Austin Otolaryngology

                                 http://austinpublishinggroup.com/otolaryngology/journalscope.php

Austin Otolaryngology is an open access, peer review journal publishing original research & review articles in all the fields of Otolaryngology. Otolaryngology deals with the study of ear, nose and throat. Austin Otolaryngology provides a new platform for students to publish their research work & update the latest research information in Otolaryngology.

Austin Otolaryngology is a comprehensive Open Access peer reviewed scientific Journal that covers multidisciplinary fields. We provide limitless access towards accessing our literature hub with colossal range of articles. The journal aims to publish high quality varied article types such as Research, Review, Short Communications, Case Reports, Perspectives (Editorials), Clinical Images.

Austin Otolaryngology supports the scientific modernization and enrichment in Otolaryngology research community by magnifying access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed member journals under one roof thereby promoting knowledge sharing, collaborative and promotion of multidisciplinary science.

Epidermal Choristoma Presenting as an Enlarging Tongue Mass

             http://austinpublishinggroup.com/otolaryngology/fulltext/ajo-v4-id1092.php

Epidermalchoristoma is an extremely rare entity characterized by histologically normal-appearing skin with associated hair follicles, sebaceous glands, and adnexa in an abnormal location. When localized to the oral cavity, this lesion presents most-commonly as an asymptomatic hyper pigmented macule or patch on the lingual dorsum of a male patient. Herein, we present an unusual case of an epidermal choristoma presenting as an acutely infected mass of the deep anterior tongue in a teenage female.

Choristomas are a developmental abnormality characterized by the proliferation of histologically normal tissue in an ectopic location. Choristomas of the head and neck have been noted in the tongue floor of mouth nasopharynx pharynx hypopharynx  and submandibular regions and are clinically important lesions as they may present as a cause of airway obstruction or feeding/ swallowing difficulties, especially in the pediatric population. In the oral cavity, heterotopic tissue consistent with choristoma has been reported with otherwise histologically-normal salivary gland, cartilaginous, osseous, thyroid, sebaceous, glial, gastric mucosa, and epidermal tissues although cartilaginous, osseous, and lingual thyroid choristomas are relatively more common. “Epidermal choristoma” or “cutaneous choristoma” is defined by the presence of stratified squamous epithelium (epidermis) with associated adnexal structures including sebaceous glands, apocrine glands, and hair follicles. Epidermal choristoma is a very rare lesion of the oral cavity, with only five reported examples in the literature to date. All reported cases have occurred in males, with the majority presenting as a hyper pigmented macule or plaque (80%), most commonly of the dorsal tongue. Follicular choristoma appear to be a related lesion defined by pigmented epidermis, sebaceous glands, sweat glands, and mature hair follicles with the additional finding of keratin-containing cysts. To date, there are two cases of follicular choristoma reported in the English language literature. Herein, we report a unique example of an epidermal choristoma presenting as an infected tongue mass in a female teenager.

A 14-year-old female with no significant medical history presented to the emergency room with two days of tongue swelling, painful swallowing, fever, and difficulty speaking. The patient complained of some difficulty in breathing. Physical exam revealed moderate swelling and tenderness of the dorsum of the tongue with a 1cm right paramedian mass just anterior to the circumvallate papillae. Of note, there was no pigmentation changes or ulceration reported. The patient did not have stridor. 

Wrist Arthroplasty Leads to Better Outcomes than Arthrodesis for Treatment of Patients with Advanced Rheumatoid Arthritis of the Wrist: A Review of Literature

                                           http://austinpublishinggroup.com/austin-orthopedics/

Rheumatoid arthritis is a chronic inflammatory condition of unknown a etiology, which can be disabling causing up to 35% of patients with 10 years of symptoms to early retire and carries a high mortality rate. It targets mainly the synovial membrane and articular cartilage of joints leading to joint deformity and instability. Genetic, immunological and environmental factors are thought to cause the disease in such a way that susceptible genes are triggered by infection or environmental factors leading to inappropriate immune response attacking the joints.

Around 1% of general population is affected in the UK it is estimated to affect about 0.8% of the population and in some countries, where it is prevalent, it affects about 2% of population above 60 years. Though highest rates are in north Europe and America some studies are showing decrease of incidence in these regions. It is more common in white race affecting elderly in the 5th and 6th decade with women being affected 3 folds more than men.

Wrist and hands are the most common joints affected in rheumatoid arthritis such that by 4 years of the onset of the disease more than 90% of patients would show symptoms of involvement of at least one of these joints. Affection of carpal ligaments and tendons around the wrist would lead to radial deviation of radio carpal joint with ulnar deviation of the fingers at the MCP joint, subluxation ofdistal ulna and dropped fingers resulting in a zigzag deformity or what is known as caput ulnae syndrome. Half of the patients might have systemic or extra articular manifestations (ExRA). Nodules are the most common ExRA with the cardiovascular system being the most affected and this might be the reason why these patients show a higher mortality rate than the non-ExRA subgroup. Patient presents complaining of painful, swollen, stiff joints, especially after period of rest, and even obvious deformity in late presentations. It is characterized by periods of remission and activity, which can be assessed using scores as the Disease Activity Score (DAS28).

Effectiveness and Safety of a Combination of Intra- Articular Corticosteroid and Local Anesthetic in Indian Patients with Knee Osteoarthritis: A Pilot Study

                                     http://austinpublishinggroup.com/orthopedics-rheumatology/

Intra-articularcorticosteroids are often used along with local anesthetics to treat osteoarthritis probably due to the rationale that the local anesthetic component acts quickly after administration, to provide immediate pain relief, and its action may last until the corticosteroid component starts to exert its effect. While some studies suggest that a combination local anesthetic/corticosteroid may have potential negative effects on intra-articular cell viability and cell metabolism, and may lead to chondrotoxicity, others support continued safe use of this combination in clinical practice. Nonetheless the combination of intra-articular steroids and local anesthetics is routinely administered universally (either in the same syringe or separately) to treat osteoarthritis.

The potential advantage of rapid onset and prolonged duration of action offered (which enables instant pain relief and anti-inflammatory response) by combination of intra-articular steroids and local anesthetics, as well as the controversy surrounding its safety makes it imperative to examine its effectiveness and safety in patients with knee osteoarthritis. However, studies exploring the effectiveness and safety of this combination are limited  especially in India. Therefore, this pilot study was conducted to determine the effectiveness and safety of administering a combination of intra-articular corticosteroid and local anesthetic in Indian patients with knee osteoarthritis.

Adults between 35-70 years of age, suffering from chronic knee pain (pain score at least 3 cm on Visual Analogue Scale [VAS] for at least three months prior to inclusion, with a clinical or radiological diagnosis of knee osteoarthritis, dissatisfied with previous non-surgical management including analgesics and other drugs were included after informed consent. Those with severe, advanced, destructive arthritis with deformity, neuropathic or septic arthritis.

Emergency Contraception Editorial Commentary

                http://austinpublishinggroup.com/obstetrics-gynecology/onlinefirst.php

Emergency contraception is method of contraception that helps to prevent unintended and unplanned pregnancies after unprotected sex and before the implantation. This contraceptive method includes either the use of Emergency Contraceptive Pills (ECPs) levonogestrel in a single dose 1.5mg, ulipristal acetate in a single pill containing 30mg or Copper-containing IUD s. The recommendation timeframe to use the emergency postcoital contraception is as following: levonogestrel pills should be taken within 72 hours, ulipristal acetate pills are indicated up to 120 hours and Copper-containing IUDs may be insert intrauterine up to 5-7 days after unprotected intercourse respectively. The exact mechanism of action of EC is not yet clear, but theoretically it can affect follicle maturation, ovulation process, quality of cervical mucus, fertilization, zygote development and transport. Also, the mechanism of action varies depending on the formulation, but also for the same formulation depends on the time of receipt in relation to sexual contact and ovulation. 

Time range the effectiveness of emergency contraception decreases as long as the time elapses from sexual intercourse to the start of treatment. A sexual contact is considered unprotected when one of the following occurs: Failure to use a contraceptive method, Condom breaking or leakage, Displacement of contraceptive diaphragm or cervical cap, Do not intake a contraceptive pill on the 1st week, Do not intake 3 or more contraceptive pills on the 2nd or 3rd week, Do not intake a progestogen pill, Detachment of a contraceptive patch, Delay of Depo-Provera injection over 2 weeks, Ejaculation in the external genitalia, Sexual abuse of a woman who does not use a reliable contraceptive method. Contraindications There are no absolute contraindications to EC, except for pregnancy, and this is because it is effective. Recent studies have shown no teratogenic effects on the neonate or adverse outcome of pregnancy, and therefore it is not advisable to stop a possible pregnancy. Monitoring A pregnancy test should be recommended in women with no menstrual bleeding 21 days after taking EC. At the same time, a follow-up consultation may be provided for contraceptive methods and prophylactic screening for sexually transmitted diseases.

Effects of Soy Supplementation on Abdominal Obesity and Metabolic Risks on Post-Menopausal Women: A Pilot Study

                  http://austinpublishinggroup.com/obesity-metabolic-syndrome/

DEXA: Dual-Energy X-ray Absorptiometry; CRP: C-Reactive Protein; IL-6: Interleukin 6; BMI: Body Mass Index; CVD: Cardiovascular Diseases; HRT: Hormone Replacement Therapy; IRB: Institutional Review Board; UTSA: The University of Texas at San Antonio; HDL: High-Density Lipoprotein; LDL: Low-Density Lipoprotein; TC: Total Cholesterol; TG: Triglyceride; ELISA: Enzyme-Linked Immunosorbent Assay; Waist: Waist Circumference; HOMA-IR: Homeostasis Model Assessment-Insulin Resistance; GI: Gastrointestinal; SBP: Systolic Blood Pressure; DBP: Diastolic Blood Pressure; GLM: General Linear Model; SE: Standard Error; MRI: Magnetic Resonance Imaging; CT: Computer Tomography; Intervention: Intervention Group; Control: Control Group.

Menopausal women are among the highest risk populations for abdominal obesity and at great risk of developing metabolic abnormalities. It was observed that menopausal women tend to accumulate visceral fat, which is a key risk factor for metabolic syndrome. The withdrawal of estrogen has negative effects on the cardiovascular system including: the transition from a gynoid to an android adipose storage pattern, reduced glucose tolerance, abnormal lipid profile, increased blood pressure, increased sympathetic tone, endothelial dysfunction, and vascular inflammation. Among the inflammatory factors, cytokine interleukin 6 (IL-6) may lead to mediating pathways for cardiovascular diseases (CVD); while C-reactive protein (CRP) is an indicator of metabolic abnormality and CVD in post-menopausal women.

Hormone replacement therapy (HRT) has been shown to be effective in reducing visceral fat and improving lipid profile in menopausal women. However, HRT may increase risk of breast and uterine cancers. As such, prolonged use of HRT is not recommended for CVD prevention. Therefore, safe, hormone substitute compounds exerting estrogenic properties are warranted to prevent and treat estrogen deficiency related disease states, e.g. abdominal obesity and its metabolic complications.

The Recognition of Respiratory Failure in Amyotrophic Lateral Sclerosis - Delays and Distress

                                      http://austinpublishinggroup.com/austin-neurology/

Amyotrophic Lateral Sclerosis/Motor Neurone Disease (ALS / MND) is a progressive disease of the nervous system affecting primarily, but not exclusively, motor neurones. The cause is unknown, but in 5-10% of cases there is a family history and there is increasing evidence of a genetic basis for the disease, with an unknown provoking environmental or other genetic involvement. Most people with ALS/MND present with muscle weakness, in arms or legs, or as swallowing or speech problems due to bulbar involvement. However a small proportion of people present with respiratory muscle weakness often as an emergency when they may even need ventilation, by non-invasive ventilation or invasive ventilation with a tracheostomy.

These cases show the issues that may arise when there is a misdiagnosis of symptoms, without a full assessment of the person’s history, symptoms and signs. Increasingly patients may be seen as presenting with a particular symptom complex which is considered to be related to a particular diagnosis, without consideration of the whole patient and a careful assessment of the situation. The names and details have been changed to protect anonymity.

Mr M was a 70 year old man who had suffered from heart failure since 1999 when he had undergone a coronary arterial bypass graft. He had been seen on a regular basis by cardiology services, including the specialist heart failure team. In September 2011 he was seen with increasing dyspnoea, which he stated had been present for over a year. His main symptom of waking at night was thought to be paroxysmal nocturnal dyspnoea. At the end of January 2012 he was admitted to hospital with shortness of breath on minimal exertion and was found to be in fast atrial fibrillation. This was treated but the episodes continued.

Therapeutic Use of Wheat Grass Juice for the Treatment of Anemia in Young Women of Ajmer City (Rajasthan, India)

                      http://austinpublishinggroup.com/nutritional-sciences/currentissue.php

Wheat grass juice isextracted from the cotyledons of the common wheat plant Triticum aestivum. It has been used therapeutically from years all around the world because of its healing properties. The juice from wheat grass is high in chlorophyll, active enzymes, vitamins and other important nutrients like Iron. The chlorophyll present in wheat grass and haemoglobin has similar structures except for the central moieties. Also the pH of wheat grass juice is 7.4 which are the same as that of blood. Therefore it is absorbed quickly in the blood and is often referred to as Green Blood. This juice is extensively used therapeutically for the management of diseases like Anemia, Thalassemia, Inflammatory Bowel diseases, etc.

According to the National Family Health Survey- 3, more than half of women (55 percent) aged between 15 to 49 years are Anaemic. Nutritional deficiency anaemia refers to a decrease in the concentration of haemoglobin in the blood due to poor dietary habits that causes deficiency of iron, proteins, vitamins like vitamin C, vitamin B₁₂ along with folic acid. Deficiency of the above nutrients can affect the production of red blood cells. Anaemia is a wide spread public health problem which is associated with an increased risk of morbidity and mortality. India is among the countries with the highest prevalence of iron deficiency anemia in the world

The reduction in oxygen available to organs and tissues when haemoglobin levels are low is responsible for many of the symptoms experienced by anaemic people. The consequences of anaemia include general body weakness, frequent tiredness, and lowered resistance to disease. Anaemia can be a particularly serious problem for pregnant women, leading to premature delivery and low birth weight. It is of concern in children since anaemia is associated with impaired mental and physical development. Haemoglobin testing is the primary method of Anaemia diagnosis. Age is associated with the category of Anaemia, with older women being somewhat more likely to be moderately or severely anaemic than younger women. The rate of moderate-to-severe Anaemia (moderate and severe Anaemia combined) among women of age 35- 49 is almost three times as high as among girls of age 15-19.

Mechanisms of Twinning IX: Influence of Prior Lactation

                                              http://austinpublishinggroup.com/nutritional-disorders/

The purpose of this study is to ascertain a physiological relationship between prior lactation and the probability of subsequent multiple pregnancies in humans, thereby lending support to the role of insulin-like growth factor in both phenomena. Data were collected in the present study to determine if there is a direct relationship between the extent of lactation in prior pregnancies and the chance of twin/triplet gestations subsequently. Positive results of such a study could support the proposed biochemical significance of insulin-like growth factor elevation in promoting multi-fetal pregnancies.

Cows with an enhanced tendency to twin have elevated levels of serum Insulin-like Growth Factor (IGF). IGF is a protein component of milk; bovine milk has a lower level of IGF than human milk, in general. Recent reports support the view that twinning in humans is also related in some way with IGF. Somatotropin-stimulated IGF augmentation often induces ovarian hyperstimulation in subfertile women undergoing in vitro fertilization. On the other hand, one small study found no significant difference in plasma follicle stimulating hormone (FSH) between mothers of Dizygotic (DZ) twins and mothers of singletons at any stage of the menstrual cycle.

Insulin-like growth factor, a 70-unit polypeptide, is a major mediator of FSH action on the ovary. IGF increases the sensitivity and responsiveness of ovaries to FSH. Variations in either FSH or IGF can modify the Spontaneous Twinning Rate (STR). The mitogenicly powerful synergistic combination of IGF and FSH enhances ovarian steroidogenesis, increases primordial follicle recruitment, and reduces ovum apoptosis, thus increasing the chance for double ovulation.  In humans, conceptions that occur while the mother is breast-feeding result in twin gestation rates (both monozygotic and dizygotic) nine times higher than in the general gravid population. Also, women who have ever lactated have a higher mean plasma IGF level than those who never lactated.

Human grand-multiparas (parity>4) more often breast-feed than women with fewer pregnancies. Also, elderly (age>40) grand-multiparas retain their fertility longer and conceive twins more often than do women of low parity. Thus, the current potential for twinning may be a function of lactation in prior pregnancies. By its cumulative effect, prolonged lactation might extend the period of enhanced availability of IGF.

Development of a Comprehensive Psycho Social Care and Support Model for Children and Adolescents Living with HIV/AIDS in India

                                             http://austinpublishinggroup.com/nursing/

Globally, it was estimated that in the year 2008 there were 33.4 million people living with HIV, out of which children below 15 years constituted 2.1 million. It was estimated that India has an overall prevalence of 0.31%. Approximately 50,000 children below 15 years are infected by HIV every year. The increased access to antiretroviral treatment resulted in increased survival rates among the children infected with HIV/AIDS and also led to the improved quality of life of sero-positive children. This continues to have an increased impact on the mental health of children and adolescents living with HIV. Children with any chronic illness, in general, are found to be at greater risk of psychiatric problems, including depression, anxiety, and feelings of isolation. A major factor that distinguishes HIV/AIDS from other chronic or terminal illness is the stigma. Too often many HIV infected children and their families live in shame associated with AIDS. 

Illness is often kept as a secret. Parents delay disclosing child’s as well as their own HIV/AIDS illness status due to stigma and possible psychological consequences. Internalizing problems such as anxiety, withdrawn behaviour, depression and somatic complaints are more in younger children with HIV and externalizing problems such as rule breaking, aggressive behaviour, and conduct disorders are common among older adolescent living with HIV. Further, children with HIV/AIDS have additional factors in the complexity of their illness and treatment as well as in the adverse psychological circumstances and poverty in which many live. These children who know about their HIV status live in fear of their disease, and fear of loss of parents with HIV/AIDS. Moreover, given the nature of HIV transmission, if both parents infected with HIV, then many children become ‘double orphans’. Children not only have to endure the pain and loss of losing parents, and also have to face stigma and survive without the emotional support of their parents. Following the death of the parents most of these infected children end up in living in orphan homes for long term care and protection. This has immediate as well as longer term emotional consequences. As a result the mental health, needs and concerns of the children and adolescents with HIV infection need to be an essential part of their care even with advancements in HAART. 

When it comes to the disclosure of HIV/AIDS infection status to the children, there is no clear consensus among the practitioners and parents on when to disclose the HIV positive status to the child. Most of the disclosure guidelines address on illness aspect and treatment adherence and not on addressing the mental health impact of disclosure of HIV status to the child. Once the HIV diagnosis has been disclosed to the infected child, there is a need to monitor in every follow-up visit, the child’s level of functioning, behavioural changes, emotional and psychological adjustment by the health care provider. Moreover, health care providers who work directly with HIV infected children are not being trained with adequate skills to handle the psychosocial and mental health issues of children infected with HIV/AIDS. This adds to the woes of the children in vulnerable situations and affects their not address the psychological and mental health issues of children either infected or affected with HIV/AIDS. The existing services in the ART centers in India are more generic than specific needs of infected children and adolescents.

Food Patterns, Diabetes and Overweight/Obesity and Some Socio-Economic Indicatorsin the Italy Regions

                                                http://austinpublishinggroup.com/nutrition-food-sciences/

Thepurpose of this study is to identify the differences in mortality due to type 2 diabetes (T2D), the increase of overweight and obesity in the different regions of Italy and their relation with change in dietary patterns within the framework of some economic indicators. In Italy in 2015, the total adult population (1000s) (20-79 years) were 44,704; the prevalence of diabetes in adults (20-79 years) was 7.9%. The number of deaths in adults due to this disease was 22,226. Cost per person with diabetes (USD) was 3,450.1. The number of undiagnosed cases of this disease in adults was (1000s) 1,324.3.

According to the International Diabetes Federation (IDF) the overall prevalence of T2D in 2015 was 8.8%, of which approximately 75% were people living in low and middle-income countries. The fastest increase of cases occurred in regions where the economy moved from low to middle-income. In low and middle-income regions, the number of people with diabetes will increase 150% over the next 25 years. Moreover, 318 million people live with impaired glucose worldwide. The IDF calculated that in the same year about 46.5% (193 million) patients were undiagnosed worldwide and one in seven births was affected by gestational diabetes. The disease caused 5 million deaths and resulting in 673 billion dollars being spent on care.

In 2015, 415 million people had diabetes worldwide. More than 59.8 million of those were in the EUR Region and over 3.5 million cases (adults 20-79 years) were in Italy. In this regard, structural social determinants should be considered, covering a wide and complex combination of socio-economic conditions and interacting cultural and other environmental elements. The conditions in which the population is born, grows, lives, works, and ages, as well as the type of systems used to combat the disease are those that determine inequality and social inequity. Political and economic forces in each region in turn influence these conditions. Analysis of health problems using social determinants is a framework of reference for research in various areas of public health and epidemiology. The field of knowledge and purpose of the DSS is to analyze inequities in the distribution of social goods and how avoidable inequalities are manifested in the state of health of social groups. Economic development has led to greater availability and diversity of the food in almost all countries and a gradual decree in food shortages, resulting in nutritional condition. There have also been improved living standards and increased access to services. However, these improvements differ between countries with low, medium and high income and between population groups within each country.

Monogenic, Polygenic and Multifactorial Obesity in Children: Genetic and Environmental Factors

                                          http://austinpublishinggroup.com/nutrition-metabolism/

Obesity is achronic disease that has increased alarmingly in recent years. It is considered a risk factor for the development of diseases such as type 2 diabetes, cardiovascular diseases, dyslipidemia, and some types of cancer. Two genetic profiles have been described: monogenic obesity, in which a single gene is mutated, usually leading to loss-of-function or haploinsufficiency, and polygenic obesity, which involves several polymorphic genes with complex interactions between genes and environmental factors. In the latter case, the frequency of polymorphisms can be very high, depending on the population analyzed. In both cases, the genes of interest are associated with changes in body composition through different mechanisms, including hyperphagia, energy expenditure, adipocyte differentiation and lipolysis. However, most studies have analyzed genes associated with obesity in other populations, and the results are often inconsistent, so it is important to study the context of obesity, such as genetics, biochemical biomarkers and environmental factors. Environmental factors include physical activity, nutritional status, and an intake of foods rich in fats and carbohydrates that favor obesity in children. In addition, several chemical compounds have been described as potential endocrine disruptors that increase BMI and produce obesity, and some biological agents can alter the homeostasis of adipose tissue. In this review, we analyzed the genetic and environmental factors that influence obesity, particularly in children.

OECD: Organization for Economic Cooperation and Development; BMI: Body Measured Index; LEP: Leptin; LEPR: Leptin Receptor; POMC: Proopiomelanocortin; PCSK1: Prohormone convertase 1/3; MC4R: Melanocortin 4 Receptor; SIM1: Single Minded Homologue 1; GWAS: Genome Wide Association Studies; PPARG: Peroxixome Proliferator-Activated Receptor γ; ADIPOQ: Adiponectin; FTO: Fat-Mass and Obesity Associated Gene; SNP: Single Nucleotide Polymorphism; CED: Chemical Endocrine Disrupters; DDE: Diphenyl-dichloro-Ethylene (DDE); BPA: Bisphenol A.

Obesity is a chronic disease of diverse etiology. In the genetic context, monogenic obesity is associated with loss-of-function mutations in a single gene. These mutations are very rare and are in some cases unique to a patient or several members of a family; in some populations with high rates of consanguinity, the mutations are more frequent. In polygenic obesity, there is an interaction between several polymorphic genes; in this case, the frequency is greater than 1% and varies by the population analyzed. In this type of obesity, the risk that is attributed to each allele is generally small, but the additive effect of several risk alleles can considerably increase susceptibility to obesity.

An Impact of Pelvic Magnetic Resonance Imaging to Radiotherapy Volume Definition in Patients with Intermediate- and High-Risk Prostate Cancer: A Population Based Study

                   http://austinpublishinggroup.com/nuclear-medicine-radiotherapy/currentissue.php

Pelvic MRI (PMRI) is an important pre-radiotherapy (RT) evaluation procedure in patients with intermediate- and high-risk prostate cancer. We conducted a retrospective study to evaluate an influence of PMRI to delineation of RT clinical target volume (CTV).

Medical records of prostate cancer patients treated with intensity-modulated RT (IMRT) in single institution in 2009-2015 were retrieved and examined retrospectively. Initial risk group affiliation was defined using NCCN criteria. PMRI reports of patients with intermediate and high-risk prostate cancer were reviewed and risk group affiliation was re-defined in regards of T- and N-stage. CTVs for IMRT treatment plans were contoured. Accounting to information obtained from PMRI. Extra-capsular extension (ECE) and seminal vesicles invasion (SVI) were included to high-dose CTV. Regional pelvic lymph nodes (RPLN) were planned to treat in all high-risk pts. RPLN considered pathological by PMRI were included to separate CTV to receive RT dose higher than unaffected RPLN stations.

Between 2009 and 2013, 169 patients with intermediate and high-risk prostate cancer underwent PMRI at around 1 month before commencing IMRT. Initially, 89 patients were affiliated to intermediate-risk and 80 to high-risk group. In general, PTV-changes based on PMRI data required in 66 patients (39%). Thirty seven of 89 intermediate-risk patients (42%) were switched to high-risk group, necessitating irradiation of RPLN. ECE and SVI were included to high-dose CTV in 64 (38%) and 29 patients (17%) respectively. RPLN were thought pathological in 10 patients (6%), which justified contouring of a separate CTV for dose escalation.

In our retrospective series, PMRI-scans had a significant impact on RT target coverage decision in patients with intermediate and high-risk prostate cancer. However, a true value of this impact should be defined a large scale prospective clinical trial.

Whistleblower Issue and Its Relevance in Autism Research

              http://austinpublishinggroup.com/neuropsychiatry-cognitive-science/currentissue.php

On August 27, 2014, CDC scientist Dr. William Thompson admitted that he and other authors had omitted vital data from a 2004 study of possible connections between MMR vaccines and autism. Dr. Thompson also acknowledged a biologically plausible relationship between Thimerosal (a mercury-based preservative) in vaccines and autistic-like symptoms. He additionally reported that the CDC has withheld information about a relationship between Thimerosal and tic disorders. Whether or not a person thinks that the admissions made by this CDC scientist reflect the truth, admitting fraud in the CDC's neurodevelopmental disorders research is certainly newsworthy. Why then has the mainstream media been mostly silent on the issue? The coverage of this story has been mostly limited to the blogosphere. Some of the mainstream media's top stories have instead included: "Artists draws his dog in whimsical scenes" (ABC News, 9/17/14); "Is the tide changing for the NFL" (MSNBC, 9/17/2014); and "Vikings: Peterson must stay away", and "Final hours before Scotland's big vote" (CNN, 9/17/14).

Admittedly, this CDC whistleblower story is controversial. This is due, in part, to enormous and far-reaching liability ramifications, to the disturbing number of potentially affected children, and because those that could be held accountable hold powerful and authoritative governmental positions. We can only speculate if the mainstream media is simply not interested in this topic, or if their silence reflects a form of disagreement, or if possibly their lack of coverage is due to external pressure to extinguish the story. The limited mainstream media coverage of such a weighty scientific matter reveals the importance of scientists themselves having a public voice on critical public policy issues. Throughout history scientists speaking loudly about dangerous toxins have saved many lives and prevented untold pain and deformities. Clear examples are Pink disease (caused by mercury in teething powders), lead poisoning diseases (from lead-based paints and other products), and thalidomide causing birth defects. And also, of course, the discovery that mercury causes neurological damage. The mainstream media's silence here emphasizes the value of peer-reviewed science journals as an avenue for scientists to be a part of necessary public dialogues.

This story also raises the issue of the importance of transparency in research and the availability of public databases to independent researchers. The current datasets used by the CDC in their own research on vaccines and autism are not easily accessible to independent researchers. For example, one of the databases used by the CDC that reportedly showed no relationship between thimerosal and autism  is no longer available to anyone outside of the CDC to examine. Neuropsychiatric disorder research data transparency is especially important considering today's staggering numbers of neurodevelopmental disorders, which in the United States has increased to about 1 in every 6 children. This has predominately been an increase in autism and attention deficit/ hyperactivity disorders, but there has also been an increase in tic disorders. World-wide neuro developmental disorders today are causing heavy consequences on the affected individuals and their families. How this unfolds remains to be seen. However, assuming continued mainstream media silence, it is likely that this whistleblower story along with its potential implications will remain missing from the forefront of public discussion.

Transcriptome Analysis of Rotenone Induced Neurotoxicity in Enriched Rat Primary Ventral Mesencephalic Neurons

                                       http://austinpublishinggroup.com/neurology-neurosciences/

Rotenone induced neurotoxicity is being widely investigated in relation to Parkinson’s Disease (PD). However the crucial molecular mechanisms involved in rotenone induced PD still remains elusive. This report details the transcriptome changes on rotenone treatment in enriched rat primary ventral mesencephalic neurons through microarray analysis. Transcriptome analysis had yielded 705 up-regulated genes and 2415 down-regulated genes. This data was further validated by quantitative real time PCR analysis. To further refine this data, association rule mining was used and a gene interaction network among 53 genes was developed. Functional characterization of the top 25 scored genes in the network was done using panther database. Interestingly TNF was the highest scored gene among them and found to be significantly down regulated on rotenone treatment. Along with TNF other inflammation related genes like Il1b, Itpr3 and TNFR2 were also significantly down-regulated on rotenone treatment. These observations suggest that down regulation of neuronal TNF might be a critical cause leading to cellular death via TNFR2, Il1b mediated Pi3Kinase pathway in rotenone induced neurotoxicity. Further investigation in this neuronal TNF related pathways may give novel therapeutic approaches in treatment of PD.

In-Vitro/In-Vivo treatments with rotenone are known to induce certain features of Parkinson Disease (PD). Dopaminergic neurodegeneration in substantianigra pars compacta of Ventral Mesencephalic (VM) brain region is the hall mark feature of PD. Rotenone, besides affecting mitochondrial function was also reported to be affecting a variety of cellular processes like cytoskeleton stability, inflammation, oxidative stress and apoptosis. All these observations were made using directed approaches studying few of the genes involved in those specific pathways. Microarray analysis of whole transcriptome is an alternative approach for identifying key genes and pathways that might not be feasible through single-gene studies. Enriched rat primary VM neurons were well characterized and studied in co-relation with rotenone induced neurotoxicity. In the present study primary VM neurons were analyzed for changes in their genome expression upon rotenone treatment using microarray analysis along with Association Rule Mining (ARM) for discovering the relationship among genes in a large dataset.

Spinal Cord Injury Intensity Modifies the Expression of Inflammation-Related Gene Expression after Immunization with Neural Derived Peptides

Previous studies revealed that the intensity of Spinal Cord Injury (SCI) plays a key role in the therapeutic effects induced by Immunizing With Neural-Derived Peptides (INDP), as severe injuries abolish the beneficial effects induced by INDP. In the present study, we analyzed the expression of some inflammation-related genes (IL6, IL12, IL-1β, IFNɣ, TNFα, IL-10, IL-4, and IGF-1) by quantitative PCR in rats subjected to SCI and INDP. We investigated the expression of these genes after a moderate or severe contusion. In addition, we evaluated the effect of INDP by utilizing2 different peptides: A91 and Cop-1. After moderate injury, both A91 andCop-1 eliciteda pattern of genes characterized by a significant reduction of IL6, IL1β,andTNFα but an increase in IL10, IL4, and IGF-1expression. There was no effect on IL-12 and INFɣ. In contrast, the opposite pattern was observed when rats were subjected to a severe spinal cord contusion. Immunization with either peptide caused a significant increase in the expression of IL-12, IL-1β, IFNɣ, (pro-inflammatory genes), and IGF-1. There was no effect on IL-4 and IL-10 compared to controls. After a moderate SCI, IND Preduced pro-inflammatory gene expression, and generated a microenvironment prone to neuroprotection. Nevertheless, severe injury elicits the expression of pro-inflammatory genes that could be aggravated by INDP. These findings correlate with our previous results demonstrating that severe injury inhibits the beneficial effects of protective autoimmunity.

Approach to Imaging in Mild Traumatic Brain Injury and Diffuse Axonal Injury

                    http://austinpublishinggroup.com/neurosurgery/onlinefirst.php

Traumatic brain injury is a commonly encountered condition in the emergency department. Mild traumatic brain injury and its squeal of diffuse axonal injury are difficult to diagnose with computed tomography scans as the preferred acute imaging modality. Our current decision on whether or not to scan a patient in the acute setting is best decided upon by the Canadian CT Head Rule. The role for MRI scans in diagnosing diffuse axonal injury is unclear, but current evidence suggests that they are preferred after the initial 48 hour period following head trauma.

While the definition has varied depending on circumstances, Traumatic Brain Injury (TBI) is defined as the result of the application of either external physical force or rapid acceleration/deceleration forces that disrupts brain function as manifested by immediately apparent impairments in cognitive or physical function. This is further classified as mild, moderate, and severe, depending on the patient’s Glasgow Coma Scale Score (GCS). The majority of these cases present to hospital as minor TBI, and previous studies suggest that 40% of these cases are secondary to motor-vehicle-related events.

In terms of neuroimaging following head injury, the decision on whether or not to scan tends to be guided by hospital-specific protocol, or is physician dependent. The general consensus, however, is that patients with new clinical symptoms or a change in GCS following head injury, should undergo a Computed Tomography (CT) scan of the brain. The specific clinical predictors for this are still very much debateable. The Canadian CT Head Rule study, as demonstrated in (Table 1), has developed a highly sensitive clinical decision rule for the use of CT in patients with minor head injuries. These patients are classified into whether or not imaging is required based off five high-risk factors for neurosurgical intervention, and two medium-risk factors for clinically important lesions. The implementation of this guideline in other centres was associated with a modest reduction in CT use and an increased diagnostic yield of head CTs for trauma to the head.

What we do and do not know about Women and Kidney Diseases; Questions Unanswered and Answers Unquestioned: Reflection on World Kidney Day and International Woman’s Day

http://austinpublishinggroup.com/nephrology/onlinefirst.php

Chronic KidneyDisease affects approximately 10% of the world’s adult population: it is within the top 20 causes of death worldwide, and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community, and the next generations, as well as to strive to be more curious about the unique aspects of kidney disease in women so that we may apply those learnings more broadly.

Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Gender differences continue to exist around the world in access to education, medical care, and participation in clinical studies. Pregnancy is a unique state for women, offering an opportunity for diagnosis of kidney disease, but also a state where acute and chronic kidney diseases may manifest, and which may impact future generations with respect to kidney health. There are various autoimmune and other conditions that are more likely to impact women with profound consequences for child bearing, and on the fetus. Women have different complications on dialysis than men, and are more likely to be donors than recipients of kidney transplants.In this editorial, we focus on what we do and do not know about women, kidney health, and kidney disease, and what we might learn in the future to improve outcomes worldwide.

Chronic Kidney Disease (CKD) affects approximately 10% of the world’s adult population: it is within the top 20 causes of death worldwide and its impact on patients and their families can be devastating. World Kidney Day and International Women’s Day in 2018 coincide, thus offering an opportunity to reflect on the importance of women’s health and specifically their kidney health, on the community, and the next generations; as well as to strive to be more curious about the unique aspects of kidney disease in women, so that we may apply those learnings more broadly.

Girls and women, who make up approximately 50% of the world’s population, are important contributors to society and their families. Besides childbearing, women are essential in childrearing and contribute to sustaining family and community health. Women in the 21^st century continue to strive for equity in business, commerce, and professional endeavours, while recognizing that in many situations, equity does not exist. In various locations around the world, access to education and medical care is not equitable amongst men and women; women remain under-represented in many clinical research studies, thus limiting the evidence base on which to make recommendations to ensure best outcomes (Figure 1). In this editorial, we focus on what we do and do not know about women’s kidney health and kidney disease, and what we might learn in the future to improve outcomes for all.

Nanotechnology- A Promising Approach for Suicide Gene Therapy

                       http://austinpublishinggroup.com/nanomedicine-nanotechnology/

Canceris one of the world’s most dreadful diseases and the battle against cancer continues till date. Suicide gene therapy for cancer is one of the best approaches for annihilation of cancer. In brief, suicide gene codes for an enzyme which converts a nontoxic prodrug into toxic metabolites and subsequently mediates death of host cells itself on account of which it is named “suicide” gene therapy. These suicide gene when constitutively expressed by the cells not only mediates death of host cells but also inflicts strong bystander effects on neighboring cells by predisposing them to toxic downstream metabolites. Due to such advantages, they manifest minimal systemic toxicity and are also effective against many drug resistance cancer cells. Among all existing suicide genes, Cytosine Deaminase (CD) and Herpes Simplex Virus-thymidine kinase (HSVtk) have shown promising results initially and has been investigated extensively since long. The HSVtk enzyme initially phosphorylates the prodrug Ganciclovir (GCV) to its monophosphate form, which is subsequently phosphorylated again by endogenous cellular kinase to generate nucleotide analogs (di- and triphosphate forms of GVC). Triphosphate form of GCV is then readily incorporated into DNA during the course of DNA synthesis and acts as a chain terminator to prevent further DNA synthesis, which ultimately induces cell death.

The therapeutic efficacy of HSVtk suicide gene therapy is often limited by cell-to-cell contact which is a prerequisite for transport of downstream metabolic byproducts of ganciclovir to neighboring cells so as to attain bystander-killing effect. As an outcome of such drawbacks, HSVtk suicide gene does not seem to be effective against different cell types. In contrary to this, Cytosine Deaminase (CD) efficiently converts prodrug 5-Fluorocytosine (5- FC) into therapeutically active anticancer agent 5-Fluorouracil (5- FU), which subsequently permeates across the cell membrane to mediate bystander killing effects on adjacent neighboring cells. Thus, 5-FC/CD system attains suicide gene therapy much more efficiently as compared to other counterparts. Although 5-FC/CD system attains better therapeutic outcomes, it is ineffective against 5-FC resistant cancer cells and thus its anticancer potential could not be generalized for all cancer types. In order to overcome such drawback, Gopinath et al. have designed Cytosine Deaminase-Uracil Phosphoribosyltransferase (CD-UPRT) bifunctional suicide gene construct in which Uracil Phosphoribosyltransferase (UPRT) acts upon product of CD i.e. 5-FU and converts it further into other toxic metabolites.

The therapeutic effect of suicide genes can be enhanced by combinatorial approaches. In combination therapy, two or more drugs with similar or different mode of action are employed to realize synergistic anticancer therapeutic potentials. Such synergistic anticancer potential of combination of radiation therapy and 5-FC/ CD plus UPRT gene therapy was demonstrated by Kambara et al. against malignant gliomas. Apart from this, the combination therapy also provides scope for exploiting radio sensitizing properties of 5-FU and by stander effects during the course of treatment. Many research groups have reported the use of suicide gene in combination with chemotherapy and radiation to enhance the therapeutic effect and to overcome the drug resistance. Gopinath et al. were the first to report the applications of silver nanoparticles for synergizing the therapeutic effect of suicide gene. They have also reported the synergistic therapeutic effect of suicide gene with anticancer drug curcumin. One of the major challenging tasks in suicide gene therapy is lack of suitable vectors for targeted delivery of suicide gene to cancer cells. The application of such DNAbased therapeutics is largely limited due to poor cellular uptake, degradation by serum nucleases and rapid renal clearance following systemic administration. In addition to these, organ specific targeted DNA therapy has been a major challenge to overcome off-target gene therapy. In order to circumvent these limitations, numerous organ specific targeted nanocarriers have been developed recently for systemic administration.

Obesity and Kidney Disease: Hidden Consequences of the Epidemic

                      http://austinpublishinggroup.com/medical-sciences/currentissue.php

Obesity has become aworldwide epidemic, and its prevalence has been projected to grow by 40% in the next decade. This increasing prevalence has implications for the risk of diabetes, cardiovascular disease and also for Chronic Kidney Disease. A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. In individuals affected by obesity, a compensatory hyper filtration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidneys and raise the risk of developing Chronic Kidney Disease in the long-term. The incidence of obesity-related glomerulopathy has increased ten-fold in recent years. Obesity has also been shown to be a risk factor for nephrolithiasis, and for a number of malignancies including kidney cancer. This year the World Kidney Day promotes education on the harmful consequences of obesity and its association with kidney disease, advocating healthy lifestyle and health policy measures that make preventive behaviors an affordable option.

In 2014, over 600 million adults worldwide, 18 years and older, were obese. Obesity is a potent risk factor for the development of kidney disease. It increases the risk of developing major risk factors for Chronic Kidney Disease (CKD), like diabetes and hypertension, and it has a direct impact on the development of CKD and its progression to End-Stage Renal Disease (ESRD). In individuals affected by obesity, a (likely) compensatory mechanism of hyper filtration occurs to meet the heightened metabolic demands of the increased body weight. The increase in intraglomerular pressure can damage the kidney structure and raise the risk of developing CKD in the long-term.

The good news is that obesity, as well as the related CKD, are largely preventable. Education and awareness of the risks of obesity and a healthy lifestyle, including proper nutrition and exercise, can dramatically help in preventing obesity and kidney disease. This article reviews the association of obesity with kidney disease on the occasion of the 2017 World Kidney Day.