MicroRNAs as diagnostic and prognostic biomarkers of age-related macular degeneration:advances and limitations

A main cause of vision loss in the elderly is age-related macular degeneration(AMD).Among the cellular,biochemical,and molecular changes linked to this disease,inflammation and angiogenesis appear as being crucial in AMD pathogenesis and progression.There are two forms of the disease:dry AMD,accounting for 80–90%of cases,and wet AMD.The disease usually begins as dry AMD associated with retinal pigment epithelium and photoreceptor degeneration,whereas wet AMD is associated with choroidal neovascularization resulting in severe vision impairment.The new vessels are largely malformed,leading to blood and fluid leakage within the disrupted tissue,which provokes inflammation and scar formation and results in retinal damage and detachment.Micro RNAs are dysregulated in AMD and may facilitate the early detection of the disease and monitoring disease progression.Two recent reviews of micro RNAs in AMD had indicated weaknesses or limitations in four earlier investigations.Studies in the last three years have shown considerable progress in overcoming some of these concerns and identifying specific micro RNAs as biomarkers for AMD.Further large-scale studies are warranted using appropriate statistical methods to take into account gender and age disparity in the study populations and confounding factors such as smoking status.

Impact of social isolation on behavioral health in elderly: Systematic review

AIM: To examine and compare the effects of subjective and objective social isolation on behavioral health in elderly adults.METHODS: A systematic search of Pub Med was performed for original research articles from peerreviewed journals examining one of the following topics: "Social isolation and sleep disturbance", "social isolation and depression", or "social isolation and fatigue in older adults". Studies were selected following the criteria established based on the aim of this review. Data were extracted from the articles by two independent reviewers. Due to the heterogeneity in study designs and outcome measures of the included studies, qualitative and narrative analyses were conducted.RESULTS: The set criteria were used to select a total of 16 studies for the review. Of the 16, 13 were crosssectional studies. The characteristics of study populations were identified as follows. A total of 12 studies randomly selected subjects irrespective of pre-existing health conditions. Consequently, an unspecified number of the study subjects had chronic diseases in the studies compared. In addition, cultural and ethnic backgrounds of studies in this review were diverse, and included subjects living in North America, South America, Asia, Europe, and Oceania. Both subjective and objective types of social isolation increased behavioral symptoms, such as sleep disturbance, depressive symptoms, and fatigue in older adults. Furthermore, a few recent studies reported stronger effects of subjective social isolation than objective social isolation on sleep disturbance and depressive symptoms.CONCLUSION: Social isolation affects behavioral health in older adults. Compared to the objective social isolation, subjective social isolation contributes more significantly to sleep disturbance and depression.

T-cell/histiocyte-rich large B-cell lymphoma in a child:A case report and review of literature

T-cell/histiocyte-rich large B-cell lymphoma is uncommon in children population. There were few cases reported in the literature with wide range clinical presentations including advanced stage, and more involvement of liver, spleen and bone marrow. Head and neck lymphadenopathy tends to present in younger children. We report a case of 10-year-old boy who initially presented intermittent fever, headaches and neck lymphadenopathy. Subsequently, he developed diffuse lymphadenopathy and hepatosplenomegaly. T-cell/histiocyte-rich large B-cell lymphoma was diagnosed on a cervical lymph node biopsy. Cervical lymphadenopathy in this age group is most commonly reactive or nonmalignant processes. Lymphoma is much less frequent; mainly are non-Hodgkin lymphomas. However, a subset of large B-cell lymphoma called T-cell/histiocyte-rich B-cell lymphoma is rare in children.

Gastritis Cystica Profunda: A Rare Gastric Tumor Masquerading as a Malignancy

Introduction: Gastritis cystica profunda (GCP) is a rare tumor which occurs more commonly in patients with prior gastric surgery. The nonspecific symptoms and radiographic appearance of this tumor mimic that of other hyperproliferative conditions making diagnosis difficult without definitive surgical resection. This report provides a comprehen-sive review of GCP and all GCP cases reported to date. Methods: A comprehensive literature search (1972-2011) was conducted with all reported GCP cases analyzed. Keywords searched included gastritis cystica profunda, submucosal cysts of the stomach, and heterotopic submucosal gastric glands. Results: Thirty-seven GCP cases have been reported since 1972, which includes 29 (78%) men and 8 (21%) women (M:F ratio, 3.6:1). The overall mean age was 60.5 years (range, 39 - 81 years) with 55.6 years (range, 39 - 79) and 62.2 years (range, 39 - 81 years) in women and men, respectively. 65% (N = 24) had prior gastric surgery. 62% (N = 23) of GCP tumors were located in the body;24% (N = 9) in the fundus;8% (N = 3) in the antrum;or 6% (N = 2) in the cardia of the stomach. GCP was an incidental finding in 19% of patients. Complete excision was performed most often (73%) followed by endomucosal resection (18%), and polypectomy (4.5%). One patient underwent surveillance (4.5%). Conclusions: GCP is a rare gastric tumor, which is difficult to diagnose preoperatively and masquerades as a malignancy. GCP is more common in men and typically presents with nonspecific symptoms. Although a benign lesion, GCP may represent an intermediate histology in the malignant progression to gastric neoplasia. To date, there have been no reports of local recurrence or distant metastasis following definitive surgical excision, which remains the standard of care.

Ketosis-prone diabetes mellitus:A phenotype that hospitalists need to understand

Diabetes has been classified mainly into types 1 and 2.Some type 2 diabetes patients,when developing ketosis,have been labeled as having atypical diabetes.Lately,syndromes of ketosis-prone diabetes,primarily in patients who we previously classified as type 2 diabetics,have emerged,and calls are being made to even reclassify diabetes.This mini-review will extensively deal with the historical,molecular,phenotypical,and clinical basis of why ketosis-prone diabetes is different than the traditional principles of type 1 and 2 diabetes and should be classified as such.Clinicians,especially those who are not diabetologists or endocrinologists,as well as hospitalists,intensivists,and primary care providers,will greatly benefit from this review.

Electrocardiogram manifestations in hyperkalemia

Hyperkalemia is defined as serum potassium level of more than 5 mmol/L. Prompt identification of hyper-kalemia and appropriate management are critical, since severe hyperkalemia can lead to lethal cardiac dysrhythmias. There is a wide range of electrocardiogram (EKG) changes associated with hyperkalemia. The sequence of EKG changes has been previously described with limited information to correlate the level of potassium to a particular change in the EKG. This study aims to describe a correlation between the level of potassium and EKG changes in the presence or absence of certain diagnoses, to determine which EKG finding in the context of level of hyperkalemia, should be considered life-threatening and prompt emergency intervention. If a relationship between serum levels of potassium and EKG changes is significant, clinicians may be able to better monitor and treat hyperkalemic patients. This paper reviews the literature on hyperkalemia, potassium homeostasis and EKG changes attributed to elevated potassium.

Primary hepatic peripheral T-cell lymphoma associated with Epstein-Barr viral infection

Primary hepatic peripheral T-cell lymphoma(H-PTCL) is one of the rarest forms of non-Hodgkin lymphoma. We report a patient who presented with worsening jaundice, abdominal pain, and vomiting. Laboratory values were significant for elevated total bilirubin, alkaline phosphatase, and liver aminotransferases. Following a liver biopsy, histopathology revealed several large dense clusters of atypical T-lymphocytes which were CD2+, CD3+, CD5+, CD7-, CD4+, CD8-, CD56-, CD57-, CD30+ by immunohistochemistry. The proliferation index was approximately 70% by labeling for ki67/mib1. The above histological profile was consistent with peripheral T-cell lymphoma of the liver. Epstein-Barr viral serology indicated a remote infection, a likely risk factor for PTCL. Bone marrow biopsy was negative for malignancy, further supporting hepatic origin.

Postpartum intrauterine device contraception: A review

AIM： To review the safety （infection, perforation） and efficacy （expulsion, continuation rates, pregnancy） of intrauterine device （IUD） insertion in the postpartum period. METHODS： MEDLINE, PubMed and Google Scholar were searched for randomized controlled trials and prospective cohort studies of IUD insertions at different times during the postpartum period. Time of insertion during the postpartum period was documented speci-fically, immediate post placenta period （within 10 min）, early post placenta period （10 min to 72 h）, and de-layed/interval period （greater than 6 wk）. Other study variables included mode of delivery, vaginal vs cesarean, manual vs use of ring forceps to insert the IUD. RESULTS： IUD insertion in the immediate postpartum （within 10 min of placental delivery）, early postpartum （10 min up to 72 h） and Interval/Delayed （6 wk onward） were found to be safe and effcacious. Expulsion rates were found to be highest in the immediate postpartum groups ranging from 14% to 27%. Immediate post placental insertion found to have expulsion rates that ranged from 3.6% to 16.2%. Expulsion rate was significantly higher after insertion following vaginal vs cesarean delivery. The rates of infection, perforation and unplanned pregnancy following postpartum IUD insertion are low. Method of insertion such as with ring forceps, by hand, or another placement method unique to the type of IUD did not show any signifcant difference in expulsion rates. Uterine perforations are highest in the delayed/interval IUD insertion groups.Breastfeeding duration and infant development are not affected by delayed/interval insertion of the non-hormonal （copper） IUD or the Levonorgestrel IUD. Timing of the Levonorgestrel IUD insertion may affect breastfeeding. CONCLUSION： IUD insertion is safe and efficacious during the immediate postpartum, early postpartum and delayed postpartum periods. Expulsion rates are highest after vaginal delivery and when inserted during the immediate postpartum period. IUD associated infection rates were not increased by insertion during the postpartum period over interval insertion rates. There is no evidence that breastfeeding is negatively affected by postpartum insertion of copper or hormone-secreting IUD. Although perforation rates were higher when inserted after lactation was initiated. Randomized controlled trials are needed to further elucidate the consequence of lactation on postpartum insertion. Despite the concerns regarding expulsion, perforation and breastfeeding, current evidence indicates that a favorable risk beneft ratio in support of postpartum IUD insertion. This may be particularly relevant for women for whom barriers exist in achieving desired pregnancy spacing.

Students’ Numeracy and Literacy Aptitude Analysis and Prediction Using Machine Learning

Education is one of the most pivotal services in societal development as it cultivates a wide variety of skills, especially numeracy and literacy skills. However, students may have varying masteries of these two aptitudes. Some attribute this to students’ intrinsic efforts while others attribute this to students’ capabilities and affiliated environments. In this work, I explore the numeracy and literacy aptitude patterns of students from various cultures based on a dataset that contains various demographic information, from which I deduced some preliminary trends. After the comparison of numerous machine learning algorithms, the optimal algorithm or combination of a few algorithms predicts students’ performances by classifying students of different backgrounds into various potential outcomes. The results suggest that proper resources and supports are necessary for enhanced learning.

Hepatitis: A Case of Infectious and Autoimmune Hepatitis Occurring with Neurosyphilis

The liver is an organ that withstands a lot of insults due to various things such as infection, toxins and even our own immune system. There are injuries to the liver that are relatively common in medicine such as viral hepatitis caused by different strains of Hepatitis A-E, autoimmune hepatitis, and injury by drugs such as acetaminophen. However, syphilis causing hepatitis is not seen often and there are certain features that distinguish syphilitic hepatitis that should be reported more to distinguish its characteristic features.

Pancreatic Abscess: An Infection Occurring with Minimal Tissue Present

Pancreatic abscess typically occurs 4 weeks after acute pancreatitis begins and is defined as an infection of the pancreatic pseudocyst. There are other causes which include but are not limited to iatrogenic intra-abdominal procedures, chronic pancreatitis, and sending from distant sites. These abscesses are typically collections of pus that are within the region of the pancreas. There is also pancreatic necrosis that is seen among these abscesses. Here is a report on a case of a pancreatic abscess of unusual occurrence in a patient that had a near-total distal pancreatectomy. This is uncommon as the patient has very minimal pancreatic tissue remaining, yet still has developed this intra-abdominal abscess. These abscesses must be recognized quickly and removed to prevent further complications from occurring.

Glycogen and amyloid-beta: key players in the shift from neuronal hyperactivity to hypoactivity observed in Alzheimer's disease?

Introduction：Alzheimer’s disease（AD）begins to develop decades prior to its clinical manifestation（Sperling et al.,2011）,and while it is the most common form of dementia,as of yet there is no cure.Two of the most researched pathological features contributing to disease development are the extracellular amyloid plaques composed of amyloid-beta proteins（Aβ）and neurofibrillary tangles of tau proteins.Another feature of AD is the progression of early neuronal excitability/hyperactivity to silencing/hypoactivity（Palop and Mucke,2010）,

Autoimmune hepatitis in the setting of human immunodeficiency virus infection: A case series

Liver injury in the setting of human immunodeficiency virus(HIV) infection is more commonly attributed to viral hepatitis or highly active antiretroviral treatment(HAART) toxicity. The severity of liver injury is an important cause of morbidity and mortality. The emergence of autoimmune diseases, particularly autoimmune hepatitis(AIH) in the setting of HIV infection, is rare. Previous reports indicate that elevated liver enzymes are a common denominator amongst these patients. We present two patients with HIV infection, on HAART, with virological suppression. Both patients presented with elevated liver enzymes, and following liver biopsies, were diagnosed with AIH. The clinical course of these patients underscore the therapeutic value of corticosteroids, and in some cases, addition of immunosuppression for AIH treatment.

Neural-based inexact graph de-anonymization

Graph de-anonymization is a technique used to reveal connections between entities in anonymized graphs,which is crucial in detecting malicious activities,network analysis,social network analysis,and more.Despite its paramount importance,conventional methods often grapple with inefficiencies and challenges tied to obtaining accurate query graph data.This paper introduces a neural-based inexact graph de-anonymization,which comprises an embedding phase,a comparison phase,and a matching procedure.The embedding phase uses a graph convolutional network to generate embedding vectors for both the query and anonymized graphs.The comparison phase uses a neural tensor network to ascertain node resemblances.The matching procedure employs a refined greedy algorithm to discern optimal node pairings.Additionally,we comprehensively evaluate its performance via well-conducted experiments on various real datasets.The results demonstrate the effectiveness of our proposed approach in enhancing the efficiency and performance of graph de-anonymization through the use of graph embedding vectors.

Hepatobiliary strongyloidiasis presenting as an ampullary lesion on esophagogastroduodenoscopy/endoscopic ultrasound

Strongyloidiasis is an intestinal infection caused by the parasitic nematodes of the Strongyloides species,most commonly Strongyloides stercoralis.We report a case of a 66-year-old immigrant male from Haiti who presented with complaints of diarrhea and an unintentional 80-lb weight loss over the past 5 years.Stool examination was positive for strongyloidiasis.Following albendazole therapy,esophagogastroduodenoscopy(EGD)showed a unique ampullary lesion.Histopathology of the ampullary lesion showed reactive epithelium with Strongyloides larva.In addition,endoscopic ultrasound(EUS)detected a large pancreatic cyst.Both these findings were absent on EGD 5 years previously,prior to the onset of his symptoms.This paper documents a rare case of an ampullary lesion and pancreatic cyst secondary to hepatobiliary strongyloidiasis in a non-Human Immunodeficiency Virus(HIV)patient.We review the epidemiology,life cycle,clinical presentation and treatment of strongyloidiasis.