The mean values and standard deviations (SDs) of VC% predicted, FVC% predicted, FEV1% predicted and FEV1/FVC ratio were 106.07 ± 13.36, 107.60 ± 13.95, 97.19 ± 14.80 and 89.76 ± 10.78 respectively. The positive rates of above four and abnormal lung ventilation function were 2.9%, 2.8%, 11.2%, 4.6% and 6.5% respectively. Gender, age, BMI and number of greenhouses owned were influence factors of lung ventilation function (p < 0.05). The mean values and SDs of MEF50% predicted, MEF25% predicted and MMEF% predicted were 69.63 ± 24.95, 54.04 ± 24.94 and 66.81 ± 24.53. The positive rates of above three and abnormal small airway function were 45.0%, 72.1%, 47.2% and 49.4% respectively. Age, education and number of greenhouses owned were influence factors for small airway function (p < 0.05). Working in a greenhouse might influence lung function of the workers. Small airway function indicators could be used as priority indicators for the surveillance of greenhouse workers’ health.Since the number of greenhouse workers are increasing in China, this observational cross-sectional study was designed to evaluate lung function and discuss the potential risk factors, to provide evidence in the surveillance of greenhouse workers’ health. 678 greenhouse workers in Gansu Province, China were enrolled. A questionnaire which included demographic and occupational information was used. Vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV Greenhouses have played an important role in agriculture. China has become a country which hosts a huge plant area inside greenhouses, and a large amount of people perform greenhouse work. However, the health conditions of greenhouse workers were not as satisfactory as the economic interests that greenhouse brought. The micro environment inside a greenhouse is semi-closed, thus factors including physical factors, ergonomic factors, chemical factors and biological factors could do harm to greenhouse workers’ health. Physical factors include high temperature and humidity, lack of fresh air, and so on. Ergonomic factors include improper working tools and postures. Chemical factors include pesticide, fertilizer and ethylene, and chlorine gas from greenhouse film. Biological factors mainly include allergens from crops and microorganisms like bacterium, fungi and mites, and so on. Previous studies have shown greenhouse workers had high positive rates and increased risk of ocular and skin symptoms , bone anThe respiratory health of greenhouse workers was not satisfactory. Based on related research ,9, high This cross-sectional study was undertaken in Gansu Province, in northwestern China. This area was selected because: (1) most of the adult residents worked as greenhouse farmers; and (2) clinical examination could be performed along with the annual checkup program. The inclusion criteria for all the subjects included: (1) local residents for 1 year and above; (2) age from 18 years and above; (3) working in greenhouse; (4) not pregnant; and (5) properly able to take the lung function test. All the participants read and signed the informed consent. The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Medical Ethics Committee of the National Institute of Occupational Health and Poison Control, Chinese Center for Disease Control and Prevention, Beijing, China .All the participants voluntarily joined this study with informed consent and then answered a questionnaire conducted by well-trained investigators face to face. The questionnaire asked for information including their demographic information, smoking status, number of greenhouses owned, greenhouse working lifetime, species of crops they planted, whether they wore a mask while working in the greenhouse. Number of greenhouses owned and greenhouse working lifetime were used as the indicators of greenhouse working exposure. TM MasterScreen Pneumo  according to its instruction manual, after age and height of subjects were measured. Lung ventilation function parameters considered in this study were vital capacity (VC), forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1:FVC ratios (FEV1/FVC). Maximal expiratory flow after 50% of the FVC has not been exhaled (MEF50), maximal expiratory flow after 25% of the FVC has not been exhaled (MEF25) and maximal mid-expiratory flow curve (MMEF) were considered as indicators of small airway function. All the indicators were shown and analyzed as the percentage of the measured value on the predicted value. Individual predicted values of these indicators were calculated with equations developed by the European Respiratory Society (ERS) in 1993 ) was used to analyze the influence factors. The entry probability for stepwise was 0.05 and the removal probability was 0.10. p value of less than 0.05 was considered to indicate statistical significance. Variable assignment and dummy variable contrast coding of multivariate analysis were showed in The data from the questionnaire and clinical examination was collected by using Epidata 3.1 . All statistical analysis was performed using SPSS 19 . All the participants were grouped into senior group (age > 47 years) and junior group (age ≤ 47 years) based on the median of age, 4 subgroups  by greenhouse working lifetime and 3 subgroups  by BMI according to the standard of Chinese. The mean values of lung function indicators and the positive rates of abnormal lung function were compared within subgroups of gender, age, BMI, education, status of smoking, number of greenhouses owned, working lifetime and mask using. A total of 783 participants were investigated, but some of them were excluded because they failed the lung function test (4.7%) or were not qualified according the inclusion criteria or their questionnaires were lack of essential information. Therefore, 678 subject were included. There were 291 (42.9%) male and 387 (57.1%) female. Their mean value and SD of age was 47.51 ± 9.07 years, ranging 24–68 years. The mean value and SD of BMI was 23.78 ± 3.49. The mean value and SD of greenhouse working lifetime was 12.77 ± 6.59 years. 86.6% of the subjects ended their education after middle school or before. 33% were ever-smokers. 89.7% owned no more than 3 greenhouses. 95.0% planted chili as cash crops. 73.3% did not wear a mask while working in the greenhouse .1% predicted and FEV1/FVC ratio was 106.07 ± 13.36, 107.60 ± 13.95, 97.19 ± 14.80 and 89.76 ± 10.78 respectively. Significant differences of VC% predicted, FVC% predicted, FEV1% predicted were observed in the subgroups of gender, BMI, status of smoking, working lifetime (p < 0.05). Also, significant uptrends were observed within the subgroups of BMI and working lifetime (p < 0.05). Statistical difference of VC% predicted was observed in the subgroups of mask using (p < 0.05)  of VC% predicted, FVC% predicted, FEV < 0.05) .1% predicted, FEV1/FVC ratio and abnormal lung ventilation function were 2.9%, 2.8%, 4.6% and 6.5%. The positive rates of FEV1% predicted were different between male and female significantly (p < 0.05). The positive rates of FVC% predicted and FEV1% predicted were statistically different between senior and junior groups (p < 0.05). Significantly different positive rates of FEV1% predicted were observed in BMI and status of smoking subgroups (p < 0.05). The positive rates of VC% predicted and FVC% predicted were different statistically in the subgroups of number of greenhouses owned (p < 0.05). Significant downtrend of the positive rate of FVC% predicted was observed in the working lifetime subgroups (ptrend < 0.05)  .1% predicted, being male and getting older were risk factors. And FEV1% predicted of the subjects whose BMI was over 18.5 were more likely to be abnormal . The mean values and SDs of MEF50% predicted were significantly different in education subgroups (p < 0.05). Both MEF50% and MMEF% showed significantly decrease trends with the level of education (p < 0.05)  .50% predicted, MEF25% predicted, MMEF% predicted and abnormal small airway function were 45.0%, 72.1%, 47.2% and 49.4% respectively. But significantly different positive rates were only observed in MMEF% predicted and abnormal small airway function in age subgroup (p > 0.05).The positive rates of small airway function indicators in total were high. As 25% predicted of the subjects who had 2 greenhouses were more likely to be abnormal than those who had 1. Age was a risk factor of abnormal MMEF% predicted and small airway function. And MMEF% predicted of the subjects who were educated until middle school were more likely to be abnormal than those who were educated until primary school  is an endogenous antimicrobial peptide, which has antimicrobial activity [Symptoms of respiratory diseases may be silent at the prodromal stage because of the compensatory reaction. Lung function test, as an objective evaluation index, is important and meaningful for the early diagnoses, the determination of lesions’ location, and the identification of the reasons for the shortness of breath. Usually, VC is tested as an index of lung volume. Factors which influence rib cage and the structure of lung tissues will decrease the level of VC. FVC is an indicator to detect restrictive ventilation dysfunction in lung. FEVuskin E.  took lun. et al.  found a activity ,13, antiactivity  and chemactivity . Sun C. activity  examinedEurling I. M. et al.  stained Our study showed subjects who owned 2 greenhouses were more likely to suffer from small airway dysfunction than those who owned 1 greenhouse. It suggested that more exposure to greenhouse environment might cause the decline of small airway function. Smoking and exposure to other factors like endotoxin and dust  could ca1% predicted <80% positive rates in ever-smokers. While the positive rate of FEV1/FVC <70% slightly increased in ever-smokers and the difference was not significant. This phenomenon suggested that smoking might reduce greenhouse workers’ lung ventilation function, but perhaps to a lesser extent. This study showed that male greenhouse workers were more likely to suffer from lung ventilation dysfunction, especially obstructive ventilation function disturbance of the airways. The possible reason is that most of smokers are males and smoking may have harmful effects as discussed above. As shown in The relationships between greenhouse workers’ lung ventilation function and other factors such as smoking habit, gender and BMI were also evaluated in this study. According to There were some limitations in our study. First, our study did not investigate the lung function of controls. Second, the levels of exposure in the greenhouse working environment were not measured, which was because the period when we did the research was after their harvest and the greenhouses were totally open. Therefore, we indicated the occupational exposure with working lifetime and numbers of greenhouses owned. Third, species of crops were unitary because chili was the only main cash crop in the area where we conducted this research. Considering these limitations and the importance of this work in occupational health in China, further studies are necessary.Our study found that mild alterations were present in greenhouse workers’ lung ventilation function. High positive rates of abnormal small airway function were detected in greenhouse workers. Greenhouse work might have an influence on the respiratory health of greenhouse workers. Small airway function indicators could be used as priority indicators for the surveillance of greenhouse workers’ health.


To explore the related factors on the clinical pregnancy outcome in intrauterine insemination, a retrospective study was conducted on the clinical data of 580 cycles for 301 infertile couples who were treated with intrauterine insemination. The female age, male age, duration of infertility, treatment protocols, endometrial thickness and sperm parameters were compared between pregnant group and non-pregnant group. The results showed that there were statistical differences in female age, duration of infertility and endometrial thickness between the two groups. The pregnancy rate was 19.34% in Group A  compared with 10.91% in Group B . The pregnancy rate was 18.44% when the duration of infertility ≤ 2 years, which was higher than another group 10.73% when the duration of infertility > 2 years. Group analysis according to endometrial thickness  demonstrated significant differences in clinical pregnancy rate . For those infertile female without ovulation failure, the higher clinical pregnancy rates were observed in patients undergoing intrauterine insemination in natural cycle 16.12% when compared with the patients in ovarian stimulated cycles 10.48%. Thus, we demonstrate that the pregnancy rate is related with female age, duration of infertility and endometrial thickness. The ovarian stimulated cycle couldn’t improve the pregnancy outcome for those women without ovulation disorder in intrauterine insemination. It is commonly applied to the infertile couples diagnosed with the mild male factor, endometriosis, ovulation failure and unexplained factors . Treatmen (ICSI) , 3. Thern (ICSI) . Howevern (ICSI) , 4. The n (ICSI) , 6, howen (ICSI) , 8. Accon (ICSI) . Thus, hA total of 580 IUI cycles from 301 couples were enrolled in the study from January 1, 2015 to February 28, 2017, including 392 cycles in primary infertility and 188 cycles in secondary infertility. According to the statistics, 121 couples performed one IUI cycle, and 109 couples as well as 40 couples performed two and three cycles. Only 31 couples performed more than four IUI cycles. The mean age of females was 30.3 years old (varied from 20 to 45), and it was 31.6 years old in males (varied from 23 to 46). The mean infertility duration was 2.57 years (varied from 1 to 10). There were 89 cases diagnosed as clinical pregnancy. The clinical pregnancy rate was 15.34% (89/580), the abortion rate was 16.85% (15/89), the twin pregnancy rate was 6.52% (3/89), and the ectopic pregnancy rate was 4.49% (4/89).p < 0.01). There was no difference in the age of males between pregnant group (31.24 ± 4.09) and non-pregnant group (31.67 ± 4.10) (p > 0.05). The clinical pregnancy rate was 19.34% (59/305) in females whose ages were below 30 years old, and that was 10.91% (30/275) in those females who were above 30 (p < 0.01), as shown in Table p > 0.05).As presented in Table group 31.4 ± 4.09 p < 0.01), as presented in Table p < 0.05), as presented in Table The duration of infertility was significantly different between the pregnant group and the non-pregnant group . As shown in Table p > 0.05).Our results showed that women with normal menstruation were performed 452 cycles, including 242 natural cycles and 210 ovarian stimulated cycles. The clinical pregnancy rate was higher in natural cycles than in ovarian stimulated cycles (16.12% to 10.48%). However, the difference was not statistical (p < 0.05). As shown in Table p < 0.05).The endometrial thickness on hCG day was 9.94 ± 1.86mm in pregnant group and 9.41 ± 2.17mm in non-pregnant group (p > 0.05). As presented in Table p > 0.05).The progressive motility of males’ sperm was 31.72 ± 9.27% in the pregnant group and 32.32 ± 9.68% in the non-pregnant group p > 0.0. As presp > 0.05). And the accumulated pregnancy rates were 14.09%、30.63%、61.15%, 76.72%, respectively. Among the pregnant group , 47.19% (42/89) patients got pregnant in the first time, and 29.21% (26/89) patients as well as 19.10% (17/89) patients got pregnant in the second and third time, respectively. Only 4.49% (4/89) patients got pregnant four times later, as shown in Figure As presented in Table The number of infertile couples has increased a lot in recent years due to the environmental pollution and work pressure. Thanks to the rapid development of ART, more and more infertile couples choose this technique to resolve their reproductive problems. IUI is the first-line treatment during ART procedure , which mIn the present research, we found that the female age was different between pregnant group and non-pregnant group. The women were younger in pregnant group than those in non-pregnant group, in agreement with the literatures , 10–13. In our study, we found that the duration of infertility was different between pregnant group and non-pregnant group. It was significantly shorter in pregnant group than in non-pregnant group. Furthermore, the clinical pregnancy rate per cycle of couples was higher when their duration of infertility was below 2 years, compared with couples over 2 years. This report is consistent with previously reported . Thus weAccording to the statistics, the average endometrial thickness was different between pregnant group and non-pregnant group. When the patients were divided into three groups according to the membrane on the day of hCG trigger , we found that the pregnancy rate was highest in the group when the endometrial thickness ranged from 8 to 12 mm compared with other two groups, which was consistent with the previous studies , 22. WeiIn current study, we found that there was no statically difference in the clinical pregnancy rate per cycle with IUI between natural cycle and ovarian stimulated cycle for those women with regular menstruations and normal ovulation. It has been revealed that ovarian stimulated treatment could not improve the outcome of the IUI for the infertile women with non-ovulation disorder. At the same time, there was no difference in the pregnancy rate among groups with different ovarian stimulated protocols. It was announced that the pregnancy rate with ovarian stimulated cycles is higher than that with natural cycles , 26. In As shown in Table In general, the ovarian stimulated cycle is not a better alternative compared with the natural cycle for the women without ovulation disorder in IUI.In our research, there was no difference in PR before sperm was washed between the pregnant group and non-pregnant group. The pregnancy rate was highest in the group when the PR was from 20% to 32%. Stone et al.  also repMost of the infertile couples performed 1–3 cycles with IUI treatment in our reproductive center. Seven couples performed 5cycles, and two couples performed 6 cycles. It is suggested that the infertile couples with unexplained reasons should be treated with IUI for at least 3 times before turning to further assisted reproductive technique, such as IVF/ICSI.Our data showed that the cumulative pregnancy rate increased gradually with the increase of cycles. The cumulative pregnancy rate was up to 61.15% when the couples preformed 3 cycles with IUI. According to the analysis in the pregnant group, 47.19% patients got pregnant in the first time, and 29.21% patients as well as 19.10% patients got pregnant in the second and third time, respectively. Only 4.49% patients got pregnant four times later. Although the cumulative pregnancy rate increases gradually by the increase of cycles, the chances of getting pregnant per cycle diminishes conversely, which is similar with Dinelli et al. [Collectively, the IUI treatment is a kind of simple, cheap and invasive technique compared with IVF/ICSI. There is lower success rate but less intervention in the reproductive process with IUI compared with other assisted reproductive techniques. We suggest those infertile couples who may get pregnant with IUI to perform this first-line technology in reproductive treatments. More importantly, natural cycle may get a better outcome for those people with non-ovulation dysfunction in the IUI treatment. In other words, the ovarian stimulated cycle is not a better alternative for infertile women with normal ovulation.A retrospective study was performed by reviewing the clinical data of 580 IUI cycles from 301 couples at the Reproductive Center of Ningbo First Hospital in China during January 2015 and February 2017. The inclusion criteria for IUI included: infertility for at least one year, at least one patent fallopian tube. Duration of infertile: from the time since a couple have sex without any contraception. Informed consent was obtained from all subjects. The study protocol was approved by the Institutional Review Board of Ningbo First Hospital, China. All methods were performed in accordance with the approved guidelines.Natural cycle was administered in females whose menstrual cycles were regular. Intrauterine insemination was administered according to the peak of the luteinizing hormone (LH) which was measured day by day since the diameter of follicle got to 16–18mm.Ovulation induction was performed as the following protocol:Clomiphene citrate ( CC) 50–100 mg/day starting from day 3–5 for 5 days.Letrozole (LE) 2.5–5.0 mg/day from day 3–5 for 5 days.HMG 37.5–75 IU/day starting from day 3–5 for a variable duration depending on the response.CC combined with HMG – CC 50–100 mg/day starting from days 3–5 for 5 days followed by the addition of 37.5–75 IU of HMG for a variable duration depending on the response.LE combined with HMG – LE 2.5–5.0 mg/day starting from day 3–5 for 5 days followed by the addition of 37.5–75 IU of HMG for a variable duration depending on the response.Intrauterine insemination (IUI) was administered according to the peak of the luteinizing hormone. And the cycle would be canceled to avoid the ovarian hyperstimulation syndrome (OHSS) if the estradiol (E2) was higher than 1500 pg/ml or the mature follicles were more than 3.When at least one mature follicle had a diameter of 18 mm or more and the endometrial thickness achieved 7 mm, we triggered ovulation with intramuscular injection of urinary human chorionic gonadotrophin (hCG) (5000–10 000 IU), or hypodermic injection of recombinant human chorionic gonadotropin alfa , or hypodermic injection of Triptorelin (0.1 mg). Insemination was performed 36–40 hours after injection.Semen was collected by masturbation after abstinence for 3–7 days and prepared with two-layer density gradient centrifugation after liquefaction. Mechanical method was used for abnormal semen liquefaction. The volume of washed semen sample used for insemination was 0.3–0.5 ml.The luteal phase was used routinely in all patients, starting from the day since IUI was performed. It consisted of Duphaston  for 14 days. A blood test for hCG assay was performed in 14 days after insemination to confirm whether pregnancy had occurred. In women with positive hCG, ultrasound examination was performed at 7 weeks’ gestation to confirm fetal viability. A clinical pregnancy was defined as one in which there was ultrasonographic evidence.t test. Pearson’s Chi-square test was used to compare the ratios between groups. A value of p less than 0.05 was considered statistically significant. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) for Windows (version 19.0).The data expresses the means ± SD. The baseline differences between the two groups were analyzed by Student’s


Objective. To predict the success rate and complications following percutaneous nephrolithotomy via the upper pole using the Guy's Stone Score (GSS) based on the findings of a preoperative intravenous pyelogram (IVP). Patients and Methods. Two hundred and twenty-seven renal operations, which were carried out using PCNL via the upper pole, were classified according to the GSS assigned. Any complications were classified according to the Clavien classification. The success rates and incidence of any complications were compared between each GSS. Results. The immediate success rates were 87.50% of GSS1, 71.43% of GSS2, 53.62% of GSS3, and 38.46% of GSS4, P < 0.01. There were statistically significant differences between the groups in stone size, overall immediate success rate, operative time, number of access tracts, and frequency of tubeless PCNL. Major complications (a Clavien score of 3–5) were significantly higher in the cases with a higher GSS. Conclusion. A GSS based on an IVP is a simple and reliable tool in predicting the success rate and possible complications following upper pole access PCNL. Percutaneous nephrolithotomy (PCNL) is accepted as being the first line treatment for large renal and upper ureteric stones. The advantage of upper pole access for percutaneous nephrolithotomy is good stone clearance due to its direct access to most intrarenal collecting systems , 2. UppeDespite advances in technology and surgical techniques, in complex stone cases, the PCNL technique does not always result in the optimal goal of stone free status and increases the risk of significant complications. The information about the success rate and complications following this procedure is very important for both surgeons and patients in informing surgical planning and preoperative patient advice and counseling. At the current time, the Guy's Stone Scoring (GSS) system –7, the SThis study focusses on the association of GSS based on an intravenous pyelogram (IVP) and on success rate and complications following PCNL via both supracostal and subcostal upper pole access.This study was approved for conduct clinical research from research committee of faculty of medicine, Chiang Mai University.Guy's stone score 1 (GSS1): a solitary stone in the mid/and or lower pole or in the renal pelvis with a normal anatomy and simple collecting systemGuy's stone score 2 (GSS2): a solitary stone in the upper pole; multiple stones in patients with simple anatomy; or a solitary stone in a patient with abnormal anatomyGuy's stone score 3 (GSS3): multiple stones in a patient with abnormal anatomy or in a calyceal diverticulum or partial staghorn calculusGuy's stone score 4 (GSS4): a complete staghorn calculus or any stone in a patient with spinal bifida or a spinal injury, calculus in patients with clinical neurological alternations Two hundred and twenty-seven patients who underwent PCNL via upper pole access were recruited, including 146 subcostal access and 81 supracostal access cases. All patients with both kidney, ureter, bladder (KUB) film, and intravenous pyelogram (IVP) preoperatively were classified into 4 grades according to their Guy Stone Score (GSS): Of the total 227 patients, the mean age was 54.28 ± 13.34, 51.77 ± 10.07, 55.12 ± 0.92, and 55.51 ± 10.03 years in GSS1, GSS2, GSS3, and GSS4, respectively. In the subgroup of patients who underwent supracostal access, the mean ages were 51.00 ± 18.14, 53.00 ± 10.68, 51.52 ± 9.17, and 53.24 ± 9.29 years, respectively.All procedures were carried out following the evaluation of hemostasis, renal function, and anatomy of collecting system by conventional serum laboratory techniques and intravenous pyelography. General anesthesia was administered. In the supine position, an open ended 6 Fr ureteral catheter was placed transurethrally into the upper ureter or renal pelvis. All punctures were performed in the prone position at the upper pole  after the injection of contrast media via the ureteric catheter under fluoroscopic guidance. All supracostal access was performed between the 11th and 12th rib into the lower part of the intercostal space with close coordination with the anesthesiologist for respiration control. The puncture was made through the retroperitoneum during full expiration, and the needle passed through the renal parenchyma into the collecting system during deep inspiration. Both working and safety guide wires were inserted after the needle was in collecting system. Tract dilatation was performed using an Amplatz dilator  or telescopic metal dilators size 8 Fr to 30 Fr followed by the Amplatz sheath 30 Fr. A standard 26 Fr nephroscope was used utilizing ultrasonic or pneumatic lithotripsy for stone disintegration. The collecting system was examined using fluoroscopy and direct inspection using a nephroscope at the end of the procedure. A 20 Fr nephrostomy tube was inserted for 48–72 hours. No nephrostomy tube was inserted if there was no significant bleeding, no significant extravasation, no distal obstruction, and no retained stone (tubeless PCNL). Postoperative chest radiographs were obtained in all cases for the evaluation and treatment of any possible pulmonary complications in recovery room.The immediate success rate was defined as the patient being stone-free or the presence of asymptomatic fragments of less than or equal to 4 mm in plain KUB film postoperative day 1. Complications were graded according to the Clavien score system, which is divided into 5 grades. Minor complications were defined as Clavien score grades 1-2 and major complications were defined as Clavien 3–5.P < 0.05 was considered statistically significant.Statistical analysis using ANOVA Prosthoc and Fisher's exact test was performed, and P < 0.01. The operative time was 48.21 ± 21.70 min in GSS1, 65.50 ± 23.80 min in GSS2, 68.91 ± 29.43 min in GSS3, and 76.30 ± 33.40 min in GSS4, P < 0.01. Tubeless PCNL was 18.75%, 20.0%, 8.7%, and 5.49%, in GSS1, GSS2, GSS3, and GSS4, respectively (P = 0.03). The immediate success rate was 87.50% in GSS1, 71.43% in GSS2, 53.62% in GSS3, and 38.46% in GSS4, P < 0.01. Major complications (Clavien 3–5) were 3.13%, 17.14%, 30.43%, and 29.67% in GSS1, GSS2, GSS3, and GSS4, respectively, P < 0.01. There was no significant difference in age, number of incidents of previous open surgery, number of access tracts, and blood transfusion between each GSS. The demographic data with the results is shown in Tables The average stone size was 27.03 ± 0.60 mm in GSS1, 26.42 ± 10.09 mm in GSS2, 42.28 ± 11.79 mm in GSS3, and 63.24 ± 17.28 mm in GSS4, P < 0.01. The immediate success rate was 83.33% in GSS1, 66.66% in GSS2, 64.00% in GSS3, and 34.14% in GSS4, P < 0.01. Major complications (Clavien 3–5) were 0% in GSS1 and GSS2, 40% in GSS3, and 31.71% in GSS4, P = 0.03. There was no significant difference in age, number of incidents of previous open surgery, number of access tracts, operative time, and rate of tubeless and blood transfusion between each GSS. The demographic data with the results is shown in Tables The average stone size was 24.16 ± 3.43 mm in GSS1, 27.00 ± 9.15 mm in GSS2, 43.27 ± 11.91 mm in GSS3, and 61.97 ± 20.04 mm in GSS4, PCNL via the upper pole was shown to achieve a greater stone free rate due to this technique being able to reach most of the intrarenal collecting system especially in the treatment of complex stones. The incidence of pulmonary complication is significantly higher in PCNL via upper pole access especially when access is the supracostal route.Several factors are associated with post-PCNL outcomes including stone size, stone burden, degree of hydronephrosis, history of previous open nephrolithotomy, and anomalies of the kidney –14. de lPreviously, there was no definite tool to predict PCNL outcome and rate of complication, which is very important to both physicians and patients. The tools should indicate the difficulty or risk related to the surgery, which is the information required for patient counseling and surgeon communication. Several studies have attempted to classify PCNL to predict the outcomes , 16, 17 Recently, urolithiasis scoring systems for percutaneous nephrolithotomy outcome have been developed including the Guy Stone Score (GSS), STONE nephrometry and the CROES nephrolithometric nomogram. The Guy Stone Score, STONE nephrometry, and CROES nomogram serve as disease stratification tools for surgical planning and patient counseling in aspects of surgical outcome, but only Guy's Score and STONE nephrometry are associated with possible complications.Guy Stone Score (GSS) is a simple and reliable tool for predicting success rate. GSS is mainly used in kidney, ureter, bladder (KUB) film, and intravenous urography (IVU) to predict the success rate following PCNL. Some studies reported the usage of computed tomographic scan in GSS estimation for more accuracy. The CT scan was used as the preoperative investigation in stone patients, which improved the accuracy of stone information and renal and collecting system anatomy , 5. ViceWe agree that a preoperative CAT scan provided more accuracy regarding the detail of the anatomy such as characterization of the stone and pelvicalyceal anatomy, which are the factors in scoring these tools. But, GSS with plain KUB and intravenous urography is inexpensive and is a common routine investigation in stone patients especially in developing countries with a high prevalence of stone disease. These investigations have the additional advantage of providing a lower radiation dose than a CT scan. This is the initial study reporting on the use of GSS based on IVP in prediction regarding the outcome of PCNL with upper pole access, either supracostal or subcostal access.This study confirmed that GSS based on KUB and intravenous urography is a valuable tool in the prediction of the outcome and complication rate following PCNL via the upper pole. Immediate success rates, operative time, tubeless rates (rate of uncomplicated procedure), and major complications are significantly different within the group of each GSS. There was few patients in this study who need multiple tracts and received blood transfusion. Fewer numbers of all positive outcome parameters and more major complications were found in higher GSS patients. A preoperative CT scan is not a common investigation in developing countries. The information in grading patients of GSS can be achieved from plain KUB and intravenous urography due to its simple classification in routine clinical practice. This nomogram does not need complex calculations. Our study demonstrated that plain KUB and intravenous urography are as useful in informing the classification grading of the GSS score as the CT scan. The results of this study demonstrates the correlation of the GSS grade with post-upper pole access PCNL outcome and complications in a large number of patients.The Limitations. The number of patients in this study is small especially with supracostal access in GSS1 and GSS2. This limitation can be explained by the less common use of supracostal access in patients with lower GSS. A future larger prospective or meta-analysis study is needed. This study did not recruit patients with other factors such as kidney anomalies that may affect the outcome. Only Guy's Stone Score (GSS) was utilized in this study based on an intravenous pyelogram (IVP) to predict the outcome, so it cannot be compared with other Stone Scores, which required a CAT scan.Guy's Stone Score (GSS) based on interpretation of an intravenous pyelogram is a simple and reliable tool in predicting the immediate success rate and possible complications following supracostal and subcostal upper pole access PCNL. This nomogram is very helpful in preoperative patient counseling and informing the decision about referral of more complicated patients to centers with higher patient volume and more expertise.


To evaluate the importance of preoperative neutrophil lymphocyte ratio (NLR) predicting malignancy in patients who undergo partial nephrectomy due to renal mass.Seventy nine patients who underwent open partial nephrectomy for renal masses were included in this retrospective study. In preoperative routine blood tests, renal ultrasonography and contrast-enhanced computed tomography were performed for all patients. Preoperative neutrophil lymphocyte ratio were compared in patients with clear cell renal cell carcinoma  and benign lesions . The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR.The mean age of patients was 59.8±11.7 years in Group1 and 57.4±12.6 years in Group 2 (p=0.493). The mean tumor size was 3.8±1.2 cm in Group 1 and 3.3±1.0 cm in Group 2 (p=0.07). The median NLR was 2.48 (1.04) in Group 1 and 1.63 (0.96) in Group 2 (p<0.001). The area under a ROC curve was 0.799 (p<0.001).Preoperative neutrophil lymphocyte ratio may predict renal masses that can not be distinguished radiologically. Our results must be confirmed by large and properly designed prospective, randomized trials. Renal cell carcinoma (RCC) represents 2-3% of all cancers , with thThe relation between inflammation and tumor development and progression has been recognized in recent decades , 9. As aThe neutrophil to lymphocyte ratio (NLR) is also a widely used inflammatory marker that is defined as the absolute neutrophil count divided by the absolute lymphocyte count, and can be easily determined from complete blood cell parameters .Unfortunately, radiological methods are still not sufficient for predicting malignancy. This can lead to unnecessary surgery in patients with benign renal masses. In this study, we investigated the importance of preoperative neutrophil lymphocyte ratio predicting malignancy in undistinguished radiological renal masses. This is the first study in the literature.Seventy nine patients who underwent open partial nephrectomy for renal masses were included in the study between 2006 and 2015. Patient data were analyzed retrospectively. In preoperative routine blood tests, renal ultrasonography and contrast-enhanced computed tomography were performed in all patients. NLR was compared in patients with clear cell RCC  and benign lesions . The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR.Normality distribution was investigated for all numeric variables. Categorical variables were described by frequencies and percentages and numeric variables were described by means and standard deviations or medians and interquartile ranges. The relationship between two categorical variables was tested by Chi-square test. Two independent means was compared by Student t test and two independent medians were compared by Mann Whitney U test. The predictive ability of NLR was analyzed by ROC curves and Youden Index method was used to identify the cut-off value for NLR. A p value less than 05 was accepted as statistically significant.Mean age of patients was 59.8±11.7 years in Group 1 and 57.4±12.6 years in Group 2 (p=0.493). Mean tumor size was 3.8±1.2cm in Group 1 and 3.3±1.0cm in Group 2 (p=0.07). The median NLR was 2.48 (1.04) in group 1 and 1.63 (0.96) in group 2 (p<0.001). Both groups were similar in terms of sex and tumor side  14 patieForty three (66.2%) of 65 patients had pT1a tumor and 22 (33.8%) of 65 patients had pT1b tumor 15 patients had grade 1 tumor, 46 patients had grade 2 tumor and 4 patients had grade 3 tumor. Optimal cut-off value of NLR was 1.725, with sensitivity of 93.8% and specificity 64.3% .The area under the ROC curve was 0.799 (p<0.001) . PredictIncreasing evidences support the involvement of systemic inflammation in cancer development and progression . It has An elevated NLR reflects both a decreased lymphocyte mediated antitumor immune response and a increased neutrophil dependent inflammatory reaction. Both of these factors may contribute to aggressive tumor biology, cancer progression, and poor prognosis , 20.Despite recent progress in the identification of genetic, epigenetic and common molecular alterations in RCC , routineRecently, several serum biomarkers and hematological indices representative of inflammatory response, notably C reactive protein (CRP), fibrinogen, lymphocyte-monocyte ratio, neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio, have been demonstrated to be closely related to poor prognosis of patients with RCC -25. TherThere are other laboratory markers of systemic inflammation reaction besides NLR, such as CRP  and modiIn previous studies, it was demonstrated a relationship between poor prognosis and NLR. Unlike previous studies, we investigated the role of NLR in the malign-benign distinction. In the present study, we found that preoperative neutrophil lymphocyte ratio may predict renal masses that cannot be distinguished radiologically.This study has several limitations. First, the study was retrospective. Second, NLR could be affected by different conditions, especially undetected diseases such as chronic infection, chronic disease, and autoimmune disorders, such as rheumatic disease. Third, the number of patients was especially low in the benign group. Our results should be confirmed by prospective randomized studies with large population patients. If confirmed, preoperative NLR will be an important tool to prevent unnecessary surgeries.Preoperative neutrophil lymphocyte ratio might predict renal masses that cannot be distinguished radiologically. Our results must be confirmed by large and properly designed prospective, randomized trials.


The prevalence rate of type 2 diabetes mellitus (T2DM) is one of the highest in United Arab Emirates (UAE), however data for the expatriate population is limited. This study aimed to identify the prevalence of T2DM amongst migrant women and test the hypothesis that acculturation (measured by years of residency) is associated with an increased risk of T2DM.This was a cross-sectional study and we recruited a representative sample  of migrant women aged 18 years and over in Al Ain, UAE. The American Diabetes Association criteria were used to diagnose T2DM. An adapted WHO STEPS questionnaire was used to collect socio-demographic, lifestyle and clinical data. Logistic regression analysis was performed to identify correlates of T2DM including length of UAE residence.The mean age of participants was 34.1 (± 9.5) years. Of the study participants, based on HbA1C levels, 18.6% (95% CI: 13.9–24.4) had prediabetes and 10.7% (95% CI: 7.2–15.6) had T2DM. Prevalence of prediabetes was 8.5% for Filipinos, 16.7% for Arabs and 30.3% for South Asians. Similarly the prevalence of T2DM was 1.7% for Filipinos, 12.2% for Arabs and 16.7% for South Asians. Significant correlates of overall T2DM (measured and known diabetes) included length of UAE residence for more than 10 years , age ≥40 years  and South Asian nationality .Diabetes is a significant public health problem among migrant women in the UAE, particularly for South Asians. Longer length of residence in the UAE is associated with a higher prevalence of diabetes. Accordihe world .Epidemiological studies in the UAE have predominantly focussed on the prevalence of diabetes and associated risk factors amongst the Emirati population. However, the UAE also has a large diverse multi-cultural and multi-national expatriate population accounting for approximately 85% of the total UAE population. In the past 40 years, the UAE has achieved remarkable economic growth, raising the prosperity of its citizens and creating opportunities for expatriates to migrate to live and work in the country. A significant proportion of immigrants include women, from Arab countries, South Asia and the Philippines who are typically employed as housemaids .Previous studies have shown that exposure to environmental factors in economically developed countries may place immigrants at a higher risk of developing T2DM . Upon ar2P (1-p)/d2) to estimate the sample size (n = 500) to identify the prevalence of diabetes in females. To account for refusals we increased the sample size and targeted 800 participants. We invited every third person on this list to participate in the study. Data collection for this study took place between 01 November 2012 and 31 May 2013. Exclusion criteria included female UAE citizens, female migrants from other countries (i.e. not Arab or South Asian countries or the Philippines), and females not providing consent. Arab included Egypt, Jordan, Palestine, Lebanon and Yemen while South Asian countries comprised.This study employed a cross-sectional design. Ethical approval was obtained from both the Al Ain Medical District Human Research Ethics Committee and the Abu Dhabi Ambulatory Healthcare Services Research Committee. Informed written consent was obtained from all the participants. All expatriate workers (including women) seeking employment in the UAE are required by law to undergo health and communicable disease screening (i.e. primarily pulmonary tuberculosis by chest X-ray and human immunodeficiency virus by serology) at a Government “visa screening center” before they can receive a residency permit. Expatriates are also required to undergo screening when they renew their visa which is usually every three years. The sampling frame in our study was a list of all the female expatriate workers (aged ≥18 years) who were enrolled for examination at the screening centre in Al Ain, Abu Dhabi, UAE. We used the formula for binomial distribution  developed by the World Health Organization (WHO) for the measurement and surveillance of non-communicable disease (NCD) risk factors in populations . Due to 2). The WHO cut-off points for BMI for adults were used to classify underweight (BMI <18.5 kg/m2), normal weight (BMI 18.5–24.9 kg/m2) overweight (BMI 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2) [We ascertained T2DM as the self-report of a physician diagnosis of T2DMs and the use of a diabetic medication or a blood glycated hemoglobin level (HbA1c) level ≥ 6.5%. Pre-diabetes was defined as an HbA1c level of 5.7–6.4% . Blood s0 kg/m2) . We used0 kg/m2) . Resting‘Active’ group  or an ‘Inactive’ group (not achieving the aforementioned level of activity) [Information on physical activity was obtained using the International Physical Activity Questionnaire (IPAQ-short version) ; which mctivity) . In the We entered the data using Microsoft Access before importation into Stata version 14.0  for analysis. Continuous variables were presented as means and standard deviations and categorical variables as counts and percentages. The crude prevalence of diabetes by nationality and duration of stay in the UAE were calculated as percentages with 95% confidence intervals (CI). Univariate logistic regression was used to calculate the un-adjusted odds ratio (and 95% CIs) of diabetes for a range of predictor variables including age, education, occupation, nationality, duration of UAE residence, family history of diabetes, physical activity, BMI category and waist circumference. Finally multiple logistic regression was used to produce odds ratios and 95% CIs, adjusted for those variables that were found to be significant in the simple logistic regression analysis.Of the 800 eligible participants, 599 (75% participation rate) agreed to participate. A substantial proportion (24.4%) of eligible participants was prevented from taking part due to the demands of the visa screening process. Of the 599 who participated, 555 (92.6%) were from three geographical areas namely the Philippines (n = 292), Arab countries (n = 136) and South Asia (n = 127). The analysis that follows is confined this sub-set of 555 participants. The mean age was 34.1 ± 9.5 years and a majority (53.8%) came from urban areas within their home countries. With respect to accommodation arrangements, 43.5% lived with their family in the UAE, 35.6% lived with their sponsor (employer), 11.2% shared accommodation with non-relatives and 9.7% had single accommodation. Fifty seven percent were married with, on average, three children. The following analysis is confined to the sub-set of 215 participants that had a blood test for HbA1c. Overall, 18.6% (95% CI: 13.9–24.4) had prediabetes and 10.7% (95% CI: 7.2–15.6) had T2DM. The prevalence of prediabetes was 8.5% (95% CI: 3.5–19.0) for Filipinos, 16.7% (95% CI: 10.2–25.9) for Arabs and 30.3% (95% CI: 20.3–42.5) for South Asians. Similarly the prevalence of T2DM was 1.7% (95% CI: 0.3–11.4) for Filipinos, 12.2% (95% CI: 6.9–20.9) for Arabs and 16.7% (95% CI: 9.4–27.8%). We have previously reported high levels of overweight, central obesity and hypertension amongst young South Asian male migrants in the UAE together with an association between length of residence (as a proxy for acculturation) and central obesity and diabetes . In thisacculturation which may be defined as the adoption by immigrants of local customs and habits; specifically, the adoption of western dietary habits which may result in adverse health effects such as obesity and T2DM [Study findings revealed that the prevalence of T2DM was significantly higher among those who had been living in the UAE for ten years or more. Our study represents the first data available on the prevalence of obesity and diabetes in female Arab, South Asian and Filipino immigrants residing in the United Arab Emirates. However, similar findings have been reported for immigrants from these countries in North America and South America. For example, a study of immigrants in Canada found higher rates of diabetes among those from South Asia and those who had been living in Canada for 15 years or more compared to those living in Canada for 5–9 years . We beliand T2DM . Indeed,and T2DM . Westernand T2DM . Unhealtand T2DM .Healthy Migrant Effect or “immigrant health advantage” is temporary. On arrival, immigrants have a better health status than the native population but their health declines as their stay increases [festival foods. These are food items high in carbohydrates, animal protein, sugar and fat that previously were consumed only few times a year on special occasions but which are now a routine part of the immigrant diet [In previous studies, evidence for an effect of acculturation on weight gain and diabetes has been most convincing in men with less consistent results in women. Explanations for this difference include the possible effect of heritage cultural influences on body image, food choices and physical activity . Alternancreases . There ancreases . Also, aant diet . Althougant diet , 39. Amoant diet . Amongstant diet . Furtherant diet .The strengths of this study include our random representative sample of women attending the mandatory health visa screening center in Al Ain, the second largest city in the emirate of Abu Dhabi in the UAE. Our response rate of 75% ensures that our sample is representative of migrant women in the UAE. We used an adapted version of the WHO STEPwise questionnaire for NCD risk factor surveillance, we used two anthropometric indices to classify obesity (BMI and waist circumference) and we objectively measured HBA1c (in a sub-sample of our study population). However, our findings must be interpreted in light of the acknowledged limitations of this study. Firstly, as with any cross sectional design, it is not possible to draw conclusions about the temporal or causal nature of the association between acculturation and the outcome variables. Secondly, we used years of residency to estimate acculturation rather than using a standardized acculturation measure. Currently, there are no validated instruments to measure acculturation amongst migrants in the Gulf region and the assessment of acculturation is culture -specific. Future researcher may wish to consider adapting tools that have been used in migrant populations in the UK and US. Alternatively, it may be appropriate to develop a new tool that is appropriate for our setting which might include dimensions such as dietary preferences, clothing style, use of own-culture media, language use and fluency, social connections, and cultural and religious beliefs.In conclusion, there are high levels of overweight, obesity and central obesity amongst migrant women in the UAE and after ten years, migrant women have three times the prevalence of T2DM compared with more recent arrivals. It is likely that changes in diet and lifestyle account for these findings. Further research is needed to understand these changes but this should not delay the design and implementation of appropriate and feasible interventions aimed at the maintenance of a healthy body size and regular assessment of glucose control.


Escherichia coli O157:H7 is an enteric foodborne pathogen associated with life threatening disease conditions. The enterobacteria are frequently found in cattle gastrointestinal tract with high potential of contaminating animal products such as meat, milk, and cheese. A cross-sectional study was conducted to investigate the presence of Shiga toxin-producing Escherichia coli O157:H7 in milk products sold within Sokoto metropolis. Two hundred and sixty (260) samples (comprising 160 raw and 100 fermented milk samples) were collected from different sources within the study area. Bacteriological isolation and biochemical characterization yielded Escherichia coli with a detection rate of 9.23% (24/260). Molecular identification of the recovered isolates by PCR amplification of the Stx1 gene revealed Escherichia coli O157:H7 with a positive rate of 20.83% (5/24). The overall prevalence of E. coli O157:H7 was 1.92% (5/260) and the positive proportions for raw and fermented milk samples were 1.86% (3/160) and 2.0% (2/100), respectively. Fisher's Exact test showed a nonsignificant association between the isolates and the different milk types . The results revealed presence of Escherichia coli O157:H7 in raw and fermented milk sold within Sokoto metropolis, Nigeria. The findings indicate possible feacal contamination of the milk products, with serious public health consequences. This necessitates the need to screen other milk products produced in the area such as butter and cheese. Health authorities in the State need to enlighten dairy farmers on the zoonotic potential of Escherichia coli O157:H7 and the role of cattle in the spread of the pathogen. Escherichia coli is a Gram-negative, rod shaped, facultative anaerobic bacterium of the family Enterobacteriaceae. Based on its virulence, the bacterial organism is classified into five groups, namely, enterotoxigenic E. coli (ETEC), enteropathogenic E. coli (EPEC), enterohemorrhagic E. coli (EHEC), attaching and effacing E. coli (AEEC), and Shiga toxin-producing E. coli (STEC) : EDTA [1 mM]) in a microfuge tube and heated at 96°C for 15 mins. The tubes were immediately transferred onto ice for 15 mins and then centrifuged at 15000 g for 2 mins at room temperature. The pellets were discarded while the supernatant containing the DNA templates was used for polymerase chain reaction.The boiling method of nucleic acid extraction was employed as earlier described . Brieflyμl reaction mixture contained 12.5 μl TopTaq Master Mix 2x, 7.5 μl RNase-free water, 2.5 μl of 200 ng DNA template, and 0.25 μM of two-primer cocktail  was done using TopTaq™ Master Mix PCR kit (Qiagen®). The 25 cocktail  amplifyi earlier . Samplesμl) was added to the liquid agarose before pouring into a gel caster set and allowed to solidify at room temperature. The caster was rightly placed into an electrophoresis tank and flooded with 1x TBE buffer to the maximum level before carefully removing the comb. The PCR products (5 μl each) were then loaded into the wells using a 10 μl Eppendorf pipette. Four microliters (4 μl) of 100 bp ladder (BioLabs Inc. New England) mixed with 2 μl Gel Loading Dye Blue 6x (BioLabs Inc. New England) was also loaded into one of the wells before connecting the tank to a power pack and plugging it to the mains supply. The products were electrophoresed at 85 volts for 50 mins. Immediately after electrophoresis, the agarose gel was viewed using a Gel Doc™ XR+ (BioRad). The gel image was captured and labelled accordingly.A 1.5% agarose gel was prepared by suspending 1.5 grams of agarose powder in 100 ml of 1x Tris-Borate-EDTA (TBE) buffer and heated on a hot plate until completely dissolved. Ethidium bromide (2.5  E. coli O157:H7 isolates and type of milk (raw and fermented) using a significance level of 5% and 95% confidence interval. All analyses were performed using SPSS .The results obtained were presented in tables and narratives. Fisher's Exact test was used to determine association between the E. coli was 9.23% (24/260) with an isolation rate of 9.38% (15/160) and 9.0% (9/100) for raw and fermented milk, respectively. Statistical analysis using Chi Square (χ2) test showed a nonsignificant association  between the E. coli isolates and the different milk types ( (Stx1) in E. coli O157:H7 showed 5 out of the 24 E. coli isolates to be positive with a prevalence of 20.83% (5/24)  between the E. coli O157:H7 isolates and the different milk types , 12.70% (8/62), and 9.30% (4/43) for Sokoto South, Sokoto North, and Dange-Shuni, respectively. Univariable analysis by logistic regression showed a nonsignificant association between the E. coli isolates and the local government areas ( E. coli recovered from raw milk samples were E. coli O157:H7 with positive proportions of 25.0% (2/8) and 33.3% (1/3) for Sokoto North and Sokoto South LGAs, respectively. None of the E. coli isolates from Dange-Shuni LGA were STEC. Fisher's Exact test revealed a nonsignificant association  between the STEC isolates and the LGAs in the study area ( E. coli isolated recovered from fermented milk were from different LGAs (Sokoto North and Sokoto South). However, no statistical analysis was undertaken to determine any association between the STEC isolates and the LGAs since both areas had one positive sample each.The overall prevalence oflk types . Molecul% (5/24) . The prelk types . The pront areas . Howeverudy area . The two Listeria monocytogenes, Salmonella species, Shigella species, and Campylobacter species have been associated with consumption of contaminated milk [ E. coli O157:H7 is the most pathogenic as it has been incriminated in various disease conditions such as hemolytic uremic syndrome, thrombotic thrombocytopenic purpura, and hemorrhagic colitis [ E. coli O157:H7 from both raw and fermented cow milk in this study indicates potential fecal shedding of the pathogen and subsequent contamination of the milk. Cattle are the major reservoirs of the organism and can actively shed the bacteria in faeces without any clinical manifestation [Milk is a good medium for the growth and proliferation of microorganisms and several disease causing bacteria such asted milk . Of all  colitis . Moreove colitis . The isoestation . Thus thestation . Hand miestation . Moreoveestation . Therefo E. coli O157:H7 has been described to be acid-resistant as it can steadily survive in fermented milk with a pH as low as 4.0 [ E. coli from milk samples collected from the different LGAs within the study area and the nonsignificant association between the isolates recovered (E. coli and STEC) and the LGAs  in the traditional methods of milk production in order to identify potential sources of microbial contaminants and introduce appropriate prevention and control measures. Veterinary extension services in the State should reiterate on farm hygiene practices with a view to educating the Hausa/Fulani nomads on the importance of farm hygiene and the risk associated with consumption of contaminated milk. Emphasis should be made on the zoonotic potential of Escherichia coli O157:H7 and the role of cattle in the spread of the pathogen. Health authorities in Sokoto State and the country at large need to regulate the production and sell of milk and milk products by introducing periodic screening and issuance of fitness certificate to farmers.The findings of this study indicate presence of


Most of the headache cases only require pain management in emergency department (ED). The present study aimed to evaluate the efficacy of intranasal lidocaine in this regard. In this clinical trial, adult patients with primary headache were randomly treated with 7.5 mg intravenous (IV) chlorpromazine and 1 ml intranasal lidocaine 2% (treatment) or normal saline 0.9% (placebo), and were compared 5, 15, and 30 minutes later regarding success rate using SPSS 21.100 patients were assigned to either treatment or placebo group. Number needed to treat of intranasal lidocaine at 5, 15, and 30 minutes were 4 (95% CI: 2.2 – 6.6), 3 (95% CI: 1.7 – 3.5), and 4 (95% CI: 2.3 – 15.9), respectively. These measures for absolute risk reduction were 30 (95% CI: 15.2 – 44.8), 44 (95% CI: 28.7 – 59.3), and 26 percent (95% CI: 6.3 – 44.3), respectively. Pain relapse occurred in 16% of treatment and 11% of control group within 1 hour of treatment (p = 0.402).It seems that, intranasal lidocaine along with IV chlorpromazine could result in more successful and faster management of primary headaches in ED.  Headache is a common cause of emergency department (ED) visits. Most of these patients only require symptomatic treatment and referral to a neurologist or the patient’s family physician on an outpatient basis .Migraine, tension, and cluster are three types of primary headaches with considerable clinical overlap, which suggests the same pathophysiology .Common drugs used to treat these headaches are intravenous (IV) and oral opioids, ergot alkaloids, antiemetic, and non-steroidal anti-inflammatory drugs (NSAIDS) , 3. Intranasal route of drug administration may be more effective than other routes, with lower chance of emesis, and a quicker onset of action . IntranaLawrence Robbins showed the safety of intranasal lidocaine as a an adjunctive medication in cluster headache control . StudiesThere has been limited experiences regarding primary headache management through intranasal medication in ED. Therefore, this study aimed to evaluate the efficacy of intranasal lidocaine in primary headache management in ED.Study design and settingThis randomized, double blind placebo controlled trial was done on patients presenting to emergency department of Golestan Hospital, Ahwaz, Iran, from July 2012, to December 2014 with primary headache . The study design was approved by ethics committee of Ahvaz Jundishapur University of Medical Sciences under the number U-91159 and registered on Iranian Registry of Clinical Trials under this number: IRCT201212289148N2. Written informed consent was obtained from all patients. Researchers adhered to declaration of Helsinki protocol and confidentiality of patients’ information.ParticipantsThe subjects were patients between 15 – 55 years old who presented to the emergency department with complaints of primary headaches  according to the definition of International Headache Society and Ad Hoc Committee on Classification of Headache. Patients with signs of secondary headaches such as fever, meningismus, trauma, unstable vital signs, and altered mental status were excluded. Lactating and pregnant women as well as who had taken analgesic medications 2 hours before referring to ED were also excluded. Participants were randomly assigned to either treatment or control group using simple random sampling method.InterventionPatients in the treatment group received 1 mL intranasal lidocaine 2% (20 mg lidocaine) and 7.5 mg intravenous (IV) chlorpromazine and those in control group received 1 mL intranasal normal saline 0.9% and 7.5 mg IV chlorpromazine. The lidocaine and normal saline were sprayed with the same shape and color containers.Data gatheringA checklist that consisted of baseline characteristics , type of primary headache, pain severity, and possible complications was filled for all patients by a senior emergency medicine resident under supervision of an emergency medicine physician. Visual analog scale (VAS) was used to rate the pain severity at the baseline as well as 5, 15, and 30 minutes after drug administration. In addition, patients were observed for an additional 30 minutes to assess whether they responded to the treatment or whether their pain returned. Patients, in charge physicians, and data analyzer were blinded to drugs given to each group. Outcome5, 15, and 30 minute success rates were considered as the main outcome of the study. Statistical analysisConsidering 95% confidence interval (CI), 80% power, and according to the Maizals et al. and Blanda et al. findings , 12, theBaseline characteristics100 patients were randomly assigned to either treatment (50 cases) or control (50 cases) group . The mean age of treatment and control groups were 32.96 ± 8.51 and 29.60 ± 8.64 years, respectively (p = 0.050). Pain controlThe mean pain severity of patients at the time of presenting to emergency department and 5, 15, and 30 minutes after treatment are summarized in The success rates of two groups at 5, 15, and 30 minutes are compared in Number needed to treat of intranasal lidocaine at 5, 15, and 30 minutes were 4 (95% CI: 2.2 – 6.6), 3 (95% CI: 1.7 – 3.5), and 4 (95% CI: 2.3 – 15.9), respectively. These measures for absolute risk reduction were 30 (95% CI: 15.2 – 44.8), 44 (95% CI: 28.7 – 59.3), and 26 percent (95% CI: 6.3 – 44.3), respectively.The side effects related to treatment were not apparent in either the treatment or the control group within 30 minutes after treatment. Pain relapse occurred in 16% of the treatment and 11% of the control group during 1 hour follow up (p = 0.402).Considering 30, 44, and 26 percent absolute risk reduction at 5, 15, and 30 minutes after treatment, intranasal lidocaine along with intravenous chlorpromazine could result in more successful pain management of primary headaches in ED. This study showed that patients who received intranasal lidocaine along with IV chlorpromazine significantly experienced higher success rate in pain control at 5, 15, and 30 minutes after treatment. Although the two studied groups had different baseline characteristics, the analysis of data didn’t show any relationship between age, sex, and type of primary headache with treatment success rate.Maizels and Geiger evaluated the efficacy of intranasal lidocaine in a double-blind controlled trial with open-label follow-up. They found that headache was relieved within 15 min in 35.8% of patients in the treatment group, with a 20.6% relapse rate .Mohammadkarimi and colleagues using intranasal lidocaine in 90 patients with primary and secondary headaches found significant pain relief after 1 minute, and showed that the level of patients’ pain did not significantly change over the course of the study. They did not assess the relapse rates or side effects related to treatment (In contrast, Blanda and colleagues found that the intranasal lidocaine did not relieve pain after 5 or 30 minutes .Although the experience of drug delivery through nasal mucosa goes back to many years ago, based on a review in 2013 the present method for delivering the drug to the posterior-superior part of the nose is not that effective and this could affect the success rate of this method to a great extent (It seems that using a new method that can be applied by the patients themselves without the need for visiting the hospital should be considered more seriously. This is of great importance, especially for cases such as primary headaches that are usually recurrent and distractive. Of course, there is still a long way to go in making the use of these drugs public and revising traditional methods.LimitationIn the current study, we administered intranasal 2% lidocaine for different types of headache and not just for migraine. We followed patients in both the treatment and control groups for only a short time. We did not perform follow-up assessments. In addition, because our treatment group received lidocaine and chlorpromazine together, our study is limited in its assessment of pure lidocaine’s ability in pain management.Considering 30, 44, and 26 percent absolute risk reduction at 5, 15, and 30 minutes after treatment, intranasal lidocaine along with IV chlorpromazine could result in more successful and faster management of primary headaches in ED.


Purpose. To determine the optimum preservation conditions for preloading DMEK lenticules using organ culture system. Methods. 8.5 mm DMEK lenticules were stripped and preserved with endothelium flap-in for 4 days at RT in an IOL cartridge that was blocked with rubber stoppers from each end. In C1, tissues were collected from tissue culture medium (TCM) and preserved in TCM. In C2, tissues were collected from transport medium (TCM + 6% dextran T500) (TM) and preserved in TM. In C3, tissues were collected from TCM and preserved in TM. Mortality, glucose uptake, histological staining, tight junctions and cell apoptosis were studied post-preservation. Results. Mortality in C1, C2, and C3 were 49.40%, 8.53%, and 27.74%, with 40.7%, 13%, and 41.8% uncovered areas. Glucose uptake (mg/mL) was 0.32, 0.43, and 0.56 in C1, C2, and C3. PAS staining showed presence of DM and endothelium in C2 but not in C1 and with fewer cells in C3. ZO-1 was expressed in all the conditions. Polymorphism was higher in C1 and C3. Mild apoptosis was observed in C3. Conclusions. Dextran may play an important role in preserving the endothelial cells before and after stripping for trifolded (endothelium-in) preloaded DMEK lenticules. Descemet's Membrane Endothelial Keratoplasty (DMEK) is a type of corneal surgery, which allows the transplantation of Descemet's Membrane (DM) and endothelium –4. DMEK We at the Veneto Eye Bank Foundation have recently started providing preloaded tissues for DSAEK and UT-DSAEK surgeries, a step further to precut tissues , 14. ThiTissue culture medium (TCM) is the most commonly used corneal storage media in Europe while hypothermic-based preservation method is pursued in America and most of the world. As the tissue preservation is important to keep the endothelium viable, it becomes necessary to investigate the optimum condition to preload a DMEK lenticule, which is the next advancement in the field of endothelial keratoplasty . PreloadThirty human donor corneal tissues were collected from the Veneto Eye Bank Foundation,  with a written consent from the donor's next of kin to be used for research.TCM was composed of 2% newborn calf serum with MEM-Earle as a base medium along with 25 mM Hepes buffer, 26 mM sodium bicarbonate, 1 mM pyruvate, 2 mM glutamine, 250 ng/mL amphotericin B, 100 IU/mL penicillin G, and 100 mg/mL streptomycin. TM was composed of TCM incorporated with 6% dextran T500. TCM and TM were prepared in house  with full regulatory compliance.All the corneas were preserved in TCM before the study. However, to load the tissues and study the effect of the preservation medium on the tissues, ten corneas were further preserved in TM. The endothelial cells were evaluated using a hypotonic sucrose solution and the viability was checked using trypan blue staining for 30 seconds followed by washing the cells with phosphate-buffered saline (PBS). Corneal thickness from the TCM and TM groups was recorded before peeling using Optical Coherence Tomography .The tissues were collected and preserved in different conditions, as described in n = 30] were mounted on a vacuum punch base and secured. The corneas were gently tapped on the endothelial side and a 9.5 mm superficial cut was created using a Moria punch . The endothelium was stained using trypan blue for 20 seconds to determine the cut area. After removing the periphery, the central DMEK lenticule was excised and placed back on the tissue with endothelium facing the air. The prestripped membrane was punched again to excise an 8.5 mm  lenticule. The peripheral remnants were removed. The lenticule was folded (trifold) with endothelium, in position using an acute forceps. The lenticule was then gently moved in the preservation chamber of a 2.2 intraocular lens (IOL) cartridge  and was further pulled inside the funnel of the cartridge using 25G microincision forceps from the funnel end. The funnel was filled with the preservation medium as listed in The procedure was carried out as described in our previously published article . In brien = 30] were stained after storage using trypan blue for 20 seconds and washed with phosphate-buffered saline (PBS). The lenticules were exposed to sucrose solution in a petri plate. The endothelial cell density (ECD) and mortality were counted using a 10 × 10 mm reticule (grid) inserted in the eyepiece of an inverted microscope  at 100x magnification by masked observers.All the lenticules [n = 30] after 4 days of preservation (poststorage) in an IOL cartridge. This helped to check the metabolic activity of the endothelial cells when preserved in vitro. Quantitative analysis was performed using D-Glucose HK kit  after preservation.Glucose uptake was determined from the preservation media of all the samples . The tissue was fixed in 4% PFA overnight followed by washing it with sucrose solution at 7.5%, 15%, and 30% for 15 minutes each. Final washing was carried out with PBS and the tissues were embedded in Optimal Cutting Temperature (OCT) for microtome cutting. Periodic Acid-Schiff (PAS) staining was performed on all the samples and sections were viewed at 10x magnifications in order to check the variability and reproducibility in tissue selection and preservation performances along with stromal interference, if any.The lenticules were opened up after storage before processing them for histological analysis. The presence of Descemet's Membrane, collagen fibers, and endothelium was investigated  were viewed at 100x magnifications of an inverted microscope. The images were analyzed using ZEN  software.Cell apoptosis was performed as described in the manufacturer's protocol for TACS 2 terminal deoxynucleotidyl transferase (TdT) diaminobenzidine (DAB)t-test was employed to check statistical significance between the different groups. p < 0.05 was deemed statistically significant.Student's 2 with initial mortality of 0.2 (±0.54)%. Successful peeling was observed in 76% of cases when the tissues were collected from TCM whereas 100% tissues were peeled successfully when the tissues were collected from TM. Average stripping time for C1 and C3 was 25 minutes and that for C2 was 19 minutes. Average loading time was 5 minutes for all the tissues. The tissues collected from TCM had a higher thickness of  963.5 (±77.02) μm as compared to TM, which was 570.3 (±49.47) μm thick before stripping. The tissues from TM showed thickness similar to in vivo corneas as they were deswelled.The average age of the donor was 67.1 (±6.20) years with male : female donor ratio of 24 : 6. Average postmortem time was 14.6 (±6.45) hours. All the corneas were previously preserved in TCM with an average preservation time of 14.27 (±6.09) days. The tissues were further preserved in TM for 3.4 (±2.72) days before stripping. The average endothelial cell density recorded was 2203.33 (±335.52) cells/mm2) after preservation in C1, C2, and C3 was found to be 1130 (±944.05), 1950 (±108.01), and 1970 (±512.18), and the mortality (%) was 25.94 (±44.23), 3.8 (±7.74), and 21.8 (±36.41), respectively. It was also observed that the cells detached from the lenticule during preservation and therefore the uncovered areas (%) determined for C1, C2, and C3 were 40.7 (±47.96), 13.0 (±18.55), and 41.8 (±37.77). Loading to postpreservation in C1 showed statistically significant endothelial cell loss (p = 0.0051); however, C2 (p = 0.1092) and C3 (p = 0.0819) did not show statistical significance, although the average ECL observed in C3 was high. ECD (cells/mmp > 0.05).Average glucose uptake by the endothelial cells in the preservation chamber for 4 days at room temperature was 0.32 (±0.18) mg/mL from C1, 0.43 (±0.27) mg/mL from C2, and 0.56 (±0.18) mg/mL from C3, which is one-third to half of the total amount of glucose present in the media. These results are similar to those showed in the preloaded DSAEK lenticules . HoweverThe analyzed tissues (100x magnification using PAS staining) showed no presence of endothelial cells, but only the DM  in C1. TThe endothelial cells showed expression of tight junction protein (ZO-1) after preservation as seen in Control cells were induced with apoptosis using TACS nuclease  to compa in vivo conditions are important for a successful corneal transplantation.As indicated in Introduction, DMEK requires high surgical skills, but there are ways to ameliorate the quality of the tissues distributed to surgeons and help them perform an easier transplantation. One of the methods is to check whether the preservation technique may affect the quality of the tissue. Dextran has been widely used to deswell the cornea after the tissue has been swollen during the TCM preservation phase. The number of viable endothelial cells and a thickness that is similar to theOrgan culture offers several advantages in terms of sterility checks, longer duration of preservation, and hence a proper planning of the surgery . Althougμm, the success rate changes as compared to the normal thickness of the graft, which has regained its original thickness (approximately 550 μm). We observed 76% successful peeling cases with higher thickness where the tissues were preserved in TCM as compared to 100% successful cases when the tissues were preserved in TM. Peripheral tearing that resulted in the loss of tissues eventually was the major reason when the tissues were excised from TCM. The stroma was thick and the punch for creating a superficial cut does not direct a regular cut in an uneven stromal base when the tissues were taken from TCM. On the contrary, when the tissues were obtained from TM, due to the regular thickness and a more constant cornea throughout, the cut obtained was precise and the excision was accurate without any peripheral tears. Therefore, to standardize the peeling technique, the tissues can be obtained from TM or from dextran-based media for peeling.Previously, it has been shown that the preservation medium has no effect on the rate of successful peeling of DMEK tissues . HoweverFurther, the tissues are usually prebubbled, prestripped, or prerolled and preserved in the respective media , 12. How2) for research. As per our previously reported article, there is a learning curve to preload a DMEK graft and after the learning curve the average endothelial cell mortality and uncovered areas after preservation in dextran-based media were 3.55% (±5.79%) and 7.8% (±14.13%), respectively. Overall endothelial cell loss (ECL) after preservation in dextran-based medium was 4.35%, which is less than the endothelial cell loss observed here that is due to the learning curve [Endothelium, if flapped in, does not have statistically more damage compared to endothelium when flapped outward  . Howeverng curve . MoreoveIn conclusion, preloading a DMEK tissue may facilitate DMEK to be more successful in terms of transplanting a validated graft along with a comparatively short surgical procedure, low costs, and logistic requirements. Dextran may therefore have an important role during preservation, preparation, and transportation, and hence it should be considered in the medium before prestripping or preloading a DMEK lenticule.


Laparoscopic common bile duct exploration has all the advantages of minimal access and is also the most cost effective compared to the other options. To study a profile on laparoscopic common bile duct exploration for a single common duct stone. A total of 30 consecutive patients with solitary common bile duct stone attending our hospital over a period of one year were enrolled in the study. Laparoscopic common bile duct exploration was done by transductal route in all the patients. There were 18 females and 12 males with age ranging from 28 to 75 years. Jaundice was present in 12 (40%) patients. Twenty-four (80%) patients had raised alkaline phosphatase. The mean size of CBD on ultrasound was 11.55 mm. The mean size of calculus was 11.06 mm and was located in the distal CBD in 26 (86.7%) patients. The mean operative time was 158.4 ± 57.89 min. There were 8 (26.6%) conversions to open procedure. T-tube was used in 26 (86.7%) patients. The postoperative complications were hospital acquired chest infection in 3 (10%), surgical site infection in 3 (10%), acute coronary syndrome in one (3.3%), and bile leak after T-tube removal in one (3.3%) patient. Laparoscopic common bile duct exploration is an effective, safe management of common bile duct stone. Approximately 10% of patients who undergo laparoscopic cholecystectomy harbor common bile duct stones . With coDuring the early days of laparoscopic cholecystectomy, the use of intraoperative laparoscopic common bile duct exploration (LCBDE) was limited. Surgeons relied on methods like ERCP ± sphincterotomy with morbidity 15%) and mortality (1%), which increased the hospital stay and cost with additional risk of acute pancreatitis [% and morIt is a prospective study in patients with solitary duct stones with or without jaundice. Multiple duct stones, CBD diameter < 6 mm, cholangitis or pancreatitis, previous history of cholecystectomy, dense and ugly abdominal scars, and those unwilling to undergo surgery and unfit for surgery were excluded.A good history and clinical examination followed by routine work-up and ultrasonography was done to see the gall stones, number, size, and location of common duct stones, and diameter of common duct. The diagnosis of single choledocholithiasis was made only after sonologist confirmed visualizing entire common duct in one or more than one setting.Laparoscopic CBD exploration was done with 10 mm umbilical and epigastric ports followed by two small accessory subcostal ports. The first 5 mm trocar was placed along the right anterior axillary line and second 5 mm port at the right subcostal region. An additional right epigastric 5 mm port was useful for inserting a rigid ureteroscope. The choledochotomy was closed with 3-0 polyglactin acid over the T-tube. The T tubes were made up of polyvinyl chloride. A subhepatic closed suction drainage (14 F) was then inserted. Visual analogue scale scoring was done in the postoperative period for assessment of pain. T-tube cholangiogram was done on 10th day to look for any retained stones or abnormal findings. T-tube was removed only after confirmation of normal findings in cholangiogram. All the data were entered in Microsoft excel and converted to SPSS version 11.5.Thirty subjects of LCBDE included 14 (46.7%) cases in the age group between 40 and 60 years. The mean age was 49.2 ± 12.89 years with a male to female ratio of 1.5 : 1 .All cases had abdomen pain and duration varied from 15 days to 9 months with a mean of 94.7 days. Jaundice was seen in 12 (40%) patients with mean duration of 16.25 days. Eight patients had comorbid conditions, namely, hypertension (4), chronic obstructive pulmonary disease (2), and type II diabetes mellitus and hypertension (2), and two cases had abdominal hysterectomy in the past. On physical examination, icterus was present in 12 (40.0%) patients, pallor in two (6.6%) patients, and hepatomegaly in two (6.6%) patients. Twenty-four (80%) patients had deranged liver function test. Total bilirubin was raised in 12 (40.0%) and alkaline phosphatase was raised in 24 (80.0%) patients. The prothrombin time and international normalized ratio (INR) were raised in 11 (36.7%) patients.Abdominal ultrasonography was the main tool for diagnosis as our institution does not have magnetic resonance cholangiography (MRC) facility. All had associated gallstones. The most common location of stone was at the distal common duct 26 (86.7%) and in four (6.6%) cases it was in the mid part of duct. The mean diameter was 11.55 ± 2.43 mm (range 8 to 17 mm); the mean size of the stone was 11.06 ± 4.42 mm (range 5.7 to 25.0 mm).The mean operative time for laparoscopic surgery was 158.40 ± 57.89 minutes (range 75 to 360 mins) . In thosLaparoscopic exploration was done successfully Figures  and 2 inThe postoperative period was fairly stable. The mean duration of analgesics administered was 5.9 ± 1.51 days (range 4 to 11 days). The visual analogue scale was used to assess the pain on days 1 and 2. The mean VAS score on the first postoperative day was 6.6 ± 1 (range 5 to 8 days). Similarly, the mean VAS score on the second day was 3.33 ± 0.76 (range 2 to 5 days).Majority, 26 (86.7%), of patients recovered from ileus on the first day. Feeding was started on the second day for 24 (80%) patients. The mean complete ambulation time was 4.33 ± 1.49 days (range 3 to 10 days). Two patients had delayed ambulation due to cardiac (1) and chest complications (1). The mean hospital stay was 6.76 ± 1.33 days (range 5 to 11 days).T-tube was used in 26 (86.7%) patients. One patient underwent primary closure after choledochotomy and the remaining two underwent choledochoduodenostomy as CBD diameter was more than 15 mm. Remaining one had Roux en Y hepaticojejunostomy after excision of choledochal cyst. Twenty-four had normal findings with free flow of contrast to the duodenum. Two patients had filling defect which was seen in the common bile duct. The T-tube removal was done before 21 days in 19 patients but all after 15 days. T-tube was removed after 21 days in 7 patients.Three (10%) patients had developed hospital acquired chest infection. Surgical site infection (SSI) was present in three (10%) patients . SSI were managed with dressings and antibiotics. One patient developed acute coronary syndrome on the first day and he recovered with no further complication and was successfully discharged. Two patients with filling defect underwent endoscopic retrograde cholangiography and stone extraction for residual stones. One case had bile leak followed by pyoperitoneum following T-tube removal (at the end of 3rd week) and was subsequently managed with laparoscopic peritoneal lavage and drainage after readmission. She recovered gradually and had an incisional hernia in the umbilical port following a port site infection. The hernia was later managed with overlay mesh.Common bile duct stones are commonly managed by ERCP ± sphincterotomy, followed by laparoscopic cholecystectomy. The risks associated with ERCP and the morbidity associated with open surgery have paved the way for considering Laparoscopic common bile duct exploration . RecentlIt is a prospective study of 30 consecutive patients of solitary common bile duct stone showing a higher prevalence in females (60.0%) comparable to other studies –10, whicThe pain was present in all patients and it varied from 15 days to 9 months. Jaundice was present in 12 (40.0%) patients with a mean of 16.25 days and fever in 5 16.7%) patients. Riciardi et al. % patient also shoAlkaline phosphatase was raised in 24 (80.0%) patients with a median of 253 U/L, higher than that in the study by Ricardi et al.  where alUltrasonogram of the abdomen was the main tool to diagnose common bile duct stone as magnetic resonance cholangiopancreaticography (MRCP) was not available at our institute and many of our patients cannot afford the cost of MRCP outside. The decision to operate was made only after sonologist had confirmed having visualized entire common duct and single stone in one or more setting. The most common location of the stone was distal CBD with as many as 26 (86.7%) patients with a mean diameter of 11.5 ± 2.43 mm (range 8 to 17 mm) comparable to a study by Chander et al.  where thWe used rigid ureteroscope for the visualization of common bile duct stone. Khan et al.  had alsoIn our study the mean operative time was 158.4 ± 57.89 minutes (range 75 to 360 minutes). Our operative time was comparable with some studies , 19 wherWe started feeding on 2nd day and ambulation on the third day. However in study by Bandyopadhyay et al.  patientsThe choledochotomy was closed over T-tube in majority 86.7%) of our patients. The decision of primary closure in one case was as per decision of operating surgeon. T-tube was used in all laparoscopic common bile duct explorations by Huang et al. . However% of our The postoperative complications were similar to other studies , 19, 21 This is a prospective study with a small sample size. Moreover, it was our initial experience that there could have been a little selection bias. We look to conduct future studies with a much bigger sample size and conduct a prospective randomized controlled trial comparing it with other options available. We had to deviate from established methods of investigations like MRCP and few intraoperative steps  due to unavailability and cost factor in our patients.In the era of minimal access surgeries, laparoscopic common bile duct exploration is an effective, safe management of common bile duct stone. Besides advantages of laparoscopic surgery, it offers a single stage management of common bile duct stone reducing the hospital stay and financial load to the patients.


To evaluate the efficacy and safety of percutaneous polidocanol injection (PPI) in treating cystic thyroid nodules.  A total of 158 cystic or predominantly cystic thyroid nodules (>80% cystic component) in 143 patients were evaluated. 114 patients with compressive symptoms or aesthetic complaints were offered PPI. 44 individuals without compressive symptoms and aesthetic complaints who were only followed up clinically were used as the control group. The efficacy and safety of PPI were evaluated for 1 month, 3 months, 6 months, 9 months, and 12 months of follow-up. 3 reduced at the 1-month follow-up to 5.1 ± 5.6 cm3 (p < 0.001) and 0.6 ± 0.9 (p < 0.001), and nodules shrunk according to the time after PPI (p < 0.001). A complete response (if ≥70% decrease) to PPI at the 12-month follow-up occurred in 100% of the cystic or predominant cystic nodules. None of the nodules recurred at the 12-month follow-up after PPI. The side effects were mild. Twenty patients (17.5%) developed mild localized pain, and fourteen cases (12.3%) experienced mild or moderate fever after PPI.  In the PPI group, the mean baseline volume of 15.6 ± 18.9 cm PPI is a safe and effective alternative to treat benign cystic or predominant cystic thyroid nodules. Thyroid nodules are characterized by excessive structural growth, functional transformation, and/or cystic degeneration of one or several areas within the gland . AccordiFrom October 2013 to April 2015, a total of 117 cystic (>90% cystic component) and 41 predominantly cystic thyroid nodules (>80% cystic component) in 143 patients  were evaluated with fine-needle aspiration cytology (FNAC), using 21 G hypodermic needles at the outpatient clinic of The First Affiliated Hospital of Wenzhou Medical University. And complete fluid aspiration was performed at this time. Benign cytological results were from two separate US-guided fine-needle aspirations to exclude malignancy. 114 consecutive patients with compressive symptoms or aesthetic complaints were offered polidocanol treatment. 44 individuals without compressive symptoms and aesthetic complaints who were only followed clinically were used as the control group. This prospective study was conducted over a period of one year.π abc/6, where a is the largest diameter and b and c are the other mutually perpendicular diameters. Upon US examination, the changes in the volume of the nodules were evaluated.US examination was performed in all patients before treatment and at the time of the 1, 3, 6, 9, and 12 months of follow-up examinations. The three orthogonal diameters of each nodule that were measured were the largest diameter and two mutually perpendicular diameters. The volume of each nodule was calculated using the equation volume = Before and after PPI treatment, the patients were asked to rate pressure symptom score on a visual analog scale (0–10 cm) and cosmetic grade ((1) no palpable mass, (2) a palpable mass but no cosmetic problem, (3) cosmetic problem on swallowing only, and (4) readily detected cosmetic problem) .To assess safety, any possible complications both during and immediately after the procedure were evaluated. Major and minor complications were defined by the definitions of the Society of Interventional Radiology . ProceduAccording to the decrease in nodular volume, polidocanol results were categorized as incomplete response (if <70% decrease) or complete response (if ≥70% decrease) .The procedures were performed in the outpatient clinic. Patients were placed in a supine position with mild neck extension. An 18-gauge needle was inserted into the cystic portion of the thyroid nodule under ultrasound guidance without local anesthesia. The fluid was first completely aspirated. The syringe tube was then replaced with another one containing polidocanol injection while keeping the puncture needle in place. The amount of polidocanol injected was about 25–33% of the amount of fluid aspirated. Then, we extracted and flushed the injection for 5 times to assure the uniform distribution of the injection and the polidocanol was left in the cysts .This study was approved by the Ethics Committee of The First Affiliated Hospital of Wenzhou Medical University. All study participants provided written informed consent before the experiments. The written informed consent was provided by each eligible patient, and the study conformed to the Declaration of Helsinki.t-test and nonparametric variables with the Mann–Whitney test. Qualitative variables were evaluated with the chi-square test. The comparison of volumes at different periods was conducted with the Friedman test, confirmed with nonparametric multiple comparison for dependent data. The same comparison in the control group was conducted with the paired Wilcoxon test. We applied the likelihood ratio to compare complete or incomplete response rates after polidocanol treatment using the chi-square test. Multivariate analysis was performed with the Statistical Package for Social Sciences (SPSS), version 19.0. We used a confidence interval of 95% and a significance level of 5%.The comparison of parametric quantitative variables between both groups was analyzed with Student's 3, with an average of 15.6 ± 18.9 cm3. In the control group, the initial volume of the nodules ranged from 0.9 to 14.2 cm3 (mean 2.3 ± 3.0 cm3). After a follow-up of 12 months, the volumes in the control group ranged from 0.4 to 16.4 cm3 .The clinical data for 114 consecutive patients with polidocanol treatment and 44 individuals in the control group are given in 3, with an average of 5.1 ± 5.6 cm3. At 3 months, 6 months, and 9 months of follow-up, the cyst nodules showed significant reduction in the volume. The mean volumes of nodules at the 3 months, 6 months, and 9 months of follow-up were 2.0 ± 3.8 cm3, 0.7 ± 1.0 cm3, and 0.7 ± 0.9 cm3, respectively. At 12-month follow-up, the nodules ranged in volume from 0.01 to 4.9 cm3, with an average of 0.6 ± 0.9 cm3. Compared with the baseline volume, the reduction after PPI treatment showed a significant difference . Mean symptom score and cosmetic grade also significantly vanished in the vast majority at last follow-up of PPI group  or free T4 (p = 0.621) levels.A comparison of the results between baseline and post-PPI showed no statistical difference in TSH (Twenty of the 114 (17.5%) patients after PPI treatment reported mild localized pain that lingered for 1 to 3 days. Fourteen cases of the 114 (12.3%) patients experienced mild or moderate fever after polidocanol injection. The fever lingered for 1–4 days that required no treatment or antipyretic drug. None suffered the major complications in this study.Simple aspiration is the treatment of choice for diagnostic and therapeutic purposes in symptomatic patients with cystic or predominant cystic thyroid nodules. However, the recurrence rate is up to 80% , even afIt is difficult to obtain the 99% ethanol used as a sclerosant in China because the absolute ethanol production has been disrupted for four years, and hospital-made absolute ethanol cannot obtain the registered document of approval. Polidocanol (Polidocanol®) is an effective sclerosant consisting of 95% hydroxypolyethoxydodecane and 5% ethyl alcohol. The Food and Drug Administration (FDA) has approved polidocanol as a medicinal sclerosant in the United States, as it has its equivalents in European countries.Although there are many studies in other areas, few studies have examined polidocanol as a sclerosant for cystic or predominant cystic thyroid nodules. In our present study, the rate of volume reduction of the nodules was 95.58% 12 months after PPI. Moreover, we achieved a 100% therapeutic success (size reduction > 70%) in 114 patients and none of the nodules recurred at 12-month follow-up. The observed success rate was better than those reported previously PEI . And symIn our experience, mild pain was only seen in 17.5% of patients and mild or moderate fever was seen in 12.3% patients treated with PPI. There were no serious side effects related to ethanol seepage outside the capsule.The present study had some limitations. We did not compare PPI treatment with a control group treated with ethanol because we could not obtain absolute ethanol. Secondly, the patients were followed up only for one year. Further studies with larger patient samples are needed to confirm these findings.The findings of this study indicate that PPI is a safe, effective, and rapid treatment that can be performed on an outpatient basis. The cost of PPI treatment for benign cystic or predominant cystic thyroid nodule is 600 RMB, and the cost of PEI treatment was 260 RMB. Although PPI has a higher cost than PEI, it is still inexpensive. In short, it may be an effective alternative to ethanol injection.