Acute presentation of cocoon abdomen as intestinal obstruction mimicking with strangulated eventration: A case report.

INTRODUCTION: Abdominal cocoon syndrome (ACS), or sclerosing encapsulating peritonitis (SEP) is a rare cause of intestinal obstruction in which the bowel and internal abdominal organs are wrapped with a fibrocollagenous cocoon-like encapsulating membrane. While cocooning of the abdomen primarily manifests in individuals undergoing peritoneal dialysis (PD), it has also been reported to occur spontaneously. Remarkably rare, SEP may present with complete mechanical bowel obstruction in select cases. CASE PRESENTATION: We hereby report a case of an 87-year-old female patient with a prior history of abdominal surgery, who presented to our emergency department with a clinical picture of complete small bowel obstruction. Clinical and radiological data were suggestive of a strangulated midline hernia, prompting a therapeutic laparotomy. The surgical exploration revealed the encasement of the small bowel loops within a thick fibrocollagenous membrane. Efficient resolution was achieved through skillful adhesiolysis and the meticulous excision of the fibrocollagenous membrane. DISCUSSION: SEP is more prevalent in men, with a higher incidence observed in tropical and subtropical countries. While the precise pathophysiology remains elusive, it is hypothesized that subclinical intraabdominal inflammation gives rise to the formation of a dense fibrocollagenous membrane. This membrane encapsulates intraperitoneal organs, ultimately leading to intestinal obstruction. Patients typically present with a recurrent history of small bowel obstruction, notably in the absence of prior abdominal surgery. Abdominal CT scan with experienced radiologist interpretation can aid in preoperative diagnosis. In cases where non-operative management fails and recurrent obstructions persist, surgical adhesiolysis stands as the well-established gold standard. CONCLUSION: SEP is a rare abdominal disease, posing challenges for preoperative diagnosis. Laparotomy plays an important role in its diagnosis and treatment. The primary objective of the surgical intervention is to release the encapsulation of the bowel and safeguard the optimal functioning of the small intestines as much as possible.

Non-infectious meningitis and CNS demyelinating diseases: A conceptual review.

Many cases of aseptic meningitis or meningoencephalitis, unresponsive to antimicrobial treatments, have been reported recently in patients with established/new-onset central nervous system (CNS) inflammatory demyelinating diseases (CNSIDDs). Given the higher probability of infectious etiologies, CNSIDDs are rarely considered among the differentials in meningitis or meningoencephalitis cases. We gathered and tabulated cases of non-infectious, steroid-responsive meningitis or meningoencephalitis associated with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-associated disease (MOGAD). This conceptual review highlights the need to bolster routine infectious workups with immunological workups in cases of meningoencephalitis or meningitis where potential autoimmune etiologies can be suspected. Although differentiating CNSIDDs with meningeal involvement from infectious meningitis may not substantially affect acute treatment strategies, long-term management and follow-up of the two are entirely different. We also discuss future research directions and hypotheses on how CNSIDDs may be associated with meningitis-like presentations, e.g. overlapping glial fibrillary acidic protein astrocytopathy or autoimmune encephalitis, alterations in regulatory T-helper cells function, and undetected viral agents.

WITHDRAWN: Incidence and mortality of COVID-19 in Iranian multiple sclerosis patients treated with disease-modifying therapies.

This article has been withdrawn at the request of the authors and editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.

Rheological and Electrical Study of a Composite Material Based on an Epoxy Polymer Containing Cyclotriphosphazene.

In this work, we have studied, formulated, prepared, and characterized the rheological and electrical behavior of a composite material based on an epoxy resin Diglycidyl Ether of Bisphenol A (DGEBA) reinforced with hexaglycidyl cyclotriphosphazene (HGCP). The epoxy system was cured with 4,4'-methylene dianiline (MDA). DGEBA-HGCP-MDA epoxy composite materials with reinforced HGCP which varied from 5% to 10% by weight were prepared by mixing in the molten state. The morphology was evaluated by SEM. The rheological behavior was studied using small deformation rheology. The electrical characterization was carried out with a frequency variation range from 1 Hz to 100 KHz at room temperature. These measurements revealed that the rheological and electrical behaviors strongly depend on the quantity of HGCP in the DGEBA matrix. The linear viscoelastic properties study reveals that the modulus of elasticity G' is dependent on the amount of HGCP present in the epoxy resin DGEBA. The capacitance-frequency measurements suggest a distribution of localized states in the band gap of the blends.

[Is the ureteral length associated with the patient's size?] / La longueur de l'uretère est-elle liée à la taille du patient ?

OBJECTIVE: To assess the relation between the ureteral length and the patients' size. PATIENTS AND METHOD: Prospective study made between September 2012 and May 2014, on 87 patients with 42 men and 45 women, in whom the ureteral measure was performed during the various procedures that require the use of a pigtail stent. The average age of the population was 53 years old (±15.9) with an average height of 168.3cm (±8.4). This has been achieved through ureteral catheter combining fluoroscopy and endoscopy. RESULTS: The ureteral average length was 23.5cm (±2.33). The ureteral average length was 23.8cm (±2.18) for man and 23.2cm (±2.44) for women. In this population, there were a positive correlation between the size of the patients and the length of the ureters (r=0.75; P=0.01). However, this correlation was not found in all subgroups, particularly among women (r=0.16; P=0.30) and on the right side of men (r=0.34; P=0.12). This correlation was still true for the left side in the men's group (r=0.50; P=0.02). CONCLUSION: In this study, there is a positive correlation between the patients' size and the ureteral length. But this correlation is not found in some subgroups. It is better to perform in vivo the ureteral measurement to have the precise length in order to set up a pigtail stent adapted to the patient. LEVEL OF EVIDENCE: 3.

Increasing the activity of copper exchanged mordenite in the direct isothermal conversion of methane to methanol by Pt and Pd doping.

PtCu- and PdCu-mordenite allow for isothermal reaction at 200 °C for the stepwise methane to methanol conversion with comparably high yields. In contrast to traditional Cu-zeolites, these materials are more reactive under isothermal conditions than after high temperature activation.

Down-regulation of CatSper 1 and CatSper 2 genes by lead and mercury.

In the study of the expression of CatSper genes, consideration of the effects of environmental metal toxicity is very important. Therefore, in this study, the effects of lead acetate and mercury chloride exposure on expression of CatSper genes, sperm parameters, histology of testis and prooxidant antioxidant balance (PAB) values of serum were investigated. A total of 28 mice was divided into four groups. The control group did not receive injections. The sham group received normal saline intraperitoneally. Lead and mercury groups were injected 60 and 1.25 mg/kg/daily lead acetate and mercury chloride respectively intraperitoneally for 2 weeks. After 35 days, the sperm analysis and histology of left testis were performed. In addition, serum was obtained to measure the PAB values. The right testis was used for molecular analysis of real-time PCR. Administration with either lead acetate or mercury caused significant damage to the seminiferous tubules as well as a reduction in sperm parameters compared to the control group. The relative expression of CatSper 1 and CatSper 2 in the lead group was lower than that of the control group (-0.01 ±â€¯0.24, -0.007 ±â€¯0.52 vs. 1 ±â€¯0.50, P = 0.34). The relative expression of CatSper 1 and CatSper 2 was significantly lower in the mercury group compared to the control ones (-0.24 ±â€¯2.28, -4.49 ±â€¯4.86 vs. 1 ±â€¯0.50, P = 0.21). PAB values significantly increased in lead or mercury exposed- mice compared to the control ones (0.93 ±â€¯0.17, 1.54 ±â€¯0.17 vs. 0.51 ±â€¯0.11; P ≤ 0.000). The results of this study showed that administration with either lead acetate or mercury chloride caused degenerative damage in seminiferous tubules and reduction in sperm quality and expression of CatSper 1, 2 genes in mice. Therefore, it is possible in infertile men who have had exposure to lead acetate or mercury chloride. Owing to structural similarities, these metals are substitutes for calcium ions and have effects on calcium channels. These cause immobility in sperm by blocking CatSper-specific calcium channels. However, more studies are required to elucidate the mechanism underlying the impact of different doses of heavy metals on CatSper genes expression.

Comparison of anti-Mullerian hormone level between uterine artery embolization and myomectomy in uterine fibroma.

Background: Uterine fibroma was a general gynecologic condition. When pharmacological therapies fail, surgical interferences such as myomectomy, hysterectomy, or embolization of uterine artery (UAE) are used as that state. This study aimed to compare hormone of anti-Mullerian measure among two methods of UAE, myomectomy into the treatment of uterine fibroma. Material and Method: In this clinical trial held in Imam Reza Hospital of Kermanshah, 40 cases by uterine fibroma were entered into the group of UAE (20 cases) and myomectomy (20 cases). Anti-Mullerian hormone levels were measured twice (ago and later therapeutic interventions) using the Monobinal kit. The information are examined by the SPSS (ver. 20.0) software by applying the Leven's test, paired and independent t-test, Wilcoxon, and Mann-Whitney tests. Results: There is n't matter variation in terms of age between two groups (P> 0.05). Not important variation is recognized regarding anti-Mullerian hormone level before and after six months the medical intervention in either group (P> 0.05). Also, no important variation was detected among the 2 groups in terms of the anti-Mullerian hormone level (P= 0.58). Conclusion: The results obtained demonstrated that where is not statistically important variation among UAE and myomectomy by in terms of anti-Mullerian hormone, which reflects ovarian capacity. Therefore, UAE, which is a less invasive method, can be a suitable substitute for surgical methods in the therapy of significant uterine fibroids between women of the sexual period.

Efficacy of subthreshold micropulse laser in the treatment of diabetic macular edema is influenced by pre-treatment central foveal thickness.

PURPOSE: To determine if the severity of diabetic macular edema influences the effectiveness of subthreshold micropulse (STMP) laser treatment. METHODS: A total of 63 eyes of 58 patients with diabetic macular edema were divided into two groups based on their initial central foveal thickness (CFT). Group 1 had CFT ≤400 µm, group 2 had CFT >400 µm. The change from baseline in CFT and visual acuity were compared at 3, 6 and 12 months follow-up. Patients were considered for retreatment with micropulse laser at 3 months if macular edema had not improved. Patients were considered for rescue anti-VEGF injections if there was clinically significant macular edema at 6 months follow-up. Number of laser retreatments, injections, and any adverse effects from STMP laser were recorded. RESULTS: Group 1 (n=33) experienced an average of 55 µm reduction in CFT and 0.2 log MAR gain in visual acuity at 12 months (P<0.001). No patient required rescue anti-VEGF injections. Group 2 (n=30) experienced no significant change in CFT or visual acuity by 6 months despite retreatment with STMP in 19 eyes. From 6 to 12 months follow-up, all the patients in group 2 received rescue Bevacizumab injections that resulted in 307 µm reduction in CFT and 0.3 log MAR improvement in visual acuity (P<0.001). No adverse effects from STMP laser were recorded. CONCLUSION: Severity of edema can influence the effects of STMP laser. STMP monotherapy is safe and effective in treating edema of mild to moderate severity.

Enterocyte-afferent nerve interactions in dietary fat sensing.

The central nervous system (CNS) constantly monitors nutrient availability in the body and, in particular, in the gastrointestinal (GI) tract to regulate nutrient and energy homeostasis. Extrinsic parasympathetic and sympathetic nerves are crucial for CNS nutrient sensing in the GI tract. These extrinsic afferent nerves detect the nature and amount of nutrients present in the GI tract and relay the information to the brain, which controls energy intake and expenditure accordingly. Dietary fat and fatty acids are sensed through various direct and indirect mechanisms. These sensing processes involve the binding of fatty acids to specific G protein-coupled receptors expressed either on the afferent nerve fibres or on the surface of enteroendocrine cells that release gut peptides, which themselves can modulate afferent nerve activity through their cognate receptors or have endocrine effects directly on the brain. Further dietary fat sensing mechanisms that are related to enterocyte fat handling and metabolism involve the release of several possible chemical mediators such as fatty acid ethanolamides or apolipoprotein A-IV. We here present evidence for yet another mechanism that may be based on ketone bodies resulting from enterocyte oxidation of dietary fat-derived fatty acids. The presently available evidence suggests that sympathetic rather than vagal afferents are involved, but further experiments are necessary to critically examine this concept.

High dietary fat intake influences the activation of specific hindbrain and hypothalamic nuclei by the satiety factor oleoylethanolamide.

Chronic exposure to a diet rich in fats changes the gastrointestinal milieu and alters responses to several signals involved in the control of food intake. Oleoylethanolamide (OEA) is a gut-derived satiety signal released from enterocytes upon the ingestion of dietary fats. The anorexigenic effect of OEA, which requires intestinal PPAR-alpha receptors and is supposedly mediated by vagal afferents, is associated with the induction of c-fos in several brain areas involved in the control of food intake, such as the nucleus of the solitary tract (NST) and the hypothalamic paraventricular (PVN) and supraoptic nuclei (SON). In the present study we investigated whether the exposure to a high fat diet (HFD) alters the hindbrain and hypothalamic responses to OEA. To this purpose we evaluated the effects of OEA at a dose that reliably inhibits eating (10mg/kg i.p.) on the induction of c-fos in the NST, area postrema (AP), PVN and SON in rats maintained either on standard chow or a HFD. We performed a detailed analysis of the different NST subnuclei activated by i.p. OEA and found that peripheral OEA strongly activates c-fos expression in the AP, NST and in the hypothalamus of both chow and HFD fed rats. The extent of c-fos expression was, however, markedly different between the two groups of rats, with a weaker activation of selected NST subnuclei and stronger activation of the PVN in HFD-fed than in chow-fed rats. HFD-fed rats were also more sensitive to the immediate hypophagic action of OEA than chow-fed rats. These effects may be due to a decreased sensitivity of vagal afferent fibers that might mediate OEA's actions on the brain and/or an altered sensitivity of brain structures to OEA.

[Renal adaptation after experimental nephrectomy in animals: a review]. / Adaptation du rein après néphrectomie expérimentale chez l'animal : revue de la littérature.

OBJECTIVE AND DATA-GATHERING: We reviewed experimental litterature about kidney adaptation after nephrectomy in mammals. KNOWLEDGE SYNTHESIS: Renal mass increases after nephrectomy thanks to two components, one is immediately due to the rise of glomulary capillary vascular flow, other is linked to cellular modifications with hyperplasia stage which precedes hypertrophy stage. After nephrectomy, young animals show higher renal adaptability than adults. Similarly, the sex influences the remnant kidney parenchyma volume, the increase of glomerular filtration, the hyperplasia's intensity or length, the hypertrophy's metabolic pathways and the glomerular and tubular cells' injury. There is no question that renal compensatory is regulated by hormones such as IGF-1, TGFß-1 and Ang-II.

Selenium content in wheat and estimation of the selenium daily intake in different regions of Algeria.

In this work, we have measured the selenium content in wheat produced locally in eight different regions of Algeria from east to west, and we have established the annual consumption of selenium for five socio-professional categories. Instrumental neutron activation analysis is used. The selenium levels in wheat samples varied from 21 (Tiaret) to 153 µg/kg (Khroub), with a mean value about 52 µg/kg. The mean of selenium daily consumption from ingestion of wheat per person in the eight regions varied from 32 to 52 µg/day which is close to the minimal FAO recommendation.

Hair-zinc levels determination in Algerian psoriatics using Instrumental Neutron Activation Analysis (INAA).

Psoriasis is a multifactorial skin disease with an unknown etiology. Zinc has a positive impact on psoriasis. The aim of this study is to determine hair-zinc concentration in Algerian psoriatics. 58 psoriatics and 31 normal controls of both genders were selected. Hair zinc levels were determined using Instrumental Neutron Activation Analysis technique (INAA). Student's t-test and One-Way ANOVA were applied. The average zinc concentration for controls and patients were 152 ± 53 µg/g and 167 ± 52 µg/g respectively. They are not significantly different (p>0.05). Zn concentration for males and females controls and patients were 171±27 µg/g, 151±37 µg/g and 145 ± 59 µg/g, 178 ± 58 µg/g respectively. However, for females we have observed a significant difference (p<0.05).

The familial aggregation of cigarette smoking in kish, iran.

BACKGROUND: Based on WHO reports, smoking is an epidemic in developing countries. One of important issues about this behavior is its distribution pattern in family members. The main purpose of this study was to evaluate if cigarette smoking had a tendency to cluster or aggregate in the families and what the determinants were. METHODS: Using a multi-stage random cluster sampling approach, a household survey was conducted in Kish Island in 2009. We used the Alternating Logistic Regressions algorithm to model to show the familial aggregation. RESULTS: The odds ratio for the aggregation of cigarette smoking between family members was 1.63 (1.29-2.06) which increased to 1.96 (1.50-2.55) after adjustment for demographic factors. There was no significant correlation between siblings' cigarette smoking nor was between spouses but the pairwise odds ratio for parents offspring was significant. In other words, cigarette smoking in at least one of the parents increased the odds of being a smoker in offspring significantly. CONCLUSION: The study showed that the smoking behavior aggregated in families significantly. The inter-parent offspring aggregation was the main component of the familial aggregation. Higher education and age-gender interaction were determinants of smoking in the families. The programs for prevention and cessation of this behavior in the community might be more successful if they were designed in a family-based rather than an individual-based approach.

Effect of group reminiscence therapy on depression in older adults attending a day centre in Shiraz, southern Islamic Republic of Iran.

The aim of this study was to examine the effectiveness of group reminiscence therapy on depression symptoms among elderly people attending a day centre in Shiraz, Islamic Republic of Iran. A sample of 49 people aged 60+ years participated in 6 group reminiscence sessions that were held twice weekly for a 3-week period and completed a Farsi version of the 15-item geriatric depression scale. Mean depression scores decreased significantly from 8.18 (SD 1.20) before the intervention to 6.73 (SD 1.20) immediately after it and 7.55 (SD 1.19) 1 month after the intervention. When analysed by demographic characteristics only marital status showed a statistically significant difference in depression scores comparing before and after the intervention.

Recurrent retinal detachment: does initial treatment matter?

BACKGROUND/AIMS: To evaluate the treatment course of patients with primary rhegmatogenous retinal detachment (RRD) that re-detach after initial retinal detachment surgery. METHODS: Patients were divided into three groups based on initial surgical treatment: scleral buckle procedure (SBP) (63 eyes), pars plana vitrectomy (PPV) (88 eyes) and combined SBP/PPV (135 eyes). Charts were reviewed for a mean follow-up of 12 months. RESULTS: Average number of secondary procedures to achieve anatomical success was lowest in the SBP group (1.1), compared with the PPV group (1.47) and the SBP/PPV group (1.5) (p<0.05). Patients that re-detached after initial PPV/SBP, PPV or SBP required silicone oil injection in 83%, 60% and 22% of the cases and had final best-corrected visual acuity better than or equal to 20/50 in 21%, 33% and 45% of the cases, respectively. Phakic patients that re-detached after initial treatment with PPV/SBP, PPV and SBP required pars plana lensectomy (PPL) in 42%, 25% and 12.5% of the cases, respectively. CONCLUSION: Patients with primary RRD that re-detach after initial treatment with SBP require fewer number of secondary operations and silicone oil injections, show a trend for better visual outcomes and are less likely to develop dense cataract or to require PPL compared to patients that re-detach after initial PPV or PPV/SBP.

Improving observer variability in target delineation for gastro-oesophageal cancer--the role of (18F)fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography.

AIM: To evaluate the effect of the addition of fused positron emission tomography-computed tomography (PET-CT) imaging vs computed tomography alone in the identification of the gross tumour volume (GTV) in patients with gastro-oesophageal carcinoma. MATERIALS AND METHODS: Ten patients with gastro-oesophageal cancer referred for radiation therapy underwent both (18F)fluoro-2-deoxy-d-glucose-PET (FDG-PET) and computed tomography in the treatment position. Image sets were anonymised and co-registered. Six radiation oncologists independently defined the GTV, first using the computed tomography data alone supplemented by standardised clinical and diagnostic imaging information, and second, using co-registered computed tomography and FDG-PET data (PET-CT). The standard deviation for both GTV length and volume (excluding involved lymph nodes) was taken as a measurement of inter-observer and intra-observer variability. Computer software that calculates volume overlap between contours was also used to generate an observer agreement index to compare intra- and inter-observer variability. RESULTS: The addition of FDG-PET imaging decreased the median standard deviation for tumour length from 10 mm (range 8.1-33.3, mean 12.4 mm) for computed tomography alone to 8mm (range 4.4-18.1, mean 8.1 mm) for PET-CT (P = 0.02). Eight of the 10 patients showed an increase in volume of overlap between observers with the addition of FDG-PET imaging to the contouring process (P = 0.05). The average observer agreement index in PET-CT was 72.7% compared with 69.1% when using computed tomography alone. There was significantly less intra-observer variability in all measures when PET-CT was used. The median standard deviation in length improved from 5.3 to 1.8 mm, the median standard deviation in volume improved from 4.5 to 3 cm3 and the median observer agreement index improved from 76.2 to 78.7% when computed tomography alone was compared with PET-CT. The corresponding P values were 0.001, 0.033 and 0.022, respectively. CONCLUSIONS: The addition of FDG-PET to computed tomography-based planning for the identification of primary tumour GTV in patients with gastro-oesophageal carcinoma decreases both inter-observer and intra-observer variability.