Exploring firm level market knowledge competence and its implications for the speed and success of export expansion : a mixed methodology study from the software industry

fi=vertaisarvioitu|en=peerReviewed

Effects of Transshenoidal Surgery on Patients with Nonfunctioning Pituitary Tumours

Objective:   The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral adenohypophyseal hormones. In addition, the pituitary hormones have also been measured directly in the adenoma tissue following its surgical removal. Materials and Methods:  The present study initially included 22 consecutive patients 18 men and 4 women, of 22-55 (44 ± 2.3) years of age operated for NFMA between 2005 and 2008 at Lahore General Hospital, Lahore. Three of these patients 2 men and 1woman died during the follow-up period and were excluded from the study.  Results:  Radiological imaging revealed a macroadenoma in all patients, with suprasellar extension in 96% and parasellar/infrasellar extension in 32% of cases. Visual field defects were present in 95% of the patients and improved in 84% of cases after surgery (complete recovery 3/19 (15%); partial recovery 13/19 (68%). The results demonstrate that in a subset of 4 of the 16 male patients with NFPAs the presurgical serum FSH values (45.1 ± 0.7 mIU/ml) were markedly and significantly greater than those of the remaining 12 patients (7.9 ± 0.7 mIU/ml) and of control subjects (8.8 ± 0.6 mIU/ml).  Conclusions:  The present study suggests that pituitary tumours diagnosed as NFPAs constitute a heterogenous group of adenomas with regard to their secretory activity of intact adenohypophyseal hormones. Whereas some of these adenomas activity may synthesize one or more pituitary hormones, peripheral concentrations may not be sufficient to produce overt clinical symptoms of hormone hypersecretion.&nbsp

Serum Hormone Levels of Prolactin and Prolactin Content of Nonfunctioning Pituitary Adenomas and Normal Pituitary Glands

Objective and Study Design:   The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral prolactin (PRL) hormone. In addition, the pituitary PRL hormone has also been measured directly in the adenoma tissue following its surgical removal and in the normal pituitary glands. Material and Methods:  The present study is based on 19 patients (16 males and 3 females), 30-50 year of age, diagnosed for NFPAs on the basis of clinical and radiological evidence. An equal number of age matched healthy subjects were included as controls.  Results:  The mean serum PRL concentration in male patients before removal of the adenoma were significantly higher (P<0.05) than values obtained after surgical removal of the adenoma and those of control subjects. In 5 of these 16 patients (PA1, PA10, PA14, PA28, PA30) serum PRL concentrations were markedly above the normal limit of circulating PRL levels (>17.0 ng/ml), the levels being ~ 2-fold of the mean control levels. The PRL levels returned to normal range following ablation of adenoma in these patients. The individual and mean serum PRL levels in the remaining 11 (68.75%) patients were in normal range before and after surgery.  Conclusions:  Taken together, the present data suggest that a significant proportion of NFPAs may actively synthesize and secrete pituitary hormones such as PRL, in amounts that may not be sufficient to produce any overt clinical signs of hormone hypersecretion

Takotsubo cardiomyopathy vs acute myocardial infarction: diagnostic utility of subtle ECG differences

The clinical findings of Takatsubo Cardiomyopathy and acute myocardial infarction can be very similar. While Takatsubo cardiomyopathy rarely leads to severe complications, acute myocardial infarction can be life threatening. Treatment of both these conditions is different and so it is imperative for clinicians to have a high index of suspicion for either. Several EKG differences between the two entities have been proposed. This article summarizes the EKG changes most likely seen in Takatsubo cardiomyopathy and compares them to those seen in Acute Myocardial infarction

Serum Resistin Levels and Related Genetic Variants Are Associated With Bone Mineral Density in Postmenopausal Women

Background: Osteoporosis is a multifactorial disorder and a number of genetic variants or loci responsible for bone mineral density (BMD) have been identified. Resistin, a novel adipokine has diverse role in human body including its function in bone remodeling. The objective of this study was to see the association of serum resistin levels and related genetic variants (rs3931020, rs13144478) with BMD in postmenopausal females. Methods: This comparative analytical study was conducted on postmenopausal osteoporotic (n=101), osteopenic (n=77) and non-osteoporotic (n=74) females. For comparison and correlational analysis, Kruskal-Wallis test and Spearman’s rho correlation were used respectively. Hardy-Weinberg equilibrium (HWE) was calculated by using Chi-square test (χ2). Results: There was significant difference in the serum levels of resistin (p &lt;0.001), among the three groups. Significant negative correlation of resistin was observed with BMD at various sites. Serum resistin levels were significantly low in the rs3931020 AA homozygous genotype (p = 0.010), and significantly high in the rs13144478 AT heterozygous genotype (p = 0.020), BMD at all sites except left femoral neck was significantly high in rs3931020 AA genotype, while BMD at lumbar spine, left hip and total BMD were significantly low in the rs13144478 TT homozygotes. Conclusion: High serum resistin levels are associated with low BMD and single nucleotide variation in rs3931020 and rs13144478 may lead to high serum resistin levels and low bone mineral density. Resistin can serve as a new genetic marker, potential therapeutic target and predictor of osteoporosis.</p

Amanita mansehraensis, a new species in section Vaginatae from Pakistan

A new species of Amanita subgenus Amanita sect. Vaginatae is described and illustrated based on material collected in pine forests in district Mansehra, Khyber Pakhtoonkhaw, Pakistan. Amanita mansehraensis is recognized by the presence of a light brown or light greyish olive pileus with strong brown or deep brown pileus center; non-appendiculate, rimose, sulcate or plicate striate pileus margin; subglobose to ellipsoid basidiospores; and a saccate volva. The internal transcribed spacer region (ITS) and large subunit of the nuclear ribosomal RNA gene (nrLSU) were used for the delimitation of this species based on sequence data. The evolutionary relationships of A. mansehraensis with other species of Amanita were inferred by means of Maximum Likelihood and Bayesian inferences of the nrLSU dataset and concatenated ITS+nrLSU dataset. Amanita mansehraensis is most closely related to A. brunneofuliginea, A. pseudovaginata, and the recently described A. glarea

Hyalopsora nodispora is the new holomorph name for Uredo capilli-veneris (Uredinales, Pucciniastraceae) from Pakistan

Hyalopsora sp. was collected on Adiantum capillus-veneris in the Himalayan moist temperate forest of Pakistan. The uredinial state of the fungus tallied with Uredo capilli-veneris is previously described from the same host plant. The new name H. nodispora is proposed for the holomorph. A key to rust species on Adiantum is presented based on the original description of specie

Secure Key Pre-distribution in Wireless Sensor Networks Using Combinatorial Design and Traversal Design Based Key Distribution

Security is an indispensable concern in Wireless Sensor Network (WSN) due to the presence of potential adversaries. For secure communication in infrastructureless sensor nodes various key predistribution have been proposed. In this paper we have evaluated various existing deterministic, probabilistic and hybrid type of key pre-distribution and dynamic key generation algorithms for distributing pair-wise, group-wise and network-wise keys and we have propose a key predistribution scheme using deterministic approach based on combinatorial design and traversal design which will improve the resiliency and achieve sufficient level of security in the network.This design can be used where large number of nodes are to be deployed in the WSN

Endoscopic Transsphenoidal Surgery for Acromegaly

Objective: The aim of this study was to determine the preoperative predictors of the extent of resection and endocrinological remission following endonasal endoscopic removal of growth hormone (GH) – secreting pituitary adenomas. Trans-sphenoidal surgery is the preferred treatment modality for growth hormone (GH) – secreting pituitary adenomas. In many series, the reported postoperative remission is based mainly on achieve-ment of GH levels less than 2 ng/ml. Strict criteria for insulin – like growth factor I normalization and even lower GH levels (&lt; 1 ng/ml) are now suggested to define cure of acromegaly, but the evidence does not yet support such low GH levels in epidemiological follow-up. We analyzed our postoperative results in a sample of local popu-lation with acromegaly. Methods: Seven patients harboring GH – secreting adenomas (07 macroadenomas) underwent transsphenoidal surgery between 2005 and 2007 in Lahore General Hospital. The patient group included 03 women and 04 men of 23 – 50 years of age. All the patients were operated for the first time. Biochemical remission was defined as a repeated fasting or glucose – suppressed GH level of 2 ng/ml or less, and a normal insulin – like growth factor I level. Results: The majority of acromegalic patients (83%) had macroadenomas &gt; 1 cm in maximum diameter. Gross – total resection was achieved in 05 (71%) of 07 patients. Notably, endoscopic transsphenoidal surgery allowed complete resection of all lesions without cavernous sinus invasion, regardless of the suprasellar extent. Biochemical remission was achieved in 06 (85%) of 07 patients. A postoperative reduction in GH serum levels were associated with a higher rate of biochemical cure (p &lt; 0.05). Significant differences were observed between pre- and postsurgical serum GH levels in male patients with Acromegalic tumors. Although mean serum GH concentrations were discernibly higher in patients as compared to controls (30.2 ± 3.1 vs 0.4 ± 0.1). In all the three premenopausal female patients included in the study, the individual presurgical serum GH levels were greater than those following surgery. The mean value was significantly higher than of the controls (38.9 ± 10.3 vs 0.2 ± 0.6 ng/ml, respectively).These values exceeded the normal serum GH concentrations described for healthy women (7 ng/ml or less). Following surgical removal of the adenoma, serum GH concentrations showed a marked decline of GH levels in all patients. Conclusion: A purely endoscopic endonasal trans-sphenoidal adenoma resection leads to a high rate of gross – total tumor resection and endocrinological remission in acromegalic patients, even those harboring macro-adenomas with wide suprasellar extension. Extended approaches and angled endoscopes are useful tools for increasing the extent of resection.&nbsp

Endocrine Accompaniments in Acromegaly Patients Before and After Surgery

Background and Aim: The aim of this study was to illustrate the present role of transsphenoidal surgery as primary therapy in GH – secreting adenomas. The present study was undertaken to assess the effect of surgical removal of adenoma on peripheral adenohypophyseal hormones. In addition, the pituitary hormones have also been measured directly in the adenoma tissue following its surgical removal.Methods: The present study is based on 07 patients (04 males and 3 females), 30-50 year of age, diagnosed for Functional Pituitary Adenomas (FPAs) on the basis of clinical and radiological evidence. An equal number of age matched healthy subjects were included as controls. Follicle stimulating hormone (FSH), thyroid stimulating hormone (TSH), growth hormone (GH) and prolactin (PRL) were determined in serum before and following trans-sphenoidal adenomectomy. The GH, FSH, TSH and PRL content of the excised adenoma tissue was also measured in male patients. All hormone determinations were carried out using commercially available immuno-assay kits (ELISA and IRMA) in duplicate.Results: The results demonstrate that the mean serum GH levels in the 04 male and 03 female patients with FPAs were found to be significantly higher before surgical removal as compared to those obtained following surgery. Significant differences were observed between pre- and postsurgical serum GH levels in male and female patients with FPA. GH content was also determined in the male adenoma tissue. Following removal of the adenoma in these 4 male and 03 female patients, peripheral serum GH levels fell within the normal range. The adenoma tissue GH content in patients with initial higher serum GH levels was also significantly greater than that of the other patients. The mean serum PRL concentration in male patients before removal of the adenoma and values obtained after surgical removal of the adenoma and those of control subjects were not significantly different. The mean PRL concentration of the adenoma tissue in all the male patients was not significantly different from the control pituitary tissue. However, the presurgical mean serum PRL concentration were significantly higher in 2 of the 3 female patients included in this study as compared to the control values. Following removal of adenoma, normal serum levels were attained in those patients. In the remaining one female patient serum PRL concentra-tion was within the normal range before and following surgical removal of the adenoma. The mean serum FSH levels in the 04 male patients with FPAs were not significantly different before and after surgical removal of ade-noma tissue. However, an examination of individual values reveals higher FSH levels in 02 of the male patients and in 01 of the three premenopausal female patients. Following surgical removal of the adenoma, serum FSH concentrations showed a marked decline of FSH levels in those patients. However, the remaining two females showed normal FSH levels before and after surgery. The adenoma FSH content of these patients was not signifi-cantly higher than those of the control pituitary tissue. No significant differences were observed between pre and post-surgical serum TSH levels. The TSH content of adenoma tissue was either non-detectable or in the low range as compared to the TSH content determined in control pooled pituitary tissue.Conclusion: Transsphenoidal surgery is thought to be an effective primary treatment for GH-secreting pituitary adenomas according to the most recent criteria of cure. Because the remission rate in cases with cavernous sinusEndocrine Accompaniments in Acromegaly Patients Before and After Surgery invasion is very low, early detection of the tumor before it extends into the cavernous sinus and a long-term endocrinological and radiological follow-up are necessary in order to improve the remission rate of acromegaly