P = 0.049) and concomitant use of beta blockers (P = 0.045) and aspirin (P = 0.008). Early identification of factors associated with DPP-4 inhibitors is essential to enhance quality use of the drugs.Dipeptidyl-4 (DPP-4) inhibitors are oral antidiabetic agents recently introduced to Malaysia. Thus, limited data is available on their utilization patterns and factors associated with their use. This study aims to analyse the utilization patterns of DPP-4 inhibitors, factors that influenced the choice of agent, and the rationale for treatment with DPP-4 inhibitors in patients with type 2 diabetes mellitus. This retrospective study was conducted to address the utilization pattern of DPP-4 inhibitors and factors that influence choice in type 2 diabetes mellitus patients. 299 subjects taking either sitagliptin or vildagliptin from September 2008 to September 2012 were included in the study. Sitagliptin was more frequently prescribed than vildagliptin. Of the patients prescribed DPP-4 inhibitors, 95% received combinations of these and other agents, whereas only 5% were prescribed DPP-4 inhibitors as monotherapy. Factors affecting the utilization of DPP-4 inhibitors included age ( The International Diabetes Federation (IDF) has estimated that 371 million people worldwide had diabetes in 2012 and that 552 million will have this disease by 2030 .According to the American Diabetes Association (ADA), management of T2DM involves a combination of life-style modifications and pharmacological approaches, consisting of oral antidiabetic (OAD) agents and insulin injection . At presSitagliptin was the first DPP-4 inhibitor approved for use in Malaysia to treat patients with T2DM . At presLittle is known about the utilization pattern of DPP-4 inhibitors, both within Malaysia and in other countries. This study was, therefore, designed to determine the patterns of DPP-4 inhibitor utilization and factors that influence their utilization.The study population consisted of all UMMC patients aged ≥18 years who were diagnosed with T2DM and had received sitagliptin or vildagliptin at any time from September 2008 to September 2012.This retrospective, cross-sectional study was performed in accordance with the Declaration of Helsinki and was approved by the medical ethics committee (MEC) of UMMC (reference number 956.29), which waived the requirement for written informed consent from the participants. Patients were included if they were aged ≥18 years, fulfilled the requirements of the ICD-10 code for T2DM (E11.0–E11.9), and were prescribed either sitagliptin or vildagliptin at any time from September 2008 to September 2012, either as monotherapy or in combination with other antidiabetic medications. Patients were excluded if they had been diagnosed with type 1 diabetes mellitus (T1DM), had never received any DPP4 inhibitor, or were diagnosed with a psychiatric illness that may compromise compliance with diabetic treatment.Demographic and clinical parameters were collected for each eligible patient. Demographic parameters included age, gender, ethnicity, weight, height, and body mass index (BMI). Characteristics of T2DM included the year of diagnosis, HbA1c concentration, and either FPG or RPG concentration. Characteristics of T2DM treatment included class and name of drug and dosage and date of prescribed DPP-4 inhibitors.Other clinical parameters included the number and type of comorbidities, with comorbidities defined as chronic diseases requiring long-term treatment; concurrent medications, including medications prescribed to manage comorbidities; renal impairment, defined as creatinine clearance <50 mL/min , and hepα, was set as 0.05 and the desired power of the study (1 − β) was 80%. Assuming an expected proportion of T2DM patients of 20.8% and a confidence limit of 5%, the minimum number of patients required was 108.The sample size required was calculated using Epi Info Program Version 7.0 . The level of significance, P value < 0.05 was considered statistically significant.All data extracted were analyzed using the Statistical Package for Social Sciences (SPSS) software version 20.0 . All continuous data were tested for normality using the Kolmogorov-Smirnov test. Normally distributed parameters were expressed as mean ± standard deviation, and nonnormally distributed parameters were expressed as median and range. Categorical data were analyzed by Pearson's chi square test or Fisher's exact tests, as appropriate. A Convenience sampling identified 370 eligible subjects, but the medical records for only 316 of these subjects (85.4%) could be successfully retrieved from the Medical Records Unit (MRU) of UMMC. Of these 316 patients, 17 were excluded for serious psychiatric illness. Thus, 299 patients were analyzed.Of the 299 subjects, 133 (44.5%) were males and 166 (55.5%) were females. Ethnically, 103 subjects (34.4%) were Chinese, 99 (33.1%) were Malay, and 97 (32.4%) were Indian. Mean subject age was 63.1 ± 11.4 years , with the Kolmogorov-Smirnov test showing a normal distribution by age. We found that 161 subjects (53.8%) were <65 years old and 138 (46.2%) were aged ≥65 years.2 . BMI was classified into four categories: underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23–27.4 kg/m2), and obese (≥27.5 kg/m2). Using these criteria, 99 subjects (33.1%) were overweight and 90 (30.1%) were obese (Height and weight were available for only 220 subjects (73.6%). BMI was not normally distributed in these 220 subjects, with median BMI of 26.9 kg/mre obese .Information on duration of T2DM since diagnosis was available for only 220 (73.6%) patients. The Kolmogorov-Smirnov test showed that the duration of T2DM for these subjects was not normally distributed. The median duration was 13.5 years . In most subjects (77.6%), the duration of T2DM was >10 years.Information on HbA1c concentration was available for 266 (89%) of the 299 patients. HbA1c concentration in these 266 patients was not normally distributed. Median HbA1c concentration was 7.75% , with more than 89% of the subjects having HbA1c concentrations ≥6.5% .Of the 299 subjects, 255 (85.3%) were taking 5 or more concurrent medications. Hypertension and hyperlipidemia were the most frequent comorbidities, observed in 251 (83.9%) and 210 (70.2%) subjects, respectively, followed by obesity, observed in 86 subjects (28.8%). Not surprisingly, the most frequently prescribed concurrent medications were HMG-CoA inhibitors and salicylates, prescribed to 251 (83.9%) and 131 (43.8%) subjects, respectively. Diuretics included thiazides (27.8%), furosemide (11.0%), and spironolactone (2.3%).Sitagliptin was the DPP-4 inhibitor most frequently utilized at UMMC, prescribed to 86% of patients, with vildagliptin prescribed to the other 14%. The most frequent doses of sitagliptin were 100 mg OD (58.7%) and 50 mg OD (28.4%). The combination of sitagliptin/metformin in one tablet was prescribed to 50% of patients, with 28.6% taking a dosage regimen of 50/850 mg OD and 21.4% taking 50/500 mg OD. Vildagliptin was available only as 50 mg tablets, with most patients taking this dose OD. The two fixed dose combinations of vildagliptin/metformin, both given twice daily, were equally preferred (36.8%).Both DPP-4 inhibitors were administered in combination with other antidiabetic medications. Only 4.3% of patients were prescribed sitagliptin monotherapy and only 2.4% were prescribed vildagliptin monotherapy. Combinations of DPP-4 inhibitors with metformin and sulfonylureas were prescribed to 224 (74.9%) and 209 (69.9%) of the subjects, respectively. Fewer DPP-4 treated patients were also treated with thiazolidinediones (TZD), meglitinides, insulin, and acarbose.P = 0.049) (The majority of patients taking either sitagliptin or vildagliptin were aged <65 years. A significant association between age and DPP-4 inhibitor use was observed (= 0.049) .(1) Beta Blockers. Of the 299 subjects, 93 (31.1%) were taking a beta blocker along with a DPP-4 inhibitor. A significant association was observed between utilization of DPP-4 inhibitors and beta blockers (P = 0.045) (= 0.045) .(2) Aspirin. Of the 299 patients, 131 (43.8%) were taking aspirin concomitantly. Aspirin use was significantly associated with prescription of DPP-4 inhibitors . HMG-CoA inhibitors (statins) were the most frequently drug class prescribed concomitantly to these subjects. More than 97% of our subjects were aged ≥40 years and were given statins regardless of baseline LDL concentration [We found that more than 85% of the subjects in this study were taking five or more medications (polypharmacy) and that older age was significantly associated with polypharmacy , 209 (69.9%), 70 (23.4%), and 41 (13.7%) subjects, respectively. This finding is in good agreement with a previous study showing that the four classes of drugs most prescribed for patients with T2DM were metformin (84%), sulphonylureas (81%), insulin 16%), and acarbose (8%) [%, and acTwo DPP-4 inhibitors were used to treat T2DM patients at UMMC, sitagliptin and vildagliptin. More than 85% of our patients were prescribed sitagliptin, whereas only 15% received vildagliptin, similar to findings showing that 57 of 66 subjects (86.4%) prescribed a DPP-4 inhibitor were taking sitagliptin . At the The Malaysian Drug Formulary for 2013 recommends that the dose of vildagliptin be 50 mg BD if taken with metformin and 50 mg OD if taken with sulphonylureas . When coFew studies to date have assessed patterns of utilization of DPP-4 inhibitors or of individual agents. Thus, our results can only be compared with general utilization patterns of OAD agents. A study of patients hospitalized at a tertiary care referral hospital found that the most widely used OAD was biguanides 23%), followed by sulphonylureas (22.5%) and thiazolidinediones (11%) [%, followCombinations of DPP-4 inhibitors with metformin and sulphonylureas were the most popular, followed by combinations with insulin. Sitagliptin can be prescribed as monotherapy as well as in combination with metformin, a sulphonylurea, or a thiazolidinedione , 22, altP = 0.049). The Malaysian Drug Formulary 2013 has recommended the use of sitagliptin in T2DM patients, especially in elderly patients with multiple comorbidities who frequently experience hypoglycemia while on other OADs. Vildagliptin has been recommended for T2DM patients with poor glycemic control on the maximal tolerated dose of metformin monotherapy and at high risk of hypoglycemia [We found that age was weakly associated with the utilization of DPP-4 inhibitors with patients aged ≥65 years more likely to be given DPP-4 inhibitors P = 0.04. The Malglycemia . HoweverP = 0.045). Most subjects taking sitagliptin and vildagliptin were not prescribed beta blockers, in line with recommendations that beta blockers are prescribed to T2DM patients with hypertension only when alternative agents cannot be used or when there are concomitant compelling indications  [This study found significant associations between the use of DPP-4 inhibitors and the concomitant use of beta blockers (arction) . The effarction) . Nevertharction) .P = 0.008), in that less aspirin was prescribed to patients taking either sitagliptin or vildagliptin. This may be due to the relatively low prevalence of comorbidities that warrant the use of aspirin as treatment or prophylaxis. The three most common comorbidities in our patient cohort were hypertension, hyperlipidemia, and obesity, all three of which do not require treatment or prophylaxis with aspirin [The concurrent use of aspirin was found to be negatively associated with the use of DPP-4 inhibitors . Besides, there was no literature found that studies the effect of these factors on prescribing of DPP-4 inhibitors. There was also no guideline found that advocates the use of DPP-4 inhibitors according to the duration of T2DM diagnosis. Therefore, it reflects that duration since the diagnosis of T2DM did not influence the prescriber in prescribing DPP-4 inhibitors.As for duration since the diagnosis of T2DM, both sitagliptin and vildagliptin had a higher proportion of subjects that had the duration since diagnosis of T2DM of more than 10 years. Despite this, the association failed to achieve significance level of P = 0.995). Hence, glycemic control, as demonstrated by A1c level, was not a determinant in prescribing DPP-4 inhibitors.World Health Organization has announced in 2011 that the new level of HbA1c <6.5% is the new cut-off point for diagnosing diabetes . FormerlAs for the BMI, most of the overweight and obese patients were taking sitagliptin and vildagliptin. There were nonsignificant associations between utilisation of sitagliptin and BMI. According to the Malaysian guidelines, the first-line treatment option for obese type 2 diabetes patients is metformin . As otheFactors identified as significantly associated with prescribing DPP-4 inhibitors in this study included patient age and concurrent use of beta blockers and aspirin. Identification of factors underlying the use of DPP-4 inhibitors may enhance rational use of drugs and, thus, diabetes care in T2DM patients.This study had several limitations, including its retrospective design. Only the subject characteristics affecting the prescribing of DPP-4 inhibitors were analyzed. In contrast, physician-associated factors were not assessed. In addition, since all information came from patient's medical records, errors may be caused by the absence of information or incorrect information.


Introduction: Cardiovascular diseases contribute to mortality and morbidity in aged individuals. It is crucial to have a clear perception of coronary artery bypass graft (CABG) risks and benefits to make logical decision in aged patients. Unfortunately, cardiovascular disease researches have focused very little on the aged patients. The aim of the present study is to evaluate in-hospital complications in patients older than 70 years old following CABG operation to determine if CABG is preferred or not considering present complications.Methods: In a cross sectional study, 500 patients older than 70 years old were randomly selected (70-75 patients for each year) from March 2004 to March 2011. Descriptive statistical methods were used for evaluating the obtained data.Results: Overall, 70.6% of patients  were male and 29.4% were female . Totally, 107 patients (21.4%) had complications during hospitalization; these complications were statistically significant in male individuals. Complications included Stroke 1.6%, deep vein thrombosis 0.8%, MI 2.4%, repeat surgery 2.80%, bleeding 2.40%, and more than 48 hours mechanical ventilation in 13.4%.Conclusion: Need for more than 48 hours mechanical ventilation and bleeding after surgery were the most occurred complications in these patients. Consequently, the number of CABG operations is increasing among the elderly patients. It is crucial to have a clear perception of CABG risks and benefits to make logical decision in aged patients. Unfortunately, cardiovascular disease researches have focused very little on the aged patients.3 The definition of aged people in the field of cardiac surgery has increased from 65 to 80 years during the past 20 years.4 This is mostly due to the decline in operation risks thanks to the advances made in the technology, methods and proper selection of patients. It is estimated that 6.2 million heart operations are performed in the United States every year 516000 of which are CABG.Different mortality rates have been reported in studies ranging from 8%-24%; postoperative stroke and renal failure incidence have been reported to be 2%-9% and 2%-13%, respectively.5 CAD is defined as the stenosis in all or parts of the coronary arteries due to atherosclerosis or presence of clot; consequently, oxygen cannot be delivered to the myocardium and angina pectoris or infarction occur.6 CABG is an effective approach for eliminating or reducing angina pectoris symptoms.8 Stroke and cognitive disorders following CABG are related to brain embolism.9 Acute renal failure occurs in more than 40% of patients 1% of which would require dialysis.10The mortality rate of the cardiac diseases in Iran is high and is the first cause of mortality before accidents and cancer.10 Manipulation of ascending aorta is one of the most important factors associated with embolism. Partial clamping of ascending aorta for anastomosing saphenous vein on aorta leads to create 28% of embolisms during operation. Acute renal failure occurs on more than 40% of patients and leads to dialysis in 1% of patients. Development of acute renal failure is associated with a rise in mortality risk, hospitalization period, need for further medications and increase in total cost. In post CABG patient several pathophysiological mechanisms are involved in the development of acute renal failure.10CABG is a surgical treatment that blocked coronary arteries and arteries with stenosis are restored by venous grafts from saphenous vein. The surgical treatment is one of treatment improvements ways which reduce death rates. CABG may be associated with several complications. Aging may not be considered as an independent contraindication in patients undergoing CABG.The aim of the study was to evaluate in-hospital complications in CABG patients older than 70 years to determine the risk benefit ratio of CABG in this age group. In a cross-sectional study, 500 patients older than 70 years old who had undergone CABG in Shahid Madani hospital from March 2004 to March 2011 were randomly included (70-75 patient from each year). Complications such as hospitalization time, stroke, and renal failure were evaluated.P value less than.05 was considered statistically significant. Data were extracted from subjects’ hospital files. Private information of patients was kept confidential.Data were analyzed using SPSS version 16. Descriptive statistical methods were used for evaluating data. Chi-square and Fisher exact test were used for qualitative data. Mean of patients’ age was 74.86 ± 3.12 years; 70.6% of patients  were male and 29.4% female . In angiographic studies, 26 patients (5.2%) had one involved vessel; 114 patients (22.8%) had 2 involved vessels and 359 patients (71.8%) had 3 involved vessels. Mean duration of hospitalization after CABG was 9.59±0.33 days with maximum and minimum of 75 and 1 day, respectively. Mean duration of hospitalization in ICU was 3.4 ± 1.12 days with maximum and minimum time of 5 and 1 day, respectively .P = .022) and include MI .The most studied risk factors was illustrated on P = .02). The rate of CABG complications was higher in individuals older than 70 years and with hypercholesteremia (P = .024). Also, complications had a significant correlation with the familial history of heart disease (P = .013). The rate of CABG complications was significantly higher in subjects with history of MI (P = .0001), respiratory disease (P = .000), renal disease (P = .000), stroke (P = .02) and diabetes (P = .009). There was significant relation between diabetes and death in hospital (P = .001).Deep vein thrombosis was observed in four patients (0.8%) while 7 cases (1.4%) of intra-hospital death were reported. Accordingly, 28 patients (5.6%) had myocardial infarction (MI) ; 16 patients before operation and 12 patients after operation had MI; 8 patients (1.6%) had stroke during hospitalization. 14 patients (2.8%) needed second operations, 12 patients (2.4%) had bleeding during their hospital stay and 13.4% of patients (67 patients) required more than 48 hours of ventilation or reintubation . BleedinP = .022). Deep vein thrombosis is seen in 4 patients (0.8%) and death entire hospital in 7 patients (1.4%).Ejection fraction (EF) on 310 patients (62%) was more than 40%; 150 patients (30%) has between 30%-40% EF and 40 patients (8%) has less than 30% EF. Among patients, 107 individuals (21.4) has different symptoms during hospitalization. This complications in males significantly were more than females (P = .009). The rate of complications in diabetics was significantly higher than others (P = .001). Also, there was significant relation between hypercholesteremia and second operation (P = .034), bleeding (P = .007) and ventilation more for more than 48 hours (P = .044).There was significant relation between diabetics and need for ventilation more than 48 hours (P = .241) or hypertension (P = .677).In our study, there was no significant relation between stroke and diabetes (Cardiovascular diseases are very common and highly contribute to the death of aged people. Several factors are involved in the occurrence of atherosclerosis such as obesity, hypertension, smoking, hyperlipidemia, and diabetes. Coronary artery bypass surgery is effective method for treatment and removing of pectoral angina; consequently, it declines death rate.13 During a clinical trial, surgical treatment was compared with medical treatment; CABG subjects older than 75 years had less complications and better quality of life.14 Mortality after CABG in Babatabar Darzi et al13 was reported to be 1.5%. In our study, the rate of mortality after CABG was 1.4%. Boeken et al14 reported the rate of neurologic complications following CABG to be 1.7%. Alexander et al15 study reported a 1.4% stroke incidence after operation. Stroke following CABG in our study was reported in 1.6% of the cases. Stamou et al16 reported a significant relation between post-CABG stroke and hypertension, age more than 75 years and diabetes. In the present study, post-CABG hemorrhage was reported in 2.4% of the subjects. While, Babatabar Darzi et al13 reported 6% of hemorrhage after CABG.Previous studies reported low rate of success with high complications.15 reported an incidence of 2.9% for acute renal failure in their studied subjects. This point in Babatabar Darzi et al13 study was 16.5%. The figures for our study were 6.4%.Alexander et al13 reported 8.7% of pulmonary complications. Consequently, Horneffer et al17 presented that individuals with more than 70 years need more ventilation after CABG.Results showed that 13.4% of patients required ventilation after 48 hours. Babatabar Darzi et alCABG like other invasive treatment methods has its own symptoms. Our results demonstrated that the need for more than 48 hours ventilation was the most occurred complication while deep vein thrombosis was the least occurred. Therefore, taking care before operation and precise monitoring of subjects for declining complications is necessary.The study was approved by the ethical committee of Tabriz University of Medical Sciences.The authors declare no conflict of interests.


Esophageal cancer is a serious clinical condition with high mortality and morbidity, and during its evolution ICU admissions are common . The maiTo evaluate clinical and epidemiological characteristics of such a population during their ICU stay.We performed a retrospective analysis of all cases with esophageal cancer that were admitted to the ICU of a large teaching hospital specializing in cancer in São Paulo, Brazil, between September 2009 and December 2014. Clinical and epidemiological characteristics of the patients were described, as well as risk factors identified regarding mortality during the ICU stay.p = 0.003).A total of 228 patients were analyzed during the period. Mean age was 60 ± 12 years and 82.5 % were male. Of the admissions, 50.4 % were related to elective surgery monitoring, and 49.6 % were clinical and emergency surgery admissions. The most frequent diagnosis that motivated ICU admission was postoperative monitoring (56.1 %), followed by acute respiratory failure (11.4 %) and severe sepsis (7.5 %). The mean value of SAPS 3 at admission was 59.3 ± 15.3. Overall mortality was 20.6 % during the ICU stay; 12.8 % were women and 87.2 % men. Logistic regression identified that the only independent variable related with mortality was SAPS 3 at admission . The only risk factor identified for ICU mortality was the value of SAPS 3 at admission. Other risk factors such as age, diagnosis of admission and organ dysfunction may be related to mortality but were not observed in our patients. Further studies regarding this issue, especially prospective studies, should be performed.


Background. Cystic fibrosis-associated liver disease (CFLD) is a major cause of death. The objective of our retrospective study was to describe the relevance of magnetic resonance imaging (MRI) and liver stiffness measurement (LSM) for CFLD evaluation. Methods. All cystic fibrosis adult patients evaluated by MRI and LSM were included. MR signs of portal hypertension (PHT), dysmorphia, or cholangitis were collected and LSM expressed in kPa and Metavir. Results. Of 25 patients, 52% had abnormal MRI. Median LSM was 5.7 kPa (3.4–9.9). Three patients had F2 score and one had F3 score. In patients with PHT, LSM was 7.85 kPa (3.7–9.9) compared to 5 (3.4–7.5) in others, p = 0.02. In patients with abnormal liver function tests, 50% had increased LSM (≥F2), whereas 94% with normal tests had normal LSM (p = 0.04). Seven patients had abnormal MRI despite normal ultrasonography. Conclusions. MRI and LSM provide useful information on CFLD and may help to screen patients with PHT. Cystic fibrosis-associated liver disease (CFLD) leads to important morbidity and mortality . Hepatobβ, induces hepatic stellate cell chemotaxis and proliferation. This inflammatory reaction is responsible for primary sclerosing cholangitis-like cholangiopathy, by the production of extracellular matrix ]  compared to 5 kPa (3.4–7.5) in patients with no evidence of PHT . Kappa values observed were 0.5 for PHT assessment with agreement reaching the threshold of “moderate” and 0.24 for fibrosis.For diagnosis of CFLD, there was low concordance between transient elastography and MRI  during the study period.Of the 60% of patients with routine US, 5 had abnormal US findings: 3 patients with signs of PHT and 2 with gallstones without evidence of any complications. All patients with abnormal US findings had at least 1 abnormal LFT.p = 0.59).FEV1 was not different between patients with or without PHT  and F3-F4. LSM may be a valid approach to screen early CFLD. To do so, cut-off values for CFLD are mandatory. For the first time, Robertson et al. reported a cut-off at 8.83 kPa . Later, Our results show a link between increased LSM and PHT. This relationship is present even in patients without evidence of cirrhosis. We ruled out cirrhosis in the absence of F4 stage in LSM and in 75% of patients in the absence of dysmorphic liver feature on MRI. This suggests that noncirrhotic portal hypertension (NCPH) is secondary to other mechanisms. These mechanisms have already been described in primary biliary cirrhosis  and primEarly treatment of CFLD is of increasing importance in the management of patients with cystic fibrosis and prevention of severe liver damage. CFLD standard treatment is based on UDCA at a dose of 20–30 mg/kg/day . ImmediaAlthough it is a retrospective design on a small sample size, our study, based on noninvasive liver explorations using MRI and LSM, provides useful and additional information on assessment of CFLD. The results of such investigations are likely to impact clinical practice justifying further studies. Transient elastography for assessment of liver stiffness may soon play a central role in the noninvasive technique of portal hypertension screening. MRI seems essential for the CFLD diagnosis.


ROC analysis demonstrated that HbA1c was a good test to identify diabetes and prediabetes, with areas under the curve of 0.918 and 0.714, respectively. Optimal HbA1c cutoffs for diagnosing diabetes and prediabetes were 6.0%  and 5.7% , respectively, although the cutoff for prediabetes showed low accuracy (67.6%) and a high false-negative rate (39.4%). Agreement between HbA1c categorization and OGTT-based diagnosis was low in diabetes (κ = 0.399) and prediabetes (κ = 0.324). In Japanese subjects, the HbA1c cutoff of 6.0% had appropriate sensitivity and specificity for diabetes screening, whereas the cutoff of 5.7% had modest sensitivity and specificity in identifying prediabetes. Thus, HbA1c may be inadequate as a screening tool for prediabetes.The aim of this study was to evaluate the utility of hemoglobin A1c (HbA1c) to identify individuals with diabetes and prediabetes in the Japanese population. A total of 1372 individuals without known diabetes were selected for this study. A 75 g oral glucose tolerance test (OGTT) was used to diagnose diabetes and prediabetes. The ability of HbA1c to detect diabetes and prediabetes was investigated using receiver operating characteristic (ROC) analysis. The kappa ( Diabetes is reaching pandemic proportions across the world. The number of diabetes patients is estimated to increase from 8.3% (366 million) globally in 2011 to 9.9% (552 million) by 2030  . We assegreement . Confiden = 784), prediabetes (n = 502), and diabetes (n = 86), respectively. Compared to subjects with normal glucose tolerance, subjects with prediabetes and diabetes were more likely to be older and have a higher BMI, higher blood pressure, elevated triglycerides and uric acid, and lower high-density lipoprotein cholesterol .κ = 0.399) and prediabetes (κ = 0.324).AUCs of ROC analysis of HbA1c for the diagnosis of diabetes and prediabetes were 0.918  and 0.714 , respectively Figures . The senThe HbA1c test has recently been recommended for the diagnosis of diabetes on the basis of a detailed analysis of IEC  and ADA In previous studies, the optimal HbA1c cutoffs for detecting undiagnosed diabetes ranged from 5.3% to 6.1% in population-based studies among Australian  and AmerIEC  and ADA The analysis of data from Japan showed that a baseline HbA1c of 5.8% or higher imposed a 10-fold increase in the risk of being diagnosed with diabetes over the next 7 years . A largeThe strengths of this study are that it is a general population-based study of a specific ethnic group, notable because race and ethnicity may affect HbA1c levels . In addiIn the Japanese population, optimal HbA1c cutoffs for diagnosing diabetes and prediabetes were 6.0%  and 5.7% . For the identification of diabetes, HbA1c has optimal sensitivity and specificity to be considered as a mass screening tool. On the other hand, for the identification of prediabetes, HbA1c may be inadequate as a screening tool because of its high false-negative results.


The implication of PTEN and FAS loss (10q23.31) support previous reports due to their critical roles in prostate carcinogenesis. Furthermore, we hypothesize that the PAPSS2 gene (10q23.2–10q23.31) may be functionally relevant in post-operative PSA recurrence because of its reported role in androgen biosynthesis. It is suggestive that the loss of the susceptible region on chromosome 10q, which implicates PTEN, FAS and PAPSS2 may serve as genetic predictors of PSA recurrence after radical prostatectomy.The multifocal nature of prostate cancer (PCa) creates a challenge to patients’ outcome prediction and their clinical management. An approach that scrutinizes every cancer focus is needed in order to generate a comprehensive evaluation of the disease, and by correlating to patients’ clinico-pathological information, specific prognostic biomarker can be identified. Our study utilized the Affymetrix SNP 6.0 Genome-wide assay to investigate forty-three fresh frozen PCa tissue foci from twenty-three patients. With a long clinical follow-up period that ranged from 2.0–9.7 (mean 5.4) years, copy number variation (CNV) data was evaluated for association with patients’ PSA status during follow-up. From our results, the loss of unique genes on 10q23.31 and 10q23.2–10q23.31 were identified to be significantly associated to PSA recurrence ( Prostate cancer is the second most commonly diagnosed cancer in males worldwide . It is aIn recent years, there has been an upsurge of information that has expanded our knowledge of prostate cancer genomics. Genomic losses have been observed to occur more frequently when compared to genomic gains in prostate cancer ,5. From In this study, 43 fresh frozen tumor foci and 10 non-tumor samples from 15 multifocal and 8 unifocal prostate cancers were investigated with the Affymetrix SNP 6.0 microarray tool . Copy number variation data was subsequently correlated to patients’ PSA recurrence status. Statistical significant associations are hoped to identify genes in altered chromosomal regions, whose biological relevance will reduce the unpredictability of prostate cancer’s progression.n = 43) show a QC range of 90.3%–98.9% with a mean QC value of 96.5%. For the non-tumor samples (nine blood samples and one benign prostate tissue (n = 10)), the QC range is between 96.8%–98.8%, with a mean QC value of 98.1%.With the Affymetrix Genotyping Console software , each chip experiment was quality controlled (QC) for contrast and intensity. All tumor foci , 16p12.1 , 15q22.31 , 9q21.11 , 8q21.11  and 8q22.3 . The most frequent copy number losses were observed at 8p21.2 , 8p21.3 , 8p21.2–8p21.1 , 8p21.3–8p21.2 , 8p23.1–8p22 , 16q24.1 , 18q11.2 , 8p11.22–8p11.21–8p11.21  and 10q23.31 . The genome-wide copy number variation results are summarized in p < 0.05). Remarkably, the PAPSS2 gene was identified to be annotated to this region. The loss of the PAPSS2 gene was observed in 6 out of 15 tumor foci from patients with PSA recurrence and in one out of 22 tumor foci were obtained from patients without PSA recurrence (p < 0.05) . They were noticeably altered in a significant number of tumor foci obtained from patients with PSA recurrence after surgical treatment. Of the genes residing in the 10q23.31 region, PTEN and FAS are considered to be the major players in prostate tumorigenesis. The PTEN and FAS genes were observed to be lost in 6 of 15 tumor foci from patients with PSA recurrence and in two out of 22 tumor foci from patients without PSA recurrence patients. In summary, the data obtained shows that the chromosomal regions 10q23.2–10q23.31 and 10q23.31 are frequently lost in prostate cancer and possibly more than one gene in the regions may be associated to PSA recurrence after radical prostatectomy.For 20 out 23 patients, PSA recurrence status was obtainable. Nine patients show PSA recurrence, while 11 patients show no PSA recurrence during 2.0–9.7 (mean 5.4) years of follow-up. Using the Fisher’s exact test to compare patients’ follow-up information and copy number variation data, specific locations on the chromosome 10q were identified as they showed correlation to PSA recurrence of prostate cancer. The copy number loss of 10q23.2–10q23.31 was identified as it correlated significantly to PSA recurrence (currence . Howevercurrence . Althoug < 0.05) . The genSTAMBPL1 . As showNKX3-1 gene, which is located on 8p21.2 . Although the losses on chromosome 8p, 13q and 16q were observed so frequently . In order to identify statistical correlations, all frequently altered chromosomal regions were utilized . A statiequently , they weequently , the folpecimens . It is oet al. [PTEN is the most recognized tumor suppressor gene in the region and is regarded to be a major player in prostate carcinogenesis . The loset al. , where tet al. ,26.Within the frequently deleted locus of 10q23.31 and its neighboring region 10q23.2–10q23.31, the genes FAS and PAPSS2 were identified to be lost. These genes are selected for discussions because of their biological functions in humans and their potential association with PSA recurrence. The aforementioned FAS gene belong to the tumor necrosis factor (TNF) family and encodes the FAS (Fatty acid synthase) receptor, which is an apoptosis initiator . FAS tri42−) donor that is required in many post-translational biological reactions [From this study, the PAPSS2 (3'-phosphoadenosine 5'-phosphosulfate synthase 2) gene was solely annotated to the 10q23.2–10q23.31 region and also identified to correlate with PSA recurrence. Here, it is necessary to highlight the hypothetical effect of PAPSS2 loss on PSA recurrence. Its influence on PSA recurrence may be due to its role in the regulation of dehydroepiandrosterone (DHEA), which is a precursor for testosterone . PAPSS2 eactions . The foreactions ,34. Altheactions , it has eactions . Here weeactions .It was reported earlier that there may be two or more tumor suppressor genes in the 10q23–26 chromosomal region  due to tPatients with multifocal and unifocal prostate cancer were treated with radical prostatectomy from 1998 to 2007 at the University Hospital Muenster, Germany and Erasmus Medical Center, Rotterdam, The Netherlands. Multifocal prostate cancer specimens were characterized with two or more tumor foci embedded in the prostate and the unifocal prostate cancer specimens were identified with a single tumor focus. The tumors were characterized by indicated clinical-pathological factors . The ageFollowing radical prostatectomy, PSA concentration in blood is expected to be below the lower limit of detection of the PSA assay. Since <0.1 ng/mL is the achievable lower limit of detection in modern PSA immuno-assays, all patients in this study were classified as having PSA recurrence if they had two consecutive PSA concentrations above 0.1 ng/mL, which progressed to higher PSA concentration during longer follow-up. Serum PSA measured before surgical treatment ranged from 3.68 to 45.2, with a mean of 12.5 ng/mL. Post-surgical serum PSA was measured twice yearly to evaluate PSA recurrence. Information on PSA recurrence was obtained from a follow-up period of 2.0–9.7 years, with a mean follow-up period of 5.4 years and a median follow-up period of 5.9 years. Nine patients had PSA recurrence during follow-up, 11 patients had no PSA recurrence and no PSA recurrence information could be obtained from three patients.n = 30), while two tumor specimens were excised from different flanks of a large tumor from five unifocal prostate cancer cases (n = 10). In addition, single tumor foci were obtained from three unifocal prostate cancer cases (n = 3). The focality of the prostate cancer cases was determined from pathological reports, which contain topographical maps of locations of adenocarcinoma foci within the prostate gland [et al. [Forty three fresh-frozen prostate cancer specimens and ten non-tumor samples  were obtained from 15 patients with multifocal prostate cancers and eight patients with unifocal prostate cancers. Two separate tumor foci were obtained from 15 multifocal prostate cancers   [p-value of ≤0.001 and signal to noise ratio of 2 ± 0.3 . The Genomic segmentation algorithm [t-test statistically compares two neighboring regions/segments and there is a significant change in chromosomal abundance (p < 0.001). The aberration status of the region is thus established when a one-sided t-test was used to statistically compare the probe distributions mean of the chromosomal regions to the expected range of the normal (1.7 to 2.3). Annotations of significant regions were conducted with Refseq [® Office Excel 2010 .Preparation of DNA and subsequent genome-wide analysis have been concisely described in Ibeawuchi et al. . Each anet al. . AfterwaMO, USA) . In the lgorithm  conductsh Refseq ,46 and sp-values obtained in all tests were considered significant at p < 0.05. Statistical analysis was conducted using the Spotfire© S+ 8.1 statistical software package .PSA recurrence status of patients was denoted with a “yes” or “no” based on serum PSA concentration levels during follow-up. Statistical associations of CNV altered regions and patients’ clinical-pathological data were evaluated by using Fisher exact test. We report that our copy number variation data reveals the loss of PTEN, FAS (10q23.31) and PAPSS2 (10q23.2–10q23.31) and these altered genes were found to be statistically associated to PSA recurrence. Although the exact influence of these genes on PSA recurrence is still unknown, they may be promising indicators to predict patients’ outcome. In addition, we draw attention to PAPSS2, which holds important biological functions that may increase our understanding of the biology of PSA recurrence and prostate cancer relapse. Based on the correlation between the copy number losses of PTEN, FAS, PAPSS2 and PSA recurrence and with the current quest for an improved biomarker, it is recommended that the molecular function and translational implication of PTEN, FAS, and PAPSS2 loss in prostate cancer are further investigated.


Introduction. The metabolic syndrome (MS) affects 21–53% of patients with chronic obstructive pulmonary disease (COPD) with a higher prevalence in the early stages of COPD, with results being highly variable between studies. MS may also affect natural course of COPD—number of exacerbations, quality of life and lung function.Aim. To examine the prevalence of MS and its correlation with comorbidities and COPD characteristics in patients with COPD admitted for exacerbation.Material and methods. 152 patients with COPD admitted for exacerbation were studied for presence of MS. All of them were also assessed for vitamin D status and diabetes mellitus type 2 (DM). Data were gathered for smoking status and exacerbations during the last year. All patients completed CAT (COPD assessment test) and mMRC  questionnaires and underwent spirometry. Duration of current hospital stay was recorded.Results. 25% of patients have MS. 23.1% of the male and 29.5% of the female patients have MS (p > 0.05). The prevalence of MS in this study is significantly lower when compared to a national representative study (44.6% in subjects over 45 years). 69.1% of all patients and 97.4% from MS patients have arterial hypertension. The presence of MS is associated with significantly worse cough and sleep  and higher total CAT score (p = 0.017). Average BMI is 27.31. None of the patients have MS and BMI <25. There is a correlation between the presence of MS and DM (p = 0.008) and with the number of exacerbations in the last year (p = 0.015). There is no correlation between the presence of MS and the pulmonary function.Conclusion. This study among hospitalized COPD patients finds comparable but relatively low prevalence of MS (25%) compared to previously published data (21–53%) and lower prevalence compared to general population (44.6%). MS may impact quality of life and the number of exacerbations of COPD. Having in mind that MS is more common in the early stages and decreases with COPD progression, the COPD patients admitted for exacerbation may be considered as having advanced COPD. Chronic Obstructive Pulmonary Disease (COPD) is a preventable and treatable disease with significant extrapulmonary effects that may contribute to the severity in individual patients. By 2030, COPD will be the fourth cause of mortality worldwide. The extrapulmonary comorbidities influence the prognosis of the patients with COPD .Metabolic syndrome (MS) is common in patients with COPD. According to the available studies the prevalence of MS in COPD patients varies between 21–53% . The preAvailable studies suggest that MS may have impact on quality of life , lung fuMany studies examine prevalence of MS in COPD patients  with resThere is not enough data to determine whether the results from these studies are applicable to specific subgroups of patients, such as COPD patients admitted for exacerbation. COPD is increasingly divided in subgroups or phenotypes based on specific features and association with prognosis or response to therapy, the most notable being the feature of frequent exacerbations . The preA total of 152 COPD patients hospitalized for exacerbation were studied for the presence of MS, DM, and vitamin D deficiency and insufficiency using well-established criteria for:•Presence of MS: at least 3 of the following: 1. Elevated waist circumference >102 cm in males, >88 cm in females; 2. Triglycerides >1.7 mmol/L (or on therapy); 3. HDL <1.0 mmol/L in males, <1.3 mmol/L in females (or on therapy); 4. Elevated blood pressure: systolic ≥130 and/or diastolic ≥85 mm Hg (or on therapy); 5. Fasting glucose >5.5 mmol/L (or on therapy) .•Presence of DM: fasting plasma glucose ≥7.0 mmol/L OR 2-h plasma glucose ≥11.1 mmol/L during an oral glucose tolerance test (OGTT) OR HbA1c≥6.5% OR on therapy ;•Presence of prediabetes: fasting plasma glucose 5.6–6.9 mmol/L OR 2-h plasma glucose 7.8–11.0 mmol/L during an OGTT OR HbA1c 5.7–6.4% ;•Presence of vitamin D deficiency: 25(OH)D <25 nmol/L; vitamin D insufficiency: 25(OH)D 25–50 nmol/L; vitamin D sufficiency: >50 nmol/L .The diagnosis of COPD was made according to GOLD  criteria (DM1). Data were gathered for age, sex, smoking status and number of pack-years, number of bone fractures, therapy for arterial hypertension, therapy for DM, COPD therapy and number of exacerbations in the last year. The patients completed CAT and mMRC questionnaires and underwent pre- and post bronchodilatatory spirometry. Blood pressure was obtained according to the American Heart Association Guidelines . A patieThe inclusion criteria were post bronchodilator spirometry obstruction defined as FEV1/FVC<0.70. All participants in this study signed informed consent.The exclusion criteria were failure to comply with study procedures  or FEV1/FVC ratio >0.70 after administration of bronchodilator.Every participant was classified according to smoking status :Never smoker—never smoked a cigarette or who smoked fewer than 100 cigarettes in their entire lifetime.Former smoker—smoked at least 100 cigarettes in their entire life but were not currently smoking.Current smoker—had smoked at least 100 cigarettes in their entire life and were still smoking.Numbers of pack-years were calculated using the formula: 2). According to BMI all patients were classified as underweight (<18.5), normal (18.5–24.99), overweight (25–29.99) and obese (>30). Waist circumference was measured at the approximate midpoint between the lower margin of the last palpable rib and the top of the iliac crest according to the WHO STEPS protocol (Body weight and height were measured and the body mass index (BMI) was calculated by dividing weight by height squared  and moderate exacerbations   in the pQuality of life was assessed with the mMRC scale and CAT questionnaire. Patients were instructed that there were no right or wrong answers. All patients’ questions were answered. Patients were classified according to GOLD as having less symptoms (CAT < 10) and breathlessness (mMRC grade 0–1) and more symptoms (CAT ≥ 10) and breathlessness (mMRC grade ≥ 2). Because all patients were hospitalized due to exacerbation there were only group C  and group D  patients according to GOLD .® New spirometer . Patients were instructed to withdraw using short-acting β2-agonists at least 6 h, long-acting β2-agonist at least 12 h, long acting muscarinic antagonist 24 h and short acting muscarinic antagonist 12 h before the spirometry  and Electro-chemiluminescence immunoassay (ECLIA). Glycated hemoglobin (HbA1c) was measured with a NycoCard device and boronate affinity assay. For patients without established DM a 75 g OGTT was performed with blood samples for glucose taken on first and second hour.A venous blood sample was collected from each subject after a 12-h fasting. Blood samples were taken as late as possible before discharging . Plasma glucose, triglyceride (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), and total cholesterol (tChol) were measured with a Roche COBAS INTEGRAT test for two samples and analysis of variance (ANOVA) for more than 2 samples. Mann–Whitney U test was used for abnormally distributed variables with 2 samples and Kruskal-Wallis test for variables with more than 2 samples. Regression analyses were used to determine risk factors for presence of MS or the consequences of having MS. Significance value  was set at 0.05.Statistical analysis was performed with the SPSS for Windows software, version 22.0 . Continuous variables were presented as mean ± standard deviation and 95 Confidence intervals (95%CI) and categorical variables—as percentages. Chi-square test was used to determine the associations between categorical variables. Continuous variables were examined for normality by Shapiro–Wilk test. For normally distributed variables, differences between the groups were determined by independent-samples All patients signed informed consent. Medical University-Sofia Research Ethics Commission approved the study (#2976/2014).1 was 55.3 ± 19.5%. 15.8% from the patients were never smokers, 57.9%—former smokers and 26.3%—current smokers. 127 patients (83.6%) were receiving inhalatory corticosteroids.A total of 152 COPD patients admitted for exacerbation were recruited from University Specialized Hospital for Active Treatment of Pulmonary Diseases ‘Saint Sofia,’ Sofia, Bulgaria. Mean age of patients in this study was 65 ± 10 years. 71.1% (108/152) were males, 28.9% (44/152) were females; mean post-bronchodilator FEV25.0% (38/152) of the patients have MS. 23.1% (25/108) of males have MS vs. 29.5% (13/44) of females but this difference is not statistically significant . Mean agFulfilled criteria for MS  are shown in p > 0.05)  is not risk factor for MS. Fasting glucose level are not influenced by ICS  .In our study, vitamin D levels do not significantly differ in relation to presence of MS (32.11 vs. 31.92 nmol/l). The presence of MS is also not related to vitamin D status .Number of fractures in our study does not significantly differ regarding the presence of MS. Presence of at least one fracture also does not differ significantly in relation to presence of MS.In our study there is a correlation between the presence of MS and DM. 52.6% (20/38) from patients with MS have DM. BMI and BAI differ significantly according to presence of MS—32.51 vs. 25.58, for BMI and 31.01 vs. 25.58, for BAI. There is also significant difference in prevalence of MS in BMI and BAI groups . It is nR = 0.542, r2 = 0.293, p < 0.0005, B = 6.928, 95% CI [5.193–8.662]) and BAI .Linear regression showed presence of MS as risk factor for higher BMI (p = 0.009 with df = 1). Nagelkerke’s R2 of 0.065 indicates a weak relationship. Odds ratio was 2.73. Vitamin D status does not improve the model (p > 0.05).A logistic regression analysis was conducted to predict presence of MS in a relation to presence of other comorbidities. Presence of DM slightly improves the model . The number of severe exacerbation, moderate exacerbation and duration of hospital stay did not reach significance.Our study found a significant difference between the number of total exacerbations according to the presence of MS . From the MS components presence of arterial hypertension is strongest risk factor for exacerbation .Linear regression showed presence of MS as risk factor for higher number of exacerbations (p = 0.002 and p = 0.001 respectively) and higher total CAT score (p = 0.017)  . However= 0.017) .R = 0.205, r2 = 0.042, p = 0.011, B = 3.711, 95% CI [0.859–6.562]). Presence of MS also impairs cough and sleep—first  and seventh  CAT questions.Regression analyses also showed that MS is a risk factor for reduced quality of life, measured with total CAT score  and FEV1 . Fasting glucose is associated with increased FEV1/FVC ratio  probably because of lowering FVC.Regression analyses also showed that MS is not a risk factor for reduced pulmonary function. However some of the components of MS are associated with reduced pulmonary function with highest impact of HDL on FVC .This study found comparable but relatively low prevalence of MS compared to previous studies  Fig. 1)Fig. 1). Two Bulgarian studies examined the prevalence of MS in COPD patients. An epidemiological study conducted in Bulgaria in COPD patients reported a prevalence of 13.8%. These results differ significantly from the literature data probably because of the different criteria for metabolic syndrome  which makes data comparing irrelevant . A more The prevalence results could be explained with differences between the populations in different studies . For example, Bulgaria is low-income country, which may impact diet preferences and treatment choices. Furthermore, patients in this study had been hospitalized due to exacerbation, which represents the most severe group of COPD patients. Having in mind that MS is more common in the early stages and decreases with COPD progression , COPD paAccording to the NHANES III study, smokers are more likely to develop MS than nonsmokers in general population, and the risk increases with the number of pack-years even after adjusting for covariates . Our stuTreatment with inhalatory corticosteroids (ICS) is not risk factor for MS similar to findings for DM  and fastCOPD is a disease that affects mainly the lungs, but is characterized by systemic inflammation and a number of extrapulmonary manifestations. Only 1/3 of patients with COPD die due to respiratory failure. Main cause of death is lung cancer and cardiovascular complications .The vast majority of patients with COPD have a vitamin D deficiency . Aside fThere are no studies that examine the relationship between osteoporosis and MS in patients with COPD. However, both diseases share common risk factors such as smoking, lack of physical activity, and treatment with corticosteroids. Some of the components of the metabolic syndrome  are risk factors for low bone density. Systemic inflammation in MS plays a role in the pathogenesis of osteoporosis . On the Most patients with DM have MS, but the opposite is not necessarily true . The preHyperglycemia is associated with elevated glucose concentrations in tissues and bronchial aspirates where it may stimulate infection by enhancing bacterial growth and by promoting bacterial interaction with the airway epithelium . HyperglThe presence of MS in patients with COPD increases the frequency of exacerbations (2.4 vs. 0.7) and their duration–(7.5 vs. 5.0 days) according to The presence of MS is associated with significantly worse cough and sleep and higher total CAT score. This confirms the data about reduced quality of life in patients with MS . HoweverCOPD is characterized by airflow obstruction, which is not fully reversible. MS is associated with a reduction of lung volumes . It shouThis study finds a 25% prevalence of MS in COPD patients admitted for exacerbation, which is significantly lower than the general population. MS is more prevalent in females, but the gender difference is not statistically significant. In this study, most of the patients are former smokers, and the prevalence of MS does not differ regarding smoking status and treatment with ICS.The presence of MS is associated with the presence of DM, higher BMI and BAI, more exacerbations during the previous year and lower quality of life. MS is not associated with increased hospital stay and lower pulmonary function.This study finds comparable but relatively low prevalence of MS compared to previously published data (21–53%). As MS is more common in the early stages and decreases with COPD progression, the COPD patients admitted for exacerbation may be considered as having advanced COPD.


The metastatic rate and risk factors of splenic hilar (No.10) lymph nodes (LNs) in gastric adenocarcinoma were still variable and uncertain, and the prognostic significance of No.10 LNs was also controversial. The aim of this retrospective study was to analyze the metastatic rate, risk factors and prognostic significance of No.10 LNs in gastric adenocarcinoma.From August 2007 to December 2011, 205 patients who were diagnosed with primary gastric adenocarcinoma and underwent total or proximal gastrectomy plus No.10 LNs dissection in West China Hospital were enrolled. Clinicopathological features and survival outcomes were retrospectively analyzed.Mean numbers of harvested LNs and metastatic LNs were 34.8±12.6 (15–73) and 8.7±10.8 (0–67), respectively. The proportion of cases with positive No.10 LNs was 8.8% (18/205). In all 204 dissected No.10 LNs, 47 LNs (23.0%) were metastatic. In 52.2% (107/205) patients, the dissected splenic hilar tissues were histologically determined as only fat tissues but without LNs structure. Histological evidence of LNs structure was found in 98 (47.8%) patients with 18.4% (18/98) metastatic No.10 LNs. In multivariate logistic regression analysis, metastasis of No.10 LNs was significantly correlated with No.4sa LNs (p = 0.010) and pN stage (p = 0.012). Regarding survival analysis, 199 (97.1%) patients were followed up (0.6–74.8 months). In all patients with R0 resection, metastatic No.10 LNs caused significantly worse prognosis both in Kaplan-Meier (p = 0.006) and Cox regression analysis (p = 0.031).Although the metastatic rate of No.10 LNs was 8.8%, dissection of No.10 LNs might be meaningful due to the poor prognosis of positive cases. And attentions should be also paid to its correlated factors including pN stage and No.4sa LNs. Gastric cancer (GC) is one of the most common malignancies worldwide with high incident rate and cancer-related mortality, especially in Asia Nowadays, the incidence of proximal GC is gradually increasing Because of the variable metastatic rate of No.10 LNs and the adjacent anatomical relationship between No.10 LNs and spleen, it seems that gastrectomy and splenectomy should be combined theoretically for proximal GC to fulfill curative intention This retrospective study was approved by Ethics Committee of West China Hospital, Sichuan University. Written informed consent was not obtained but patient records were anonymized and de-identified prior to analysis.We retrospectively enrolled the patients from August 2007 to December 2011, who were histologically diagnosed with GC and underwent total or proximal gastrectomy with No.10 LNs dissection in Department of Gastrointestinal Surgery, West China Hospital, Sichuan University. All the patients were neo-adjuvant chemotherapy-naïve, and adjuvant chemotherapy or chemoradiotherapy were given according to patients' personal willing. There was no limitation of age, sex or race.For middle and upper thirds tumors, total gastrectomy was preferred, while some selected cardia tumors  were considered for proximal gastrectomy with negative margins by intra-operative frozen section. All the patients received D2/D2+ lymphadenectomy according to the classification of JGCA. Synchronous prophylactic splenectomy was not routinely performed. Due to the complicated structure of splenic artery and vein in hilar region, enbloc resection of No. 10 LNs was sometimes not able to be achieved in primary lymphadenectomy for the sake of surgical safety. After stomach was removed, secondary lymphadenectomy of No. 10 LNs including all the fat, lymphatic and connective tissues along distal splenic artery and splenic hilum was performed by ultrasonic scalpel.rd English version) by JGCA Clinicopathological characteristics, mainly concerning macroscopic type, differentiation grade, tumor location, maximal diameter of tumor and pathological TNM stage according to Japanese classification of gastric carcinoma  and 159 (77.6%) patients underwent proximal and total gastrectomy respectively. Average operation time was 266.0±42.3 min. Open surgeries were carried out for 145 patients and laparoscopy-assisted surgery for 60 patients, in whom 2 patients received conversion to laparotomy. Surgeons decided whether to perform combined resection of other organs according to the situation of GC invasion and other independent diseases. Finally, fourteen (6.8%) patients underwent gastrectomy combined with other organs resections, including three splenectomies, three hepatic nodules resections, three gallbladder resections, two resections for part of diaphragm, and four resections for part of small intestine. Among them, one patient underwent both hepatic nodule and part of diaphragm resection. After pathological examination of these resected organs, the dissected hepatic nodule in one patient and the diaphragm in another patient were confirmed as carcinoma cells invasion (T4b).Average numbers of total dissected LNs was 34.8±12.6 (15–73) and metastatic LNs was 8.7±10.8 (0–67) in all patients. The metastatic rates of No.10 LNs were 8.8% (18/205) in all patients, 6.5% (3/46) in proximal gastrectomy and 9.4% (15/159) in total gastrectomy. In total 204 dissected No.10 LNs, 47 (23.0%) metastatic No.10 LNs were found. Histological evidence of dissected No.10 LNs was found in 98 patients , while the dissected No.10 LNs were determined as fat tissues in 107 patients . For the 98 cases with histological evidence of No.10 LNs, the metastatic rates were 18 (18.4%) in all patients, 14.3% (3/21) in proximal gastrectomy and 19.5% (15/77) in total gastrectomy. The metastatic rates of regional LNs within D2 range were illustrated according to tumor longitudinal location in Demographic and correlations between No.10 LNs and clinicopathological characteristics were shown in For the group of patients with histological evidence of LNs structure in No.10 LNs, the correlated factors were also analyzed. Similarly, longitudinal location (p = 0.033), cross-sectional location (p = 0.035), tumor size (p = 0.009), pN stage (p = 0.001), M stage (p = 0.004) and pTNM stage (p = 0.002) were also significantly correlated with metastasis of No.10 LNs , Table 2In total 205 patients, 199 patients  were followed up for survival analysis with median 29.9 (0.6–74.8) months. Because of the limitation of follow-up time, the survival rate was larger than 50% and the median survival time was not figured out in the group with negative No.10 LNs. The median survival time of positive No.10 LNs was 15.9, 19.5 and 15.9 months in all patients, GC specific group and R0 resection group respectively. The 1- and 2-year cumulative survival rates of overall survival, GC specific group, R0 resection group and GC specific + R0 resection group were 83% and 66%, 85% and 69%, 85% and 68%, 87% and 71% respectively . The comFor the patients with histological evidence of LNs structure in No.10 LNs, the 1- and 2-year cumulative survival rates of overall survival, GC specific group, R0 resection group and GC specific + R0 resection group were 81% and 62%, 83% and 65%, 81% and 62%, 85% and 67% respectively . Kaplan-Twenty-seven patients  suffered from postoperative complications, with surgery-related complications in 12 patients  and non-surgery-related complications in 16 patients . One patient underwent secondary operation because of intraperitoneal bleeding. Details of postoperative complications were shown in In this retrospective study, we calculated the metastatic rates of No.10 LNs in different subgroups and analyzed the correlated factors of No.10 LNs metastasis. The metastatic rates of No.10 LNs were 8.8% in all patients and 18.4% in patients with histological evidence of No.10 LNs, which were between 7.3%–30% as reported in previous researches In this study, we also analyzed the metastatic rates of No.10 LNs at different locations of stomach. Longitudinally, carcinomas at UM/MU or UML of stomach had remarkably higher metastatic rates of No.10 LNs than other locations. At the same time, the metastatic rates of No.10 LNs were also significantly higher when tumors were located at the greater curvature, posterior wall or multi-walls of stomach, which was similar to the results of some previous reports Besides the tumor location, tumor size was also significantly associated with the metastatic rate of No.10 LNs. The maximal diameter of tumors larger than 5 cm indicated a remarkably increasing metastatic rate of No.10 LNs, which was similar to the previous studies No.10 LNs are located at splenic hilum, distributing closely along splenic hilar vessels and adjacent to No.4sa LNs No.4sb LNs and No.11d LNs as well. As we know, No.4sa LNs are located along the short gastric vessels and No.4sb LNs along left gastroepiploic vessels, which are continuation of the splenic vessels. It is known that lymphatics are the main metastatic routes for tumor cells and that the direction of lymphatic drainage of upper left stomach is from the stomach to the spleen. Tumor cells from the primary lesion in the stomach enter into lymphatics and then reach the splenic hilar area, which means tumor cells arrive at No.10 LNs. Then the lymphatic drainage flows along splenic vessels to the celiac artery. The univariate analysis showed the close relationship among No.10 LNs, No. 4sa LNs, No. 4sb LNs, No. 11d LNs and No. 9 LNs. Nonetheless, the logistic regression only confirmed the significance of No.4sa LNs in the metastasis of No.10 LNs.The relationship between positive No.10 LNs and prognostic outcome is still controversial, though more studies showed poor postoperative survival rate For the sake of close relationship between No.10 LNs and spleen, it is controversial whether to perform the splenectomy. From the previous studies, gastrectomy combined with conventional splenectomy did not bring the benefit for survival but cause more morbidity There were still some limitations of this study. The histological evidence of LNs structure in No.10 LNs was not demonstrated in approximate half patients. One of the reasons why so many fat tissues were harvested might be due to anatomic variation. To eliminate the limitation in this study, we did subgroup analysis in patients with histological evidence of LNs structure in No.10 LNs to calculate the relative factor. And the results were similar to all patients. Another limitation was that there were proximal and total gastrectomies, laparoscopy-assisted and open approaches in this study. However, proximal and laparoscopy-assisted gastrectomies were mainly indicated for small tumors and the differences between proximal and total, laparoscopy-assisted and open gastrectomies were focused on the quality of life. Therefore, the survival outcome was not influenced very much by different surgical procedures.In summary, although the metastatic rate of No.10 LNs was 8.8%, dissection of No.10 LNs still had clinical value due to the poor prognosis in positive cases and the close relationship with TNM stage, tumor location and size. Additionally, attentions should be also paid to its correlated factors including pN stage and No.4sa LNs.


CYP1B1 is the most commonly mutated gene in primary congenital glaucoma (PCG). This study was undertaken to identify mutations in CYP1B1 in the Western region of Saudi Arabia.CYP1B1 gene.Blood of patients who had typical findings of PCG, were screened by direct sequencing of all coding exons and splice junctions of the 34 patients were studied; 18 patients belonged to 8 families, and 16 patients were non-familial, isolated PCG. Consanguinity was found in 27/34 (79.4%) of cases. All patients were diagnosed to have bilateral PCG at birth except one child, who had glaucoma in the right eye. More males (61.8%) were affected than females (38.2%). 79.4% (27/34) of patients were solved with pathogenic mutations and 20.6% (7/34) remained unsolved. Of the solved ones, 22.2% (6/27) of patients carry a pathogenic allele on one allele while the other allele remained yet to be determined. Direct sequencing of exon 2 revealed two pathogenic variants . P.Gly61Glu substitution was found both homozygously in 63% (17/27) of cases, and heterozygously in one patient. P.Glu229Lys variant was found heterozygous in 3.7% (1/27) of cases. One pathogenic variant (p.Arg469Trp) was found in exon 3, and is present homozygously in 14.8% (4/27) of cases while four patients have this variant heterozygously. All mutations were reported previously in the Saudi population, except p.Glu229Lys. Severe cases were associated with p.Gly61Glu, and p.Arg469Trp in 50% and 30% of ten patients respectively.CYP1B1 mutations are the most frequent cause of PCG in the Saudi population, with p.Gly61Glu being the major disease-associated mutation. P.Glu229Lys is a newly discovered mutation in our PCG patients. Patient lacking mutation in CYP1B1 gene seems likely, to have another genetic loci involved in the pathogenesis of the disease, and need further study. Genetic studies of recessive diseases such as PCG is important in consanguineous populations, since it will increase awareness and allows genetic counseling to be offered to patients and their relatives. This will not only reduce the disease to be inherited to future generations, but will also reduce the disease burden in the community.This study confirms that  Primary congenital glaucoma (PCG) refers to a glaucoma occurring within the first 3 years of life, due to isolated trabeculodysgenesis . It is rCYP1B1 was the only gene found to be associated with bilateral PCG in consanguineous Saudi Arabian families. CYP1B1 mutations were identified in 96% of cases of the study described by Bejjani et al. [CYP1B1 mutations. Expatriates were excluded from all previous gene studies [The link between PCG and gene abnormalities is the initial step in the establishment of the pathophysiology of the disease. Three previous major studies -7 were ci et al.  but was  studies -8.CYP1B1 mutations in Saudi PCG patients with various ethnic backgrounds, and to identify those patients who carry novel mutations. Patients were collected at King Abdulaziz University Hospital, one of the major hospitals in the Western province of Saudi Arabia and a main referral centre for congenital glaucoma in the province.This study was conducted to identify The study adhered to the guidelines of the Declaration of Helsinki and was approved by King Abdulaziz University Research ethics committee (Reference No. 922–12).After signed informed consents were obtained, blood samples were collected for DNA isolation from 34 patients with PCG.Patients were recruited from the glaucoma clinic at King Abdulaziz University Hospital (KAUH) and the pediatric ophthalmology clinic at King Fahd Armed Forces Hospital (KFAFH), in Jeddah, Kingdom of Saudi Arabia. The diagnosis of PCG was established by the following signs: 1) increased intraocular pressure (IOP) (>21 mmHg), (2) cornea diameter (>10 mm) and changes , (3) optic nerve glaucomatous cupping, and by the following symptoms: photophobia, epiphora, and/or blephrospasm [ increaseCYP1B1 gene using Primer 3 (primer sequences and PCR conditions are available on request). PCR products were visualized on 2% agarose gel and purified with PCR clean-up purification plates , according to the manufacturer’s protocol. Purified PCR products were analyzed by Sanger sequencing in both directions using both forward and reverse primers in an automated DNA sequencer . Sequencing results were aligned with the reference sequence (obtained from the hg19 human genome build) and analyzed using Vector NTI Advance (TM) 2011 software (Invitrogen). In addition, the pathogenicity of CYP1B1 missense variants was evaluated by publically available in silico tools including PhyloP, Grantham, PolyPhen2, and SIFT.Primers were designed for the two coding exons and splice site junctions of the Data were collected from the medical records in a special form and then entered and stored in computer Microsoft ward. Graph Prism 5 software  was used to analyze the data. Frequency distribution tables were used to present the data. Mean, standard deviation and (student’s) t-test were used to compare continuous variables.All tests were two sided and at a 5% level of statistical significance. Fisher’s exact test also used to compare the real values of native and non-native Saudi groups.Our study included 34 PCG patients: 23 patients from KAUH and 11 patients from KFAFH. 18 patients belonged to 8 families with consanguineous parents, while9 patients were unrelated, non-familial, isolated PCG cases belonging to consanguineous parents. 7 patients were unrelated, non-familial, isolated PCG belonging to non-consanguineous parents. Consanguinity was reported in 27/34 (79.4%) of cases.All 34 patients were diagnosed to have bilateral PCG at birth except one child, who had glaucoma only in the right eye. More males (21/34) were affected than females (13/34). At presentation, the mean IOP +/− standard deviation (SD) was 30.48+/−6.93 (range 20 – 47) mmHg, the mean corneal diameter +/− SD was 12.71 +/−1.26 (range 10 – 17) mm. The mean cupping +/− SD and mean refraction +/− SD of 23 eyes with clear cornea was 0.47 +/− 0.29 (range 0.1 - 1.0), and - 4.92 +/− 5 (range +2.3 to −16) D respectively.CYP1B1 mutations, and 2 (9%) were negative. Eleven patients were non-native Saudi, originating from Yemen (4), Sudan (3), Afghanistan (2), Burma (1), and Syria (1). Of the non-native cases, 6 (54.5%) were positive for CYP1B1 mutations, and 5 (45.5%) were negative. Overall 27/34 (79.4%) cases carried CYP1B1 mutations and 20.6% (7/34) patients remained unsolved. Table CYP1B1 mutations between native and non-native Saudis. No significant differences were observed between the 2 groups, except for the mean C/D ratio, which was higher in the non-native Saudi group.Twenty three cases were native Saudi, of which 21 (91%) were positive for Ten patients were classified to have severe glaucoma on presentation  according to Al-Hazmi et al.  classifiCYP1B1 gene. Pathogenic variants were detected in CYP1B1 gene in 27 patients. 77.8% (21/27) patients were completely solved with pathogenic mutations, while 22.2% (6/27) patients were carrying a pathogenic allele on one allele while the other allele remained yet to be known. Direct sequencing of exon 2 revealed two pathogenic variants . The p.Gly61Glu substitution was found homozygously in 63% (17/27) patients, of which 10 cases belong to 4 consanguineous families. The p.Glu229Lys variant was found heterozygously in 3.7% (1/27) of cases Table DNA samples of all patients were screened for mutations in the Similarly, one pathogenic variant (c.1405C > T: p.Arg469Trp) was detected in exon 3. The p.Arg469Trp was found in 29.6% (8/27) patients. The p.Arg469Trp substitution was found homozygously in four patients belonging to two consanguineous families.The probable pathogenic mutations of the 22.2% (6/27) patients were, p.Arg469Trp in four patients, p.Gly61Glu in one patient and p.Glu229Lys in one patient, heterozygously. These six patients might have a second variant in the same gene that lies in the noncoding region i.e. intron or promoter Table In addition to those pathogenic variants, 6 other common SNPs  were also found either homozygously and heterozygously, that were not predicted to be pathogenic Table The populations of the Arabian Peninsula descend from a small number of founders. Their descendants established various tribes that dispersed across the kingdom. Therefore, the majority of native Saudi Arabians living today have common ancestors . This isCYP1B1 gene was selected to screen for mutations in our PCG patients, since it was considered the main candidate gene for PCG in Saudi Arabia. CYP1B1 mutations were found in 79.4% of our patients, which is higher than that reported by Abu-Amero et al. [The o et al. .CYP1B1 mutations in 91% and 54.5% of native and non-native Saudi Arabian PCG patients, respectively. This difference in rate of mutations could be secondary to the lower consanguinity rate in the non-native Saudi population (54.6%) compared to the native population (91.3%). The rate of CYP1B1 mutations in our non-native Saudi cases is low and comparable to populations with low consanguinity rates like India (44%) [CYP1B1 mutations in the native Saudi PCG cases may be explained by the population structure. Since the native Saudi population descended from a limited number of founders, it is likely that one of a small number of founder mutations have arisen that explain the majority of the cases among the native Saudi populations. Two of the pathogenic variants  identified in our cases were previously reported in the literature in PCG patients of various populations (ethnic groups), including native Saudi Arabians [We detected ia (44%)  and Brazia (44%) . In addiArabians . The GlyArabians . We idenArabians , but it Arabians , Indian Arabians , IranianArabians  patientsArabians .CYP1B1 analysis by Bejjani et al. [CYP1B1 in the current study, 4 patients had this haplotype T/G/T/C/C/A while three individuals were heterozygous for all these five SNPs. Bejjani et al. [In a previous study of i et al.  in PCG pi et al. ,16. HoweCYP1B1 mutations [CYP1B1 mutations and the severity of glaucoma on the basis of anterior chamber angle histological changes and difficulty in controlling IOP. Panicker et al. [In the literature, there has not been a consistent correlation between the severity of PCG and presence and types of utations . Hollandutations  found a r et al.  found thCYP1B1 mutations are the most frequent cause of PCG in the Saudi Arabian population, with p.Gly61Glu being the major disease-associated allele. The p.Glu229Lys is a new mutation in Saudi Arabian PCG patients. Genetic studies of recessive diseases such as PCG is important in consanguineous populations, since it will increase awareness and allows genetic counseling to be offered to patients and their relatives. This will not only reduce the disease to be inherited to future generations, but will also reduce the disease burden in the community.This study confirms that


Security policies for the patient are an interest to any health professional. The rates of adverse events in hospitals reach values ranging between 3.7 and 16.6%, being the highest range (40 to 70%) considered preventable or avoidable [P < 0.05 two-tailed and CIs at 95% (CI) were used for the odds ratios (OR) estimated in the sample. Demographics (gender and average age) and aspects related to adverse events were analyzed, the latter being under the impact and probability of death.Research conducted from database analysis regarding hospitalizations from 1 May 2012 until 31 October 2013 in a coronary care unit of the city of Presidente Prudente, Brazil. Statistical analysis was performed using EPI INFO, version 3.5.2 software, which was considered significant at A total of 1,067 admissions were analyzed in the period, with 57.38% male and 42.63% female. The average age was 67.7 ± 13.2 years. The average CICU length of stay was 3.74 ± 5.51 days. A total of 211 adverse events occurring in 140 different admissions were recorded. The most frequent were drug administration errors (24.3%), pressure ulcer (24.3%), phlebitis (22.1%), loss of enteric tube (13.6%) and central venous cannulation accident (7.1%). The statistical analysis shows that hospitalization time longer than 2 days are related to the occurrence of the events (OR: 8.08 CI: 4.95 to 13.2) and that the presence of the first occurrence is significant to increase the probability of death in the unit . Pressure ulcer , enteral tube loss  and drug administration errors  were also related to higher mortality.The research draws attention to a significant incidence of adverse events and shows that their occurrence implies an increase of death in the unit. Therefore, security measures should be employed for the reduction, and thus enhance the quality of service provided by health professionals to patients admitted to a coronary care unit.


Plasmodium falciparum has been extensively studied in various countries. However, limited data are available from Ethiopia. This study was conducted to evaluate the extent of genetic diversity of P. falciparum in Kolla-Shele, in the southwest of Ethiopia.The genetic diversity of P. falciparum attending Kolla-Shele Health Centre was collected from September to December, 2008. After extraction of DNA by Chelex® method, the samples were genotyped by using nested-PCR of msp1 (block 2) and msp2 (block 3) including their allelic families: K1, MAD20, RO33 and FC27, 3D7/IC1, respectively.A total of 88 isolates from patients with uncomplicated msp1 and msp2 were identified in the 88 blood samples. For msp1 67% (59/88) and msp2 44% (39/88) were observed. K1 was the predominant msp1 allelic family observed in 33.9% (20/59) of the samples followed by RO33 and MAD20. Of the msp2 allelic family 3D7/IC1 showed higher frequency (21.5%) compared to FC27 (10.3%). A total of twenty-three alleles were detected; of which, eleven were from msp2 and twelve from msp2 genes. Fifty-nine percent of isolates had multiple genotypes and the overall mean multiplicity of infection was 1.8 (95% CI: 1.48-2.04). The heterozygosity index was 0.79 and 0.54for msp1 and msp2, respectively. There was no statically significant difference in the multiplicity of infection by either age or parasite density (P > 0.05).Allelic variation in both msp1 family and 3D7/IC1 in the msp2 family. Multiple infections were observed in nearly 60% of the samples.This genetic diversity study showed the presence of five allelic types in the study area, with dominance K1 in the The online version of this article (doi:10.1186/s12936-015-0604-8) contains supplementary material, which is available to authorized users. Plasmodium falciparum, is a major public health problem. The global burden is 207 million malaria cases every year resulting into 627,000 deaths . Th. Th13]. P. falciparum blood spotted samples were collected from patients aged six months to twenty years, who visited the health centre during the evaluation of a therapeutic efficacy study, September-December, 2008  [(1-Σpi2 )], where n is the number of isolates sampled and pi is the allele frequency at a given locus [All samples were genotyped for echnique . All reaechnique . Gel phoen locus .msp1 and msp2 allelic frequency was calculated as the proportion of the allele found for the allelic family out of the alleles detected in the isolates. The number of samples with more than one amplified fragment within total samples is defined as frequency of polyclonal infection. The mean multiplicity of infection (MOI) was calculated as a total number of P. falciparum genotype detected per total number of positive samples. The Chi-square test was used to compare MOI with the event of a previous malaria attack. Spearman’s rank correlation coefficient was calculated to assess association between MOI and parasite density and age. Statistical significance was defined as P value ≤ 0.05.Data were entered and analysed using SPSS version 16 . The The study was ethically approved by the Institutional Review Board (IRB) of Department of Medical Laboratory Science Addis Ababa University. In addition, Scientific and Ethical approval was obtained from Scientific and Ethical Review Office (SERO) of the Ethiopian Public Health Institute (EPHI).P. falciparum isolates was analysed for msp1 and msp2 genes. The estimated of frequency of msp-1 and msp-2 gene amplification reactions with family specific primers was 67% (59/88) and 44% (39/88), respectively.The characteristics of the study populations are detailed in Table P. falciparum isolates within the allelic families of msp1 and msp2 with a total of 155 distinct fragments detected. This allele typing analysis displayed the highly polymorphic nature of P. falciparum in Kolla-Shele isolates with respect to msp1. In msp1, K1, RO33 and MAD20 allele types were identified. Frequencies of different msp-1 alleles and their combinations and multiplicity of infection are shown in Tables Length polymorphism was assessed in 88 msp1 . The monoclonal infections were 34 (57.6%). Among Polyclonal infections those that carried two allelic types K1/RO33, K1/MAD20, MAD20/RO33 comprised 25.4%, 5.1% and 3.4%, respectively. Trimorphic infections K1/MAD20/RO33were detected in 8.5% of cases . Among msp1 isolated, three for K1 (200–250 bp), five for RO33 (150–225 bp) and three for MAD20 (100-300 bp) allele families were observed ) was higher than the sample with only FC27 allelic type (10.3% (4/39)). Twenty-seven of the isolated (69.2%) carried both msp2 allelic families  were monoclonal infection while 69.2% (27/39) were polyclonal infections. The length variants of the amplified products were seven for FC27 (300–600 bp) and five for 3D7/IC1 (200–500 bp) . Out of the 88 samples, 52 (59%) harbored more than one parasite genotype. When considering P = 0.00), but not non-expose malaria   Figure .Figure 2P. falciparum than other countries. This is the first MSP based study to provide information about the genetic diversity of P. falciparum in Ethiopia. These finding may be an important element for implementing malaria control strategies in the country, as elimination may influence genetic diversity and their heterozygosity.In Ethiopia, less attention has been given to investigating the genetic diversity of P. falciparum msp1 and msp2 genotyping has shown that malaria parasite population in Kolla-Shele area is moderate to high allelic diversity. However, the number of alleles may have been underestimated due to the limitation of the technique. Indeed, fragments with the length interval of less than 20 bp could not clearly be distinguished as a separate allele. In their allelic frequency, out of the 59 allelic types detected in msp1, the K1 allelic family with 33.9% allelic frequency besides its representation in poly allelic bands, was found predominant This is in line with previous studies in Central Africa, Gabon, Benin, and Ghana [msp2, 39 allelic types were found and the alleles belonging to 3D7/IC1 family were more frequently detected (21.5%). This is similar to data reported from Kenya, Congo Brazzaville and other sub-Saharan-African countries [The allele specific nd Ghana ,22-24, bnd Ghana ,26. Withountries ,20,27, aountries ,29.The entomologic inoculation rate (EIR) study conducted in the same region showed a value of 17.1 infectious bites per person per year , the mode) was high for msp1 (0.79), indicating a larger genotype diversity within the msp1 locus than that of msp2, with He 0.54, which is nearly 0.5, i.e. the maximum expected Nei diversity index for allelic locus. This is almost parallel to the Hardy Weinberg’s 0.5 “2pq” equilibrium heterozygosity, in equal frequency P and q alleles. Similarly a moderate heterozygosity level of 0.51 < He 1998-1999-2002 < 0.58 was observed in the population diversity of P. falciparum in Djibouti [msp1.The Nei unbiased heterozygosity index  to high (msp1) He values.The MOI values reported in this study was higher than found in countries like Malaysia where the multiplicity of ectively . but lowly [msp2 . This di, in the Republic of Congo [The present study found that about two-third of the samples (59%) harboured multiple genotypes; almost similar frequency (62%) to that in the Sudan , while 8of Congo . This maThe mean MOI of persons with previous exposure to malaria attack is higher compared to persons with absence of previous malaria attack (non-exposed) i.e. high frequency of MOI correlates with high frequency of parasitic density. The finding may indicate that persons with lower parasitic density may have low acquired immunity , that they become symptomatic at a lower parasite threshold, unlike those with previous exposures. This is a tacit indicator that just few previous exposures, can elicit certain level of clinical immunity to make them tolerant to lower parasitaemic threshold up to 10,000Ps/ul blood.P. falciparum population. However, future study needs to be designed to increase the representative sample sizes in different transmission areas and use more robust techniques, such as microsatellite DNA sequencing, to study in depth the molecular diversity of the P. falciparum parasite.This study represents a first attempt to analyse the molecular characteristic of msp1 and msp2 in P. falciparum isolates from Kolla-Shelle area. The change in HE and MOI could be potential useful parameters in the evaluation of intervention against malaria, but this needs further studies in several parts of the country, to examine the allelic dominances and the dynamism of spatial/periodic changes in the genetic diversity of P. falciparum in Ethiopia.The results of this study showed genetic diversity and allelic distribution in