Primary repair with no flaps for lower lip defects (30-80 %) after cancer excision

Reconstruction of the lip is a necessary procedure when lip tumors are excised. Although many good techniques have been described, they often have disadvantages such as necrosis and extensive suture lines. In our approach, we aim to minimize the suture line and avoid tissue necrosis for medium-sized lip defects (30-80 %). This is a surgical technique report from a single center. After tumor resection, we made a bilateral 15 mm horizontal skin and mucosa incision from the angles of the lip to the lateral sides. The mucosa and skin were dissected from the underlying muscle, and the muscle was cut approximately 15 mm on each side. The lip defect was then closed and sutured in four layers. Finally, the released mucosa was sutured to the corner of the incised skin. We followed the patients for 36 months and found that their speech intelligibility, sensation, mobility, and aesthetic satisfaction were preserved. The scars were also less pronounced compared to flaps, and there were no signs of edema or drooling. In conclusion, our technique offers many advantages for moderate defects of lower lip tumors. By avoiding the use of flaps, we eliminate the complications associated with flap surgery while achieving aesthetically satisfactory results. However, further evaluation by other surgeons is necessary to fully examine the technique's benefits.

Up-regulation of GINS1 highlighted a good diagnostic and prognostic potential of survival in three different subtypes of human cancer

Cancer is a fatal malignancy and its increasing worldwide prevalence demands the discovery of more sensitive and reliable molecular biomarkers. To investigate the GINS1 expression level and its prognostic value in distinct human cancers using a series of multi-layered in silico approach may help to establish it as a potential shared diagnostic and prognostic biomarker of different cancer subtypes. The GINS1 mRNA, protein expression, and promoter methylation were analyzed using UALCAN and Human Protein Atlas (HPA), while mRNA expression was further validated via GENT2. The potential prognostic values of GINS1 were evaluated through KM plotter. Then, cBioPortal was utilized to examine the GINS1-related genetic mutations and copy number variations (CNVs), while pathway enrichment analysis was performed using DAVID. Moreover, a correlational analysis between GINS1 expression and CD8+ T immune cells and a the construction of gene-drug interaction network was performed using TIMER, CDT, and Cytoscape. The GINS1 was found down-regulated in a single subtypes of human cancer while commonly up-regulated in 23 different other subtypes. The up-regulation of GINS1 was significantly correlated with the poor overall survival (OS) of Liver Hepatocellular Carcinoma (LIHC), Lung Adenocarcinoma (LUAD), and Kidney renal clear cell carcinoma (KIRC). The GINS1 was also found up-regulated in LIHC, LUAD, and KIRC patients of different clinicopathological features. Pathways enrichment analysis revealed the involvement of GINS1 in two diverse pathways, while few interesting correlations were also documented between GINS1 expression and its promoter methylation level, CD8+ T immune cells level, and CNVs. Moreover, we also predicted few drugs that could be used in the treatment of LIHC, LUAD, and KIRC by regulating the GINS1 expression. The expression profiling of GINS1 in the current study has suggested it a novel shared diagnostic and prognostic biomarker of LIHC, LUAD, and KIRC.

Solitary circumscribed neuroma of the glans penis. An unusual finding

Palisaded encapsulated neuroma is a rare, benign neural tumor. The involvement of the glans penis is rare; few cases have been reported. We present a 52-year-old man with a five-month course of a solitary painless lesion of the glans penis. Full excision of the nodule was performed. Histopathological and immunohistochemical analyses and examination was consistent with a palisaded encapsulated neuroma. We describe one of a few existing cases of this kind of tumor in the glans penis.

Exposure to heavy metals and the risk of osteopenia or osteoporosis: a systematic review and meta-analysis

The relationship between heavy metal exposure and risk of osteopenia or osteoporosis has biological plausibility, yet it remains inconclusive; therefore, we conducted a systematic review and meta-analysis to evaluate the associations between exposure to heavy metals (i.e., cadmium, lead, and mercury) and the risk of osteopenia or osteoporosis. Databases of MEDLINE, Embase, Scopus, and Web of Science were searched through November 2019, to identify studies that evaluated the relationship between exposure to cadmium, lead, and mercury and risk of osteopenia or osteoporosis in adults. Fourteen eligible studies were included. Effect sizes expressed as pooled odds ratios (OR) and 95% confidence intervals (CI) were estimated using weighted random-effect models. Exposure to cadmium (OR = 1.35; 95% CI: 1.17 to 1.56; P ≤ 0.001) and lead (OR = 1.15; 95% CI: 1.00 to 1.32; P = 0.05) was associated with an increased risk of osteopenia or osteoporosis, unlike mercury. Subgroup analyses showed cadmium exposure increased the risk of osteopenia or osteoporosis in older (> 65 yrs.; OR = 1.43; 95%CI: 1.08 to 1.88, P = 0.01) compared with younger (18-65 yrs.; OR = 1.24; 95% CI: 1.02 to 1.52, P = 0.03) adults. Also, lead exposure increased the risk in men (OR = 1.55; 95% CI: 1.15 to 2.09, P = 0.007) unlike in women. By contrast to urinary levels, blood (OR = 1.26; 95% CI: 1.08 to 1.47, P = 0.003) and dietary (OR = 1.46; 95% CI: 1.28 to 1.67, P < 0.001) levels of cadmium were associated with an increased risk of osteopenia or osteoporosis. Exposure to cadmium and lead may be associated with an increased risk of osteopenia or osteoporosis, although high heterogeneity was detected.

[The contribution of systematic implementation of cardiovascular explorations for the detection of cardiac sources of embolism in patients with stroke: About 230 patients]

OBJECTIVES

Ischemic stroke are estimated at 80% of all strokes. Embolism of cardiac origin accounts for around 20% of them. The aim of our study is to report the contribution of cardiovascular investigations performed as a routine during the evaluation of patients with ischemic stroke.

PATIENTS AND METHODS

This is a retrospective study of ischemic stroke cases collated in Cardiology department of the military hospital of Marrakech between January 2010 and December 2014. All our patients have systematically ECG, transthoracic echocardiography and Echo-Doppler ultrasound of the neck vessels while the transesophageal (TEE) echocardiography and Holter ECG was performed in some indications.

RESULTS

Two hundred and thirty patients were collected. The average age of patients was 66.3±12.5years with a male predominance in 64.2%. Eighty-five percent of patients had at least three cardiovascular risk factors. Hypertension (60.8%), diabetics (41.7%) and tobacco (33.3%). Cardiovascular history was noted in 30% of cases with 10% of dilated cardiomyopathy and 9.2% of ischemic stroke. Cardiovascular explorations led to the diagnosis of heart disease embolism in 32% and atherosclerosis of the neck vessels in 16%. The TEE performed in 8% of cases showed an emboligenic cause in 42% of them.

CONCLUSION

Cardiovascular explorations remain indispensable in the workup of all ischemic strokes even if their therapeutic effect is modest. The lacunar infarct out first at 34% followed by 32% of cardio embolic causes and atheroma of the neck vessels in approximately 16%.

Synthesis and optical properties of ordered-vacancy perovskite cesium bismuth halide nanocrystals

Vacancy-ordered cesium bismuth halide nanocrystals were synthesized using hot-injection methods.

Realist review to understand the efficacy of culturally appropriate diabetes education programmes

AIMS

Minority populations often face linguistic, cultural and financial barriers to diabetes education and care. The aim was to understand why culturally appropriate diabetes education interventions work, when they work best and for whom they are most effective.

METHODS

This review used a critical realist approach to examine culturally appropriate diabetes interventions. Beginning with the behavioural model and access to medical care, it reanalysed 11 randomized controlled trials from a Cochrane systematic review and related programme and training documents on culturally appropriate diabetes interventions. The analysis examined context and mechanism to understand their relationship to participant retention and statistically improved outcomes.

RESULTS

Minority patients with language barriers and limited access to diabetes programmes responded to interventions using health workers from the same ethnic group and interventions promoting culturally acceptable and financially affordable food choices using local ingredients. Programme incentives improved retention in the programmes and this was associated with improved HbA(1c) levels at least in the short term. Adopting a positive learning environment, a flexible and less intensive approach, one-to-one teaching in informal settings compared with a group approach in clinics led to improved retention rates.

CONCLUSIONS

Minority and uninsured migrants with unmet health needs showed the highest participation and HbA(1c) responses from culturally appropriate programmes.

Arsenicosis in Bangladesh: prevalence and socio-economic correlates

The potential effects of arsenic-contaminated drinking water on health are of concern, but our understanding of the risk factors of arsenicosis remains limited. This study assessed the prevalence of and socio-economic differentials in arsenic-associated skin lesions in a rural community in Bangladesh. Data were collected from a village where the Bangladesh Rural Advancement Committee has operated a health surveillance system and a community-based arsenic mitigation project since 1999. In total, 1654 residents in the study village were examined in May 2000 for arsenic-associated lesions on their skin. Socio-economic information was extracted from the surveillance system database covering the village. Nearly 2.9% of the study population had clinical manifestations of arsenic poisoning. The prevalence of arsenicosis was associated with age, sex, education and the economic status of the household. Multivariate analysis identified age and economic status as significant predictors of arsenicosis controlling for education and gender. In conclusion, a clear understanding of the socio-economic distribution of arsenicosis in different demographic and socio-economic groups will be useful in identifying the high-risk groups from arsenic-affected communities. More studies are needed to design effective interventions to mitigate the effects of arsenic in Bangladesh.

Immunological and clinical effects of post-transplant G-CSF versus placebo in T-cell replete allogeneic blood transplant patients: Results from a randomized double-blind study

BACKGROUND

Immunological and clinical effects of post-transplant growth factor administration have not been well studied. This report describes the outcome and immune functions of a total of 50 HLA-matched related donor allogeneic blood stem-cell transplantation patients who received post-transplant G-CSF (10 microg/kg) or placebo.

METHODS

Immune status, including number of lymphocyte subsets and their functions, and serum immunoglobulin levels and clinical status--including GvHD, rate of relapse, event-free survival, and overall survival--were determined in the patients enrolled in this study.

RESULTS

Twenty-eight patients survived 1 year after transplant, and 15 patients had available results to compare immune function by randomization assignment. At 12 months post-transplant, immune parameters in G-CSF versus placebo groups showed no statistically significant differences in number of circulating lymphocyte subsets CD3, CD4, CD8, CD19 and CD56 in the two groups. There was no significant (NS) difference in immunoglobulin IgG, IgA and IgM levels, NK or LAK cell-mediated cytotoxicity levels, and mitogen-induced proliferation between post-transplant G-CSF and placebo group. In addition, the analyses of immune parameters at earlier time-points on Days 28, 100, 180, and 270 revealed that, except for LAK cytotoxicity at Day 100, there was no differences between the two groups. Fourteen of 26 patients are alive in the G-CSF arm and nine of 24 in the placebo arm. Median follow-up of surviving patients is 43 months. Four year overall and event-free survival in the G-CSF and the placebo group were 53% and 35% (NS), and 44% and 36% (NS) respectively. Bacterial or fungal infections were the cause of six of 12 deaths in the G-CSF arm (all bacterial) and of four of 15 deaths in the placebo arm (two deaths from Aspergillus) (P=0.26). Two patients relapsed in the G-CSF arm and three in the placebo arm. Four year cumulative incidences of relapse were 8% versus 13% in G-CSF versus placebo arms, respectively, (NS). Chronic GvHD developed in 14 of 19 100-day survivors after G-CSF (11 extensive stage), and in 17 of 20 (14 extensive stage) in the placebo arm. The 4-year cumulative incidence of chronic GvHD was 56% [95% confidence interval (CI) 24-88%] after G-CSF and 71% (95% CI 48-94%) after placebo; this difference was not statistically significant (log rank P=0.41).

CONCLUSION

In summary, there were no significant immunological or alterations in clinical benefit of post-transplant G-CSF administration in T-replete allotransplant recipients.

Seasonal changes of CO(2), CH(4) and N(2)O fluxes in relation to land-use change in tropical peatlands located in coastal area of South Kalimantan

Tropical peatland could be a source of greenhouse gases emission because it contains large amounts of soil carbon and nitrogen. However these emissions are strongly influenced by soil moisture conditions. Tropical climate is characterized typically by wet and dry seasons. Seasonal changes in the emission of carbon dioxide (CO(2)), methane (CH(4)) and nitrous oxide (N(2)O) were investigated over a year at three sites (secondary forest, paddy field and upland field) in the tropical peatland in South Kalimantan, Indonesia. The amount of these gases emitted from the fields varied widely according to the seasonal pattern of precipitation, especially methane emission rates were positively correlated with precipitation. Converting from secondary forest peatland to paddy field tended to increase annual emissions of CO(2) and CH(4) to the atmosphere (from 1.2 to 1.5 kg CO(2)-C m(-2)y(-1) and from 1.2 to 1.9 g CH(4)-C m(-2)y(-1)), while changing land-use from secondary forest to upland tended to decrease these gases emissions (from 1.2 to 1.0 kg CO(2)-C m(-2)y(-1) and from 1.2 to 0.6 g CH(4)-C m(-2)y(-1)), but no clear trend was observed for N(2)O which kept negative value as annual rates at three sites.

Integrating prevention of acute respiratory infections with micro-credit programme: experience of BRAC, Bangladesh

The contribution of acute respiratory infection control project within the framework of micro-credit-based development intervention in promoting maternal knowledge of ARIs in children was assessed. Data came from a cross-sectional survey of 2814 mothers of under 5-y-old children residing in 200 randomly selected villages in five districts in Bangladesh. Findings revealed that the ARI control project had significant positive effects in raising knowledge of clinical signs and preventive measures. When ARI control project activities were integrated with the credit-based development initiative, maternal knowledge improved even further. The study concludes that the micro-credit programme can be a catalytic agent in raising health knowledge among poor women in developing countries.

Promoting health knowledge through micro-credit programmes: experience of BRAC in Bangladesh

This paper aims to assess the contribution of the micro-credit programme in raising health knowledge among poor women in rural Bangladesh. Data were collected from the 1998 sample survey of 500 mothers aged 15-49 years who had at least one child aged <5 years. Findings revealed that the socio-demographic factors such as the age of the woman, land ownership of the family and occupation of husband had no association with the prevalence of maternal knowledge. The knowledge was much greater among credit forum participants than non-participants, although exposure to the media and the education of women had also played a significant role in raising the level of knowledge. Multivariate analysis suggested that the duration of credit programme participation and exposure to the media were significantly more likely to raise the health knowledge among women when the influence of demographic and socio-economic factors were controlled. The paper concludes that the micro-credit programme can be an effective tool in promoting health among poor women in Bangladesh.

Acute respiratory infections in rural Bangladesh: cultural understandings, practices and the role of mothers and community health volunteers

Qualitative data collected from 63 older and younger mothers revealed that almost all recognized pneumonia and all described mild and severe signs and symptoms to explain incidences of pneumonia. Respiratory illnesses were attributed to humoral imbalances, supernatural causes and "negligent" mothers. Home care practices involved drinking specially prepared juices, massaging the child with oil and avoiding "cooling" foods. Traditional and allopathic care was sought depending on the perceived severity of the illness. The role of the family was important in decision-making. Rural mothers were relieved and satisfied to be able to quickly access low-cost medicines from Bangladesh Rural Advancement Committee (BRAC) health volunteers, who clearly influence health care practices. In-depth interviews and focus group discussions with 23 health volunteers showed that 22 were able to correctly identify breathing rates and their association with pneumonia. All had knowledge of acute respiratory infections (ARI) and were able to list a range of signs and symptoms. Some health volunteers complained of operational constraints with monitoring and technical equipment. Nevertheless, the programme has strong links with grassroots volunteers and community people, making it a successful intervention.

Diagnosis of pneumonia by community health volunteers: experience of BRAC, Bangladesh

The study assessed the validity of community health volunteers'diagnosis of pneumonia in children through simple clinical signs. Data were collected by a group of research physicians who observed the case management performance of 120 health volunteers in Bangladesh where the Bangladesh Rural Advancement Committee has been providing community-based acute respiratory infection control since mid-1992.1,166 children age 3-60 months were assessed at household level by both a community health volunteer and a research physician. Using physician diagnosis as gold standard, health volunteers'diagnosis of pneumonia was 67.6% sensitive and 95.2% specific. Cohen's kappa for agreement between volunteers and physicians was 0.67. Of the clinical signs elicited, chest in drawing and noisy breathing predicted physician's diagnosis of pneumonia most strongly ([positive predictive value (PPV)] 84% and 79%, respectively). The study concludes that less educated health volunteers can be effectively used in diagnosing pneumonia at grassroots level in developing countries.

A participatory approach to sanitation: experience of Bangladeshi NGOs

This study assesses the role of participatory development programmes in improving sanitation in rural Bangladesh. Data for this study came from a health surveillance system of BRAC covering 70 villages in 10 regions of the country. In-depth interviews were conducted with one adult member of a total of 1556 randomly selected households that provided basic socioeconomic information on the households and their involvement with NGO-led development programmes in the community. The findings reveal that households involved with credit programmes were more likely to use safe latrines than others who were equally poor but not involved in such programmes. The study indicates that an unmet need to build or buy safe and hygienic latrines existed among those who did not own one. Such latent need could be raised further if health education at the grassroots level along with supervised credit supports were provided to them. Unlike conventional belief, the concept of community-managed jointly owned latrines did not seem a very attractive alternative. The study argues that social and behavioural aspects of the participatory development programmes can significantly improve environmental sanitation in a traditional community.

Child abuse among working children in rural Bangladesh: prevalence and determinants

The paper aims to improve our understanding about the prevalence and determinants of child abuse in rural Bangladesh. Data from the 1995 sample survey of 4643 children aged 10-15 y in 150 villages were used. Findings revealed that 21% of the children were in the labour force although the Bangladeshi laws prohibited child labour. The prevalence of child abuse and exploitation was widespread in Bangladeshi villages as 2.3% of all children were physically abused, 2% were financially exploited, 1.7% were forced to involve in inappropriate activities, and 3% were forced to work for long hours. The prevalence of physical assault was much higher among younger children although the probability of other types of abuse was higher among older children. Boys were more exposed than girls to abuse of any kind. Poverty was also significantly associated with child abuse. Multivariate analysis suggested that the out-of-school children and the children of illiterate, landless and unskilled labourers were more likely to be abused than others when age and sex of children were controlled. The paper concludes that raising public awareness against child abuse and promoting preventive measures should be adopted to reduce child abuse in Bangladesh.

Role of education in reducing child labour: evidence from rural Bangladesh

This paper explores the hypothesis that the level of education of children and their parents plays a major role in reducing child labour. Data were generated from a sample survey of 3809 children aged 10-14 years living in 150 villages in two rural districts of Bangladesh. A significant inverse relationship was found between child labour and years of schooling. Age and education of children, parental education, land ownership of household and fathers' occupation were the determinants of child labour force participation. Child's years of schooling is the variable that has most influence on the probability of participation in the labour force, followed by father's and mother's education.

Effect of balloon material and inflation strategy on arterial trauma and mechanisms of percutaneous transluminal coronary angioplasty as determined by intracoronary ultrasound

Twenty-three patients were randomized to a minimally invasive strategy or to standard percutaneous transluminal coronary angioplasty followed by intracoronary ultrasound. There was no difference in intracoronary ultrasound-determined dissection after the procedure in the 2 groups, and the mechanism of lumen enlargement by percutaneous transluminal coronary angioplasty in both groups predominantly was due to vessel stretch.

A preliminary chemotaxonomic review of Kopsia (Apocynaceae)

The present paper is the result of a botanical and chemical study of the Indo-Pacific genus Kopsia (Plumerioideae-Rauvolfieae) Apocynaceae. Some of the species of this genus possess medicinal uses. A survey of the accepted taxa and their synonymy, based on the study of types, is presented. Studies on alkaloids provides chemotaxonomic information. Indeed, in some cases, chemical relationships occur between species belonging to the same botanical group.

Analysis of the functional role of chromosome 10 loss in human glioblastomas

Molecular and cytogenetic analyses of primary brain tumors have shown that losses on chromosome 10 occur very frequently in human glioblastoma multiforme suggesting the presence of a glioma-associated tumor suppressor gene on this chromosome. To examine this hypothesis, a copy of chromosome 10 derived from a human fibroblast cell line was introduced into the human glioma cell line U251 by microcell-mediated chromosomal transfer. A human chromosome 2 was also independently introduced into U251 cells. The presence of novel chromosomes or chromosomal fragments was confirmed by molecular and karyotypic analyses. The hybrid clones containing a transferred chromosome 10 exhibited a suppression of their transformed and tumorigenic phenotype in vivo and in vitro, whereas cells containing a transferred chromosome 2 failed to alter their phenotype. The hybrid cells containing a transferred chromosome 10 displayed a significant decrease in their saturation density and an altered cellular morphology at high cell density but only a slight decrease in their exponential growth rate. A dramatic decrease was observed in the ability of cells with an introduced chromosome 10 to grow in soft agarose. The introduction of chromosome 10 completely suppressed tumor formation when the hybrid cells were injected into nude mice. These findings indicate that chromosome 10 harbors a tumor suppressor gene that is directly involved in glioma oncogenesis.

Flavonone and chalcone derivatives from Cryptocarya kurzii

Four complex flavanones, kurziflavolactones A [2], B [3], C [4], and D [5] and a complex chalcone 6 with an unprecedented carbon side chain on the flavanone or chalcone A ring have been isolated from a Malaysian plant, Cryptocarya kurzii (Lauraceae). Their structures were determined by extensive spectroscopic analysis, especially 2D nmr experiments. Compounds 3 and 6 showed slight cytotoxicity against KB cells, with IC50 values of 4 and 15 micrograms/ml, respectively. A biosynthetic pathway for the formation of these compounds is suggested.

Inhibition of epidermal growth factor receptor activity by retinoic acid in glioma cells

The growth inhibitory effects of exogenously added retinoic acid (RA) on various cultured human glioma cells was observed to be heterogenous, with an ID50 ranging from 10(-7) M to no response. The protein tyrosine kinase activity of epidermal growth factor receptor (EGF-receptor) appeared to parallel the cell's growth responsiveness to RA. Cells sensitive to RA-induced growth inhibition exhibited a dose-dependent decrease in EGF-receptor activity, whereas RA-resistant cells showed no alterations in EGF-receptor protein tyrosine kinase activity or expression. The modulation of EGF-receptor by RA was further examined with RA-sensitive (LG) and -resistant (NG-1) cell lines. Both cell lines were approximately equal in their ability to bind and internalize epidermal growth factor in the presence or absence of RA. Several independent assays suggested that the inhibition of EGF-receptor activity was independent of protein kinase C modulation as mediated by phorbol myristate acetate. However, alterations in associated glycoconjugates of EGF-receptor were observed among the sensitive cells but not the resistant cells. These results suggest RA-induced growth inhibition in sensitive cells may arise, at least in part, through alterations in EGF-receptor and structure.