Latest Developments in Adapting Deep Learning for Assessing TAVR Procedures and Outcomes.

Aortic valve defects are among the most prevalent clinical conditions. A severely damaged or non-functioning aortic valve is commonly replaced with a bioprosthetic heart valve (BHV) via the transcatheter aortic valve replacement (TAVR) procedure. Accurate pre-operative planning is crucial for a successful TAVR outcome. Assessment of computational fluid dynamics (CFD), finite element analysis (FEA), and fluid-solid interaction (FSI) analysis offer a solution that has been increasingly utilized to evaluate BHV mechanics and dynamics. However, the high computational costs and the complex operation of computational modeling hinder its application. Recent advancements in the deep learning (DL) domain can offer a real-time surrogate that can render hemodynamic parameters in a few seconds, thus guiding clinicians to select the optimal treatment option. Herein, we provide a comprehensive review of classical computational modeling approaches, medical imaging, and DL approaches for planning and outcome assessment of TAVR. Particularly, we focus on DL approaches in previous studies, highlighting the utilized datasets, deployed DL models, and achieved results. We emphasize the critical challenges and recommend several future directions for innovative researchers to tackle. Finally, an end-to-end smart DL framework is outlined for real-time assessment and recommendation of the best BHV design for TAVR. Ultimately, deploying such a framework in future studies will support clinicians in minimizing risks during TAVR therapy planning and will help in improving patient care.

Prevalence and Risk of Obstructive Sleep Apnea and Association with Orofacial Symptoms in Patients Attending the Dental Clinics.

BACKGROUND: Dentists have a vital role in detection of the signs and symptoms of obstructive sleep apnea (OSA) as it modifies in anatomy of orofacial structures. AIMS AND OBJECTIVES: This study aims to assess the prevalence of OSA risk in patients attending dental department and explore the factors related with high-risk OSA. MATERIALS AND METHODS: The study was carried in the Al-Farabi Dental College, Jeddah, Saudi Arabia, on 200 consecutive dental patients from June 1, 2018, to July 31, 2019. Demographic details and the OSA risk were evaluated based on the Berlin questionnaire (Arabic version). Two qualified investigators independently did anthropometric measurements, medical and dental examination. RESULTS: About 3.7% of males and 13.8% of females were found to be at high risk of OSA. Obese individuals almost had twice more likely chance to have OSA symptoms. CONCLUSION: Our findings confirm that dentists have an important role in recognizing the OSA signs and symptoms.

Surgical Management of Incomplete Abortion by Manual Vacuum Aspiration (MVA).

This cross sectional study was carried out on incomplete abortion cases in Obstetrics and Gynaecology (ObG) Department, Sir Salimullah Medical College and Mitford Hospital (SSMC & MH), Dhaka, Bangladesh. It was carried out from 1st January 2012 to 30th June 2012 to assess the effectiveness of MVA in terms of completeness, duration, cost and complication of the procedure and duration of hospital stay. Incomplete abortion cases attending the ObG indoor were considered as study population. A total of 50 patients were collected by purposive sampling. Inclusion criteria were: i) Incomplete abortion up to 12 weeks of gestation, ii) Failed medical abortion and iii) Incomplete MR. Exclusion criteria were: i) Induced abortion, ii) Septic abortion with fever, iii) Haemodynamically unstable patients. Counseling was done to provide emotional support during the procedure. Pain management was done by paracervical block, analgesia and or mild sedation. During MVA, measures taken to prevent infection. Complication like excessive pervaginal bleeding and incomplete evacuation was assessed by ultrasonogram. Duration of hospital stay and total cost were assessed. Limitation of the study: short sample, short follow-up, small population not enough for a reproducible data. Further study needed in future. Mean age of the patients was 21-30 years. Most of them were grand multipara (36%), 70% belong to below average income group, 44% of them never used contraceptives. Many of the incomplete abortion cases presented with 9-10 weeks (66%) of gestation with per vaginal bleeding (96%). Lower abdominal pain (66%), passage of fleshy mass (14%). 88% of them are mildly anaemic and 12% were severely anaemic. Eighty two percent (82%) of them were haemodynamically stable and 18% were haemodynamiclly unstable. The mean time of the procedure was 6-10 minutes. Most of the patients (82%) did not need any resuscitation after the procedure. For 25% cases, analgesics had to be used. Four percent (4%) cases had complication like incomplete evacuation and excessive p/v bleeding after the procedure.

Orlistat (The Lipase Inhibitor) Therapy in Overweight and Obese Subfertile Women.

This experimental study was carried out to evaluate the efficacy of orlistat (a pancreatic lipase inhibitor) therapy over lifestyle change on weight reduction and ovulation in overweight and obese subfertile women. It was carried out in Department of Gynecology and Obstetrics, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh from August 2015 to January 2016. Subfertile obese and overweight female patients attending the study centre during study period was considered as study population. Subfertile women with normozoospermic husband with BMI (25-40) Kg/M2, age (18-35) years with no history of taking medication or dietary modification for weight loss currently or for the preceding 3 months were included in this study but subfertile patients having laparoscopic ovarian drilling and metformin and those with structural abnormalities in reproductive tract and known hormonal and medical disorder were excluded from this study. Detailed history taking, physical examination including weight, Body Mass Index (BMI) and baseline relevant investigations were done. Transvaginal sonography (TVS) on day 12 and day 14 of menstrual cycle was done for evaluation of ovulatory status of the patients. Counseling was done about life style change by diet of low glycemic index and moderate exercise. Following written informed consent, 120 patients were enrolled into either of the two groups. Group I received capsule Orlistat 120 mg twice daily for 3 months period. Group II was counseled for life style modification only. Post treatment weight measurement and TVS on day 12 and 14 were done after completion of intervention. Then pre and post-treatment parameters were assessed between two groups. Mean age was (27.31±4.58) years in Group I and (26.20±4.71) years in Group II. Majority patients, (78.3%) in Group I and (76.7%) in Group II had oligomenorrhoea. Hirsuitism was observed in (25%) in Group I and (43.3%) in Group II. Mean weight (kg) at booking was (72.26±7.81) in Group I and (67.10±5.93) in Group II; after 3 months (67.77±7.82) and (63.55±6.07). Reduction of weight (%): (6.52±2.28) in Group I and (5.33±2.14) in Group II which was significantly higher in Group I than that of Group II in (25.0-29.9) BMI. Ovulation assessed by TVS at booking and after 3 months in Group I: 13(21.7%) and 37 (61.7%) and in Group II: 14 (23.3%) and 27 (45.0%). Ovulation was higher in Group I than that of Group II, but the difference was not statistically significant. Majority of the overweight and obese subfertile patients suffered from oligomenorrhoea and anovulation. Weight significantly reduced in both groups along with ovulation improvement, more in Group I, but insignificant in between groups. Therefore this study suggested that orlistat can improve ovulation as it acts indirectly by weight reduction more than life style modification alone.

Thermostable phycocyanin from the red microalga Cyanidioschyzon merolae, a new natural blue food colorant.

The demand for natural food colorants is growing as consumers question the use of artificial colorants more and more. The phycobiliprotein C-phycocyanin of Arthospira platensis is used as a natural blue colorant in certain food products. The thermoacidophilic red microalga Cyanidioschyzon merolae might provide an alternative source of phycocyanin. Cyanidioschyzon merolae belongs to the order Cyanidiophyceae of the phylum Rhodophyta. Its natural habitat are sulfuric hot springs and geysers found near volcanic areas in, e.g., Yellowstone National Park in the USA and in Java, Indonesia. It grows optimally at a pH between 0.5 and 3.0 and at temperatures up to 56 °C. The low pH at which C. merolae grows minimizes the risk of microbial contamination and could limit production loss. As C. merolae lacks a cell wall, phycocyanin with a high purity number of 9.9 could be extracted by an osmotic shock using a simple ultrapure water extraction followed by centrifugation. The denaturation midpoint at pH 5 was 83 °C, being considerably higher than the A. platensis phycocyanin (65 °C). The C. merolae phycocyanin was relatively stable at pH 4 and 5 up to 80 °C. The high thermostability at slightly acidic pH makes the C. merolae phycocyanin an interesting alternative to A. platensis phycocyanin as a natural blue food colorant.

Psychosocial Consequences of Infertility on Infertile Women.

This study explores to find out the qualitative and quantitative psychosocial consequences of infertility in women coming for infertility treatment in tertiary infertility center. A total of 400 infertile couples who agreed to participate in the study were asked to fill up the questionnaires and later interviewed to access the psychosocial consequences of infertility on their personal life in a tertiary infertility clinic in Dhaka at Center for Assisted Reproduction (CARe Hospital), Dhaka from June 2011 to December 2011 and agreed to participate in the study were included in the study. The data was analyzed and the quantitative and qualitative psychosocial factors were evaluated. Four hundred infertile couple who filled the questionnaires was included in the study. Sixty three percent of the women belonged to age group >20 30 years at the time of interview. Regarding age at marriage 43.8% of the women were married by 20 years, 51.3% were married between 20 30 years. Mean±SD duration of present married life was 7.20±4.45 (range 1 to 28) years and 74.4% of the women were living with their husbands. Of them 75.5% women were housewife. When asked whether they knew what was the reason of infertility in the couple, 32.5% knew the cause was in the female partner, 14.5%, knew the cause was in the male partner, 10.3% knew the cause was in both partners, 21.5% knew cause of infertility was not in any of the partners, and 21.3% had no idea about the cause of infertility. The male partner's response about the issue of prognosis and outcome of couple's infertility revealed 37.3% believed their wives will conceive someday, 31.3% had no intention for a second marriage, 13% were indifferent, 11.3% blamed their wives for infertility and 4.8% threatened for a second marriage. Only 2.5% of the male partners were suggested on consulting and continuing treatment by specialist. The family pressure by in-laws and relatives towards their infertility was that 57.3% insisted on consulting a good gynaecologist, 29.8% had no family pressure, 11.3% insisted the male partners to remarry, and 1.8% insisted the husbands to divorce their wives. In evaluating the social response it showed that 55.8% was suggested to consult a good gynaecologist, 31% asks embarrassing questions, 13% taunted and 0.3% insisted the husband to divorce the wife. In developing countries, despite overpopulation, unwanted childlessness is also an important psychosocial burden that needs attention. The consequences of infertility have greater impact on woman's life and can be a life time crisis. There is no direct intervention regarding infertility from government or NGO's. National services is lacking because policy makers and donor NGOs are not interested to invest on it and also women want to hide their infertility as long as they can.

The protective role of the opioid antagonist LY255582 in the management of high fat diet-induced obesity in adult male albino rats.

OBJECTIVES: The involvement of the opioid system in energy balance has been known for several decades but many questions remain unanswered. Therefore, this study was designed to investigate the effect of the non-selective opioid receptor antagonist (LY255582) on high fat diet (HFD)-induced obesity. METHODS: Twenty-four adult male albino rats were divided into 4 groups: Control, HFD non-treated, HFD+LY255582 treated during the first 4 weeks and Obese-LY255582- treated groups during the following 4 weeks after the induction of obesity. LY255582 (0.31 mg/kg, s.c.) was administrated daily with HFD feeding. Blood samples were collected for measurement of lipid profile, glucose, insulin, and leptin. Body weight, body mass index (BMI), and food intake were also measured. RESULTS: Consumption of HFD resulted in a significant increase in body weight, body mass index (BMI), glucose, insulin, leptin levels, and induced a state of dyslipideamia. Opioid antagonist LY255582 administration with HFD decreased food intake, body weight and BMI, in addition to the improvement of HFD related metabolic abnormalities (dyslipidemia and insulin resistance) during the dynamic phase of obesity development than in animals with already developed dietary obesity. CONCLUSION: The use of opioid antagonist may be a promising approach in treatment of HFD-induced obesity.

Association of Blood and Semen Lead and Zinc Level with Semen Parameter in the Male Partner of Infertile Couple.

This cross sectional study was carried out in Center for Assisted Reproduction, Dhaka, and in the Department of Biochemistry, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2012 to December 2012. The study population was 71 consecutive male partners of infertile couple suffering from at least one year of infertility. Lead and Zinc level was measured in blood and semen in the male partner of infertile couple and compared with semen parameters. Serum zinc at different values did not show any statistically significant change in semen volume, total count of sperm and total motility of sperm. At serum zinc level 80-< 90 µg/dl blood lead and semen lead level was lowest 20.6 ± 8.60 µg/dl and 48.17 ± 51.33 µg/dl respectively and showed highest total count of sperm (54.00 ± 46.67 million/ml) but was not statistically significant. Rapid linear motility and normal sperm morphology was also highest at values 80-< 90 µg/dl and was 45.33 ± 26.62% and 36.67 ± 11.60% respectively and was statistically significant. At serum zinc level > 90 µg/dl semen lead level was significantly higher (120.73 ± 58.02 µg/dl) and showed statistically significant decrease in rapid linear motility and normal sperm morphology. Total count of sperm was lowest at blood zinc level of 70-< 80 µg/dl. Sperm morphology also showed statistically significant improvement at Serum zinc values of 80-< 90 µg/dl. The results suggest that Serum zinc level of values 80-< 90 µg/dl is the optimum level to have the best impact on semen parameter as well it is the critical level at which the semen lead level is lowest. Serum zinc levels higher as well as lower than values 80-< 90 µg/dl was associated with increased semen lead values and with negative impact on semen parameters.

Quality and quantity of infertility care in Bangladesh.

Infertility is an important health issue which has been neglected in the developing countries. First test-tube babies (triplet) in Bangladesh were born on 30th May, 2001. Although there is no tertiary level infertility center in the public sector, several private centers have come up with the facilities. The objective of the study was to find i) the quality and quantity of infertility care in Bangladesh and ii) the cause of infertility in the attending patients iii) the treatment seeking behaviors iv) and the reasons for not taking treatment among the attending patients. There are now 10 tertiary level Infertility centers in Bangladesh. The information was collected in a preformed datasheet about the facilities and the profile of the patients and the treatment seeking behavior of the attending patients. Out of the ten centers two centers refused to respond and did not disclose their data. Around 16700 new patients are enrolled in a year in the responsive clinics. Five percent (5%) of the patients underwent ART, 7% of the patients gave only one visit, 84% of the patients completed their evaluation, 76% of the patients took treatment. Causes of infertility in the patients taking treatment were male factor in 36.4%, bilateral tubal block in 20.2%, PCOS and anovulation in 31.7%, endometriosis in 19.6%, unexplained in 10.95, combined in 3.5%, ovarian failure in 1.4%, testicular failure in 0.33%, congenital anomaly in 0.3%. The main reason for not taking treatment was financial constrainment. The quality and quantity of infertility care is dependent on the available resources and on the use of the resources by the patients. In developing countries the resources are merging and confined to specified areas which cannot meet the demand of their population. The study gives us the idea of the need and the demand of the services in the country.

Outcome of triplet pregnancy with hydatidiform mole and coexisting twin live fetus following ICSI.

The hydatidiform mole with coexisting fetus is a rare condition. There have been few reports on this condition following ovulation induction and ART. We describe here the clinical features, management and outcome of a case of complete hydatidiform mole with coexisting viable twin fetus following Intra-cytoplasmic sperm injection. A 29 year old lady was pregnant following Intra-cytoplasmic Sperm Injection (ICSI) and Embryo Transfer. Three good quality embryo with two pronuclei on pronuclear check was transferred. A triplet pregnancy with two live fetus and a complete mole was delivered at 37 completed weeks of pregnancy. The antenatal period was uneventful and the human chorionic gonodotrophin returned to baseline by 4 weeks after delivery. There was no further complication at one year follow-up. Continuation of pregnancy as long as maternal complications are absent or controllable can be a safe and rewarding effort in managing the patient.

Sexually transmitted infections and sexual behaviour among youth clients of hotel-based female sex workers in Dhaka, Bangladesh.

A cross-sectional study was conducted among youth clients of hotel-based female sex workers (YCHBFSWs) in nine randomly selected hotels in Bangladesh to examine sexual-risk behaviour, condom use and determinants of condom use in last sex, knowledge of HIV, sexually transmitted infection (STI) prevalence and STI care-seeking behaviour. A prestructured questionnaire was used to collect sociodemographic, behavioural, clinical information; urine specimens (before sex) and blood were collected for diagnosis of Neisseria gonorrhoeae, Chlamydia trachomatis, Trichomonas vaginalis, syphilis and herpes simplex virus 2 (HSV2) infection. One thousand and thirteen participants were enroled in the study. Approximately half of them reported visiting female sex workers (FSWs) at least once a month and 25% visited FSWs at least once a week. Only 12% of participants reported regular condom use. The prevalence of N. gonorrhoeae, C. trachomatis, T. vaginalis, syphilis and HSV2 was 2.2%, 3.9%, 7.2%, 2.6% and 12.9%, respectively. Only 15.3% of the YCHBFSW sought STI care in the past year. Negotiation of condom use with FSWs was the main determinant (odds ratio = 17.95) for condom use at last sex. Male clients of FSWs, including YCHBFSW, are an important bridge population for HIV transmission in Bangladesh and HIV interventions should be designed and implemented for them.

Semen parameters at different age groups of male partners of infertile couples.

As a good number of couples are coming to infertility clinics to have children at advanced ages, it is essential to know whether advanced paternal age is associated with diminished semen quality and a higher risk of infertility. This retrospective study was done to see the effects of age on semen quality, a well-known indicator of fertility status. Semen parameters of smokers and non-smokers in the study population were also analyzed. A sample of 1121 male partners of infertile couples (aged 25-55 years) who came to an infertility clinic for treatment were included into the study. In addition to clinical history including lifestyle, medical and occupational details and physical examination, their semen samples were examined. Semen volume (ml), sperm concentration (x 10(6)/ml), motility (%), rapidly progressing (%), slowly progressing (%), non-progressive (%) motility and morphology (%) were measured. Semen volume showed IQR 1.5-3.0 ml, and significant decreasing trend with increasing age (r = -0.070, p<0.05). Sperm motility and rapidly progressing motility showed significant decrease (IQR 40.0-70.0, r = -0.115, p<0.01 and IQR 20.0-50.0, r = -0.107, p<0.01 respectively) with increasing age. There was no significant difference between semen parameters of smokers and non-smokers in the study population. This study shown that semen volume, sperm motility and rapidly progressing motility were significantly decreased with increasing age.

Immunogenic and tolerogenic signatures in human immunodeficiency virus (HIV)-infected controllers compared with progressors and a conversion strategy of virus control.

Epidemiological studies have identified a small cohort of controllers of human immunodeficiency virus (HIV)-1 infection, who without treatment have no detectable virus, and others who progress at a variable rate. The objective of this study was to distinguish immune signatures in HIV controllers and progressors, by evaluating tolerogenic and immunogenic factors in untreated HIV-1 infected individuals. The recruited population was divided into putative elite controllers (PEC), long-term non-progressors (LTNP), normal progressors (NP) and fast progressors (FP). The proportion of regulatory T cells [T(regs) , CD4+ CD25+ forkhead box P3 (FoxP3+)], programmed death (PD)-1 and cytotoxic T lymphocyte antigen (CTLA)-inhibitory molecules and CD40L, CD69 and Ki67 activation markers were evaluated in peripheral blood mononuclear cells (PBMC) by flow cytometry. Significant differences were found between HIV controllers and HIV progressors, with up-regulation of T(regs) , PD-1 and CTLA-4 and decrease of CD40L expression in progressors compared with controllers. Expression of CD40L and concentrations of interleukin (IL)-6, CCL-3, and CCL-4 were significantly higher in PEC and LTNP than in NP and FP. In an attempt to convert immune signatures of progressors to those of controllers, seven agents were used to stimulate PBMC from the four cohorts. Treatment with CD40L and IL-4 or PD-1 antibodies in vitro were most effective in converting the immune signatures of progressors to those observed in controllers by down-regulating T(regs) and up-regulating CD40L expression in CD4+ T cells. The conversion concept merits translation to in vivo immune control of HIV infection.

Outcome of pregnancies after inadvertent exposure to GnRH agonist in early pregnancy.

Four pregnancies were exposed to gonadotrophin-releasing hormone agonist (GnRHa) during early pregnancy and the patients were followed up to find out the outcome of their pregnancies. In three patients long-acting GnRHa (triptorelin acetate 3.75 mg) once monthly was used for severe pelvic endometriosis as part of preparation for undergoing assisted reproductive technology (ART) cycle, and in one patient daily injections of short-acting GnRHa (buserelin 0.05 mg) was given for down-regulation for ART cycle. The age of the patients ranged from 29 to 38 years and duration of infertility was 3 to 13 years. In patients prescribed long-acting GnRHa, diagnosis of pregnancy was done late at around 5-8 weeks by ultrasonography, whereas in patients using short-acting GnRHa diagnosis of pregnancy was made with blood beta human chorionic gonadotropin (HCG) level after the 26th day of injections. Three pregnancies were delivered around term and the babies had no apparent complication or any congenital anomaly. One of the pregnancies ended up into spontaneous abortion at 14 weeks of pregnancy. The children were regularly examined by pediatricians regarding physical and mental development and for any abnormal behavioral problems. All of them are normal till now.

[Multiple non-responding ESWL lithiasis in ectopic pelvic kidney: laparotomic surgical management]. / Calcolosi renale multipla refrattaria a ESWL in rene ectopico pelvico: approccio chirurgico laparotomico.

A 34 year-old male with multiple lithiasis of ectopic pelvic left kidney, which for 5 years had been causing pain in the left iliac region irradiating to ipsilateral inguinal region and testis. 4 ESWL treatments were unsuccessful. The diagnostic imaging (Angio-CT + Uro-CT) showed ectopic pelvic left kidney with abnormal vascularisation, characterised by multiple lithiasis extending in total area of 4x2 cm with shorter ureter. Right kidney was in normal position. A left pyelocalicolithotomy after DJ stent positioning was performed.

Relationship of blood and semen lead level with semen parameter.

Lead has for long been known to affect multiple organs and can affect reproduction in male and female as well as the offspring. The study was done to find out the level of lead in blood and semen of infertile men and to find its effect on the semen parameters, as well as the minimum level of lead in blood and semen that can have negative impacts on semen parameters. The study was cross sectional in design. Male partners of 57 infertile couples attending a tertiary infertility center in Dhaka, Bangladesh were recruited for the study. Blood lead was measured by the Graphite Furnance Atomic Absorption Spectrophotometer and semen analysis was done according to the WHO recommendation (1999). With increasing blood lead concentration there was corresponding increase in the mean semen lead concentration. Reduction of mean semen volume started at level of mean blood lead level of >40mugm/dl. Mean total count of sperm (x106/ml) started decreasing at blood lead level of >30mugm/dl with very significant reduction of the count at level >40mugm/dl. At mean blood lead level >35mugm/dl there was decrease in mean values for total motility and rapid linear motility of sperm. In 12.3 % of the patients mean blood lead level was above >35mugm/dl. Higher mean blood and semen lead level was associated with significant declining semen parameters.

[a-blockers in benign prostatic hyperplasia: the problem of "floppy iris syndrome". Results of a case-control study to evaluate the surgical risk through the meausurement of pupil diameter].

OBJECTIVES. α-blockers are a group of α-adrenoceptor antagonists used by urologists to treat lower urinary tract symptoms suggestive of benign prostatic hyperplasia. Recent studies have suggested that these drugs - tamsulosin in particular - are involved in the development of iris complications during phacoemulsification. The objective of this study is to investigate the effects of α-blockers - especially tamsulosin - on pupil diameter. MATERIALS AND METHODS. We measured the photopic, mesopic and post-dilatation pupil diameters in both eyes of 24 patients (46 eyes in total), 16 of them treated with α-blockers and 8 of them (16 eyes in total) not treated with any drugs (controls). RESULTS. All patients treated with tamsulosin showed minor photopic, mesopic and post-dilatation diameters compared to controls. Patients treated with other α-blockers did not show any difference compared to controls. CONCLUSIONS. Even if a small number of eyes was evaluated, our study shows that tamsulosin - through its selective effect on α1A receptors - is the most involved drug in the Intraoperative Floppy Iris Syndrome.

Characterization of major allergens of royal jelly Apis mellifera.

Royal jelly is widely consumed in the community and has perceived benefits ranging from promoting growth in children and improvement of general health status to enhancement of longevity for the elderly. However, royal jelly consumption has been linked to contact dermatitis, acute asthma, anaphylaxis and death. High prevalence of positive skin tests to royal jelly have been reported among atopic populations in countries with a high rate of royal jelly consumption. The present study is aimed to identify the major allergens of royal jelly. Royal jelly extract was separated by sodium dodecyl polyacrylamide gel electrophoresis (SDS-PAGE) and 2-dimensional electrophoresis (2-D). Immunoblotting of the SDS-PAGE and 2-D profiles were performed to identify the allergenic spots. Spots were then excised from the 2-D gel, digested with trypsin and analyzed by mass spectrometry. The SDS-PAGE of royal jelly extract revealed 18 bands between 10 to 167 kD. Western blot of the fractionated proteins detected 15 IgE-binding bands between 14 to 127 kD with seven major allergens of 32, 40, 42, 49, 55, 60 and 67 kD using serum from 53 subjects with royal jelly allergy. The 2-D gel fractionated the royal jelly proteins to more than 50 different protein spots. Out of these, 30 spots demonstrated specific IgE affinity to the sera tested. Eight spots of the major royal jelly allergens were selected for mass-spectrometry analysis. Digested tryptic peptides of the spots were compared to the amino acid sequence search in protein databases which identified the fragments of royal jelly homologus to major royal jelly protein 1 (MRJ1) and major royal jelly protein 2 (MRJ2). In conclusion, the major allergens of royal jelly are MRJ1 and MRJ2 in our patients' population.

Recombinant activated factor VII for intractable bleeding post splenectomy in a patient with myeloproliferative disorder.

Recombinant activated factor VII has been Food and Drug Administration approved to treat hemorrhages in hemophiliac patients with inhibitors and in acquired hemophilia patients. Recombinant activated factor VII use has also been considered for the management of uncontrolled bleeding in a number of congenital and acquired hemostatic abnormalities. The myeloproliferative disorders are a group of clonal hematologic diseases where, frequently, abnormal platelet function is considered a hallmark. This is the first case report addressing the clinical benefit of off-label use of recombinant activated factor VII in an attempt to control intractable bleeding in a patient with a myeloproliferative disorder after splenectomy.