Pulmonary sequestration: A rare case in a patient with acute chest pain and palpitation mimicking the acute coronary syndrome

Pulmonary sequestration (PS), a non-functioning lung tissue, which lacks the normal communication with the tracheobronchial tree and receives the blood supply from the systemic circulation, is a rare congenital malformation that comprises 0.5-6% of all congenital pulmonary malformations. The presentation of PS with chest pain is very rare. In this article, we are aimed to report the case of a patient with chief complaints of retrosternal chest pain and palpitation, which was suspected to be of cardiac origin. Primary evaluations including exercise tolerance test, 48-hour holter monitoring, coronary angiography ruled out any cardiac problem. Further evaluations with Thoracic CT scan revealed a cystic mass in the retrocardiac region of the lung. Thoracotomy surgery was done and the patient was finally diagnosed to be extralobar pulmonary sequestration

Familial Alzheimer’s Disease Mutations within the Amyloid Precursor Protein Alter the Aggregation and Conformation of the Amyloid-β Peptide* * This work was supported by National Institutes of Health Grants AG033069 and AG00538 and a grant from the Cure Alzheimer’s fund. The authors declare that they have no conflicts of interest with the contents of this article. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Most cases of Alzheimer's disease (AD) are sporadic, but a small percentage of AD cases, called familial AD (FAD), are associated with mutations in presenilin 1, presenilin 2, or the amyloid precursor protein. Amyloid precursor protein mutations falling within the amyloid-β (Aβ) sequence lead to a wide range of disease phenotypes. There is increasing evidence that distinct amyloid structures distinguished by amyloid conformation-dependent monoclonal antibodies have similarly distinct roles in pathology. It is possible that this phenotypic diversity of FAD associated with mutations within the Aβ sequence is due to differences in the conformations adopted by mutant Aβ peptides, but the effects of FAD mutations on aggregation kinetics and conformational and morphological changes of the Aβ peptide are poorly defined. To gain more insight into this possibility, we therefore investigated the effects of 11 FAD mutations on the aggregation kinetics of Aβ, as well as its ability to form distinct conformations recognized by a panel of amyloid conformation-specific monoclonal antibodies. We found that most FAD mutations increased the rate of aggregation of Aβ. The FAD mutations also led to the adoption of alternative amyloid conformations distinguished by monoclonal antibodies and resulted in the formation of distinct aggregate morphologies as determined by transmission electron microscopy. In addition, several of the mutant peptides displayed a large reduction in thioflavin T fluorescence, despite forming abundant fibrils indicating that thioflavin T is a probe of conformational polymorphisms rather than a reliable indicator of fibrillization. Taken together, these results indicate that FAD mutations falling within the Aβ sequence lead to dramatic changes in aggregation kinetics and influence the ability of Aβ to form immunologically and morphologically distinct amyloid structures

Different muscle strategy during head/knee level of functional reaching-transporting task to decrease falling probability in postmenopausal women with osteoporosis

Abstract Background The reaching-transporting task as an essential daily activity impacts balance control and falling in older women. This study investigated the different muscle strategies during the head/knee level of the functional reaching-transporting task in postmenopausal women with osteoporosis. Methods 24 postmenopausal volunteers were classified into two groups based on the lumbar T-score: osteoporosis (≤ -2.5, n = 12) and non-osteoporosis (> –1, n = 12). Using a custom-designed device, participants randomly performed 12 reaching-transporting tasks at the head and knee levels. Electromyography signals were collected while reaching and transporting phases with a wireless system. The peak of the root means square (PRMS) and time to PRMS (TPRMS) were measured. In addition, the isometric muscle strength and the fear of falling were assessed. Results The isometric muscle strength in the osteoporotic group was significantly lower than in the non-osteoporotic group (P < 0.05), except for vastus lateralis (VL). The PRMS of VL, (P = 0.010) during the reaching phase and VL (P = 0.002) and gastrocnemius lateralis (GL) (P < 0.001) during transporting phase was greater than the non-osteoporotic group. The PRMS value of the muscles was greater for reaching-transporting at the knee level than the head level; this increase was significant just for VL and biceps femoris during the transporting phase (P = 0.036 and P = 0.004, respectively). Conclusion Osteoporotic women have more muscle activities during the reaching-transporting task, especially at the knee level, compared to the head level. Their muscle weakness may lead to insufficient stability during the task and cause disturbance and falling, which requires further investigation

Post-transplantation diabetes mellitus; frequency and related risk factors: A single center study

Post-transplantation Diabetes Mellitus (PTDM) is a serious complication after organ transplantation, which could lead to cardiovascular morbidity and mortality. The rate of PTDM increased in recent years, probably due to new immunosuppressive drugs such as Tacrolimus. In this study, we retrospectively evaluated the frequency of PTDM and related risk factors in 644 non diabetic patients who underwent renal transplantation. Data was analyzed by chi-square and Fisher&#x2032;s exact test in SPSS software ver11.5. Among 644 patients PTDM developed in 10.2&#x0025; similar to literature. PTDM was significantly correlated to age (P value = 0.000), positive familial history (P= 0.003) and HBV infection (P= 0.046). In conclusion, PTDM is not uncommon in Iranian patients and a positive family history of diabetes, HBV infection and older age increases the likelihood to develop PTDM

Monoclonal Antibodies against Aβ42 Fibrils Distinguish Multiple Aggregation State Polymorphisms in Vitro and in Alzheimer Disease Brain*

Amyloidogenic proteins generally form intermolecularly hydrogen-bonded β-sheet aggregates, including parallel, in-register β-sheets (recognized by antiserum OC) or antiparallel β-sheets, β-solenoids, β-barrels, and β-cylindrins (recognized by antiserum A11). Although these groups share many common properties, some amyloid sequences have been reported to form polymorphic structural variants or strains. We investigated the humoral immune response to Aβ42 fibrils and produced 23 OC-type monoclonal antibodies recognizing distinct epitopes differentially associated with polymorphic structural variants. These mOC antibodies define at least 18 different immunological profiles represented in aggregates of amyloid-β (Aβ). All of the antibodies strongly prefer amyloid aggregates over monomer, indicating that they recognize conformational epitopes. Most of the antibodies react with N-terminal linear segments of Aβ, although many recognize a discontinuous epitope consisting of an N-terminal domain and a central domain. Several of the antibodies that recognize linear Aβ segments also react with fibrils formed from unrelated amyloid sequences, indicating that reactivity with linear segments of Aβ does not mean the antibody is sequence-specific. The antibodies display strikingly different patterns of immunoreactivity in Alzheimer disease and transgenic mouse brain and identify spatially and temporally unique amyloid deposits. Our results indicate that the immune response to Aβ42 fibrils is diverse and reflects the structural polymorphisms in fibrillar amyloid structures. These polymorphisms may contribute to differences in toxicity and consequent effects on pathological processes. Thus, a single therapeutic monoclonal antibody may not be able to target all of the pathological aggregates necessary to make an impact on the overall disease process

The Effect of Low-Dose Remifentanil on the Hemodynamic Responses of Endotracheal Extubation

Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. We have examined the effect of remifentanil on the hemodynamic response to the emergence from anesthesia and tracheal extubation. In a double-blind, randomized trial, we enrolled 50 adult patients undergoing abdominal surgery. All patients received a standard general anesthetic comprising propofol, atracurium and 1% isoflurane with 50% nitrous oxide in oxygen. At the end of surgery, a bolus dose of remifentanil 0.2 microgram/kg (n = 25) or saline placebo (n = 25) was given and tracheal extubation was performed when standard criteria were achieved. Arterial pressure and heart rate were measured non-invasively, immediately after tracheal extubation and then at 1-min intervals. Remifentanil attenuated the increase in both systolic and diastolic arterial pressure and heart rate after extubation compared to the control group. No differences in SpO2, cough and laryngospasm were observed between two groups. Use of a low-dose remifentanil has clinically acceptable effect in blunting the cardiovascular changes induced by tracheal extubation

Effect of an educational program on awareness about peritoneal dialysis among patients on hemodialysis

Several years after the initial usage of continuous ambulatory peritoneal dialysis (CAPD), the percentage of patients using this continues to be very low constituting about 15&#x0025; of all patients with end-stage renal disease (ESRD). In this study, we attempt to define the impact of an educational program for improving the use of CAPD. This is a quasi-experimental study (before-after) conducted with educational materials including workshop, teaching by booklet and showing educational films, performed in Urmia, Iran. We designed a questionnaire for data col-lection and enrolled 160 patients with an aim-based sampling method. We used descriptive sta-tistics and Friedman test for analysis in SPSS software version 11.5. The overall patients&#x2032; infor-mation about CAPD defined by total scoring was as follows: 75&#x0025; had little information; 19&#x0025; had moderate information and 6&#x0025; of patients were well informed. All the information levels increased after intervention. Our study suggests that the poor utilization of CAPD is due to relative un-awareness about PD and/or lack of adequate facilities

Thematic analysis of iranian female adolescents′ perceptions about hiv/aids: A qualitative study

Background: HIV/AIDS continues to be a major global health problem. The aim of this study was to evaluate common opinions and beliefs about HIV/AIDS among Iranian teenager girls. Methods: This Qualitative study (face-to-face interviews with tape recording) was conducted among fifty female teenager school students in Urmia-Iran. Results: The thematic analysis indicated the main information sources for HIV/AIDS among teenage girls to be their mother and teachers. The participants had little concern about the dissemination of HIV/AIDS in Iran. Using a common syringe is mentioned as the main risk factor for HIV transmission. There were some misconceptions about the at-risk group among teenage girls. Conclusions: Considering the misconceptions among the teenage girls, their beliefs should be reformed and reorganized in order to reduce the risk of exposure to HIV. The best practice is training life skills in the school level

Frequency of occurrence of vesico-ureteral reflux in kidney transplanted patients with the new technique of uretero-neo- cystostomy (Barry-Taguchi)

There are several ways of performing vesico-ureteral anastomosis in kidney trans-plantation (Tx); they are broadly classified into two categories: extra-vesical and intra-vesical. Extra-vesical methods are preferred in kidney transplantation. In this study, we attempt to integ-rate two extra-vesical techniques of Barry and Taguchi and to evaluate the frequency of occu-rrence of vesico-ureteral reflux (VUR) with this technique. Also, an attempt is made to compare the results with other techniques reported in the literature. Fifty consecutive transplant recipients, who underwent uretero-neo-cystostomy (uretero-vesical anastomosis) by the new technique of Barry-Taguchi were evaluated for VUR by sonography and cystoureterography, six months after Tx. The mean age of the study subjects was 34.8 years; there were 33 males and 17 females. The mean time between Tx and evaluating for VUR was 6.6 months. Two cases of asymptomatic VUR (4&#x0025;) were detected at the end of the study period. The occurrence of 4&#x0025; asymptomatic VUR suggests that this technique is more acceptable compared to others. Because of the simple nature of the procedure as well as the short time required, this technique could be a suitable choice in kidney transplantation

Clearance of transaminases during normothermic ex situ liver perfusion.

BackgroundOne of the most promising applications of liver normothermic machine perfusion (NMP) is the potential to directly assess graft viability and injury. In most NMP studies, perfusate transaminases are utilized as markers of graft injury. Our aim was to further elucidate the metabolism of transaminases by healthy porcine livers during NMP, specifically whether such livers could clear circuit perfusate transaminases.MethodsA highly concentrated transaminase solution was prepared from homogenized liver, with an aspartate aminotransferase (AST) level of 107,427 U/L. Three livers in the treatment group were compared to three controls, during 48 hours of NMP. In the treatment group, the circuit perfusate was injected with the transaminase solution to artificially raise the AST level to a target of 7,500 U/L. Perfusate samples were taken at two-hour intervals and analyzed for biochemistry until NMP end. Graft oxygen consumption and vascular parameters were monitored.ResultsCompared to controls, treated perfusions demonstrated abrupt elevations in transaminase levels (p>0.0001) and lactate dehydrogenase (LDH) (p>0.0001), which decreased over time, but never to control baseline. Liver function, as demonstrated by lactate clearance and oxygen consumption was not different between groups. The treatment group demonstrated a higher portal vein resistance (p = 0.0003), however hepatic artery resistance was similar. Treated livers had higher bile production overall (pConclusionsAddition of high levels of transaminases and LDH to a healthy porcine liver during ex situ perfusion results in progressive clearance of these enzymes, suggesting preserved liver metabolism. Such tolerance tests may provide valuable indicators of prospective graft function