The early and intermediate outcome of patients requiring intraaortic balloon pump (IABP) was studied in a cohort of 2697 adult cardiac surgical patients.136 patients requiring IABP (5.04%) support analysed over a 4 year period. Prospective data collection, obtained.The overall operative mortality was 35.3%. The "operation specific" mortality was higher on the Valve population.The mortality (%) as per time of balloon insertion was: Preoperative 18.2, Intraopeartive 33.3, postoperative 58.3 (p < 0.05).The incremental risk factors for death were: Female gender (Odds Ratio (OR) = 3.87 with Confidence Intervals (CI) = 1.3-11.6), Smoking , Preoperative Creatinine>120 , Cross Clamp time>80 min  and IABP insertion postoperatively .The incremental risk factors for the development of complications were: Poor EF , Euroscore >7 , history of PVD .The 5 years survival was 79.2% for the CABG population and 71.5% for the valve group. .IABP represents a safe option of supporting the failing heart. The need for IABP especially in a high risk Valve population is associated with early unfavourable outcome, however the positive mid term results further justify its use. Intra-aortic balloon pump (IABP) is the most usable tool of temporary mechanical circulatory support for cardiac surgical patients suffered from low cardiac output in the early postoperative phase. Only in United States, more than 70.000 patients are supported annually by IABP ,2. Its bThe main indication of IABP use in cardiac surgical patients is peri-operatively in the treatment of a low cardiac output state refractory to the usual inotropic support. Furthermore, it has been used prior to surgery in patients having sustained mechanical complications following myocardial infarction, as well as in patients with refractory angina -7.The hospital and also the 30-day mortality for the patients necessitating IABP is high because of the cardiac problems that led to the need for this pump, ranged from 26% to 50% .Aim of this study was to analyse our clinical experience with IABP in a high risk cohort of operated patients. It includes a risk analysis by means of looking into variables predicting mortality and early adverse outcome. In addition, the 5-year survival was reported.Within a 4 year period between January 2000 and December 2004, 2697 consecutive adult patients underwent cardiac surgery; 136 patients (5.04%) required support with IABP. The mean age was 66.3 +/- 9.9 years (range from 39 to 82 years).There were 99 (72.8%) males and 37 (27.2%) female patients. First operation was carried out in 119 patients (87.5%) and re-operations in 17 patients (12.5%). Brake down of the referrals showed elective 24.3%, urgent 50.7%, emergency 19.9% and salvaged operations in 5.1% of the cases. 16.9% of the patients were diabetics.Data pertaining to the patients past medical history were studied and also variables (see Table The indications for initiating treatment with IABP in this cohort of patients was the following: a) IABP support for persistent preoperative ischemia despite maximum medical treatment b) patients not able to be discontinued from CPB although forced inotropic support, c) patients in low-cardiac output status just after a "difficult" discontinuation of CPB, supported by high-doses of inotropes, d) patients with "difficult" discontinuation from CPB and spontaneous appearance of arrhythmia (premature ventricular beats or VT) not amenable in anti-arrhythmic continuous infusion and e) post cardiotomy low cardiac output syndrome. Prophylactic initiation of IABP treatment was not advocated in any of the cases. A Datascope system  was utilised. The IABP was introduced percutaneously through the common femoral artery in 131 patients and through an open access of the femoral artery in the remaining 5 patients.nd generation in combination with vancomycin, through out the IABP support, was maintained.Correct placement of the device was routinely confirmed with Chest X Ray in ICU. Once mediastinal drainage was minimum (< 50 ml/h), patients were anticoagulated with Heparin infusion, keeping the ACT >180-200 sec. Routine administration of a Cefalosporin 2Collection of the data is served using the Patients Analysis and Tracking System (PATS) software. Eighty variables were prospectively collected and carefully validated before being analysed.Categorical variables were tested using a qui square test or Fisher exact test (two-tailed), and continuous variables were tested using Students t test (two-tailed). A p Value of less than 0.05 was regarded as statistical significant. All calculations were made using SPSS 11 edition. Operative mortality is reported as 30 day mortality. Long term survival data were obtained by sending questionnaires to the medical practitioners (98.5% response). The median period of follow up was 64 ± 11 months. Survival analysis was performed according to Kaplan-Meier method using life tables. Survival rates were given as cumulative survival +/- standard error.The CABG, Valve and CABG and Valve population requiring IABP consist off 58.8%, 10.3% and 16.2% of the total number of patients treated with an IABP.The mean Euroscore of the patients requiring IABP was 8.43 ± 4.5 (range 4 to 16).Twenty two patients underwent IABP support preoperatively (16.2%). There was one elective case due to intractable angina (4.5%) and 8(36.3%) urgent cases  due to angina refractory to medical treatment. Eleven cases (50%) were treated as an emergency and underwent an operation within 24 hours from the cardiology referral and 2 cases (9.2%) were in severe cardiogenic shock and were deemed salvaged.Four patients died  two from the emergency group & also the two patients operated on under salvaging conditions.Intra-operatively, ninety patients (66.2%) needed intraaortic balloon inserted following failure to be weaned off cardiopulmonary bypass. The overall mortality for this subgroup was 33.33% (30 patients).Post operatively, twenty-four patients (17.6%) needed intraaortic balloon inserted due to low Cardiac output syndrome. The mortality of this subgroup was high, 58.33% (14 patients).The incidence of patients needed IABP support per year was between 4.2 and 5% with a mean incidence of 4.3 ± 0.6.Out of 1919 CABG patients operated on (mean Euroscore 3.71 ± 1.25) over the same period  eighty patients required IABP (4.17%).Out of the entire subgroup requiring IABP, 3 patients underwent off pump CABG and 77 patients on pump. The mean CPB time was 102.1 ± 34.72 minutes.The overall mortality of the subgroup requiring IABP was 16 patients (21.2%). There were 63 males (78.8%) and 17 females (21.2%). The mortality for the males was 14.28% and for the females 41.17% (p < 0.05). Nine patients requiring IABP support underwent a redo-CABG (11.25%) with a mortality of 11.1%.Out of 211 CABG & Valve patients operated on over the same period, twenty two patients (10.42%) required support with IABP. 152 patients underwent CABG and AVR out of which 9 patients (5.92%) required IABP.There were 53 GABG and MVR patients out of which 13 patients (24.5%) required IABP.This subgroup consists of 13 males (59.1%) and 9 females (40.9%). The mean CPB time was 161.5 ± 38.2 min.The overall mortality was 11 patients (50%). The mortality for the males was 53.84% and for the females 44. 44%.This group of patients consists of a high risk population of eleven patients. Six out of them underwent CABG & Ischemic Ventricular Septal Defect (VSD) repair with mortality of 50%.Out of the total population of 281 AVR valves operated on during the study period, 7 patients (2.5%) required IABP. Out of the total population of 85 MVR valves, 4 patients (4.7%) required IABP. Out of the total population of 25 Double valves 3 patients (12%) required IABP. The overall mortality of the group was 9 patients . Nine patients have had redo CABG, three had AVR/MVR and CABG, one had CABG and Aortic root replacement, one had CABG and aneurysm on a previous saphenous vein, and two patients underwent second time MVR operations. The overall mortality for the group was 27.1%.From all 11 patients with post infarction VSDs over the 4 year period, 6 patients died . In all these patients a preoperative IABP support had been applied.Eight patients underwent pericardiectomy (without CPB) and 2 of them developed early postoperatively low cardiac output syndrome; they were supported with an IABP and died .The overall 30 day mortality was 35.3%. The mortality was mainly due to a severe low cardiac output in 17 patients (12.5%), intractable sepsis 13 patients (9.6%), cardiac arrest 13 patients (9.6%), stroke 2 patients(1.5%), Ischeamic bowel 1(0.7%), Pancreatitis 1(0.7%), GI bleed 1 (0.7%).A regression analysis Table  taking iThe incremental risk factors for development of complications were: Poor EF , Euroscore >7 , PVD .The subgroup of patients required IABP support compare to the rest of the cardiac surgical population had a higher incidence of reoperation for bleeding (11.8% Vs 4.5%), prolong ventilation (42.6% Vs 7%), re-intubation rate (18.4% Vs 4.9%), tracheostomy rate (9.6% Vs 1.2%) and new dialysis required (23.5% Vs 4.9%).Actuarial survival curve for the entire group is presented in Figure The need for increased use of IABP during cardiac surgery in the recent years has been reported by many groups ,9. This In our series IABP used in 5% of the cases, however its use was increased to 24.5% in patients requiring MVR and CABG procedure. This probably reflects the severity of LV dysfunction and the high incidence of low cardiac output syndrome in this group of patients.As per other groups  the majoThe CPB time was prolonged (205 ± 38 min) for the complex cases. That was most probably due to: bleeding, a prolong "resting on CPB" after aortic cross-clamp removal because of difficulties in weaning from CPB and also a rather high threshold for intraoperative IABP insertion.Ninety patients had intraaortic balloon inserted intraoperatively with a mortality of 33.3%. We attempt to split the intraoperative IABP insertion patient group into subgroups depending on time of IABP insertion and compare the outcome; however it became apparent that this was not feasible because the number of patients in those subgroups were too small to demonstrate any differences.Through out the literature the mortality rates range widely from 7% to 86% ,15. ThisTiming of insertion and operative mortality has been reported by few groups ,16 with Incremental risk factors for perioperative death have been reported by various investigators ,17,18. ISurprisingly the overall mortality for redo CABG patients requiring IABP treatment was at around 11%. This is probably due to the fact that in the majority of those cases the EF was only moderate impaired and the IABP was inserted prophylactically preoperatively under stable circumstances.The complication rates are higher in older studies ,10,19,20In our report, cold pulse-less leg was detected in 1/4 of the cases. In 18 patients the ischemia resolved when the IABP was removed and in 8 patients following thrombectomy. Similar to other reports ,24, poorFinally the cumulative survival of 85,2% in 4 years is rather higher compare with other groups,25. MoreThis is a report of ongoing clinical practice. The subgroups  of the patients supported with IABP are small; therefore the derived results should be taken with skepticism. The weaknesses of the study are due to its observational character; furthermore there may also be a selection bias for patients supported (ie.pre/postoperatively) with an IABP, due to individual clinical practices patterns. Lastly, variables that were not collected from the database (PATS) were obviously missed out from the multiple logistic regression analysis model.In summary the peri-operative mortality of patients needed IABP support remains high. The mortality is increased exponentially when low cardiac output occurs in ischemic female population who also required concomitant valve surgery.Nevertheless the use of IABP is justifiable. With respect to timing of IABP insertion, the literature is lacking on well defined guidelines. There is a trend to suggest that earlier use of the device is associated with better outcome possibly due to a better myocardial protection, but this remains to be tested with appropriate trials.The authors declare that they have no competing interests.Haralabos Parissis conceived of the study, gathered the data and wrote the manuscript, Michael Leotsinidis participated in the design of the study and performed the statistical analysis, Mohammad Tauqeer Akbar participated in the sequence alignment, Efstratios Apostolakis participated in the design and coordination Dimitrios Dougenis overlooked the progress of the manuscript and advised on valuable amendments. All authors read and approved the final manuscript.


BBS1 and BBS10 are the two major genes accounting for greater than 50% of the BBS patients [BBS5 is a minor contributor to BBS as only 2% of families from various ethnic backgrounds harbor BBS5 mutations [Bardet–Biedl syndrome (BBS) is a rare genetically heterogeneous disorder presenting with retinal dystrophy, postaxial polydactyly, obesity, renal malformations, learning disabilities, and male hypogenitalism . To datepatients . Mutatiopatients . BBS5 isutations .We studied five BBS patients from two nonconsanguineous families residing in Denmark: A Somali family (Family 1) with five siblings of whom four were affected, and an affected boy from Sri Lanka (Family 2). The Sri Lankan patient was a single adopted child and no further information of his biological parents was available. The patients were identified from the files of the Retinitis Pigmentosa Registry at the National Eye Clinic, Hellerup, Denmark . DiagnosBBS1, BBS2, BBS4, MKKS, and BBS10 was done by denaturing high performance liquid chromatography  followed by DNA sequencing of aberrant products on an ABI3100 automated capillary sequencer using Big Dye Terminator v.3.1 . BBS5 mutational analysis was likewise performed by DHPLC. Primer sequences and PCR protocols for BBS5 are available upon request.As part of a larger study screening of Genotyping of the two families was done separately. For Family 1 we used the Affymetrix GeneChip Mapping 10K 2.0 Array to search for regions of shared genotypes among the affected siblings. Sample processing for this part of the study was carried out at the Microarray Facility in Tübingen, Germany. For Family 2, SNP genotyping was performed on Affymetrix GeneChip Human Mapping 50K Hind 240 SNP microarrays . We allowed SNPs that could not be scored to be included in the regions of interest. An average call rate >95% was obtained.BBS1, BBS2, BBS4, MKKS, and BBS10 by DHPLC did not reveal causative mutations in the five patients. We therefore performed SNP genotyping in order to identify other BBS loci. Since we had no information of consanguinity in Family 1, we searched for regions of shared genotypes covering more than 5 Mb among the four affected sibs and different from the unaffected sib. We identified three major regions: Two regions at 6q15 (23 Mb) and 12q32 (34 Mb) did not contain any known BBS gene while a region spanning 11 Mb at 2q31 contained the BBS5 locus (see the online Table I at http://www.interscience.wiley.com/jpages/1552-4825/suppmat/index.html). Mutational analysis of BBS5 revealed a homozygous nucleotide change, c.214G>A (p.Gly72Ser) in exon 4, identified in all four affected siblings in Family 1 but not in the unaffected sib. Both parents were carriers. The mutation was absent in 202 ethnically matched control chromosomes. Sequence alignment showed the change to be localized within a conserved region  while the other locus spanning 16.6 Mb at 2p31 contained BBS5 (see the online Table I at http://www.interscience.wiley.com/jpages/1552-4825/suppmat/index.html). Sequence analysis of TRIM32 did not reveal any causative nucleotide changes in the patient. However, direct screening of the entire BBS5 gene identified a novel single base pair change, c.547A>G, in exon 7 in the homozygous state predicted to result in a non-conserved amino acid change, p.Thr183Ala —GenBank RefSeq cDNA accession number: NM_152384.2.


The aim of this analysis was to assess the efficacy and safety of intensifying insulin therapy from a basal-only regimen to biphasic insulin aspart 30 (BIAsp 30) in patients with type 2 diabetes previously failing to reach glycaemic targets.n = 348), or human basal insulin (long and intermediate acting) , who were transferred to BIAsp 30. Efficacy end-points included change in glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and postprandial plasma glucose (PPG), from baseline to the end of the study. Episodes of hypoglycaemia, adverse events, and physician and patient satisfaction were also recorded. End-points were considered separately by previous basal regimen (AB or HB).The analysis is based on data from a subpopulation of the Physicians’ Routine Evaluation of Safety and Efficacy of NovoMix® 30 Therapy (PRESENT) study, which was a 6-month observational study in 15 countries. This subanalysis included patients previously receiving long-acting analogue insulin . Reductions in FPG and PPG were also statistically significant in both groups. The rate (events/patient/year) of overall hypoglycaemia remained relatively constant in patients switching from AB, but it was statistically lower in patients switching from HB .After 6 months' treatment with BIAsp 30, HbAIn routine clinical practice, patients with type 2 diabetes who are failing to reach glycaemic targets on basal insulin can achieve better glycaemic control without an increase in overall hypoglycaemia by intensifying with BIAsp 30.Disclosure Hak Chul Jang, Serdar Guler and Marina Shestakova have no conflicts of interest.Basal insulin is a commonly used insulin initiation regimen in patients with type 2 diabetes who fail to achieve optimal glycaemic control on oral anti-diabetic drugs.As type 2 diabetes takes its natural course of progression, treatment regimens need to be monitored and, when necessary, intensified to maintain acceptable glycaemic control.To date, there are little data that demonstrate how effective modern premixes can be in type 2 patients who are failing to achieve glycaemic targets with basal insulin.The PRESENT study is a 6-month, prospective, uncontrolled, clinical experience evaluation study using biphasic insulin aspart 30 (BIAsp 30) for type 2 diabetes patients in daily clinical practice in several countries.1c) on basal insulin were able to significantly improve their glycaemic control by simply intensifying with the modern premix insulin, BIAsp 30.In this subanalysis, we show that patients failing to achieve good control (as defined by HbA It is well established that achieving and maintaining good glycaemic control is essential for reducing the risk of incidence and progression of diabetes-related complications in type 2 diabetes . The pro1c) – by up to 1.5% per drug (1c (by around 1.6%) with better tolerability compared with traditional basal insulins  levels above the study target of 140 mg/dl (7.8 mmol/l). Furthermore, around one-quarter of patients needed to supplement their diminishing endogenous prandial insulin response by administering additional short-acting insulin to limit mealtime glucose excursions.Initiating insulin is not the end of the story. Long-term data from the UKPDS  show tha1c < 6.5%  study is an observational study that has collected data on the use of biphasic insulin aspart 30  in over 33,000 patients with type 2 diabetes from 15 countries. The large quantity of data collected from such large observational studies offers the opportunity to investigate treatment efficacy in specific patient groups.The aim of this subanalysis, therefore, was to investigate the safety and efficacy of BIAsp 30 in patients who had previously been treated with basal insulin ± OADs: a previously un-reported patient cohort.Full details of the study's design and treatment have been reported by Khutsoane et al. . In summ1c < 7.0%, although they may have been considered by their physicians to have poor glycaemic control based on other factors such as hypoglycaemia or poor postprandial plasma glucose (PPG) control.Similarly, no inclusion and exclusion criteria were defined although patients who were inadequately controlled on their current therapy were eligible for inclusion. A low percentage of patients enrolled in the study had a baseline HbAIn this subanalysis, data were analysed from patients who, at baseline, were recorded as receiving the following treatments, with or without OADs:n = 348);analogue basal insulin .human basal insulin  HbA1c target < 6.5% were also reported. FPG and PPG, taken between 90 and 120 min after breakfast, was also recorded at each visit.Baseline, 3-month, and 6-month data were recorded. Efficacy end-points included change in HbABody weight, hypoglycaemia and adverse drug reactions (ADRs) were recorded at baseline , and from the last visit for the 3- and 6-month data collection points. Nocturnal hypoglycaemia was defined as episodes occurring between 00:00 and 06:00 hours. Hypoglycaemia was based on patient-reported symptoms only. Major hypoglycaemia was defined as an episode of hypoglycaemia where the patient was unable to treat him/herself, whereas episodes where the patient was able to self-treat were classified as minor.A treatment satisfaction questionnaire was answered by physicians at 6 months to obtain opinions about patient satisfaction, physician satisfaction and expectations about BIAsp 30.1c, FPG, PPG and body weight were tested using the paired t-test. Changes from baseline in the proportion of patients achieving HbA1c < 6.5% . A total of 16.5% and 2.6% of patients previously receiving AB used BIAsp 30 qd, and three times daily (tid) respectively. For HB, the numbers were 23.7% and 3% for qd and tid respectively. The total daily BIAsp 30 dose at baseline was 0.45 ± 0.20 U/kg for patients previously treated with AB, and 0.50 ± 0.21 U/kg if coming from HB. By the end of the study, very small increases in total daily insulin dose were seen: 0.48 ± 0.22 and 0.56 ± 0.22 U/kg for AB and HB groups respectively.1c were 1.60% and 1.42%, and end of study mean HbA1c values were 7.8 ± 1.3% and 7.9 ± 1.4% in patients previously treated with AB and HB respectively. After 6 months, the proportions of patients achieving the IDF recommended HbA1c target of < 6.5% were 10% and 14% for AB and HB. In both of the pretreatment subgroups 24% of patients achieved the less stringent American Diabetes Association HbA1c target of < 7%.Irrespective of previous basal insulin treatment, intensification with BIAsp 30 significantly improved all glycaemic end-points measured after 3 and 6 months . After 6Fasting plasma glucose and PPG concentrations were also significantly reduced after 3 and 6 months’ treatment with BIAsp 30, again, irrespective of type of previous basal insulin treatment . FPG valCorresponding values for PPG were:AB: 191 ± 49 mg/dl (10.6 ± 2.7 mmol/l);HB: 198 ± 61 mg/dl (11.0 ± 3.4 mmol/l).At baseline, the rate (events/patient/year) of overall hypoglycaemia (both major and minor) was lower in patients receiving AB (4.0) compared with those receiving HB (5.9). At the end of the study, the rate of overall hypoglycaemia was very similar between these two groups: AB 2.2 and HB 2.1.In the AB group, there was no statistically significant change in the rate of overall hypoglycaemia from baseline compared with the end of study . When looking specifically at major hypoglycaemia, the rate at the end of study was significantly lower . Rates of minor hypoglycaemia did not significantly change .In the HB group, rates of overall hypoglycaemia significantly reduced by the end of the trial to 2.1 . The rate of major hypoglycaemia was also significantly lower at the end of study compared with baseline: 0.39–0.10 (p < 0.001). In addition, the minor hypoglycaemia rate was also lowered .There was no change in the rate of daytime or nocturnal hypoglycaemia in the AB group, but significant reductions in both daytime and nocturnal hypoglycaemia in the HB group .There was no change in weight from baseline to end of study in the two groups. Mean weight after 6 months’ treatment with BIAsp 30 was 74.6 ± 15.9 and 70.5 ± 14.3 kg in the AB and HB groups respectively.During the 6-month study, two and 77 ADRs were reported in the AB and HB groups, respectively. The majority (57 events) were reported during the first 3 months of the study. Event rates (event/patient/year) were low in both groups (0.014 and 0.049). There were three serious events in three patients that were classed as a symptom of generalised hypersensitivity, lipodystrophy and other; all other events were classed as non-serious. The most commonly reported ADRs were: symptoms of local hypersensitivity (22 events); refraction disorders (19 events); and acute painful neuropathy (13 events).After 6 months' treatment with BIAsp 30, 95.6% of doctors perceived their patients as being either satisfied or very satisfied with BIAsp 30 compared with their previous treatment with AB. Furthermore, 89.6% of doctors were either satisfied or very satisfied with BIAsp 30 compared with their patients’ previous treatment of AB. Corresponding values for the HB group were 91.9% for perceived patient satisfaction, and 92.0% for physician satisfaction.Intensifying existing insulin treatment regimens in type 2 diabetes is essential if optimal glycaemic control is to be maintained because of the progressive nature of the disease. While basal insulin remains a popular initiation insulin regimen, its ability to maintain glycaemia is not indefinite because of the continuing decline of beta-cell function .Until now, there have been few data to provide guidance for physicians as to what the next step should be once basal insulin is no longer effective in terms of glycaemic control. The results from this subanalysis of the PRESENT study provide data showing that, by intensifying existing basal insulin by using the modern premixed insulin BIAsp 30, significant improvements in glycaemic control can be achieved but without incurring the penalty of increased hypoglycaemia or weight gain.1c reductions of between 1.42% and 1.60% were achieved after 6 months. This is in line with previous reports of the use of BIAsp 30 in non-treat-to-target clinical trials, albeit in patients who were mainly insulin-naïve. In the EuroMix trial, where BIAsp 30 was used in combination with metformin for 26 weeks as an initiation regimen, a reduction in HbA1c of 1.6% was reported  as well as the way the various efficacy parameters are reported, both the FPG and PPG results achieved in our current study compare well with those reported in both the EuroMix and 1-2-3 studies. For example, the EuroMix study reported a reduction in FPG of 47 mg/dl (2.6 mmol/l); in the PRESENT study, the two groups saw reductions of between 51 and 67 mg/dl (2.83 and 3.73 mmol/l), indicating that the prandial component administered at the evening meal leads to an improved glucose level at the beginning of the night, which in turn reduces nocturnal and early morning glucose levels. This is important to note as the basal component of the premixed insulin is similar to that in the previously given insulin preparations. In the 1-2-3 study, the use of BIAsp 30 in a bid regimen achieved a reduction, from baseline, of the postbreakfast blood glucose value of 97 mg/dl (5.4 mmol/l). In this subanalysis of PRESENT data, PPG reductions  of 91 and 105 mg/dl (5.09 and 5.86 mmol/l) were seen.1c target. Although the reduction in HbA1c was similar to those previously reported, the baseline HbA1c values were much higher in our study (between 9.32% and 9.38%) than seen in the 1-2-3 study (8.6%), where 77% of patients reaching the HbA1c target of 7% using qd, bid or tid BIAsp 30. Thus it was more difficult to reach these targets without forced dose titration. Furthermore, many patients in the 1-2-3 study were insulin-naïve and thus their initial response to insulin was greater than in patients already treated with insulin.One glycaemic parameter in our study that did not match these previously reported trials was the proportion of patients reaching HbA1c of 2.8% was seen  study, where a reduction in HbAwas seen . The INI1c are often compromised by increases in hypoglycaemia , they do provide supporting evidence for the more rigorous clinical trials . Indeed,For the PRESENT study, data collected for hypoglycaemia and ADRs was by patient recollection, which may be imprecise and under-reported. While the results from the study should be treated with caution, the relatively high patient numbers reported in this subanalysis  cannot be dismissed.In patients with type 2 diabetes who are poorly controlled with basal insulin (with or without OADs), simple intensification with BIAsp 30 over a 6-month period can significantly improve glycaemia without incurring hypoglycaemia or weight gain.


During 1995 to 1999, we collected 1,210 Salmonella isolates; 629 were from Finnish travelers returning from abroad. These isolates were tested for susceptibility by determining MICs to ciprofloxacin, nalidixic acid, and seven additional antimicrobial agents. From 1995 to 1999, the annual proportion of reduced ciprofloxacin susceptibility (MIC > 0.125 microg/mL) among all travelers' isolates increased from 3.9% to 23.5% (p<0.001). The increasing trend was outstanding among the isolates from Southeast Asia; isolates from Thailand alone increased from 5.6% to 50.0% (p<0.001). The reduced fluoroquinolone susceptibility was nonclonal in character and significantly associated with multidrug resistance. A point mutation in the quinolone resistance-determining region of gyrA was present in all isolates with reduced susceptibility. These data provide further evidence for the rapid spread of multidrug-resistant pathogens from one continent to another.


Patients were only permitted one prior regimen. 35 patients were enrolled and evaluable for response. 3 patients (8.6%) had a partial response to treatment  with a median time to response of 8.1 weeks and a median duration of response of 17.6 weeks. Response was also evaluated by CA125 and was also found to be 8%. For all 35 patients, median time to progression was 16.1 weeks and median survival was 43.6 weeks. The principal toxicity was myelosuppression although grade 4 neutropenia occurred in only 8.8% of patients (2.1% of courses) and infectious complications were relatively infrequent. Non-haematological toxicity was generally mild and mainly consisted of gastrointestinal events, alopecia and fatigue. A prolonged infusion of topotecan was well tolerated with a low incidence of severe neutropenia. Responses were seen in both North American and European patients. Response rates varied between the 2 studies possibly due to differences in patient demographics. © 2001 Cancer Research Campaign http://www.bjcancer.comA phase II programme was carried out in both Europe and North America to evaluate the activity of topotecan administered as a 21-day continuous intravenous infusion to patients with recurrent ovarian cancer. The European results are reported here. Patients who had failed first line therapy with a platinum-based regimen received topotecan 0.4 mg/m


To the Editor: In industrialized countries, blood culture is negative for 2.5%–31% of infectious endocarditis cases  of the 111 patients. Serum from 63 patients was available for serologic testing. Of these patients, 30 were male and 33 were female; age range was 5–65 years and mean age was 25.5 years. Endocarditis involved the native valve for 60 (95.23%) and a prosthetic valve for 3 (4.76%). The most frequent predisposing factor was rheumatic heart disease, found in 38 (60.31%). Of the 60 with native valve endocarditis, the involved valve was mitral for most , followed by aortic , tricuspid , and pulmonary ; 8 (13.33%) had both valvular and nonvalvular endocarditis. Of the 3 patients with prosthetic valve endocarditis, the involved valve was mitral for 2 and aortic for 1.Bartonella spp. and C. burnetii by microimmunofluorescence  and a Western blot profile consistent with endocarditis . Of the 63 patients, 9 had a positive antibody response against a tested antigen (C. burnetii and 8 to Bartonella spp. (IgG >200). Of these, 7 had a 1-fold dilution higher titer to B. quintana than to B. henselae, including 1 with a low-level cross-reaction with C. burnetii, and 1 had identical titers to both. For all 8 patients, Western blot results were consistent with Bartonella endocarditis. For 7, cross-adsorption identified B. quintana as the causative species; for the other, the infecting Bartonella species remained undetermined because adsorption with B. quintana and B. henselae antigens removed all antibodies. Serologic results for B. melitensis were negative for all patients.Identification of the causative species was obtained by Western blot after cross-adsorption with either  antigen : 1 to phB. quintana is mostly associated with human body lice but has also been found in fleas . The most commonly associated risk factor was rheumatic heart disease . C. burnBartonella spp., are prevalent causative organisms of blood culture–negative endocarditis in India. We recommend serologic screening for antibodies to zoonotic microorganisms as diagnostic tools for this disease in India.Our preliminary study suggests that zoonotic agents, especially


To determine the visual outcome of cataract surgery in diabetes mellitus with advanced cataract in a tertiary institution in Nigeria.A retrospective case control study conducted at the University College Hospital, Ibadan Nigeria.Twenty three consecutive patients with diabetes and 23 age and sex matched non-diabetic control patients who had extracapsular cataract extraction for advanced cataract between 2002-2005.Mean post operative visual acuity and surgical complications.Twenty three patients with diabetes mellitus and 23 non diabetic controls were studied; mean duration of diabetes was 8.1 ± 7.2 years. The mean post operative visual acuity in diabetics was 0.11±0.38, 0.33±0.57 and 0.38±0.49 at one week, two months and six months compared with 0.23±0.19, 0.46±0.37 and 0.48±0.31 in non diabetics. . Improvement in preoperative visual acuity was noted in 84.2% and 90% in diabetics and non-diabetics respectively. Poor visual outcome in diabetics was mainly due to diabetic retinopathy, maculopathy or diabetes related surgical complications.Visual improvement was seen following surgery for advanced cataract in diabetics in this study population. Post operative monitoring for treatment of diabetic retinopathy may enhance visual outcome. Diabetes mellitus is a risk factor for development of cataract.127In contrast, in developing countries, mature and hypermature cataracts presenting for surgical care is the rule rather than the exception.8The study was carried out at the University College Hospital, Ibadan a tertiary health care institution in southwest Nigeria. This retrospective study was conducted in accordance with the ethical standards of Institutional Ethical Review Committee.The cases consisted of consecutive diabetic patients who underwent cataract surgical procedure between January 2002 and December 2005 (Group I). All surgeries were performed by consultant ophthalmologists. The controls were age and sex matched non-diabetic patients who had cataract extraction during the same period (Group II) by consultant ophthalmologists. The diagnosis of diabetes was based on fasting blood sugar of >120mg/dl. Patients with traumatic, uveitic or complicated cataracts were excluded. All patients routinely had preoperative fasting blood glucose analysis within one week of the surgery. Glycemic control level in Group I patients was regarded as good (<70mg/dl), moderate (70-100mg/dl) or poor (>100mg/dl). Extracapsular cataract extraction with posterior chamber intraocular lens implantation (ECCE/PCIOL) under peribulbar anaesthesia was the procedure of choice. Group I patients were co-managed with endocrinologists. None of the patients had biometry for IOL power calculation as facilities for such were not available.The duration of diabetes, method of treatment, systemic and ocular co-morbidities were recorded. Preoperative best visual acuity, intra-operative and post-operative complications as well as presenting visual acuity at 1 week, 4 weeks, 2 months and 6 months post cataract extraction was noted for all patients. The Snellen acuity was recorded as decimal number and presented as mean and standard deviation of the visual acuity during postoperative period.Data was imputed and analyzed using the SPSS version 11 . Statistical significance was inferred at p<0.05 and p values were determined using chi square or ANOVA tests as appropriate.Forty-six patients, 23 diabetic and 23 age and sex matched non diabetic controls constituted the study population. The age and sex distribution patients were similar with a mean age of 59.3±16.8 years and 58.7±17.4 years in diabetics and non-diabetics respectively (p=0.92). The preoperative best visual acuity were <3/60 in all patients (100%) in diabetics and in 22 (95.7%) patients in non-diabetics. A mature cataract was present in all patients of both groups precluding examination of the posterior segment. The duration between the diagnosis of diabetes and cataract surgery ranged from 6 months to 20 years with mean of 8.1 ± 7.2 years. Most (82.6%) patients had Type II diabetes while the remaining 4 (17.4%) were Type I diabetics. Oral hypoglycemic agent was the method of treatment in 16 (69.9%) patients, insulin in 6 (26.1%) while 1 (4.3%) patient was on dietary control only. The immediate preoperative glycemic control was good in 6 (26.1%), moderate in 14 (60.9%) and poor in 3 (13.0%) of group 1 patients.The ocular co-morbid diseases were similar in both groups. Hypertension was the most frequent systemic co-morbid disorder in both groups; it was more frequent in diabetics (60.9%) compared with 26.1% in non diabetics (p=0.017). P=0.40).Good visual outcome was recorded more commonly in group 2 patients when compared with group 1. However, these differences were not statistically significant throughout the postoperative period . The meaThe post operative visual acuity improved in 16 (84.2%), remained the same in 2 (10.5%) and was worse in 1(5.3%) patient in Group 1 whereas improvement was seen in 18 (90%) and remained the same 2(10%) patients in group 2. The visual outcome was poor (<6/60) at 2months postoperatively in 6 (30%) of 20 patients in Group I and in 2 (10.5%) of 19 patients in group 2. The reason for poor outcome was noted with diabetic retinopathy or maculopathy accounting for 33% in group 1 .Intra-operative complications were more frequent in Group 1 patients (p = 0.001) with posterior capsular rent being the most frequent complication. Post operative complications were also more frequently noted among Group 1 patients .In this study, the indication for surgery in all patients was for visual improvement or when the density of lens opacity was severe enough to prevent retinal assessment. Advanced cataract presenting for surgical removal is still widespread in this region similar to that reported previously.125et al.et al. reported that serum glucose level had no influence on the peri-operative clinical complications and final visual outcome of cataract surgery amongst diabetic patients.13The mean duration of diabetes mellitus prior to surgery of 8.1 years in this study is lower than 13 years reported by Squirell Systemic hypertension though the most frequent systemic co-morbid disease in both groups was more frequent amongst diabetics as seen in 60.9% compared with 26.1% of non diabetic counterparts (p=0.017). A similar high incidence of hypertension of 58% amongst diabetics for cataract surgery has been reported.10th day and 6th months post cataract extraction.5The post-operative visual acuity was worse throughout the post-operative period amongst diabetics. This differs slightly from a previous report in which visual acuity was worse only by 7Extracapsular cataract extraction with intraocular lens implantation is well tolerated in diabetics125et al. reported intraocular inflammation and its sequelae as the most common complication in their study.et al. reported that inflammatory reactions and bleeding which resulted in post-operative keratopathy, fibrinous uveitis and posterior capsule opacity as the common complications of cataract surgery amongst diabetics.Complications were more frequent among diabetic patient's especially posterior capsular rent, striate keratopathy and fibrinous exudation. Menchini Diabetics with advanced cataract presenting for cataract surgery have an overall good visual outcome and should not be denied surgery. However, extra precaution needs to be taken intra-operatively as well as adequate post operative monitoring is recommended. Also treatment of existing diabetic retinopathy or maculopathy should be performed to improve visual outcome.


In contrast, only of 17 tumors (6%) >4cm was T1. Histological grade was correlated with nodal status and O.S. There was a significant difference between histological grade and thepresence of metastatic lymph nodes . Patients with welldifferentiated tumors had a mean survival of 21 months compared to a mean survival of 10 months forless differentiated tumors (p<0.05). This difference was even more significant when stratified for nodalstatus. The patients with well differentiated tumors and no RLN involvement had a mean survival of32.5 months compared to 8.6 months for well differentiated tumors with RLN involvement. Insummary, we have shown that size, histological grade, and local spread predict for nodal status.However, specific patient subsets  may exhibit an excellent survival when curativepancreas resection is successful.We have examined the histopathological factors affecting the degree of local spread, regional lymphnode (RLN) metastases, and overall survival (O.S.) in a group of 39 cases of resected carcinoma of theexocrine pancreas. Although the mean O.S. for the group was 14.3 months, resected patients withoutRLN involvement had a mean survival of 24 months. In contrast the mean O.S. rate was 8 months forpatients with RLNs involved. Size, tumor location, and histological grade were compared to RLNinvolvement and O.S. The mean size of primary tumor did not differ significantly between patients withor without RLN's (r.1 versus 4.6cms). However, 7 or 8 T


Geographical variability has also been reported in some studies. We have investigated temporal trends and spatial variation of testicular cancer at ages 20–49 in Britain. Temporal trends in testicular cancer incidence were examined, 1974 to 1991 and in mortality, 1981–1997. Spatial variation in incidence was analysed across electoral wards, 1975 to 1991. We used Poisson regression to examine for regional and socio-economic effects and Bayesian mapping techniques to analyse small-area spatial variability. Incidence increased from 6.5 to 11.1 per 100 000 in men at ages 20–34, and from 5.6 to 9.7 per 100 000 in men at ages 35–49, while mortality declined by 50% in both age groups. Risks of testicular cancer varied across regional cancer registries, ranging from 0.79 (95% CI: 0.73–0.84) to 1.32 (95% CI: 1.25–1.38), and was higher in the most affluent compared with the most deprived areas. Analyses within 2 regions  did not indicate any localized geographical clustering. The increasing incidence contrasted with a decreasing mortality over time in Great Britain, similar to that found in other countries. The higher risk in more affluent areas is not consistent with findings on social class at the individual level. The absence of any marked geographical variability at small area scale argues against a geographically varying environmental factor operating strongly in the aetiology of testicular cancer. © 2001 Cancer Research Campaign


Low lignan status has been reported to be related to an elevated risk of breast cancer. Since lignan status is reduced by antibacterial medications, it is plausible to hypothesize that repeated use of antibiotics may also be a risk factor for breast cancer. History of treatment for urinary tract infection was studied for its prediction of breast cancer among 9461 Finnish women 19–89 years of age and initially cancer-free. During a follow-up in 1973–1991, a total of 157 breast cancer cases were diagnosed. Women reporting previous or present medication for urinary tract infection at baseline showed an elevated breast cancer risk in comparison with other women. The age-adjusted relative risk was 1.34  = 0.98–1.83). The association was concentrated to women under 50 years of age. The relative risk for these women was 1.74 (95% CI 1.13–2.68), whereas it was 0.97 (95% CI 0.59–1.58) for older women. The relative risk in the younger age-group was 1.47 (95% CI 0.73–2.97) during the first 10 years of follow-up, and 1.93 (95% CI 1.11–3.37) for follow-up times longer than 10 years. These data suggest that premenopausal women using long-term medication for urinary tract infections show a possible elevated risk of future breast cancer. The results are, however, still inconclusive and the hypothesis needs to be tested by other studies. © 2000 Cancer ResearchCampaign


A number of intervention studies have shown that therapy with angiotensin receptor blockers, such as irbesartan, can improve metabolic parameters and reduce the incidence of diabetes mellitus. It is unknown whether this observation also holds true in routine clinical settings.We evaluated the effect of irbesartan (150 mg or 300 mg/d) together with or without hydrochlorothiazide (12.5 mg/d) in 3259 German patients. A total of 750 primary care physicians evaluated up to 5 subsequent patients with metabolic syndrome (58.9% diabetic), in whom irbesartan therapy was newly initiated (87%) or continued (13%).Six months of irbesartan therapy decreased systolic blood pressure by 14% (157.4 ± 14.7 vs. 135.0 ± 10.7 mmHg) and diastolic blood pressure by 13% (92.9 ± 9.2 vs. 80.8 ± 6.8 mmHg). This was associated with a decrease in body weight (-2.3%), fasting glucose (-9.5%), HbA1c (-4.6%), LDL-cholesterol (-11%), triglycerides (-16%) and gamma-GT (-12%) and an increase in HDL-cholesterol (+5%). These changes were somewhat more pronounced in male than in female patients and in obese than in lean patients. Changes in glucose concentration and HbA1c were much more prominent in diabetic patients.Irbesartan therapy improves metabolic parameters in routine clinical settings. Thus, our study confirms previously published results from large intervention trials and extends the findings to routine clinical practice. The metabolic syndrome which describes the concomitant presence of visceral obesity, insulin resistance or glucose intolerance, atherogenic dyslipidemia and hypertension is highly prevalent (approximately 25%) in Germany. The risk of developing diabetes mellitus type 2 for subjects with the metabolic syndrome is increased five-to nine-fold ,2. In adLarge clinical trials evaluated the effect of angiotensin receptor blockers (ARB) on cardiovascular end points, generally showing very positive results. Therefore ARB and ACE-Inhibitors are now considered first line therapy in hypertensive patients with the metabolic syndrome ,5. An anThus, a large body of data indicates that interfering with the angiotensin system has positive effects on metabolic parameters. However, it is unknown whether these positive effects can also be observed in daily routine clinical practice, although recently published data from a post authorization trial indicate that this may be the case . We therA total of 3259 patients participated in this prospective, 6-month, open-label, observational, post-authorization survey. The patients were recruited from 649 general practitioners throughout Germany, who included up to 5 subsequent patients who fulfilled the inclusion criteria specified below and who at the time of the index visit were either already on irbesartan therapy or in whom irbesartan therapy was started at that time point. All subjects had elevated blood pressure (>130/85 mmHg or antihypertensive therapy). In addition, at least two of the following criteria were present: abdominal obesity  or >88 cm ), elevated triglycerides (>150 mg/dl), decreased HDL-cholesterol , elevated fasting glucose (>110 mg/dl). The characteristics of the subjects are shown in Table Each subject was evaluated three times: At baseline (index visit), after three months and after six months. Patients were evaluated using a standardized form with which data on duration of hypertension, duration of metabolic syndrome, nicotine and alcohol consumption, blood pressure, pulse, weight, height, waist circumference, medications, lab-values  were collected.Mean and standard deviation as well as median and range were used to describe the population. t-tests were used to evaluate intergender differences, differences between diabetic and non-diabetic patients, and differences between different doses. Non-parametric tests were used for statistical evaluation were appropriate. SAS, version 9.1 was used for statistical analysis. The analysis was performed by GKM – Gesellschaft fuer Therapieforschung, Munich, Germany.In this cohort of German hypertensive patients 49.1% did not take any antihypertensive medications at the index visit, while 50.9% were taking at least one antihypertensive drug. At baseline 423 patients (13.2%) were taking irbesartan, while in all others irbesartan therapy was initiated at the index visit. Furthermore, the patients were also taking a significant number of other medications (Table In this study 594 patients (18.8%) were treated with irbesartan 150 mg/d, 665 patients (21%) with irbesartan 300 mg/d, 754 patients (23.8%) with 150 mg irbesartan and 12.5 mg hydrochlorothiazide and the rest (36.4%) with irbesartan 300 mg/d and 12.5 mg hydrochlorothiazide. During the observation period the number of patients treated with irbesartan 150 mg/d decreased slightly (from 42.6% to 37.0%) while those groups taking 300 mg/d increased (from 57.4% to 63%).Within the observation period (6 months) systolic blood pressure decreased from 157.4 ± 14.7 mmHg to 135.0 ± 10.9 mmHg (-22.3%). Diastolic blood pressure decreased from 92.9 ± 9.2 mmHg to 80.8 ± 6.8 mmHg (-12.1%). Thus, the rate of patients with systolic blood pressure <130 mmHg increased from 1.6% to 20.4%. While the rate of patients with systolic blood pressure >180 mmHg decreased from 9.4 to 0.4%. Similarly, diastolic blood pressure was <85 mmHg in 15.7% at the index visit and 67% after 6 months of therapy. The rate of patients who had blood pressure <140/90 mmHg increased from 4.9 to 59.2%.During the observation period the body weight decreased from 91.4 ± 15 kg to 89.3 ± 14.6 kg (-2.2%). This decrease was somewhat more pronounced in men (-2.5%) than in women (-1.4%). Similarly waist circumference decreased from 106.4 to 104.3 cm .The effect on metabolic parameters is shown in Table 2) than in leaner patients. HbA1c and fasting glucose reduction was significant in diabetic and non-diabetic patients, but was much more pronounced in those with diabetes. All other parameters decreased in diabetic and non-diabetic patients, however, improvement was overall more pronounced in patients with diabetes  than in older (≥62 years), in more obese . Notably, we also observed a small but significant decrease in body weight, which also indicates that some of the beneficial effects observed during the study are related to the study-in effect. On the other hand, as outlined above, irbesartan stimulates PPAR-gamma dependent pathways and thus results in an altered flux of free fatty acids, which may affect nutritional behavior and caloric intake. Furthermore, metabolic improvement was related to blood pressure reduction. It therefore cannot be decided whether the improvement in metabolic parameters is specific for irbesartan (or ARB therapy) or the result of blood pressure reduction. However, a number of large intervention trials have shown that the effect of ARB therapy on metabolic parameters reaches beyond blood pressure reduction.The present study indicates that hypertensive patients with metabolic syndrome with and without diabetes benefit from irbesartan therapy not only with respect to blood pressure reduction but also with respect to a significant improvement of metabolic parameters such as glucose, lipids and liver values.KGP has received speaker's fees from Bristol-Myers Squibb.KG participated in the design of the study and the analysis of the data and drafted the manuscript. FM participated in the design of the study and helped to draft the manuscript. MK conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.


Accurate estimation of body surface area (BSA) burn is important. In small and patchy burns, the patient's hand is used to estimate percentage of burn which is traditionally considered as 1%. There is discrepancy about what percentage of TBSA is constituted by the palm and hand. Therefore, this study was designed to determine correctly the TBSA represented by the palmar surface of the entire hand and palm in the Indian population.300 healthy adult  and 300 healthy children  were included in the study. TBSA was calculated using DuBois formula and hand and palm surface area was calculated using hand tracing on plain paper. The hand/palm percentage of BSA (ratio) was determined by dividing hand/palm surface area by total BSA.The mean hand and palm ratio for adults was 0.92% and 0.50%, respectively. The mean hand and palm ratio in children was 1.06% and 0.632%, respectively.The hand area  is more closely represented to 1% of TBSA in Indian population. Thermal burns and related injuries are a major cause of death and disability. The single most important factor in predicting burn-related mortality, need for specialized care, likelihood of complications, treatment plans, including initial resuscitation and subsequent nutritional requirement the size of burn. ThereforThere are several methods for assessment of burn size. These include the 'rule of nine' and Lund and Browder chart. SometimeThis study was conducted in the plastic surgery unit, Department of Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur over a period of one year. 300 healthy adult and 300 healthy children of both sexes and from varying social and cultural backgrounds, representing the general population, were included in the study. Subjects were numbered and age, gender, height, weight and dominant hand were noted. The dominant hand tracing was obtained by asking the volunteer to keep the hand flat on a plain sheet of paper, keeping the fingers together and thumb lying comfortably against the radial aspect of hand and index finger. A tracing was made using pencil. The tracing started from tip of the radial styloid and passing all around the hand ended at the tip of ulnar styloid. The area of tracing was closed with a straight line drawn between the two styloid tips and termed the interstylon. The percentage of hand area was calculated by following method. The leng.425 H.725,[The BSA was calculated using DuBois formula BSA= 71.84 W25 H.725,.t test. All means were expressed as mean ± standard deviation. The critical level of significance of the results was considered at 0.05 levels i.e. P < 0.05 was considered significant.The hand's percentage of BSA (hand ratio) was determined by dividing hand area by total BSA. Similarly the palm's percentage of BSA  was determined by dividing the palm area by total BSA. The mean values of TBSA, palm ratio, hand ratio were tested using the Student 2, and 1.43 m2, respectively and for combined male and female was 1.51 m2. These values were less as compared to western population which is 1.9 m2, 1.6 m2 and 1.7 m2 for male, female and combined, respectively.[2, 0.800 m2 and 0.805 m2, respectively [In this study 300 adults and 300 children at random were selected in order to determine hand area and palm area ratio as compared to BSA in Indian population. The age group in pediatric patients was 2-17 years and in adults it was 18-60 years. The mean TBSA for male and female was 1.59 mectively .2, while in female it was 132.42 cm2. The mean hand area for combined male and female was 139.46 cm2. There is statistically significant difference in the hand area between male and female (P < 0.0001) [In our study the mean hand area in adult male was 146.50 cm 0.0001) .2 and in adult female was 73.65 cm2. The mean palm area for combined male and female was 75.75 cm2. There is statistically significant difference in palm area between male and female (P < 0.001) [The mean palm area in adult male was 77.85 cm< 0.001) .P > 0.05) [The hand ratio in adult male and female was 0.92% and 0.92%, respectively, and the mean hand ratio for combined male and female was 0.92%. There was no significant difference between the hand ratio in adult male and female ( > 0.05) .P < 0.01) [The palm ratio in adults male and female was 0.49% and 0.51%, respectively. The mean palm ratio for combined male and female was 0.50%. There was significant difference in palm ratio been male and female ( < 0.01) .2 and 84.77 cm2 respectively. Combined value in male and female child was 85.64 cm2. The male and female values are comparable with no significant difference (P > 0.05) [In our study the mean hand area in male and female children were 86.51 cm > 0.05) .2 and 49.65 cm2. Combined value in male and female child was 50.67 cm2. The mean palm area of male and female child is comparable with no statistically significant difference (P > 0.05) [The mean palm area in male and female child was 51.70 cm > 0.05) .P > 0.05) [The hand ratio in male and female children was 1.06% and 1.06%, respectively. The combined value in male and female child was 1.06%. This study also reveals that the hand ratio in case of male and female children was comparable with ( > 0.05) .P > 0.01) [The palm ratio in male and female children was 0.63% and 0.62%, respectively. The combined value for male and female was 0.632%. The palm ratio between male and female children was comparable with no significant difference ( > 0.01) .There is wide debate on what percentage constitutes hand and palm area and existing literature gives the value for western population,‐12 and hIn our study, the adult hand ratio was 0.92% compared to 0.77% by Perry The averMoreover, the palm ratio in adults male and female was 0.49% and 0.51%, respectively, with significant difference between male and female. Rossiter also fouIn our study, the hand ratio in children was 1.065% with no significant difference between male and female as compared to 0.94% by Nagel and 0.82Amirsheybani used intPerry studied Rossiter also pubNagel calculatSheridan measuredWith this study it is evident that using hand surface area alone, the size of the burn will be overestimated. For more accurate assessment the resultant area should be multiplied by 0.9 for adults. We have used the simple tracing of hand for determination of hand/ palm surface area because it is a simple and convenient method and it is within 2% of the hand area measured by an integrated planimeter. Therefor2 and the same for child was 85.646 ± 21.11 cm2. 0 Mean palm area in adult and children was 75.756 ± 9.938 cm2 and 50.675 ± 12.603 cm2, respectively. In our study, the mean hand ratio in adult was 0.921 ± 0.088 and for children it was 1.065 ± 0.110. In many studies done in western countries, the ratio of hand area to TBSA is found to be around 0.8%. This may be due to reduced TBSA of Indian population as compared to their western counterpart. Mean palm ratio in adult was 0.502 ± 0.065 and in child was 0.632 ± 0.084. The palm ratio in western population for adult and children was 0.4% and 0.5%, respectively. We can observe that the results of our study differ with that of western studies. The hand area as compared to TBSA more closely represents 1% of TBSA in Indian population.Mean hand area in adult was 139.462 ± 16.21 cm


To evaluate skeletal and non-skeletal fluorosis in patients living at endemic fluoridated areas and also the morphological changes in red blood cells (R.B.C.’s).The cross-sectional study was conducted at Vidharbha region of Maharashtra, India. An ethical clearance was obtained from the concerned authorities. Fifty families were screened and 204 subjects who had dental/skeletal fluorosis were included in the study. The aims and objectives were explained to the study subjects of the village and biochemical, hematological and radiological assessment was done. The main source of drinking water in this area was tube well. The concentrations of fluoride in two different areas of same village were 4 and 4.5 ppm.P value was 0.003. Hb% in male patients was 12.44 ± 1.76 and in female patients it was 11.31± 1.34, showing significant difference between male and female patients P value 0.038. Alkaline phosphate level in male patients was 289.68 ± 149.09 and in female patients it was 276.68 ± 164.97. ESR count in male patients was found 11.41 ± 8.75 and in female patients it was 13.29 ±7.37. Radiological finding of fluorosis patients shows thickening of inner and outer tables of skull bone in 83.92% of patients and only 7.84% of the patients were suffering from barrowing of long bone.Prevalence of skeletal fluorosis and non-skeletal fluorosis in male patients was 56.87% (116) and in female patients (88) it was 43.13%. RBC count in male patients was 5.03 ± 0.49 while in female patients it was 4.70 ± 0.47. With significant difference between male and female patients,  In human nutrition, fluorine plays a dual role; to prevent dental caries at a certain level of intake and can cause serious damages in bony and dental tissues. SkeletalThe estimated range of safe and adequate intake of fluorides for adults is 1.5 to 4.0 mg per day and it is less for children and those with renal disease. and erythrocyte sedimentation rate (ESR) and morphological evaluation of RBC. Biochemical investigations included were measurement of serum alkaline phosphates levels.Each patient was subjected to radiographic examination of cervical spine and long bone in the Department of Radio-diagnosis, Jawaharlal Nehru Medical College and Hospital, Sawangi (M), Wardha for evaluation of skeletal flurosis.Data was analyzed by using the statistical software SPSS (Windows versions 17). The independent-samples t-test was used to test the difference between genders.In the present study, a total of 204 subjects were examined including 116 males and 88 females, the mean age of male subject was 17.4 years and that of female subject was 15.9 years. All the results obtained after various investigations were recorded and data was analyzed by using the statistical software SPSS, (Windows versions 17). The independent-samples t-test was used to test the difference between genders.Endemic fluorosis has been reported from different parts of the country.8 The eti9P value 0.037. These finding are similar to the findings obtained by Gupta S, Goel D, Singhal A in 2005. than male patients 11.41±8.75), which correlate well with the finding obtained by Gupta S. Goel D Singhal A, in 2005..41±8.75,15Radiologic changes in jaw bone were seen in the form of prominent marrow spaces  In the p415


The trial was designed as an equivalence study aiming to exclude a reduction in the 3-year progression-free survival in patients allocated to carboplatin of between 10 and 15%, requiring initially a target accrual of 250 patients (90% power significance level 5% (one-sided)). The trial closed after 130 patients had been randomized following recommendation by an independent data monitoring committee. At a median follow-up time of 4.5 years, 81% of patients had been followed up for at least 3 years and 19 patients have died. The estimated PFS rate ) at 3 years was 71% (60–82%) in patients allocated C and 81% (71–90%) in those allocated EP; the 95% CI for the difference in 3 year PFS was – 6% to +19%. The hazard ratio of 0.64 (95% CI 0.32–1.28) favoured EP but the difference was not statistically significant (log rank chi-squared = 1.59 P = 0.21). The 3-year survival rate was 84% (75–92%) in those allocated C, and 89% (81–96%) in those allocated EP. The hazard ratio for survival was 0.85 with 95% CI, 0.35–2.10, log rank chi-squared = 0.12, P = 0.73. The trial has not demonstrated statistically significant differences in the major survival endpoints comparing single agent carboplatin with a combination of etoposide + cisplatin. This cannot be taken as an indication of equivalence since the limited size of this trial rendered it unable to exclude a 19% lower progression-free survival and survival in those treated with single agent carboplatin which would be important clinically. Standard initial chemotherapy for advanced seminoma should be based on cisplatin combinations and the role of carboplatin awaits the outcome of further studies. © 2000 Cancer Research Campaign http://www.bjcancer.comThe UK Medical Research Council conducted this trial of carboplatin chemotherapy in advanced seminoma to compare single agent carboplatin with a standard combination of etoposide with cisplatin. The use of single agent carboplatin was expected to be associated with reduced toxicity. A total of 130 patients with advanced seminoma were randomly assigned to treatment with either single agent carboplatin (C) at a dose of 400 mg/m


The treatment schedules for stereotactic body radiotherapy (SBRT) for lung cancer vary from institution to institution. Several reports have indicated that stage IB patients had worse outcomes than stage IA patients when the same dose was used. We evaluated the clinical outcomes of SBRT for stage I non-small cell lung cancer (NSCLC) treated with different doses depending on tumor diameter.Between February 2004 and November 2008, 124 patients with stage I NSCLC underwent SBRT. Total doses of 44, 48, and 52 Gy were administered for tumors with a longest diameter of less than 1.5 cm, 1.5-3 cm, and larger than 3 cm, respectively. All doses were given in 4 fractions.p = 0.05). At 3 years, cause-specific survival was 91% for the former group and 79% for the latter (p = 0.18), and progression-free survival was 62% versus 54% (p = 0.30). The 3-year local control rate was 81% versus 74% (p = 0.35). The cumulative incidence of grade 2 or 3 radiation pneumonitis was 11% in stage IA patients and 30% in stage IB patients (p = 0.02).For all 124 patients, overall survival was 71%, cause-specific survival was 87%, progression-free survival was 60%, and local control was 80%, at 3 years. The 3-year overall survival was 79% for 85 stage IA patients treated with 48 Gy and 56% for 37 stage IB patients treated with 52 Gy (There was no difference in local control between stage IA and IB tumors despite the difference in tumor size. The benefit of increasing the SBRT dose for larger tumors should be investigated further. Stereotactic body radiotherapy (SBRT) for lung tumors was introduced in the mid 1990s -9. AccorAs a result, it was found that the outcomes of stage IB patients were worse than those of stage IA patients at the same dose -5, whichThe eligibility criteria were as follows: histologically-confirmed non-small cell lung cancer (NSCLC) diagnosed as T1N0M0 or T2N0M0 stage according to the International Union Against Cancer 1997 system by CT of the chest and upper abdomen, bone scintigraphy, and brain magnetic resonance imaging and a World Health Organization performance status ≤ 2. When 18-fluoro-deoxyglucose-positron emission tomography (FDG-PET) was performed, bone scintigraphy was omitted. Even when the diagnosis of NSCLC could not be confirmed with transbronchial lung biopsy or CT-guided biopsy, such cases were included in the study if FDG-PET findings were positive and the tumor increased in size during the observation period. No restrictions were imposed with regard to the tumor location. Any patients who had undergone prior therapy were excluded. All patients consented to the treatment after they had been informed of the method and rationale of the study.Between February 2004 and November 2008, 124 patients underwent SBRT for NSCLC. Eighty-four were men and 40 were women. The age at SBRT ranged from 26 to 89 years, with a median of 77 years. The tumor diameter ranged from 12 to 55 mm with a median of 27 mm. In 10 patients, NSCLC could not be histologically proven. The patient characteristics are summarized in Table Our methods for immobilization and treatment planning were described in detail previously . We usedThe dose was prescribed according to the tumor diameter. The planned dose was 44 Gy in 4 fractions for tumors with a maximum diameter of less than 1.5 cm, 48 Gy in 4 fractions for tumors with a maximum diameter of 1.5-3 cm, and 52 Gy in 4 fractions for those with a maximum diameter larger than 3 cm. Assuming an α/β ratio of 10 Gy, the biological effective dose (BED) was 92 Gy for the 44-Gy schedule, 106 Gy for the 48-Gy schedule, and 120 Gy for the 52-Gy schedule. However, the BED must be cautiously used in these dose-fractionation ranges [For follow-up after SBRT, chest CT was performed at 2-month intervals until 6th months, and every 2 to 4 months thereafter. FDG-PET was performed whenever necessary. Local recurrence was suspected when enlargement of a consolidated fibrotic mass was detected on CT images without signs of inflammation and was diagnosed by high uptake on FDG-PET  and/or biopsy. Local recurrence was confirmed by biopsy in 2 patients. Toxicity was evaluated using the Common Terminology Criteria for Adverse Events Version 3. Grade 2 radiation pneumonitis was defined as symptomatic but not interfering with activities of daily life.The unpaired t-test or the Mann-Whitney U test was used to compare the characteristics of the patients. Survival rates and cumulative incidences of complications were calculated by the Kaplan-Meier method from the start of SBRT. The log-rank test was used to compare the control and survival rates between the subsets. Statistical analysis was carried out using StatView software version 5.0 .p = 0.95), gender (p = 0.11), PS (p = 0.26), operability (p = 0.82), histology (p = 0.71), or tumor location (p = 0.31) between the 85 stage IA patients treated with 48 Gy in 4 fractions and the 37 stage IB patients. The median follow-up period for living patients was 26 months (range: 7 to 66 months). Local recurrence developed in 18 patients (11 among the stage IA patients and 7 among the stage IB patients). Regional lymph node recurrence occurred in 19 patients (10 among the stage IA patients and 9 among the stage IB patients). Distant metastases appeared in 25 patients (16 among the stage IA patients and 9 among the stage IB patients).Among 124 NSCLC patients treated with SBRT, 87 had stage IA and 37 had stage IB disease. Two stage IA patients with tumors of less than 1.5 cm in diameter were treated with 44 Gy in 4 fractions, and 85 patients with larger T1 tumors were treated with 48 Gy in 4 fractions. All 37 stage IB patients were treated with 52 Gy in 4 fractions. There were no significant differences in the distribution of age (p = 0.05). The 3-year CSS was 91% for the former group and 79% for the latter (p = 0.18). The 3-year PFS was 62% versus 54% (p = 0.30). The 3-year local control rate was 80% for all patients, and it was 81% for the stage IA patients treated with 48 Gy and 74% for the stage IB patients, with no significant difference between them (p = 0.35). Two stage IA patients treated with 44 Gy in 4 fractions were alive without recurrence at 21 and 14 months, respectively.For all 124 patients, the overall survival (OAS) rate was 71%, the cause-specific survival (CSS) rate was 87%, and the progression-free survival (PFS) rate was 60% at 3 years . The 3-year CSS was 82% for patients with central tumors and 89% for patients with peripheral tumors (p = 0.63). The 3-year PFS was 52% versus 62% (p = 0.79), and the 3-year local control was 66% versus 83% (p = 0.33).Treatment outcomes were also analyzed with respect to the tumor location . The 3-yp = 0.02). Other adverse events were as follows: grade 2 esophagitis was seen in 3 patients, grade 1 and 3 pleural effusion were detected in 23 and 1 patient(s), respectively; grade 1 atelectasis was found in 6 patients; grade 1 pneumothorax was detected in 3 patients; grade 1 and 2 dermatitis were observed in 7 and 6 patients, respectively; grade 1 and 2 rib fractures were seen in 7 and 1 patient(s), respectively; grade 1 soft tissue swelling was detected in 6 patients; and grade 2 cardiac muscle damage and effusion were detected in 1 patient each. At 3 years, the cumulative incidence of grade 2 or 3 radiation pneumonitis was 25% in patients with central tumors and 13% in patients with peripheral tumors (p = 0.11).Grade 1, 2, and 3 radiation pneumonitis was observed in 66, 17, and 2 patients, respectively. At 3 years, the cumulative incidence of grade 2 or 3 pneumonitis was 16%, and it was 11% for stage IA patients treated with 48 Gy in 4 fractions and 30% for stage IB patients treated with 52 Gy in 4 fractions . So, the PTV of stage IB tumors was significantly larger than that of stage IA tumors. The V 20 was 5.9% ± 2.3% for the 48-Gy group and 8.4% ± 3.5% for the 52-Gy group (p < 0.0001), and the MLD were 4.1 ± 1.2 Gy and 5.4 ± 1.8 Gy, respectively (p < 0.0001). These data indicate that a greater dose was absorbed in the normal lung. This was considered to have caused the significantly higher cumulative incidence of grade 2 or 3 radiation pneumonitis in the stage IB patients treated with 52 Gy in 4 fractions compared with that of the stage IA patients treated with 48 Gy in 4 fractions in our study. A dose-response relationship for radiation-induced pneumonitis after SBRT has also been reported recently [Since greater doses were prescribed to a larger PTV, the normal tissues around the PTV absorbed greater doses, which may have increased toxicities in normal organs. Radiation pneumonitis is the most significant dose-related toxicity. Some dose-volume parameters such as the V20 and MLD are reported to correlate with radiation pneumonitis ,25. Takerecently ,23.Various dose fractionation schedules have been used in SBRT for lung cancers , and optA protocol involving 44, 48, or 52 Gy being delivered in 4 fractions to the isocenter was feasible for patients with stage IA or IB NSCLC. There was no difference in local control between stage IA and IB tumors despite the difference in tumor size. The benefit of increasing the doses for larger tumors should be investigated further.The authors declare that they have no competing interests.FB carried out the study and drafted the manuscript. YS designed the study and gave final approval for publication. HO participated in the design of the study and helped to perform the statistical analyses. RM and CS participated in the analysis and the data interpretation. HI, SO, KK, and AN participated in the data acquisition and analysis. TM and AM contributed to the data acquisition. All authors have read and approved the final manuscript.


Constipation is a significant problem in the elderly, specifically nursing home and/or extended-care facility residents are reported to suffer from constipation. Lactic acid bacteria (LAB) are beneficial probiotic organisms that contribute to improved nutrition, microbial balance, and immuno-enhancement of the intestinal tract, as well as diarrhea and constipation effect. The objective of this study was to investigate the efficacy of this LAB supplement in the management of nursing home residents.11 CFU/g) twice (to be taken 30 minutes after breakfast and dinner) a day for 2 weeks in November 2008. Subjects draw up a questionnaire on defecation habits , and we collected fecal samples from the subjects both before entering and after ending the trial, to investigate LAB levels and inhibition of harmful enzyme activities. Results were tested with SAS and Student's t-test.Nineteen subjects  suffering with chronic constipation were assigned to receive LAB (3.0 × 10p < 0.05) fecal LAB levels. In addition, tryptophanase and urease among harmful enzyme activities of intestinal microflora were significantly decreased (p < 0.05) after LAB treatment.Analysis of questionnaire showed that there was an increase in the frequency of defecation and amount of stool excreted in defecation habit after LAB treatment, but there were no significant changes. And it also affects the intestinal environment, through significantly increase (LAB, when added to the standard treatment regimen for nursing home residents with chronic constipation, increased defecation habit such as frequency of defecation, amount and state of stool. So, it may be used as functional probiotics to improve human health by helping to prevent constipation. Constipation is prevalent in modern societies and is a common symptom in clinical practice .Constipation involves the large intestine and is a symptom rather than a disease. It is characterized by a constellation of symptoms and complaints, the most common of which are low defecation frequency (e.g. less than 3/week), irregular stool expulsion, painful and strained defecation, hard and dry stool consistency, a feeling of incomplete rectal defecation, and passing of abnormally small stools (e.g. less than 50 g/day) .The prevalence of constipation and its impact on quality of life are most significant among elderly individuals, with a reported incidence among ambulatory adults 65 years of age and older of 26% in men and 34% in women. The prevalence of constipation is usually higher among elderly people living in nursing homes and hospitals than those living in the community. Once admitted, other factors may contribute to constipation . More than 80% of nursing home and/or extended-care facility residents are reported to suffer from constipation. This population includes persons with higher frequency of risk factors .Dementia was reported as a risk factor for constipation, and such residents may be more difficult to manage than cognitively intact patients . Other rLAB are currently used in the prevention and treatment of disease ,6, speciLactobacillus acidophilus (affects acute diarrhea and colitis), Pediococcus pentosaceus , and Bifidobacterium longum SPM1205  to demonstrate any potential probiotic activity [In the present study, we used LAB supplements containing activity -12.We aimed to investigate the efficacy of this LAB supplement in the management of nursing home residents with chronic constipation.Bifidobacteria, fecal samples of healthy Koreans (20-30 years old) were collected by BBL's anaerobic sample collection and transport system to maintain anaerobic conditions, and were used within 24 h. Fecal samples were serially diluted 10-fold from 10-1 to 10-8, and 100 μl was spread onto selective BL (Blood Liver)  agar containing 5% sheep blood. After 48 hr of incubation in anaerobic conditions   at 37°C, brown or reddish-brown colonies 2-3 mm in diameter were selected for further identification [The origins of the strains used in this study are shown in Table fication .Bifidobacteria. To identify the isolated Bifidobacterium spp. at the species level, 16S rRNA sequencing was performed by Bioleaders .A fructose-6-phosphate phosphoketolase (F6PPK) test was performed  to ensurAll the participants were recruited from the Eden Adventist Hospital in Gyeonggi-do, Korea. Male and female nursing home residents with chronic constipation, and who were presently receiving intervention  were evaluated for enrolment in the study. Because a significant number of the study participants were nursing home residents, it was not always feasible to obtain a diagnosis according to "Rome II" criteria for constipation as a prerequisite for the inclusion criteria. Such a diagnosis would require a level of communication with the patient that was not always possible in this study. The exclusion criteria were participants with ileus, renal failure, dialysis, Crohn's disease, ulcerative colitis and chronic abdominal pain. Thus, we screened 25 participants and included 8 male and 11 female participants that chose to participate in the study.11 CFU/g) in the regimen of nursing home residents suffering from chronic constipation, the dispensing of standard treatment by nursing home staffs and on costs of care and medications. Participants with chronic constipation were defined as residents who used laxatives at least once a week.This study was designed to assess the effects of LAB  a day for 2 weeks in November 2008. During the trial period, the participants were prohibited from administering their existing laxative medications and/or enemas in addition to the investigational product.Before entering the trial, the subjects completed a questionnaire on name, age, sex and current defecation habits such as frequency of defecation in four steps from 'once more than three days' to 'more than twice a day', amount of stool in three steps from 'large' to 'small', state of stool in five steps from 'like stone' to 'like water' and yes or no about 'currently taking any medicine for defecation' (Appendix 1).Subjects were observed for any untoward symptoms such as vomiting, diarrhea or abdominal pain. The nursing home staff recorded a defecation habit diary during the study and this included information such as frequency of defecation as well as amount and state of stool passed by the subjects.After ending the trial, the subjects draw up a questionnaire on defecation habits.We collected fecal samples from the subjects both before entering and after ending the trial, to investigate LAB levels and harmful enzyme activity.-1 to 10-7. 1 ml was then poured into selective MRS broth (pH 7.0) . After 48 h of incubation under anaerobic conditions  , colonies were counted as LAB [Fecal samples (0.1 g) were suspended in 0.9 ml of 0.1 M phosphate buffer (pH 6.8 containing 0.5% cysteine) using a vortex, and 0.1 ml was then serially diluted 10-fold from 10d as LAB . The numHarmful enzyme activities such as β-glucosidase, β-glucuronidase, tryptophanase, and urease of intestinal microflora related to colon cancer were tested in human fecal samples as previously described -17.β-glucosidase activity was assayed using 2 ml of a reaction mixture containing 0.8 ml of 2 mM p-nitrophenyl-β-D-glucopyranoside and 0.2 ml of the enzyme solution , incubated for 30 min at 37°C, and then stopped by adding 1 ml of 0.5 N NaOH. The reaction mixture was then centrifuged at 3,000 rpm for 10 min. Enzyme activity was measured by monitoring absorbance at 405 nm.β-glucuronidase activity was assayed using 2 ml of a reaction mixture consisting of 0.8 ml of 2 mM p-nitrophenyl-β-D-glucuronide and 0.2 ml of the enzyme solution, incubated for 30 min at 37°C, and then stopped by adding 1 ml of 0.5 N NaOH. The reaction mixture was centrifuged at 3,000 rpm for 10 min. Enzyme activity was measured by monitoring absorbance at 405 nm.2SO4 and 948 ml 95% ethanol). The reaction mixture was then centrifuged at 3,000 rpm for 10 min. Enzyme activity was measured by monitoring absorbance at 550 nm.Tryptophanase activity was assayed using 2.5 ml of a reaction mixture consisting of 0.2 ml of complete reagent solution , 0.2 ml of 20 mM tryptophan, and 0.1 ml of the enzyme solution, incubated for 1 h at 37°C, and then stopped by adding 2 ml of color reagent solution  and alkaline hypochlorite reagent  were added to the stopped reaction mixture and incubated for 20 min at 65°C. The reaction mixture was centrifuged at 3,000 rpm for 10 min. Enzyme activity was measured by monitoring absorbance at 603 nm.Urease activity was assayed using 0.5 ml of a reaction mixture consisting of 0.3 ml of urea substrate solution  and 0.1 ml of the enzyme solution, incubated for 30 min at 37°C and then stopped by adding 0.1 ml of 1 N (NH4)p < 0.05.The data were collected and analyzed independently of the investigators, who did not have access to it or to its analysis. Analysis data of questionnaire were processed using the SAS, and comparisons data of fecal LAB levels and harmful enzyme activity of intestinal microflora were analyzed using the unpaired Student's t-test. Differences were considered statistically significant at This study tested 19 subjects with a mean age of 77.1 and suffering from chronic constipation; 8 males of mean age 77.4 and 11 females of mean age 76.9. Of these subjects, only 15 subjects (79%) were currently receiving intervention such as laxatives and/or enemas: 8 males (100%) and 7 females (64%) Table .11 CFU/g) twice (to be taken 30 minutes after breakfast and dinner) a day for 2 weeks, and answered their defecation habits as follows; frequency of defecation: 11 individuals reported 'once more than three days' (57.9%), 3 'once two days' (15.8%), 4 'once a day' (21.1%) and 1 'more than twice a day' (5.3%) before LAB treatment; 6 'once more than three days' (31.6%), 7 'once two days' (36.8%), 6 'once a day' (31.6%) and 0 'more than twice a day' (0.0%) after LAB treatment; amount of stool: 4 individuals reported 'large' (21.1%), 11 'medium' (57.9%) and 4 'small' (21.1%) before LAB treatment; 8 'large' (42.1%), 9 'medium' (47.4%) and 2 'small' (10.5%) after LAB treatment; state of stool: 1 individual reported 'like stone' (5.3%), 5 'hard' (26.3%), 12 'soft' (63.2%), 1 'watery' (5.3%) and 0 'like water' (0.0%) before LAB treatment; 0 'like stone' (0.0%), 6 'hard' (31.6%), 11 'soft' (57.9%), 2 'watery' (10.5%) and 0 'like water' (0.0%) after LAB treatment (Table All 19 subjects were assigned to receive LAB (3.0 × 10p = 0.676), amount of stool  and state of stool  were not statistically significant   and urease (p = 0.005) activities. However, β-glucosidase and β-glucuronidase activities were increased, and there was not a statistically significant increase in both β-glucosidase (p = 0.074) and β-glucuronidase (p = 0.061) activities.The harmful enzyme activities of intestinal microflora were shown in Table The composition of fecal microbiota, harmful enzyme activities such as β-glucosidase, β-glucuronidase, tryptophanase, and urease of intestinal microflora, fecal frequency, and consistency were determined .For this reason, we analyzed the questionnaire and tested the fecal LAB levels and harmful enzyme activities during the trials. The results showed that there were no significant changes in defecation habits, but there was an increase in the frequency of defecation and amount of stool excreted, after LAB treatment. In frequency of defecation, 'once more than three days' was decreased from 11 (57.9%) to 6 (31.6%), whereas 'once two days' and 'once a day' were increased from 3 (15.8%) to 7 (36.8%) and from 4 (21.1%) to 6 (31.6%), respectively. In amount of stool, 'small' was decreased from 4 (57.9%) to 2 (31.6%), whereas 'large' was increased from 4 (21.1%) to 8 (42.1%).p = 0.024). That is, LAB survive passage through the upper-gastrointestinal tract after oral feeding [We also found that fecal LAB levels were significantly increased from 4.4 log10 CFU/g to 7.3 log10 CFU/g after LAB treatment . Thus, LAB may be potentially beneficial as functional probiotics in preventing colon cancer because of their inhibitory effects on harmful enzyme activities of intestinal microflora.Harmful enzyme activities of intestinal microflora can implicate enterohepatic circulation of toxic and carcinogenic substances . The resIt would appear that one of the shortcomings of this study was that it was not conducted as a randomized, double-blind, placebo-controlled study. However, this was not possible given the serious health conditions and the number of subjects involved in the study.Another possible limitation of this study was that while the difference in frequency of defecation, amount, and state of stool were evaluated, other potentially related variables such as time and sense of defecation were not evaluated. This was because of the difficulties in conversing with several subjects and the time and work-restrictions of the nursing home staff members.LAB affected the intestinal environment by producing a clinically relevant difference in defecation habits, fecal LAB levels and harmful enzyme activities of intestinal microflora. Also, we encountered no adverse events with the daily use of LAB, which can be used alone or in combination with other previously mentioned interventions.Thus, the results of this study showed that the LAB supplement tested, produced positive effects on the management of nursing home residents with chronic constipation.The present study demonstrated that LAB improves defecation habit  in nursing home residents with chronic constipation. In addition, this LAB improved the balance the intestinal microflora, which exert beneficial effects by decreasing harmful enzymes activities such as trytophanase and urease. Furthermore, it also affects the intestinal environment, through increase of fecal LAB levels. Therefore, LAB may be used as functional probiotics to improve human health by the management of constipation, helping to prevent colon cancer. Thus, the results of this study warrant follow-up with a larger multicenter study to further assess efficacy.The authors declare that they have no competing interests.This study was conceived by NJH and designed by NJH, KOL and JGP. NJH, KOL and JGP were responsible for obtaining funding and sample collection. Clinical trials, fecal LAB levels and harmful enzyme activities test were done by HMA, EHB, SJ, DKL, MJK and JRK. HMA performed data analysis and wrote the draft of the manuscript. All authors read and approved the final manuscript.Name: Age: Sex: Male , Female The following list shows the questions about currently your defecation habits.1. Frequency of defecation?①Once more than three days ②Once two days ③Once a day ④More than twice a day2. Amount of stool?①Large ②Medium ③Small3. State of stool?①Like stone ②Hard ③Soft ④Watery ⑤Like water4. Are you currently take any medicine for defecate the stool?①Yes (What is it?) ②NoThe following list shows the questions about your defecation habits after LAB treatment.1. Frequency of defecation?①Once more than three days ②Once two days ③Once a day ④More than twice a day2. Amount of stool?①Large ②Medium ③Small3. State of stool?①Like stone ②Hard ③Soft ④Watery ⑤Like water


The number of hepatectomies has increased greatly in recent years. Surgery for hepatocellularcarcinoma (HCC) in the normal liver has not increased. However, the increase in numbers ofhepatectomies for HCC associated with liver cirrhosis is remarkable. More than 80% of our hepatectomycases were cirrhotic and about 80% of these cirrhotic cases had HCCs 5cm or less in diameter. Theoperative mortality rate has improved in the latter half of this series, from 10.1% (9/89) to 1.5% (5/338),in spite of an increase in cases with poor liver function. This corresponds to a decrease in the mean valueof the annual operative blood loss. The survival rates after hepatectomy for all cases (n = 378) were40.6% ± 6.6 (% ± SE) for 5 year and 22.7% ± 5.3 for 10 year at the end of 1988. A difference of the5-year survival rate between the patients operated on before 1981  and after 1982 was observed (p<0.05). Because the cancer-free survival rates of the patientsoperated on in the two periods, before 1981 and after 1982, were almost the same, the recentimprovement of the survival rates seems to be due to a prolongation of survival time after recurrence.