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Immature ovarian teratomas are a rare subtype of germ cell tumours characterized by the presence of embryonic elements, particularly primitive neuroepithelium, and they typically affect young women. We report the case of a 20-year-old woman who presented with a growing abdominal mass that turned out to be a grade II immature teratoma after adnexectomy. This article reviews the clinical presentation, imaging features, and some of the main problems that arise in the management of immature ovarian teratomas.

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Acute fatty liver of pregnancy (AFLP) is a specific but rare hepatopathy that can usually complicate the third trimester of pregnancy. It is potentially fatal for the mother and the fetus. To our knowledge, only eight cases of recurrence have been published, we report a new case. The first episode presented by our 23-year-old patient was suspected in front of a cutaneous-mucosal jaundice with vomiting occurring on pregnancy of 35weeks of gestation (WG). Hyperleucytosis, abnormalities of the hepatic balance, as well as a hypoglycemia were biological elements supporting the diagnostic beam. On the other hand, medical imaging could not bring a clear confirmation. The evolution was favorable after deferred delivery by caesarean section for pulmonary maturation. Three years later, she presented to the obstetrical emergency room at 36weeks and six days of gestation, with a clinical and biological picture almost similar to that of the first episode. A caesarean section was then indicated for suspicion of recurrence. The evolution is favorable for the mother and her children. The interest of the communication on the risk of recurrence, the clinical and biological monitoring in particular in the third trimester of the subsequent pregnancy are imperative, in order to improve the prognosis of this pathology.

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BACKGROUND: Some brain tumors such as ependymoma and Medulloblastoma have similar MR images which may result to undifferentiated them from each other. OBJECTIVE: This study aimed to compare the apparent diffusion coefficient (ADC) of two different cerebellar pediatric tumors, including ependymoma and medulloblastoma which have shown similar clinical images in conventional magnetic resonance imaging (MRI) methods. MATERIAL AND METHODS: In this analytical study, thirty six pediatric patients who were suspected to have the mentioned tumors according to their CT image findings were included in this study. The patients were subjected to conventional MRI protocols followed by diffusion weighted imaging (DWI) and ADC values of the tumors were calculated automatically using MRI scanner software. RESULTS: The mean (± SD) ADC value for ependymoma (1.2± 0.06 ×10-3 mm2/s) was significantly higher than medulloblastoma (0.87 ± 0.02 ×10-3 mm2/s) (p = 0.041). Moreover, the maximum ADC value of ependymoma was considerably different in comparison with medulloblastoma (1.4 ×10-3 mm2/s and 0.96×10-3 mm2/s, respectively; p = 0.035). Furthermore, the minimum ADC value of ependymoma was higher compared to medulloblastoma (1.0 ×10-3 mm2/s and 0.61×10-3 mm2/s, respectively), but there was not significant (p = 0.067). CONCLUSION: Evaluation of ADC values for ependymoma and medulloblastoma is a reliable method to differentiate these two malignancies. This is due to different ADC values reflected during the evaluation.

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Localized traveling-wave solutions to a nonlinear Schrödinger equation were recently shown to be a consequence of Fourier mode synchronization. The reduced dynamics describing mode interaction take the form of a phase model with novel ternary coupling. We analyze this model in the presence of quenched disorder and explore transitions to partial and complete synchronization. For both Gaussian and uniform disorder, first-order transitions with hysteresis are observed. These results are compared with the phenomenology of the Kuramoto model which exhibits starkly different behavior. An infinite-oscillator limit of the model is derived and solved to provide theoretical predictions for the observed transitions. Treatment of the nonlocal ternary coupling in this limit sheds some light on the model's novel structure.

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The objective of this study was to investigate the effect of a monocomponent protease and dietary inclusion of canola meal (CM) and poultry by-product meal (PBM) on growth performance, carcass characteristics and blood metabolites of turkeys fed on low crude protein (CP) diets from 28 to 55 d post hatch. Experimental treatments included control, maize-soybean meal diet including 258.3 g/kg CP; negative control 1 (NC1), maize-soybean meal diet with reduced CP (232.4 g/kg); NC2, control diet (CP, 258.3 g/kg) including CM (80 g/kg) and PBM (80 g/kg); NC3, maize-soybean meal diet with reduced CP (232.4 g/kg) including CM (80 g/kg) and PBM (80 g/kg). Also, the NC1 + P and NC3 + P diets were created by addition of protease enzyme (30 000 units/kg of diet) to the NC1 and NC3 diets, respectively. The NC3 group had lower body weight gain (BWG) compared to those fed on the control diet, and no improvement with enzyme addition (NC3 + P) was achieved. The protease addition to the NC1 diet (NC1 + P) improved BWG to the level of the control diet. The NC1 group had higher feed conversion ratio (FCR) compared to the control and NC3 + P, but protease addition to the NC1 diet improved FCR. Protease addition to the low CP diets resulted in higher nitrogen (N) retention than in the control and NC2 groups. Also, the NC1 + P and NC3 + P diets increased apparent ileal digestibility (AID) of CP compared to the control group. It was concluded that addition of CM (up to 80 g/kg) and PBM (up to 80 g/kg) to turkey diets had no negative effect on growth performance from 28 to 55 d of age. The NC1 + P group achieved the BWG of the control group which was partially due to increases in N retention and AID of CP, but the NC3 + P group failed to recover the growth losses. This difference implies that the efficacy of the protease may depend upon the protein source in the ration.

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1. Two trials were conducted to evaluate the effect of high-dose phytase alone or in combination with citric acid (CA) in the diet severely limited in available phosphorus (P) on performance, plasma P and plasma Ca of broilers from 22 to 42 d of age. 2. In Trial 1, 297 21-d-old female chicks were placed into 27 pens and allocated to 9 maize-soybean meal-based dietary treatments, which were a positive control [PC, 4.23 g/kg non-phytate P (NPP)] and 8 negative control (NC, 1.35 g/kg NPP) groups consisting of two concentrations of CA (0 and 20 g/kg) and 4 concentrations of phytase (0, 1000, 2000 and 4000 U/kg) in a 2 × 4 factorial arrangement. In Trial 2, 192 21-d-old male chicks were placed into 24 pens and allocated to 6 wheat-canola meal-based dietary treatments, which were a PC (4.2 g/kg NPP), a NC (1.68 g/kg NPP) and 4 NC groups consisting of two concentrations of CA (0 and 20 g/kg) and two concentrations of phytase (2000 and 4000 U/kg) in a 2 × 2 factorial arrangement. 3. In both trials, birds fed on the PC had significantly higher average daily gain (ADG), average daily feed intake (ADFI), plasma P and lower feed conversion ratio (FCR) and plasma Ca than those of birds fed on the NC. CA supplementation significantly increased ADG and ADFI. There was a significant interaction between CA and phytase on plasma P where CA improved the effect of phytase on plasma P. In Trial 1, phytase addition improved ADG, ADFI, FCR and plasma Ca linearly. 4. Briefly, this research showed the interaction effect between CA and phytase on plasma P when broilers were fed on diets based on maize-soybean meal or wheat-canola meal. The results showed that CA supplementation lowered the concentration of phytase that is needed in low NPP diets to increase plasma P.

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1. Two trials were conducted from 22 to 42 d post-hatch to evaluate the effectiveness of high concentrations of supplemental phytase in maize-soya bean meal-based diets severely limited in available phosphorus (P). Growth performance, plasma P and tibia ash (TA) were measured. 2. Each trial used 220 21-d-old male broilers in 20 pens with 11 birds per pen. Dietary treatments included a positive control [PC, 4.3 g/kg nonphytate P (NPP)], negative control [NC, 2.3 g/kg NPP (Trial 1) or 1.4 g/kg NPP (Trial 2)] and NC plus 1000, 2000 or 4000 phytase U/kg of the diet. 3. Birds fed on the PC diet had higher average daily gain (ADG), gain to feed ratio (G:F), plasma P (Trials 1 and 2) and TA (Trial 2) than those fed on the NC. 4. In Trial 1, ADG and G:F values of the NC plus 1000, 2000 or 4000 phytase U/kg reached those of the PC. Plasma P values of the NC plus 2000 or 4000 phytase U/kg reached that of the PC. Although TA values of the NC, NC + 1000 or NC + 2000 reached that of the PC, TA of the NC + 4000 was more than that of the PC. 5. In Trial 2, ADG and G:F values of the NC plus 4000 phytase U/kg reached those of the PC; nevertheless, plasma P values of the NC diets did not come up to that of the PC. While TA values of the NC, NC + 1000 or NC + 2000 did not reach that of the PC, TA of the NC + 4000 was greater than that of the PC. 6. Results of this study showed that, in the diets with 2.3 and 1.4 g/kg NPP, respectively, 1000 and 4000 phytase U/kg can be sufficient to obtain a comparable performance in broilers to those given diets adequate in available P.

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This paper presents an adaptive control approach for robotic movement therapy that learns a state-dependent model of patient impairment. Unlike previous work, this approach uses an unstructured inertial model that depends on both the position and direction of the desired motion in the robot's workspace. This method learns a patient impairment model that accounts for movement specific disability in neuro-muscular output (such as flexion vs. extension and slow vs. dynamic tasks). Combined with assist-as-needed force decay, this approach may promote further patient engagement and participation. Using the robotic therapy device, FINGER (Finger Individuating Grasp Exercise Robot), several experiments are presented to demonstrate the ability of the adaptive control to learn state-dependent abilities.

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OBJECTIVE: To assess the current practice of analgesia after thoracotomy and thoracoscopy in France. STUDY DESIGN: Cross-sectional practice survey. MATERIAL: Anaesthetist physicians, each referent for one of the French centres practicing thoracic surgery, during year 2012. METHODS: Electronic questionnaire about the activity of the centre in thoracic surgery, and modalities and estimated frequencies of different analgesic techniques. Primary assessment was the estimated percentage of acts, after imputation from original data. RESULTS: Eighty-four centres out of 103 (82 %) answered the questionnaire. Coupling locoregional to general anaesthesia involved 74 % of thoracotomies and 35 % of thoracoscopies. A practice (i.e. for more than 5 % of patients) of epidural analgesia was declared by 68 centres (81 %), and by 27 centres (32 %) for paravertebral block. The most current practices for epidural analgesia were: thoracic puncture, intraoperative initiation, ropivacaïne 0.2 % plus sufentanil, patient-controlled administration with infusion plus bolus, application more than 48hrs post surgery. The practice rates for technique of paravertebral block were: Eason & Wyatt 34 %, ultrasound-guided 24 %, internal 42 %. The most frequent systemic analgesia was patient-controlled intravenous morphine. Ketamine was used in 60 % of the cases. CONCLUSIONS: French practice of analgesia after thoracic surgery improved quality during the last decade, but more than one patient on four (compared to 8 % in UK) may have neither epidural nor paravertebral block, while such techniques are nowadays considered as standard.

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Background. Breast carcinoma is the most common malignancy in women worldwide. It is most commonly associated with metastases to the liver, lung, bone, and the brain. Invasive lobular carcinoma is a less common pathology with slightly higher metastases to the upper gastrointestinal tract. Invasive lobular carcinoma metastasis to the gallbladder is extremely rare. Method. In this paper we are presenting a case of a 67-year-old female with metastases of invasive lobular breast cancer to the gallbladder six years after her therapy. Conclusion. This case clearly signifies the nature of the micrometastatic foci of the invasive lobular carcinoma even many years after a successful treatment.

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1. The objective of this research was to investigate the efficacy of combined or single use of Lactobacillus crispatus LT116 and Lactobacillus johnsonii LT171 on broiler performance. 2. A total of 320 one-d-old male Ross broiler chicks were allocated in 4 experimental treatments for 6 weeks. The experimental treatments received a maize-soybean meal basal diet that was supplemented as follows: 'control', with no other additions; 'LJ', 1 × 10(6) CFU of L. johnsonii LT171; 'LC', 1 × 10(6) CFU of L. crispatus LT116; and 'LCJ', 0·5 × 10(6) CFU of L. johnsonii LT171 + 0·5 × 10(6) CFU of L. crispatus LT116/g of the diet. A suspension of sheep red blood cells (SRBC) was injected into the breast of 8 birds from each treatment on d 14 and 30, and the antibody titre was measured on d 20, 26, 36 and 42. 3. Body weight was improved when compared with control for broilers fed diets supplemented with LCJ. The feed conversion ratio (FCR) decreased in LC and LCJ groups compared with control. The number of coliforms in the ileum of LJ, LC and LCJ birds was lower than that from the control birds. However, only the LCJ treatment significantly decreased the number of coliforms in the caecum. The LCJ group had greater villus height in the duodenum than the LC group, and both LCJ and LC groups showed increased villus height in the duodenum and jejunum relative to the control. Antibody titre against SRBC was higher for the LCJ group than for the LJ and control groups in terms of secondary immune response (mean of 36 and 42 d). 4. This study showed, compared with the control, that the combination of Lactobacillus spp. could positively affect body weight, coliform numbers in the caecum and immune response.

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Viroids are nonencapsidated, small, circular, single-stranded RNAs that replicate autonomously when inoculated in their host plants in which they may elicit diseases (sensitive hosts) or replicate as latent infections (tolerant hosts). Citrus viroid V (CVd-V) was initially identified in Spain (1) and later found to be present in the United States, Nepal, and the Sultanate of Oman (2). CVd-V is a member of the Apscaviroid genus within the Pospiviroidae family. Like other members of this genus, CVd-V has a restricted host range but it is able to infect a wide range of citrus and citrus related species (1,2). Within the framework of a comprehensive survey of the sanitary status of the citrus industry in Iran, a sample from a private orchard of symptomless Moro blood sweet orange (Citrus sinensis) trees grafted on Mexican lime (C. aurantifolia) located at Javanan in the southern inland region was found to be infected with CVd-V. Briefly, RNAs of nucleic acid preparations from bark tissues were separated by 5% polyacrylamide gel electrophoresis (PAGE), electrotransferred to positively charged nylon membranes, immobilized by UV cross-linking, and hybridized with a full length CVd-V specific digoxigenin (DIG)-labeled DNA probe (2). A positive identification of CVd-V was made in these extracts. This positive detection of CVd-V was confirmed by reverse transcription-PCR using CVd-V specific primers of opposite polarity (5'-GACGAAGGCCGGTGAGCAGTAAGCC-3') and (5'-GACGACGACAGGTGAGTACTTTC-3') corresponding to CVd-V positions 90 to 114 and 69 to 89, respectively. Analysis of the sequence of the 293-bp amplicon (Genbank Accession No. GQ466068) revealed 99% identity with the reference sequence (Genbank Accession No. NC010165) of CVd-V. The rod-like predicted minimum free energy secondary structure of this new variant has 68.3% paired nucleotides. The changes with respect to the reference CVd-V variant are: (i) a deletion (48→-U) located in a loop of the V domain; (ii) a substitution (155A→C) located in a loop of the TR domain of the viroid secondary structure; and (iii) two compensatory substitutions located in the upper (46A→G) and lower (244U→C) strands of the viroid secondary structure. As shown earlier, the genome of CVd-V allows little variation with a large loop located in the segment I of the secondary structure (2) being the most amenable for mutations/changes. Among the viroids that have been found naturally infecting citrus, the members of the genus Apscaviroid are not associated with specific diseases but they cause a reduction of tree size and fruit harvest (3), an effect that is enhanced when several viroids coinfect the same plant (4). Therefore, the presence of CVd-V should be considered in further indexing tests aimed at the production and distribution of pathogen-free plants in Iran. References: (1) P. Serra et al. Virology 370:102, 2008. (2) P. Serra et al. Phytopathology 98:1199, 2008. (3) C. Vernière et al. Plant Dis. 88:1189, 2004. (4) C. Vernière et al. Phytopathology 96:356, 2006.

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In this study, 332 lactic acid bacteria of broiler gut origin were investigated as putative probiotic candidates. Sixty-two bacteria showed the highest aggregation while showing antibacterial effects against Salmonella Enteritidis, Salmonella Typhimurium, and Escherichia coli O78:K80. Enzymatic activities of the selected bacteria were examined. No lipase activity was detected, but all of them showed almost similar proteolytic activities. However, they had different amylase and phytase activities. Four of the 62 bacterial strains were selected as a result of aggregation and amylase tests. They were chosen for the following attributes: high cell surface hydrophobicity, co-aggregation, and resistance to bile salts and also acidic conditions. Finally, Lactobacillus crispatus was selected as a source of potential probiotic because of its predominant characteristics in comparison to the other isolated strains from the gastrointestinal tract of chickens. This study has provided a good arrangement of rapid methods for screening a high number of bacteria: a series of beneficial tests that are used together for the first time on chickens, and not any other animals.

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The assessment of the postoperative risk in lung resection is a major challenge for pneumologists and thoracic surgeons. Restrictive syndromes have been observed along with a disproportionate decrease of FEV1 in lobectomies. The purpose of the present study is to describe the early response of pulmonary function after thoracotomy and resection for lung cancer. In a prospective study, the authors included 31 patients (19 lobectomy patients: mean age 59+/-10 years and 12 pneumonectomy patients: mean age 56+/-9 years) without postoperative complications. Pulmonary function tests were performed before and after surgery on Days 1, 5 (D5), 10 and within the fourth month. The main aspect of the ventilation was an unexpected similarity in subgroups during the early perioperative period up to D5. When compared with the preoperative value, about a 50% decrease in the vital capacity and total lung capacity was observed. In both subgroups about a 40% decrease was noted in the inspiratory and expiratory reserve volume. In the lobectomy sub-group, the change in the forced expiratory volume in one second over forced vital capacity (FEV/FVC) ratio was found to be higher than predicted (52+/-16% at D5 versus 67+/-14% predicted). However, the FEV/FVC ratio did not change, attesting to major restrictive ventilation. Partial recovery of the FEV was dependant on the mobile volume and especially the inspiratory volume. These findings should have implications in patient management.

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Congenital pseudarthrosis is very rare in upper extremity, and has only previously been reported in the forearm. A case of bilateral congenital pseudarthrosis of the index metacarpal bones is described.

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BACKGROUND: Thalassaemia is considered the most common genetic disorder worldwide. An association between the heterozygous beta-thalassaemia trait and myocardial infarction has previously been observed. However, the relationship between heterozygous beta-thalassaemia and atherosclerosis, considering other coronary artery disease (CAD) risk factors, has remained unclear. METHODS: A case-control study was conducted to evaluate the hypothesis that thalassaemia minor affects the likelihood of atherosclerotic plaque formation. Blood counts and blood chemistry data as well as traditional risk factors from 1,363 patients referred to heart centres for coronary angiography were recorded. Heterozygous beta-thalassaemia was diagnosed by the presence of hypochoromic-microcytic anaemia, ferritin levels > 12 ng/ml and haemoglobin-A2 levels > 3.5. RESULTS: Chi-squared analysis showed that the prevalence of heterozygous beta-thalassaemia was not significantly different between patients with and without CAD (p > 0.05). Multivariate logistic regression analysis using CAD as the dependent variable and traditional risk factors, haematocrit, ferritin levels and heterozygous beta-thalassaemia as independent variables, did not show any significant difference either. Independent two-tailed student's t-tests showed that haematocrit levels were statistically different (p = 0.000) between CAD(+) and CAD(-) groups, but low-density lipids (LDL), high-density lipids (HDL), triglycerides (TG), total cholesterol and serum ferritin levels were not statistically different (p > 0.05). CONCLUSION: The prevalence of heterozygous beta-thalassaemia in the case group was not significantly different from the control group. This case-control study did not support the hypothesis that thalassaemia minor affects the likelihood of atherosclerotic plaque formation.

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BACKGROUND AND OBJECTIVES: It is uncertain whether high serum uric acid levels are a true independent risk factor for coronary atherosclerosis or whether the association is due to other confounding variables. We therefore studied the relationship between elevated serum uric acid levels and coronary atherosclerosis after adjustment was made for confounding factors such as age, gender, body mass index, smoking, lipid profile, blood pressure and blood glucose levels. METHODS: A cross-sectional study was conducted on 240 patients referred for coronary angiography to heart centres in the Shahid-Chamran and Sina hospitals, Isfahan, Iran. Blood chemistry data as well as traditional risk factors and uric acid levels were measured at enrollment. We used vessel, stenosis and extent scores to indicate the degree of coronary artery involvement. RESULTS: This study was conducted on 240 patients with a mean age of 56 +/- 10.9 years (66% male; 37% female) who underwent coronary angiography. Student's t-test analyses revealed that there were significant differences in the mean uric acid levels between male and female patients (p = 0.001). We found no statistically significant correlation between serum uric acid levels and coronary atherosclerosis (p > 0.05). In addition, multivariate logistic regression analyses, using coronary atherosclerosis as dependent variable and traditional risk factors and uric acid levels as independent variables, did not show any significant difference. CONCLUSION: These findings indicated that uric acid is not associated with coronary atherosclerosis. Any correlation reported in other studies was probably due to the relationship between high serum uric acid levels and other cardiovascular risk factors.

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BACKGROUND: A definitive treatment for functional dyspepsia (FD), and the role of Helicobacter pylori eradication on the course of this disease are controversial. AIM: To investigate the effect of a combination of acid-suppressing and prokinetic drugs or eradication therapy on the course of H. pylori-positive FD. METHOD: A total of 157 patients with endoscopically-proven H. pylori-positive FD and no response to 4 weeks of antacid therapy were randomly divided into 2 groups. 84 were placed on bismuth subnitrate plus metronidazole and amoxicillin (group A) and 73 received ranitidine and metoclopramide for 4 weeks (group B). The severity of symptoms (7 items) were assessed on a 6-point categorical scale. Group B patients who failed to respond to their medication underwent eradication therapy after 3 months. All patients were followed and assessed for 9 months after the end of therapy by the same clinicians who initiated the therapy. RESULTS: At the end of the medication period, symptom's score decreased significantly, and to the same extent. At 3-month follow-up moderate or complete response was achieved in 27.4% (group A) and 19.2% (group B) by intention-to-treat analysis. 34 patients of group B, not responding to treatment, underwent eradication therapy and followed as group A. Eradication of H. pylori was successful in 60 of 110 controlled patients (54%). After 9-month follow-up, complete or moderate response was observed in only 30% of 60 patients in whom H. pylori had been eradicated (intention-to-treat analysis), compared to 38% in 50 noneradicated cases (p > 0.05, 95% CI: 19-43 vs. 24-52). CONCLUSION: Eradication therapy with bismuth compound is effective as ranitidine plus metoclopramide in a subgroup of patients with FD not responding to antacid therapy. There is no difference in improvement between patients cured or not cured from H. pylori infection. This suggests that bismuth compounds were effective in FD when used in the eradication regimen. Combination therapy with acid-suppressing drugs plus prokinetic and bismuth seems to hold promise for FD.

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Autoimmune hepatitis (AIH), a chronic T-cell-mediated liver injury, is treated with corticosteroids with or without Azathioprine. Corticosteroids are not universally effective and have serious side effects. Cyclosporin A was effective in refractory cases. To assess efficacy and safety of Cyclosporin A (Neoral) in induction of remission in AIH patients this study was performed. Nineteen consenting AIH patients (nine treatment-naive) were treated with cyclosporin A in an open label trial and followed for 26 weeks. Liver biopsy was done and hepatitis activity index (HAI) determined at the beginning and end of treatment. Four patients did not complete the study for various reasons. Mean AST and ALT levels decreased from 948.7 +/- 103.5 and 454.8 +/- 354 to 100.6 +/- 111.8 and 78.5 +/- 40.3 (P < 0.03, P < 0.001) respectively. HAI decreased from 15.2 +/- 3.16 to 7.14 +/- 4.01 (P < 0.005). Serum creatinine did not change significantly. In conclusion, low-dose cyclosporin A appears to be safe and effective even in treatment-naive autoimmune hepatitis patients. Randomized controlled trials are warranted.

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Preventive therapies such as cholesterol reduction significantly reduce the risk of acute coronary events. Diagnostic tools that identify asymptomatic coronary atherosclerosis would permit initiation of aggressive preventive therapies at an earlier stage of coronary disease. Histologic and angiographic data demonstrate that coronary calcium has a very high sensitivity for the presence of coronary plaque. Therefore, coronary calcification can be regarded as a marker for coronary atherosclerosis. Coronary calcium scanning has been suggested as a tool for identification of a high-risk asymptomatic patient group. It can be utilized to guide the aggressiveness of risk factor modification and therapeutic preventive interventions toward those at higher risk for future events. Based on the available data, we review the clinical use of coronary calcium scanning in preventive cardiology.

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