Retroperitoneal sarcoma is relatively uncommon. We share our experience in encountering retroperitoneal sarcoma with vascular and urethral adhesion in a 46-year-old woman. Given the rarity of these tumors, evaluation and management should ideally be performed in a center equipped with multidisciplinary expertise in treating sarcomas.

We report a case of P. yeei CAPD-peritonitis in a patient experiencing repeated episodes of peritonitis. P. yeei, an emerging opportunistic pathogen, takes advantage of specific virulence factors and peculiar circumstances. We discuss the exogenous or endogenous microbial source of the peritonitis and guidelines to decrease its occurrence.

Purpose: Some patients who undergo robot-assisted laparoscopic radical prostatectomy (RARP) continue to experience long-term urinary incontinence (UI). This study aimed to evaluate easily obtainable factors that can predict long-term UI following RARP. Materials and Methods: A total of 315 patients who underwent RARP for localized prostatic cancer were analyzed. We separated the patients into two groups, namely, the Continence group and the Incontinence group, according to the presence or absence of UI at 12 months after surgery, and we compared the patients’ characteristics and operative data to identify clinical signs associated with long-term UI. Additionally, correlations between these factors and postoperative urethral function were evaluated. Urinary continence was defined as both the use of 0 pads/per day and <2 g of urine lost using the 24-h pad weight test. Results: Of 315 patients, 250 (79.4%) achieved urinary continence and 65 (20.6%) had UI. Age, storage-related lower urinary tract symptoms before surgery, nerve-sparing surgery, and the 24-h urine loss immediately after urethral catheter removal significantly affected long-term UI after RARP. Multivariate logistic regression analyses revealed that the 24-h urine loss after catheter removal was a significant predictor of long-term UI. Receiver operating characteristic curve analysis identified a urine loss of 330 g/day as the optimal cutoff value, which yielded 92% sensitivity and 84% specificity, and it showed significant correlations with postoperative urethral function and the time to recover urinary continence. Conclusion: The 24-h urine loss immediately after urethral catheter removal may be the most reliable and useful predictor of long-term UI following RARP.

Background: Evidence shows that simplified SOFA scoring system has better clinical practice. Objective: This study aimed to compare the scores acquired with the simplified sequential organ failure assessment (sSOFA), simplified organ dysfunction criteria optimized for electronic health records (eSOFA), and simplified and accurate sequential organ failure assessment (sa-SOFA) for their accuracies in predicting the prognosis of septic patients. Methods: This retrospective observational study was conducted at three major academic hospitals. Clinical data from 574 patients diagnosed with sepsis following the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)were retrospectively retrieved and analyzed. Scores from the quick sequential organ failure assessment (qSOFA) and sequential organ failure assessment (SOFA) were used as reference scores. The area under the receiver operating characteristic curve (AUROC) was used to compare the accuracies of eSOFA, sSOFA, and sa-SOFA scores in predicting in-hospital mortality. Results: AUROC analysis demonstrated the predictability of the five scoring systems for sepsis surveillance, listed in descending order as: sa-SOFA,0.790 (95% confidence interval [CI]: 0.754-0.822); SOFA, 0.774 (95% CI: 0.738-0.808); eSOFA,0.729 (95% CI: 0.691-0.765); sSOFA,0.681 (95% CI: 0.641- 0.719); and qSOFA,0.618(95% CI: 0.577-0.658). Moreover, sa-SOFA and SOFA scores (Z= 1.950, p = 0.051) did not significantly differ from each other in discriminatory power, but the sa-SOFA score had a higher power than either the sSOFA or eSOFA scores (p values <0.001). Conclusion: sa-SOFA showed the highest accuracy in predicting in-hospital fatality of septic patients when compared with sSOFA and eSOFA.

Background: It is not known whether the optimal Atrioventricular delay (AV opt) varies between left ventricular (LV) pacing site during endocardial biventricular pacing (BiVP) and may therefore needs consideration. Methods: We assessed the haemodynamic AV opt in patients with chronic heart failure undergoing endocardial LV lead implantation. AV opt was assessed during atrio-biventricular pacing (BVP) with a “roving LV lead”. Up to four locations were studied: mid lateral wall, mid septum (or a close alternative), site of greatest haemodynamic improvement and LV lead implant site. The AV opt was compared to a fixed AV delay of 180ms. Results: Seventeen patients were included (12 male, aged 66.5 +/- 12.8 years, ejection fraction 26 +/- 7%, 16 left bundle branch block or high percentage of right ventricular pacing (RVP), QRS duration 167 +/-27 ms). In most locations (62/63), AV opt increased systolic blood pressure during BiVP compared with RVP (relative improvement 6 mmHg, IQR 4-9mmHg). Compared to a fixed AV delay the haemodynamic improvement at AV opt was higher (1mmHg, IQR 0.2-2.6mmHg, p<0.001). Within most patients (16/17), we observed a difference in AV opt between pacing sites (median paced AV opt 209 ms, IQR 117-250). Within this range, the haemodynamic impact of these differences was small (median loss 0.6 mmHg, IQR 0.1-2.6mmHg). Conclusion: Within a patient, different endocardial LV lead locations have slightly different haemodynamic AV opt which are superior to a fixed AV delay. The haemodynamic consequence of applying an optimum from a different lead location is small.

Environmental pollution can result in poor sperm quality either directly or indirectly. However, adaptive and compensatory sperm morphology change and motility improvement rapidly evolved in tree sparrow (Passer montanus) inhabited the polluted area within the past 65 years. To identify the genetic underpinnings of the rapidly evolved sperm phenotype, both the population genomic and transcriptomic methods were used in our study. We identified a gene encoding serine/threonine protein kinase PIM1 which may drive the rapid phenotypic evolution of sperm. An unprecedent and remarkably expansion of PIM gene family caused by tandem and segmental duplication of PIM1 was subsequently noticed in tree sparrow genome. Most of the PIM1 duplicates showed a testis-specific expression pattern, suggesting their functions related to male reproduction. Furthermore, the elevated expression level of PIM1 was consistent with our earlier findings of longer and faster swimming sperm in polluted site, indicating an important role of duplicated PIM1 in facilitating rapid evolution of sperm. Our results suggested that the duplicated PIM1 provide sources of genetic variation that enable rapid evolution of sperm under environmental heavy metal pollution. The findings in this study verified the duplicated genes can be targets of selection and predominant sources for rapid adaptation to environmental change and shed lights on the sperm evolution under environmental stress.

Background Zanamivir is a neuraminidase inhibitor effective against influenza A and B viruses. In 2009, GlaxoSmithKline (GSK) began clinical development of intravenous (IV) zanamivir, and initiated a global Compassionate Use Program (CUP) in response to the evolving H1N1 global pandemic. The goal of the CUP was to provide zanamivir to critically ill patients with limited treatment options. Methods Zanamivir was administered to patients with suspected or confirmed influenza infection, who were not suitable for other approved antiviral treatments. Reporting of serious adverse events (SAEs) was mandatory and recorded in the GSK safety database. A master summary tracking sheet captured requests and patient characteristics. A case report form was available for detailing medical conditions, dosing, treatment duration, and clinical outcomes. Results In total, 4033 requests were made for zanamivir treatment of hospitalized patients from 38 countries between 2009 and 2019. Europe had the highest number of requests (n=3051) followed by North America (n=713). At least 20 patients were aged ≤6 months, of whom 12 were born prematurely. The GSK safety database included 466 patients with ≥1 SAE, of whom 374 (80%) had a fatal outcome. Drug-related SAEs were reported in 41 (11%) patients, including hepatic failure (n=6 [2%]) and acute kidney injury (n=5 [1%)]. Conclusions The CUP fulfilled the need to provide global access to zanamivir prior to product approval. No new safety concerns were identified in the CUP compared with IV zanamivir clinical studies.

A 59-year-old male was incidentally diagnosed with a left atrial mitral valve chordae involving the junction of the A1 and A2 mitral valve leaflets and resulting in moderate mitral regurgitation. The recognition of this extremely rare congenital malformation prevented over diagnosis and overtreatment.

Semantic memory remains relatively stable with normal cognitive aging and declines in early stages of neurodegenerative disease. We measured electroencephalography (EEG) oscillatory correlates of semantic memory retrieval to examine the effects of normal and pathological aging. Twenty-nine cognitively healthy young adults (YA), 22 cognitively healthy aging adults (HA), and 20 patients with mild cognitive impairment (MCI) completed a semantic memory retrieval task with concurrent EEG recording in which they judged whether two words (features of objects) led to retrieval of an object (retrieval) or not (non-retrieval). Event-related power changes contrasting the two conditions (retrieval vs. non-retrieval) within theta, alpha, low-beta, and high-beta EEG frequency bands were analyzed across time to examine normal aging (YA versus HA) and pathological aging effects (HA versus MCI). Though no behavioral differences between the cognitively healthy groups were observed, we found later theta and alpha power differences between conditions only in YA, and a high-beta power difference between conditions only in HA. For pathological aging effects, we found reduced accuracy in MCI. While we found different EEG patterns of early beta power differences between conditions in MCI compared to HA, a low-beta power difference between conditions was found only in HA. We conclude that the aging brain relies on faster (beta) oscillations during the semantic memory task. With pathological aging, retrieval accuracy declines and patterns of beta oscillation changes. The findings improve understanding on age-related neural mechanisms underlying semantic memory and have implications for early detection of pathological aging.

Gastric cancer was diagnosed with dilation of the main pancreatic duct. SPACE revealed adenocarcinoma, total gastrectomy with distal pancreatectomy were underwent. More case reports are needed to determine whether adjuvant chemotherapy is indicated for patients with PCIS and whether the extent of lymph node dissection can be safely reduced.

The fretting damage and wear debris on the dental implant-abutment interface (IAI) are unclear. In this study, fatigue cycle loading (FT) and chewing cycle loading (CW) test were applied to two implant systems, the fretting damage morphology and wear debris generation on the IAI were observed by a scanning electron microscope. The torque value of the central screw was measured by electronic torque tester. The fretting damage on the IAI was relatively slight and mainly plastic deformation in the FT group, which was more serious and mainly furrow wear in the CW group. Various forms of wear debris were generated. The removal torques were lower than its pre-tightening value in both groups, the decline and loss rate of the CW group was significantly higher. This study confirmed the critical roles of fretting damages and metal wear debris on the IAI in the implant-supported prosthesis.

Porokeratotic adnexal ostial nevus (PAON) is a term encompassing porokeratotic eccrine ostial and dermal duct naevus (PEODDN) and porokeratotic eccrine and hair follicle naevus (PEHFN). We present the case of a seven-year-old girl who presented with hyperkeratotic verrucous papules in a blaschkolinear distribution on the sole of her left foot.

A document by Eray Guler. Click on the document to view its contents.

Primary tuberculosis of the parotid gland is rare even in endemic countries. the clinical manifestations are polymorphic and non-specific. it is important for clinicians to be aware of this pathology.

We herein report first Iranian families with spastic paraplegia 35 and 49 and claim that TECPR2 gene causes complicated spastic paraplegia 49 with or without sensory autonomic neuropathy. In addition, we show how coexistence of SPG49 and griscelli syndrome can lead to misdiagnosis.

Ecosystems remain under enormous pressure from multiple anthropogenic stressors. Manipulative experiments evaluating stressor interactions and impacts mostly apply stressors under static conditions without considering how variable stressor intensity (i.e., fluctuations) and synchronicity (i.e., timing of fluctuations) affect biological responses. We ask how variable stressor intensity and synchronicity, and interaction type, can influence how multiple stressors affect seagrass. At the highest intensities, fluctuating stressors applied asynchronously reduced seagrass biomass 36% more than for static stressors, yet no such difference occurred for photosynthetic capacity. Testing three separate hypotheses to predict underlying drivers of differences in biological responses highlighted alternative modes of action dependent on how stressors fluctuated over time. Given that environmental conditions are constantly changing, assessing static stressors may lead to inaccurate predictions of cumulative effects. Translating multiple stressor experiments to the real-world, therefore, requires considering variability in stressor intensity and the synchronicity of fluctuations.

Nodular fasciitis (NF) is a rare benign, rapidly growing, self- limiting condition rarely affecting head and neck district. Following a short Literature review, the authors report a rare case of maxillary Nodular Fasciitis in an elderly, pointing out that in selected cases direct surgery could avoid misdiagnosis, delays and overtreatment.

The current study focuses on the thermal distribution in the boundary layer of a wedge with a variable surface temperature. The governing equations of MHD flow for variable wall temperature conditions can be converted to ODE by using similarity solutions, and the Hartmann number (Ha) from 1 to 3 can be solved via the colocation method. This method’s results are compared to those of the numerical method, and it is then evaluated and validated. As the angle or Ha increases, the width of the hydrodynamic boundary layer decreases, and the slope of the boundary layer increases, increasing the coefficient of friction on the surface. The results are obtained for variable wall temperature (n), Prandtl number (Pr) and Eckert number (Ec), where they are 0.5≤n≤1.5, 0.5≤Pr≤5, and 0.001≤Ec≤0.002, and at a certain angle. It is observed that when Ha, Pr, and n increase, the thermal boundary layer grows faster than before; thus, thickness decreases and the Nusselt number (Nu) rises; however, as the Ec adds, the Nu decreases on the wall.