This study aimed to compare the subcutaneous tissue responses to MTAD , 17% EDTA, and 2.6% NaOCl.Thirty-six Wistar albino rats were used for this study. Test solutions were injected subcutaneously into predetermined areas on the animal dorsum. The rats were then randomly divided into three groups of twelve each and sacrificed at 2 hours, 2 days, and 2 weeks. The severity of inflammation induced by each irrigant at different time intervals was assessed histologically. The data were analyzed using Kruskal-Wallis and Friedman tests.The difference in severity of inflammatory reactions induced by tested irrigants at the different time intervals was statically significant (P<0.05). There was no significant difference between the severity of inflammation induced by MTAD and 2.6% NaOCl at the various time intervals (P>0.05). Subcutaneous tissue responses to MTAD were not different from those observed in 17% EDTA specimens at 2-hour and 2-day intervals (P>0.05).Under the conditions of this study, MTAD has the same toxicity as 2.6% NaOCl. Removal of bacteria from the root canal system is necessary for successful root canal therapy. Effective endodontic treatment and consequent healing depends on thorough chemomechanical cleaning and shaping of the root canal system . An ideaEDTA, however, does remove the mineralized portion of the smear layer . For effMTAD, introduced by Torabinejad in 2003, is an aqueous solution of 3% doxycycline, a broad-spectrum antibiotic; 4.25% citric acid, a demineralizing agent; and 0.5% polysorbate 80 detergent (Tween 80) . MTAD fiEndodontic irrigants can come in contact with periradicular tissues. Use of toxic irrigants can not only cause complications and tissue damage during root-canal treatment but may also interfere with the repair process 19]. The. The19].2 paste [Researchers have evaluated the biocompatibility of MTAD and have found that it was less cytotoxic and more biocompatible than other irrigating solutions 21]22][[22][21][[[22][21]2 paste . In a stThe research protocol was approved by the research ethics committee of Tehran University. Thirty-six Wistar albino rats weighing 180-220 g were used for this study. Animals were anesthetized with an intramuscular injection of Ketamine hydrochloride 25 to 44 mg/kg and acetylpromazine 0.75 mg/kg. The back of the rats were shaved and disinfected with 70% ethanol. Four circles with 1.5-2 cm distance from each other were drawn on the dermis of the rat by an indelible marker, two on each side of vertebral column.A total of 0.1 mL of Biopure MTAD , 17% EDTA Solution, 2.6% NaOCl, and 0.9% normal saline as control, were injected subcutaneously into the center of each circle in the back of each rat by an insulin syringe. The rats were then randomly divided into three groups of twelve and sacrificed at 2 hours, 2 days, and 2 weeks. Samples of dermis, epidermis and parts of the surrounding muscles were removed and fixed in 10% buffered formalin solution for 2 weeks. 5-µm tissue sections were prepared and stained with haematoxylin and eosin and then evaluated under a light microscope  with different magnifications. A pathologist who was unaware of test groups evaluated the specimens.According to ISO 7405:1997 standard, the tissue and inflammatory reactions were graded as follows :1. None: No inflammatory cells infiltration2. Mild: Scattered chronic inflammatory cells without tissue changes3. Moderate: Focal inflammatory cell infiltration with tissue changes but without necrosis4. Severe: Severe infiltration of inflammatory cells5. Abscess: Abscess formationThe severity of inflammatory reactions induced by irrigants was analyzed using Kruskal-Wallis test. Friedman test was used for analysis of inflammatory reactions of each irrigant at different time intervals. Statistical analysis was performed with SPSS 11.5 for Windows.The severity of inflammatory reactions induced by test solutions at different time intervals is shown in At 2-hour interval, no significant difference was found between the inflammatory reactions induced by MTAD and those induced by 2.6% NaOCl and 17% EDTA (P>0.05). The difference in inflammatory reactions between 17% EDTA and 2.6% NaOCl (P=0.006) and 17% EDTA and normal saline (P<0.001) was statistically significant.There was no significant difference in the degree of inflammatory reactions induced by tested irrigants at 2-day interval (P=0.061).The results showed significant difference in the severity of inflammation between four irrigants at 2-week interval (P<0.000). There was a significant difference in the degree of inflammation between MTAD and 17% EDTA (P=0.005), and MTAD and normal saline (P<0.001); however, the difference between MTAD and 2.6% NaOCl was not significant (P=0.562). NaOCl also showed significant difference when compared to normal saline (P<0.001); however 17% EDTA did not (P=0.031).The results showed no significant differences between the severity of inflammatory reactions induced by MTAD and 2.6% NaOCl at 2-hour, 2-day, and 2-week intervals (P>0.05). The difference between inflammatory reactions of MTAD and 17% EDTA was significant only at 2-week interval (P=0.005).In the present study, subcutaneous tissue responses to tested endodontic irrigants were evaluated using rats as an in vivo animal model. Yesilsoy et al. used guinea pigs as an in vivo model to examine subcutaneous local tissue reactions to some irrigants .The findings of this study revealed that the severity of inflammation and subcutaneous tissue responses to MTAD and 2.6% NaOCl was not significantly different at any of the time intervals. On the contrary, Zhang et al. showed that the cytotoxicity of MTAD on L929 fibroblasts was more than that of 2.63% NaOCl after 24 hours . They alIn contrast to this investigation, Yesilsoy et al. in a study on subcutaneous tissue reactions found that 0.5% and 2.5% NaOCl exhibited no inflammation at 2 hours; however, tested solutions induced mild inflammation after 2 days .The variation between the findings of different studies could be attributed to the concentration of tested solutions. It has been shown a correlation between the cytotoxicity of NaOCl and its concentration . FurtherUnder the conditions of this animal study, MTAD was as cytotoxic as 2.6% NaOCl. The subcutaneous tissue reaction to MTAD was similar to EDTA after 2 hours and 2 days.


Associated with the increase in the aging population, there is an increase in the incidence of hip fractures worldwide. Outcome following such fractures is affected by age of the patient. This study aims to assess the incidence and early outcome of hip fractures, comparing between different age groups.Data of hip fractures collected over a period of five years was analysed. Patients were divided into three groups, group A (patients under the age of 64), group B (patients between 65 and 84 years of age), and group C (patients over the age of 85).Of the 1177 patients included in the study, there were 90 patients in group A, 702 patients in group B and 385 patients in group C. There was a female preponderance across all age groups, and this increased as age advanced (p < 0.0001). A significantly larger number of older patients lived alone and needed aids to walk before the injury (p < 0.0001). There was no significant difference in the type of fracture across the three groups (p = 0.13). A higher proportion of the elderly with intracapsular fractures were treated by replacement arthroplasty. Older patients who had internal fixation of intracapsular fractures had a better walking ability at 4 months. The overall deterioration in mobility was greater in older patients (p < 0.0001). Mortality was higher in older patients.Hip fractures are more common among females irrespective of age group. Older patients have a higher mortality and a greater deterioration of walking ability after such injuries. Internal fixation of intracapsular fractures have demonstrated satisfactory early outcome in the immediate period. This could be attributed to retention of native bone, better propioception and shorter operation time. The United Kingdom has a population of over 60.2 million with adults over the age of 65 forming 16% part of the population 10 million) ,4, this  million The aim of this study was to assess the affect of age on the incidence, fracture pattern, management and outcome of hip fractures in different age groups.We analysed data on hip fractures collected prospectively over a period of five years at Wishaw General Hospital, Lanarkshire Scotland. This is a typical district general hospital which is the secondary referral centre for a population of approximately 200,000 people. Demographic details, pre- operative, intra operative and post operative details of these patients were collected. Patients were followed up for up to 4 months following the fracture. For the purpose of the study we divided the patients into three groups; group A, those aged 64 or less; group B, those between 65 and 84 and group C, those above the age of 85.The type of surgery and post operative care determined by the type of fracture, age, co-morbid medical status and general level of mobility. The data was analysed using the SPSS 11.0 . Variables between groups were compared using the chi square test at 95% confidence interval with p < 0.05 considered as significant.(> 85 years).During the five year period 1177 patients were admitted with hip fractures. There were 90 patients below the in group A (<64 years), 702 patients in group B (65-84) and 385 patients in group CIn Group A (n = 90), hip fractures were seen more commonly in females (71.1%). 90% of patients came from their own home and 71% living with family or friends. 67.4% of the patients were able to walk without any aids. There was a roughly equal distribution of intracapsular (51.1%) and extracapsular fractures (48.9%). 67.4% of patients with intracapsular fractures were treated by internal fixation and the remaining (32.6%) were treated by total or hemi arthroplasty. None of the patients were treated non-operatively. At 4 months 76.7% of patients were living in their own home and 23.3% were able to walk without any aids. The re-operative rate within the first 4 months was 6.7%. Mortality rate at 4 months was 12.2%.In group B (n = 702), hip fractures were seen more commonly in females (77.8%). 65% of patients came from their own home and a greater proportion of patients compared to group A living alone (38.6%). 48.6% of the patients were able to walk without any aids. 53.6% had intracapsular fractures with 46.4% having extracapsular fractures. Of the patients with intracapsular fractures, 73.1% of patients were treated with a hemi or total arthroplasty and 26.9% had internal fixation. 4.5% of patients were treated non-operatively. By four months, 48.3% of patients were living in their own home and 7.7% were able to walk without aids by four months. There was a 4.4% re operation rate within 4 months. Mortality rate at four months was 20% with 56.2% of the patients treated non operatively.In Group C (n = 385), hip fractures were seen more commonly in females (87%). 44.2% of patients came from their own home and 44.9% were living alone. 29.9% of the patients were able to ambulate without aids. There was an approximately equal distribution of intracapsular (48.5%) and extracapsular (51.5%) fractures. 79.1% of patients with intracapsular fractures were treated by a hemi or total arthroplasty. 4.2% of patients had non operative management. At 4 months 22.1% of patients were living in their own home and only 1.8% managed to walk without any aids. There was a 5.4% re operation rate within the first four months. Mortality rate at 4 months was 30.7% with 81.3% of the patients treated non operatively.These results are summarised in tables Hip fractures are reported to be more common in females and the elderly ,11,12. IProportionally, majority of patients with neck of femur fractures belong to group C Figure . A signiThe type of fixation varied based on the patient group. In Group A, 67% of the patients underwent internal fixation while 33% underwent hemi/total arthroplasty. In Group B, the rates of internal fixation dropped to 27% and further to 16% in Group C. Patients in Group B and Group C, who had internal fixation fared better at 4 months compared to those who have hemi/total arthroplasty with no statistically significant difference in re operation rates. It has been reported that over a longer period of follow up younger patients with a replacement arthroplasty have a better walking ability with lower re operation rates ,18. HowePerioperatively  the mortality rate were 1.1% in Group A, 5.6% in Group B and 9.0% in Group C. The mortality rate rose to 12.2% in Group A, 19.9% in Group B and 30.6% in Group C at 4 months (p < 0.0001). There was a significantly higher mortality associated with hip fractures with increasing age. Between Group A and C, this represents a 900% in increase in peri-operative and 250% increase 4 months post operative mortality. Our results compare well with other reports . A recenRe-operation rate in group B was 6.3% for those who had internal fixation compared with 4.6% for those who had a hemi/total arthroplasty (p = 0.59). While, in group C was 3.4% and 7.4% following internal fixation and replacement arthroplasty respectively (p = 0.69).Most of the functional recovery after a hip fracture occurs by 4 months . In our From group A, 86.7% of patients who have been living in their own home for greater than 4 months had internal fixation and managed to return to their home. All of the patients who came from their own home and had a replacement arthroplasty were back at home by 4 months (p = 0.3). 71.4% of patients regained their mobility after internal fixation, compared to 76.9% following hemi or total arthroplasty (p = 1.0). Type of surgery did not make a statistically significant difference in these outcomes and reoperation rate (p = 0.52). In group B, among the patients who had an internal fixation of the intracapsular hip fracture, 82.4% returned to their home by four months compared to 76.9% following a replacement arthroplasty (p = 0.39). 52.4% of patients who were independently mobile prior to their fracture regained mobility after internal fixation. This value was 38.3% among those who had a replacement arthroplasty (p = 0.028). Hence patients who had internal fixation had a statistically significant improved walking ability compared to those who had replacement arthroplasty in this group. In the Group C, of patients, 88.9% of patients returned home following an internal fixation compared to 52.2% following a replacement arthroplasty (p = 0.037). 45% of patients who were walking independently or with one stick managed to do so at 4 months following internal fixation, whereas following a replacement arthroplasty this figure was only 13.3% (p = 0.0008). Again type of surgery made a statistically significant difference in outcome, with those having internal fixation faring better at four months.Hip fractures were more common among females across all age groups. There was no significant difference in fracture patterns between the groups. A higher mortality and a greater deterioration of walking ability were noted among older patients. A larger proportion of older patients with hip fractures were unable to return home. In patients over the age of 65, at 4 months, a better walking ability and lower re operation rate was found after internal fixation compared to replacement arthroplasty. This variation was not seen in younger patients.The authors declare that they have no competing interests.AP, VE and RS designed the study, accumulated data, analysed data, drafted manuscript and MH supervised the entire study. All authors read and approved the final manuscript.


Purpose. To evaluate outcomes of peripheral iridotomy (PI) for initial management of primary angle closure suspects (PACS), chronic primary angle closure (CPAC), and chronic primary angle closure glaucoma (CPACG). Patients and Methods. Seventy-nine eyes with PACS, CPAC, or CPACG and better than 20/50 visual acuity that underwent PI as initial management were included. Eyes with previous acute angle closure attacks, laser trabeculoplasties, surgeries, or intraocular injections were excluded. Additional treatments, glaucomatous progression, intraocular pressure, visual acuity, and the number of medications were evaluated. Results. The mean followup was 57.1 ± 29.0 months (range 13.8–150.6 months). Sixty-eight eyes (86.1%) underwent additional medical, laser, or surgical treatment. Forty eyes (50.6%) underwent lens extraction due to reduced visual acuity. The mean 10× logMAR visual acuity score for all patients significantly declined from 0.94 ± 1.12 at baseline to 1.83 ± 3.49  at the last followup. Conclusions. Most patients who undergo PI for CPAC spectrum will require additional intervention for either IOP lowering or improvement of visual acuity. This suggests that a procedure that not only deepens the angle but also lowers IOP and improves visual acuity would be desirable as further intervention could be avoided. Evaluation of techniques that achieve all 3 goals is warranted. Primary angle closure glaucoma (PACG) is a leading cause of bilateral blindness worldwide . The disPACS consist of eyes with anatomically narrow angles potentially predisposing to angle closure. Once closure has developed (as evidenced by elevated intraocular pressure (IOP), peripheral anterior synechia (PAS), trabecular pigment smudging, or other signs of true apposition of iris to trabecular meshwork),CPAC has occurred. Chronic primary angle closure glaucoma (CPACG) is diagnosed when, in addition to CPAC, glaucomatous optic neuropathy is present, as evidenced by visual field, nerve fiber layer, or optic nerve damage .Treatment of the CPAC spectrum is directed toward 2 goals: (1) eliminate the mechanism of angle closure and (2) control any remaining IOP elevation. Peripheral iridotomy (PI) is currently the first line of treatment . If PI dIt has been suggested that lens extraction (LE) may be effective as an initial treatment for the CPAC spectrum –9. The rThe aim of the current study is to evaluate the outcomes of PI for the initial management of the CPAC spectrum in phakic patients with good vision at the time of iridotomy.This retrospective case series was conducted at the Robert Cizik Eye Clinic of the Ruiz Department of Ophthalmology and Visual Science at The University of Texas Medical School at Houston, Houston, USA. The Institutional Review Board  determined that this study was exempt from review prior to chart search and review. All research adhered to the tenets of the Declaration of Helsinki and was HIPAA compliant.A computerized search of the practice database was performed to identify all patients who had PI from January 1995 to December 2005 for the CPAC spectrum of disease. Eyes with best corrected visual acuity better than 20/50 and PI were identified. Eyes with less than 1 year of followup, a history of acute angle closure, and previous laser trabeculoplasty, intraocular incisional surgery, extraocular surgery, or intraocular injections were excluded. PACS: a narrow, potentially occludable angle with no identifiable anatomic or syndrome-related causes other than pathological angle closure;  CPAC: PACS with the presence of peripheral anterior synechiae (PAS), IOP ≥ 21 mmHg, or on IOP-lowering medications;  CPACG: CPAC with glaucomatous visual field, nerve fiber layer, or optic disc damage.The CPAC spectrum was divided into 3 groups , IOP (applanation), cataract grade , number of IOP-lowering medications, Spaeth gonioscopic angle classification  performeThe primary outcome variables were glaucomatous visual field/optic disc progression and the need for additional treatments. Additional treatments were further classified into the following categories: (1) medical IOP-lowering therapy; (2) additional glaucoma surgery; or (3) lens extraction surgery. Secondary outcome variables included change in angle status, IOP, BCVA, change in cataract grading, and a number of IOP-lowering medications from baseline to the last visit. Additionally, if cataract extraction or glaucoma surgery was performed, the visit prior was taken as the last visit data.t-test was performed to assess pre- to post-PI means. The Student's two-sample t-test was used for other comparisons. Logistic regression analysis was used to examine the effect of using IOP-lowering medication prior to PI on the requirement of IOP-lowering medications after PI.Demographic and baseline clinical data were summarized by mean (± standard deviation) or frequency (percentage). The primary outcome variables were reported as frequency (percentage). The time to additional treatment was defined as the number of months following initial laser PI until the introduction of any treatment . Similarly, time to additional glaucoma treatment was defined as the number of months after initial laser PI until the introduction of IOP-lowering medication or glaucoma surgery was performed, and time to lens extraction was defined as the number of months after initial laser PI until cataract surgery. Time to progression was defined as the number of months after PI until visual field and/or optic disc progression was observed. Snellen BCVA was converted to the 10× logMAR scale, −log(BCVA) × 10. Count fingers was coded as 20/1500, hand motion as 20/4000, and light perception as 20/8000. The paired All statistical tests were conducted at a 5% level of significance. Analysis was performed using SAS software version 9.2 for Windows .A total of 79 eyes of 52 patients with PACS (25 eyes), CPAC (30 eyes), or CPACG (24 eyes) met inclusion/exclusion criteria. There were 34 women (65.4%), and the mean age of the patients was 64.6 ± 12.5 years. The study included 22 White (42.3%), 15 Black (28.9%), 11 Hispanic (21.2%), and 4 Asian (7.7%) patients. The baseline ocular characteristics are shown in P = 0.0205). Forty of the total 79 eyes were right eyes (50.6%). All eyes (by eligibility criteria) had BCVA better than 20/50, while 55 eyes (69.6%) were 20/25 or better at the baseline. Seventy of the 79 eyes had cataract grading greater than 0 at baseline. Of these, 49 were classified as CPAC or CPACG. Higher graded nuclear sclerosis was more likely to be found in eyes with more advanced degrees of angle closure . Fifteen medically untreated eyes had an IOP ≥ 21 mm Hg. The mean IOP  was 19.6 ± 5.5 mm Hg, and the mean number of IOP-lowering medications was 0.75 ± 0.98.Thirty-six eyes were on IOP-lowering therapy at the time of PI. The use of IOP-lowering medications prior to PI was correlated with disease severity; that is, no PACS patients were on IOP-lowering medications before PI, while 18 (60%) CPAC and 18 (75%) CPACG patients were on IOP-lowering medications before PI  had some PAS.All eyes had a laser PI as the initial management. Three eyes  required repeated PI due to nonpatency. In one eye, repeated PI was performed at 4 months and the remaining 2 eyes had repeated PI at the 1-year followup visit. Twelve of the 79 study eyes  had iridoplasty after PI.The mean followup time was 57.1 ± 29.0 months, with a range of 13.8–150.6 months. The mean number of followup visits was 4.2 ± 3.2 per year  with a median of 3.6 per year. Sixty-eight of the 79 eyes (86.1%) required additional medical, laser, or surgical treatment. A breakdown of the additional treatments by diagnostic group is presented in N = 50). The mean number of medications required at the last followup (1.03 ± 1.11) was significantly increased from baseline . At the last followup, 25 (31.6%) eyes were on more IOP-lowering medications than baseline. Additional details on medical therapy can be seen in P = 0.0012; 95% CI, 2.0–16.6). One month after initial PI, 50 eyes (63.3%) required at least 1 IOP-lowering medication. The mean duration from initial PI to introduction of medication was 9.7 ± 12.7 months  underwent additional surgical interventions after initial PI. In most cases, additional surgical intervention occurred later than 1 month after PI. However, 2 eyes had additional glaucoma surgery within 1 month of initial PI . One eye had an IOP spike (48 mm Hg) immediately after the initial PI that could not be controlled medically, and trabeculectomy was performed urgently. IOP was controlled without additional glaucoma treatment throughout the next 7 years of followup. The other eye, which was on 4 IOP-lowering medications prior to PI, had elevated IOP (31 mm Hg) at 3 weeks after PI. A laser trabeculoplasty was performed. This eye was continuously treated with 4 IOP-lowering medications during 6 years of followup, with no glaucomatous progression observed. All 13 PACS eyes that had additional surgery had cataract extraction alone and no glaucoma surgery; 9 CPAC and 3 CPACG eyes had cataract extraction alone; 2 CPAC and 6 CPACG eyes had glaucoma surgery alone; 5 eyes had cataract extraction and glaucoma surgery combined; 7 eyes had glaucoma surgery followed by cataract extraction; and 3 eyes required glaucoma surgery after cataract extraction. See P = 0.0017) immediately prior to cataract extraction. Visual acuity improved to 2.13 ± 3.27 (P = 0.1084) after cataract extraction. One eye developed bullous keratopathy with resultant visual acuity of hand motion. After excluding this eye, the mean BCVA at the last followup was 1.69 ± 1.81 , which was not statistically different from the baseline. The mean duration from initial PI to cataract extraction was 31.7 ± 22.4 months (N = 40).Forty eyes (50.6%) underwent cataract extraction for an indication of reduced visual acuity believed secondary to cataract. In the eyes that underwent cataract extraction, BCVA (10× logMAR) decreased from 1.25 ± 1.15 at baseline to 3.15 ± 3.72 (Fourteen eyes (17.7%) had glaucomatous progression during the course of followup; 4 eyes demonstrated visual field progression only, 6 eyes optic disc progression only, and 4 both . The meaP = 0.8270, P = 0.5019, In addition to baseline, 69 eyes (87.3%) had gonioscopy examinations by the 1-month followup visits, while the remaining 10 eyes were examined later. In 53 eyes (67.2%), the angle deepened by at least 10 degrees after PI . HoweverIOP and number of IOP-lowering medications at each time point are summarized in N = 79). At the last followup, 23 (29.5%) eyes lost 2 or more lines of vision while 50 (63.3%) eyes had an increase in cataract grade  at the last followup (mean followup duration 57.1 ± 29.0 months). Two eyes had BCVA worse than 16  at the last followup: 1 due to bullous keratopathy (as mentioned above) and the other due to a cerebrovascular accident. If these eyes are excluded, the mean BCVA was 1.34 ± 1.59, which is still statistically significantly worse than baseline .BCVA in 10× logMAR scale was 0.94 ± 1.12 at baseline for all eyes  is currently the initial treatment for cases of CPAC. If after initial PI IOP remains elevated, patients are usually treated with glaucoma medications first and then surgery as necessary . HoweverThis case series demonstrates that PI alone does not prevent patients from requiring additional treatment or surgery. Eyes that were on medications before PI were 5.8 times more likely to be on medications after PI. Six months after PI, the number of medications used before surgical treatment was not any different from baseline. Of the 79 study eyes, 68 (86.1%) required additional medical and/or surgical intervention, including IOP-lowering medications, trabeculectomy, or cataract extraction. Twenty-four eyes with CPAC (80.0%) and 20 eyes with CPACG (83.3%) required additional glaucoma treatment after initial PI. Only 7 (28.0%) PACS eyes required additional glaucoma treatment but 13 (52.0%) required cataract extraction. PI alone generally failed to control IOP. By the 6-month followup visit, the mean number of IOP-lowering medications was not reduced from preiridotomy levels. Additionally, 23 CPAC/CPACG eyes (29.1%) required filtering surgery. In the current study, 51 of 79 eyes (64.6%) required additional medical and/or surgical treatment to control IOP (including 83.3% (20 of 24 eyes) in the CPACG group). Despite these interventions, 2 PACS eyes (8% of 25 PACS eyes), 3 CPAC eyes (10% of 30 CPAC eyes), and 9 CPACG eyes (38% of 24 CPACG eyes) demonstrated glaucomatous progression. The results of this study regarding the need for additional intervention for IOP lowering are similar to the results of Rosman et al., a North American population . In theiIn the current study, 7 of 25 PACS eyes (28.0%), 24 of 30 CPAC eyes (80.0%), and 20 of 24 CPACG eyes (83.3%) required additional medical and surgical glaucoma treatments; 0 of 25 PACS eyes (0.0%), 9 of 30 CPAC eyes (30%), and 14 of 24 CPACG eyes (58.3%) required additional glaucoma surgery. In another study by Peng et al. analyzing a spectrum of Vietnamese patients with CPAC, 7.1% (17 of 239 eyes) with PACS, 42.4% (42 of 99 eyes) with CPAC, and 100% (21 of 21 eyes) with PACG required medical and/or surgical intervention after PI. Of these eyes, 0.4% (1 eye) with PACS, 8.1% (8 eyes) with CPAC, and 42.9% (9 eyes) with CPACG underwent filtering surgery . These tThe PACS group in both the current study and Peng et al.'s did much better in terms of IOP control after PI. In the current study, 7 eyes (28.0%) developed ocular hypertension, requiring additional medical therapy with 2 eyes progressing to glaucomatous damage . In the study by Peng et al., 9 of 239 PACS (3.8%) eyes progressed. The combined results of these 2 studies indicate that continued vigilance is warranted for PACS patients treated with PI. Although PACS eyes are not likely to require surgical intervention for glaucoma, they are likely to develop visually significant cataract requiring extraction. Thirteen of the 25 PACS (52%) eyes underwent cataract extraction in the current study. Additionally, Peng et al. included a risk factor analysis for progression of disease and found that lens extraction was potentially protective of progression to PAC from PACS .N = 12). Gonioscopy examination revealed that angle deepening had no effect on the need for IOP-lowering medications. Fifty-three eyes (67.2%) showed that the angle was deepened by at least 10 degrees after PI. However, the degrees of angle deepening after PI neither affected the need for IOP-lowering medications nor change in number of medications from baseline. Treatment with iridoplasty also did not result in any changes in outcomes. However, the number of patients with iridoplasty in this study was small  is traditionally used to treat CPACG, lens extraction  has been proposed as an alternative. It is known that the lens is integral in the pathogenesis of CPAC , and in Not only did PI fail to control IOP without medications and did not prevent the need for further glaucoma treatment, but visual acuity loss continued uninterrupted, as evidenced by more than half of the eyes  requiring cataract extraction in the course of the study. This rate of cataract extraction is probably higher than expected, given the good initial visual acuity required for inclusion in the study. However, there exists a potential for bias because the surgeon was aware of the angle closure diagnosis, which may have lowered the threshold for cataract extraction. In other words, lens extraction could have been performed at a lower threshold of visual acuity loss in this study population than in a nonangle closure population. At baseline, visual acuity (10× logMAR) was 0.94 ± 1.12, and even though 40 eyes underwent cataract extraction, BCVA at last followup visit declined to 1.83 ± 3.49, mostly related to 2 eyes with severe visual loss. There was no significant difference in BCVA between those who underwent cataract extraction and those who did not. Of the eyes with severe visual loss, 1 had a trabeculectomy complicated by hypotony with a flat anterior chamber and choroidal effusions. The patient later underwent cataract extraction and developed pseudophakic bullous keratopathy; the cornea never recovered, and the patient refused corneal transplantation. The second eye, which did not have cataract extraction, developed poor visual acuity after the patient suffered from a cerebrovascular accident. If these 2 eyes are excluded, visual acuity still declined but not to a clinically significant degree. Significant loss of acuity is uncommon after cataract extraction. It is unknown if eyes with CPAC spectrum disease are at higher risk than the general population for complications which may result in loss of acuity.de novo, which may have different clinical implications. This study differs from previous studies in that the study population included only eyes with good visual acuity and evaluated patient outcomes in terms of additional surgery, including cataract extraction, intraocular pressure control, and glaucoma progression. In clinical practice, the visual acuity loss from poorly controlled angle closure and the visual loss from cataracts often develop concurrently. Additionally, this study does not include eyes with a history of previous acute angle closure attacks. Inclusion of eyes with previous acute angle closure attacks combines residual angle closure and chronic angle closure occurring The current study has several limitations. As is typical in retrospective studies, followup periods and data available varied. The loss of followup is an inherent characteristic of retrospective studies. Eyes with less than a year of followup were excluded, which could bias the results because patients who did well may have returned to referring physicians for care, while those who were not doing well either remained in the practice or were referred back for further care. Also, since the CPAC spectrum diseases are generally asymptomatic, patients may have been treated with PI and lost to followup care entirely, which may bias the results in an unknown way. The vast majority of patients in the study were followed continuously and came from internal referrals. κ = 0.6 for requiring additional treatment intervention). However, by including an additional 27 eyes, the estimation of the means gained some precision.Because both eyes of a patient were included if eligible in this study, this may have biased the estimation of standard deviations of outcome variables, as there was a correlation between eyes (We were unable to adequately assess progression from PACS to CPAC based on the retrospective data available in the charts. The criteria of Foster et al.  could noThis study does not examine the direct progression of the anatomy of angle closure but rather analyzes surrogate measures of further clinical intervention, which ultimately will affect the patient. Gonioscopy is a very subjective technique, where intraobserver and interobserver variability is poor –25. AddiAlso, only 2 ophthalmologists were involved in the care and treatment of the patients, making generalizability of the results limited. Nevertheless, this study is unique in that it is the first study to provide information regarding clinical outcomes after initial PI in the entire CPAC spectrum of patients.In conclusion, most patients who undergo PI for CPAC spectrum will require additional intervention for either IOP lowering or improvement of visual acuity. This suggests that a procedure that not only deepens the angle but also lowers IOP and improves visual acuity would be desirable in the treatment of PAC as further intervention could be avoided. Evaluation of techniques that achieve all 3 goals is warranted.


Chromosome 22q11.2 Deletion Syndrome (22q11.2DS) occurs in approximately 1:4,000 live births with a complex and variable presentation that includes medical, socioemotional and psychological symptoms with intellectual impairment. Cognitive impairments in spatiotemporal and visuospatial attention have also been reported. However, maintenance of selective attention to dynamic and interacting objects has not been systematically investigated in children with 22q11.2DS.We used a multiple object tracking task to assay capacity and resolution performance of children with 22q11.2DS aged 7 to 14 years versus age-matched typically developing (TD) peers.Children with 22q11.2DS but not TD children demonstrated impaired performance when task demands increased due to an increase in the number of targets presented, but not from an increase in object speed. Task performance in children with 22q11.2DS was also unrelated to intelligence or measures of attention deficit hyperactivity disorder.These findings suggest that children with 22q11.2DS may be particularly susceptible to dynamic crowding of objects with increasing cognitive demands related to monitoring multiple targets reflecting a reduced acuity in spatiotemporal cognitive representation. Chromosome 22q11.2 deletion syndrome (22q11.2DS), also known as DiGeorge  syndromeCognitive deficits commonly reported with 22q11.2DS include difficulties with numerical thinking  that mayMultiple object tracking (MOT) tasks have been used as a means to assess the capacity and resolution of spatiotemporal attention -20. In aIn the current study, we use a MOT task on a computerized touch screen based on Trick and colleagues' (2005) "catch the spies" MOT task developed for children to investigate the ability of children with 22q11.2DS to accurately maintain attention to dynamically interacting targets and distractors in visual space over time. We hypothesized that when asked to dynamically track one or more targets in a field of moving distractors, children with 22q11.2DS would demonstrate increasingly impaired performance with increasing task demands  than typically-developing (TD) age-matched peers.in-situ hybridization analysis. Typically developing (TD) child participants had no known diagnosis of developmental disorder. Inclusion criteria for study recruitment in both groups included: proficiency in English, no brain infarct, central nervous system infection, head injury or other focal neurological abnormality, and as part of a larger study - no issues contraindicated for MRI. All participants had normal or corrected-to-normal vision.Participants were tested at the University of California Davis (UC Davis) Medical Center M.I.N.D. Institute in accordance with a UC Davis Institutional Review Board approved protocol. Parental consent and child assent were obtained for all participants. Diagnosis of 22q11.2DS was confirmed in children using fluorescent Intelligence quotient (IQ) measures were obtained using the Wechsler Intelligence Scale for Children, Version 4 WISC-IV;  and the A total of 47 children with 22q11.2DS and 45 TD children were recruited for the study. Participants were subsequently excluded from further analyses if they were unable to complete both MOT tasks (described below) and/or if their performance on either task was below chance or 2.5 SD below the mean group performance. In total, 34 children with 22q11.2DS  and 41 TD children  were able to complete both the 30 frames per second (fps) and 60 fps tasks and were included in further analyses.P = 0.0001); Processing Speed Scale scores  (t(60) = 8.84, P = 0.0001); Working Memory Scale scores  (t(59) = 6.07, P = 0.0001); Verbal Comprehension Scale scores  (t(67) = 8.73, P = 0.0001); and Perceptual Reasoning Scale scores  (t(67) = 9.14, P = 0.0001), as measured by the WISC-4 or the WASI. Groups did not differ in mean age (t(73) = 1.48, P = 0.14)) or gender composition  and excluded and included children did not differ in Full Scale IQ, age, gender composition, or SNAP-IV measures of inattentive-, hyperactive/impulsive-, or combined-type ADHD .As a group, children with 22q11.2DS had lower Full Scale scores  (t(68) = 12.35, Children were trained on a simple two-part version of the task and were told that they were helping space explorers find friendly aliens hiding on one or more of the planets they were exploring. A schematic of an example three-target trial is illustrated in Figure Stimuli were presented using Macromedia Projector , running on Windows XP operating system  on a touch-sensitive monitor  placed 60 cm away from the participant. Measurement of the black tracking field was 756 by 756 pixels. Each trial began with seven identical cartoon planets measuring 56.7 by 56.7 pixels surrounding the instructions "Track Aliens", centered at fixation. Next, one, two or three identical cartoon aliens measuring 94.5 by 94.5 pixels appeared and then shrank to 56.7 by 56.7 pixels before moving 'behind' a planet to 'hide'. To signal the start of motion, the planets with 'hidden' aliens flashed for one second then moved randomly and independently of one another at three pixels per frame in vertical, diagonal and horizontal directions. Objects collided with one another or the field boundary but did not overlap or cross over the field boundary. Objects changed directions when colliding with one another or the field boundary, independently changing direction with a 0.005 probability per frame. The task was presented in two parts at an apparent frame rate of 30 fps (8.25 ms/frame) and 60 fps (16.5 ms/frame) for all participants. Total tracking time for the 30 fps version was 10 sec and 6 sec for the 60 fps version. Length of tracking time was reduced in the 60 fps version of the task because pilot data demonstrated that several children with 22q11.2DS were performing at less than chance levels when required to track targets at 60 fps for 10 sec. Both the 30 and 60 fps versions of the task were made up of 30 trials: 10 with one target, 11 with two targets, and 9 with three targets presented pseudo-randomly. The 30 and 60 fps versions were presented in random order.Participants were instructed to visually track the target objects, identifying them by pressing them on the monitor using their dominant index finger. Selected planets became 'highlighted' until the participant ended the trial by pressing the spacebar button on the computer keyboard. Trials were not time limited and participants were able to deselect highlighted planets and select other choices as often as they wished.et al. (2010), we calculated performance corrected for error using the following formula to generate a k-score for each trial in the two separate tasks :Based on Hulleman (2005) and O'Hearn n equals the number of distractor elements (seven planets) that appear on the screen at the beginning of each trial, t equals the number of targets  to track, with c equal to the number of correct choices made by the participant during the response phase of a given trial. The k-scores generated for each trial were averaged within conditions to generate a one-target, two-target and three-target mean k-score for each participant. These values accounted for the relative difficulty of the trials with regards to the number of targets and distractors. Perfect accuracy on all trials would generate a k-score of 1, 2, and 3 for the one-target, two-target and three-target conditions respectively.where k-scores. Data for children whose performance was still below chance level or 2.5 SD below group mean performance after this correction was removed from further analyses.Next, we generated a proportional performance score by dividing participants' k-scores by the highest possible k-score value for each condition. Statistical analyses were performed on proportional If the participant selected a target more than once, it was included as a final choice if the number of selections was an odd number, given that an even number of selections implies that for every selection a corresponding de-selection of the same target followed. Final choices for each trial were characterized as the first, second and third non-identical selections depending on the number of targets in the trial . The number of extra non-identical selections was calculated as 'Intrusion errors'.F = 18.48, P < 0.0001, η2 = 0.21) but not of AGE  = 2.65, P = 0.11) or GENDER  = 0.35, P = 0.56). An interaction between GROUP and NUMBER OF TARGETS  = 12.39, P < 0.0001, η2 = 0.15) also reached statistical significance. There were no other statistically significant main effects or interactions for OBJECT SPEED, NUMBER OF TARGETS, AGE, or GENDER .All analyses were conducted using SPSS version 20  with an accepted confidence level of 0.95  reporting exact statistics or using Bonferroni correction for multiple comparisons. Group differences in task performance were measured by comparing proportional k-scores across GROUP  and OBJECT SPEED  and NUMBER OF TARGETS  controlling for AGE and GENDER using a repeated measures multivariate analysis of variance (MANOVA). There was a main effect of GROUP  = 10.51 P = 0.002, η2 = 0.13). Within groups at 30 fps, there was a significant main effect of NUMBER OF TARGETS  = 9.63, P < 0.001, η2 = 0.117) and an significant interaction of GROUP and NUMBER OF TARGETS  = 4.07, P = 0.02, η2 = 0.05).Next, we used Repeated Measures MANOVA with the AGE and GENDER covariates removed to explore the GROUP by NUMBER OF TARGETS interaction at 30 fps and then at 60 fps. At 30 fps, there was a significant main effect of GROUP . Within groups at 60 fps, there was a significant main effect of NUMBER OF TARGETS  = 13.36, P < 0.0001, η2 = 0.16) and an significant interaction of GROUP and NUMBER OF TARGETS  = 6.62, P = 0.002, η2 = 0.09).At 60 fps there was a significant main effect of GROUP  = 8.83, P = 0.04, η2 = 0.059) at 30 fps and 3 targets at 30 fps  = 10.89, P = 0.002, η2 = 0.13) or 60 fps  = 8.82, P = 0.004, η2 = 0.11). Group differences indicating poorer performance by the 22q11.2DS group versus the TD group approached but did not reach statistical thresholds in performance when tracking one target at 30 fps  = 2.80, P = 0.10) or 60 fps  = 2.97, P = 0.09) or when tracking two targets at 60 fps  = 1.33, P = 0.25).Group differences in performance were then interrogated at each level of NUMBER OF TARGETS with pairwise comparisons corrected for multiple comparisons using the Bonferroni method. As illustrated in Figure Post-hoc analyses of NUMBER OF TARGETS were conducted using Bonferroni-corrected paired t-tests at each level of OBJECT SPEED within groups. As illustrated in Figure t(33) = 1.05, P = 0.30) but a significant performance impairment difference between the one- and three-target tasks (t(33) = 2.89, P = 0.007) and between the two- and three-target tasks (t(33) = 2.72, P = 0.01). In the 60 fps condition, performance did not differ for the 22q11.2DS group between the one- and two-target conditions (t(33) = 0.51, P = 0.96) but performance was lower on the three-target task than the one-target (t(33) = 3.90, P = 0.0001) or two-target tasks (t(33) = 3.75, P = 0.001). There were no significant differences in task performance when tracking one, two or three targets in TD children for either the 30 or 60 fps version of the task .P = 0.001), compared to TD children, FSIQ did not predict performance on any component of the MOT task  in children with 22q11.2DS. However, within the TD group, FSIQ was positively correlated with performance on one-target 30 fps trials (r(37) = 0.33, P < 0.05] but not for other trial types. SNAP-IV scores of inattentive, hyperactive/impulsive and combined-type ADHD for children with 22q11.2DS were treated as continuous variables and correlated against MOT task performance. SNAP-IV scores did not predict performance on any component of the MOT task .Although children with 22q11.2DS had significantly lower FSIQ (For children with 22q11.2DS, having two or more targets to track negatively impacted MOT task performance. Increasing the speed of object motion from 30 to 60 fps did not have a statistically measurable effect on performance in either group. In contrast to the 22q11.2DS group, MOT task performance in the TD group was unaffected by the number of targets or speed of motion. MOT task performance in the 22q11.2DS group was not predicted by intelligence measures or ADHD symptoms. Unpacking inter-group performance by target number, we found that tracking a single target was statistically the same for both groups at the 30 fps object speed. Adding a second target at 30 fps, the 22q11.2DS group showed impaired performance relative to their TD counterparts that was not apparent between the groups when tracking two targets at 60 fps. This suggests that increasing speed in combination with the additional target began to affect children in the TD group at 60 fps leveling group performance to that of children with 22q11.2DS. This finding also indicates that speed-induced dynamic crowding is not specific to children with 22q11.2DS and that increasing the object speed was increasing task demands in part even though a significant main effect of speed was not statistically detectable. As task demands further increased with three targets at 30 and 60 fps, children with 22q11.2DS demonstrated a significant drop in performance and accuracy that TD children did not experience. This suggests that capacity to track objects in space and time is impaired in children with 22q11.2DS.The origins of this impairment in children with 22q11.2DS may stem from reduced acuity in spatiotemporal representation. Increasing the number of targets serves to increase the number of object interactions and the likelihood that attention will erroneously shift from the target object to a distractor. Poorer acuity in spatiotemporal representation of moving objects in space increases apparent crowding and interaction of objects. In the brain, the origin of these impairments in children with 22q11.2DS may stem from atypical brain development in frontoparietal cortical circuitry on which attention depends ,25. HoweA variety of factors affect MOT task performance. For example, in TD adults, tracking four or more targets begins to impact MOT performance and accuracy ,20. Our Although there was no statistically measurable difference in performance from increasing object speed from 30 to 60 fps in the present study, speed has been shown to modulate spatial attention capacity. Alvarez and Franconeri  report tAlthough the TD group generally outperformed the 22q11.2DS group, errors made by TD children and the positive correlation between FSIQ and performance on the one-target, 30 fps trials but not for the one-target trials at 60 fps for TD children are interesting. The presentation of target number trials is random and it might be expected that the performance would decrease with increased task loads in children with lower FSIQ. It is possible that children with lower FSIQ are deploying different cognitive strategies across trial types. Capacity and resolution of spatiotemporal attention likely continues to develop beyond the age range designated in this study, which is consistent with the findings of Trick and colleagues . ProspecAlthough the findings demonstrate impaired attentional capacity for tracking multiple objects over time in children with 22q11.2DS, the study is not without limitations. The length of the trials was adjusted so that the 30 fps trials were 4 sec longer than the 60 fps trials. Preliminary data collection revealed that several children with 22q11.2DS were performing at less than chance when attempting the 10 sec duration 60 fps trials. A ceiling effect was not evident in the TD children but larger performance impairment may have been evident in the TD group had the 10 sec 60 fps condition been used. Although, intelligence was not predictive of MOT task performance in children with 22q11.2DS, the study could have also benefited from the inclusion of a second control group comprised of age-matched children with another neurodevelopmental disorder. This would serve to test the specificity of hypothesized spatiotemporal and attentional impairment in children with 22q11.2DS. The study could also be improved by the addition of eye-tracking technology. Individual differences in ability to saccade and maintain gaze on a moving target could explain some performance differences. Eye tracking could also be used to measure specific incidences where gaze and attention shifts from the targets to distractors.Unrelated to intellectual ability, increasing MOT task demands in the form of additional targets negatively impacted performance in children with 22q11.2DS but not TD children. Children with 22q11.2DS may be particularly susceptible to spatial interactions and dynamic crowding of moving objects because of a reduced acuity in spatiotemporal resolution and representation.22q11.2DS: Chromosome 22q11.2 deletion syndrome; ADHD: Attention deficit hyperactivity disorder; Fps: Frames per second; MANOVA: Multivariate analysis of variance; MOT: Multiple object tracking; SNAP-IV: Swanson, Nolan, and Pelham version IV; TD: Typically developing; VCFS: Velocardiofacial syndromeAll authors state that there are no actual or potential conflicts of interest, including financial, personal or any other relationships or organizations within three years of beginning this work, that could inappropriately influence, or be perceived to influence, their work.MHC acquired the data as well as played a primary role in data collection, analysis and interpretation in addition to drafting the manuscript. EAB played a critical role in generating the statistical models for analysis, provided data interpretation and contributed significantly to drafting the manuscript. JS participated in the design of the study and provided data interpretation and support. TJS conceptualized the study and played a primary role in the task design and data interpretation. All authors have read and approved the final manuscript.


Poecilia reticulata). Content of Ag(I) increased with increasing time of the treatment and applied concentrations in fish tissues. It can be concluded that a carbon tip or carbon pencil coupled with a miniaturized potentiostat can be used for detection of silver(I) ions in environmental samples and thus represents a small, portable, low cost and easy-to-use instrument for such purposes.We used carbon paste electrodes and a standard potentiostat to detect silver ions. The detection limit  was estimated as 0.5 μM. A standard electrochemical instrument microanalysis of silver(I) ions was suggested. As a working electrode a carbon tip (1 mL) or carbon pencil was used. Limits of detection estimated by dilution of a standard were 1 (carbon tip) or 10 nM (carbon pencil). Further we employed flow injection analysis coupled with carbon tip to detect silver(I) ions released in various beverages and mineral waters. During first, second and third week the amount of silver(I) ions releasing into water samples was under the detection limit of the technique used for their quantification. At the end of a thirteen weeks long experiment the content of silver(I) ions was several times higher compared to the beginning of release detected in the third week and was on the order of tens of nanomoles. In subsequent experiments the influence of silver(I) ions  on a plant model system (tobacco BY-2 cells) during a four-day exposition was investigated. Silver(I) ions were highly toxic to the cells, which was revealed by a double staining viability assay. Moreover we investigated the effect of silver(I) ions  on guppies ( The mechanisms of their effects can be very heterogeneous. For these reasons the new procedures and technologies, not only to monitor the levels of contamination, but also to remediate the polluted environment are still developing. The heavy metal ions such as lead, cadmium, mercury, silver and their compounds are considered to be among the most toxic substances polluting all parts of environment –5. The htic life . Recentltic life –11 and otic life –20 have Determination of silver(I) ions in waters is difficult because the formation of a number of silver complexes with inorganic as well as organic compounds that depress the acute silver toxicity ,18,19. TThe aim of this work was to detect silver(I) ions by using various electrochemical instruments. Several carbon electrodes were tested for silver(I) determination. The optimized procedures were utilized for determination of silver(I) in various water samples, tobacco BY-2 cells and guppies treated with silver(I) ions.2.2.1.2− formed. There are many others compounds with which silver(I) ions can interact, forming many hardly soluble compounds, which do not pose a threat to organisms. The toxicity of silver ions is probably caused by their very good affinity for nucleic acids and proteins. The binding into an active site of the enzyme leads to the expressive inhibition of enzyme activity. This effect was observed by using of simple spectrometric test, in which we studied inhibition of urease activity by silver(I) ions (in vivo experiments [Silver(I) ions in aquatic environment are stable over a wide range of pH values . Only in(I) ions . Compareeriments ,15,32–342.2.Several authors have reported on the use of carbon electrodes as the working one to determine silver(I) ions –29,35,362.3.In the following experiments, we aimed at detection of silver(I) ions by using micro-instruments. For this purpose a miniaturized PalmSens potentiostat connected with and auxiliary platinum electrode and referent Ag/AgCl 3 M KCl electrode was utilized. As working electrode a carbon tip (1 mL) purchased from Eppendorf was used. Electrodes were placed in a simple plastic cell. Solutions exchange was carried out by peristaltic pump. The whole detection system was connected to a PC . MeasureFurther the calibration dependence was determined. Within a concentration range from 0 to 1.5 μM a characteristic non-linear calibration dependence was observed . If we s2.4.2 = 0.9987. Relative standard deviation was 4.5%. Limit of detection estimated by diluting was 10 nM (time of accumulation 240 s). Course of hydrodynamic voltammogram for silver(I) ions measured at carbon pencil differed slightly compared to the carbon tip one, with a maximum at 600 mV (In addition to detection of silver(I) ions at carbon tip, a carbon pencil (500 μm) was used for the same purpose. Using this electrode we obtained well developed silver(I) ions signal at 255 mV inset in , which wt 600 mV . The shi2.5.−) presented in tap water. At the end of the experiment the Ag(I) concentration was several times higher to the beginning of the release detected in the third week  ions released into various waters. During first, second and third week the amount of silver(I) ions released into water samples was under detection limit of the technique . In the ird week . In addi2.6.In the next experiments the influence of silver(I) ions on a plant model system (tobacco BY-2 cells) was investigated. Primarily we aimed our attention on the viability of the cells measured by double staining. Control BY-2 cell viability did not change during the four day long experiments and ranged between 97 and 100%. If BY-2 cells were exposed to silver(I) ions (5 μM), only a slight decline in viability was determined. Two times higher concentration caused a marked decrease in the viability already from the beginning of the experiment . The strDue to complexity of the extracts prepared from untreated and treated BY-2 cells, samples were analysed using HPLC coupled with a CoulochemIII detector to quantify silver(I) ions . It foll2.7.Silver(I) ions are very toxic to fish, hence their monitoring is very important indicator of environmental quality. In our experiments guppy fish were used. They were kept in 100 L aquaria according to OECD guidelines. In spite of the fact that all fish were fed, treated fish lost weight compared to untreated ones. At the very end of the experiment the weight of fish treated with 0.6, 1.2 and 2.5 μM of silver(I) ions was significantly lower compared to controls. HPLC-ED chromatograms of silver(I) ions detected in tissues of fishes treated with 2.5 μM are shown in 3.3.1.Urease EC 3.5.1.5  was purchased from Sigma Aldrich . Silver nitrate and all other reagents used were purchased from Sigma Aldrich (ACS purity unless noted otherwise). Stock standard solutions were prepared with ACS water (Sigma-Aldrich) and stored in the dark at a temperature of −20 °C. Working standard solutions were prepared daily by dilution of the stock solutions. All solutions were filtered through a 0.45 μm Nylon filter discs  prior to HPLC analysis. The pH value was measured using WTW inoLab Level 3 with terminal Level 3 , controlled by the personal computer program . The pH-electrode  was calibrated by set of WTW buffers . Deionised water underwent demineralization by reverse osmosis using the instruments Aqua Osmotic 02  and then it was subsequently purified using Millipore RG –MiliQ water.3.2.The system consisted of a solvent delivery pump operating in range of 0.001–9.999 ml/min , a guard cell , a reaction coil (1 m) and/or a chromatographic column , and an electrochemical detector. The electrochemical detector (ED) includes one low volume flow-through analytical cell , which is consisted of glassy carbon working electrode, palladium electrode as reference electrode and auxiliary carbon electrode, and Coulochem III as a control module. The sample (5 μL) was injected manually. The obtained data were processed by CSW 32 software. The experiments were carried out at room temperature. Guard cell potential was 0 V. A glassy carbon electrode was polished mechanically by 0.1 μm of alumina  and sonicated at room temperature for 5 min using a Sonorex Digital 10 P Sonicator  at 40 W ,41.3.3.Electrochemical measurements were performed using an AUTOLAB analyser . The three electrode system consisted of a carbon paste working electrode, an Ag/AgCl/3 M KCl reference electrode and a carbon counter electrode. The differential pulse voltammetry (DPV) parameters were as follows: initial potential −0.4 V, end potential 0.8 V, modulation amplitude 25 mV and step potential 0.5 mV. All experiments were carried out at laboratory temperature. Acetate buffer  was used as the supporting electrolyte. The raw data were treated using the Savitzky and Golay filter (level 2) and the moving average baseline correction (peak width 0.03) of the GPES software. The carbon paste was made of 70% graphite powder (Aldrich) and 30% mineral oil . The carbon paste was housed in a Teflon body having a 2.5 mm diameter of active disk surface. The electrode surface was polished before each determination with a soft filter paper prior to measurement –45.3.4.2. The electrodes were used without any pre-treatment. They were polished mechanically by 0.1 μm of alumina  [Electrochemical measurements were performed using a PalmSens instrument  using a plastic cell with three electrodes. The three electrode system consisted of carbon tip or carbon pencil working electrode, an Ag/AgCl/3 M KCl reference electrode and a platinum counter electrode. Carbon tips were purchased from Tosoh (Japan). A pipette tip is made from polymeric material and coated by graphite. The sampling tip is made of conductive resin and a part of the electrode of a capacitor which is a component of the oscillation circuit. The pencil leads  were purchased from Kohinor . Immersing 3 mm of the pencil lead into a solution resulted in an active electrode area of 4.91 mmc., USA) –48. All 3.5.To study the releasing of silver ions into water, tap water from city of Brno, distilled water, Milli-Q water, common mineral waters , flavoured mineral waters  and beverages  available in the supermarket were used. Into one litre of certain water sample silver plate (app. 1 g) was added. During 13 weeks long experiment one millilitre was sampled per a week from certain sample of water.3.6.Nicotiana tabacum BY 2 line was grown in liquid Murashige and Skoog medium supplemented with sucrose (30 g/L), KH2PO4 (0.2 g/L), thiamine (1 mg/L) and 2,4-dichlorophenoxyaetic acid (0.2 mg/L) according to Nagata [The suspension culture of o Nagata . The sus3.7.Modified double staining with fluoresceine diacetate (FDA) and propidium iodide (PI) for the determination of the viability of the cells was used ,51. In o3.8.N,N,N′,N′-tetraacetic acid, 10 mM MgCl2 containing 4% formaldehyde (v/v). After 30 minutes long fixation the cells were three times washed by PEM buffer. The cells were resuspended by PEM buffer containing 0.1% of Triton X100 (v/v) and 1 μg/ml Hoechst 33285. Cells were observed by fluorescent microscope AX 70 .Tobacco BY-2 cells were fixed by mixing of cell suspension with PEM buffer, ratio 1:1. PEM buffer consisted from 100 mM piperazine-1,4-bis(2-ethansulfonic acid) pH 6.9, 10 mM ethyleneglycol-bis(2-aminoethylether)-3.9.2HPO4 and 0.37 M NaOH, adjusted to pH 12) and with 42 μL of phenol solution . This mixture was stirred and incubated for 15 min at 37°C. After this incubation the differences of absorption at 630 and 670 nm were measured. To investigate the effect of silver(I) ions on urease activity, solution of silver(I) ions (1 μM) was added to solution of soya beans urease.Spectrometric measurements were carried using an automated chemical analyser BS-200 . Reagents and samples were placed on cooled sample holder (4 °C) and automatically pipetted directly into plastic cuvettes. Incubation proceeded at 37 °C. Mixture was consequently stirred. The washing steps by distilled water (18 mΩ) were done in the midst of the pipetting. Apparatus was operated using software BS-200 . The reagents for spectrometric measurements of urease activity were prepared as described in ,52,53. S3.10.Poecilia reticulate), 2 or 3 months old, were exposed to silver nitrate, always seven specimens per dose 0, 0.3, 0.6, 1.2, 2.5 or 5 μM. The experiment lasted 7 days (168 hours); a fish from each experimental variant was sampled per day. The experimental conditions such as pH value of the solution were kept constant; oxygen concentration and temperature were monitored during the experiment. Oxygen concentration varied within the range from 1.7 to 4.0 mg/L, the pH level from 6.34 to 7.00, and the temperature from 20.2 to 21.5 °C during the 7 days long experiment. The sampled fish was killed by CO2, washed one time with distilled water and one time with 0.5 M EDTA.Guppies (3.11.Data were processed using MICROSOFT EXCEL® (USA). Results are expressed as mean ±S.D. unless noted otherwise. Differences with p < 0.05 were considered significant (t-test was applied for means comparison). The detection limits  were calculated according to Long and Winefordner , whereas4.in situ analysis of target molecules is very topical. Heavy metals still are among the most dangerous environmental pollutants. In this work we show that a common carbon tip or carbon pencil coupled with a miniaturized potentiostat can be used for detection of silver(I) ions at nM levels. The instrument was tested on analysis of various water samples contaminated by silver(I) ions. Moreover, we used a commercial instrument liquid chromatography with electrochemical detection to analyse extracts from tobacco BY-2 cells and guppies treated with these toxic ions. If we consider selectivity of liquid chromatography and sensitivity of instrument proposed by us with working electrode as carbon tip, a small, portable, low cost and easy-to-use instrument could be fabricated.Suggesting of instruments for


Blunt abdominal trauma (BAT) is a leading cause of morbidity and mortality. Rapid diagnosis and treatment with the Advanced Trauma Life Support guidelines are vital, leading to the development of focused assessment with sonography in trauma (FAST).A retrospective study carried out from January 2007 to 2008 on all patients who presented with BAT and underwent FAST scan. All patients subsequently had a CT scan within 2 hours of admission or a laparotomy within 2 days. The presence of intraperitoneal free fluid was interpreted as positive.P = 0.001). Cohen's chance corrected agreement was 0.3. Twenty-one out of 28 who underwent laparotomies had positive FAST results, indicating accuracy of 75% (95% CI: 57 to 87%).One hundred patients with BAT presented; 71 had complete data. The accuracy of FAST in BAT was 59.2%; in these, 31 (43.7%) were confirmed by CT and 11 (15%) by laparotomy. There were 29 (40.8%) inaccurate FAST scans, all confirmed by CT. FAST had a specificity of 94.7% (95% CI: 0.75 to 0.99) and sensitivity of 46.2% (95% CI: 0.33 to 0.60). A positive predictive value of 0.96 (0.81 to 0.99) and negative predictive value of 0.39 (0.26 to 0.54). Fisher's exact test shows positive FAST is significantly associated with intra-abdominal pathology (Patients with false negative scans requiring therapeutic laparotomy is concerning. In unstable patients, FAST may help in triaging and identifying those requiring laparotomy. Negative FAST scans do not exclude abdominal injury. Further randomised control trials are recommended if the role of FAST is to be better understood.


We sought to characterize the compacted and trabeculated layers of the left ventricle in patients presenting with ventricular dysrhythmias. Our results showed the dysrhythmic group had a statistically significant increase in the trabecular thickness as well as increased prevalence of trabecular to compacted thickness ratio.Cardiac MRI (CMR) is increasingly being used clinically to assess patients with ventricular dysrhythmias. Structural heart disease such as non-compaction is associated with dysrhythmic risk. Recent literature has characterized the regional thickness of the compacted and trabeculated layers of the left ventricle (LV) in normal subjects but not in patients with ventricular dysrhythmias. We sought to characterize the regional thickness of the compacted and trabeculated layers in a young community-based ventricular dysrhythmia population.The study consisted of 98 patients under the age of 50 who had undergone CMR for ventricular dysrhythmia evaluation. These patients were compared to 26 age-matched normal subjects. Patients who had known cardiomyopathy or myocardial infarction and those referred for AICD evaluation were excluded. SSFP cine images were used to assess cardiac structure and function. Intravenous gadolinium was given for late gadolinium enhancement (LGE) assessment. Regional thickness of the compacted and trabeculated layers were assessed in short axis cine views in 16 of the standard 17 segments at end-diastole. The trabeculated layer thickness and the ratio of trabeculated to compacted layer were compared between the dysrhythmic and control group.The mean age was 37 years and 56 (57%) were women. In the dysrhythmic group, 45 had premature ventricular contractions (PVC) and 55 had ventricular tachycardia (VT). Mean LV ejection fraction was 54±7% in the dysrhythmia group. LGE was present in 10 cases (10%) but none showed an infarct pattern. On average, the trabeculated layer was significantly larger in the dysrhythmic group than in control group: 3.7±1.4 mm vs. 3.0±1.0 mm at base (p<0.001), 4.6±1.3 mm vs. 3.4±1.0 mm in mid segment (p<0.001) and 5.4±1.5 mm vs. 3.5±0.9 mm in apical segment (p<0.001). The prevalence of trabeculated to compacted ratio ≥2.0 was 19% in controls, 20% in PVC group and 20% in VT group (p=NS). In contrast, the prevalence of a ratio ≥2.3 was 0 in controls, 16% in PVC group and 11% in VT group (p=0.01). The most common areas where the ratio exceeded 2.3 were mid-anterior, mid-anterolateral, apical anterior and apical lateral walls.In this young cohort with ventricular dysrhythmias, the trabeculated layer was significantly thicker than age-matched controls. Moreover, a trabeculated to compacted ratio greater than 2.3 was only present in patients with ventricular dysrhythmias, but not in normal controls. Our findings suggest that increased thickness of the trabeculated layer in young subjects may be associated with the risk of ventricular dysrhythmia.None.


Prevalence of food allergy is considered to be increasing with some even suggesting a food allergy epidemic. We aimed to look at the changes in reported symptoms of food allergy and food allergen sensitisation over a 10 year period in the same geographical area. We compared the prevalence of reported food allergy and food allergen sensitisation in 9-10 year old children between the Isle of Wight (IoW) birth cohort and Food Allergy and Intolerance Research (FAIR) cohort.Subjects from the 1989 IOW birth cohort (n=1456) were followed up at 1, 2, 4, 10 and 18 years; the 10 year follow up was completed in 1999-2001. The FAIR cohort was established in 2001 (n=988) and children were followed up at 1, 3 and 9 years; the 9 year follow up was completed in 2010-2011. Reported symptoms were based on the questionnaire data and sensitisation to food allergens was defined as ≥3mm response on skin prick test (SPT).Reported food allergy information was available for 1368 and 827 children and SPT was available for 1034 and 588 children in the IoW and FAIR cohort respectively. Reported allergy to Milk (1.2% to 2.1%), Egg (0.7% to 1.6%), Peanut (1.1% to 1.7%) showed an increase but not statistically significant. Reported allergy to Fish (0.4% to 0.1%) decreased but this was not significant. Statistically significant increase was seen for wheat . Allergic sensitisation to Milk (0.3% to 0.3%), Egg 0.4% to 0.3%), Peanut (1.7% to 2.4%) and Fish (0.8% to 0.2%) did not show significant change.There was no significant increase in reported food allergy or sensitisation over a decade for milk, egg, fish and peanut. There is an increase in reported allergy to wheat.None declared.


Breast MRI has been incorporated into the NHSBSP programme and therefore is subject to quality assurance (QA) to NHSBSP standards. The breast screening technical guidelines recommend weekly testing of signal-to-noise ratio (SNR) and suppression effectiveness. We tested a method of implementing these recommendations on a Siemens 1.5T Avanto scanner using phantoms and software supplied as standard.Phantoms were placed in the right and left apertures of the Siemens four-element breast matrix coil and manufacturer QA performed. Suppression effectiveness was measured by acquiring a 3D spoiled gradient echo (FLASH) sequence with and without water suppression. Regions of interest (ROI) were drawn in both phantoms and percentage signal reduction due to water suppression calculated for three slices. SNR was measured using the standard fat-suppressed 3D FLASH sequence acquired three times after waiting 10 minutes to minimise fluid motion artefacts. Subtractions were performed and ROI drawn in both phantoms. SNR was calculated as √2×/(standard deviation of the subtraction image) for three slices.The breast coil passed the manufacturer QA tests. Mean suppression effectiveness was 97.0% (95.6 to 98.0%) for the right phantom and 96.9% (95.4 to 97.7%) for the left. Mean SNR was 98.8 (41.2 to 110.9) for the right phantom and 96.2 (53.8 to 115.4) for the left. The low values of SNR were likely to be due to artefacts from fluid motion on the subtraction images used for noise calculations.The methods proposed allowed an independent measure of suppression effectiveness. More work is needed to ensure a reliable measurement of SNR.


To estimate the prevalence of exposure to domestic violence in primary care patients in Slovenia and determine the associated factors.In a systematic cross-sectional survey, 70 physicians from 70 family medicine practices from urban and rural settings conducted interviews with every fifth patient from January 15 to February 15, 2010.P < 0.001; OR, 4.52; 95% CI, 2.83-7.20; P < 0.001, respectively) and formal divorce . Factors that decreased the chances of exposure to psychological violence were age of 65 years or above  and single status , while age of 65 years or above  and parenting of two children  decreased the chances of exposure to physical violence.Of 2075 patients (98.8% response rate), 372 (17.9%) were exposed to psychological or physical violence in the family in the last five years. Factors that increased the chances of exposure to psychological and physical violence were female sex (odds ratio [OR], 3.27; 95% confidence interval [CI], 2.24-4.76; We found the rate of exposure to psychological and physical violence of 17.9%, which indicates that this problem is a serious public health issue that needs to be addressed by adequate measures. The identified risk and protective factors could serve as a valid guidance for family physicians dealing with physical violence. Domestic violence is a serious health issue, with consequences ranging from physical impairments to psychological symptoms, physical trauma, and death -3. Its pThe study included 70 general practitioners (GP) who interviewed every fifth patient about domestic violence exposure from January 15, 2010 till either 30 patients were interviewed or February 15, 2010. The practices were selected from both urban and rural settings, serving populations with diverse socio-economic and ethnic characteristics; the diversity and geographical representativeness of family care settings followed the study design described by Svab et al  . The study was approved by the National Medical Ethics Committee of the Republic of Slovenia.2 test. Multivariate binary logistic regression analysis was used to determine the risk factors for psychological and physical violence. The modeling included all the variables from the questionnaire. With regard to each predictive variable in the logistic model, the Wald χ2 value, statistical significance , odds ratios (OR), and 95% confidence intervals (CI) were calculated. Statistical analysis was performed with SPSS 15.0 software . P < 0.05 was set as the level of statistical significance.The sample data were presented by frequencies and percentages. Univariate comparisons were made using χThe sample included 2075 individuals (98.8% response rate), 768 (37.0%) men and 1307 (63.0%) women . The majThe age structure of the whole sample was as follows: up to 35 years, 22.5% (n = 467); 36-49 years, 30.0% (n = 622); 50-64 years, 27.8% (n = 577); and 65 years or above, 19.7% (n = 409), with a mean age of 49.4 ± 16.1. The victims of psychological abuse were 48.6 ± 15.6 years old, while the victims of physical violence were 46.4 ± 16.5 years old.P = 0.023)  and 60 participants (35.9%), respectively, were exposed to psychological and physical violence rarely (once or twice a year); 76 (37.1%) and 60 (35.9%), respectively, were exposed sometimes (once a month); 35 (17.1%) and 34 (20.4%), respectively, were exposed often (once or twice a week); and 32 (15.6%) and 11 (6.6%) respectively, were exposed constantly (up to twice a week). Those who experienced psychological violence were significantly more frequently exposed to it than those who experienced physical violence (= 0.023) .The perpetrators of psychological violence were other family members in 38.0% (n = 78) of the cases and the partner in 62.0% (n = 127) of the cases. Similarly, the partner was involved in 70.1% (n = 117) of the cases of physical violence, and other family members in 29.9% (n = 50) of the cases .2 = 0.080; P < 0.001) and 13% of the variance of physical violence   Female sex  and formal divorce  increased the likelihood of psychological violence exposure in patients, while age of 65 years or above  and single status  decreased it. Age of 65 years or above  and parenting of two children  decreased the likelihood of physical violence .This study found the prevalence of domestic violence in Slovenian family practice patients in the period from 2005-2009 to be 17.9%, and identified the perpetrators and the factors associated with the exposure to psychological and physical violence in primary care patients. The exposure to psychological domestic violence was more frequent than exposure to physical violence. A significantly greater percentage of victims were women, while the perpetrators were mostly victims` intimate partners. The psychological violence exposure in patients was associated with female sex and formal divorce.Many experts in the field have concluded that the direct approach to violence screening is the most effective one ,24. In aIn Slovenia, before the adoption of the Law on the Prevention of Domestic Violence, the only official data on domestic violence were collected by the police; however, the police only recorded data on reported crimes. According to these records, the number of victims of domestic crime grew by 95% from 2000 to 2007. In 2007, the police dealt with more than 2700 victims of domestic violence in a country with only about two million inhabitants . The lacOur results provided sufficient evidence about domestic violence exposure in primary care patients in Slovenia, therefore future research should be focused on determining the characteristics of domestic violence victims, for which a different approach should be used . Other means should be developed to encourage the victims to seek help or at least to disclose victimization to health workers. Although other studies have shown that the most effective way of domestic violence detection were face-to-face interviews by a health care provider, a self-administered questionnaire or a follow-up of the interview with a later consultation could also be used . This stAlthough the elderly have been considered as a risk group for victimization , this stIn comparison to a study on a representative sample of Slovenian family clinic attendees , our stuIt is also interesting to note that, in spite of a structured interview procedure, only 7 cases of coerced sexual intercourse were identified. This may be due to physicians’ lack of training or motivation, patient-physician interaction, or patients’ shame. Since the rates of sexual abuse in the majority of other studies ranged from 3.9 to 8.3% , this raThe detected frequency of violence is similar to other published data ,23,24,31


Clostridium difficile infection (CDI) in Emilia-Romagna Region (ER) by linking data of Patient Hospital Discharge Form (PHDF) and microbiological labs.To estimate the incidence of Confirmed case” (Cc) where a specific ICD9 code (00845) was present on the PHDF or an unspecific code for diarrhoea  and positivity for CD toxin was retrieved from the lab; “Probable case” (Pc) where either a specific ICD9 code without positivity for CD toxin test or exclusively CD toxin positivity was present. We considered only people older than 1 year and incidence was calculated both for all inpatients and for residents in ER. By linking dates of hospital admission and discharge and date of lab testing we defined CDI as hospital-acquired (HA: >2 days from admission within 28 day from discharge), community-acquired  or indeterminate .We linked regional data of PHDF and labs by anonymous patient code and we considered only public hospitals with at least 1 identified positive lab test for CD. CDI was defined as follows: “Cc) were identified in 27 ER public hospitals accounting for more than 2.6 millions hospital-days . Most cases were resident in ER (92.2%), female (57.2%) and old (median age = 80). Of the total cases, 43.5% had only CD toxin positivity without a specific or unspecific ICD9 code for CDI and 15.0% had only a specific code without lab confirmatory data. The overall incidence among the population older than 1 year was 13.7 per 100,000 inhabitants for Cc and 31.8 for Cc and Pc. The HA incidence density was 2.7/10,000 patient-days. The place of transmission for residents in ER was HA in 76.1% of cases and CA in 9.4%; 5.2% were IA and 9.3% were not attributable because of lacking of lab results.For 2011, 980 CDI (41.5% were The linkage of administrative data allows to improve incidence estimates of CDI in ER, yielding values in line with European data. It also allows to assess the locus of CD transmission, which is predominantly the hospital, though community CDI accounted for almost one tenth of cases.None declared