Patients With Kidney Cancer

To develop a preoperative prognostic model in order to predict recurrence-free survival in patients with nonmetastatic kidney cancer.A multi-institutional data base of 1889 patients who underwent surgical resection between 1987 and 2007 for kidney cancer was retrospectively analyzed. Preoperative variables were defined as age, gender, presentation, size, presence of radiological lymph nodes and clinical stage. Univariate and multivariate analyses of the variables were performed using the Cox proportional hazards regression model. A model was developed with preoperative variables as predictors of recurrence after nephrectomy. Internal validation was performed by Harrells concordance index.The median follow-up was 23.6 months (1222 months). During the follow-up, 258 patients (13.7) developed cancer recurrence. The median follow-up for patients who did not develop recurrence was 25 months. The median time from surgery to recurrence was 13 months. The 5-year freedom from recurrence probability was 78.6. All variables except age were associated with freedom from recurrence in multivariate analyses (P 0.05). Age was marginally significant in the univariate analysis. All variables were included in the predictive model. The calculated c-index was 0.747.This preoperative model utilizes easy to obtain clinical variables and predicts the likelihood of development of recurrent disease in patients with kidney tumors

The Early Bronze Age figurine from Hasanoglan, central Turkey: New archaeometrical insights

The following article discusses the archaeometrical dimension of a well-known Early Bronze Age metal figurine from Hasanolan, Turkey, on permanent display in the Anatolian Civilisations Museum in Ankara. The transfer of the object to a new display case allowed for an examination with a portable X-ray fluorescence (P-XRF) device in order to reveal the chemical composition of the statuette and its attached ornaments. The figurine was confirmed to be made of silver. However, it is alloyed with a small but still substantial amount of copper. The applications are basically made of gold, but with a suspected substantial (up to 23% ) amount of silver involved. The final section of the article is dedicated to a critical comparison with recently published figurines from Alaca Hoÿük, together with an archaeological and chronological reappraisal of this unique piece of art. © 2016 The British Institute at Ankara

Pharmacokinetics of orally administered tetrahydrobiopterin in patients with phenylalanine hydroxylase deficiency

Summary: The oral loading test with tetrahydrobiopterin (BH4) is used to discriminate between variants of hyperphenylalaninaemia and to detect BH4-responsive patients. The outcome of the loading test depends on the genotype, dosage of BH4, and BH4 pharmacokinetics. A total of 71 patients with hyperphenylalaninaemia (mild to classic) were challenged with BH4 (20 mg/kg) according to different protocols (1 × 20 mg or 2 × 20 mg) and blood BH4 concentrations were measured in dried blood spots at different time points (T0, T2, T4, T8, T12, T24, T32 and T48 h). Maximal BH4 concentrations (median 22.69 nmol/g Hb) were measured 4 h after BH4 administration in 63 out of 71 patients. Eight patients presented with maximal BH4 concentrations ∼44% higher at 8 h than at 4 h. After 24 h, BH4 blood concentrations dropped to 11% of maximal values. This profile was similar using different protocols. The following pharmacokinetic parameters were calculated for BH4 in blood: t max = 4 h, AUC (T0−32) = 370 nmol × h/g Hb, and t 1/2 for absorption (1.1 h), distribution (2.5 h), and elimination (46.0 h) phases. Maximal BH4 blood concentrations were not significantly lower in non-responders and there was no correlation between blood concentrations and responsiveness. Of mild PKU patients, 97% responded to BH4 administration, while one was found to be a non-responder. Only 10/19 patients (53%) with Phe concentrations of 600-1200 μmol/L responded to BH4 administration, and of the patients with the severe classical phenotype (blood Phe > 1200 μmol/L) only 4 out of 17 patient responded. An additional 36 patients with mild hyperphenylalaninaemia (HPA) who underwent the combined loading test with Phe+BH4 were all responders. Slow responders and non-responders were found in all groups of HP

Non-equilibrium Condensation Process in a Holographic Superconductor

We study the non-equilibrium condensation process in a holographic superconductor. When the temperature T is smaller than a critical temperature T_c, there are two black hole solutions, the Reissner-Nordstrom-AdS black hole and a black hole with a scalar hair. In the boundary theory, they can be regarded as the supercooled normal phase and the superconducting phase, respectively. We consider perturbations on supercooled Reissner-Nordstrom-AdS black holes and study their non-linear time evolution to know about physical phenomena associated with rapidly-cooled superconductors. We find that, for T<T_c, the initial perturbations grow exponentially and, eventually, spacetimes approach the hairy black holes. We also clarify how the relaxation process from a far-from-equilibrium state proceeds in the boundary theory by observing the time dependence of the superconducting order parameter. Finally, we study the time evolution of event and apparent horizons and discuss their correspondence with the entropy of the boundary theory. Our result gives a first step toward the holographic understanding of the non-equilibrium process in superconductors.Comment: 20 pages, 7 figure

Giant coronary artery aneurysms in juvenile polyarteritis nodosa: a case report

Juvenile polyarteritis nodosa (PAN) is a rare, necrotizing vasculitis, primarily affecting small to medium-sized muscular arteries. Cardiac involvement amongst patients with PAN is uncommon and reports of coronary artery aneurysms in juvenile PAN are exceedingly rare. We describe a 16 year old girl who presented with fever, arthritis and two giant coronary artery aneurysms, initially diagnosed as atypical Kawasaki disease and treated with IVIG and methylprednisolone. Her persistent fevers, arthritis, myalgias were refractory to treatment, and onset of a vasculitic rash suggested an alternative diagnosis. Based on angiographic abnormalities, polymyalgia, hypertension and skin involvement, this patient met criteria for juvenile PAN. She was treated with six months of intravenous cyclophosphamide and high dose corticosteroids for presumed PAN related coronary vasculitis. Maintenance therapy was continued with azathioprine and the patient currently remains without evidence of active vasculitis. She remains on anticoagulation for persistence of the aneurysms. This case illustrates a rare and unusual presentation of giant coronary artery aneurysms in the setting of juvenile PAN

Egypt’s 2011–2012 parliamentary elections: Voting for religious vs. secular democracy?

This study investigates whether individuals’ attitudes towards democracy and secular politics have any influence on voting behavior in Egypt. Based on data from a survey conducted immediately after the Egyptian parliamentary elections in January 2012, this study finds that Egyptians’ attitudes towards democratic governance were quite negative around the parliamentary elections, yet Egyptians still endorsed democracy as the ideal political system for their country. However, empirical findings suggest that support for democracy has a limited impact on electoral results. On the other hand, the main division in Egyptian society around the first free and fair parliamentary elections was the religious-secular cleavage. As people support secular politics more, they become significantly less likely to vote for Islamist parties. These results illustrate that preferences in regard to the type of democracy – either a liberal and secular or a religious democracy – were the main determinant of the historic 2012 elections in Egypt

Metabolic Treatment of Wolfram Syndrome

Wolfram Syndrome (WS) is a very rare genetic disorder characterized by several symptoms that occur from childhood to adulthood. Usually, the first clinical sign is non-autoimmune diabetes even if other clinical features (optic subatrophy, neurosensorial deafness, diabetes insipidus) may be present in an early state and may be diagnosed after diabetes' onset. Prognosis is poor, and the death occurs at the median age of 39 years as a consequence of progressive respiratory impairment, secondary to brain atrophy and neurological failure. The aim of this paper is the description of the metabolic treatment of the WS. We reported the experience of long treatment in patients with this syndrome diagnosed in pediatric age and followed also in adult age. It is known that there is a correlation between metabolic control of diabetes, the onset of other associated symptoms, and the progression of the neurodegenerative alterations. Therefore, a multidisciplinary approach is necessary in order to prevent, treat and carefully monitor all the comorbidities that may occur. An extensive understanding of WS from pathophysiology to novel possible therapy is fundamental and further studies are needed to better manage this devastating disease and to guarantee to patients a better quality of life and a longer life expectancy