Logistic analysis has shown that

Logistic analysis has shown that age and the count of inhalation device are significant factors that lead to diminished inhalation technique, even when the type of inhalation device is taken into account (Table 3). Although it apomorphine has been previously reported that the type of the inhalation device, in addition to age, causes a difference in the performance of the inhalation technique, this divergence seems to be attributable to individual patients or to differences in the method of evaluation. In the current study, patients of a variety of ages were recruited without bias to determine the effects of age as primary endpoints. However, in regard to the inhalation device, the secondary endpoint, various inhalation devices including the aforementioned three devices used by many patients are currently available, and the prominent effects of age on inhalation devices could be detected, but it was also possible that the influences of inhalation devices were hardly detected. On the other hand, the count of inhalation device is the significant factor of inhalation technique independent from age. In order to prevent the confusions, we should choose same device for same patient as possible. Thus, it is presumed that confirmation of inhalation technique is important for elderly patients, regardless of the type of inhalation device. In recent years, inhalation devices with simplified operation have become available, and it is expected that the development of inhalation devices associated with fewer operational errors will be further promoted according to advances in pharmaceutical technology.
Table 4 shows the results of comparison between the two groups of patients, i.e., the elderly group (≥66.5 years of age) and the non-elderly group (<66.5 years of age), in regard to the frequencies of specific problems. Similar to the NRS scores, the number of patients who reported some problems on their subjective assessment was significantly greater in the non-elderly group, whereas those with problems were more frequent in the elderly group on the objective assessment of medical professionals, showing a divergence. Thus, these results highlighted the lack of awareness of problems among elderly patients. Medical professionals\’ objective assessment revealed that patients who had problems in inhalation technique were predominant particularly in the elderly group. In contrast, patients\’ subjective assessment showed that there were more patients who had difficulty continuing medication in the non-elderly group. In general, older age in patients is reported to be associated with low adherence to treatment because of decreased cognitive and physical function. On the other hand, Transcribed spacer has been reported that elderly patients have higher respect for medical professionals and are more likely to visit a hospital regularly, and therefore medical professionals play an important role in the patients\’ acceptance of treatment. The results of this study also suggest that tolerance to continuation of medication, i.e., motivation for treatment, remained undiminished. The decrease in resistance to continuation of treatment might also be derived from the fact that elderly patients are more likely to be unemployed and thus have fewer temporal restrictions than non-elderly patients. There are some limitations in this study. (1) Medical professionals\’ assessment was not based on a checklist, and therefore the rating scale might have varied among different raters. However, the variance among individual raters is presumed to be great enough to affect the relationship between age, the primary endpoint, and the technique or knowledge of inhalation. (2) The present study was not complete survey, and therefore there is potential for bias that the participants are likely to be health-conscious patients. Despite those health conscious patients, increasing age spoils their light recognition for inhalation therapy. (3) Because the present study is a questionnaire survey, we could not capture the detailed patients information, such as activities of daily living (ADL) and complications. However, in the present study, patients were not eligible if it was difficult for them to respond to the questionnaire because of decreased cognitive function. Therefore, patients who have extremely low ADL were not included in the present study. Generally, the ADL associates with the age of patient. In the present study, we considered that the influence of ADL on inhalation therapy was included in the influence of age.

In this study the most common

In this study, the most common reported associated extra pancreatic finding was dilated CBD and intra hepatic biliary radical, which was seen in 6 patients (42%); this is seen in 75% of patients with head masses. John et al. stated that ductal dilatation occurs in 58% of patients with pancreatic neoplasm and ductal dilatation proximal to the obstructing tumors was detected in approximately 88% of pancreatic head tumors.
Liver metastases were detected by multi slice CT in 7 patients (50%). This comes in agreement with Murfitt who stated that Phos-tag Acrylamide to the liver occurred in approximately 17–55% of the patients.
Chest distant metastatic finding was a common association with pancreatic neoplasm in the current study. This was reported in 28.5% of the patients. Osteolytic bony lesion was found in 7%. This comes in agreement with the statement of Kloppel who stated that metastasis to lung, pleura and bone is only seen in advanced tumor stages.
In our study, 5 cases were resectable out of 14 cases (35%). Near to this is the study of Grenacher and KlauB which stated that only 20% of all patients believed to have a surgically resectable disease.
Resection is aborted in one case out of 6 cases (about 16% of the suspected resectable cases) due to unsuspected peritoneal deposits, whereas Zamboni et al. decided that resection was aborted in 11% of their suspected resectable cases.
Darren et al. stated that False-negative results almost often occur because of the unsuspected liver surface metastases, peritoneal deposits, or unsuspected vascular invasion.
Frate et al. stated that MSCT has an accuracy rate for staging of pancreatic adenocarcinoma of virtually 100%. In our study the overall accuracy of tumor staging by MSCT was 84%. Whereas Zamboni et al. stated that the accuracies ranged from 85% to 95%, Scaglione et al. decided that the accuracy of MSCT in staging of pancreatic cancer is as high as 93%.
In our study insulinoma appeared as well defined small lesion which enhanced more intensely than the normal pancreatic parenchyma in all phases. This coincides with McLean study which stated that insulinomas are typically hyper attenuating on at least one phase of contrast enhancement typically on the late arterial [25s] or pancreatic phase [35–40s] of imaging but occasionally in the portal venous phase.
In our study there were two cases of pathologically confirmed pancreatic mucinous cystadenoma. Both patients were female and in relatively younger age group (53 and 57years). Aslam and Yee stated that a mucinous cystic neoplasm occurs predominantly in women.
One case was diagnosed by MDCT as serous cystadenoma. This was a 54year old male. This is in contrast to Dewhurst et al. who stated that about 80% occur in women who are more than 60years old. This is possibly attributed to small number of cases enrolled in our study.
One case of pancreatic metastasis was from renal cell carcinoma. Paspulati stated that the common primary tumors that metastasize to the pancreas are from lung, breast, kidney, and melanoma. Mechó et al. stated that pancreatic metastases are uncommon, representing 4.5% of pancreatic tumors.


Conflict of interest

Chronic pelvic pain (CPP) is a significant health problem in women particularly during childbearing age and may account for 10% of outpatient gynecologic visits. Etiology of chronic pelvic pain includes irritable bowel syndrome, endometriosis, adenomyosis, pelvic congestion syndrome, atypical menstrual pain, urologic disorders, and psychosocial issues.
Pelvic congestion syndrome occurs mostly because of ovarian vein reflux, but can also occur because of the obstruction of ovarian vein outflow resulting in reversed flow.
Ovarian vein reflux (OVR) is found and PCS is diagnosed most frequently in multiparous women. During pregnancy, ovarian vein flow may increase up to 60 times. This increase in blood flow causes ovarian vein dilatation and may result in venous valve incompetence. PCS is likely caused by the incompetence of the venous valves of the ovarian and pelvic veins, which results in OVR leading to ovarian and pelvic vein dilatation and stasis. Therefore incompetence, venous reflux, and dilatation of the ovarian veins lead to the development of pelvic varicosities and congestion, which are known causes of pelvic pain and the most likely etiology of PCS.

The term Energised was problematic in translation as

The term “Energised” was problematic in translation as it could correspond to wzmocniony (fortified), pobudzony (aroused) and pobudzony do działania (aroused to action) and in meaning coincides with other BAES concepts like Stimulated (pobudzony), Up (gotowy do działania) or Vigorous (pełen energii, pełen wigoru). Therefore, as in the statements of Polish respondents the term ośmielony (encouraged) appeared, it was decided to use it instead of the more ambiguous Energised, which also coincided with the meanings of many other concepts. This change should not collide with the content of the stimulatory effects factor, but should develop it, which allowed us also to include it in the empirical analysis.
As a result of the introduced changes to the original (BAES), and to simplify the name of the instrument, we have called it Skala Efektów Picia Alkoholu (SEPA).
The psychometric properties of SEPA. The original experimental validating procedures that were carried out on BAES involved administering real doses of alcohol and the monitoring of alcohol in the blood [2, 3, 6, 7, 14]. In research on the validity of SEPA, we limited ourselves to defining its factor validity and verification of the Cyt 387 that the subjective assessment of short-term effects of consumed alcohol are positively associated with responses in terms of valence and similar in terms of the content expectations of the effects of drinking [4, 5, 7, 9, 10].

Materials and Methods
Participants. The study was carried out on two normative samples from a large city among declared drinkers of alcohol who had agreed to take part in it.
Methods and procedure. SEPA was presented to subjects with the following instructions:
Apart from SEPA, subjects also completed Poprawa\’s Alcohol Use Scale (Skala Używania Alkoholu, SUA) [16]. Also the second sample subjects filled in the Comprehensive Effects of Alcohol Questionnaire by Fromme, Stroot and Kaplan [17, 18].
Poprawa\’s Alcohol Use Scale (SUA) assesses the degree of alcohol use involvement from abstinence to probable dependency based on 11 weighted indicators (diagnostic criteria). The higher the general SUA score, the greater the involvement in use of alcohol. Empirical studies conducted hitherto with the aid of SUA indicated the very good psychometric properties of this instrument both in terms of its reliability and validity [16]. The tool was employed in order to control the degree to which the subjects were involved in drinking so that the final sample contained only current drinkers and no abstainers or those suspected of having an alcohol dependence.
Kwestionariusz Oczekiwanych Efektów Picia (KOEP) is a modified Polish language version of the Comprehensive Effects of Alcohol Questionnaire by Fromme, Stroot and Kaplan [17, 18]. It includes 45 descriptions of likely positive and negative effects of drinking assessed by subjects on a 4-point Likert-type scale from 1 – I don’t agree to 4 – I agree. KOEP factor analysis revealed six types of expected effects of drinking:


Discussion and conclusions
The subjectively experienced, short-term effects of drinking alcohol depend on, among other things, the length of time and stage of metabolising in the body (see Figure 1). As the level of alcohol rises in the blood, usually at the start of consumption, the effects are experienced as stimulating. The drinkers feel an improvement of mood, a rise in energy level, they are excited, more self-confident, talkative and ready for action. However, as alcohol levels in the blood drop with its metabolisation, the experienced effects of alcohol use become ever more clearly sedative. Drinkers start having ever greater difficulty with concentration, they feel dizzy, thinking processes slow down, it is ever more difficult to control their own reactions and they become irritable, sleepy and vacant. These effects are more intense the greater the dose of consumed alcohol [1–3].
The aim of the conducted research was to formulate a Polish language adaptation of Martin et al.’s Biphasic Alcohol Effects Scale (BAES) [2, 3]. This instrument is supposed to measure the subjective assessment of the stimulatory-sedative, short-term (direct) effects of drinking alcohol. The experience of the subjective effects of alcohol has a significant bearing on involvement in alcohol consumption, and so poses the risk of the development of resulting problems and disorders [4–7, 11–14].

BIRB796 In Galeana S nchez and Delgado

In  [6] Galeana-Sánchez and Delgado-Escalante used the work of Arpin and Linek  [5] in order to introduce the following concepts:

Since the existence of an -walk between two vertices does not guarantee the existence of an -path between those vertices and the concatenation of two -paths is not always an -path, we can claim that if has an -kernel by walks, then not necessarily has an -kernel as the example in Fig. 1 shows. In Fig. 1 we have that is an -kernel by walks of , because (, , , , ) is an -walk in that finishes in and it BIRB796 contains every vertex of . It is easy to check that has no -kernel (notice that every -independent set of has cardinality one).
We also claim that if has an -kernel, then not necessarily has an -kernel by walks as the example in Fig. 2 shows. In Fig. 2 we have that is an -kernel in . It is easy to see that has no -kernel by walks (notice that every -independent set by walks in has cardinality one because (, , , , ) is an -walk between and in ).
In  [6] Galeana-Sánchez and Delgado-Escalante proved the existence of -kernels in possibly infinite -colored digraphs. In  [7] Galeana-Sánchez and Sánchez-López showed necessary and sufficient conditions for the existence of -kernels in the -join of digraphs. Finally in  [8] Galeana-Sánchez and Sánchez-López showed more conditions for the existence of -kernels in infinite digraphs.

Main results
The following lemma, which was proved in  [5], will be useful in order to prove Theorems 1.5 and 1.6.

Theorem 3.2 allows us to establish the following results. Before we need a definition.
Let be a digraph with , , and a sequence of vertex disjoint digraphs with and for each . The -join of the digraph and the sequence is the digraph () such that:
Notice that from the definition of () we have that () contains an isomorphic digraph to for each . Denote by the copy of in ().
Observe that .
The following theorem shows how to produce more digraphs in from a digraph in . It is necessary to mention that the following result was proved in  [5] by Arpin and Linek. Here we are going to prove that Theorem 3.4 is also a direct consequence of Theorem 3.2.

The following result shows another sufficient condition for the existence of an -kernel by walks.


A five-connected planar graph is called a doughnut graph if has an embedding such that (a) has two vertex-disjoint faces each of which has exactly vertices, , and all the other faces of has exactly three vertices; and (b) has the minimum number of vertices satisfying condition (a). Fig. 1(a) illustrates a doughnut graph where and are two vertex disjoint faces. Faces and are depicted by thick lines. The name of doughnut graph was chosen in  [1] for such a graph since the graph has a doughnut like embedding, as illustrated in Fig. 1(b). The class of doughnut graphs is an interesting class of graphs which was recently introduced in graph drawing literature for it’s beautiful area-efficient drawing properties  [1–3]. A doughnut graph admits a straight-line grid drawing with linear area  [1,3]. Any spanning subgraph of a doughnut graph also admits straight-line grid drawing with linear area  [2,3]. The outerplanarity of this class is 3  [3].
Given a graph , natural numbers , , , such that , we wish to find a -partition of the vertex set such that and induces a connected subgraph of for each . The problem of finding a -partition of a given graph often appears in the load distribution among different power plants and the fault-tolerant routing of communication networks  [4,5]. A doughnut graph is -partitionable  [6].
A class of graph has recursive structure if every instance of it can be created by connecting the smaller instances of the same class of graphs. In this paper, we show that any instance of a doughnut graph can be constructed by connecting smaller instances of doughnut graphs. We show that one can find a shortest path between any pair of vertices and of a doughnut graph in time where is the length of shortest path between and by exploiting its beautiful structure. We study the other topological properties like degree, diameter, connectivity and fault tolerance. We show that it’s diameter is . It has maximal fault tolerance, and has ring embedding since it is Hamilton-connected. One may explore the suitability of a doughnut graph as an interconnection network since some of its properties are similar to that of the graph classes usually used for interconnection networks.

In several classes of graphs are collected whether they

In  [3], several 3X FLAG of graphs are collected whether they are SEM or not. For examples, path graphs and odd cycles are SEM, but even cycles are not. However, not much has been done concerning an SEM labeling in hypergraphs. Hence, we generalize the notion of the SEM for graph to the SEM in hypergraph.
In this paper, we will consider two classes of hypergraphs, namely, -node-uniform hyperpaths, and -node-uniform hypercycles, . These classes are the generalizations of paths and cycles in graph theory. By defining SEM labelings on “small size” hypergraphs of these two classes, we then can have algorithms to construct the SEM labelings on “bigger” hypergraphs. Finally, we can conclude that are SEM and under some conditions on and , are SEM. We note that these conditions agree with the condition for a cycle to be SEM in graphs.

Let us begin with the definitions of hypergraph, and .

If there is no ambiguity, we may denote as and as . For more convenience, we let and . Notice that, by Definition 2.1, can be empty. However, in this paper, our hypergraphs consist of at least one vertex. Moreover, if for all , then is called a -uniform hypergraph and it is denoted by . We can see that is an ordinary graph.

According to Fig. 2, we can regard each hyperedge of as a combination of 3 parts. Two of them are called nodes which both consist of equal vertices and . The third part is called the middle which consist . The node part is usually the intersection part of two adjacent hyperedges except for and which only their right node and left node are the intersection parts, respectively.
Notice that, has hyperedges. Each hyperedge consists of exactly vertices and has two nodes containing exactly vertices. Thus, has totally vertices.

According to Fig. 4, each hyperedge of is similar to the hyperedge of . It is a combination of 2 nodes, and , and the middle . However, each node of is the intersection of two adjacent hyperedges. Thus, it is easy to see that has vertices. Notice that and are the path and cycle in the ordinary graph sense.
We extend the notion of the SEM labeling for a hypergraph stated as Definition 2.4.

In the case of an empty edge, , we let the sum of all vertex-labels, which is none, to be zero. If a hypergraph is a 2-uniform hypergraph, then Definition 2.4 agrees with the definition of SEM labeling in graphs (see Figs. 2, 4 and 6–13).
By Definition 2.4, for every SEM labeling of , since , we obtain which is the set of consecutive integers. Moreover, since is a constant for every , must also be the set of consecutive integers. From this observation, we state the equivalent form of the SEM labeling for hypergraph as the following theorem.

We point out here that Theorem 2.5 is a generalization of the following result found in  [5] for graphs.
By Theorem 2.5, to give an SEM labeling for a hypergraph , then it is enough to assign only the labels to vertices of the hypergraph in such a way that the assignment satisfies the necessary part of the theorem.

First, we will give the SEM labelings for and . Then, we show how to extend those SEM labelings to the SEM labeling for .

For Theorems 3.2, 3.3 and 3.4, we will give the SEM labelings for and , respectively. However, the proofs of these theorems are similar to the proof of Theorem 3.1. Thus, we omit their proofs.

Now, we give the idea used in this paper on how to extend those SEM labelings in Theorems 3.1–3.4 to the SEM labelings of . First, observe that every hypergraph has nodes. If we add two vertices to each node of , then receives another vertices and becomes .
This addition of vertices can preserve the SEM property. To see that let having vertices be SEM. Then, we add new vertices to construct . We assign the label to these vertices. Next, we make pairs from these vertices such that the sum of vertex-labels of each pair is , i.e., the vertex whose label is must be paired with the vertex whose label is for every . Now, we put these pairs of vertices to each nodes, in any order. Thus, we obtain the new labeling for . Since each hyperedge of has two nodes, it is easy to see that the sum of vertex-labels in each hyperedge increased from the old one of by . Therefore, the set of the sum of vertex-labels in each hyperedge of is the set of consecutive integers. Consequently, by Theorem 2.5, is SEM. Moreover, since has more vertices from and the sum of vertex-labels is also increased by , the magic constant for is increased by from the magic constant for . We conclude this observation as Lemma 3.5.

L association du cancer de la prostate avec

L\’association du cancer de la prostate avec la leucémie lymphoïde chronique (LLC) est rare [1–3]. Elle pose le problème de savoir, est ce qu\’il s\’agit d\’une association fortuite ou est ce qu\’elle tient d\’une relation de cause à effet. Nous rapportons une observation exceptionnelle d\’un cancer de la prostate associé à une leucémie lymphoïde chronique (LLC).

Cas clinique
Un patient âgé de 69ans, sans antécédents pathologiques particuliers, a consulté pour une altération de l’état général faite de fièvre prolongée et d\’un amaigrissement non chiffré.
L\’examen clinique retrouvait une pâleur cutanéo-muqueuse, des adénopathies cervicales et axillaires bilatérales (diamètre: 3-4cm), une splénomégalie (débord costal:9cm) et une hépatomégalie (flèche hépatique: 13cm). Il n\’a pas été noté de signes hémorragiques ni infectieux. Le toucher rectal était normal.
L\’hémogrammemontrait un taux d\’hémoglobine à 9g/dl, volume globulaire moyen: 88 fl, concentration corpusculaire moyenne en hémoglobine: 36,4%, globules blancs: 240150/mm3, lymphocytes: 238630/mm3, polynucléaires neutrophiles: 1020/mm3, plaquettes: 159100/mm3. Le frottis sanguin a objectivé une hyperlymphocytose morphologiquement monotone faite de petits histone methyltransferase matures, avec rapport nucléo-cytoplasmique élevé, un noyau arrondie sans encoche, une chromatine mature mottée, sans nucléole visible, le cytoplasme était réduit bleuté dépourvu de granulations. On notait la présence de cellules altérées réduites à une ombre nucléaire (Fig. 1). L’ immunophénotypage des lymphocytes sanguins a confirmé le diagnostic de LLC de phénotype B: CD5+, CD19+, CD20 faible, CD 23+, FMC 7-, immunoglobulines (Ig) de surface faibles et CD79b faibles (score de Matutes: 5/5) [4].
Le patient était classé stade C de Binet (lymphocytose, hémoglobine <100g/l et/ou plaquettes <100 G/l, indépendamment du nombre d\'aires ganglionnaires atteintes [5]) et traité par chimiothérapie selon le protocole FCR (fludarabine: 40mg/m2 J1 à J3, Cyclophosphamide 250mg/m2 J1 à J3, Rituximab IV: 375mg/m2 J1) pendant six cycles mensuels, associé à une prévention des infections zostériennes et à pneumocystis jiroveci respectivement par aciclovir et triméthoprime-sulfaméthoxazole. A la fin du traitement le patient était en rémission complète. Le dosage de l\'antigène spécifique de prostate (PSA) total, fait avant le toucher rectal, montrait un taux élevé à 1103 ng/ml (normale <3) (Kit PSA Hybritec*). L’échographie prostatique a mis en évidence une prostate de 32g d’échostrusture hétérogène. La biopsie prostatique objectivait un adénocarcinome prostatique peu différencié (score de Gleason: 8). L\'iRM dorso-lombaire montrait des lésions osseuses lombosacrées et iliaques gauches avec épidurite tumorale responsables d\'une compression du film terminal associées à une infiltration tumorale des vertèbres avec discarthrose bi-étagée L1-L2 et L2-L3. (Fig. 2).

Il s\’agit d\’une association entre adénocarcinome de la prostate avec métastases osseuses et LLC chez un patient de 69ans. Le diagnostic du cancer de la prostate, effectué par biopsie prostatique, était réalisé 24 mois après celui de la LLC. Le patient était décédé 29 mois après la découverte la LLC.
La leucémie lymphoïde chronique (LLC) est un syndrome lymphoprolifératif caractérisé par la prolifération médullaire d\’un clone lymphocytaire B envahissant secondairement le sang et les organes lymphoïdes [5]. Les atteintes prostatiques au cours de la LLC sont rares [1–3]. Elles peuvent résulter soit d\’une association synchrone avec un cancer de la prostate soit d\’une infiltration prostatique par les cellules leucémiques. Cette dernière éventualité est difficile à écarter, dans notre cas, étant donné que le diagnostic a été réalisé par biopsie prostatique à l\’aiguille (et non sur pièce de résection trans-urétrale) [2,3].

One can posit that the aim of the

One can posit that the aim of the dual system was to allow for a transition rivastigmine tartrate whereby clinicians could continue to use paper records for documentation, which were scanned to the online database to be available for effective communication while these same clinicians slowly familiarise themselves with a full EMR system. The dual system, however, does not seem to be working at KH. In a resource-limited area, fixing this problem will involve short-term and long-term changes. In the short term, the goal is to figure out ways to optimise the ECM online database. This should involve increasing resources, manpower, supervision, and training. One example of a change in resources concerns the lack of vital signs in patient charts. It could be that temperature and blood pressure measurements are left out of patient charts because thermometers and blood pressure cuffs are scarce in the hospital. These vital signs, however, cannot be overlooked, as they are used to calculate patient severity scores, which have been shown to be sensitive and specific predictors of patient outcomes. It could also be that the healthcare workers do not know how to use these instruments. Or, it could be that the healthcare workers do not record these values because there is no accountability for not doing their jobs. All of these are possible reasons for incompletely filled out folders, and any hospital looking to use systems like this should first address these issues. Another example of lacking resources can be seen in the medical records department, where there are workers and adequate supervision, yet there are only a few scanners available in a hospital that serves the needs of the 400,000 residents of Khayelitsha. Meeting such demands is quite a difficult task to achieve, as evidenced by the stacks of folders waiting to be scanned in the records office. Although improvements in these areas require upfront costs, they are necessary to achieve the full advantages of the ECM online database.
In the long term, a complete conversion to a full EMR system that involves direct input of doctors’ and nurses’ notes into the computer will be the most ideal solution. Such a system should apply the “cradle to the grave” approach. For an efficient EMR system to be implemented, there must be important pieces in the toolkit, including the development of a system that has adaptable, interoperable, and scalable software while fostering relationships in the community to provide “technical, financial, and training support”. Since the Western Cape market is dominated by Clinicom, this would be the most likely system to be implemented. As expected, this is a larger undertaking, and requires a large investment to implement and maintain. Some solutions are available to help with funding. Governments like the US have provided incentives for “meaningful use” of this technology to healthcare facilities. The South African government can do the same, providing subsidies for hospitals that use the system and penalties for those that do not. Furthermore, there are cheaper and more malleable options for EMRs, such as open source versions, which would be much more feasible in a low-resource environment.
For any new technology, there is always a lag time for adjustment. This is another one of the pitfalls for the EMRs. The time can vary according to institution, with some institutions taking up to two years of dedicated effort to achieve full use. It could be that KH needs a few years for all the systems to come into place and fully realise the benefits of the installed records system. Further research should look at how efficient the system is in the coming years. Additionally, this study had only a small sample. Though KH is a large and fairly representative hospital of those in South Africa installing EMRs, this study only looked at the effects on one department in one large hospital. Future studies should look at more hospitals to determine whether there are common issues and solutions. Finally, as both the registry and Clinicom were incomplete, it was difficult to establish a gold standard for the trauma load at KH. It is possible that some of the encounters on Clinicom were incorrectly coded as non-trauma, thereby underestimating the trauma load.

br Conflicts of interest br Introduction Hepatitis

Conflicts of interest

Hepatitis B virus (HBV)-related acute-on-chronic liver failure (ACLF) refers to an acute deterioration of liver function due to a precipitating event such as microbial infection, reactivation of viral hepatitis, hepatotoxic drugs, surgical procedures, or variceal bleeding occurring in patients with any form of underlying chronic HBV infection. In China, HBV infection constitutes >80% of all etiologies of ACLF owing to a high carriage rate of HBV. HBV-related ACLF exhibits relatively high mortalities and liver transplantation is the most promising treatment.
Recent studies have shed light on CD4+CD25+ regulatory T cells (Treg) that are actively engaged in the maintenance of immune tolerance to both self and nonself dhpg by suppressing aggressive T-cell response. This specialized subpopulation of CD4+ T cells constitutively expresses interleukin (IL)-2 receptor α-chain (CD25), and represents approximately 2–4% of peripheral CD4+ T cells. The forkhead-winged helix transcription factor (Foxp3) has been demonstrated to be a unique molecule for the development and functions of CD4+CD25+ Treg.
Accumulating evidence indicates that increased Treg numbers are associated with persistence of HBV infection by downregulating HBV-specific effector T cell responses. Depletion of this proportion of cells in vitro can enhance proliferation of effector cells and secretion of interferon-γ (IFN-γ) against HBV antigens in a dose-dependent manner. By contrast, the suppressive role of Treg may prevent excessive immunopathological damages induced by sustained immune activation and inflammation. ACLF often represents a complicated state of host immune dysregulation, in which exacerbated innate immune responses and aberrant adaptive immune responses may mediate hepatic inflammation. However, it is still controversial whether Treg is increased or decreased in HBV-related ACLF due to discrepant results.
In this study, we examined the frequency of peripheral CD4+CD25+ Treg and the distribution of liver-infiltrating Foxp3+ cells in patients with HBV-related ACLF. We also investigated inhibitory functions of Treg, as well as its association with short-term prognosis in HBV-related ACLF.

Patients and methods


HBV infection remains a serious public health problem, worldwide affecting 350–400 million people. A small proportion of patients with chronic HBV infection may develop ACLF which exhibits high mortalities and poor prognosis. Although pathogenesis of HBV-related ACLF is extremely complex and still remains unclear, dysregulation of host immune responses induced by host-HBV interactions is proposed to be the most contributing factor. It has been suggested that Treg may play a crucial role in controlling immunopathological damage, but it may also contribute to hyporesponsiveness against infection.
The relationship between Treg and HBV-related ACLF is poorly understood. We observed that ACLF patients had a markedly higher peripheral CD4+CD25+ Treg, as well as increased inhibitory activity against CD4+CD25− responder cells, than healthy controls. Our data are identical to those observed by Xu et al, who showed that patients with chronic severe hepatitis B (i.e., HBV-related ACLF) had the highest circulating CD4+CD25high Treg among patients with different phases of HBV infections. These results support the notion that upregulation of Treg in ACLF may suppress immune responses, thereby limiting liver injuries and inflammation caused by necrosis or apoptosis of hepatocytes. However, Wang et al demonstrated the opposite finding that decreased peripheral CD4+CD25+CD127low Treg could aggravate liver injuries by enhancing immunological responsiveness to HBV in HBV-related ACLF. The discrepancies between these studies may be largely attributed to differences in the molecular markers selected for identifying Treg. Previous studies have confirmed that early-stage ACLF are usually characterized by immune activation, but “sepsis-like” immune paralysis usually accompanies late-stage ACLF. Thus, we propose that host immune status in different phases of ACLF may also be responsible for numbers and functions of Treg. Although higher Treg were observed in patients with severe complications with no statistical significance, a larger sample size may lead to a statistical significance.

angiotensin receptor blocker In a cohort study in the city

In a cohort study in the city of Pelotas, infants that had excessive crying in the first three months had approximately 30% more behavioral problems than those that did not have excessive crying, even after controlling for all confounding factors. Additionally, it is associated with early weaning, and maternal anxiety and depression.

Definitions and classification
In a classic study about crying in infants, Brazelton defines excessive crying as any amount of crying that worries the parents, but the consensus definition by several authors are the criteria defined by Wessel, known as the “rule of three” (crying spells at least three hours a day, three times a week for three consecutive weeks and lasting three months). Even with a consensus, there is no single definition of what should be considered excessive crying. An attempt at classification was carried out using three criteria: from newborn up to 4 months of age, infants with crying spells and irritability for three or more hours a day, three days a week and at least for one week, and no failure to thrive, i.e., without any consequences for the child\’s development. An example would be a healthy infant, aged up to 3 months, who feeds well and has a prolonged, strident crying spell, which can last up to a few hours, writhing and bending the knees and thighs over the abdomen eliminating gases; the child seems hungry, but does not calm down after being fed. It is a crying spell without apparent cause and may be a manifestation of other medical conditions, self-limited and benign.
Although it has a benign etiology, it causes parental stress, often leading parents to exhaustion without solving the problem, which, as a result, can lead parents to take dangerous measures in an attempt to calm the infant. In addition to the indiscriminate use of painkillers and sedative medications, there are several studies showing angiotensin receptor blocker that excessive crying without quick angiotensin receptor blocker in infants is one of the causes of shaken baby syndrome.
In study by Brazelton of typical infants, excessive crying is measured in hours/day. In this study, the mean crying time of an infant aged 2 weeks is one hour and 45minutes, and at 12 weeks of age, the mean time is up to two hours and 45minutes; at 12 weeks, the mean time decreases to one hour. These crying spells are more frequent in the late afternoon, with a peak occurrence at 3–6 weeks of age.
Over time, attentive caregivers begin to differentiate what motivates the infant\’s crying, but the perception of discomfort and suffering often confounds their interpretation, leading to an overvaluation and hindering a more thorough assessment. As a didactic characterization and classification, the crying could be divided into three categories: (1) normal/physiological; (2) excessive, secondary to discomfort or disease; and (3) without an apparent cause, where colic is included.

Conflicts of interest

Since the conception, characterized by the moment when the sperm enters the egg, the biological potential for the formation of a new human being develops into a fascinating process of cell multiplication and differentiation. The maturation of the individual occurs during the course of different stages of life. Currently, the first 1000 days, starting at conception, are considered to be a critical period to define the health status of the individual and can have consequences throughout life.
The first two years of life are an important part of this period, which is characterized by accelerated growth rate and development of several organs and systems. Therefore, gastrointestinal signs and symptoms can occur in infants, which may be linked to several anatomical and functional changes observed at this stage of life. In addition to these clinical manifestations, there may be repercussions in the individual\’s future, as well as consequences that will interfere in family dynamics and the parents’ emotional status.

Conclusion The microstructure and mechanical properties

The microstructure and mechanical properties of tgf beta receptor Mg–9Al–2Sn–xMn (x = 0, 0.1, 0.3 wt.%) alloys in as-cast, solution treated and aged conditions are investigated and the following conclusions can be drawn.

This research work is collaborated by General Motors Global Research and Development (GM R&D), Warren, MI, USA, and Shanghai Jiao Tong University (SJTU), Shanghai, China. Dr P. Fu would like to acknowledge the support of a Specialized Research Fund for the Doctoral Program of Higher Education (20110073120008) and a project from Shanghai Science and Technology Committee (12DZ0501700).

The desire to use lightweight metallic alloys in the automobile and aerospace industries has increased in recent years as the search for lightweight solutions has become amplified. Magnesium alloys are one of these lightweight metallic alloys currently being investigated, because of its low density, 1.74 g/cm3, and high mechanical stiffness. The mechanical benefits of magnesium, however, are contrasted by a high corrosion rate as compared to aluminium or steel. Because of magnesium\’s electrochemical potential, as illustrated in the galvanic series, it corrodes easily in the presence of seawater. The high corrosion of magnesium has relegated the alloy to use in areas unexposed to the atmosphere, including car seats and electronic boxes [1,2]. However, the corrosion resistance of the Mg-based alloys is generally inadequate due to the low standard electrochemical potential −2.37 V compared to the SHE (Standard Hydrogen Electrode) and this limits the range of applications for Mg and its alloys. Therefore, the study of corrosion behaviour of magnesium alloys in active media, especially those containing aggressive ions, is crucial to the understanding the corrosion mechanisms, and hence, to improving the corrosion resistance under various service conditions. The reason for the less corrosion resistance of magnesium and its alloys results primarily from two mechanisms: (i) oxide films forming on the surface is not perfect and protective; (ii) galvanic or bi-metallic corrosion can be caused by impurities and secondary phases [3].
This research focused on comparing immersion testing with potentiodynamic polarization testing, which are the two main techniques for corrosion studies, in an effort to expose the magnesium alloy to environments similar to those environments experienced by automotive engine blocks [4]. It is well known that Mg alloys are susceptible to corrosion such as pitting and stress cracking corrosion (SCC). Major studies shows that the SCC susceptibility of Mg alloys is increased in solutions containing chloride [5].
The galvanic couples formed by the second phase particles and the matrix are the main source of the localized corrosion of magnesium alloys [6]. The corrosion of AZ31 magnesium alloy in simulated acid rain solution is controlled by the rate of anodic dissolution and hydrogen evolution, and the corrosion rate tgf beta receptor of AZ31 increases with increasing concentration of Cl− ion [7]. The corrosion attack of Mg and its alloy in dilute chloride solutions depends on both Al content and alloy microstructure [8]. Yingwei song et al. [9], investigated the effect of second phases on the corrosion behaviour of wrought Mg–Zn–Y–Zr alloy and they found that the increase of exposure time, the second phases can promote the corrosion rate significantly and cause pitting corrosion. Rajan Ambat et al. [10], studied the evaluation of micro structural effects on corrosion behaviour of AZ91D magnesium alloy and they reported that size and morphology of β phase and coring were found to have significant influence on corrosion behaviour of AZ91D alloy. Pardo et al. [11], explored the influence of microstructure and composition on the corrosion behaviour of Mg/Al alloys in chloride media and it was found that the aluminium enrichment on the corroded surface for the magnesium alloy, and the β-phase (Mg17Al12), which acted as a barrier for the corrosion progress for the magnesium alloys. The corrosion product consisted of magnesium hydroxide, fallen β particles and magnesium–aluminium oxide; the amount of each component was found to be a function of chloride ion concentration and pH [12].