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Despite extensive ecotoxicological evidence on the adverse effects of oil pollution on rodents, little is known about how rodents make decisions in oil-polluted environments (i.e., outside of lab settings). We investigated the foraging behavior of Allenby gerbils, Gerbillus andersoni allenbyi (GA), that were presented with feeding trays in a semi-natural environment. The trays contained seeds mixed into one of three types of soils – clean soil, and two different soil samples collected from two well-documented terrestrial oil spill sites in Israel. The oil spill disasters occurred in 1975 and 2014 and the spill sites are located within a few hundred meters of each other, in the 'Avrona Nature Reserve in the Arava hyper-arid region in Israel. Gerbils of both sexes avoided foraging in 2014-polluted soil, but surprisingly, they foraged more in 1975-polluted soil. Our results indicate that for the GA, the 1975-polluted soil is an advantageous substrate to forage on, probably because its texture facilitates more efficient foraging, leading to greater energetic gain, and creating a trade-off between energetic gain and perceived foraging cost due to its pollution. We also proceeded to investigate some physiological consequences of chronic exposure to the 2014-polluted soil in the laboratory. Chronic oil exposure did not lead to mortality or weight loss, but female gerbils exhibited heightened cortisol. We conclude that terrestrial oil pollution may have significant sublethal impacts on animal behavior, even when there is no obvious short-term physiological cost to the exposure. [Display omitted] • We assessed the effects of two terrestrial oil spills on foraging in gerbils. • We used soil polluted by crude oil in 1975, 2014, and a control from the same area. • Gerbils foraged more in 1975-polluted soil but avoided the 2014-polluted soil. • Oil exposure begot no mortality or weight loss, but females had heightened cortisol. • Terrestrial oil pollution may have significant sublethal impacts on animal behavior. [ABSTRACT FROM AUTHOR]

This article aims to contribute to the emerging body of research on community engagement of college students from minority and underserved groups. It examines community engagement programs involving students from the Jewish ultra-Orthodox society in Israel, a minority group that is clearly underrepresented in the higher education system in Israel. Using qualitative methods, this article analyzes how ultra-Orthodox students experience their community engagement and perceive its effects on themselves and on their communities. The findings illuminate how the students' social interactions during their volunteer work enhance meaningful learning despite considerable challenges and dilemmas. Ultra-orthodox students constantly cross social and cultural boundaries, and their choice to enroll in higher education is often delegitimized in their communities. Their ability to contribute to their communities through collegiate community engagement programs helps justify their decision to pursue an academic education. This ability also empowers them in the challenging liminal state between the ultra-Orthodox society and academia. Hence, community engagement helps reinforce the academization of the ultra-Orthodox society. This case study proposes that student volunteers from underrepresented minority groups can bridge the gap between academic institutions and their minority communities, serving as agents of societal change. • Community engagement of underrepresented college students fosters their learning. • Students' activity facilitates their passage through the liminal space of academia. • The engaged students bridge between academia and their communities. • They serve as agents of knowledge and societal change. • The findings can contribute to diversifying community engagement programs worldwide. [ABSTRACT FROM AUTHOR]

Abstract Objective The aim of the current study was to compare the prevalence of, and risk factors for postpartum depression (PPD) among Jewish and Arab women in Israel. Design Data were obtained from a study on 'Family Relations and Violence' conducted in Israel in 2014–2015 using a multilayered nationwide representative sample of mothers who were interviewed face to face using a structured questionnaire in each woman's native language (Arabic / Hebrew) 6 weeks to 6 months postpartum. Setting 63 Maternal and Child Health (MCH) clinics from five geographical districts. Participants Jewish (N = 853) and Arab (N = 275) women aged 16–48 who were 6 weeks to 6 months postpartum. Measurements PPD was measured by the Edinburgh Postnatal Depression Scale with a cutoff of ≥10. We examined a range of risk factors using multivariate logistic regression analysis and Generalized Estimating Equations (GEE) for the total sample, then separately for each ethnic group. Results For the total sample (n = 1128). Prevalence of PPD was 10.3%. Prevalence among Arab women was significantly higher compared to Jewish women (20.8% vs 7%, respectively). In the multivariable analysis, chronic stress, low social support, and unwanted pregnancy were major risk factors for PPD for Arab women. Among Jewish women the risk factors for PPD included chronic stress, low level of education, and intimate partner violence. Conclusions Our findings indicate ethnic inequalities in the prevalence of, and risk factors for PPD in Israel that should be considered in health planning and policymaking. Implications for practice Maternal health care nurses and other professionals should be aware of these inequalities and provide culturally sensitive health care services and programs to protect women in these population groups from PPD. [ABSTRACT FROM AUTHOR]

Introduction: Preeclampsia is a leading cause of maternal and fetal morbidity and mortality. Regarding the offspring, little is known about the long-term complications. The objective of the current study is to assess whether in utero exposure to preeclampsia increases the risk of long-term cardiovascular morbidity in the offspring.Materials and Methods: A population-based cohort study compared the incidence of cardiovascular disease between singletons exposed and unexposed to preeclampsia. Deliveries occurred between 1991 and 2014 in a regional tertiary medical center. A Cox proportional hazard model was used to control for confounders.Results: During the study period 231,298 deliveries met the inclusion criteria; 4.1% of the births were to mothers diagnosed with preeclampsia, of which 3.2% with mild preeclampsia (n = 7286), 0.9% with severe preeclampsia (n = 2174) and 0.03% with eclampsia (n = 73). A significant linear association was noted between preeclampsia (no preeclampsia, mild preeclampsia, severe preeclampsia and eclampsia) and cardiovascular disease of the offspring (0.24%, vs. 0.33% vs. 0.51% vs. 2.73% respectively, p < 0.001 using the chi-square test for trends). In the offspring born at term, severe preeclampsia was found to be an independent risk factor for cardiovascular morbidity (adjusted HR = 2.32; 95% CI 1.15-4.67). In offspring born preterm, neither severe preeclampsia (adjusted HR = 1.36; 95% CI 0.53-3.48) nor mild preeclampsia (adjusted HR = 0.37; 95% CI 0.52-2.71) were associated with cardiovascular morbidity of the offspring.Conclusion: Exposure to severe maternal preeclampsia is an independent risk factor for long-term cardiovascular morbidity in the offspring born at term. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate the effects of pentoxifylline [PTX] and caffeic acid phenethyl ester [CAPE] in D -galactosamine [ D -GAL]-induced pulmonary injury in rats. The rats were randomly divided into six groups: control, D -GAL, D -GAL+PTX, D -GAL+CAPE, PTX and CAPE. Each group included eight animals. Lung sections from the control, PTX and CAPE groups had a normal histological appearance. The D -GAL group showed histopathological changes in lung tissue, including haemorrhage, oedema, inter-alveolar septal thickening and widespread infiltration of inflammatory lymphocytes and macrophages. Administration of PTX and CAPE significantly reduced histopathological damage scores in the D -GAL+PTX and D -GAL+CAPE groups compared with the D -GAL group. PTX and CAPE treatment also significantly decreased malondialdehyde levels, increased levels of reduced GSH and increased catalase and superoxide dismutase activity in lung tissue samples. These results indicate that the destructive effects of D -GAL-induced inflammation in the rat lung are significantly reduced following administration of PTX and CAPE. • D -GAL induces the secretion of cytokines, mainly tumor necrosis factor α, by activating macrophages. • Pentoxifylline is a phosphodiesterase inhibitor with anti-TNF-alpha activity, associated with its anti-inflammatory action. • Caffeic acid phenethyl ester has been reported to have the potent anti-inflammatory activity. [ABSTRACT FROM AUTHOR]

Background/purpose In pathogenesis of necrotizing enterocolitis (NEC), both oxidative stress and inflammation are considerable risk factors. The study was designed to evaluate whether administration of dexpanthenol (Dxp) is able to attenuate intestinal injury through the antioxidant and antiinflammatory mechanisms in a neonatal rat model of NEC. Methods Forty newborn pups divided into four groups were included in the study: control, control + Dxp, NEC, and NEC + Dxp. NEC was induced by hyperosmolar formula and additionally the pups were exposed to hypoxia/hyperoxia and cold stress. They were sacrificed on postnatal day four, and their intestinal tissues were analyzed biochemically and histopathologically. Results Dxp caused a significant decrease in intestinal damage as determined by the histological score, villus height and number of goblet cells in NEC groups ( p < 0.0001). Tissue malondialdehyde, total oxidant status, and oxidative stress indexes levels were higher in the NEC group than in the control and control + Dxp groups ( p < 0.001). These values were reduced in the pups treated with Dxp ( p ≤ 0.004). Superoxide dismutase, glutathione peroxidase, and reduced glutathione activities were significantly reduced in the NEC group compared to the others ( p < 0.005). Treatment with Dxp significantly reduced elevations in tissue homogenate levels of tumor necrosis factor-α and interleukin-1β in the NEC + Dxp group ( p = 0.002 and p = 0.01, respectively). Conclusions Dexpanthenol seems to have antiinflammatory and antioxidant properties. Prophylaxis with Dxp has a potential to reduce the severity of intestinal damage in NEC in the animals. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the effect of aminoguanidine (AG) against testicular damage streptozotocin (STZ) induced diabetes. Thirty two rats were separated into four groups: control, AG, STZ and STZ + AG. In the STZ group, 12.5 ± 1.3% of tubules were seen as containing sloughed spermatogenic cells into the lumen, 28.7 ± 1.8% of tubules were atrophic, 46.2 ± 2.1% of tubules were degenerative and 8.5 ± 0.9% of tubules contained giant cells. Statistically, the affected tubule number was significantly lower in the STZ + AG group than in the STZ group. Intensely stained caspase-3 cells showed a statistically significant increase in the STZ group, while it decreased in the STZ + AG group. The enzyme activities of catalase (CAT), superoxide dismutase (SOD) and glutathione (GSH) level decreased and the level of malondialdehyde (MDA) and nitric oxide (NO) increased in the STZ group, while AG treated diabetic rats showed an increase of CAT, SOD activity and GSH level and a decrease in MDA and NO levels. This study shows that the oxidative stress, increased NO level and apoptotic cell death play an important role in diabetic rat testicular damage and that AG treatment of diabetic rats results in protection of spermatogenic cells against oxidative stress and apoptotic cell death. [ABSTRACT FROM AUTHOR]

Purpose To assess the ability of 2 independent surgical techniques, an inside-out technique and an outside-in technique, using bony landmarks on the femoral wall, to place the anterior cruciate ligament graft anatomically. Methods A retrospective single-center study was conducted in 2012 and included patients who underwent anterior cruciate ligament reconstruction. Two techniques were used: The lateral condylar wall was visualized from the anterolateral portal and tunnels were drilled “outside-in” in one group, whereas viewing was performed from the anteromedial portal and retrograde drilling (“inside-out”) was performed in the other group. The primary outcome measure was the placement of the tunnel center point on postoperative computed tomography scans with 3-dimensional reconstruction, according to the radiographic quadrant method of Bernard and Hertel. The measurements were compared with optimal placements according to Bird et al. Their reliability was assessed with Spearman (rho) and intraclass correlation coefficients. Results Forty patients were included, with 20 in each group; the mean age was 29.8 ± 9.6 years, and there were 33 men and 7 women. The interobserver reliability and intraobserver reliability of measurements were good, with a Spearman ρ between 0.46 ( P = .002) and 0.93 ( P < .001) and an intraclass correlation coefficient between 0.44 ( P = .001) and 0.86 ( P < .001). The femoral tunnel positions of both techniques were close to the previously published anatomic placements, but there was a significant difference between our results and the theoretical position in proximal-distal measurements ( P = .01). There was no difference in the anteroposterior measurements. There was no statistical difference in the accuracy of placement of the femoral tunnel center point between these 2 independent techniques. Conclusions The direct arthroscopic visualization of bony landmarks seems sufficient for accurate positioning of the femoral tunnel whatever the drilling technique. This finding is clinically relevant because the routine use of direct measurement techniques or intraoperative radiographs may not be necessary to obtain anatomic tunnel placement. Level of Evidence Level IV, case series. [ABSTRACT FROM AUTHOR]

Exposure to various organic compounds including several environmental pollutants and drugs can cause cellular damage through the generation of lipid peroxidation products. Carbon tetrachloride (CCl 4) is a potent toxic agent that causes peroxidative degeneration in many tissues. Dexpanthenol (Dxp) is a member of the B complex vitamins that exhibits antioxidant effects against lipid peroxidation products. This study was designed to evaluate the cardioprotective effect of Dxp against CCl 4 -induced myocardial toxicity in rats. Administration of a single dose of CCl 4 caused cardiotoxicity by the increase in lipid peroxidation and histopathological changes (cardiomyocytes degeneration, interstitial edema) in the myocardial tissue. Moreover, CCl 4 caused a decrease in lactate dehydrogenase (LDH) and troponin-I immunoreactivities, while significantly increasing tumor necrosis factor-alpha (TNF-α) and caspase-3 immunoreactivities. On the other hand, administration of Dxp improved biochemical, histopathological, and immunohistochemical parameters compared to the CCl 4 treated group. Overall, this study suggests that Dxp is effective in inhibiting CCl 4 -induced lipid peroxidation, and that administration of Dxp may help prevent CCl 4 related inflammation, necrosis, and apoptosis on the cardiac tissue. • CCl 4 caused cardiotoxicity by the increase in lipid peroxidation in the myocardial tissue. • CCl 4 decreases LDH and troponin I immunoreactivity in cardiomyocytes. • CCl 4 increases TNF alpha and caspase-3 immunoreactivity. • Dxp treatment ameliorates CCl 4 -induced cardiomyocyte damage. • Dxp ameliorates myocardial damage with its anti-necrotic, anti-inflammatory and anti-apoptotic effects. [ABSTRACT FROM AUTHOR]

Objectives This study sought to identify predictors of recurrent ischemic neurologic events within the CLOSURE I (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke and/or Transient Ischemic Attack Due to Presumed Paradoxical Embolism Through a Patent Foramen Ovale) trial. Background The CLOSURE I trial found that transcatheter patent foramen ovale (PFO) closure using the STARFlex device was not superior to medical therapy in patients with cryptogenic stroke or transient ischemic attack (TIA) and PFO. Methods The CLOSURE I trial is a multicenter, randomized trial of transcatheter PFO closure compared with medical therapy in patients who presented with cryptogenic stroke or TIA and had a PFO. We identified clinical predictors of recurrent ischemic stroke or TIA during 2 years of follow-up using Cox proportional hazards regression within the pooled intention-to-treat cohort. Results In 909 patients, the incidence of recurrent events was 5.7% with 25 patients suffering a recurrent stroke and 30 a TIA. Patients who had a recurrent event had higher body mass index (30.2 ± 6.2 vs. 28.3 ± 5.8%; p = 0.03) and more frequently had diabetes (19.2% vs. 7.1%; p = 0.0016), hypertension (46.2% vs. 30.1%; p = 0.015), and ischemic heart disease (3.8% vs. 0.9%; p = 0.05). Diabetes (hazard ratio [HR]: 3.39; 95% confidence interval [CI]: 1.69 to 6.84; p = 0.0007), index TIA (HR vs. stroke: 2.13; 95% CI: 1.20 to 3.80; p = 0.01), and the detection of atrial fibrillation after study enrollment (HR: 4.85; 95% CI: 2.05 to 11.47; p = 0.0003) independently predicted recurrent ischemic neurologic events. Recurrent neurologic events were more frequent in subjects with RoPE (Risk of Paradoxical Embolism) score ↜5 than those with >5 (14.5% vs. 4.2%; p < 0.0001). Conclusions These findings suggest an alternative etiology to paradoxical embolism was frequently responsible for recurrent events within the CLOSURE I trial. (Evaluation of the STARFlex Septal Closure System in Patients With a Stroke or TIA Due to the Possible Passage of a Clot of Unknown Origin Through a Patent Foramen Ovale (PFO) [CLOSURE I]; NCT00201461). [ABSTRACT FROM AUTHOR]

Background: Burkholderia cepacia complex (Bcc) is a group of common environmental bacteria that preferentially colonize and infect patients with cystic fibrosis but are also emerging as nosocomial pathogens, possibly due to their resistance to disinfectants and antimicrobials. Methods: We investigated a 3-month outbreak of Bcc bacteremia among hospitalized hematology patients. Environmental investigation and infection control measures were implemented. A retrospective, cross-sectional study was conducted to identify risk factors. Results: Bcc was repeatedly isolated from the blood of 9 patients without central venous catheter who did not easily respond to targeted antibiotic treatment and 3 died of the infection. A point source was not identified and horizontal spread was suspected. Strict infection control measures terminated the outbreak. Interestingly, diagnosis of acute myeloid leukemia but not neutropenia or prior chemotherapy was a risk factor for infection acquisition. Neutropenia was positively correlated with infection duration. Conclusions: Bcc is not only a serious threat among immunocompromized hematology patients, but is also transmissible in clinical settings. Acute myeloid leukemia appears to confer additional risk for infection acquisition. [Copyright &y& Elsevier]

Abstract: Silver–Russell syndrome (SRS) is a heterogeneous syndrome which is characterized by severe intrauterine and postnatal growth retardation and typical dysmorphic features. In 5–10% of SRS patients, a maternal uniparental disomy of chromosome 7 (UPD7) can be detected. We describe a 4.5-y old boy. Physical examination at the age of 4.5 y was remarkable for small stature, relatively big head, triangular face, broad forehead, pointed chin and clinodactyly. He had hypopigmented macules on his back with no evidence of asymmetry/hemihypertrophy. Clinical diagnosis of Silver–Russell syndrome was made. Maternal UPD of chromosome 7 was found, confirming the diagnosis. Along with the clinical findings that are described in this syndrome he had moderate developmental delay which is not commonly found in these patients and underwent an autistic regression around the age of 2 years. This association has only once been described before in this syndrome. A possible explanation is that the autism is not a part of SRS but is due to the UPD. Our case suggests an association of autistic regression with a locus on chromosome 7. [Copyright &y& Elsevier]

OBJECTIVE: The admission of patients with cystic fibrosis (CF) to the intensive care unit (ICU) is controversial. Our aim was to study the long-term outcome of patients with CF who were admitted to the ICU and the effect of ventilation modality. METHODS: The medical records of 104 admissions (1996-2006) of 48 patients with CF (age 18+/-9 years) were reviewed. Seventeen patients were admitted with reversible conditions (group 1). Thirty-one patients were admitted for acute on chronic respiratory failure (group 2). RESULTS: In group 1, 16 of 17 patients survived up to 10 years from ICU admission. Conversely, in group 2, 23 of 31 patients (74%) died of respiratory failure. In group 2, 17 of 18 patients who were mechanically ventilated died within 90 days from admission, and 7 of 10 patients treated for prolonged periods with bi-level positive airway pressure are still alive up to 10 years after admission and transplantation. CONCLUSION: Patients requiring mechanical ventilation may have a poor prognosis. The outcome of treatment with bi-level positive airway pressure is good, even in patients who had many episodes of acute respiratory failure. [ABSTRACT FROM AUTHOR]

Abstract: Polymeric scaffolds have been reported to promote angiogenesis, facilitating oxygen delivery; however, little is known about the effect of diabetes on the neo-vascularization of implanted polymeric scaffolds at subcutaneous (SC) sites. In this study we compare the effect of diabetes on scaffold vascularization following SC implantation into diabetic and non-diabetic mice. Wide pore agarose cryogel scaffolds with grafted gelatin were prepared by a two-step freezing procedure and subsequent thawing. The scaffolds were implanted subcutaneously into streptozoticin-induced diabetic mice and control, non-diabetic mice. The vascularization process was estimated using histological sections, in which endothelial cells were identified by Von Willebrand factor (vWF) and CD31 antigen staining and the pericyte layer was confirmed by α-smooth muscle actin (α-SMA) visualization. Comparative analysis showed a similar thickness of fibrous capsules around the vascularized scaffolds in both diabetic and non-diabetic animals. Intensive staining for α-SMA indicated the formation of mature blood vessels in the surrounding fibrous capsule and tissue invading the scaffold area. No statistically significant differences in capillary density and area occupied by blood vessels were found between diabetic and non-diabetic mice. In conclusion, the present study shows no adverse effects of diabetes on new blood vessel formation in SC implanted agarose cryogel scaffolds with grafted gelatin. [Copyright &y& Elsevier]

Abstract: Background: The metabolic syndrome (MTS) is comprised of insulin resistance, glucose intolerance, obesity, hypertension, and dyslipidemia. Secondary renal dysfunction can develop after prolonged duration of each component except for dyslipidemia. Here we present 7 obese individuals in whom MTS and proteinuria developed concomitantly during adolescence. Subject and methods: Seven (f:m=4:3) individuals (Caucasian or African American, ages 11–17 at disease onset) developed macroproteinuria of whom 6 were directly evaluated and had typical MTS characteristics. Body mass index range was 30.8–73.2kg/m2, being highest in African Americans. All had positive family history of MTS. Six patients underwent complete general, hormonal and metabolic work-up, including fasting and stimulated insulin and C-peptide levels. Genomic DNA of 4 patients and their relatives was studied by linkage analysis for MODY 1–4 genes, and for a locus associated with focal segmental glomerulosclerosis (FSGS) and microalbuminuria. Results: Fasting and stimulated insulin and C-peptide levels were elevated. All patients were normoalbuminemic, and five of six patients had mildly elevated liver enzymes. The 24-h urinary protein excretion range was 2.5–9g, and decreased markedly in 2 patients who lost weight. Renal biopsy of 3 patients showed FSGS. In 2 pedigrees FSGS was familial. Genomic DNA analysis excluded any linkage with common MODY genes or with familial FSGS. Conclusions: The early concomitant development of MTS, proteinuria and FSGS appears to be associated with hyperinsulinemia, presenting as early as adolescence, and may be reversed by weight loss. We propose that in genetically predisposed individuals, excessive insulin plays a crucial pathogenic role in development of the metabolic syndrome and FSGS. [Copyright &y& Elsevier]

Objectives: To assess near-infrared spectroscopy (NIRS) as a method for the diagnosis and evaluation of peripheral vascular disease. Search strategy: MEDLINE and CENTRAL were searched with a search protocol presented below. Handsearching through reference lists of the retrieved articles and reviews was conducted. Main results: 224 and 57 abstracts from MEDLINE and CENTRAL respectively were retrieved from which 21 studies were selected. NIRS was evaluated for the diagnosis and severity evaluation in patients with peripheral vascular disease. Its parameters were shown to reflect the clinical status of patients, with good correlation to existing methods. Conclusions: Currently NIRS technology can serve as an adjunct method for the diagnosis and evaluation of patients with peripheral vascular disease. [Copyright &y& Elsevier]

Summary: Background: The metabolic syndrome (MTS) is important risk factor for cardiovascular disease in adults and until recently, it was rarely described in children. Aim: The aim of our study was to evaluate the frequency of individual MTS components in obese children, and determine risk factors for their early development. Subjects and methods: Data of 374 obese children (mean age of 11.4±2.3 years), (f/m=211/163), (BMI≥95th percentile) were included in the study, of whom 242 were >10 years. Nine adolescents were referred with overt diabetes. All subjects underwent full clinical and laboratory evaluation, and their data was compared to 191, age, and sex-matched healthy lean controls. Data of OGTT performed on 111 obese children (101 >10 years) and 66, age- and sex-matched healthy controls (22 >10 years) was analyzed. Insulin secretion and insulin sensitivity were determined with validated OGTT derived indices. Results: Results of OGTT showed that 3/101 (3%) adolescents had diabetes, 8 (8%) impaired glucose tolerance (IGT), and 4 (4.%), impaired fasting glucose (IFG) A significantly higher frequency of MTS components was found in obese children when compared to controls, not always associated with insulin resistance. Predictors of early/full presentation of MTS components included: BMI>33; family history of T2DM; female gender; age >15 years; elevated fasting insulin, and insulin resistance. Conclusion: About 50% of obese children in Israel present one or more MTS components, and 15% have CHO intolerance. Early and full MTS development seems to be associated with family history of T2DM. In obese prepubertal children development of MTS components are independent of hyperinsulinemia and insulin resistance. [Copyright &y& Elsevier]

Background & Aims: Economic analysis in chronic diseases is a prerequisite for planning a proper distribution of health care resources. We aimed to determine the cost of inflammatory bowel disease, a lifetime illness with considerable morbidity. Methods: We studied 1321 patients from an inception cohort in 8 European countries and Israel over 10 years. Data on consumption of resources were obtained retrospectively. The cost of health care was calculated from the use of resources and their median prices. Data were analyzed using regression models based on the generalized estimating equations approach. Results: The mean annual total expenditure on health care was 1871€/patient-year for inflammatory bowel disease, 1524€/patient-year for ulcerative colitis, and 2548€/patient-year for Crohn’s disease (P < .001). The most expensive resources were medical and surgical hospitalizations, together accounting for 63% of the cost in Crohn’s disease and 45% in ulcerative colitis. Total and hospitalization costs were much higher in the first year after diagnosis than in subsequent years. Differences in medical and surgical hospitalizations were the primary cause of substantial intercountry variations of cost; the mean cost of health care was 3705€/patient-year in Denmark and 888€/patient-year in Norway. The outlay for mesalamine, a costly medication with extensive use, was greater than for all other drugs combined. Patient age at diagnosis and sex did not affect costs. Conclusions: In this multinational, population-based, time-dependent characterization of the health care cost of inflammatory bowel disease, increased expenditure was driven largely by country, diagnosis, hospitalization, and follow-up year. [Copyright &y& Elsevier]

Objective: Perioperative hypothermia might be detrimental to the patient undergoing off-pump coronary artery bypass surgery. We assessed the efficacy of the Allon thermoregulation system (MTRE Advanced Technologies Ltd, Or-Akiva, Israel) compared with that of routine thermal care in maintaining normothermia during and after off-pump coronary artery bypass surgery. Methods: Patients undergoing off-pump coronary artery bypass surgery were perioperatively and randomly warmed with the 2 techniques (n = 45 per group). Core temperature, hemodynamics, and troponin I, interleukin 6, interleukin 8, and interleukin 10 blood levels were assessed. Results: The mean temperature of the patients in the Allon thermoregulation system group (AT group) was significantly (P < .005) higher than that of the patients receiving routine thermal care (the RTC group); less than 40% of the latter reached 36°C compared with 100% of the former. The cardiac index was higher and the systemic vascular resistance was lower (P < .05) by 16% and 25%, respectively, in the individuals in the AT group compared with in the individuals in the RTC group during the 4 postoperative hours. End-of-surgery interleukin 6 levels and 24-hour postoperative troponin I levels were significantly (P < .01) lower in the patients in the AT group than in the RTC group. The RTC group’s troponin levels closely correlated with their interleukin 6 levels at the end of the operation (R = 0.51, P = .002). Conclusions: Unlike routine thermal care, the Allon thermoregulation system maintains core normothermia in more than 80% of patients undergoing off-pump coronary artery bypass surgery. Normothermia is associated with better cardiac and vascular conditions, a lower cardiac injury rate, and a lower inflammatory response. The close correlation between the increased interleukin 6 and troponin I levels in the routine thermal care group indicates a potential deleterious effect of lowered temperature on the patient’s outcome. [Copyright &y& Elsevier]

Evaluates perinatal outcome of infants with pathologic fetal heart rate tracings during the first stage of labor. Presence of meconium in the stained amniotic fluid; Measurement of hydrogen ion concentration of the umbilical arterial sample; Occurrence of fetal acidosis after monitoring.

Evaluates the consideration of infertility treatment as risk factor for cesarean section among nulliparous women in Israel. Effects of infertility treatment on the rate of low-birth weight; Relationship between age and cesarean delivery; Application of Fisher exact test for the comparison of qualitative data.

• Valproic acid (VPA) is used to treat epilepsy, but is associated with many side effects, including hepatotoxicity. • Naringin (NRG) is a natural flavanone glycoside that has anti-inflammatory, anti-apoptotic and antioxidant properties. • Histopathological changes in the VPA group were increased significantly when compared to the control group. Valproic acid (VPA) is mainly prescribed to treat epilepsy. VPA has been reported to be associated with many adverse effects, including hepatotoxicity. Naringin (NRG) is a natural, therapeutically active flavanone glycoside with anti-inflammatory, anti-apoptotic, and antioxidant. The current study was therefore designed to investigate the protective effect of NRG against the VPA-induced experimental hepatotoxicity model. For this purpose, 24 Wistar albino rats were randomly divided into three groups as control (Vehicle), VPA (500 mg/kg), and NRG + VPA (100 mg/kg NRG + 500 mg/kg VPA) groups. The agents were administered via oral gavage for 14 days. Blood and liver tissue samples were taken on the end of the experiment. Biochemical analyzes were performed on the blood and liver samples. Also, malondialdehyde (MDA), superoxide dismutase (SOD) enzyme, glutathione (GSH) content, catalase (CAT) enzyme levels were examined in the liver tissue samples. Histopathological changes (hydropic degeneration and congestion) in the VPA group were increased significantly when compared to the control group (p < 0.05). We also found a decrease in enzymes of serum liver function in the VPA group. However, NRG has been shown not to prevent histopathological changes in the VPA group. According to our results with this experiment protocol, NRG could not exert sufficient protection against VPA-induced hepatotoxicity. [ABSTRACT FROM AUTHOR]

Abstract: INTRODUCTION: When adhesions, internal hernias, malignant intra- and retro-peritoneal neoplasms are excluded in patients presenting with new onset constipation and abdominal mass appearance after previous abdominal surgery, other causes must be considered. PRESENTATION OF CASE: Giant enteroliths formed within ileal diverticula in the site of small bowel anastomosis may extrude and produce a palpable abdominal lump. Recent experience with such a patient is the basis of this report. DISCUSSION: Ileal diverticula with interior enteroliths may be suspected in patients presenting with an abdominal lump following previous small bowel resection. CONCLUSION: Open or laparoscopic assisted surgical resection of the involved segment is the treatment of choice. [Copyright &y& Elsevier]

Objective: Studies have questioned the long-term health effects of offspring conceived after fertility treatments.Methods: We aimed to evaluate whether an association exists between mode of conception (in vitro fertilization, ovulation induction, or spontaneous pregnancy) and neoplasm risk (both benign and malignant tumors) among the offspring; we observed the offspring for up to 18 years.Study Design: A population-based cohort analysis was performed that compared the risk for neoplasms among children (up to the age of 18 years) based on mode of conception. Neoplasm diagnoses were based on hospital records of the same single tertiary center in the region. All singletons born during from 1991-2013 and discharged alive were included in the study. Offspring with congenital malformations were excluded from the analysis. Kaplan-Meier survival curves were constructed to compare cumulative neoplasms incidence; multivariable survival analyses were used to control for confounders that included gestational age, pregnancy complications, and maternal factors.Results: During the study period, 242,187 newborn infants met the inclusion criteria: 2603 (1.1%) were conceived after in vitro fertilization; 1721 (0.7%) were conceived after ovulation induction treatments, and 237,863 (98.3%) were conceived spontaneously. During the follow-up period (median, 10.55 years), 1498 neoplasms(0.6%) were diagnosed. Incidence density rate for neoplasms was higher among children conceived either after in vitro fertilization (1.5/1000 person years) or ovulation induction treatments (1.0/1000 person years), as compared with naturally conceived children (0.59/1000 person years; Kaplan-Meier log rank, P<.001). The association between in vitro fertilization and total pediatric neoplasms and the association between any fertility treatments and malignancies remained significant; we controlled for confounders such as gestational diabetes mellitus, hypertensive disorders, preterm birth, and maternal age (adjusted hazard ratio, 2.48; 95% confidence interval, 1.71-3.50; and adjusted hazard ratio, 1.96; 95% confidence interval, 1.14-3.36, for all neoplasms and all malignancies, respectively).Conclusion: Children conceived after fertility treatments are at an increased risk for pediatric neoplasms. [ABSTRACT FROM AUTHOR]

Background: The reported rates of gestational diabetes mellitus are constantly escalating and little is known about long-term complications in the offspring. Evidence from the field of epigenetics strongly advocates the need for research on the neuropsychiatric complications in offspring prenatally exposed to gestational diabetes mellitus.Objective: We sought to assess whether in utero exposure to gestational diabetes mellitus increases the risk of long-term neuropsychiatric morbidity in the offspring.Study Design: A population-based cohort study compared the incidence of hospitalizations due to neuropsychiatric disease between singletons exposed and unexposed to gestational diabetes mellitus. Deliveries occurred in the years 1991 through 2014 in a regional tertiary medical center. Perinatal deaths, multiple gestations, mothers with pregestational diabetes or lack of prenatal care, and children with congenital malformations were excluded from the study. A multivariate generalized estimating equation logistic regression model analysis was used to control for confounders and for maternal clusters.Results: During the study period 231,271 deliveries met the inclusion criteria; 5.4% of the births were to mothers diagnosed with gestational diabetes mellitus (n = 12,642), of these 4.3% had gestational diabetes type A1 (n = 10,076) and 1.1% had gestational diabetes type A2 (n = 2566). During the follow-up period, a significant linear association was noted between the severity of the gestational diabetes (no gestational diabetes, gestational diabetes mellitus A1, gestational diabetes mellitus A2) and neuropsychiatric disease of the offspring (1.02% vs 1.36% vs 1.68%, respectively, P < .001). A Kaplan-Meier curve demonstrated that children born to women with gestational diabetes mellitus had higher cumulative incidence of neuropsychiatric morbidity. Using a generalized estimating equation multivariable logistic regression model, controlling for time-to-event, maternal age, gestational age at delivery, maternal obesity, maternal preeclampsia and fertility treatments, maternal gestational diabetes mellitus was found to be an independent risk factor for long-term neuropsychiatric disease of the offspring (gestational diabetes mellitus A1 [adjusted odds ratio, 1.83; 95% confidence interval, 1.53-2.19] and gestational diabetes mellitus A2 [adjusted odds ratio, 1.64; 95% confidence interval, 1.18-2.27]). Within the limits of our database, our findings also point to a possible association between in utero exposure to gestational diabetes mellitus and autistic spectrum disorder of the offspring (adjusted odds ratio, 4.44; 95% confidence interval, 1.55-12.69), which was found significant also after controlling for time-to-event, maternal age, gestational age at delivery, and offspring weight at birth.Conclusion: Exposure to maternal gestational diabetes mellitus is an independent risk factor for long-term neuropsychiatric morbidity in the offspring. [ABSTRACT FROM AUTHOR]