INFLUENCE OF URSODEOXYCHOLIC ACID ON THE CHOLECYSTOKININ LEVELS IN PATIENTS WITH GASTRO-ESOPHAGEAL REFLUX DISEASE AND TYPE 2 DIABETES MELLITUS.

Of particular interest is the study of the peculiarities of clinical findings and diagnostics of gastroesophageal reflux disease (GERD) in patients with diabetes mellitus (DM). The aim of the research - to study the dynamics of cholecystokinin (CCK) level on the background of complex therapy using the ursodeoxycholic acid (UDCA) drug in patients with GERD with type 2 DM. 68 patients with combination of type 2 DM and GERD were examined. The levels of CCK were studied in these patients, depending on the clinical forms of GERD, as well as their dynamics on the background of UDCA therapy. More pronounced increase in the serum level of CCK in patients with combination of type 2 DM and extra-esophageal manifestations of GERD was observed. Decrease in the CCK level in 2,4 - 2,7 times was reached on the background of complex therapy with UDCA in patients with combination of type 2 DM and GERD (p<0,01). In patients with type 2 DM and GERD, an increase in blood serum CCK level is observed, especially in case of extra-esophageal form of reflux disease. The maximum concentration of CCK in blood serum was revealed in overweight patients with type 2 DM in case of an extra-esophageal form of GERD. The use of UDC medication in the complex treatment of patients with type 2 DM and GERD leads to a normalization tendency of blood serum CCK levels, as well as to a decrease in body mass in these patients.

[The assessment of cardiovascular risk factors in patients with nonalcoholic fatty liver disease].

Article presents the result of assessmaent of cardiovascular risk factors in patients with nonalcoholic fatty liver disease (NAFLD). The results show the presence of cardiovascular risk factors in patients with NAFLD, namely the increase of waist and hip circumferences compared with patients of the control group, hyperglycemia and dyslipidemia, decrease in apolipoprotein A1 (AroA1) compared to practically healthy people.

Interrater Reliability of NI-RADS on Posttreatment PET/Contrast-enhanced CT Scans in Head and Neck Squamous Cell Carcinoma.

Purpose To evaluate the interrater reliability among radiologists examining posttreatment head and neck squamous cell carcinoma (HNSCC) fluorodeoxyglucose PET/contrast-enhanced CT (CECT) scans using Neck Imaging Reporting and Data System (NI-RADS). Materials and Methods In this retrospective study, images in 80 patients with HNSCC who underwent posttreatment surveillance PET/CECT and immediate prior comparison CECT or PET/CECT (from June 2014 to July 2016) were uploaded to the American College of Radiology's cloud-based website, Cortex. Eight radiologists from seven institutions with variable NI-RADS experience independently evaluated each case and assigned an appropriate prose description and NI-RADS category for the primary site and the neck site. Five of these individuals were experienced readers (> 5 years of experience), and three were novices (< 5 years of experience). In total, 640 lexicon-based and NI-RADS categories were assigned to lesions among the 80 included patients by the eight radiologists. Light generalization of Cohen κ for interrater reliability was performed. Results Of the 80 included patients (mean age, 63 years ± 10 [standard deviation]), there were 58 men (73%); 60 patients had stage IV HNSCC (75%), and the most common tumor location was oropharynx (n = 32; 40%). Light κ for lexicon was 0.30 (95% CI: 0.23, 0.36) at the primary site and 0.31 (95% CI: 0.24, 0.37) at the neck site. Light κ for NI-RADS category was 0.55 (95% CI: 0.46, 0.63) at the primary site and 0.60 (95% CI: 0.48, 0.69) at the neck site. Percent agreement between lexicon and correlative NI-RADS category was 84.4% (540 of 640) at the primary site and 92.6% (593 of 640) at the neck site. There was no significant difference in interobserver agreement among the experienced versus novice raters. Conclusion Moderate agreement was achieved among eight radiologists using NI-RADS at posttreatment HNSCC surveillance imaging. Keywords: CT, PET/CT, Head/Neck, Neck, Neoplasms-Primary, Observer Performance Supplemental material is available for this article. © RSNA, 2021.

Update on neonatal resuscitation.

Although only 10% of neonates born in the United States require resuscitation, availability of well trained personnel skilled in neonatal resuscitation can result in a significant decline in neonatal morbidity and mortality. One important aspect of performing a successful resuscitation is having a good understanding of the complex dynamics of fetal/neonatal physiology and the adaptations that must be made to transition to extrauterine life. This knowledge will allow one to better serve the resuscitative needs of the neonate. Performing a risk assessment by evaluating maternal and fetal risk factors is important. Review of medical history including medications, may reveal other medical conditions (e.g. gestational diabetes, preeclampsia, etc.). Once the need for resuscitation is recognized, easy access to equipment, medication and supplies can result in a successful resuscitative effort.

Zirconia Use in Dentistry - Manufacturing and Properties.

Several types of metal-free ceramics have been developed to meet the patients demand for natural looking appearance restorations. Owing to their biocompatibility and good mechanical properties zirconia has been successfully used in recent years as a dental biomaterial. Due to its high opacity zirconia cores are generally covered with ceramic veneers that provide a more natural appearance but have frequent incidence of chipping. As an alternative to veneered zirconia full-contour zirconia restorations become more widely used nowadays. The paper reviews the current knowledge and scientific data of the zirconia use in dentistry in order to compare the zirconia based dental restorations with the metal-ceramic ones and also the two types of dental restoration based on zirconia, veneered or monolithic zirconia.

Acute cardiotoxicity induced by doxorubicin in right ventricle is associated with increase of oxidative stress and apoptosis in rats.

Doxorubicin (DOX) is one of the most effective chemotherapeutic agents, but its efficiency is seriously limited by the risk of developing cardiomyopathy. The most recognized cardiotoxic effect is left ventricular (LF) dysfunction, but MRI and echocardiography data demonstrated significant right ventricle (RV) function impairment. In order to clarify this aspect, the present study investigated the potential of DOX to induce acute RV cardiotoxicity at the same time as LV impairment. Rats were intraperitoneally (i.p.) injected with a single dose of 15 mg/kg DOX. DOX-treated rats were characterized by decreased body and heart weights, elevated levels of creatine kinase (CK-MB) and lactate dehydrogenase (LDH) activities compared to controls. Biochemical analyses on RV tissue revealed that the level of malondialdehyde (MDA) was significant increased (p<0.05) and activities of catalase (CAT), glutathione reductase (GR), glutathione peroxidase (GPX) antioxidant enzymes were decreased by 13%, 27% and 18%, respectively, compared to control. Histopathogical and electron microscopic studies revealed DOX-induced damage in both ventricles and an increase of interstitial collagen fibers compared to controls (p<0.001), whereas immunohistochemical analysis showed weak and irregular desmin expression. Furthermore, mitochondrion-induced apoptotic pathways were also activated in both ventricles, as reflected by the up-regulation of Bax/Bcl-2 mRNA expression ratio (p<0.001) and increase of Bax and caspase-3 protein expression, as well as by the significant elevation of TUNEL positive nuclei, compared to controls (p<0.001). The results showed that DOX exerted RV toxic effects at the same time as those reported in the LV, which might be mediated through the mitochondrial-dependent apoptosis.

Phosphomolybdic acid as a reagent for the spectrophotometric determination of certain phenothiazine derivatives of pharmaceutical products.

Phosphomolybdic acid is used as reagent for colorimetric determination of phenothiazine derivatives in various pharmaceutical products. The reagent oxidizes the derivative to a cationic free radical, with which it then forms a coloured salt. The method is simple and rapid. A preliminary extraction is necessary if certain reductants (sulphite or ascorbic acid) are present as stabilizers of the pharmaceuticals, as otherwise they reduce the reagent to phosphomolybdenum blue.

[Not Available]. / Nouvelle micromethode colorimétrique de dosage de l'ion I(-) dans les eaux et les substances organiques.

A microdetermination of iodide in waters and organic materials is based on oxidation with hydrogen peroxide to iodine which gives a blue colour with o-tolidine at pH 3.5-4.5. The sensitivity is 0.02 mug/ml.

Endoscopic intravascular esophageal pressure measurements in cirrhotic patients: response to metoclopramide.

This study reports the effects of metoclopramide (10 mg i.v.) on intravascular esophageal variceal pressure in 12 patients with alcoholic cirrhosis. The esophageal variceal pressure was measured by the direct variceal puncture technique. Metoclopramide caused a reduction in the variceal pressure in 10 out of 12 patients; overall, there was a decrease from 21.5 +/- 5.0 mmHg to 14.0 +/- 3.4 mmHg (p < 0.001). In conclusion, intravenous metoclopramide, which increases lower esophageal sphincter pressure, significantly decreases intravascular variceal pressure in cirrhotic patients.

Erectile implants in female-to-male transsexuals: our experience in 129 patients.

BACKGROUND: The combination of a neourethra and erection prosthesis in a single neophallus in the female-to-male transsexual remains a challenge. No good data are available on this subject. OBJECTIVE: To report the outcome in 129 female-to-male transsexuals with a neophallus after the implantation of an erectile prosthesis. DESIGN, SETTING, AND PARTICIPANTS: From March 1996 until October 2007, 129 female-to-male transsexuals with a neophallus underwent the implantation of an erectile prosthesis. The mean follow-up was 30.2 mo (range: 0-132 mo). INTERVENTION: A Dynaflex prosthesis was implanted initially in 9 patients, a three-piece hydraulic device (AMS CX or AMS CXM) in 50 patients, and a CX Inhibizone, Ambicor, and Coloplast/Mentor prosthesis in 17, 47, and 6 patients, respectively. MEASUREMENTS: Data on outcome in these patients were retrospectively evaluated. RESULTS AND LIMITATIONS: Of 129 patients, 76 patients (58.9%) still have their original implant in place. Fifty-three patients (41.1%) needed to undergo either removal or revision of the prosthesis due to infection, erosion, dysfunction, or leak. Forty-one patients underwent a replacement of the prosthesis, nine needed a second revision, five needed a third revision, and one patient needed a fourth revision of prosthesis. Malposition of prosthesis was corrected by surgical repositioning so that removal or revision could be avoided. Of 185 prostheses used in 129 patients, 108 (58.4%) still remain in place, with a total infection rate of 11.9%, a total protrusion rate of 8.1%, a total prosthesis leak rate of 9.2%, a total dysfunction rate of 13%, and a total malposition rate of 14.6%. The period of follow-up in the more recent types of prostheses (Ambicor, Coloplast/Mentor) is much shorter; therefore, comparison with earlier types is difficult to make. CONCLUSIONS: Despite high complication rates, implantation of a hydraulic erectile prosthesis remains the best option for achieving the possibility of sexual intercourse in female-to-male transsexuals.

Locally administered ketorolac and bupivacaine for control of postoperative pain in breast augmentation patients: part II. 10-day follow-up.

BACKGROUND: Previously, it was shown that locally applied intraoperative ketorolac and bupivacaine significantly reduced pain in the recovery room. The objective of this study was to test the effectiveness of the same solution over the first 10 days. METHODS: This study was a prospective, randomized, double-blind clinical trial with ethical approval. Fifty submuscular breast augmentation patients were enrolled, and informed consent was obtained. Standard anesthetic and surgical protocols were followed. Either normal saline or ketorolac and bupivacaine (30 mg and 150 mg, respectively) were placed into the pocket. The power of this study to detect a 20 percent difference was 0.90, and values of p < 0.05 were considered significant. The primary outcome was pain measured with the visual analogue pain scale recorded in a take-home diary. The secondary outcome was codeine usage. RESULTS: Forty-five patients completed the study. Of the patients who did not, three were in the normal saline group (n = 22) and two were in the ketorolac-bupivacaine group (n = 23). The ketorolac-bupivacaine combination significantly reduced pain over the first 5 days. By the tenth day postoperatively, the effect had dissipated. These patients also used less codeine. There were no significant complications. CONCLUSION: Locally applied, intraoperative ketorolac and bupivacaine significantly reduced pain for 5 days after surgery in women who had undergone primary breast augmentation.

Regional parasite density in the skin of dogs with symptomatic canine leishmaniosis.

In canine leishmaniosis, the parasitic density of the skin may be important for the infection of sandflies, and increased accumulation of inflammatory cells infected with Leishmania is believed to occur in dermal areas subjected to mechanical trauma. Parasite density and inflammatory responses in the upper and lower dermis of three body sites: flank (control site), dorsal muzzle (sandfly feeding site), and footpads (mechanical stress sites) were thus investigated in 15 dogs with symptomatic leishmaniosis. Parasite density did not differ between the control and tested sites or between the upper and lower dermis, apart from the footpads where it was higher in the upper dermis, and there was no correlation with severity of the macroscopic lesions or inflammatory infiltrate, except for the lower footpad dermis. No selective accumulation of the parasite in the muzzle that would favour its transmission to sandflies occurred, and the mechanical stress imposed on the footpads was not associated with increased parasitic density, or with inflammatory infiltrate.

Physician use of electronic medical records: issues and successes with direct data entry and physician productivity.

At Intermountain Health Care, we evaluated whether physicians in an ambulatory setting will voluntarily choose to enter data directly into an electronic health record (EHR). In this paper we describe the benefits of an EHR, as they exist in the current IHC application and the ways in which we have sought to minimize obstacles to physician data entry. Currently, of 472 IHC employed physicians, 321 (68%) routinely enter some data directly into the EHR without coercion. Twenty-five percent (80/321) of the physicians use voice recognition for some data entry. Twelve of our 95 ambulatory clinics have voluntarily adopted measures to eliminate paper charts. Of the 212 physicians who entered data in 2004, sixty-nine physicians (22%) increased their level of data entry, while 12 (6%) decreased. We conclude that physicians will voluntarily adopt an EHR system, and will continue and even increase use after implementation barriers are addressed.

[An analytical study of 2 dimethylxanthine derivatives with action at the level of the cardiovascular system]. / Studiul analitic a doi derivati ai dimetilxantinei cu actiune la nivelul aparatului cardiovascular.

The analytical investigation of two derivatives of dimenthylxantine series, conventionally termed Imfilin and Carprofilin, is presented. For the quantitative determination of these derivatives the authors suggest spectrophotometric methods in UV which gave good results in the physicochemical control of the substances and of certain pharmaceutical forms (injectable solutions, tablets). The suggested methods were applied in observing the stability of these pharmaceutical forms as well as in their determination in the biological material.

Helicobacter pylori infection, nonsteroidal anti-inflammatory drugs, and gastroduodenal pathology: current status.

Non-steroidal anti-inflammatory drugs (NSAIDs) are now widely used medicines and their relationship with gastroduodenal injury is well established. The overall risk for serious gastrointestinal side effects in patients taking NSAIDs is three times greater than that of control groups and this risk rises to more than five times in elderly patients. Moreover, the risk of gastrointestinal surgery is ten times greater in elderly patients taking NSAIDs than in controls. Therapeutic aspects like the necessity of eradication of Helicobacter pylori (H. pylori) in order to reduce the gastroduodenal risks for NSAIDs users, the indication for eradication of H.pylori of those with past history of peptic ulcer and require NSAID therapy, the role of eradication when the NSAIDs are used in association with misoprostol.

[The photocolorimetric determination of reducing agents using sodium metavanadate as reagent]. / Consideratii privind determinarea fotocolorimetrica a unor reducatori utilizind ca reactiv metavanadatul de sodiu.

The oxidative properties of Vv can be used in the photocolorimetric determination of those reducers which give no other reactions with vanadium ions-penta and tetravalent. Two determination scales of the reducers were elaborated and the isoniazide hydrazide from tablets was dosed with satisfactory results.

[Clinico-epidemiological considerations on an outbreak of Q fever in the Arges region]. / Consideratii clinicoepidemiologice asupra unui episod de febra Q din judetul Arges.

The present paper reports on a Q fever episode, including 45 subjects (caretakers, technicians, workers building stables) in a zootechnical cooperative in the district of Arges. In the new unit milch and reproduction cows were brought from various parts of the district. None of the animals showed visible signs of the disease. No cases of Q fever had been reported in man or animals in the locality until then. The episode had an explosive character, the outbreak occurring during the calving season. The diagnosis was established clinically, epidemiologically, radiologically and serologically.

Protein kinase C-mediated phosphorylation of Kv beta 2 in adult rat brain.

The phosphorylation of Kvbeta2 was investigated by different protein kinases. Protein kinase A catalytic subunit (PKA-CS) yielded the greatest phosphorylation of recombinant Kvbeta2 (rKvbeta2), with limited phosphorylation by protein kinase C catalytic subunit (PKC-CS) and no detectable phosphorylation by casein kinase II (CKII). Protein kinase(s) from adult rat brain lysate phosphorylated both rKvbeta2 and endogenous Kvbeta. The PKA inhibitor, PKI 6-22, fully inhibited PKA-mediated phophorylation of rKvbeta2 yet showed minimal inhibition of kinase activity present in rat brain. The inhibitor Gö 6983, that blocks PKCalpha, PKCbeta, PKCgamma, PKCdelta and PKCzeta activities, inhibited rKvbeta2 phosphorylation by rat brain kinases, with no inhibition by Gö 6976 which blocks PKCalpha and PKCbetaI activities. Dose-response analysis of Gö 6983 inhibitory activity indicates that at least two PKC isozymes account for the kinase activity present in rat brain. Thus, while PKA was the most active protein kinase to phosphorylate rKvbeta2 in vitro, Kvbeta2 phosphorylation in the rat brain is mainly mediated by PKC isozymes.

Locally administered ketorolac and bupivacaine for control of postoperative pain in breast augmentation patients.

With recent developments in the field of analgesia, the question arises whether there is a role for placing local anesthetics, nonsteroidal anti-inflammatory drugs, or both into the breast implant pocket. The objective of this study was to test the effectiveness of locally administered intraoperative ketorolac and bupivacaine with epinephrine at reducing pain in the postoperative period. The study was a prospective, randomized, double-blind clinical trial. One hundred consecutive retropectoral breast augmentation patients were enrolled, and informed consent was obtained. A standard anesthetic protocol and surgical procedure were followed. Normal saline, ketorolac alone (30 mg), bupivacaine alone (150 mg), or ketorolac and bupivacaine (30 mg and 150 mg respectively) were placed into the implant pocket before implant insertion. All patients completed the study. The power of this study to detect a 20 percent difference with respect to the primary outcome was 0.90 and confidence intervals of 95 percent were used to determine significance. The primary outcome was pain as measured by the visual analogue pain scale. The secondary outcome was time spent in the recovery room. Intraoperative placement of ketorolac combined with bupivacaine reduced pain in the postoperative period. It did not appear that anesthesiologist, anesthesia time, surgeon, operating room time, difficulty of dissection, breast incision, or implant size had a significant effect on postoperative pain. There was a trend that the ketorolac and bupivacaine patients spent less time in the recovery room and used fewer analgesics postoperatively than the other patients. There were no hematomas requiring reoperation and no complications. Locally administered intraoperative ketorolac and bupivacaine with epinephrine significantly reduced pain in the postoperative period.