A total of 85 non-metastatic advanced SCCHN patients were accrued from January 2003 to December 2007. Of these, 48 and 37 patients received CCRT and CCB, respectively. The patients were randomized to receive either three cycles of carboplatin and 5-fluorouracil plus conventional radiotherapy  or hybrid accelerated radiotherapy . The primary endpoint was determined by locoregional control rate. The secondary endpoints were overall survival and toxicity. With a median follow-up of 43 months , the 5-year locoregional control rate was 69.6% in the CCRT arm vs 55.0% in the CCB arm (P = 0.184). The 5-year overall survival rate was marginally significantly different (P = 0.05): 76.1% in the CCRT arm vs 63.5% in the CCB arm. Radiotherapy treatment interruptions of more than three days were 60.4% and 40.5% in the CCRT arm and CCB arm, respectively. The median total treatment time was 55.5 days in the CCRT arm and 49 days in the CCB arm. The rate of Grade 3–4 acute mucositis was significantly higher in the CCB arm , but no high grade hematologic toxicities were found in the CCB arm (27.2% vs 0%). CCRT has shown a trend of improving outcome over CCB irradiation in locoregionally advanced head and neck cancer.The aim of this study was to compare the efficacy and safety of concurrent chemoradiotherapy (CCRT) vs accelerated hyperfractionation with concomitant boost (CCB) as a primary treatment for patients with Stage III At the median follow-up of 5.2 years, conventional chemoradiotherapy improved progression-free survival (PFS) compared with very accelerated radiotherapy (P = 0.041). However, accelerated RT-CT offered no PFS benefit compared with conventional chemoradiotherapy (P = 0.88) or very accelerated radiotherapy (P = 0.060). The 3-year PFS was 37.6% (95% CI 32.1–43.4) after conventional chemoradiotherapy, 34.1% (28.7–39.8) after accelerated RT-CT, and 32.2% (27.0–37.9) after very accelerated radiotherapy. More patients in the very accelerated radiotherapy group had RTOG Grade 3–4 acute mucosal toxicity  compared with accelerated RT-CT  or conventional chemoradiotherapy . They concluded that conventional chemoradiotherapy had the most favorable outcomes, suggesting that the acceleration of radiotherapy is probably not beneficial in CCRT schedules. A similarity between GORTEC 99-02 and our current study is they both support CCRT over altered fractionation, with our study showing a significant benefit in OS, rather than DFS as in GORTEC. An intriguing difference between the GORTEC 99-02 study and our current study is the fractionation of the second daily dose, in which we used 1.2 Gy and GORTEC 99-02's accelerated arm continued with a second 1.8-Gy daily dose. Grade 3–4 acute mucosal toxicity was quite high in both studies, 67.6% in our CCB group (graded by NCI-CTC version 2.0) vs 84% in GORTEC 99-02 (scored by RTOG grading); in addition, severe Grade 3–4 late radiation toxicities were similar between the two studies .The latest publication of CCRT vs accelerated radiotherapy with or without concomitant chemotherapy for locally advanced head and neck carcinoma (GORTEC 99-02)  reported(P = 0.18) and a marginally significant improved OS (P = 0.05). The difference in LRC, although not statistically significant, appeared to have an impact on OS. There might be an association between LRC and OS, but this study was underpowered to detect it. Two caveats regarding the interpretation of OS benefit are the higher median age of patients in the CCB arm vs the CCRT arm (63.0 vs 58.5 years), and the failure to recruit sufficient patients in this small study. A final factor that could have affected the OS could be the lower compliance with radiotherapy seen in the CCRT group.As stated earlier, our two main findings in support of CCRT are a trend of better LRC In conclusion, our results indicated that CCRT produced a trend towards better outcome compared with CCB irradiation. However, the higher hematologic toxicities and poor radiotherapy compliance rate are important limiting factors to be considered regarding this treatment.


Objective: To assess the effectiveness of sodium hyaluronate Eye Gel in Dry Eye Disease (DED) patientsMethods: A Multi-center, Open-label, Uncontrolled clinical trial was conducted in different centers of Pakistan. Ten ophthalmologists conducted this study in which 250 diagnosed patients with dry eye disease were enrolled after obtaining a written informed consent. Ten patients were dropped out during the study period. All patients were assessed as per following criteria for enrolling a patient into the study: Tear Film Break – up time (TBUT) ≤ 10 seconds, Schirmer Test – 1 ≤ 6 mm / 5 minutes and Positive Corneal Staining. Tolerability/safety was assessed by the monitoring and recording of all adverse events. The physical examination was done at baseline, 4th week and 8th week.Results: The mean age of the patients was 43.4 ±17.8 years and out of 240 patients 117 (48.7%) were males and 123 (51.3%) females. The Mean duration of symptoms was 19.3±23.9. At the initial visit the foreign body sensation was 50.6%, itching 35.9%, burning 50.6%, watering 42.9%, photophobia 25.3% and feeling of dryness in 14.7% of patients. After 4 weeks (2nd visit), the symptoms were decreased to 47.1% foreign body sensation, 32.4% itching, 48.2% burning, 41.8% watering, 25.3% photophobia and 13.5% feeling of dryness. At the 3rd visit (after 8 weeks) the frequency of symptoms were: 45.3% foreign body sensation, 30.6% itching, 45.9% burning, 40% watering, 24.7% photophobia and 13.5% feeling of dryness.Conclusion: Sodium Hyaluronate can provide a suitable alternate in the treatment of dry eye disease due to its reported efficacy on foreign body sensation, itching, burning, watering, photophobia and feeling of dryness,  The dry eye is a “multifactorial disease of the tears and ocular surface that results in symptoms of discomfort, visual disturbance, and tear film instability with potential damage to the ocular surface. It is accompanied by increased osmolarity of the tear film and inflammation of the ocular surface”.2The Dry eye disease (DED) is a common health problem which has an effect on the quality of life.3, 4 Only a few population based studies are available regarding the magnitude of the problem. The studies conducted in US to determine the prevalence of DED showed 14.6% .5 The reported frequency of dry eye syndrome was found 16%.in adult patients attending the eye clinic of tertiary care hospital in Pakistan.6Dry eye is a common ocular problem and also an important public health problem. DED patients are having problems in daily routine activities such as reading, working on a computer, and car driving. DED also increases the risk of ocular infections, ocular discomfort, fatigue, and visual disturbance.7-8 A study conducted on elderly Korean population found that female sex, age, and hormonal influence were risk factors for both DED and depression.9 Wang et al and Galor et al, reported a relationship between depression and DED.10,11The important risk factors for DED are older age, female sex, reduced androgen levels, exogenous estrogen use, and an imbalance in the dietary intake of essential fatty acids as identified by the studies over the past decade.12-14 HA is found mainly in the connective tissue of the skin, inside the umbilical cord, synovial fluid in joints and eye. In eye, it is found in the vitreous, lacrimal gland, cornea, conjunctiva, and tear fluid. HA has an anti-inflammatory and wound healing property. HA inhibits free radicals thus prevents oxidative damage to cells.15,16Hyaluronan (HA) has distinctive viscoelastic and hygroscopic properties and plays many important roles in the human body. It is a naturally occurring lubricant and is made up of biocompatible polysaccharide It is because of its excellent water-retaining properties that it is used in ophthalmic products.The objective of this study was to assess the effectiveness of sodium hyaluronate Eye Gel in diagnosed patients of DED.A Multi-center, Open-label, Uncontrolled clinical trial was conducted in different centers of Pakistan. Ten ophthalmologists conducted this study in which 250 diagnosed patients with dry eye disease were included after obtaining a written informed consent. All patients were assessed as per following criteria for enrolling a patient into the study: Presence of at least 2 of the 6 symptoms  and at least one of the 3 tests, Tear Film Break – up time (TBUT) ≤ 10 seconds, 2) Schirmer Test – 1 ≤ 6 mm / 5 min and Positive Corneal Staining. Patients with Entropion, Ectropion, Trichiasis, or using Cortico-steroids drugs were excluded from the study.th week and 8th week. The confidentiality of data and patient anonymity was protected by the codes given in the study documents.Sodium hyaluronate Eye Gel 2-4 times a day was prescribed to patients for 8 weeks. Tolerability/safety was assessed by the monitoring and recording of all adverse events. The physical examination was performed at baseline, 4+ standard deviation for continuous data and frequency and percentages were calculated for categorical data. One Way ANOVA was performed and p value <0.05 was considered as significant.Demographic and baseline variables were described by mean Ten patients dropped out during the study period from a total of 250 diagnosed patients of Dry Eye and the response rate was 96%. The mean age of the patients was 43.4 ±17.8 years. Out of 240 patients, 117 (48.7%) were males and 123 (51.3%) females. The Mean duration of symptoms was 19.3 ±23.9 months. At the baseline, foreign body sensation 50.6%, itching 35.9%, burning 50.6%, watering 42.9%, photophobia 25.4% and feeling of dryness 14.7%.nd visit) the results showed that the foreign body sensation 47.1%, itching 32.4%, burning 48.2%, watering 41.8%, photophobia 25.3% and feeling of dryness 13.5%. After 8 weeks (3rd visit) the changes in ocular symptoms were: foreign body sensation 45.3%, itching 30.6%, burning 45.9%, watering 40%, photophobia 24.7% and feeling of dryness 13.5%. The Mean TBUT was 6.6±2.2 in the first visit, 8.3±2.2 second visit and 10.1±2.3 seconds in the third visit . Schirmer’s test was 9.1 ±5.7 in the first visit, 10.6 ±5.3 in the second visit and 11.8±4.1 in the third visit .The above results showed a significant difference in the ocular symptoms between the visits.After 4 weeks  in the state of the corneo-conjunctival epithelium, than the isotonic solution.18,19 Brignole and associates found that comfort was better in Sodium hyaluronate (SH) group as compared to carboxymethylcellulose (CMC) group. SH group also showed faster recovery in keratitis  and symptoms than in the CMC group.20 A comparative study between diquafosol group and sodium hyaluronate group also showed that the SH group had lower adverse reactions such as eye discharge and eye irritation than in the other group.21In vitro hyaluronate promotes cell migration and can stabilize ocular surface epithelial barrier suggesting that it may be directly involved in the process of epithelial repair by activation of the CD44 .22 Our study also showed the improvement of mean TBUT from 6.6 second (SD±2.2) in the first visit to 10.1 seconds (SD±2.3) in the third visit . Prabhasawat and coworkers also found the increase in TBUT in HA group at 30 and 60 minutes .23 Our study found that the foreign body sensation, itching, burning, watering, photophobia, and feeling of dryness decreased after 8 weeks of treatment with HA. Dumbleton and associates also reported the efficacy of HA with a significant difference in subjective symptoms in the group using HA.24Johnson and coworkers compared the effect of saline and 0.1% and 0.3% HA on TBUT. A significant improvement was found in TBUT up to 6 hours. They also noticed that the 0.3% HA had greater effect on TBUT as well as on symptoms (P < 0.04).25Literature review showed that HA is found throughout the body and can be used to mimic the natural tears in such products as artificial tears. Previous studies also show that HA-based ophthalmic preparations can serve as natural tears.In conclusion, this study suggests that sodium hyaluronate Eye Gel has a beneficial effect on the foreign body sensation, itching, burning, watering, photophobia and feeling of dryness in a well defined and homogeneous population of patients with dry eye, selected by using stringent inclusion criteria. No adverse event with sodium hyaluronate eye gel was reported by the patients.Prof. Dr. Nasir Saeed: Design, drafting, data collection, critical review.Dr. ZA Qazi: Data collection, writing the results, drafting.Dr. Nadeem H Butt: Writing the discussion, Drafting, Data collection.Dr. Ahson Siddiqi: Design, critical review.Dr. Neeta Maheshwary: Data collection, Data analysis.Dr. Muhammad Athar Khan: Data analysis, writing the results.


The subjects reported recalling dreams at least once a week (76%), and that dreams typically depicted actions (93%), known people (92%), sounds/voices (78%), and colored images (76%). The oneiric content was associated with plans for the upcoming days (37%), memories of the previous day (13%), or unrelated to the dreamer (30%). Nightmares usually depicted anxiety/fear (65%), being stalked (48%), or other unpleasant sensations (47%). These data corroborate Freudian notion of day residue in dreams, and suggest that dreams and nightmares are simulations of life situations that are related to our psychobiological integrity. Regarding LD, we observed that 77% of the subjects experienced LD at least once in life (44% up to 10 episodes ever), and for 48% LD subjectively lasted less than 1 min. LD frequency correlated weakly with dream recall frequency , and LD control was rare (29%). LD occurrence was facilitated when subjects did not need to wake up early (38%), a situation that increases rapid eye movement sleep (REMS) duration, or when subjects were under stress (30%), which increases REMS transitions into waking. These results indicate that LD is relatively ubiquitous but rare, unstable, difficult to control, and facilitated by increases in REMS duration and transitions to wake state. Together with LD incidence in USA, Europe and Asia, our data from Latin America strengthen the notion that LD is a general phenomenon of the human species.During sleep, humans experience the offline images and sensations that we call dreams, which are typically emotional and lacking in rational judgment of their bizarreness. However, during lucid dreaming (LD), subjects know that they are dreaming, and may control oneiric content. Dreaming and LD features have been studied in North Americans, Europeans and Asians, but not among Brazilians, the largest population in Latin America. Here we investigated dreams and LD characteristics in a Brazilian sample ( On sleep and sleeplessness is one of the first known references on the possibility of becoming aware of the dream while dreaming. In The interpretation of dreams Freud  reported having a LD at least once in life , 51% said so       Yu, , respect348) Yu, , age dif348) Yu, , or vari348) Yu, .To our knowledge, there are to date no studies about dream features among Brazilians, nor studies regarding LD prevalence among Latin Americans. Moreover, there is a lack of knowledge regarding LD characteristics in this population, such as number of episodes experienced in lifetime, ability to control oneiric content, episode duration, and facilitating factors of occurrence. It is therefore important to obtain data on these LD features to compare with other populations, or with laboratory studies, such as Laberge et al. , who obsn = 3,909) completed an online informed term of consent before completing the questionnaire. Subjects were invited to respond the questionnaire directly by email, or indirectly by online social network services or TV program ads. Subjects who did not answer a given question were excluded from the analysis of this question. We also excluded the subjects who answered less than 90% of the first part of the questionnaire  . We also investigated a possible age group effect on the questionnaire responses.The study was approved by the Research Ethics Committee of the Federal University of Rio Grande do Norte (permit #061/2008). As stated by the Ethics Committee, all subjects , 1 check-box question  and 5 table questions. These table questions were divided by dream items according to frequency of occurrence: never, very rare (once a year), rare (once a month), frequent (once a week), very frequent , and always (every day); for the sake of synthesis, we present the results of the last three answers grouped. The second part of the questionnaire was divided in 7 radio questions, 2 check-box questions and 1 mixed (radio and check-box) question. Details about the original questionnaire can be found at: Questionnaires were created using HTML and PHP language and were available to be answered in a website of the Federal University of Rio Grande do Norte.For dreams Figure  and LD , we plotn = 3,427), 56% were female, 24% were male and 20% did not answer the gender. The median age was 25 years . We also investigated a possible age group effect on the responses, but no significant differences were observed.3,909 voluntaries responded to the survey, but we excluded those who answered less than 90% of the dream questionnaire . In our final sample . We found that 34.1% of the subjects remembered dreams frequently (1 or 2 times per week), 33.2% almost every day, 19.8% about twice a month, 9.2% every day, 3.4% once a year and 0.1% less than once a year Figure . With reWe also observed that dream content mainly involved movements/actions (93.3%), known people (92.9%), sounds/voices (78.5%), colored images (76.3%), something pleasurable (70.7%) and natural scenes (63.9%). The less common features were unknown people (49.7%), sexual intercourse (30.4%), flying (26.9%), tastes/flavors (26.8%), someone who has died (21.2%), a smell (20.0%), things to read (17.4%), nonexistent creatures (15.0%), black and white images (14.3%) Figure . During The main sleep room or environmental stimuli that incubate into dreams were the voice of someone (47.6%), phone ring (40.1%), alarm clock (37.5%), house/street noise (37.4%), a tactile sensation (36.2%), TV/radio sounds (32.9%), a light (25.9%), a smell (15.7%) Figure . The recWe observed in our sample that 77.2% of the subjects had already experienced at least one LD episode in their whole lifetime Figure . With rer = 0.20, p < 0.01— Figure r = 0.34, p < 0.01— Figure r = −0.33, p < 0.01— Figure r = −0.38, p < 0.01— Figure χ2 = 10.2, p = 0.001).With respect to LD episode duration, 26.7% report that LD takes between 1–10 min, but 25.2% tend to wake up after realizing the LD. For 16% LD takes between 10 s and 1 min, and for 12.8% LD takes the time the dreamer wants. For 11.7% LD takes more than 10 min and for 7.3% less than 10 s Figure . The facOne important limitation of our study, intrinsic to an online survey, is the lack of information about the physiological state underlying each dream report. Dreams are not restricted to REMS , or the future (associated with plans and expectations)  Laberge, . FinallyThe authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Continuous exposure to nitrates is associated with tachyphylaxis. This study compares the effects and tolerance during intravenous treatment with nitroglycerin and nicorandil over a 48-hour period.Twenty patients with congestive heart failure and pulmonary capillary wedge pressure (PCWP) ≥18 mmHg were randomly assigned to nitroglycerin or nicorandil intravenous infusions. Doses were titrated to obtain a reduction of PCWP of at least 30% at 6 hours and then maintained for 48 hours.P = 0.79 pretreatment and 0.23 at 6 hours). The mean PCWP values for 24 hours were 19.7 and 17.4, respectively, which was statistically significant (P = 0.036). Similarly, the values for 48 hours were 20.6 and 17.9, which was significant (P = 0.026) (see Table There was no statistical difference between the groups in terms of age, sex, and NYHA grade. The pretreatment PCWP for nitroglycerin was 25.7 mmHg, decreasing to 18.4 mmHg at 6 hours. The values for nicorandil were 25.4 mmHg and 17.3 mmHg, respectively. There was no statistical difference between the two groups (Intravenous nicorandil administration gives similar reductions in PCWP compared with nitroglycerin with significantly less haemodynamic tolerance over a 48-hour period compared with nitroglycerin. This might represent a clinical advantage of nicorandil in the short-term treatment of patients with congestive heart failure.


Scenedesmus sp. through in situtransesterification by optimizing various process parameters. Based on the orthogonal matrix analysis for the acidic catalyst, the effects of the factors decreased in the order of reaction temperature(47.5%) > solvent quantity (26.7%) > reaction time (17.5%) > catalyst amount (8.3%). Based on a Taguchianalysis, the effects of the factors decreased in the order of solvent ratio (34.36%) > catalyst (28.62%) > time (19.72%)> temperature (17.32%). The overall biodiesel production appeared to be better using NaOH as an alkaline catalyst rather than using H2SO4in an acidic process, at 55.07 ± 2.18% (based on lipid weight) versus 48.41 ± 0.21%. However, in considering the purified biodiesel, it was found that the acidic catalyst was approximately 2.5 times more efficient than the alkalinecatalyst under the following optimal conditions: temperature of 70°C (level 2), reaction time of 10 hrs (level 2), catalyst amountof 5% (level 3), and biomass to solvent ratio of 1 : 15 (level 2), respectively. These results clearly demonstrated that the acidic solvent, which combined oil extraction with in situtransesterification, was an effective catalyst for the production of high-quantity, high-quality biodiesel from a Scenedesmus sp.The aim of this study was to increase the yield of biodiesel produced by  Biodiesel is an alternative renewable fuel that is derived from vegetable oils, animal fats, spent frying oils, and microbial oils. This fuel can replace petroleum-based fuels and can be used in all types of the currently available diesel engines without them being modified , 2.Jatropha. However, a major criticism of large-scale fuel production from nonedible resources is that vast areas of farmland or native habitats will be consumed, and food prices will increase. Because of these problems, microalgae are currently considered one of the most promising resources for biodiesel production . Si. SiRf, bstances . FAMEs wbstances . The matbstances . Therefo.9~42.6% –42. To ein situ transesterification via alkaline or acidic catalysis for the production of biodiesel from Scenedesmus sp., several objective variables were analyzed using an L9 orthogonal matrix as follows: the reaction time and temperature and the amounts of catalyst and solvents [in situ transesterification, the effects of the factors decreased in the order of biomass to solvent ratio (34.36%) > catalyst amount (28.62%) > reaction time (19.72%) > reaction temperature (17.32%). The maximum yield of 48.41 ± 0.21% (P < 0.05) (based on lipid weight) was obtained at a biomass to solvent ratio of 1 : 15, H2SO4 at 5% , a reaction time of 10 hrs, and a reaction temperature of 70°C. For the alkaline catalyst, the effects of the factors decreased in the order of the reaction temperature (47.5%) > solvent quantity (26.7%) > reaction time (17.5%) > amount of catalyst (8.3%). The maximum biodiesel yield of 55.07 ± 2.18% (based on lipid weight) was obtained under the following conditions : solvent quantity of 50 mL, NaOH amount of 0.5% (based on the lipid weight), a reaction time of 2 hrs, and a reaction temperature of 60°C (P < 0.05). However, TLC analysis of the FAMEs showed that 48.41% of highly purified FAME was obtained through acidic catalysis, whereas 23.67% was obtained through alkaline catalysis, with less contamination by lipid pigments. It was also found that the quality of the biodiesel produced using the acidic catalyst was better than that produced using the alkaline catalyst by having higher amounts of C16 : 0 and C18 : 3. These results clearly indicated that an in situ transesterification process using an acidic catalyst should have an excellent potential for directly producing biodiesel from microalgae [Scenedesmus sp. microalga based on the quantity and quality of the algal biodiesel produced in this study.To optimize solvents . In usincroalgae . However


To assess the efficacy and safety of once-daily lixisenatide versus placebo in Asian patients with type 2 diabetes insufficiently controlled on basal insulin ± sulfonylurea.1c 8.53%) from Japan, Republic of Korea, Taiwan and the Philippines received lixisenatide (n = 154) or placebo (n = 157) in a stepwise dose increase to 20 µg once daily. The primary endpoint was HbA1c change from baseline to week 24.In this 24-week, randomized, double-blind, placebo-controlled, parallel-group, multicentre study, participants , and allowed more patients to achieve HbA1c <7.0% (35.6 vs. 5.2%) and ≤6.5% (17.8 vs. 1.3%). Lixisenatide also significantly improved 2-h postprandial plasma glucose and glucose excursion, average 7-point self-monitored blood glucose and fasting plasma glucose. Lixisenatide was well tolerated; 86% of patients on lixisenatide completed the study versus 92% on placebo. Ten (6.5%) lixisenatide and 9 (5.7%) placebo patients experienced serious adverse events. More lixisenatide patients [14 (9.1%)] discontinued for adverse events versus placebo [5 (3.2%)], mainly with gastrointestinal causes. Nausea and vomiting were reported in 39.6 and 18.2% of patients on lixisenatide versus 4.5 and 1.9% on placebo. Symptomatic hypoglycaemia was more frequent with lixisenatide (42.9%) versus placebo (23.6%), but was similar between groups , in those not receiving sulfonylureas. No severe hypoglycaemia was reported.Once-daily lixisenatide significantly improved HbAIn an Asian type 2 diabetes population insufficiently controlled by basal insulin ± sulfonylurea, once-daily lixisenatide significantly improved glycaemic control, with a pronounced postprandial effect, and was well tolerated. Effective treatment of type 2 diabetes requires a multidisciplinary approach, including both lifestyle and pharmacological interventions. Treatment to maintain glycaemic control typically progresses in a stepwise fashion, culminating in the use of multiple oral glucose-lowering agents and/or insulin . PatientIncretin-based therapies appear to be particularly effective in Asian and Japanese patients with type 2 diabetes (who tend to have a pathophysiology of insulin deficiency rather than insulin resistance), and there is some evidence to suggest a profound underlying GLP-1 insufficiency in these patients –8.1c versus placebo and a good efficacy/tolerability ratio  were performed using an analysis of covariance (ancova) model with treatment group, screening strata for HbA1c (<8%/≥8%), sulfonylurea use (yes/no), and country as fixed factors, and baseline HbA1c as a covariate. Continuous secondary efficacy variables were also analysed by ancova, and categorical secondary efficacy variables were analysed using a Cochran–Mantel–Haenszel method stratified on randomization strata. Summaries of safety data (descriptive statistics and frequency tables) were presented by treatment group. Statistical analyses were performed by using the Statistical Analysis System software version 9.2.Sample sizes of 145 patients in each of the two study groups were calculated to provide a statistical power of 90% assuming the common standard deviation of 1.3% to detect a 0.5% difference in change from baseline to week 24 in HbA2 and baseline HbA1c of 8.53%. Approximately 70% of patients were receiving a sulfonylurea at screening. The mean duration of treatment with basal insulin was approximately 3 years, with around 60% of the patients receiving insulin glargine, 27% insulin detemir and 13% NPH. Demographic and baseline characteristics were well matched and there were no clinically relevant differences between the two groups  and all received at least one dose of double-blind treatment. Patients had a mean age of 58.4 years, diabetes duration of 13.9 years, BMI of 25.3 kg/mo groups . Thirty-1c was 8.5% in both groups. The LS mean change from baseline to endpoint (week 24) was −0.77% for the lixisenatide group and +0.11% for the placebo group   A. HbA1c observed A. The goDuring the standardized meal test, treatment with lixisenatide significantly improved post-prandial glycaemic control as shown by the significant decrease in 2-h PPG values and blood glucose excursions from baseline to week 24 compared with the placebo group .Overall, the incidence of treatment-emergent adverse events (TEAEs) was higher in the lixisenatide group than the placebo group, mostly attributable to gastrointestinal and hypoglycaemic events . Most ofMore patients in the lixisenatide group [14 (9.1%)] discontinued treatment due to a TEAE compared with the placebo group [5 (3.2%)], mainly as a result of gastrointestinal TEAEs — six (3.9%) and four (2.6%) patients in the lixisenatide group discontinued treatment due to nausea and vomiting, respectively, versus none in the placebo group. One death was reported during the treatment period (a case of suicide in the placebo group).Hypoglycaemia was the most frequently reported TEAE in the lixisenatide group — 66 (42.9%) lixisenatide-treated patients and 37 (23.6%) placebo-treated patients reported symptomatic hypoglycaemia meeting the protocol-specified definition. None of these events was severe. In the subgroup of patients not receiving a sulfonylurea, the incidence of hypoglycaemia in lixisenatide-treated patients was close to that of placebo: 32.6% versus 28.3%, respectively .No pancreatitis was reported during this study. One lixisenatide-treated patient had an increase in lipase, which was <3 ULN, and one placebo-treated patient had an increase in pancreatic enzymes with lipase ≥3 ULN. No increases in calcitonin or TEAEs related to the thyroid gland were reported.A total of four patients (two patients in each group) experienced injection site reactions; none of the reactions were considered serious or severe or led to treatment discontinuation. A total of seven possible allergic reactions were reported (five events in the lixisenatide group and two events in the placebo group) during the on-treatment period. Only one of these events  was adjudicated by the ARAC as an allergic reaction possibly related to study medication.1c versus placebo . Significantly more lixisenatide patients achieved HbA1c targets of ≤6.5% (17.8%) and <7.0% (35.6%) than placebo . The magnitude of improvement in HbA1c is consistent with that seen with lixisenatide monotherapy administered once daily for 12 weeks in previously drug-naïve patients with type 2 diabetes [In this Phase III, randomized, placebo-controlled trial, lixisenatide 20 µg once daily as add-on to basal insulin with or without sulfonylureas met its primary endpoint of significantly improving HbAdiabetes  and as adiabetes  in a pri1c decreased by 1.7% (baseline 8.4%) with exenatide twice daily and 1.0% (baseline 8.5%) with placebo – a significant between-group difference of −0.7%. It should be noted, however, that the study population in this exenatide trial was predominantly Caucasian, with only 3% of patients being of Asian origin.The only other published prospective randomized controlled trial looking at addition of a GLP-1 receptor agonist to insulin therapy compared exenatide twice daily and placebo in 259 patients on insulin glargine (with or without metformin and/or pioglitazone) . After 31c after 24 weeks by 1.9% (baseline 8.8%) versus a reduction of 1.4% with glibenclamide 2.5 mg/day [1c reduction relative to glibenclamide was 0.49% [1c by 1.6%  without causing any major hypoglycaemic episodes, although higher rates of minor hypoglycaemia were reported among subjects in the liraglutide group than in those on placebo [1c was 1.33% [1c reduction of 1.6% (baseline 8.2%) versus a reduction of 0.3% (baseline 8.1%) with placebo, with mild-to-moderate hypoglycaemia reported in 58 and 23% of patients, respectively [Although several studies have looked at the efficacy and safety of other GLP-1 receptor agonists  in Japanese populations –16,18–22as 0.49% . In anot placebo . At weekas 1.33% . Data arData from populations with a significant proportion of Korean patients are rare. The study by Yang and colleagues, which included 18% Korean patients (the remainder were of Chinese or Indian origin), looked at liraglutide add-on to metformin over 16 weeks and yielded results similar to the global liraglutide Phase III trials . In the Lixisenatide had a pronounced effect on postprandial glycaemic control, significantly improving 2-h PPG and glucose excursion. These results are also consistent with reports from previous studies of lixisenatide –12. The 1c as patients start to approach recommended HbA1c goals .Targeting FPG with basal insulin in patients insufficiently controlled (HbA1c <7%) on oral agents has been shown to markedly increase the relative contribution of PPG to overall glycaemia from 20–24 to 59–69% [1c targets, a focus on PPG may become increasingly relevant at lower  HbA1c levels [1c simultaneously for treatment of type 2 diabetes; in terms of PPG, the International Diabetes Federation (IDF) considers a 2-h PPG target <7.8 mmol/l (140 mg/dl) to be both “reasonable and achievable” [Furthermore, PPG makes a greater contribution to HbAo 59–69% . Thus, ic levels , and PPGc levels . Accordiievable” .Lixisenatide also significantly improved FPG and average 7-point SMBG levels relative to placebo. When interpreting these plasma glucose results, it should be noted that there was no formal titration of basal insulin doses and the protocol specified that the dose was to be kept stable within a ±20% range. Nevertheless, a significant reduction in the daily basal insulin dose was seen with lixisenatide compared with placebo.2 and 66 kg, respectively), observed weight changes were generally small. Nevertheless, maintaining weight stability represents an important achievement in an insulin-treated population, who typically would be expected to gain weight, especially with concomitant sulfonylurea therapy. Despite the small changes, there was a clear trend towards weight loss for lixisenatide compared with placebo (p = 0.0857).A statistically significant decrease in weight with lixisenatide versus placebo has been reported previously . In the Lixisenatide was generally well tolerated in the present study. Overall, 86.4% of patients in the lixisenatide group completed the study compared with 91.7% on placebo, and 81.8% of patients were still on full doses of lixisenatide at the end of the double-blind treatment period. As expected, the most frequent adverse events were gastrointestinal in nature – mainly nausea, with lower rates of vomiting and other gastrointestinal symptoms. The frequency of nausea (39.6% for lixisenatide) is slightly higher in this exclusively Asian population than that observed with lixisenatide monotherapy or add-on to metformin at the 20 µg once daily dose (22–25%) in a global population ,11.Hypoglycaemia was not unexpected in this insulin-treated population, particularly considering that 70% were also receiving sulfonylureas. A higher incidence was reported in those lixisenatide-treated patients who were also receiving sulfonylureas, while the incidence in those receiving purely basal insulin in combination with lixisenatide was close to the rate with placebo. There were no reports of severe hypoglycaemia.1c and a pronounced effect on postprandial glucose control. Overall, lixisenatide was well tolerated in this population. These results support those of other Phase III studies [In conclusion, lixisenatide administered once daily as an add-on treatment to basal insulin with or without a sulfonylurea in Asian patients with type 2 diabetes and FPG at screening <250 mg/dl provided a significant improvement in HbA studies –30, high


AbstractPhoridae, in 6 genera, are reported from the Kola Peninsula, north of the Arctic Circle. The new species Megaselia elenae and Megaselia kozlovi are described. 33 species of Megaselia, only known from females, are given code numbers. Keys to the species of all the females of Megaselia and Phora are provided; and also a key to the males European Megaselia species with a notopleural cleft.64 species of  Diptera: Phoridae) from the Kola Peninsula refers to PageBreakMegaselia opacicornis Schmitz parasitizing the pupae of the leaf beetle Chrysomela lapponica (L.) (Chrysomelidae)  is situated north of the Arctic Circle. It is the centre for the smelting of copper and nickel in the Kola Peninsula and is one of the most polluted towns in the Russian Federation  . The towderation . During egaselia  and a nelsewhere . Two newSamples were collected in 10 study sites located between 1 km North and 40 km South of Mochegorsk. In 2009 insects were collected in traps baited with dead mice, the trap being described by BT refers to specimens caught in the traps baited with dead mice in 2009. 1335 scuttle flies were obtained. YT refers to those caught in the yellow traps in 2010. 344 scuttle flies were trapped. Voucher specimens, including all the type material, are deposited in the University of Cambridge, Museum of Zoology (UCMZ).The gut contents has been noted for several specimens. Amorphous detrital material is almost certainly derived from carrion fluids.Abaristophora kolaensis Disney: YT - 1 male. This species has been recently described (escribed .Anevrina thoracica (Meigen): BT - 2 females. A new record for Russia west of the Urals.Anevrina unispinosa (Zetterstedt): BT - 155 males, 140 females. The males were 11.6% of the phorids obtained in the traps baited with dead mice and the females were 10.5%. Together they were 22.1%. None were collected in the yellow traps. A new record for Russia west of the Urals. This species has been reared from dead snails (Keilin 1919) and carrion baits, including liver, dead molluscs and earthworms, and from rotting wheat flour, vegetation and mushrooms : BT - 13 females. Some females had amorphous detrital material in the gut, which in one case included a few fungus spores. Gravid females had 5 or 7 eggs. The recognition of this species has been recently clarified  with it and then produced a hybrid description  with the lower pair clearly shorter and less robust than the upper pair. [Note: the right side of frons lacks its antial bristle but has 2 pre-ocellars. The following positions of these bristles is based on the left side]. The antials slightly lower on frons than upper SAs and anterolaterals, which are about level with the latter, and about midway between upper SAs and AL bristles. Pre-ocellars slightly further apart than either is from a mediolateral bristle, which is about the same level on frons. Cheek with 4 bristles and jowl with two. The subglobose postpedicels brown, each with more than 40 subcutaneous pit sensilla (SPS) vesicles which are about 0.01 mm in diameter. Palps yellow, at most a third as broad as postpedicel but slightly longer than breadth of latter, with 6-7 bristles, the most apical being shorter PageBreakthan a lower SA but the longest subequal to latter, and as many hairs. Labrum yellowish brown and about half as wide as a postpedicel. Labella coloured as palps but with light brown bands on upper sides towards margins and with very few short spinules below. Thorax brown. Two notopleural bristles and a cleft in front of these, which ends just before reaching a c-shaped ridge across its path. Mesopleuron bare. Scutellum with an anterior pair of small hairs and a posterior pair of bristles. Abdominal tergites brown with small hairs except for clearly longer hairs at rear of T6. Venter brown, and with a few hairs on segments 3–6, those at rear of segment 5 being longer, and those at rear of T6 being clearly the longest. The (damaged) hypopygium is brown, with a pale brown anal tube, which is clearly longer than the length of the dorsal face of the epandrium. Each side of the latter 16–18 hairs, which are longer and stronger anteriorly but are smaller and weaker behind, and with a strong bristles (about 0.13 mm long). The hairs of the proctiger are as long and clearly thicker than hairs of the cerci. The left lobe of the hypandrium is pale grey, about 0.06 mm long, and lacking micritrichia. The right lobe is also pale grey and bare, but is only 0.02 mm long (and only 0.03 mm wide at its base). With 4 rectal papillae. Legs yellowish brown with the hind femora being the darkest and the front legs the more yellowish. Fore tarsus with a posterodorsal hair palisade on segments 1–5 and 5 a little longer than 4. Dorsal hair palisade of mid tibia extends about two thirds of its length. Hairs below basal half of hind femur clearly longer than those of anteroventral row of outer half, which are themselves long .PageBreakMegaselia haraldlundi Disney: YT – 1 female.Megaselia humeralis (Zetterstedt): BT – 1 male. This species parasitizes the pupae of the leaf beetle Chrysomela lapponica (Chrysomelidae) (Disney and Zvereva 2008).Megaselia immodensior Disney: BT – 1 male, 1 female. YT – 1 male. This species is a little variable and the specimens from the Kola Peninsula extend the range of variation a little. For example the costal index of the male is only 0.42, but in the type series it is more than 0.44  in Germany.nguished . It has Megaselia fuscovariana (Schmitz): BT – 1 male, 1 female. YT - 1 male, 1 female.http://zoobank.org/33869855-A189-4460-B780-E546125885ADhttp://species-id.net/wiki/Megaselia_kozloviIn the key to the males of the species of the British Isles  the maleNamed for its collector Mikhail Kozlov.Male. Frons brown, clearly broader than long, with 30–42 hairs and very dense but very fine microtrichia. Supra-antennal bristles (SAs) unequal, the lower pair being about as long as the longest  bristle of the palp but less robust than it. The antials lower on frons than anterolaterals, and more than twice as far from upper SAs as either is from an AL bristle. Pre-ocellars slightly closer together than either is from a mediolateral bristle, which is very slightly higher on frons. Cheek with 2–3 short bristles and jowl with one long and one short bristle. The subglobose postpedicels brown, without SPS vesicles. Palps yellow, at most a third as broad as postpedicel but about 1.4 times as long as breadth of latter, with 5–8 bristles, 3–4 being long and the rest short, and 1–3 hairs. Labrum pale yellow and about 0.8 times as wide as a postpedicel. Labella a little paler than palps, with only a few short spinules below but with several pale teeth along their inner edges.. Thorax brown. Three notopleural bristles and no cleft in front of these. Mesopleuron bare. Scutellum with an anterior pair of small hairs and a posterior pair of bristles. Abdominal tergites brown with T6 being longest and with longer hairs at its rear margin than on the rest of the tergites. Venter PageBreakgrey, and with fine hairs on segments 3–6. Hypopygium brown, with a light brown anal tube, and as Female. Head similar to male except palps with 7–8 bristles, the longer ones being a little shorter than those of male, and with 3–7 hairs. Thorax as male. Abdominal tergites brown. T3-T7 as Holotype ♂, RUSSIA, Kola Peninsula, near Monchegorsk, at dead mouse, 18–25.vii 2009, M. Kozlov . Paratypes, 2F the same except (17-48 & 72), 1 F, 25.vii–1.viii.2009 , 1 male, in yellow trap, 6-16.vii.2010 .PageBreakPageBreakMegaselia limburgensis (Schmitz): YT – 1 male.Megaselia nudiventris (Wood): YT – 1 male. This species has recently been rescued from synonymy . Some females had amorphous detrital material in the gut, which in two cases included several fungus spores. This is mainly a boreo-alpine species of northern Europe and Canada.Megaselia petraea Schmitz: BT – 2 males, 12 females. One female was gravid.Megaselia sordida (Zeterstedt): BT – 744 females, which is 56.3% of the phorids obtained in the traps baited with dead mice. This was the commonest species in the traps. YT – 12 males, 74 females. Thus the males were 3.4% of the phorids obtained in yellow traps and the females were 20.8%. Only a few had amorphous detrital material in the gut. Only a few were gravid. Of these one had 19 eggs, which measured 0.67 mm long and 0.25 mm wide (HF = 1.02 mm long). One had 32 half developed eggs (HF = 0.99 mm long).PageBreakThe following species are only known in the female sex and are given code numbers only until they can be linked to their males. The sequence of numbers is incomplete as some females were subsequently linked to their males.Megaselia species 3: BT – 25 females. YT – 3 females. None were gravid but more than 40 immature eggs were recorded. There was no evidence of feeding on carrion fluids.Megaselia species 4: YT – 1 female.Megaselia species 5: BT – 30 females. These were 2.2% of phorids caught at dead mice. YT – 94 females, which was 27.3% of the phorids in the yellow traps. None were gravid and one had amorphous detrital material in the gut.Megaselia species 6: BT – 6 females. One with 2 relatively large eggs, that were 0.74 mm long and 0.28 mm wide (HF = 0.91 mm long). There was no evidence of feeding on carrion fluids.Megaselia species 7: BT – 2 females. None was gravid and there was no evidence of feeding on carrion fluids.Megaselia species 8: BT – 11 females. YT – 8 females. None were gravid and there was no evidence of feeding on carrion fluids.Megaselia species 10: BT – 7 females. YT – 1 female. None were gravid but one had fungus spores in the crop.Megaselia species 11: BT – 1 female. With amorphous detrital material in the gut.Megaselia species 12: BT – 1 female. With amorphous detrital material in the gut.Megaselia species 13: BT – 1 female.Megaselia species 16: BT – 29 females. YT – 7 females. Most had amorphous detrital material in the gut and in one case this included short, thick walled, fungus bodies. One had 2 mature eggs remaining, the rest of the batch evidently having been deposited.Megaselia species 17: BT – 2 females.Megaselia species 18: BT – 5 females. Three with amorphous detrital material in the gut, one of which included a few spindle-shaped fungus spores.Megaselia species 19: BT – 20 females. Three with amorphous detrital material plus fungus spores in the gut, the spores being round in one case and spindle shaped in two. A few pollen grains were present in guts of two specimens. One with 24 half developed eggs.Megaselia species 20: BT – 3 females.Megaselia species 21: BT – 2 females.Megaselia species 24: BT – 1 female, with dark amorphous material in the gut.Megaselia species 25: BT – 1 female.Megaselia species 26: BT – 1 female.Megaselia species 27: BT – 1 female. With amorphous detrital material in the gut.Megaselia species 28: BT - 1 female.Megaselia species 29: BT – 1 female. With amorphous detrital material in the gut.Megaselia species 30: BT – 1 female. With pollen grains in gut.Megaselia species 31: BT – 2 females. One was gravid, with 8 eggs which measured 0.51 long and 0. 25-0.26 mm wide (HF = 0.90 mm long). The other with amorphous detrital material in the gut.PageBreakMegaselia species 33: BT – 2 females. One had a single egg remaining. It measured 0.32 mm long and 0.12 mm wide (HF = 0.49 mm long).Megaselia species 34: BT – 3 females. One had two eggs remaining, they measured 0.51-0.54 mm long and 0.21-0.23 mm wide (HF = 0.73 mm long). Another had granular material in the gut.Megaselia species 36: BT – 1 female. With a little amorphous detrital material in the gut.Megaselia species 37: BT – 1 female. YT – 10 females.Megaselia species 38: BT – 1 female.Megaselia species 39: BT – 1 female.Megaselia species 40: BT – 1 female. The gut had fine amorphous debris. Fungus mycelium was present in the abdomen.Megaselia species 42: BT – 2 females. Both had fungus spores in the gut. One was gravid. The eggs are 0.99-1.00 mm long and 0.32 mm wide and have a plastron running the length of the dorsal face. There were 14 eggs (HF = 1.21 mm long).Megaselia species 46: BT – 1 female.Megaselia species 47: BT – 1 female. There was a single relatively large egg measuring 0.66 mm long and 0.29 mm wide; this egg being longer than the length of the hind femur (at 0.47 mm).Microselia forsiusi (Schmitz): BT – 1 female. This species was previously only known from Finland.PageBreakPhora dubia in Section I  has 1 or 2 bristles on its hind tibia, and in some specimens there is 1 on one leg and 2 on the other. Likewise Phora stictica in Section II occasionally has 2 bristles on the hind tibia and only 1 bristle on the mid tibia; and Phora artifrons in the same section likewise sometimes has only 1 bristle on the mid tibia. Such variation has to be taken into account when trying to match up females with their males. In addition there is evidently some sexual dimorphism in these bristle number differences. For example for some Phora atra (Meigen) males I have obtained mating there were 4 or 5 dorsal bristles on the mid tibia, but only 2 or 3 on those of their female partners. Furthermore, some males of this species occasionally have 2 anterior bristles on at least one mid tibia; which means they would be in Schmitz’s Section II instead of Section III. One specimen attributed to Phora holosericea has no anterior bristles on the mid tibiae. Other variation occurs with respect to colour, such as the costa, the thin veins and the wing membrane (including the extent of the regions devoid of microtrichia), and the front tibia and tarsus. As none of the females were gravid, apart from one with immature eggs, some of the paler specimens were probably only recently emerged from their pupae and were not fully darkened. The result of these variations is that females are still poorly known in this genus. However, The recognition of the species in this genus is based on the males, with particular attention to the hypopygium. In his keys to the Palaearctic species, Phora artifrons Schmitz: YT – 1 male.Phora dubia (Zetterstedt): BT – 2 females. YT – 1 male, 2 females.Phora holosericea Schmitz: BT – 41 females, which was 3.1% of the phorids caught at dead mice. YT – 4 males, 83 females. Thus the females were 23.4% of the phorids caught in the yellow traps. Larvae prey upon the root feeding Aphididae and Pemphigidae .Phora pubipes Schmitz: BT – 5 females. YT – 3 males, 1 female. One female had 20 immature eggs (HF = 1.9-2.0 mm long).Phora stictica Meigen: YT – 2 males, 11 females. These represented 3.7% of the phorids caught in the yellow traps.Triphleba palposa (Zetterstedt): Bt – 1 female.The female of this species was only briefly described by Triphleba renidens Schmitz: YT – 1 female.This key provides a preliminary sorting only. Identification requires checking out the details given under the brief description of each species.Note: Variable species are keyed both ways at several coupletsMegaselia giraudii. Reference to most figures are in D . For Iceland, which lies immediately south of the Arctic Circle, 11 species have been recorded . For thePageBreak


Despite years of salt iodization, goitre continues to be a major public health problem worldwide. We examined the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of Chandigarh, north India.3, T4, TSH, anti-TPO (thyroid peroxidase) antibody, haemoglobin, ferritin and selenium.Two phase study; in the first phase, 2148 children of 6 to 16 yr were screened for goitre by two independent observers as per the WHO grading system. In the second phase, a case-control study, 191 children with goitre and 165 children without goitre were compared with respect to urinary iodine, iodine content of salt, serum levels of TP= 0.03). Median urinary iodine excretion in both the groups was sufficient and comparable (137 and 130 µg/l). 3.2 per cent children with goitre and 2.4 per cent without goitre had hypothyroidism  and only one child with goitre had subclinical hyperthyroidism. Nine (4.9%) children in the goitre group and 3 (1.9%) in control group had anti-TPO antibody positivity. The median serum selenium levels were not different in both the groups (181.9 and 193.5 µg/l). Seventy one (37.4%) of the goitrous children had anaemia (haemoglobin <12 g/dl) as compared to 41 (24.8%) of the control group (P <0.01). More number of goitrous children  were depleted of tissue iron stores (serum ferritin <12 µg/l) as compared to controls . Serum ferritin level negatively correlated with the presence of goitre  and had an OR of 2.8 .Prevalence of goitre in the studied subjects was 15.1 per cent (13.9% in 6 to 12 yr and 17.7% in 13 to 16 yr age group, There was a high prevalence of goitre in young children despite iodine repletion and low thyroid autoimmunity. The concurrent iron deficiency correlated with the presence of goiter. However, the cause and effect relationship between iron deficiency state and goitre requires further elucidation. Iodine is an essential micronutrient required for structural development and optimal functional activity of the thyroid gland and central nervous system. Iodine deficiency has been shown to be associated with endemic cretinism, endemic goitre and subcretinous mental subnormalitiesDespite being iodine replete, goitre continues to be prevalent in mild to moderate degree of endemicity in most states of IndiaThe current study was aimed to survey the prevalence of goitre in the post-iodization phase and the relationship of goitre with micronutrient status and thyroid autoimmunity in school children of the Union Territory of Chandigarh, a city of northern India.The study was conducted in two phases . In the Goitre was screened by palpation method and was graded as per definition provided by WHO/UNICEF/ICCIDDGoitre was examined by 2 trained physicians independently, and if the observation was not concordant, the lower grade recorded by either of them was taken as the grade of the goitre.In the second phase of the study, 204 children with goitre and similar number (n=204) of children without goitre were selected from the same cohort for the subsequent case-control study. Consent could be obtained in 356 children . The demographic parameters, history and physical examination were recorded as per the protocol. The smoking habit of the parents was obtained through the proforma supplied to the children. The socio-economic status was assessed by modified Kuppuswamy scaleSpot urine samples were collected in a wide mouthed iodine free plastic tubes with tight screw tops and kept in a refrigerator at -4°C after addition of 1 drop of toluene. Urinary iodine was estimated by ammonium per sulphate methodUnder aseptic condition, 7 ml of blood was collected from ante-cubital vein in both plain and EDTA vaccutainers. EDTA samples were processed for haemoglobin estimation within 6 h of collection of the samples. Blood samples collected in the plain vials were immediately centrifuged at -4°C, transported to the Endocrinology laboratory with proper maintenance of cold chain and were stored at -20°C. Haemoglobin was determined by colorimetric method3(tri-iodothyronine), T4(tetraiodothyronine), TSH (thyroid stimulating hormone), anti-TPO (thyroid peroxidase) antibody and serum ferritin were determined by immunochemiluminiscence . The normal range and coefficient of variation (CV) of various parameters are listed in Serum T3, T4and TSH), subclinical hypothyroid , hypothyroid (TSH>97th percentile with T4< 4.8 µg/dl), subclinical hyperthyroid  and hyperthyroid (TSH<0.27 µIU/ml with T4>12.7 µg/dl and T3>2 ng/ml)Depending on the thyroid function tests (TFT) results, children were classified into euthyroid  was used for statistical analysis. Number and percentage were calculated for categorical data. Fisher’s exact test and Chi-square test were applied to examine difference between proportions at a level of significance of 0.05. For continuous quantitative data mean, standard deviation and median were calculated. Data were checked for normal distribution with Kolmogorov-Smirnov test. For skewed data Mann-Whitney test was used to compare difference between means and for normally distributed data unpaired t test was applied. Multivariate regression analysis was done to predict the independent variables associated with goitre. Spearman’s correlation was used for assessing the correlation between goiter, haemoglobin and ferritin levels. Finally, the power of the study was 85 per cent with 95 per cent confidence interval.P=0.03). All had diffuse goiter; 14.3 per cent (n=308) had grade-1 and 0.8 per cent (n=17) had grade-2 goitre. The inter and intra-observer variations in grading of goitre were 2.7 and 2 per cent respectively. Goitre was more prevalent in girls than in boys  and this sex difference was more marked in 13 to 16 yr of age group  was 15.1 per cent (n=325). The prevalence of goiter was higher in the adolescents (13 to 16 yr) as compared to younger children (6 to 12 yr)  children with goitre and 126 (83.4%) control children in their day to day life. Only 155 (45.5%) of parents knew the advantages of iodized salt. Only 78 (23.5%) of parents knew that iodized salt prevents goitre.The mean iodine content of salt in 321 samples was 36.47 ± 6.44 ppm. The iodine content of the salt samples from goitre and control groups was comparable (36.55 ± 6.28 vs 38.38 ± 6.63 ppm). Majority (315) of the samples (98.1%) had salt iodine content of >15 ppm. The median urinary iodine excretion in children with goitre and control group were 137 and 130 µg/l respectively. None of the children had urinary iodine excretion <20 µg/l.3, T4 and TSH were found between goitre and control groups  Nine (2.6%) children had subclinical hypothyroidism, one (0.3%) had overt hypothyroidism, 1 (0.3%) child had subclinical hyperthyroidism and none had overt hyperthyroidism. Five (2.7%) children with goitre and 4 (2.4%) without goitre had subclinical hypothyroidism. One child with overt hypothyroidism and another with subclinical hyperthyroidism had goitre.No differences in mean TP=0.005).A total of 12 (3.5%) children were anti-TPO antibody positive (≥ 34 IU/ml), 4.9 per cent in goitre group and 1.9 per cent in the control group. There was no sex predilection for anti-TPO antibody positivity  but more children with deranged thyroid hormonal status  had anti-TPO antibody positivity than euthyroid children  and 37.4 per cent of goitrous children and 24.8 per cent of control children had haemoglobin levels <12 g/dl (P<0.05). There was a significant difference in ferritin levels among goitrous and control children . Serum ferritin level was <50 µg/l in 86.7 per cent children in goitre group compared to 78.8 per cent in controls (P<0.057) and it was <12 µg/l (severe iron deficiency state) in 20.6 per cent of goitrous children as compared to 6.4 per cent of control children (P<0.001).Anaemia (Hb<12 g/dl) was present in (31.7%) of children. Haemoglobin was significantly lower in children with goitre than in the control group  while 43.4 per cent (23/53) of adolescents (13-16 yr) with goitre and 34.9 per cent of those without goitre had anaemia. In girls of 13 to16 yr of age group, 44.4 per cent of cases with goitre had anaemia as compared to 50 per cent in the control group.On further analysis, 35.2 per cent of children with goitre and 21.1 per cent without goitre in the age group of 6 to12 yr were anaemic (P<0.05). In the 13 to16 yr age group, 23.5 per cent of adolescents had serum ferritin <12 µg/l as compared to 7.3 per cent among controls (P<0.05). In girls of 13 to 16 yr age group, 29.6 per cent with goitre had serum ferritin <12 µg/l as compared to 13 per cent among controls. Thus, anaemia was more prevalent in adolescent girls in both the cases and control group.In the 6 to12 yr age group, 19.5 per cent of those with goitre had serum ferritin levels <12 µg/l as compared to 6.1 per cent in the control group  and distribution of goitre in different quartiles of serum selenium was not statistically different.P=0.82) and none were active smoker.17.3 per cent of goitrous children and 18.8 per cent of control children had history of passive smoking (th) in children with goitre was poorer as compared to the controls , but similar difference in paternal education was not found . Scholastic performance in terms of failure rate was higher in children with goitre than controls , and it did not correlate with thyroid function status, anaemia and selenium levels.Socio-economic status was not different between the two groups. Maternal educational status (below class XP=0.017). The results for other variables did not achieve statistical significance (P=0.008) and Hb  were negatively correlated with the presence of goitre.On multiple regression analysis considering goitre as a dependent variable and gender, urinary iodine, haemoglobin, serum ferritin, anti-TPO antibody positivity, serum selenium and smoking as independent variables, low serum ferritin had a significant OR of 2.8  is an important goitrogen5In conclusion, there was a high prevalence of goitre in young children in c0 handigarh, north India despite iodine sufficiency and low thyroid autoimmunity. The concurrent iron deficiency might be decreasing the effectiveness of iodine supplementation programme. The cause and effect relationship between iron deficiency and goitre requires further elucidation.


Aspergillus oryzae on the apparent total tract digestibility (ATTD) of phosphorus and calcium in corn-soybean meal diets fed to weanling and growing pigs. In Exp. 1 and 2, pigs were randomly allotted to 6 dietary treatments using a randomized complete block design and a balanced 2 period changeover design, respectively. In both experiments, 6 diets were formulated. The positive control diet was a corn-soybean meal diet with added inorganic phosphorus . A negative control diet and 4 diets with the novel phytase  added to the negative control diet at levels of 500, 1,000, 2,000, and 4,000 phytase units (FYT)/kg were also formulated. In Exp. 1, the ATTD of phosphorus was greater (P < 0.01) for the positive control diet (60.5%) than for the negative control diet (40.5%), but increased  as phytase was added to the negative control diet . The breakpoint for the ATTD of phosphorus (68.4%) was reached at a phytase inclusion level of 1,016 FYT/kg. In Exp. 2, the ATTD of phosphorus was greater (P < 0.01) for the positive control diet (59.4%) than for the negative control diet (39.8%) and increased  as phytase was added to the negative control diet . The breakpoint for the ATTD of phosphorus (69.1%) was reached at a phytase inclusion level of 801 FYT/kg. In conclusion, the novel bacterial 6-phytase improved the ATTD of phosphorus and calcium in both weanling and growing pigs. The optimum level of inclusion for this phytase is 800 to 1,000 FYT/kg of complete feed to maximize ATTD of phosphorus and calcium in weanling and growing pigs.In 2 experiments, 48 weanling  and 24 growing pigs  were used to determine effects of a novel bacterial 6-phytase expressed in  Therefore, 2 experiments were conducted to determine the efficacy of this novel bacterial 6-phytase expressed in Aspergillus oryzae on phosphorus and calcium digestibility in corn-soybean meal diets fed to weanling or growing pigs.In feedstuffs of plant origin, phosphorus is present in both organic and inorganic forms. Most of the organic phosphorus in plant ingredients is bound to complex structures called phytate .For Exp. 1, a total of 48 weanling pigs  were blocked by initial BW and randomly allotted to 6 dietary treatments using a randomized complete block design. There were 8 blocks for each collection period. For Exp. 2, 24 growing barrows were used in a 2 period changeover design . In periIn each experiment, 6 diets were formulated Tables , and 4. 0.75; NRC, [All pigs were fed at a level of 3 times their estimated maintenance energy requirement  and wat75; NRC, . ChromicAt the conclusion of each experiment, fecal samples were dried in a forced air oven and ground to pass a 2 mm screen. Fecal samples and diets were analyzed for calcium and phosphorus by inductively coupled plasma (ICP) spectroscopy (method 985.01 ) after wThe apparent total tract digestibility (ATTD) of phosphorus in each diet was calculated according to the following equation: 6 to 11 . The samIn Exp. 1 and 2, data were analyzed as a randomized complete block design and as a changeover design , respectFor both experiments, contrasts were performed between the positive control and the negative control and the negative control vs. diets with phytase. Orthogonal polynomial contrasts were also conducted to test linear and quadratic responses to the inclusion of increasing levels of phytase to the diets. Appropriate coefficients for unequally spaced concentrations of supplemental phytase were obtained using the interactive matrix language procedure (PROC IML) of SAS. Treatment means were subjected to a least squares broken-line analysis performed using the procedures of Robbins et al.  to deterP < 0.01) for pigs fed the positive control diet than for pigs fed the negative control diet, but fecal phosphorus concentration was less (P < 0.05) for pigs fed the negative control diet than those fed the positive control diet. Likewise, pigs fed the phytase-containing diets had less  fecal phosphorus concentration than pigs fed the negative control diet. The daily phosphorus output was also less (P < 0.01) for pigs fed the negative control diet than for pigs fed the positive control diet, and the inclusion of increasing levels of phytase to the negative control diet reduced  phosphorus output. The ATTD of phosphorus was greater (P < 0.01) for pigs fed the positive control diet than for pigs fed the negative control diet (60.5% vs. 40.5%); however, ATTD of phosphorus increased  as phytase was added to the negative control diet . The amount of phosphorus absorbed was greater (P < 0.01) for pigs fed the positive control diet than for pigs fed the negative control diet (2.6 vs. 0.9 g/d). Likewise, the addition of increasing levels of phytase to the negative control diet increased  the amount of phosphorus absorbed. The ATTD of phosphorus plateaued at 68.4% which was reached when 1,016 FYT/kg of phytase was added to the diet  for pigs fed the positive control diet than for pigs fed the negative control diet (5.6 vs. 3.0 g/d). Pigs that were fed phytase containing diets tended (P = 0.06) to have a greater calcium intake than pigs fed the negative control diet. Concentration of calcium in feces was greater (P < 0.05) for pigs fed the positive control diet compared with pigs fed the negative control diet (2.29% vs. 1.86%); however, pigs fed phytase containing diets had less  calcium concentration in feces than pigs fed the negative control diet. The daily calcium output was also greater (P < 0.01) for pigs fed the positive control diet than for pigs fed the negative control diet (1.5 vs. 1.1 g/d), but the addition of 500, 1,000, 2,000, or 4,000 FYT/kg of phytase to the negative control diet reduced  calcium output to 0.80%, 0.60%, 0.52%, and 0.50%, respectively. The ATTD of calcium was greater (P < 0.05) for pigs fed the positive control diet than for pigs fed the negative control diet (72.5% vs. 63.9%), but pigs fed diets containing 500, 1,000, 2,000, or 4,000 FYT/kg of phytase had greater  ATTD of calcium than pigs fed the negative control diet . The amount of calcium absorbed was reduced (P < 0.01) from 4.0 to 2.0 g/d for pigs fed the negative control diet rather than the positive control diet, but calcium absorption was increased  for pigs fed phytase containing diets compared with pigs fed the negative control diet . The breakpoint for phytase concentration was reached at 1,155 FYT/kg of phytase, which resulted in an optimal ATTD of calcium of 84.7%  for pigs fed the positive control diet than for pigs fed the negative control diet (8.5 vs. 4.8 g/d) and fecal phosphorus output tended (P = 0.08) to be greater for pigs fed the positive control diet than for pigs fed the negative control diet. The phosphorus concentration in feces was less  for pigs fed phytase containing diets than for pigs fed the negative control diet. The daily phosphorus output was less (P < 0.01) for pigs fed the negative control diet than for pigs fed the positive control diet (2.9 vs. 3.4 g/d). Addition of phytase to the negative control diet reduced  daily phosphorus output . The ATTD of phosphorus was greater (P < 0.01) for pigs fed the positive control diet than for pigs fed the negative control diet (59.4% vs. 39.8%). Pigs fed phytase containing diets also had greater  ATTD of phosphorus than pigs fed the negative control diet . Phosphorus absorption was greater (P < 0.01) for pigs fed the positive control diet than for pigs fed the negative control diet (5.1 vs. 1.9 g/d); however, addition of phytase to the negative control diet increased  absorption of phosphorus to 3.0, 3.3, 3.5, and 3.7 g/d. The breakpoint for phytase concentration resulted in an ATTD of phosphorus of 69.1%, which was reached when 801 FYT/kg of phytase was added to the diet  for pigs fed the positive control diet than for pigs fed the negative control diet (12.0 vs. 8.5 g/d). Concentration of calcium in feces was reduced  as phytase was added to the negative control diet . The daily calcium output tended (P = 0.07) to be greater for pigs fed the positive control diet compared with pigs fed the negative control diet (3.2 vs. 2.7 g/d). Addition of phytase to the negative control diet reduced  the daily calcium output to 1.6, 1.5, 1.5, and 1.1 g/d. There was also a tendency (P = 0.07) for pigs fed the positive control diet to have greater ATTD of calcium than pigs fed the negative control diet (72.9% vs. 67.3%). As phytase was added to the negative control diet, the ATTD of calcium increased  to 81.4%, 82.6%, 82.4%, and 85.6%. Calcium absorption was greater (P < 0.01) for pigs fed the positive control diet than for pigs fed the negative control diet (8.8 vs. 5.7 g/d). Likewise, pigs fed phytase containing diets had greater (P < 0.01) absorption of calcium than pigs fed the negative control diet. For the ATTD of calcium, the breakpoint for phytase concentration was reached when 574 FYT/kg of phytase was added to the diet, which resulted in an ATTD of calcium of 83.5%  or 6-phytases EC 3.1.3.26), which is grouped according to the specific position of the phosphomonoester group on the phytate molecule at which hydrolysis is initiated . Traditi6, which elevance . Dependielevance ,11,24,25elevance ,23,26,27In the present study, phosphorus digestibility of the negative control diet was 40.5% and 39.8% for weanling and growing pigs, respectively. These values were within the range determined in previous studies using low-phosphorus, corn-soybean meal-based diets fed to weanling  and A. niger phytase [E.coli phytases [E. coli, A. niger, or P. lycii phytases [Values for the ATTD of phosphorus that were observed for weanling pigs fed the diets containing phytase are similar to values reported from previous nursery pig studies in which  phytase ,35 or E.phytases ,29,36 wephytases ,37,38. TAs a result of greater phytate hydrolysis, fecal phosphorus excretion was markedly reduced in weanling and growing pigs fed low-phosphorus diets containing the bacterial 6-phytase compared with pigs fed the positive or the negative control diets. This observation is also in agreement with results of previous experiments ,35,38,39A. niger phytase have indicated a curvilinear relationship between phytase level and phosphorus digestibility [E. coli phytase was achieved at 738 FYT/kg. Thus, the observation that the response to increasing levels of the bacterial 6-phytase that was used in the present experiments is dose-dependent is in agreement with results obtained with other commercially-available phytases.The use of a broken line model in this experiment may have underestimated the phytase levels that maximises the ATTD of phosphorus and calcium, and a quadratic regression curve could have been a more accurate fit to this data . Howevertibility -43, and tibility  reportedtibility  also obsThe improvement in calcium digestibility that was observed as phytase was added to the diets is in agreement with previous data -29,38 anThe linear and quadratic relationship between the level of bacterial 6-phytase in the diet and the improvements in calcium digestibility and fecal calcium output in both weanling and growing pigs is in agreement with data from Jendza et al.  and VeumAspergillus oryzae may be used in phosphorus-deficient, corn-soybean meal diets to improve the ATTD of phosphorus and calcium and reduce fecal phosphorus excretion in pigs. Responses of this phytase is similar to or slightly greater than what has been reported for other sources of microbial phytase. The optimum level of inclusion for this phytase is 800 to 1,000 FYT/kg of complete feed to maximize ATTD of phosphorus and calcium in weanling and growing pigs.Results from the present experiments demonstrate that the novel bacterial 6-phytase expressed in AA: Amino acids; ADF: Acid detergent fibre; aP: Available phosphorus; ATTD: Apparent total tract digestibility; BW: Body weight; CP: Crude protein; DM: Dry matter; FYT: Phytase units; ICP: Inductively coupled plasma; NDF: Neutral detergent fibreAuthors have no competing interests.All authors equally contributed to this research. All authors read and approved the final manuscript.


Washington, DC has long been considered a non-healthy place to live according to the American Lung Association due to its poor air quality. This recognition clearly includes the negative PM-related human health effects within the region. Specifically, DC fine particulate matter (PM2.5) [or particulate matter with an aerodynamic diameter less than 2.5 μm] poses notable health risks to subpopulations having an annual mean value of 16.70 μg/m3 during the years 1999–2004, exceeding the EPA National Ambient Air Quality Standard (NAAQS) of 15 μg/m3. Incessant exposure to significant levels of PM has previously been linked to deleterious health effects, such as heart and lung diseases. The environmental quality and public health statistics of Washington, DC indicate the need for higher-resolution measurements of emissions, both spatially and temporally, and increased analysis of PM-related health effects. Our findings show that there are significant risks of ward-specific pediatric asthma emergency room visits (ERV). Results also illustrate lifetime excess lung cancer risks, exceeding the 1×10−6 threshold for the measured levels of particulate matter and heavy metals (chromium and arsenic) on behalf of numerous subpopulations in the DC selected wards.In this research, we investigated the public health risks associated with atmospheric exposure to PM Both are considered safe concentration limits regarding public human health effects. Washington, DC had an annual PM2.5 mean of 16.70 μg/m3 during the years 1999–2004. Although this value only exceeds the NAAQS by 11.3%, the high population density, 9,378 persons per square mile, in the urban DC environment warrants concern for this level of pollutants. Ultimately, this places more individuals at risk for exposure to contaminants in a concentrated area.Air quality and pollution control have been on the forefront of environmental concerns for the last four decades. In 1990, the Environmental Protection Agency (EPA) found it beneficial to implement some revised control strategies on industrial emissions via the Clean Air Act, originally implemented in 1970, and National Ambient Air Quality Standards (NAAQS). At this time, fine particulate matter  . Exposur2.5) to lung cancer (and cardiopulmonary disease). In the study, 500,000 people in 116 metropolitan areas across the United States were linked to air pollution data over a 16-year period. The study found that when there were slight increases in the fine particulate matter level, there was a correlating increase for both lung cancer and cardiopulmonary mortality health risks.There are a series of studies that spotlight asthma and lung cancer independently. The large majority of epidemiological studies of PM have been acute exposure studies that evaluated short-term  variations in health, such as mortality counts, hospitalizations, symptoms, and lung function associated with short-term variations in levels of pollution. There are more than 40 published studies evaluating associations between daily respiratory symptoms and/or lung function and particulate air pollution . Many ofThis study was developed for the purpose of applying risk assessment approach to interpret air pollution exposure measurements in Washington, DC. The focus was placed on the three wards with the highest cancer incidences during 1995–2000 within DC –9. ThoseWashington, DC has an approximate area of 61 square miles and is comprised of eight individual wards see . The 200Ward 1 is home to Howard University and Adams-Morgan. It is mostly residential, with more than 80% of its land devoted to housing units. It has a population of 73,364 with 45.7% Black, 31.7% White, 24.7% Hispanic, and 3.5% Asian. The age distribution is 21% (under 18), 69% (18 to 64), and 10% (65 or older).Ward 4 has 87% of its land devoted to residential use, which is the highest percentage of any ward. It contains a stretch of the city’s longest commercial corridor, Georgia Avenue, which runs through the middle of Ward 4. The total population of 74,092 is 70.7% Black, 17.7% White, 12.5% Hispanic, and 1% Asian. The age population is 19% (under 18), 64% (18 to 64), and 17% (65 or older).Ward 5 is home to two major commuter arteries, New York Avenue and Rhode Island Avenue, which are gateways into the District. The ward has more industrial acreage than any other in the city. The population is 72,527 with 86.7% Black, 9.4% White, 2.6% Hispanic, and 0.8% Asian. The age distribution is 22% (under 18), 62% (18 to 64), and 16% (65 or older).2.5 DC emissions data. The population in Ward 7 is 70,540 with 96.8% Black, 1.4% White, 0.9% Hispanic, and <<1% for all other. The age population is 27% (under 18), 60% (18 to 64), and 13% (65 or older).Ward 7 uses much of its land as parkland and sits on the right bank of the Anacostia River. However, this ward is home to the Pepco-Benning power plant, a primary source of heavy metals contributing approximately 13% of the annual total based on the 1999 EPA PMInvestigating Spatial Distributions of Fine Particulate Matter Exposures in an Urban Area, or the manuscript may be found on the NOAA Centers for Atmospheric Sciences (NCAS) website: http://www.gs.howard.edu/atmosci/research.htm.Considering the demographics of DC and the heterogeneity of individual responses to air pollution, the severity of health effects experienced by a subpopulation may be much greater than that experienced by the population at large . Thus, trd to August 8th of 2003. The fall IOP was performed from October 20th to December 4th of 2003. The plan for each IOP was to complete the daily data collections of PM2.5 and PM10 in all four wards (32 locations) using a mobile platform for a continuous six week period. This demanded sampling between 7 and 9 sites per day . Samples were taken on the weekdays (Monday through Thursday) between the hours of 10AM and 4PM daily, to eliminate the “Sunday effect”, which is characterized by high late-week (such as weekends) pollution as opposed to the early week .Upon further review, it is shown that the individual risk is in fact a very simple calculation that does not need to take into account both the body weight and inhalation rate because they are accounted for in the unit risk factor of inhalation. Therefore, 2.5 exposure and greater than 4% with PM10 exposure. Ward 7 also showed a health concern to its residents with a 4.6% and 3.3% risk for the fine and coarse particulate (PM10) respectively. Ward 1 had a slightly lower risk of 3.8% for PM2.5 and 2.9% for the larger particulate. Ward 5, still significant, only measured a 2.7% increase in risk per unit of fine particulate and less than 2% in the PM10 size.2.5. More interesting, Ward 7 is far less of a concern for pediatric asthma ERV due to risks at only 1.5% and 1.2% for the fine and coarse particulates respectively. Ward 5 exceeds the risks of Ward 1 by 0.9% and 0.6% for the PM2.5 and PM10.Using risk are listed in The results of these calculations for POPpot) for cancer assessment:ic) becomes:Outdoor air, particularly in densely populated urban environments, contains a variety of known human carcinogens . In thisWe have assumed exposure duration (ED) of 91 days/year for a 70 year period, equating 6,370 days for a lifetime  exposure to contaminants. Converting AT into days results in 25,550 days for a lifetime period. The US EPA usually assumes a non-threshold dose-response for carcinogens  .10-fold ADAF▪ For exposures before 2 years of age , there is a 3-fold ADAF▪ For exposures between 2 and 15 years of age (spanning a 14 year period from a child’s second birthday up until their sixteenth birthday), there is a ▪ For exposures between 16 and up, no adjustments are neededCommonly speaking, cancer risks vary by particular stages in life. They are typically higher from early-life exposure than from similar exposure durations later in life . These pI would like to clarify that the time period, two six-week IOPs, of this study is not considered adequate to establish a one-to-one causal relationship between cancer rates and fine PM emissions in DC, as in a cohort or case-control study, but was rather utilized to compare ward-specific PM levels with public health effects and calculate the individual risks for both pediatric asthma emergency room visits and the onset of (lung) cancer.www.epa.gov/iris/). The unit risk for lead (Pb), the Group B2 probable carcinogen, was determined from the Office of Environmental Health Hazard Assessment . The unit risk for PM2.5, which encompasses many more heavy metals, volatile organic carbons (VOCs), and various other constituents not investigated in this research, is according to Pope et al. (2002) [ic for the contaminants . A sample calculation of these values is shown below:The unit risks (UR) for the three known carcinogens  and one probable human carcinogen (Cd) are defined by the US EPA Integrated Risk Information System (IRIS) (. (2002) . All valic via exposure to As is determined as …For residents in Ward 1, the RHowever, this is not the actual lifetime risk. The ADAF values must be applied to properly assess the lifetime risk over numerous stages.ic) is the combination of these lifestage risk values :icR−6 or 2.9 per 1 million2.87 × 10For baby (0 to 2 years) stage,2.5. The data reflects a clear distinction between summer and fall risks with the excess risk for cancer via exposure during the summer months (2.5 in 10) nearly doubling relative to the fall season (1.3 in 10). Particularly, Ward 4 (8.9 in 100) and Ward 1 (7 in 100) surpassed the other two wards for PM-related health effects during the summer IOP. Ward 7 showed a threefold increase to outdoor pollution with 5.5 in 100 (summer) and 1.8 in 100 . However, to gain a more accurate measurement for exposure over a long-term period, such as the time interval for the onset of cancer, it is best to average over the seasonal risks. Therefore, the seasonally-averaged  individual lifetime cancer risk for each ward is as follows: 4.9 in 100 (Ward 1), 6.8 in 100 (Ward 4), 3.9 in 100 (Ward 5), and 3.7 in 100 (Ward 7).Individual lifetime cancer risks (by wards) are displayed in −6  for both As and Cr. The Pb  and Ni were negligible estimates at all points.It should be noted that any cancer risk less than 1×102.5. Ward 4 again exceeds all others in lifetime risk vales, followed by Ward 5, Ward 1, and Ward 7. The lifetime excess risk is now greatest for Cr and followed by As. The largest Cr and As values, nearly equal, are once again evident in Ward 4 at 2.6×10−6 (Cr) and 2.55×10−6 (As). All wards, except Ward 7, exceed the threshold levels for both Cr and As. Ward 7 barely missed the 1 per million threshold with .96×10−6 (As) and .99×10−6 (Cr). Ni and Pb are insignificant contributors in this assessment for (lung) cancer risks, which helps bring the focus to arsenic and chromium for more stringent limitations on the DC area industrial emissions. It also identifies Ward 4 residents at an increased risk within the DC area. Coincidentally, the average cancer deaths from 1995–2002 say the same with the highest average of 245.5 for Ward 4.It was mentioned earlier that the effects of air pollution may vary widely across subpopulations. Both −6 benchmark. Cd presents an individual risk above 1×10−6 for both blacks and females. Overall, As poses a serious health threat to blacks with a 7.2 in a million individual risk for cancer development. Cr closely aligns this with 6.7×10−6. The Hispanic and elderly populations appear to be least likely at risk for lifetime lung cancer development. Moreover, the white population, although it bears risk values pass the threshold mark for both Cr and As, is of no comparison to the black population risk with greater than a 4-fold difference. These findings are also consistent with actual statistics in which blacks in DC exceed the national average for lung cancer rates at 69.8 per 100,000 persons, whereas whites have a rate of 39.3 per 100,000 (www.cdc.gov/cancer/CancerBurden/dc.htm). Although the risks for youth and elderly do not appear as threatening individually, when combined with other subgroups, they too are at risk over a lifetime exposure. For instance, arsenic poses a risk of 8.31×10−6 for the black youth and 7.23×10−6 for the black elderly versus a risk of 2.81×10−6 for the white youth and 1.73×10−6 for the white elderly population. It is apparent that the elderly do not appear to have a significant at risk value due to their exposure length. It is factored into the risk equation that the elderly population has only a 6-year exposure interval (65–70 years). Additionally, the elderly population only account for 14.1% of the total ward population.−6 for blacks exposed to Cr. The Hispanic and youth populations have once more fallen behind the one in a million thresholds. Once again, combining subgroups yield much higher individual risks for the development of lung cancer over a lifetime. Exposure to chromium has established risks of 6.2×10−6 for the black youth and 5.38×10−6 for the black elderly, whereas these risks are far less for the white youth (1.9×10−6) and white elderly (1.22×10−6) populations.Like the pediatric asthma ERV excess cases that are displayed in 2.5 respectively. The lifetime excess lung cancer risks have revealed that Ward 4 has the greatest increased risk for a unit increase in arsenic and chromium exposures, likely contributors to the cancer mortality rate in the DC area. It can also be concluded that the black, female, and adult populations have the highest lifetime risks for development of new lung cancer cases with 3.5 (blacks), 1.8 , and 1.2 (adults) during the summer IOP and 2.7 (blacks), 1.4 , and .92 (adults) during the fall IOP. Moreover, combining these subgroups exposes even higher risks for surplus lung cancer incidences over a lifetime (i.e. black adults or white youth). This study has also provided evidence that spatially and temporally resolved datasets can lead to additional insights into health disparities and may suggest that more rigorous strategies for controlling emissions are needed. This may be applicable to other urban areas across the nation.Risk assessments can provide a great deal of information to an epidemiological investigation and especially in understanding PM-related health effects. They often are difficult if one considers controlling factors. We have employed a risk assessment approach in order to establish boundary conditions for individual risks on a general urban population. This study has shown increased risks for pediatric asthma ERV during both the summer and fall IOP with an average of 4.3% and 2.1% for PM


CAV1) and CAV2 among patients and controls from Saudi Arabia.To determine the role of the recently discovered primary open angle glaucoma (POAG) single nucleotide polymorphism (SNP) rs4236601 near the caveolin-1 (CAV1 and CAV2 using a standard polymerase chain reaction (PCR) and sequencing method.A cohort of 220 POAG patients and 405 control subjects from Saudi Arabia were genotyped for a SNP  in the chromosome 7q31 locus near The minor allele frequency (MAF) of rs4236601 was 0.3 in controls and 0.31 in POAG patients. We detected no statistical difference when we compared the allele frequencies between POAG patients and control subjects (p=0.699). Similarly, we detected no statistical difference in the frequency of the three possible rs4236601 genotypes between patients and controls. The p-values were 0.928 and 0.683 for heterozygous genotype (G/A) and homozygous mutant genotype (A/A), respectively. We found no statistically significant difference among patients with any of the three possible genotypes and various clinical indices important for glaucoma. Among patients with homozygous (A/A), the mean IOP was higher (21.4) compared to patients with G/G wildtype (20.4) and to patients with G/A genotype (18.5). However, this apparent difference did not reach the statistical significance threshold (p=0.062).We were unable to detect this association in our POAG-patients from Saudi Arabia, suggesting that this risk factor may not have a strong effect in all populations. A founder effect may play a role in certain populations where the link was established. Glaucomatous optic neuropathy is a chronic degenerative disease characterized by loss of retinal ganglion cells and their axons leading to progressive loss of vision ,2. With HUGO) genome nomenclature committee has designated 15 as GLC1A  to GLC1O and mutations in only four genes, which have been identified thus far. These include myocilin , optineurin , WD repeat domain 36 , and neurotrophin-4  ). Comparison of means was done using one way ANOVA (ANOVA) test in case of continuous variables, Kruskal–Wallis H test was used instead of ANOVA when indicated, while χThe total recruited sample size is 625 (mean (SD) age; 56.6 (12.5), range [11–93], male; 323 (51.7%), female; 302 (48.3%). Out of these 625 subjects, 220 subjects were recruited as cases (with confirmed diagnosis of primary open angle glaucoma) and the remaining 405 subjects served as controls. The case to control ratio was 1:1.84.The mean (SD) age of cases was 61.4 (12.5), range [27–91] with males; 127 (57.7%) slightly exceeding females; 93 (42.3%). Among controls, the mean (SD) age was 54 (11.7), range [11–93], where females; 209 (51.6%) were slightly more than males; 196 (48.4%).Among cases, the majority of subjects were of wildtype genotype (G/G); 110 (50%), followed by heterozygous (G/A); 83 (37.7%) and then homozygous mutant genotype (A/A); 27 (12.3%). Among controls, the majority of subjects were also of wildtype genotype (G/G); 207 (51.1%), followed by heterozygous (G/A) 153 (37.8%) and (A/A); 45 (11.1%).On comparing genotypes between cases and controls, there were no statistically significant difference either for the heterozygous genotype (G/A);  or the homozygous mutant genotype (A/A); . Additionally, there was no statistically significant association between having POAG and the type of allele  .Looking specifically at the group of cases, 208 (94.5%) out of the 220 were able to be linked with the clinical data at our clinical registry database, while 12 (5.5%) were either unable to link or having some missing data. After excluding those 12 cases, we conducted further analysis focusing on this group. Out of these 208 cases, 16 (7.7%) had a family history of glaucoma, 5 (2.4%) had consanguine parents, 99 (47.6%) had diabetes mellitus, 2 (1%) were smokers, 91 (43.8%) had hypertension, 1 (0.5%) had cardiac disease, and 3 (1.4%) had hypercholesterolemia. Other systemic diseases were also recognized among the cases group. We compared the three genotype groups in terms of different demographic and clinical characteristics at presentation, findings from these comparison are presented in details in On the other hand, when comparing the different demographic and health status indicators of glaucoma across the three genotype groups, having a family history of glaucoma was the only significant variable (p=0.001). The overall prevalence of cases with family history was 7.7% of all cases; meanwhile, the G/G group had the highest prevalence of this characteristic 9.3% than the other two groups . According to genotypes, the G/G group showed an awareness prevalence of 35.6%, G/A that of 36% and A/A group of 30.8%. However, the difference was statistically insignificant (p=0.883). Similarly, the G/A group showed the best prevalence of controlled IOP (78.7%), which has much exceeded both G/G (69.2%) and A/A (61.5%) groups .CAV1 and CAV2 . In this study, association between SNP rs4236601 and POAG was found among populations from Iceland, Australia, Hong Kong Chinese, and Shantou Chinese. In the same study, this association could not be established among Swedish and UK populations [rs4236601. This study was unable to find a link between this SNP and POAG and suggested that this risk factor may not have a strong effect in all populations [rs4236601 with POAG and more so, the effect was significant in women but not in men. To the best of our knowledge, no other study has investigated this association thus far.In 2010, a genome-wide association study of subjects from Iceland mapped the first common genetic risk factor for POAG to a small region of the genome on chromosome 7q31 that contains the caveolin genes ulations . The secrs4236601 as a risk factor for POAG among the Saudi Arabian population. Our results indicated that there was no difference in allele association (p=0.699) or genotype frequencies  between cases and controls.We set out to determine the role of SNP rs4236601 varies significantly between populations, association based on this SNP will be particularly sensitive to ethnic variability. The minor allele “A” frequency is 0.209 in the current default global population 1000 Genome phase 1 genotype data from 1094 worldwide individuals, released in the May, 2011 data set. Additionally, the HapMap database shows a great variability in MAF of SNP rs4236601 between populations. HapMap data shows that Asians have low minor allele frequencies (0–0.04), while Africans have high MAF (0.3–0.43). As for Hispanic and non-Hispanic Caucasians and an intermediate MAF rate was observed (0.22–0.29). In our Saudi cohort the MAF was 0.3 among controls group and this was slightly higher than the rate observed in US cohorts (0.27–0.28), Iceland (0.22), Sweden (0.27), UK (0.26), and Australia (0.26). Our MAF rate of 0.3 was much higher than the rates observed among Asians from Hong Kong (0.004) and Shantou Chinese (0.003) populations reported thus far in the two studies investigating the role of this SNP in POAG [rs4236601 is important to POAG in some populations than others due to a founder effect.Since minor allele frequency (MAF) of SNP  in POAG . This inrs4236601 with various clinical indices important for glaucoma. We found no statistically significant difference among patients with various genotypes and this may be because of the relatively small sample size (n=208). We then compared different demographic and health status indicators of glaucoma across the three genotype groups, having a family history of glaucoma was the only significant variable (p=0.001).Then we proceeded with trying to link the genotyping data with various clinical indices. This is the first attempt in the literature trying to link the genotypes of SNP CAV1/CAV2 genes, Wiggs et al. [CAV1/CAV2 and identified 14 additional SNPs and 2 haplotypes (of which rs4236601 was not a part of) with modest effects on POAG. Having said that, no glaucoma-causing mutations have been identified either in CAV1 or CAV2 to date. Failing to find a strong link between the recently discovered SNP rs4236601 by others and us [Caveolin 1 and caveolin 2 are expressed in non-muscle cells while caveloin 3 is present in skeletal and a few muscle cells . Immunohs et al.  had exams and us  raises dMYOC, OPTN, and WDR36 [To conclude, it is fair to say that in our attempt to link this SNP with POAG among the Saudi population our study failed to establish a link. This leaves the true genetic cause of POAG among the Saudi population open for further investigation. Previously, we showed that the Saudi POAG patients lack mutation(s) in nd WDR36 . Thus, a