[Dynamics of cognitive functions in elderly and old people after completing a comprehensive neurocognitive rehabilitation program]. / Dinamika kognitivnykh funktsii u lits pozhilogo i starcheskogo vozrasta po okonchanii kompleksnoi programmy neirokognitivnoi reabilitatsii.

OBJECTIVE: To analyze the differences in the dynamics of cognitive functions in the elderly and old people during a comprehensive neurocognitive rehabilitation program with- and without drug therapy. MATERIAL AND METHODS: Ninety-six patients, aged 53-88 years, with cognitive impairment of varying degrees are divided into two groups depending on the presence/absence of drug therapy during the neurocognitive rehabilitation program. Assessment of cognitive functions was carried out twice: at the beginning and at the end of the rehabilitation program using international cognitive status assessment scales (MMSE and MoCA). RESULTS: The analysis of the dynamics of cognitive functions revealed the high efficiency of the neurocognitive rehabilitation program in both groups. The results of the study demonstrate insignificant differences in the dynamics of cognitive functions in the two groups, however, a clear direct effect of drug therapy on changes in cognitive functions has not been established. An analysis of the statistical significance of the data did not reveal differences. CONCLUSIONS: The study confirmed the positive dynamics of cognitive functions in the elderly and old people who underwent the neurocognitive rehabilitation program both with the use of drug therapy and without its use. The issue of the need to use drugs in the framework of this program requires further study. The results of the study can be used in planning programs of psychological, medical and social support for the elderly and old people.

[Complex Program of Neurocognitive Rehabilitation for Elderly Patients Suffering from Mild Cognitive Impairment Syndrome in Medical Rehabilitation Department «Memory Clinic¼].

The article introduces a complex program of neurocognitive rehabilitation into the system of dementia prevention in patients with mild cognitive impairment syndrome. It took about a year to prepare and form a complex program of neurocognitive rehabilitation (the Program). The researchers have also developed clear algorithms of the specialized medical rehabilitation unit Memory Clinic. The conducted study has proved the effectiveness of cognitive functions improvement in patients with mild cognitive impairment after participation in the Program in Memory Clinic. The authors, Professor Kostyuk, and Research Institute for Healthcare Organization and Medical Management have prepared Medical Rehabilitation Guidelines for Elderly Patients with Early Signs of Cognitive Deficits (Structural and Functional Model). The guidelines serve as a tool for practice distribution and transforming them into a project Memory Clinic.

Large energy storage efficiency of the dielectric layer of graphene nanocapacitors.

Electric capacitors are commonly used in electronic circuits for the short-term storage of small amounts of energy. It is desirable however to use capacitors to store much larger energy amounts to replace rechargeable batteries. Unfortunately existing capacitors cannot store sufficient energy to be able to replace common electrochemical energy storage systems. Here we examine the energy storage capabilities of graphene nanocapacitors, which are tri-layer devices involving an Al film, Al2O3 dielectric layer, and a single layer of carbon atoms, i.e., graphene. This is a purely electronic capacitor and therefore it can function in a wide temperature interval. The capacitor shows a high dielectric breakdown electric field strength, of the order of 1000 kV mm-1 (i.e., 1 GV m-1), which is much larger than the table value of the Al2O3 dielectric strength. The corresponding energy density is 10-100 times larger than the energy density of a common electrolytic capacitor. Moreover, we discover that the amount of charge stored in the dielectric layer can be equal or can even exceed the amount of charge stored on the capacitor plates. The dielectric discharge current follows a power-law time dependence. We suggest a model to explain this behavior.

The utility of intra-operative frozen section for the evaluation of microscopic extrathyroidal extension in papillary thyroid carcinoma.

OBJECTIVES: This study was designed to evaluate the usefulness of intra-operative frozen section for the evaluation of microscopic extrathyroidal extension (ETE) in papillary thyroid carcinoma (PTC). DESIGN: Retrospective cohort study. SETTING: Dong-A University Medical Center, Busan, Korea. PARTICIPANTS: Three hundred and sixty-four patients who underwent thyroid surgery from January 2000 to December 2010 with PTC confined to one unilateral lobe as diagnosed using preoperative ultrasonography were enrolled. MAIN OUTCOME MEASURES: The patients who had microscopic ETE on frozen section were classified into "group A," and those who did not have microscopic ETE on frozen section were classified into "group B." Clinicopathologic factors including age, gender, size of the tumour, extent of operation, ETE, multifocality, bilaterality, lymph node metastasis and recurrence were compared between the two groups. RESULTS: Of the 364 patients enrolled, ETE was confirmed in 100 patients (group A, 27.5%) on frozen biopsy. The nodule size in group A (0.94±0.87 cm) was larger than that in group B (0.86±0.79 cm) (P=.042). In group A, 15 patients (15%) showed multifocality and 11 patients (14.47%) showed bilaterality. In group B, 37 patients (14.02%) showed multifocality and seven patients (43.35%) showed bilaterality. They did not differ significantly between the two groups (P=.811, P=.182). There was a higher frequency of lymph node metastases in group A (52/86, 60.47%) than in group B (7/16, 43.75%, P=.214). Recurrence was observed in only two patients who had received thyroid lobectomy as the initial surgery in group A. CONCLUSIONS: Intra-operative frozen biopsy can be a useful method for identifying the microscopic ETE. During the surgery, it can also help the surgeon to decide the optimal extent of surgery and the need for central compartment neck dissection in PTC patients.

(32)P measurment of urine samples and internal dose assessment for radiation workers in life science laboratories.

(32)P measurements of urine samples and internal dose assessments were conducted for workers in life science laboratories. A procedure for sample pre-treatment was established and validation was performed to exclude interference and to detect (32)P levels accurately. The detection conditions for Cherenkov radiation were evaluated and the accuracy of Cherenkov radiation measurements validated. The analytical and measurement procedures were applied to urine samples collected from 11 workers from life sciences laboratories. The results of the measurements generally indicated very low background radiation levels, but daily urine samples from two workers were above the minimum detectable activity. The (32)P concentrations for two of the workers were 29.3 ± 10.4 Bq•d(-1) and 24.1 ± 11.8 Bq•d(-1), respectively, at intake levels of 4.12 kBq and 2.61 kBq. The effective doses for these two workers were 4.6 µSv and 2.9 µSv. Overall, the results indicate very low levels of radioactivity, except for cases related to specific working conditions.

The mannose cap of mycobacterial lipoarabinomannan does not dominate the Mycobacterium-host interaction.

Pathogenic mycobacteria have the ability to persist in phagocytic cells and to suppress the immune system. The glycolipid lipoarabinomannan (LAM), in particular its mannose cap, has been shown to inhibit phagolysosome fusion and to induce immunosuppressive IL-10 production via interaction with the mannose receptor or DC-SIGN. Hence, the current paradigm is that the mannose cap of LAM is a crucial factor in mycobacterial virulence. However, the above studies were performed with purified LAM, never with live bacteria. Here we evaluate the biological properties of capless mutants of Mycobacterium marinum and M. bovis BCG, made by inactivating homologues of Rv1635c. We show that its gene product is an undecaprenyl phosphomannose-dependent mannosyltransferase. Compared with parent strain, capless M. marinum induced slightly less uptake by and slightly more phagolysosome fusion in infected macrophages but this did not lead to decreased survival of the bacteria in vitro, nor in vivo in zebra fish. Loss of caps in M. bovis BCG resulted in a sometimes decreased binding to human dendritic cells or DC-SIGN-transfected Raji cells, but no differences in IL-10 induction were observed. In mice, capless M. bovis BCG did not survive less well in lung, spleen or liver and induced a similar cytokine profile. Our data contradict the current paradigm and demonstrate that mannose-capped LAM does not dominate the Mycobacterium-host interaction.

Cowden's disease with vocal fold involvement.

Cowden's disease is a hereditary disorder characterized by oropharyngeal fibrosis and multiple hamartomas with potential malignant changes. We treated a 47-year-old man who had fibrotic lesions on the left vocal fold and an extensive amount of papillomatous lesions on the mucosa of the lips, tongue, and pharyngeal wall and on the skin of the axillae and buttocks. The pattern of distribution and the histopathologic features of these mucocutaneous lesions were diagnostic of Cowden's disease. To the best of our knowledge, this is the first reported case of Cowden's disease involving a vocal fold.

In vivo diagnosis of nasopharyngeal carcinoma using contact rhinoscopy.

OBJECTIVES: To evaluate the potential use of contact endoscopy for the diagnosis of nasopharyngeal carcinoma (NPC). STUDY DESIGN: Prospective study to examine the nasopharynx of 30 patients with nasopharyngeal carcinoma and 18 subjects with normal nasopharynx in a clinic setting using contact rhinoscopes (Karl Storz, Tuttlingen, Germany, 7215 AA, 00 and 7215 BA, 300; 23 cm long; 4 mm in diameter). METHODS: The superficial cells of the normal nasopharynx and the nasopharyngeal tumors were stained with 1% methylene blue and examined with contact rhinoscopes at high magnifications (x 60 and x 150). The areas under examination were then biopsied. The contact endoscopic images were compared with the corresponding hematoxylin and eosin-stained histologic sections of the biopsied tissues. RESULTS: Sixty-six procedures were performed in 48 patients. The images of normal pseudostratified ciliated epithelium and squamous epithelium were readily recognized by contact endoscopy in all subjects with normal nasopharynx (10 men and 8 women; mean age, 51.9 y). Twenty-six of 30 patients with NPC (86.6%; 18 men and 8 women; mean age, 50.6 y) were successfully examined by contact endoscopy under local anesthesia. In these 26 patients, two patterns of malignant cells were identified with contact endoscopy. The patterns of contact endoscopic images corresponded well with the histologic findings. CONCLUSION: Contact endoscopy is an accurate and reliable office-based procedure, which allows for in-vivo diagnosis of nasopharyngeal carcinoma.

Unusual T- and T/NK- cell non-Hodgkin's lymphoma of the larynx: a diagnostic challenge for clinicians and pathologists.

BACKGROUND: Lymphomas of T-cell and T/natural killer (T/NK)-cell types rarely involve the larynx. Early symptoms are subtle and nonspecific, and confirmation of the diagnosis is often difficult. Because of the rarity of this disease entity, the optimal management remains controversial. METHODS: The case records of patients with the diagnosis of lymphoma involving the larynx were retrospectively reviewed. Details of the pathologic condition, the difficulties in diagnosis, and treatment were presented. RESULTS: One case of T-cell lymphoma (Lennert's lymphoma subtype) and two cases of T/NK-cell lymphomas involving the larynx were presented. The diagnoses were all difficult to establish. All three patients received either multiagent chemotherapy or radiotherapy as the first-line treatment. They all died of the disease within 32 months of diagnosis. CONCLUSIONS: T- and T/NK-cell non-Hodgkin's lymphoma of the larynx is a diagnostic challenge for clinicians and pathologists. Conventional chemotherapy or radiotherapy has not been effective. A more aggressive therapy should be considered.

Lateralized carotid artery: an unusual cause of pulsatile tinnitus.

We describe the case of a patient who had a pulsatile tinnitus that was caused by a laterally displaced internal carotid artery. Her condition was treated with the use of a hearing did, which suppressed the tinnitus. We also review the literature on laterally displaced internal carotid arteries, and discuss their differentiation from a congenitally aberrant artery.

A prospective study of foreign-body ingestion in 311 children.

OBJECTIVE: To determine the preferable management protocol of foreign body ingestion in pediatric patients. METHODS: All pediatric patients aged less than 12 years who presented with suspected foreign body ingestion in a hospital setting over a period of 3 years were prospectively studied. The usefulness of symptoms and various diagnostic procedures to identify the impacted foreign bodies were analyzed. RESULTS: Of 311 children aged 4 months to 12 years, 115 foreign bodies were encountered. The presentations in children aged younger than 5 years were markedly different from the older children, who behaved more like adults. All sharp foreign bodies (107 cases or 93%), mostly fish bones (90.4%), were found in the oropharynx under direct vision using either tongue depressor (57%), Macintosh laryngoscope (6%), indirect laryngeal mirror (2%) or transnasal flexible endoscopy (28%). Coins (eight cases or 7%) were the only foreign body impacted at or below the level of cricopharyngeus. A plain cervical X-ray has a low sensitivity (15.9%) and a high specificity (99.5%) in identifying the foreign bodies. CONCLUSIONS: As the majority of the foreign bodies were sharp bones and situated in the oropharynx, a management protocol involving examination with a tongue depressor, transnasal laryngoscope, selective lateral soft tissue neck X-ray, chest X-ray and watchful observation is usually adequate. Removal of these foreign bodies can be accomplished using a tongue depressor and Macintosh laryngoscope. Patients with a suspected coin ingestion have to be evaluated by X-ray, and a rigid pharyngo-oesophagoscopy should be the mainstay of treatment.

Prognostic significance of argyrophilic nucleolar organizer regions in nasopharyngeal carcinoma.

Increased expression of argyrophilic nucleolar organizer regions (AgNORs) has been identified in certain malignant tumors including nasopharyngeal carcinoma (NPC). However, its prognostic significance in NPC is uncertain and remains to be evaluated. To address this we silver-stained 63 paraffin sections of NPC cases, and examined the correlation between AgNOR count and area, calculated by the CAS 200 image analysis system, and tumor behavior, locoregional control, and survival of patients. The mean AgNOR count and area were 1.62 +/- 0.31 and 3.98 +/- 11.4 microm2, respectively. The AgNOR area was positively associated with T stage (r = 0.26, P = 0.04). The Mann-Whitney test confirmed no significant difference in AgNOR area and count between patients with different outcomes. Multivariate analysis using the Cox proportional hazard model showed neither AgNOR count nor area to be significant predictors of actuarial survival or disease-free survival. It is concluded that AgNOR does not have an independent and significant prognostic value in NPC. AgNOR expression may be merely a reflection of malignant phenotype as well as cellular activity but not necessarily the ultimate behavior of the tumor.

Morphometric analysis of argyrophilic nucleolar organizer regions (AgNORs) in nasopharyngeal carcinoma.

BACKGROUND: Nucleolar organizer regions (NORs), which are loops of DNA containing ribosomal RNA genes, have been shown to correlate with cell proliferation and malignant transformation. Conventional eyeball measurement of silver staining NORs (AgNORs) is time-consuming and subject to error. The diagnostic value of AgNOR area in nasopharyngeal carcinoma (NPC) by computer-assisted morphometric analysis is evaluated. METHODS: Silver-staining of NORs was applied to 23 paraffin sections of NPC containing both normal squamous epithelial and malignant cells. Various parameters of the AgNORs of these two cell types were analyzed by a computer-assisted image analysis system and then compared. RESULTS: The mean AgNOR area, AgNOR/nuclear area ratio, and AgNOR area/count ratio of malignant tumors were statistically significantly higher than those for the normal epithelium. There was no significant difference in the AgNOR counts between the two cell types. CONCLUSIONS: Computer-assisted morphometric analysis of AgNOR is an objective and reliable assessment method applicable to paraffin sections of NPC. The AgNOR area and its derivatives may aid in the diagnosis of NPC.

Fish bone inhalation in infancy.

Inhalation of sharp bones by infants is an uncommon but hazardous occurrence. management relies not only on a high index of clinical suspicion and timely treatment but also demands expertise in therapeutic bronchoscopy. The potential complications and the management of this condition are reviewed.

Cochlear deafness in a Chinese family with Fechtner's syndrome.

OBJECTIVE: To identify the nature of the hearing impairment in the members of a Chinese family with Fechtner's syndrome. STUDY DESIGN: Retrospective case review. SETTING: Tertiary referral center. PATIENTS: A Chinese family with a variant of Alport's syndrome: high-tone sensorineural hearing loss, proteinuria, macrothrombocytopenia, and ocular disease. INTERVENTIONS: The diagnosis of Fechtner's syndrome was confirmed by the characteristic ultrastructure of the Döhle-like inclusion bodies in the neutrophils of the mother and her three children. Pure-tone audiometry, evoked response audiometry (ERA), and distortion product otoacoustic emissions (DPOAE) were performed in two subjects to investigate the hearing impairment. MAIN OUTCOME MEASURE: The parameters of the ERA and DPOAEs were correlated. RESULTS: In both subjects, the ERA was within normal limits, and there were no measurable DPOAEs in frequencies >2 kHz. CONCLUSION: The hearing loss in Fechtner's syndrome is cochlear rather than neural.

CT and MR imaging appearances of an extraosseous calcifying epithelial odontogenic tumor (Pindborg tumor).

We herein report a rare case of extraosseous calcifying epithelial odontogenic tumor with local aggressive behavior. CT and MR imaging showed the distinctive appearances of this histologic entity. We briefly discuss the radiologic features of calcifying epithelial odontogenic tumor and the relevant literature.

Nasal manifestation of extranodal Rosai-Dorfman disease--diagnosis and management.

Two cases of Rosai-Dorfman disease with polypoid nasal infiltration mimicking nasal tuberculosis and malignant lymphoma are reported. This rare benign disease was first described by Rosai and Dorfman in 1969 and is characterized by histiocytic proliferation. It is seldom considered in the differential diagnosis of granulomatous diseases due to its rarity and histological similarity to other diseases. Extranodal manifestations of this disease are uncommon. Although no specific treatment can guarantee a sustained remission of this disease, surgery for loco-regional lesions can result in long-term symptomatic control and restoration of function. Both patients underwent endoscopic resection of the nasal polypoid lesions and have subsequently been free of recurrence. Loco-regional infiltration of the nasal cavity by Rosai-Dorfman disease is effectively managed by endoscopic resection.

Concurrent chaperone and protease activities of ClpAP and the requirement for the N-terminal ClpA ATP binding site for chaperone activity.

ClpA, a member of the Clp/Hsp100 family of ATPases, is both an ATP-dependent molecular chaperone and the regulatory component of ClpAP protease. We demonstrate that chaperone and protease activities occur concurrently in ClpAP complexes during a single round of RepA binding to ClpAP and ATP-dependent release. This result was substantiated with a ClpA mutant, ClpA(K220V), carrying an amino acid substitution in the N-terminal ATP binding site. ClpA(K220V) is unable to activate RepA, but the presence of ClpP or chemically inactivated ClpP restores its ability to activate RepA. The presence of ClpP simultaneously facilitates degradation of RepA. ClpP must remain bound to ClpA(K220V) for these effects, indicating that both chaperone and proteolytic activities of the mutant complex occur concurrently. ClpA(K220V) itself is able to form stable complexes with RepA in the presence of a poorly hydrolyzed ATP analog, adenosine 5'-O-(thiotriphosphate), and to release RepA upon exchange of adenosine 5'-O-(thiotriphosphate) with ATP. However, the released RepA is inactive in DNA binding, indicating that the N-terminal ATP binding site is essential for the chaperone activity of ClpA. Taken together, these results suggest that substrates bound to the complex of the proteolytic and ATPase components can be partitioned between release/reactivation and translocation/degradation.

Retropharyngeal abscess. A rare presentation of nasopharyngeal carcinoma.

Early symptoms of nasopharyngeal carcinoma (NPC) can often be deceptive and confusing. Most patients with nasopharyngeal carcinoma present at an advanced stage with metastatic cervical nodes present at the time of diagnosis. A deep neck abscess as the presenting feature has not been reported. We report two cases of nasopharyngeal carcinoma which presented with retropharyngeal abscesses and persistent lymphadenopathy. These two patients illustrate that refractory lymphadenopathy, despite adequate treatment of the associated infection, should prompt a search for underlying disease. The relationship between nasopharyngeal carcinoma and retropharyngeal abscess is discussed.