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Cardiovascular toxicity is the most common cause of fatality in the first 24 hours of poisoning with aluminium phosphide (AlP). Most often manifesting itself in cardiac dysrhythmias. The aim of this study was to evaluate the benefits of amiodarone prophylaxis against cardiac dysrhythmia in 46 patients with acute AlP poisoning. They were divided in two groups of 23: one receiving amiodarone and the other not (control). The treatment group received amiodarone prophylaxis in the initial intravenous bolus dose of 150 mg, followed by a drip of 1 mg/min for six hours and then of 0.5 mg/min for eighteen hours. Both groups were Holter-monitored for 24 hours since admission. Save for amiodarone, both groups received the same standard treatment. Amiodarone had a significant beneficial effect in reducing the frequency of STsegment elevation and ventricular fibrillation plus atrial fibrillation (P=0.02 and P=0.01, respectively), but the groups did not differ significantly in mortality (9 vs 11 patients, respectively). The mean time between ICU admission and death (survival time) was significantly longer in the treatment group (22 vs 10 h, respectively; P=0.03). Regardless its obvious limitations, our study suggests that even though amiodarone alone did not reduce mortality, it may provide enough time for antioxidant therapy to tip the balance in favour of survival and we therefore advocate its prophylactic use within the first 24 h of AlP poisoning., Najčešći uzrok smrti u prva 24 sata od otrovanja aluminijevim fosfidom (AlP) jesu njegovi toksični učinci na srce I krvožilje. Oni se obično manifestiraju srčanim disritmijama. Cilj je ovoga ispitivanja bio procijeniti blagotvorne učinke amiodarona u profilaksi srčane disritmije u 46 bolesnika primljenih na intenzivnu njegu s otrovanjem AlP-om. Bolesnici su podijeljeni u dvije skupine od 23 ispitanika. Jedna je primala amiodaron, a druga (kontrolna) nije. Ostalo liječenje bilo je standardno i identično u objema skupinama. Amiodaronska se je profilaksa sastojala od udarne intravenske bolusne doze od 150 mg, nakon čega je uslijedila infuzija u dozi od 1 mg/min prvih šest sati, a zatim od 0,5 mg/min sljedećih osamnaest sati. Obje su skupine od prijama na intenzivnu njegu bile nadzirane 24-satnim holterom. Amiodaron je iskazao značajnu djelotvornost u smanjenju učestalosti povišenoga ST-segmenta odnosno ventrikulske i atrijske fibrilacije (P=0,02 odnosno P=0,01), ali nije značajno smanjio smrtnost (9 bolesnika u skupini na amiodaronu odnosno 11 u kontrolnoj skupini). Srednje vrijeme od prijama na intenzivnu njegu do smrti (vrijeme preživljenja), međutim, značajno se produžilo u skupini na amiodaronu (22 h prema 10 h u kontrolnoj skupini; P=0,03). Unatoč jasnim ograničenjima, napose zbog premaloga uzorka, ovo ispitivanje upućuje na to da amiodaron može dovoljno produžiti vrijeme preživljenja i time dati dovoljno vremena antioksidacijskom liječenju da spasi život te iz tog razloga preporučujemo njegovu profilaktičku primjenu u prva 24 sata od otrovanja AlP-om.

The omphalomesenteric duct (OMD) usually involutes by the ninth gestational week. If this obliteration fails, OMD remnant will result in different pathologies mostly in the pediatrics and infrequently in adults. The most well-known OMD remnant disease is Meckel's diverticulum. Omphalomesenteric cyst is rather rare, and their combination is even more exceptional with few cases in literature.We present an adolescent patient with nausea and vomiting and occasional periumbilical abdominal pain who was diagnosed with concurrent omphalomesenteric cyst and ileal diverticulum, causing internal hernia and bowel obstruction that underwent surgery.OMD remnants mostly present in childhood with symptoms of intestinal obstruction, and rarely internal hernias for which conservative management is usually not curative, warranting surgery. Imaging presence of cystic lesion in mid abdomen in young patient with bowel obstruction should raise the suspicion for OMD remnants. Presence of OMD cyst together with Meckel's diverticulum necessitates more extensive resection, rare concurrence which is better to be prepared for in advance.Preoperative radiologic workup is helpful to diagnose the obstruction and its probable cause. Presence of periumbilical cyst should raise the suspicion of OMD remnant specially in young adults with previous episodes of crampy abdominal pain and obstruction without history of abdominal surgery. Being familiar with possible concurrence of OMD cyst and Meckel's diverticulum will increase preparedness at the time of surgery.

Many studies have been shown that maternal stress during pregnancy and in early life period influences offspring in the behavioral and molecular aspects in human and animal models. Recent research has indicated that the environmental condition of males before conception has effects on next generations. We evaluated whether preconception paternal stress (PPS) could influence on hippocampal glucocorticoid receptor gene (GR), (NR3C1) expression, corticosterone response and behavioral outcomes of their offspring. For this purpose, adult male rats were subjected to daily 10min session of forced swimming for 21 consecutive days. Then, two parental breeding groups were formed: stressed father (SF) and non-stressed father (NSF) or control group. 30-day-old pups were tested for anxiety-like behavior by using the elevated plus maze (EPM). Serum corticosterone level was also measured by ELISA. Hippocampal NR3C1 DNA methylation, gene and protein expression were respectively assayed by methylation sensitive restriction enzymes (Real Time PCR), Reverse Transcriptase PCR (RT-PCR) and Western-blotting in all groups. More anxiety-related behavior, serum corticosterone concentration, DNA methylation levels of NR3C1 and lower expression of this gene were significantly observed in paternally stressed pups compared to control pups. As well, molecular changes were more pronounced in male pups compared to female pups. Our results revealed that paternal stress prior to conception has a negative effect on molecular, hormonal and behavioral outcomes in their offspring.

Highlights • A 33 year-old woman presented with a mass in her upper abdomen. • Non-mobile fullness palpated in her epigastric region and left upper quadrant of the abdomen without any tenderness or abdominal guarding. • Pathology assessment reported a neoplasm composed of various tissues including skin, respiratory mucosa, gastrointestinal mucosa, fat, smooth muscle, hyaline cartilage, peripheral nerves and ganglions along with vast areas indicative of previous bleeding with aggregation of hemosiderin. The final diagnosis was made as a mature cystic teratoma with no evidence of malignancy or immature components., Background Mature cystic teratoma is one of the most common tumors of the ovaries; however, primary retroperitoneal lesions are rare entities in adults. Case summary We report a case of a 33 year-old woman noticing a mass in her epigastric and left upper abdominal region without any specific signs and symptoms. Radiological evaluation revealed a retroperitoneal mass with extension from the posterior aspect of the pancreas to the pelvic cavity, composed of calcifications and cystic elements. Conclusion The tumor was resected through a midline laparotomy and the pathology report confirmed the diagnosis of a mature cystic teratoma with no evidence of malignancy or immature components.

The most common malignant neoplasm of the head and neck region is laryngeal cancer which presents a significant international health problem. The present study aims to screen potential proteins related to laryngeal cancer by network analysis to further understanding disease pathogenesis and biomarker discovery. Differentially expressed proteins were extracted from literatures of laryngeal cancer that compare proteome profiling of patient›s tissue with healthy controls. The PPI network analyzed for up and down regulated proteins with Cytoscape Version 3.4. After PPI construction, topological properties of the two networks have been analyzed. Besides, by using MCODE. the Gene Ontology (GO) analysis, the related modules and pathways were examined. Our study screened 275 differentially changed proteins, including 136 up- and 139 down-regulated proteins. For each network, it has been considered 20 key proteins as hub and 20 as bottleneck. A number of 26 hub-bottleneck nodes is introduced for the two networks. A total of 11 modules including 6 downregulated and 5 upregulated network modules were obtained. The most significant GO function in the significant upregulated module was the RNA processing, and the most significant one in the downregulated module with highest score was the respiratory electron transport chain. Among 275 investigated proteins, 12 crucial proteins are determined that 4 of them can be introduce as a possible biomarker panel including YWHAZ, PPP2R1A, HSP90AA1, and CALM3 for human laryngeal cancer.

To compare the outcomes of a modified laparoscopic intraluminal stenting with the conventional laparatomic technique in patients with esophageal caustic injuries. A total of 103 patients with esophageal burns were included in this retrospective analysis. Patients were candidates for esophageal stenting to prevent future stenosis. According to patient preference, stenting was done with either the innovatory stent with the modified technique (52 patients) or the conventional method that required laparotomy (51 patients). The modified technique consists of placing an inflation balloon stent via laparoscopy. Overall mortality and complications after follow-up period (3 months) were compared between the two groups. Two perioperative mortalities were seen, one in each group. Except one patient in the modified technique, all patients returned to normal intake after 3 months of follow-up. However, five patients of the modified group and three in the conventional group developed esophageal strictures (p > 0.05). Gastric outlet obstruction was observed in three patients of the modified group and one in the conventional group (p > 0.05). DeMeester scores showed that there was no gastro-esophageal reflux in both groups (p > 0.05). Our results show that the modified technique can reach the efficacy of the conventional method without requiring laparotomy. Thus, far several studies have demonstrated the advantages of laparoscopy over laparotomy. Thus, and in line with the clinical guidelines of the Society of American Gastrointestinal and Endoscopic Surgeons, we recommend using the presented modified technique in patients with caustic esophageal injuries.

Acute pancreatitis is characterized by activation of digestive enzymes inside the pancreas. In severe pancreatitis, necrosis of pancreas and surrounding tissues may occur. Acute necrotizing pancreatitis commonly presents as pancreatic abscess occasionally with systemic complications. Rarely, necrotic tissue may be drained from scrotum due to retroperitoneal extension of necrotic process. Here, we report a case of acute necrotizing pancreatitis in a 29-year-old man who presented with severe abdominal pain, nausea and vomiting. A computerized tomography (CT) scan confirmed necrotizing pancreatitis with multiple abscesses spreading bilaterally in the pelvic cavity. Several surgical operations were performed, including necrosectomy and drainage. Subsequently, the patient developed a scrotal abscess, which was drained surgically. The patient's condition was complicated by pleural effusion, acute respiratory distress syndrome, colocutaneous and scrotal fistulas, and incisional hernia. It seems that the scrotal abscess is a very rare complication of necrotizing pancreatitis.

Aim: The aim of this study is to investigate the Protein-Protein Interaction Network of Celiac Disease. Background: Celiac disease (CD) is an autoimmune disease with susceptibility of individuals to gluten of wheat, rye and barley. Understanding the molecular mechanisms and involved pathway may lead to the development of drug target discovery. The protein interaction network is one of the supportive fields to discover the pathogenesis biomarkers for celiac disease. Material and methods: In the present study, we collected the articles that focused on the proteomic data in celiac disease. According to the gene expression investigations of these articles, 31 candidate proteins were selected for this study. The networks of related differentially expressed protein were explored using Cytoscape 3.3 and the PPI analysis methods such as MCODE and ClueGO. Results: According to the network analysis Ubiquitin C, Heat shock protein 90kDa alpha (cytosolic and Grp94); class A, B and 1 member, Heat shock 70kDa protein, and protein 5 (glucose-regulated protein, 78kDa), T-complex, Chaperon in containing TCP1; subunit 7 (beta) and subunit 4 (delta) and subunit 2 (beta), have been introduced as hub-bottlnecks proteins. HSP90AA1, MKKS, EZR, HSPA14, APOB and CAD have been determined as seed proteins. Conclusion: Chaperons have a bold presentation in curtail area in network therefore these key proteins beside the other hub-bottlneck proteins may be a suitable candidates biomarker panel for diagnosis, prognosis and treatment processes in celiac disease.

Introduction: Diabetic retinopathy (DR) is a serious microvascular complication of diabetes which can cause vision loss or blindness ultimately. Non enzymatic glycation of proteins leads to advanced glycation end products (AGEs) in DR. Since laser therapy is a well-established method, in this study, protein-protein interaction (PPI) network is applied for protein targets in DR disease in rats treated by laser. Methods: In this study, we focused on articles that investigated and compared the proteome profiles of DR rats with healthy control and also DR rats before and after laser therapy. The networks of related differentially expressed proteins were explored using Cytoscape version 3.3.0, the PPI analysis methods and ClueGO. Results: Analysis of PPI network of 37 related proteins to DR rats including 108 nodes, introduced 10 hub-bottleneck proteins and 5 concerned biochemical pathways. On the other hand, PPI analysis of related proteins to DR rats before and after laser therapy corresponded to 33 proteins and 2 biological pathways. Discussion: Centrality and cluster screening identified hub-bottelneck genes, including Aldoa, HSPD1, Pgam2, Mapk3, SLC2A4, Ctnnb1, Ywhab, HSPA8, GAPDH and Actb for DR rats versus healthy control and ENO1, Aldoa, GAPDH for DR samples after laser therapy. Conclusion: Gene expression analysis of the DR samples treated via laser therapy provides a molecular evidence in support of the therapeutic effect of laser.

BACKGROUND Ingrowing toenail is one of the most common nail complaints. Although many surgical treatments are described for complicated nails, frequent recurrence of pain and postoperative disability necessitate finding an appropriate treatment. METHODS In a clinical trial, we compared the Winograd and sleeve (gutter) surgical methods to find a simple, painless, and practical alternative. RESULTS Of 100 patients (mean 27.8) included in the study, 50 underwent Winograd surgery and the rest the sleeve method. Postoperative infection occurred in four (8%) patients in the sleeve and three (6%) in the Winograd group. The condition reoccurred in five (10%) patients who underwent sleeve surgery and six (12%) who underwent Winograd. Recurrence rate was higher in female patients, although the difference was not statistically significant. Mean surgery duration for Winograd and sleeve methods was 15.7 minutes and 9.4 minutes, respectively, and postoperative work day loss was 2.0 weeks and 1.1 weeks, respectively. CONCLUSION The sleeve method seems to be more practical and appropriate for patients planning to go back to work sooner and better fulfills the main characteristics for the primary treatment of choice. The authors have indicated no significant interest with commercial supporters.

Objective Over 5% of the world's population suffers from disabling hearing loss. Stem cell homing in target tissue is an important aspect of cell-based therapy, which its augmentation increases cell therapy efficiency. Deferoxamine (DFO) can induce the Akt activation, and phosphorylation status of AKT (p-AKT) upregulates CXC chemokine receptor-4 (CXCR4) expression. We examined whether DFO can enhance mesenchymal stem cells (MSCs) homing in noise-induced damaged cochlea by PI3K/AKT dependent mechanism. Materials and methods Mesenchymal stem cells were treated with DFO. AKT, p-AKT protein and hypoxia inducible factor 1- α (HIF-1α) and CXCR4 gene and protein expression was evaluated by RT- PCR and Western blot analysis. For in vivo assay, rats were assigned to control, sham, noise exposure groups without any treatment or receiving normal, DFO-treated and DFO +LY294002 (The PI3K inhibitor)-treated MSCs. Following chronic exposure to 115 dB white noise, MSCs were injected into the rat cochlea through the round window. Number of Hoechst- labelled cells was determined in the endolymph after 24 hours. Results Deferoxamine increased P-AKT, HIF-1α and CXCR4 expression in MSCs compared to non-treated cells. DFO pre-conditioning significantly increased the homing ability of MSCs into injured ear compared to normal MSCs. These effects of DFO were blocked by LY294002. Conclusions Pre-conditioning of MSCs by DFO before transplantation can improve stem cell homing in the damaged cochlea through PI3K/AKT pathway activation.

The traditional autopsy is unpleasant for the family members of the dead person. The aim of this study was to assess abdominal traumas by a laparoscope and to determine the accuracy of laparoscopic examination in comparison with the traditional autopsy.From December 2004 through August 2005, 50 fresh cadavers (24 hours old) of blunt trauma victims were selected. They were first assessed by a laparoscope for intraperitoneal and retroperitoneal organs and then the traditional autopsy was performed as gold standard. The organs were assessed regarding the nature and intensity of damages and the results were compared with laparoscopic findings. The diagnostic accuracy of laparoscope was determined for each case with 95% confidence intervals (CIs) using Fisher's exact test.The accuracy for investigation of intraperitoneal and retroperitoneal organs and the overall accuracy values were significant. The accuracy of laparoscope for detecting intraperitoneal organ damage was 90% (95%CI of 81.7%to 94.8%) while for the retroperitoneal organs was 92% (95%CI of 84.7% to 96%). The overall accuracy of laparoscope was 84% (with 95%CI of 74.3% to 90.5%).The sensitivity and specificity of laparoscopic examination for intraperitoneal organs are acceptable but its accuracy for retroperitoneal organs is lower. Therefore, it seems that laparoscopic examination is an eligible substitute for the traditional autopsy.