Investigation of Optimal Strategy of Internal Target Volume Generation for Liver Stereotactic Body Radiotherapy (SBRT)

                          http://austinpublishinggroup.com/radiation-oncology-cancer/ 

The success of liver Stereotactic Body Radiation Therapy (SBRT) programmed depends on high precision delivery of hypo fractionated radiation and accurate sparing of adjacent Organs at Risk (OARs). While proximity to OARs is well addressed with the use of highly conformal treatment planning techniques  the intra-fraction target displacement poses challenge in accurate delivery of planned hypo fractionated treatment to the target. While the average liver motion varies from 3-50mm the Centre Of Mass (COM) of the tumor (or target) moves about 9.7mm±5mm. Often anisotropic margin of 1-2cm is added to the Gross Tumor Volume (GTV) to account for the target motion without actual knowledge of patient specific motion which may not be representative of anisotropic tumor trajectory.

This may lead to under dosing of target volume or overdosing the OARs. Different strategies have been adopted to estimate the target motion like ultrasonography/x-ray cine fluoroscopy. In recent years, four dimensional CT (4DCT) has been widely used to generate Internal Target Volume (ITV) for hepatic and pulmonary tumors. ITV generation using 4DCT involves contouring of target volume in each of the respiratory phases, which may possibly be an accurate method of ITV generation. Various commercial systems are presently available to bin the respiration correlated CT into number of respiratory phases. 

Binning the 4DCT data set into 10 respiratory phases is considered optimum. However, target delineation in all the phases is time consuming and labor intensive. Ability to accurately characterize respiratory phase movement in limited phase datasets or maximum/minimum intensity projection images (MIP/MinIP) may provide a time efficient method of encompassing internal target motion Unlike lung tumors, limited information on accuracy of MIP/MinIP is available for liver tumors. Furthermore contouring on MIP/MinIP may not be applicable to all intrahepatic tumors due to variability in enhancement patterns and occasionally presence of I¹³¹ Lipidiol and other artifacts after Trans Arterial Chemo Embolization (TACE) Or Radiofrequency Ablation (RFA).

Cerebral Metastasis Revealing a Choriocarcinoma: Case Report

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

Choriocarcinomas- revealed by brain metastasis are quite rare; we report the case of a patient with a history of abortion; she is admitted for a disorder of consciousness. CT scan and magnetic resonance imaging of the brain denoted several haemorragic lesions that looked suspicious, biological tests revealed an elevated blood level of beta human chorionic gonadotropin (β-hCG), and pelvic ultrasound showed the presence of a choriocarcinome. The evolution was not favorable and led to the death of the patient after the 2nd cure of chemotherapy. Choriocarcinoma is a malignant and very aggressive form of gestational trophoblastic diseases characterized by a highly metastatic potential; brain metastasis is associated with poor prognosis. In this case report, we show the importance of early diagnosis of choriocarcinoma to limit dramatic complications.

A 19-year-old woman, married, on oral contraception, having a history of an abortion 6 months ago, admitted for a sudden consciousness disorder. The patient had had progressive worsening headaches over 2 weeks, resistant to analgesic treatment. The clinical examination denoted a GCS of 9, a temperature at 37°C, a heart rate at 105 beats / minute, a respiratory rate at 25 cycles/minute, a blood pressure at 170/100 and an oxygen saturation at 90% in ambient air.A cerebral computed tomography (CT) showed the presence of multiple hemorrhagic localizations in both sides of the frontal and parietal lobes; and the right occipital lobe; all of them are surrounded by significant peri-lesional edema.

Cerebral Magnetic Resonance Imaging (MRI) showed that these hemorrhagic localizations corresponded to heterogeneous hyper signal in T1, T2, FLAIR and diffusion (Figure 1), (Figure 2a,c,d); surrounded by a hypo-signal corona on T2 sequences with peripheral enhancement after gadolinium injection (Figure 2b). The results of the MRI suspected secondary brain lesions that led us to perform a pelvic ultrasound and a thoraco-abdomino-pelvic CT scan which showed a globular uterus with the presence of a partitioned mass.

Austin Plastic Surgery: Open Access

                                               http://austinpublishinggroup.com/plastic-surgery/

Austin Plastic Surgery: Open Access is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Plastic Surgery.

The journal aims to promote latest information and provide a forum for doctors, researchers, physicians, surgeons and healthcare professionals to find most recent advances in the areas of plastic surgery. Austin Plastic Surgery: Open Access accepts research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of plastic surgery.

Austin Plastic Surgery: Open Access strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.

Austin Journal of Pregnancy & Child Birth

                                             http://austinpublishinggroup.com/pregnancy-child-birth

Austin Journal of Pregnancy & Child Birth is an open access, peer reviewed, scholarly journal dedicated to publish articles covering all areas of Pregnancy & Child Birth.

The journal aims to promote research communications and provide a forum for doctors, researchers, physicians and healthcare professionals to find most recent advances in all the areas of Pregnancy & Child Birth. Austin Journal of Pregnancy & Child Birth accepts original research articles, reviews, mini reviews, case reports and rapid communication covering all aspects of Pregnancy & Child Birth.

Austin Journal of Pregnancy & Child Birth strongly supports the scientific up gradation and fortification in related scientific research community by enhancing access to peer reviewed scientific literary works. Austin Publishing Group also brings universally peer reviewed journals under one roof thereby promoting knowledge sharing, mutual promotion of multidisciplinary science.

Humanity and Science in Pain Managements

                                           http://austinpublishinggroup.com/austin-pain-relief/

Pain is known to be the first medical consultation pattern and a global health concern. Therapeutic medicine was for a long time interested in treatment of disease more than relieving patients. Although medically correct, this approach remains insufficiently human. Unfortunately, such conducts still practiced actually. For example, in emergency, when a patient with acute appendicitis arrives, he’s accusing an abdominal pain. So, pending diagnosis using all necessary examinations, the patient still suffering, because the medical team is concentrated on diagnosis establishment more than relieving pain. Such approaches were based for a long time on the convenience that if pain is relieved, the diagnosis became more difficult. It’s actually known that this idea is absolutely false. This is the proof that, despite of all efforts, pain management still insufficient. Whatever the type of pain or its origin, suffer pain is causing significant health and social problems with evidence that patients are receiving inadequate care. Several reflections are raised.

Progress in understanding mechanisms involved in the onset of pain improved the management. In fact, distinguishing acute pain and chronic pain is fundamental basis. Defining pain is the first step to manage it. If acute pain (like acute inflammation, postoperative pain, or trauma) therapies are overall excellent, they still not satisfying in chronic pain such as neuropathic pain, complex regional pain syndrome or fibromyalgia. The first reason is that acute pain mechanisms are clearer than chronicles. The second reason, also related to the first, is pharmacotherapies availability. The necessity of improve basic understanding of the mechanisms underlying pain is likely to suggest new avenues for the development of novel pharmacotherapies. Epigenetic abnormality in the spinal cord during neuropathic pain is confirmed since few years. Epigenetic modifications in the spinal cord are caused by long-term increases in chemokine expression. Nerve injury activates primary afferent nociceptors, which transmit information to the dorsal horn of the spinal cord. Activation of secondary neurons in spinal pathways by long-term chemokine expression is capable of inducing epigenetic modifications. The final result is central sensitization leading to a neuropathic pain-like state. The complexity of pain mechanisms explains the multitude of analgesics and numerous used protocols.

The High Cost of Perfection: Medical Student Suicides

                                     http://austinpublishinggroup.com/psychiatry-mental-disorders/

Debt + Deadlines +Depression: A formula for suicide, during medical school?

When you’re a student, especially a medical student, the need for achievement is high and the sources of stress are many: regular exams, National Boards, mounting debt, the need for perfectionism, the fear of failure, isolation, guilt, fatigue, and uncertainty are just a few. For one thing medical school encompasses regular, seemingly endless exams. Some exams are computer or paper-based, riddled with multiple choice questions requiring students to choose the single best answer from a sea of possible selections while others are performance-based, requiring students to demonstrate the clinical skills they’ve learned on real, live simulated patients.

And if that’s not enough, the fear that even bigger exams are ahead is instilled during medical school. Early in Year I, students are made acutely aware of that they’ll soon be facing the National Board Exams; and not just one, but three, innocently referred to as steps 1, 2, and 3. Students are not only under pressure associated with exam-taking, but they must also study for these exams and earn passing scores. These often occur under low fuel, sleep-deprived, and sometimes even panic-stricken conditions. While passing produces relief, near-misses or failed exams incite their own form of stress.

Uncertainty abounds. This begins in the early weeks of medical school, when transitioning from the competitive arena faced as a pre-med student to the pass or fail expanse of medical school. Another source of uncertainty is associated with the inexactitudes of medical knowledge a problem magnified if there is any ambiguity in the learning objectives or course content. All of these have offshoots that impact medical school performance, leaving students who are high achievers with the feeling that it’s never enough, a feeling which paves the way for a fear of failure. High achievers strive for perfection, especially in medical school. Perfectionism has been linked to a fear of failure. When the fear of failure is combined with the need to maintain a strong outward demeanor, ever-increasing debt, the isolation that comes with always having to study and the guilt of spending time away from family and friends, the vulnerability to suicide/suicidal ideation heightens.

Poetry and Mental Health

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

Poetry like otherforms of literature or art can enrich our lives. It can be used to find new meaning in our daily lives. The Australian poet Les Murray described poetry as “a zoo in which you keep your demons and angels” and Mich Imlan, the poetry editor of the Times Literary Supplement, said it is “ a way of talking about things that frighten you. Poetry is not an antidepressant or antipsychotic or anxiolytic medication or cognitive behavioural therapy, but it can play a role in the therapeutic journey of a patient.

My interest in poetry is only recent. I learnt through poetry one can re-imagine the things we usually experience on daily basis. I found poetry to be an excellent medium to express our feelings and can feel cathartic. With poetry, one starts to see and interpret things differently. Through poetry, our use of five senses heightens when we read words that have an emotive content. Eventually, I started writing poems which I have continued to do since.

I found writing poetry a solacing, stimulating and creative exercise. It gave me a medium to express my views and emotions in a way that is nonjudgmental. I have been able to express my views, beliefs and emotions that would not have been possible through ordinary conversations. It has helped me to make sense of my thoughts, feelings, emotions, values and gave a new meaning to my life. Through poetry, one can express both personal and universal truths. Writing poems has slowly given me a sense of accomplishment as well, as I have been able to share my poetry with others. I was eventually able to publish the first collection of my poems. “Gushing Fountain: A Collection of Poems”. Most importantly I was able to write about things that would have been otherwise impossible. Australian poet Peter Porter suggests. “Writing a poem is crucially about making something”. Word poetry is derived from the Greek verb Poiesis, which means to make. That very approach gives a sense of accomplishment after writing a poem.

Importance of Oral Care Before, During and After Chemotherapy

                                     http://austinpublishinggroup.com/pediatric-oncology/

Within the mostcurrent concepts of health, it is of fundamental importance to consider the patient in a holistic manner. A multidisciplinary team should form the oncology group, especially in the hospital setting. The role of a dentist on this team is to diagnose, prevent and minimize the immediate effects of chemotherapy and/or radiotherapy as well as identify the effects of treatment to improve the quality of life of patients.

The objective of the protocol is to establish a standard for the care of patients with cancer. Emphasize the importance of oral health, in support for outcomes associated with oral care health, the knowledge of oral health for effectiveness in continuing the therapeutic treatment of cancer and awareness of effects acute and late in the mouth from cancer therapy: prevention of local and systemic infections, control pain, maintain oral functions, reduce side effects and improve the quality of life of patients.

Hematopoietic Stem Cell Transplantation (HSCT) is a procedure that requires conditioning to high doses of chemotherapy and/or radiotherapy. Dental treatment prior of HSCT is important. The oral mucosa and teeth should be examined using panoramic radiography to document oral status prior to HSCT. Moreover, such patients need to develop a specific oral hygiene regimen, the instructions for which should be clear and concise. Motivation and understanding with regard to oral care can have a considerable impact during HSCT. Bacterial plaque should also be evaluated, as this is a key factor to the development of gingival and periodontal disease and can contribute to acute infection as well as systemic disorders.

The dental evaluation should be initiated with a panoramic radiograph to gain a broad view of dental treatment and remove any sources of active or potential infection in the oral cavity. Acute and chronic oral infections, such as dental caries and periodontal disease, as well as teeth with questionable prognoses justify an aggressive approach, as any odontogenic infection in an immune suppressed patient can progress to a systemic infection with a possible risk of death. The goal of dental care is to establish a standardized oral evaluation.

Palliative Care - An Ideal Environment for Interprofessional Education and Practice

                                             http://austinpublishinggroup.com/palliative-care/

Palliative care involves an interprofessional collaborative approach in working with patients and their families and caregivers by providing patient-centered and individualized pain relief compassion, caring, and overall minimization of symptom severity. Because palliative care patients most often also have one or more chronic illnesses, the need for the interprofessional practice model is even more important. This type of collaborative care is often referred to as “comfort” care or “end-of-life” care, with the focus being on improving quality of life for both the patient, family, and both family and non-family caregivers. This paper discusses palliative care and the importance of it in the interprofessional education of students in the educational pipeline and of professionals for ongoing effective practice in addition to the interprofessional education of students placed under their supervision during practicums and clinical supervision. There has been a paucity of research specifically in the area focused on the interprofessional proponent in the palliative care setting. A thorough literature review was conducted to analyze the unique components of palliative care that make it an ideal setting for the interprofessional team-building model. Given the increased emphasis on interprofessional education over the past five years with the establishment of the Core Competencies for Interprofessional (IPE) Collaborative Practice, the incorporation of interprofessional education standards into over 60 professional health education organizations, and the need to increase the clinical training and active participation for students in interprofessional settings, palliative care should be utilized more in educational settings as a primary interprofessional education environment for learning about the interprofessional core competences through active involvement of students, practitioners, patients, family members, and caregivers. Although the literature is limited in relationship to Interprofessional education and practice in palliative care, it is clear that palliative care emphasizes a focus on both the patient and family and provides an ideal interprofessional environment including but not limited to physical, social, emotional, and spiritual care. Interprofessional care is integral in palliative care. Additionally, the high risk of burnout among professionals in palliative care further suggests the need for interprofessionalism and integration of IPE core competences in both preservice and continuing education. IPE can build resilience among professionals, family members, and caregivers. While the interprofessional proponent is critical to the outcomes of palliative care, the resilience of team members must be taken into consideration. These findings need to be further developed so that interprofessional care in palliative care settings is used more extensively to prepare students and practicing professionals in interprofessional patient-centered care. The clinical component of interprofessional education is most often lacking in student education. Palliative care environments can help in developing interprofessional leaders for the entire health care delivery system. In addition, there is a need to collect ongoing outcomes data related to the Interprofessional outcomes resulting from effective collaborative care delivery in the palliative care setting. A meta review of the literature was implemented to review the peer-reviewed literature and other professional publications of the past 20 years (1996-2016) to examine the role of palliative care in interprofessional education and practice for professionals and for students in the academic pipeline.

Low-Dose Pamidronate Therapy for Pediatric Osteoporosis: Influence of Diagnosis on Changes in Fracture Rate and Bone Mineral Density

                                http://austinpublishinggroup.com/pediatrics-child-health-care/

Controversy surrounds the optimal agent, dose and duration of bisphosphonate therapy for pediatric osteoporosis. We conducted a prospective, observational study of low-dose (4 mg/kg/year) intravenous pamidronate in 31 children with Osteogenesis Imperfecta (OI) or non-OI osteoporosis treated for a median of 39 months (range 6.5-164). Subjects in both diagnostic groups showed significant gains in spine areal Bone Mineral Density (aBMD) during the first year of therapy (29% median gain in children with OI and 15% in children with non-OI osteoporosis). Fracture frequency also declined significantly in both patient groups during the first year of treatment, including for two patients who had <10% improvement in spine aBMD over this time frame. The correlation between % change in aBMD and % change in fracture rate for our study population was weak, as demonstrated by a Spearman’s rank correlation coefficient (rho) of 0.13 (p-value 0.32, 95% confidence interval -0.32 to 1.00). Minor side effects of bisphosphonate therapy were self-limited, and no osteopetrosis, jaw osteonecrosis, or atypical femur fractures occurred during treatment for up to 13.6 years. These data suggest that low dose pamidronate is safe and effective for long-term use in pediatric osteoporosis, and that change in aBMD is an imperfect predictor of reduction in fracture risk.

Bone fragility and osteoporosis (OP) are common complications of several genetic and acquired disorders of childhood. Pediatric patients with Osteogenesis Imperfecta (OI), inflammatory bowel disease, rheumatologic disorders, cerebral palsy, muscular dystrophy, cystic fibrosis, or a history of transplantation may develop low bone mass and fragility fractures. Treatment of pediatric osteoporosis begins with optimizing nutrition, vitamin D stores, endocrine function, and weight-bearing physical activity. When these measures are insufficient to prevent bone loss and fracture, use of pharmacologic therapies is considered.

Pharmacologic options for treating OP in adults include bisphosphonates to reduce bone resorption and anabolic agents to stimulate bone formation. The safety and efficacy of these medications in older patients have been established in large randomized controlled trials (RCTs), but data are limited in pediatrics. The best studied anabolic agent, synthetic parathyroid hormone, should not be used in children due to a black box warning about the risk of osteosarcoma. The anti-resorptive bisphosphonates have been used to treat primary and secondary osteoporosis in children, but the optimal agent, dose and duration of therapy remain controversial due to a lack of RCTs comparing different drugs and dosing regimens.

Petrous Bone Eosinophilic Granuloma

                                  http://austinpublishinggroup.com/pathology-microbiology/

Eosinophilic granuloma is a lytic lesion, driving from histiocyte proliferation of the bone. The lesions mostly occur in long bones, rib or skull, but the involvement of temporal bones is rare. We report the case of a 4-year-old girl with isolated eosinophilic granuloma of petrous apex, presenting with fever and right abducens paralysis. Eosinophilic granuloma is a lytic lesion, driving from histiocyte proliferation of the bone and is a form of Langerhans Cell Histiocytosis (LCH) that is classified into three spectrums of diseases: Letterer Siwe disease, Hand schuller Christian syndrome and Eosinophilic granuloma. These three patterns of disease have specific clinical manifestation.

Eosinophilic granuloma might be confused with chronic otitis media, external otitis and chronic mastoiditis. It usually occurs before the age of ten years and has been reported in skull, spine, ribs, femur and pelvis.Treatment includes curettage, radiation, radiosurgery and injection of steroid in lesions.In this report we present a 4 year old girl with petrous apex Eosinophilic granuloma. A 4-year-old girl was referred to the infectious ward of Children Medical Center, the referral pediatric center in Tehran, Iran from ENT ward with diagnosis of mastoiditis. She had a history of fever and headache for one month and right eye internal deviation for fifteen days before admission to ENT department. Her CT scan which was done in ENT ward revealed a destructive lesion on the tip of petrous bone due to petrositis (Figures 1 & 2). Brain MRI revealed the increase of signal in air cells of mastoid and right petrous apex in T2 that suggested right mastoiditis and AOM (Figures 3 & 4).

On admission in our department she had fever without headache and vomiting. A complete examination showed that her ears were normal but she had abducens paralysis in right side and other exam was normal. The results of initial laboratory tests were as follows: WBC=8040/mm3, neutrophils=47/8%, lymphocytes=42/2%, hemoglobin=10/6g/dl, Platelet=456000/mm3.

The Sensory Processing Dysfunction and Related Postnatal Environmental Factors in Preschool Aged Children in Qingdao, China

                                      http://austinpublishinggroup.com/austin-public-health/

Previous studies have shown that prenatal chemical or non-chemical exposure may contribute to the Sensory Processing Dysfunction (SPD). To date, few studies have examined the possible influence of postnatal environmental factors on the SPD. We hypothesized that the postnatal environment in early childhood might also influence the SPD. Parents or guardians of pre-school children completed questionnaires about their postnatal living environment. The sensory processing dysfunction profile was used to measure the possible SPD. Results showed girls invulnerable to the SPD in dyspraxia and visual senses with OR (95% CI) 0.42 (0.30, 0.59) and 0.64 (0.48, 0.86), respectively. Strict or let-alone or not special care style seemed averse to the sensory processing compared to generous care style. Lower frequency of floor vacuuming or cleaning indicated higher risk of SPD in vestibular and tactile sensory. Consistently, child with dirty hands usually showed higher risk of SPD in all 6 sensory except proprioceptive senses. Child living in the home having more furniture in bad materials commonly releasing more volatile or semi-volatile organic compounds indicated higher risk of SPD in vestibular or tactile sensory with OR (95% CI) 1.12 (1.00 – 1.24) and 1.16 (1.04 – 1.30), respectively. Poor gestational nutrition, taken drugs during pregnancy, and gestational passive smoking were also entered the multivariate models and showed adverse association. Our results indicate that a social environment of parental guidance and an indoor environment of exposure to chemical are associated with SPD.

The integration of sensory information from the body and the environment is essential for almost every human activity and involves the brain selecting, inhibiting, comparing, and associating sensory information. This information permits the planning and production of organized behavior. The sensory processing patterns could affect the child’s daily experiences, and consequently impact their physical growth, social-emotional development, and academic performance. Therefore, Sensory Processing Disorders (SPD) are regarded as impairments of neurological process of recognizing, modulating, interpreting, and responding to sensory stimulus, and these effects can negatively affect development and functional abilities in behavioral, emotional, motoric, and cognitive domains. The aforementioned problems may affect the child’s performance in school and daily life.

Applications of Ultrastructural Morphometry in Diagnostic Pathology

                                              http://austinpublishinggroup.com/pathology/

Quantitativeultrastructural cytopathology, hematopathology and histopathology have been playing a vital role in understanding of cellular, subcellular and extracellular components. Role of various cellular and tissue structures, taking part in physiology and pathophysiology of diseases could be better understood through quantitative evaluation. Optical microscopy still remains a valid tool in diagnostic hematopathology, cytopathology and histopathology, but has its own limitations in terms of resolution. Majority of the pathologists never go beyond 40x objective lens that could give a resolving power of 385 nm only. Deeper exploration at ultrastructural level complemented with Ultrastructural Morphometry (UM) has been found to be of great help in resolving the diagnostic issues in a variety of pathological conditions like: renal disorders, myopathies, neuropathies, carcinomas, liver disorders, viral lesions etc. Image analysis provides systematic means of quantitative measurements. Statistical analysis of quantitative parameters could be used to evaluate the correlation between survival and mortality due to a pathological malady.

Digital imaging technology and use of image analysis software at Transmission Electron Microscopes (TEM) have given quantitative flip to our diagnostic capabilities. Optimal applications of ultrastructural morphometry on the acquired images would provide us a wealth of quantitative data for diagnostic and research pursuits. Manual Morphometry for computing the ultrastructural size using ‘Slide Guide’ ultrastructural size calculator (Dunn & Reidman, Calif, USA), supplied by M/s Taab Laboratories, Berkshire, UK, still remains a valid method on accurately enlarged electron micrographs. Rayat validated a new method for ultrastructural morphometry using ‘dual axes tangential scale. Measurement of ‘Glomerular Basement Membrane Thickness’ (GBMT) is must for an accurate diagnosis of ‘Thin Basement Membrane Disease’ (TBMD). Rayat et al. exhibited the role of ultrastructural morphometry in ascertaining a cut-off value of GBMT in Indian adults following the footsteps of Steffes et al. and Jensen et al.

Inoculation with Pythium irregulare Increases the Water Use Efficiency of Wheat Exposed to Post-Anthesis Drought

                                                http://austinpublishinggroup.com/jpceonline/

Thehypothesis that root rot caused by Pythium irregulare reduces the water use efficiency of wheat was tested in a system which simulated field conditions with late season water stress. Inoculation with Pythium significantly reduced transpiration during vegetative growth, so that plants entered post-anthesis drought with more available water. Although weekly transpiration rates were higher in inoculated plants than controls during the later stages of drought, infected plants were unable to make use of all of the extra water. There were no significant effects of inoculation on shoot biomass or grain yield, while total transpiration was reduced by 14%. Infected plants therefore had significantly higher integrated water use efficiency (grain yield relative to transpiration) than controls. Infected plants were significantly more stressed than controls during the drought, despite higher soil moisture, and showed reduced ability to use stomatal conductance to regulate leaf water potential. Pythium infection caused adverse changes to plant water use and water relations, but these did not translate into reductions in growth or yield. This, and the unexpected increase in water use efficiency, highlights the need to consider interactions with other environmental stresses when making assumptions about the effects of root diseases on crop productivity.

Wheat (Triticumaestivum) is one of the most important food crops in the world. In rainfed agriculture, the potential yield of wheat is limited by availability of water, with an attainable Water Use Efficiency (WUE) of 22 kg grainha-1mm-1 having been calculated for dry areas in Australia, North America, China and the Mediterranean basin (Sadras and Angus 2006). However, the average WUE in each of these areas is less than half of this (Sadras and Angus 2006). Among the constraints that potentially limit the ability of wheat to make effective use of available water is root disease. While the effect of various root diseases on the yield of wheat is well established, there has been very little examination of their effect on water relations and WUE.

showed that cereal cyst nematode greatly reduced the transpiration of wheat plants, and that this effect could be mimicked by root pruning, suggesting that disease reduced the effective volume of the root system. On the other hand found a relatively small effect of inoculation with Gaeumannomyces graminis var. tritici (cause of take-all) on transpiration in wheat. However, there was a larger effect on carbon assimilation rates, leading to a reduction in instantaneous WUE (ratio of carbon assimilation to transpiration measured at the individual leaf level. In previous work we have studied the effects of Pythium irregulare on water relations of wheat in a hydroponic system. Root infection with Pythium reduced rates of transpiration and carbon assimilation, and shoot biomass, but did not significantly affect WUE.

An Unusual Presentation of Massive Intrathoracic Schwannoma with Concomittant Pleural Tuberculosis: About a Case and Review of the Literature

                          http://austinpublishinggroup.com/pulmonary-respiratory-medicine/

Schwannomas are the most common neurogenic tumor of the thorax, and may involve any thoracic nerve The case of a 49-year old male patient with a massive intrathoracic schwannoma is reported. A thoracotomy resection of the tumor was performed. The presence of adhesions of the tumor to the chest wall pleura created a suspicion of malignancy. This article’s aim is to draw attention to this infrequent pathology with concomitant tuberculosis and to discuss different aspects regarding diagnosis and treatment of pleura schwannome.

A 49-year-old male with no significant clinical history, presented to the emergency department with a 1-month history of cough productive of white sputum, Haemoptysis, unexplained loss of weight and associated with progressive shortness of breath on exertion, which had persisted despite courses of co-amoxiclav. On examination, his vital parameters (temperature; oxygen saturation; blood pressure; respiratory rate; pulse rate) were all within the normal range for a man of his age. Physical examination revealed dull percussion note on right mid chest wall with diminished breath sound with occasional expiratory wheezing at the auscultation of the chest, and syndrome (facial swelling, neck distension). Lymph nodes examination is unremarkable and the rest of the examination was unrevealing. Standard chest X-ray showed a large, well-defined mass in the the right hemithorax, around 18cm in diameter, associated with displacement of the trachea to the opposite side. Initially, this was thought to be a bronchogenic cyst or un lymphoma process.

Computed Tomography (CT) scan of thorax demonstrated a large (20x15x13cm) well-circumscribed, heterogeneously enhancing rounded mass in the right hemithorax to whose density was mostly similar to fluid, associated with a solid component in the uppermost part. The mediastinal structures, particularly the trachea and right bronchus, were noted to be compressed and displaced to the left side by this lesion (Figure 2A,B). Examination of the sputum smear samples to identify AFB was positive. Fine needle aspiration was performed, but the specimen was insufficient for diagnosis. Results from percutanous biopsy confirmed a pleural schwannome and has eliminated a lymphoma process. Surgery was planned after ruling out an an intraspinal component of tumor. Complete excision of the well-encapsulated mass was achieved through the right posterolateral thoracotomy (Figure 3A). A 20cm tumor was found in the right chest cavity, adhering closely to the parietal pleura and superior vena cava, which was severely dilated. The mass was found to be benign schwannoma without malignant components and the anatomopathologic examination of pariétal pleura retained it to be tubercular (Figure 3B). The postoperative course of the patient was uneventful. The respiratory and vascular symptoms and facial edema resolved immediately after the surgery. The patient returned to her normal life and recovered gradually through regular chest physiotherapy. He has been followed-up for 1 year with no evidence of recurrence.

Self Management Level among Children with Type 1 Diabetes Attending a Residential Diabetes Camps; A 2- Years Review, Ras Al Khaimah, United Arab Emirates, 2017

http://austinpublishinggroup.com/public-health-epidemiology/

Type 1 diabetes is one of the most common endocrine conditions in childhood. Approximately 86,000 children under 15 year are estimated to develop type 1 diabetes annually worldwide. In 2015 the number of children with type 1 diabetes exceeded half million. Therapeutic education is central to the management of diabetes, especially in children and adolescents. Diabetes Self-Management Education (DSME) in residential camps exposes children and adolescents with Type 1 diabetes to intensive self-management education in a short-term recreational camp setting. Albasma Camp for children with Diabetes was established in 2008, to educate children about diabetes management in an enriching, diabetes-friendly environment. The aim of this study is to assess the effect of short-term residential camps in improving the practice and skills of diabetes self-management among children attending a seven-day diabetes camp where 306 diabetic children participated from different states of United Arab Emirates. Data was collected using pretested questionnaire, check list and Focus Groups Discussion. The study found that there was a strongly significant improvement in the overall Diabetes Self-Management (DSM) practices of the study participants pre and post the camp (P-value<0.00).and the majority of the study participants did not exposed to any hyper (67%) or (58%) hypoglycaemic episodes during the 6 months following the camp. Highly statistically significance between participant ages and average HbA1c pre and post camp (p value < 0.00) for the between the age of 8 and 12 years, however, among the participants aged 13 to 14 there was a statistically significance in HbA1c values compared to age only before attending the camp, but after the camp the relationship was not significant (P- value > 0.05). Existence of first degree relatives with diabetes, and experience of attending a previous camp duration of diabetes were not significant factor in the study. The study concluded residential diabetes camps had a positive impact on glycemic control in children living with type 1 diabetes. The study recommended repeated educational programmes to assure continuity of diabetes management and controlling glycaemia in children with diabetes. The study suggested further studies with more duration of follow up

Diabetes Mellitus is characterized by a state of chronic hyperglycemia resulting from a diversity of aetiologies, environmental and genetic, acting jointly (Figure 1). Chronic hyperglycemia, from whatever cause, leads to a number of complications – cardiovascular, renal, neurological, ocular and others such as inter current infections. According to WHO, there will be an alarming increase in the population with type 1 diabetes mellitus, both in the developed and developing countries over the next two decades WHO, 2008 (Figure 2). Epidemiological data indicate the most common age of onset of type 1 diabetes is from 10 to 14 years, with the incidence of diabetes increasing worldwide

Nightmare Utilization by Successful Artists: A Case Report Series

                             http://austinpublishinggroup.com/psychiatry-behavioral-sciences/

Many successful artists use their nightmares in their work. This series of case reports (N=14) is a series of in-depth interviews with such artists, including an assessment of nightmare use in their work, any experience of trauma that may have contributed to their nightmares, and an assessment as to any past and current symptoms of PTSD. While some of these artists were best classified diagnostically as having Nightmare Disorder, a majority (11/14) of these successful artists had histories of significant trauma, and met DSM-V diagnostic criteria for PTSD. There is some evidence that these individuals did their best creative work after their experiences of trauma. These findings suggest that for the artist, nightmare expression rather than suppression (the objective of most PTSD therapies) might be a reasonable therapeutic option.

Artists ranging from Goya, to Fusili and Picasso have used their nightmares in their work. In our Sundance filmmaker work with dream use in creativity, we discovered significantly elevated levels of dream and nightmare recall and use when compared to clinical sleep and medical practice groupings, and the working/professional film making groups. Sleep lab subjects reporting levels of creative interest and/or creative process were also found to report a higher incidence of nightmares than those reporting no creative interests. These studies suggested the possibility that the report of nightmares might be a signifier or a marker for interest and involvement in the process of creativity. In a study of non-dreamers (a sleep laboratory grouping (N = 17) reporting no dream or nightmare recall by history or after multiple lab awakenings) the one documentable behavioral difference between this group and a grouping with minimal dream recall was a lack of interest and involvement in creative process. This current study includes a series of fourteen in-depth interviews with successful visual artists who do creative work based at least in part on their nightmares. The interviews were minimally directed in order to obtain information as to recurrent nightmare content, any description of associated trauma, and any reported use of nightmares in their work. Due to the small group size, this is primarily a descriptive study designed to obtain answers to the following for this sample: 1) age, gender, and trauma exposure; 2) Post-Traumatic Stress Disorder (PTSD) symptom incidence; 3) characteristic nightmare content; and 4) incidence for the successful use of nightmares in artistic production.

Low Heterozygosity and Gene Flow Obtained in Hatchery Raised Populations of Catla Catla (Ham, 1822) as Compared to Feral Population Identified Through DNA Fingerprinting

                            http://austinpublishinggroup.com/proteomics-bioinformatics-genomics/

The present investigation focused to revealed gene flow and genetic differentiation among riverine (Narmada river, n=04), reservoir (Tighra reservoir, n=04 and hatchery raised (Fish Federation Pond, n=07; Khatik Fish Farm, n=05) populations of Catla Catla (Hamilton, 1822) of Madhya Pradesh. Results clearly reflected as Riverine>Reservoir>Fish Federation Pond>Khatik Fish Farm gene flow and even all parameter analyzed for genetic divergence among the populations. Nei’s gene diversity (h) was observed as 0.1382 in Fish Federation Pond, 0.1342 and 0.1739 in Khatik Fish Farm and Narmada River, 0.1490 populations reflecting much higher gene diversity in feral population. The Genetic Differentiation (GST) among the populations was found as GST=0.2380, estimates of gene flow between population (Nm=1.6010), intra-population heterozygosity as HS 0.2457 and total heterozygosity as HT=0.3225 clearly reflecting less genetic differentiation as overall when compared to other fish populations. Analyses genetic polymorphism (P) as 38.59% in hatchery raised population was obtained which as well much slighter as compared to wild populations since 60.30 in Narmada River and 51.63 in Tighra reservoir have been obtained. Overall research indicates that, as compared to wild stock, the genetic changes including reduced genetic diversity have taken place in hatched stocks. This baseline information on genetic variation would be useful for planning intended for effective strategies for conservation and remediation of Catla Catla freshwater fish species.

Freshwater animals have been much greater losses than animals found in terrestrial ecosystems, and freshwater fishes are among the world’s most endangered vertebrates. Most of the fish used for human consumption is obtained through exploitation of wild populations. Allelic diversity (richness) is one of the most important and commonly used estimators of genetic diversity in populations. It strongly depends on the effective population size and past evolutionary history. However, the number of observed alleles and their frequency distribution also depend on the sample size and the genetic marker system used. Thus, a practical method for reliable estimation of genetic diversity parameters in large populations is needed for population genetic studies and to develop scientifically sound strategies for genetic resource conservation. RAPD technique evaluates the genetic disparity within or between the taxa of concern by assessing the occurrence or lack of each product, which is directed by alteration in the DNA sequence at each locus.

Proteomics Profiling of Heterozygous and Homozygous Patients with ABCA1 Gene Mutation: A Tangier Disease Molecular Map

                                                 http://austinpublishinggroup.com/proteomics/

TangierDisease (TD) is a rare inherited disorder with approximately 100 worldwide identified cases. Alpha-lipoprotein deficiency is the main characteristic of this disease, associated with a virtual absence of High Density Lipoproteins (HDL) in blood. Additional symptoms are mild hypertriglyceridemia, neuropathy and enlarged, orange-colored tonsils. Genetically TD is caused by mutations in the ABCA1 gene, which prevent the release of cholesterol and phospholipids from cells, leading to the accumulation of lipids within cells and body tissues. In this work a TD patient and his parental heterozygous were examined from a proteomics point of view. Plasma as well as proteome and secretome of circulating monocytes were analyzed.

Plasma proteins underlined in TD the imbalance of lipid trafficking and metabolism, associated with the stimulation of pro-inflammatory pathways. Proteome and secretome of monocytes highlighted an extensive down regulation of mitochondrial enzymes and vesicular trafficking agents along with a substantial cytoskeletal rearrangement, suggesting a reduced activation state of monocytes from TD homozygous patient.This work is the first proteomics profiling of heterozygous and homozygous TD phenotypes and it suggests a TD case as a model to understand general mechanisms of lipid transport and metabolism and their linkage to inflammatory processes.

Keywords: Tangier disease; Protemics profiling; Monocyte proteomics; Rare disease

First Report of Bhendi Yellow Vein Mosaic Virus in Tabernaemontana Divaricata and Albizia Saman in India

                                               http://austinpublishinggroup.com/plant-biology/

During survey from March 2014 to October 2015, in Barasat, West Bengal, India, incidence of symptoms suggestive of virus infection was observed in Tabernaemontana divaricata (family –Apocynaceae) and Albizia saman (Fabaceae). Infected plants were showing typical symptoms of Begomovirus infection, including leaf curling, leaf yellowing and stunted growth. The occurrences of geminivirus were confirmed by symptomatology, southern blot analysis, Polymerase Chain Reaction (PCR) and nucleotide analysis of the part of genome. Sequence analysis showed that the virus from both the plants share 93-99% identity with the sequences of other BYVMV isolates. The sequence from T. divaricata and A. saman share 99% identity with each other at the nucleotide level showing close phylogenetic relationship. Host range study shows that viruses from both the plants can transfer to chilli plant through mechanically. This is the first molecular evidence of Bhendi yellow vein mosaic virus infecting T. divaricata and A. saman in West Bengal, India.

Viruses of the genus Begomovirus are transmitted by the whitefly Bemisia tabaci and are the most numerous and economically destructive viruses among the geminiviruses. They comprise the largest numbers of species (288 of 325 total species) in the family Geminiviridae. During the last 30 years, begomoviruses have emerged as important viral pathogens in the field that infect a broad variety of food, fiber, and ornamental crops and cause significant losses worldwide. Begomoviruses have been sub-divided into two types with either a bipartite or monopartite genome.