissue death characterized by rapid progression , systemic toxicity , and even death . nf often appears as a red , hot , painful , and swollen wound with an ill - defined border . as the infective process continu...
progressive increase of reproductive aging has increased the number of couples seeking help for assisted reproductive techniques . demonstrated that an increase in follicle stimulating hormone ( fsh ) occurs several years before elevation in luteinizing hormone ( lh ) and concluded that the first intimation of decrea...	backgroundthis study was undertaken to evaluate the role of day 3 fsh / lh ratio and day 3 lh level as predictors of ivf cycle outcomes.methodsthis prospective observational study was undertaken in the ivf and reproductive biology centre and lok nayak hospital , affiliated to maulana azad medical college , in new delhi...
	nitrous acid , a component of photochemical smog and a common indoor air pollutant , may reach levels of 100 ppb where gas stoves and unvented portable kerosene heaters are used . nitrous acid is a primary product of combustion and may also be a secondary product by reaction of nitrogen dioxide with water . because t...
the poor access to water supply is a prevalent issue in over 850 million people worldwide with over 2.5 billion limited by access to sanitation facilities . the global burden of disease and mortality rates could be reduced by about 9.1% and 6.3% , respectively , if rapid success is attained in facilitating access to ...	purpose . this review was done to explore the impact of water treatment , hygiene , and sanitary interventions on improving child health outcomes such as absenteeism , infections , knowledge , attitudes , and practices and adoption of point - of - use water treatment . methods . a literature search was conducted ...
	a zinc prophenol - catalyzed direct asymmetric aldol reaction between glycine schiff bases and aldehydes is reported . the design and synthesis of new prophenol ligands bearing 2,5-trans - disubstituted pyrrolidines was essential for the success of this process . the transformation operates at room tempera...
thirty adult new zealand white rabbits ( 2.0 to 3.0 kg , 20 weeks old ) were used for this study . the animals were handled in accordance with the association for research and vision and ophthalmology statement for the use of animals in ophthalmic and vision research . all surgical procedures were performed identic...	purposethe purpose of this study was to investigate the myotoxicity of bevacizumab on extraocular muscles in a rabbit model.methodsthirty new zealand white rabbits were used for this study . the animals were evenly divided into two groups . in the first group , 15 rabbits were treated with intramuscular injections ...
during an influenza pandemic , measures to stop the transmission of influenza virus will be a critical part of the public health response . although influenza is known to be transmitted through respiratory secretions containing the virus , infectious material can be passed from person to person in many different ways...	backgroundto prepare for a possible influenza pandemic , a better understanding of the potential for the airborne transmission of influenza from person to person is needed.objectivesthe objective of this study was to directly compare the generation of aerosol particles containing viable influenza virus during coughs an...
removal of smear layer has been considered as an important step in periodontal regenerative therapy . scaling and root planning alone with saline irrigation does not remove the smear layer . the addition of a detergent to edta proved to remove smear layer more efficiently than edta alone . traditional surgical and ...	background : to evaluate the efficacy of 15% ethylenediaminetetraacetic acid ( edta)-s ( edta with soft soap ) preparation for the removal of smear layer at human root surfaces.materials and methods : twenty teeth indicated for extraction due to periodontal disease were sectioned using high speed cylindrical bur under ...
diabetes is one of the most common chronic diseases of human societies and is a major problem for public health . in terms of early and late complications of the disease , the patients and the societies impose many problems ( 1 ) . diabetes care may account for up to 15% of national health care budgets ( 2 ) . this...	background : one of the characteristics of agents is mobility which makes them very suitable for remote electronic health and tele medicine . the aim of this study is developing a framework for agent based diabetes information management at national level through identifying required agents.methods:the main tool is a q...
f10.7 , ap , and dst replicate time series of radiative cooling by nitric oxide quantified relative roles of solar irradiance , geomagnetism in radiative cooling establish a new index and extend record of thermospheric cooling back 70 years f10.7 , ap , and dst replicate time series of radiative cooling by nitr...	infrared radiation from nitric oxide ( no ) at 5.3 m is a primary mechanism by which the thermosphere cools to space . the sounding of the atmosphere using broadband emission radiometry ( saber ) instrument on the nasa thermosphere - ionosphere - mesosphere energetics and dynamics satellite has been measuring thermo...
anti - synthetase syndrome ( as ) is a clinical entity which is described classically by the triad of interstitial lung disease ( ild ) , inflammatory myositis and presence of aminoacyl - trna synthetase antibodies ( asa ) [ 1 , 2 ] . the anti - histidyl - trna synthetase ( anti - jo-1 ) antibody is the most commonly...	anti - synthetase syndrome ( as ) is a clinical entity which is described classically by the triad of interstitial lung disease ( ild ) , inflammatory myositis and presence of aminoacyl - trna synthetase antibodies ( asa ) . we describe a rare presentation of this condition with regard to the uncharacteristically acu...
the uncertainty quantification of pk parameters from preclinical experiments to clinical has been extensively investigated in the literature . prediction methods for clearance is by far the most studied case because of its importance for systemic drug elimination and oral bioavailability . clearance is defined as t...	human dose - prediction is fundamental for ranking lead - optimization compounds in drug discovery and to inform design of early clinical trials . this tutorial describes how uncertainty in such predictions can be quantified and efficiently communicated to facilitate decision - making . using three drug - discovery c...
primary non - hodgkin lymphomas of the gastrointestinal tract are rare , accounting for only 14% of malignancies arising in the stomach , small intestine or colon . mucosa - associated lymphoid tissue ( malt ) lymphoma comprises 78% of all b - cell lymphomas and at least 50% of primary gastric lymphomas . it reache...	the risk of misdiagnosing neoplastic cells typically infiltrating an epithelium forming a lymphoepithelial lesion as poorly differentiated gastric cancer in endoscopic biopsies , particularly in low - grade mucosa - associated lymphoid tissue ( malt ) lymphomas , is described . a 76-year - old woman was referred for ...
health risk of osteoporosis is increasing in korean women and there were many trials to reduce and prevent osteoporotic fracture risk ( 1 , 2 ) . vitamin k plays a role in bone metabolism and may decrease the risk of fracture ( 3 , 4 ) . vitamin k also acts synergistically with vitamin d on bone mineral density ( b...	there are inconsistent findings on the effects of vitamin k on bone mineral density ( bmd ) and undercarboxylated osteocalcin ( ucoc ) . the present intervention study evaluated the effect in subjects over 60-yr - old . the vitamin k group ( vitamin k + vitamin d + calcium supplement ; 15 mg of vitamin k2 [ menatet...
hepatitis is caused by many factors including alcohol , viruses , drugs , immune injury , and idiopathic factors and has remained a serious human health problem throughout the world [ 1 , 2 ] . the features of hepatitis are the release of inflammatory cytokines , the elevation of aspartate aminotransferase ( ast ) and ...	objective . shikonin possesses anti - inflammatory effects . however , its function in concanavalin a - induced acute liver injury remains uncertain . the aim of the present study was to investigate the functions of shikonin and its mechanism of protection on cona - induced acute liver injury . materials and method...
the first few days after birth are a critical period for mothers ( 1 ) . childbirth is a significant life transition event , especially for primiparous women ( 2 ) . in the postpartum period , mothers are faced with multiple biological , psychological , and social changes and the need to adapt to new problems and c...	backgroundanxiety disorder is common during the postpartum period . back massage relaxation techniques are one of the most important nonpharmacological interventions to prevent and control postpartum - related anxiety.objectivesto determine the effectiveness of slow - stroke back massage on the anxiety levels of prim...
retinal detachment is the separation of multilayer neurosensory retina from the underlying retinal pigment epithelium . the incidence of rhegmatogenous retinal detachment ( rrd ) has significant geographic variations ranging between 6.3 and 17.9 per 100,000 people per year.1 in current clinical practice , scleral buc...	backgroundpneumatic retinopexy ( pr ) remains a popular technique for the treatment of rhegmatogenous retinal detachment ( rrd).objectiveto evaluate the single operation and final success rate of pr for primary treatment of rrd and to determine factors associated with anatomical and visual outcomes.methodsthis retrospe...
ochronosis is defined as the accumulation of metabolites of oxidation and polimerization of homogentisic acid ( hga ) in the connective tissues , which have high affinity to collogen . because of the defect occurred in the gene which codes homogentisate 1,2 dioxygenase located on the 3q chromosome , homogentisic acid a...	introductionochronosis is a rare disorder which is defined as the deposition of metabolites of oxidation and polymerization of homogentisic acid , which have high affinity to collogen , in the connective tissues . it is a clinical condition characterized with ochronotic pigmentation of tissues , degenerative arthropa...
deletions , point mutations , amplifications , insertions , inversions and translocations can alter the dna sequence . transmission from parent to offspring results in fixation of these mutations within a population . as schematized in the poster , mice caught in the wild can contain one of four bases ( a , c , g o...	the mouse is the leading organism for disease research . a rich resource of genetic variation occurs naturally in inbred and special strains owing to spontaneous mutations . however , one can also obtain desired gene mutations by using the following processes : targeted mutations that eliminate function in the whol...
in recent years , air pollution has been a serious problem in some asian countries . an important consequence of air pollution is its effect on health , particularly on the respiratory system1 , 2 . as an assessment of respiratory health , forced expiratory volume in 1 second ( fev1 ) is an important measure ...	[ purpose ] we examined factors affecting annual change in pulmonary function in residents previously exposed to air pollution in an area where pollution has been reduced and a long time period has elapsed . [ subjects and methods ] data of 730 officially acknowledged victims of pollution - related illness from...
a 32-year - old female patient with symptoms of widespread pain , fatigue and sleep problems presented at the outpatient clinic one year ago . physical examination indicated that range of motion of spine and peripheric joints were not limited and painful . she had 11 positive tender points ( according to acr 1990 f...	several pharmacological and non - pharmacological modalities have been proposed for the treatment of fibromyalgia syndrome ( fms ) , a common rheumatic disease . pregabalin is suggested as a first - step medication for fms in the newest guidelines . drowsiness , dizziness , and peripheral edema are well - known sid...
purification of endogenous regiiiendogenous regiii was purified from the small intestines of c57bl/6 mice . intestinal tissues were homogenized in 20% acetic acid solution containing protease inhibitors using a pre - chilled homogenization probe and lysed by sonication using a misonix xl sonicator . the ex...	members of the regiii family of intestinal c - type lectins are directly antibacterial proteins that play a vital role in maintaining host - bacterial homeostasis in the mammalian gut , yet little is known about the mechanisms that regulate their biological activity . here we show that the antibacterial a...
successful walking is affected by the integration of complex cognition and neuromuscular , sensory , and skeletal factors , which can degenerate with disease and aging2 . elderly walking is characterized by reduced velocity and increased basal plane . in particular , elderly persons have difficulty changing d...	[ purpose ] this study was to assessed the efficacy of a complex exercise program for the elderly , with respect to the effects on walking ability during direction change and on falls efficacy . [ subjects ] in total , 40 subjects were selected for this study and assigned randomly to either a complex exercise ( n...
radiographic images are routinely used in the field of endodontics for diagnosis , treatment planning , and follow - up of periapical bone lesions . however they do not provide information on the size of a lesion and its spatial relationship with the anatomic structures as it is a two - dimensional representation of ...	aims : to assess the reliability of ultrasound imaging coupled with color power doppler for monitoring the healing after nonsurgical endodontic therapy.materials and methods : ten asymptomatic maxillary anterior teeth with approximately similar - sized periapical radiolucent lesions of average dimension 1.3 1.9 cm , a...
because of continuous efforts to minimize scarring and make procedures less invasive , reduced port surgery ( rps ) procedures , such as laparoendoscopic single - site surgery , have been developed and have gained popularity in not only general but also pediatric surgery over the past few years . for rps , the initial ...	background and objectives : for reduced port surgery in pediatric patients , the initial umbilical incision plays an important role in both functional ability and cosmetic impact . larger umbilical incisions enable better manipulation of forceps , extraction of larger surgical specimens , and easier exteriorization o...
nuclear and mitochondrial dna is damaged by radiation , by organic and inorganic chemical agents and by the misdirected activity of enzymes . exogenous and endogenous processes that contribute to genomic damage include oxidation , alkylation , and deamination of dna . adducts arising from nucleic acid damage ...	the dna and rna repair protein alkb removes alkyl groups from nucleic acids by a unique iron- and -ketoglutarate - dependent oxidation strategy . when alkylated adenines are used as alkb targets , earlier work suggests that the initial target of oxidation can be the alkyl carbon adjacent to n1 . such may ...
	gw182-family proteins are essential for microrna - mediated translational repression and deadenylation in animal cells . here we show that a conserved motif in the human gw182 paralog tnrc6c interacts with the c - terminal domain of polyadenylate binding protein 1 ( pabc ) and present the crystal structure of the compl...
one of the tantalizing questions raised by molecular biology is whether the basic structures of life as we know them arose through a darwinian evolutionary process and , if so , what were the evolutionary pressures acting on them ? the genetic code was initially believed to be universal throughout all living things ,...	backgroundthe genetic code is known to be efficient in limiting the effect of mistranslation errors . a misread codon often codes for the same amino acid or one with similar biochemical properties , so the structure and function of the coded protein remain relatively unaltered . previous studies have attempted to a...
the online version of this article ( doi:10.1007/s00192 - 014 - 2549 - 9 ) contains supplementary material , which is available to authorized users . this video is also available to watch on http://videos.springer.com/. please search for the video by the article title . the objective of this study was to identify n...	introduction and hypothesistactile imaging ( ti ) is the high - definition pressure mapping technology which allows recording pressure patterns from vaginal walls under applied load and during pelvic floor muscle contraction . the objective of this study was to identify new tactile imaging and muscle contraction mark...
in recent years , it has become widely accepted that catalytic promiscuity , i.e. , the ability of many enzymes to catalyze the turnover of multiple chemically distinct substrates , plays a key role in the evolution of new functions , allowing for rapid responses to environmental changes . furthermore , int...	it is becoming widely accepted that catalytic promiscuity , i.e. , the ability of a single enzyme to catalyze the turnover of multiple , chemically distinct substrates , plays a key role in the evolution of new enzyme functions . in this context , the members of the alkaline phosphatase superfamily have been ...
gestational acute respiratory distress syndrome ( ards ) has an estimated incidence of 1670 per 100 000 pregnancies with a mortality rate approaching 50% . here , we present a case of a woman in her 21st week of pregnancy who developed severe ards with multiple etiologic confounders including lymphangioleiomyomatosis...	gestational acute respiratory distress syndrome ( ards ) is a complicated problem with the potential to gravely harm both mother and fetus . this case report describes a young woman in her second trimester of pregnancy who developed progressive respiratory failure in the setting of newly diagnosed influenza , diffuse...
renal cell carcinoma ( rcc ) is the most common cancer of the kidney , accounting for 85% of renal tumors . according to the american cancer society estimates , rcc is the seventh most common cancer and is the tenth leading cause for cancer - specific deaths . data from india regarding the incidence and mortality of rc...	introduction : renal cell carcinoma ( rcc ) is the most common cancer of the kidney accounting for 85% of renal tumors . metastatic rcc ( mrcc ) had a poor prognosis and with the introduction of tyrosine - kinase inhibitors , such as sunitinib , pazopanib the outcomes improved . there is only one study reported fro...
classic polyarteritis nodosa ( cpan ) is a multisystem disease characterized by necrotizing nongranulomatous vasculitis of medium - sized or small muscular arteries without glomerulonephritis1 and was first described by kussmaul and maier in 1866.2 the clinical features vary widely depending on the size and extent of i...	in the medical literature , there have been few reported cases of classic polyarteritis nodosa ( cpan ) presenting with acute renal failure ( arf ) and , unlike microscopic polyangiitis ( mpa ) , no documentation to our knowledge of cpan with clinical presentation similar to acute interstitial nephritis . we describe...
hepatoid adenocarcinoma ( hac ) is a very unusual histological type of primitive extrahepatic cancer . hac can virtually never be distinguished at pathologic examination , on the basis of morphology alone , from hepatocellular carcinoma , whose gross and microscopic features ( sheet - like or trabecular proliferation...	hepatoid adenocarcinoma ( hac ) is a rare type of extrahepatic cancer , whose pathologic features are indistinguishable from those of hepatocellular carcinoma . about thirty cases , nearly half of which occurring in the lung , have been described in patients with a normal liver . no imaging features are typical enoug...
end - stage renal disease ( esrd ) is one of the most serious complication of systemic lupus erythematosus ( sle ) and caries significant short- and long - term morbidity . approximately , 50% of sle patients have clinical evidence of lupus nephritis ( ln ) at the time of diagnosis , with an even greater incidence of...	chronic kidney disease is one of the most common complication of systemic lupus erythematosus , which if untreated can lead to the end - stage renal disease ( esrd ) . early diagnosis and adequate treatment of lupus nephritis ( ln ) is critical to prevent the chronic kidney disease incidence and to reduce the develop...
primary percutaneous coronary intervention ( pci ) is a standard interventional treatment modality for managing patients with st - segment elevation myocardial infarction ( stemi ) . remarkable advances in pci have been made with the development of interventional technologies and the accumulation of experience by int...	primary percutaneous coronary intervention ( pci ) is a standard interventional treatment modality for st - segment elevation myocardial infarction ( stemi ) . diagnostic coronary angiogram during pci reveals multivessel coronary artery disease in about half of patients with stemi , and it is difficult to make decisi...

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