Pregnancy associated plasma protein-A (PAPP-A) as an early marker for the diagnosis of acute coronary syndrome.

Aims and objectives Pregnancy associated plasma protein-A (PAPP-A), a metalloproteinase plays a pivotal role in the pathogenesis of atherosclerosis. Recent studies have reported that elevated levels of PAPP-A, signal the onset of acute coronary syndrome (ACS). We, therefore, proposed to study the analytical competence of PAPP-A in patients admitted to the emergency department with chest pain and finally diagnosed as ACS. Methods and results Pregnancy associated plasma protein-A was measured using enzyme-linked immunosorbent assay (ELISA) in 485 patients admitted to emergency care unit, of which 89 patients were diagnosed as Non-cardiac chest pain (NCCP). Elevated levels of PAPP-A were observed in patients diagnosed as ACS on comparison with the controls. Receiver operator characteristic (ROC) curve analysis showed PAPP-A to be a good discriminator between ischaemic and non-ischaemic patients. The area under the curve was found to be 0.904, 95% CI (0.874–0.929) with 90% sensitivity and 85% specificity (P< 0.0001). The cut-off value from the ROC curve was 0.55 μg/mL above which PAPP-A was considered to be positive. Conclusion Pregnancy associated plasma protein-A seems to be a promising biomarker for identification and risk stratification for patients with ACS

Current understanding on venous leg ulcer

Venous leg ulcer (VLU) or stasis ulcer is a relatively common, chronic and recurring problem. Besides being costly to the health-care system, it significantly impairs the quality of life of the patients. Nearly 1% of adults and 3.6% of older patients are reported to suffer from this chronic condition. Chronic venous insufficiency is considered to be the predominant cause of VLU. The most recent theories associate the pathogenesis of venous ulcer with microcirculatory abnormalities and generation of an inflammatory response. The pharmacological treatment for VLU is based on the pathogenesis and often includes diosmin, pentoxifylline, diuretics as well as antibiotics and the non-pharmacological treatment like compression and skin grafting. VLU has a high rate of recurrence and requires self-care to avoid relapse. Treatment of VLU should always focus for complete treatment, and improve quality of life for patients along with minimum relapse. In recent years novel therapeutic approaches for venous ulcers have offered valuable tools for the management of patients with this disorder

Complete resolution of gastric amyloidosis after autologous stem cell transplantation.

A 48-year-old female with multiple myeloma (MM) and amyloidosis presented with massive upper gastrointestinal (GI) bleeding one week after autologous stem cell transplantation (autologous-SCT). Esophagogastroduodenoscopy (EGD) demonstrated necrotic, purple, pigmented, friable lesions throughout the stomach (Figure 1a), along with a bleeding ulcer in the cardia (Figure 1b, Video 1) which was successfully treated with epinephrine (1:10,000) injections. Biopsies demonstrated nodular amyloid deposition (Figures 2) which was Congo red positive. The patient had no further hematemesis and was discharged home 4 days later. Ten months after autologous-SCT, EGD revealed a normal stomach (Figure 3, Video 2) with no histologic evidence of amyloid

Structural Studies of Cu(II) & Ni(II) Complexes with a Chiral Schiff Base

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Second-order Democratic Aggregation

Aggregated second-order features extracted from deep convolutional networks have been shown to be effective for texture generation, fine-grained recognition, material classification, and scene understanding. In this paper, we study a class of orderless aggregation functions designed to minimize interference or equalize contributions in the context of second-order features and we show that they can be computed just as efficiently as their first-order counterparts and they have favorable properties over aggregation by summation. Another line of work has shown that matrix power normalization after aggregation can significantly improve the generalization of second-order representations. We show that matrix power normalization implicitly equalizes contributions during aggregation thus establishing a connection between matrix normalization techniques and prior work on minimizing interference. Based on the analysis we present {\gamma}-democratic aggregators that interpolate between sum ({\gamma}=1) and democratic pooling ({\gamma}=0) outperforming both on several classification tasks. Moreover, unlike power normalization, the {\gamma}-democratic aggregations can be computed in a low dimensional space by sketching that allows the use of very high-dimensional second-order features. This results in a state-of-the-art performance on several datasets

Isolated bilateral simplex ureteric ectopia: Bladder capacity as an indicator of continence outcome

INTRODUCTION: Isolated bilateral simplex ectopic ureters (BSEUs) are rare but pose a therapeutic challenge: ureteric reimplantation alone does not accomplish continence in all. Identifying the patients needing additional procedures for continence early could prevent multiple operations. OBJECTIVE: Potential preoperative indicators for postoperative continence are explored in eight BSEU girls without cloacal, anorectal, or spinal anomalies. STUDY DESIGN: With institutional approval, all patients with BSEU between 1985 and 2012 were retrospectively reviewed. Cystoscopy determined the site of ureteric ectopia (6 of 16 at the bladder neck [BN], 5 of 16 below the BN, and 5 of 16 in the distal urethra). Bladders were assessed by a combination of ultrasound, urodynamics, micturating cystourethrogram, cystoscopic, and intraoperative observations. Expected bladder capacity for age (EBCA) was calculated by 30 ml + (30 ml × age in years) or 38 ml + (2.5 ml × age in months) for children greater or less than 2 years, respectively. Continence outcomes were appraised at a minimum of 4 years. The small number of patients precludes credible statistical analysis and therefore raw data are presented. RESULTS: Patients underwent cross-trigonal ureteric reimplantation at 1–5.5 years, in five without BN surgery and in three with a Young–Dees–Leadbetter BN tightening. Of those without BN surgery at reimplantation, four achieved satisfactory continence for their age, but one has had multiple procedures culminating in BN closure, ileocystoplasty, and Mitrofanoff. Among the BN-tightening group, one was in nappies at 4 years, one had residual stress incontinence after two further BN injections, and one proceeded to artificial urinary sphincter after two BN injections. Five patients had significant renal impairment. DISCUSSION: Patients with satisfactory continence after reimplantation alone and those needing further procedures tended to differ in their preoperative observations of bladder capacity and apparent BN competence. This study suggests preoperative observations of an empty bladder on serial ultrasound and/or a wide-open BN with small or even moderate bladder capacity at cystoscopy to indicate the need for BN surgery. In contrast, children with bladder filling to at least 30% of expected bladder capacity for age on preoperative ultrasound or apposition of the BN at cystoscopy may achieve satisfactory continence after ureteric reimplantation alone. Bladder capacity as an indicator of BN competence can also be correlated to continence outcomes in previously published series. Polyuria associated with renal impairment can exacerbate the challenge for continence. CONCLUSION: Preoperative bladder capacity appears to be an indicator of inherent BN function and a thorough assessment of the urinary tract by cystoscopy, ultrasound, micturating cystourethrogram, and functional imaging may guide the surgeon on the need for BN surgery at the time of ureteric reimplantation. Where continence remains elusive, patients should be counselled that a further BN injection is occasionally of value although more significant BN procedures are required for most