The cumulative incidence of cardiotoxicity was 35% (95% CI 23 to 48) at 3 years. Patients who developed cardiotoxicity were more likely to receive third-line cancer treatments and had lower final LVEF than patients without (54.9% ± 6.3% vs 64% ± 4.9%, p less then 0.001). Of the 23 patients with cardiotoxicity, 10 (43%) had trastuzumab interrupted for at least 1 cycle, only 7 (30%) patients were seen by a cardiologist and 4 (17%) received cardiac medications. In conclusion, patients with metastatic breast cancer receiving prolonged trastuzumab therapy appear to have high rates of cardiotoxicity. This was associated with high rates of trastuzumab interruption, but low rates of cardiology referral and cardiac treatment, reflecting a potential cardiac care gap. https://www.selleckchem.com/CDK.html Pulmonary vein isolation is the cornerstone of atrial fibrillation (AF) ablation. Radiofrequency (RF) represents a standard of care for pulmonary vein isolation, whereas cryoballoon (CB) ablation has emerged as a valid alternative. The aim of our meta-analysis was to explore the efficacy and safety of CB compared with RF as first ablation procedure for AF. We searched the literature for studies that investigated this issue. The primary efficacy outcome was AF recurrence. The safety outcomes were pericardial effusion, cardiac tamponade, phrenic nerve palsy, vascular complications, and major bleedings. Fourteen randomized controlled studies and 34 observational studies were included in the analysis. A total of 7,951 patients underwent CB ablation, whereas 9,641 received RF ablation. Mean follow-up was 14 ± 7 months. Overall, CB reduced the incidence of AF recurrence compared with RF ablation (relative risk [RR] 0.86; 95% confidence interval [CI] 0.78 to 0.94; p = 0.001), and this result was consistent across different study design and AF type. CB had a significantly higher rate of phrenic nerve palsy, whereas it was related to a lower incidence of pericardial effusion, cardiac tamponade (RR 0.58; 95% CI 0.38 to 0.88; p = 0.011) and vascular complications (RR 0.61; 95% CI 0.48 to 0.77; p less then 0.001) compared with RF. There was no significant difference in major bleedings between the 2 strategies. CB ablation had a shorter procedural time compared with RF (mean difference -20.76 minutes; p less then 0.001). In conclusion, considered its efficacy/safety profile and short procedural time, CB ablation represents the preferable option for first AF ablation procedure. New-generation devices such as Evolut and Portico have provided favorable results in patients who underwent transcatheter aortic valve implantation (TAVI) for aortic stenosis, but their comparative effectiveness remains debated, despite its relevance when envisioning TAVI in low-risk patients. We evaluated the safety and efficacy of 2 leading TAVI devices (Evolut and Portico) used by the same team of experienced TAVI operators, focusing on long-term outcomes, including major adverse events (i.e., the composite of death, stroke, myocardial infarction, major vascular complication, or major bleeding). Unadjusted and propensity score-adjusted analyses were carried out. A total of 233 patients were included, 119 (51.1%) receiving Evolut and 114 (49%) Portico. Baseline and procedural data showed significant between-device differences, including functional class, surgical risk, chronic obstructive pulmonary disease, renal function, transesophageal guidance, device size, postdilation, and procedural time (all p 0.05). In conclusion, Evolut and Portico devices yield similarly favorable results at long-term follow-up when used by experienced TAVI operators. We aimed to evaluate the burden of coronary artery disease (CAD) using the computed tomography (CT) Leaman score in low-risk transcatheter aortic valve implantation (TAVI) patients. The extent of CAD in low-risk patients with aortic stenosis who are candidates for TAVI has not been accurately quantified. The CT Leaman score was developed to quantify coronary CT angiography (CCTA) atherosclerotic burden and has been validated to evaluate the extent of CAD. CT Leaman score >5 has been associated with an increase in major adverse cardiac events over long-term follow-up. The study population included patients enrolled in the Low Risk TAVI trial who underwent CCTA before the procedure. For the CT Leaman score, we used 3 sets of weighting factors (1) location of coronary plaques, (2) type of plaque, and (3) degree of stenosis. A total of 200 patients were enrolled in the Low Risk TAVI trial. Excluded were 31 patients who had no analyzable CCTA imaging. For the remaining 169 patients, the mean CT Leaman score was 6.27 ± 0.27, of whom 102 (60.4%) had CT Leaman score >5. Nearly all analyzed patients (97%) had coronary plaques. Furthermore, 33 patients (19.5%) had potentially obstructive coronary plaques (>50% stenosis by CCTA) in proximal segments. Most low-risk TAVI patients have significant CAD burden by CCTA. It should be a priority for future TAVI devices to guarantee unimpeded access to the coronary arteries for selective angiography and interventions. Bleeding risk stratification is an unresolved issue in older adults. Anemia may reflect subclinical blood losses that can be exacerbated after percutaneous coronary intervention . We sought to prospectively determine the contribution of anemia to the risk of bleeding in 448 consecutive patients aged 75 or more years, treated by percutaneous coronary interventions without concomitant indication for oral anticoagulation. We evaluated the effect of WHO-defined anemia on the incidence of 1-year nonaccess site-related major bleeding. The prevalence of anemia was 39%, and 13.1% of anemic and 5.2% of nonanemic patients suffered a bleeding event (hazard ratio 2.75, 95% confidence interval 1.37 to 5.54, p = 0.004). Neither PRECISE-DAPT nor CRUSADE scores were superior to hemoglobin for the prediction of bleeding. In conclusion, anemia is a powerful predictor of bleeding with potential utility for simplifying tailoring therapies. PURPOSE Investigate the efficacy of sublingual gland removal for the treatment of simple and plunging ranulas. MATERIALS AND METHODS After IRB approval, a retrospective review was performed on patients treated for a ranula from February 2013 to May 2018 at Texas Children's Hospital in Houston, TX. Clinical data was collected from medical records and patients were contacted in November 2018 to obtain additional information about recurrences or complications. RESULTS This study included 52 patients with ranulas (10 plunging, 42 simple; MF 2131) with a mean age of 9.68 years. Eighteen patients provided information in the extended follow-up period. Simple ranulas were treated with intraoral excision of the cyst and the sublingual gland (27 cases), marsupialization (7 cases), intraoral excision of the cyst alone (7 cases), and intraoral excision of the cystic component and subsequent marsupialization after recurrence (1 case); intraoral excision of the sublingual gland was not associated with any recurrence. Plunging ranulas were treated with intraoral excision of the cyst and/or sublingual gland (7 cases) or with a transcervical approach (3 cases).

Raman spectroscopy and X-ray photoelectron spectroscopy revealed the high dispersion of graphene oxide-like carbonaceous moieties in MCS materials; the type and amount of oxygen-containing groups in obtained MCS materials were determined by H2SO4 concentration. The enhanced hydrophobicity of MCS nanocomposites was related to the carbon content and the depletion of surface silanol groups, as confirmed by the water sorption measurement. The study on the controlled release of diclofenac in simulated gastrointestinal environment suggests a potential application of MCS materials as drug carriers.Research in genetics relies heavily on voluntary contributions of personal data. We aimed to acquire insights into the differences between participants and refusers of participation in a Dutch population-based biobank. Accordingly, we assessed the demographic and prosocial intrapersonal characteristics of respondents who participated (n = 2615) or refused to participate (n = 404) in the Lifelines biobank and databank. Our results indicated that health-related values critically influence participation decisions. The participation threshold for Lifelines was determined by an absence of health-related values and of trust in government. Therefore, considering these factors in communication and recruitment strategies could enhance participation in biomedical research. No indications were found of a stronger general prosociality of participants or their trust in researchers beyond the context of biobanking. This emphasizes the contextual understanding of the decision of participation in biobanking. Our findings may contribute to improving recruitment strategies by incorporating relevant values and/or highlighting prosocial benefits. Moreover, they foreground the need to address trust issues in collaborations between data repositories and commercial companies. Future research should explore how prosocial intrapersonal characteristics drive participation and withdrawal decisions and relate to contextual attributes.Defects in optic fissure closure can lead to congenital ocular coloboma. This ocular malformation, often associated with microphthalmia, is described in various clinical forms with different inheritance patterns and genetic heterogeneity. In recent times, the identification of an increased number of genes involved in numerous cellular functions has led to a better understanding in optic fissure closure mechanisms. https://www.selleckchem.com/products/piperaquine-phosphate.html Nevertheless, most of these genes are also involved in wider eye growth defects such as micro-anophthalmia, questioning the mechanisms controlling both extension and severity of optic fissure closure defects. However, some genes, such as FZD5, have only been so far identified in isolated coloboma. Thus, to estimate the frequency of implication of different ocular genes, we screened a cohort of 50 patients affected by ocular coloboma by using targeted sequencing of 119 genes involved in ocular development. This analysis revealed seven heterozygous (likely) pathogenic variants in RARB, MAB21L2, RBP4, TFAP2A, and FZD5. Surprisingly, three out of the seven variants detected herein were novel disease-causing variants in FZD5 identified in three unrelated families with dominant inheritance. Although molecular diagnosis rate remains relatively low in patients with ocular coloboma (14% (7/50) in this work), these results, however, highlight the importance of genetic screening, especially of FZD5, in such patients. Indeed, in our series, FZD5 variants represent half of the genetic causes, constituting 6% (3/50) of the patients who benefited from a molecular diagnosis. Our findings support the involvement of FZD5 in ocular coloboma and provide clues for screening this gene during current diagnostic procedures.Although over 50 genes are known to cause renal malformation if mutated, the underlying genetic basis, most easily identified in syndromic cases, remains unsolved in most patients. In search of novel causative genes, whole-exome sequencing in a patient with renal, i.e., crossed fused renal ectopia, and extrarenal, i.e., skeletal, eye, and ear, malformations yielded a rare heterozygous variant in the GDF6 gene encoding growth differentiation factor 6, a member of the BMP family of ligands. Previously, GDF6 variants were reported to cause pleiotropic defects including skeletal, e.g., vertebral, carpal, tarsal fusions, and ocular, e.g., microphthalmia and coloboma, phenotypes. To assess the role of GDF6 in the pathogenesis of renal malformation, we performed targeted sequencing in 193 further patients identifying rare GDF6 variants in two cases with kidney hypodysplasia and extrarenal manifestations. During development, gdf6 was expressed in the pronephric tubule of Xenopus laevis, and Gdf6 expression was observed in the ureteric tree of the murine kidney by RNA in situ hybridization. CRISPR/Cas9-derived knockout of Gdf6 attenuated migration of murine IMCD3 cells, an effect rescued by expression of wild-type but not mutant GDF6, indicating affected variant function regarding a fundamental developmental process. Knockdown of gdf6 in Xenopus laevis resulted in impaired pronephros development. Altogether, we identified rare heterozygous GDF6 variants in 1.6% of all renal anomaly patients and 5.4% of renal anomaly patients additionally manifesting skeletal, ocular, or auricular abnormalities, adding renal hypodysplasia and fusion to the phenotype spectrum of GDF6 variant carriers and suggesting an involvement of GDF6 in nephrogenesis.In this study, we aimed to explore regional differences in maternal lifestyle during pregnancy related to congenital heart defects (CHD) in Shaanxi province, Northwestern China. A large-scale epidemiologic survey of birth defects among infants born during 2010-2013, was conducted in Shaanxi province. Non-spatial and geographic weighted logistic regression models were used for analysis. The spatial model indicated that passive smoking frequency was positively associated with CHD for 43.3% of participants (P  less then  0.05), with the highest OR in North Shaanxi and the lowest in South Shaanxi. Approximately 49.2% of all mothers who ever drink tea were more likely to have an infant with CHD (P  less then  0.05), with the highest OR values observed in North and Central Shaanxi. Additionally, maternal alcohol intake frequency ≥ 1/week was significantly correlated with CHD among about 24.7% of participants (P  less then  0.05), with OR values ranging from 0.738 (Central Shaanxi) to 1.198 (North Shaanxi). The rates of unhealthy maternal lifestyles during pregnancy associated with CHD differed in various areas of the province.

To evaluate the objective and subjective long-term outcome of maxillomandibular advancement (MMA) in Far-East Asian patients with moderate to severe obstructive sleep apnea (OSA). This is a long-term follow-up study to evaluate the treatment outcome of MMA in OSA patients by objective polysomnography (PSG) and subjective questionnaires (Pittsburgh Sleep Quality Index-PSQI, Insomnia Severity Index-ISI, Beck Anxiety Inventory-BAI, Beck Depression Inventory-BDI, Epworth Sleepiness scale-ESS, and Short Form-36 Quality of Life-SF-36). Evaluation was done before surgery and we followed these patients one and two years after surgery. We also assessed the neurocognitive function by Continuous performance test (CPT) and Wisconsin Card Sorting Test (WCST) before and after MMA. A total of 82 patients with OSA (female=19) were enrolled and 53 participants (75.7% men, age 35.66±11.66 years [mean±SD], BMI=24.80±3.29) completed the two-year follow-up. The apnea-hypopnea index (AHI) decreased from a mean of 34.78±26.01 to 3.61±2.79 and 7.43±6.70 events/hour (p=0.007) at the first and second year evaluation. There was significant improvement in PSG (especially respiratory profile), questionnaires (PSQI and ISI total score), and neurocognitive testing (attention and executive function) after MMA. Meanwhile, no major complication such as avascular necrosis of bonny segments, facial nerve injury, blindness or compromise of airway was found after surgery. MMA is a clinically effective treatment for patients with moderate-to-severe OSA as demonstrated by significant long-term decrease in AHI and improvement in neurocognitive testing. MMA is a clinically effective treatment for patients with moderate-to-severe OSA as demonstrated by significant long-term decrease in AHI and improvement in neurocognitive testing.Peroxidase, a key enzyme causing enzymatic browning, and affected the potential values of fruit and vegetables. Phytic acid and NADH inhibited peroxidase in a competitive manner due to their reducing properties, and it's IC50 (1.18 ± 0.32) × 10-8, (8.02 ± 0.45) × 10-6 mol L-1, respectively. The interaction between phytic acid, NADH and peroxidase contributed to intrinsic fluorescence quenching and conformation alternation with a accuracy determination by multispectroscopic techniques (fluorescence spectra, FT-IR and CD spectra), respectively. Molecular docking simulation revealed that phytic acid, NADH interacted with His170, Ala34, Arg38, Ser73, Arg31, Lys174, Gln176, Asn175, Arg75; Gln176, Asn175, Phe221, Lys174, Gly173, Ser167, Phe172, Gly169, His170 in peroxidase, respectively and blocked substrates into catalytic reactions.In this study, we investigated the possibility of interactions between the solvent molecules with the Heme group in the human hemoglobin. The results of this study answer a key question whether the interactions of the Heme unit with its surroundings are interdependent or independent of the protein units of human hemoglobin. https://www.selleckchem.com/products/pt2399.html Contributions of the intermolecular interactions were determined by exploiting the solvatochromism spectroscopic data by Kamlet-Taft (KAT) polarity functions. Solvent polarity effects on the nonlinear properties of the Heme's groups in the human hemoglobin (Hb) were investigated via the Z-scan method. The experimental results obtained with spectroscopic and nonlinear optical parameters (absorption coefficient and refractive index) show that the mechanism of solvation and the interactions of Heme are controlled by suitable configuration of the protein units of hemoglobin. In other words, interactions of the Heme with α- and β-globins are an effective factor in controlling the optical behavior of Heme.Two newly introduced pharmaceutical mixtures of amlodipine/celecoxib and amlodipine/ramipril were developed to manage hypertension and the associated osteoarthritis. The current work presents three newly developed UV spectrophotometric methods depending on minimal mathematical manipulations on the zero-order spectrum namely absorption correction, induced dual-wavelength, and Fourier self deconvoluted method; for the simultaneous determination of celecoxib and ramipril in their pharmaceutical combined dosage forms with amlodipine. In absorption correction and induced dual-wavelength method, celecoxib and ramipril were determined at 253 and 222 nm for absorption correction and (251-270 nm) and (222-230 nm) for induced dual-wavelength method, respectively from the zero-order spectrum after calculating the absorption correction and equality factors for amlodipine. Amlodipine itself was determined at 361 nm from the zero-order spectrum in both methods. In Fourier self deconvoluted method, celecoxib and amlodipine zero-order spectra were deconvoluted, using the spectrophotometer software built-in Fourier wavelet function, and then was determined at 360 and 269 nm, respectively. The proposed methods were simple, accurate, and sensitive requiring minimal mathematical manipulations saving the time needed for analysis. The methods were linear over the range of (5-60 μg/ml), (5-30 μg/ml), and (5-110 μg/ml) for each of amlodipine, celecoxib, and ramipril, respectively. The limit of detection was in the range of (0.5781-0.7132 μg/ml) for amlodipine, (0.6497-1.0450 μg/ml) for celecoxib, and (0.0001-0.0003 μg/ml) for ramipril that indicated the sensitivity of these suggested methods. All methods were validated as per ICH recommendations regarding linearity, range, accuracy, precision, and selectivity. A statistical comparative study executed for the proposed methods with each other and with the reported methods showed no significant difference between the proposed methods and the reported methods.A functional ratio fluorescence sensor based on the molecularly imprinted polymer (MIP) coated double quantum dots (QDs) being composited of Mn-ZnS QDs and silica-coated graphene quantum dots (GQDs@SiO2) had been established for the sensitive, selective and visual detection of sinapic acid (SA). MIPs@Mn-ZnS/GQDs@SiO2 was synthesized through a simple one-pot sol-gel reaction, and it exhibited two fluorescence emission peaks with yellow fluorescence of Mn-ZnS QDs at 580 nm and the blue fluorescence of GQDs at 445 nm. SA can selectively enhance the fluorescence of GQDs but quench the Mn-ZnS QDs fluorescence to the MIPs@Mn-ZnS/GQDs@SiO2. The ratio of fluorescence enhancement to fluorescence reduction is linear with the concentration of SA from 9 to 81 nM with the detection limits of 0.8388 nM (S/N = 3). And the constructed fluorescent probe can also be used to visually detect SA according to the change of color. More importantly, molecular imprinting technique enables the sensors to selectively recognize the SA while other similar structure molecules hardly interfere with the SA determination in the measurement environment.

Practical formulas are derived for calculating the far-field radiation pattern and coupling coefficient of a rectangular dielectric resonator (cuboid) with free space as well as mutual coupling coefficients between two cuboids for their different orientations relative to each other. An approach is developed using the coupled mode theory and the perturbation theory for the Maxwell equations. The correctness of obtained formulas is checked against the full-wave numerical simulations performed by the COMSOL Multiphysics electromagnetic solver. In particular, the obtained formulas can be used for revealing optical features of realistic (i.e., consisting of a finite number of resonators) all-dielectric metasurfaces with arbitrary curved shapes.Current methods to retrieve optically relevant properties from ocean color observations do not explicitly make use of prior knowledge about property distributions. Here we implement a simplified Bayesian approach that takes into account prior probability distributions on two sets of five optically relevant parameters, and conduct a retrieval of these parameters using hyperspectral simulated water-leaving reflectances. We focus specifically on the ability of the model to distinguish between two optically similar phytoplankton taxa, diatoms and Noctiluca scintillans. The inversion retrieval gives most-likely concentrations and uncertainty estimates, and we find that the model is able to probabilistically predict the occurrence of Noctiluca scintillans blooms using these metrics. We discuss how this method can be expanded to include a priori covariances between different parameters, and show the effect of varying measurement uncertainty and spectral resolution on Noctiluca scintillans bloom predictions.In this paper, a novel and efficient approach for solving the beam propagation method (BPM) governing equation is proposed. The approach is based on the reformulation of the beam propagation equation to solve real system matrices only at each propagation step. The reformulated equation utilizes a leap-frog (LF) technique to couple the real and imaginary components of the field in an iterative scheme. The method yields higher processing speed by at least 30% more than that of the conventional BPM method. To validate the proposed LF-BPM method, different photonic systems, including directional couplers and multimode interferometers, are simulated. Results have been experimentally verified by comparing them with results measured for fabricated micro-photonic structures. A stability analysis was performed to study the effect of the design parameters on the performance of the proposed scheme. The proposed LF-BPM approach is considered a promising technique for efficient modeling of optical structures.Objects with shiny surfaces cannot be directly measured using the conventional structured-light method. To cope with this problem, in this paper, we propose a novel method for removing the saturated components in an image. First, the specular pixels in the image are identified using a highlight extraction algorithm. Then, based on the reflection component separation (RCS) theory, the diffuse and specular components of these specular pixels are separated. For objects with shiny surfaces, use of the RCS approach destroys the color information of highlighted pixels with a large specular reflection component. As such, finally, the color information of the highlighted pixels is recovered using an image repair process. Experimental results indicate that 95% of the highlights in the images were eliminated. The highlight caused by the strong reflecting surface can be well suppressed. This proposed method effectively overcomes the interference of reflected light and provides a feasible solution to the problems associated with the structured-light measurement of objects with smooth surfaces.A stretchable chiral metamaterial with L-shaped and T-shaped Au patterns (SCMM-LT) is proposed to generate asymmetric transmission (AT) for circularly polarized waves on the polydimethylsiloxane substrate in the mid-infrared region. The peak value of AT can reach 50.02% at the resonance wavelength of 19.1 µm, owing to the enantiomerically sensitive plasmons. With stretching along the x axis and the y axis. respectively, the band of AT shifts to a longer wavelength, which proves the SCMM-LT can be a candidate as the tunable chiral metamaterial. In the future, the proposed stretchable chiral metamaterial could potentially possess high applicability for wearable electronic devices in a variety of sensor fields.The most intuitive approach for infrared stealth, namely, the indiscriminate suppression of thermal radiation, is often at the risk of overheating the target. Spectrally selective metamaterials may solve this problem by satisfying radiative cooling as well as infrared suppression. Therefore, we have designed and fabricated a broadband metamaterial by depositing a Fabry-Perot (F-P) resonator on top of a metal pattern. The composite structure has two absorption peaks, one originating from F-P resonance, the other from the magnetic resonance of the metal pattern, and they can be merged into the 5∼8 µm range through optimization. According to Kirchhoff's law, this results in high emissivity in the 5∼8 µm range (the best choice of nonatmospheric-window ranges) and low emissivity in the 3∼5 µm and 8∼14 µm ranges (the two atmospheric windows), satisfying both infrared suppression and radiative cooling. Energy dissipation distributions indicate apparent coupling of F-P resonance and magnetic resonance, but these two resonances are stronger at their respective intrinsic wavelengths. https://www.selleckchem.com/products/atglistatin.html This paper reveals an alternative method for infrared suppression with radiative cooling, which is also meaningful in the design of broad/multiband absorbers.In high-power laser facilities, the application of a traditional wavefront control method is limited under the influence of a continuous phase plate (CPP). In order to obtain a satisfactory far-field intensity distribution at the target of the beamline with the CPP, a novel deformable mirror (DM) resolution-matching-based two-stage wavefront sensorless adaptive optics method is proposed and demonstrated. The principles of the DM resolution-matching method and two-stage wavefront sensorless adaptive optics method are introduced, respectively. Based on the numerical model, the matching relationship between the actuator space of the DM and the spatial period of the CPP is investigated. By using the resolution-matched DM, the feasibility of the two-stage wavefront sensorless adaptive optics method is numerically and experimentally verified. Both the numerical and the experimental results show that the presented DM resolution-matching-based two-stage wavefront sensorless adaptive optics method could achieve the target focal spot control under the influence of the CPP, and the profile and the intensity uniformity of the corrected focal spot are optimized close to the designed ideal focal spot.

These genes and protein enzymatic activities have not been previously reported in WRC and provide an opportunity to assess their potential roles in heartwood rot resistance in this economically important species.Structural health monitoring systems provide many advantages for full-scale measurements in bridge monitoring. In this study, a strong landing typhoon event recorded at the Jintang Bridge (Zhejiang Province, China) in 2019 was selected to study the nonstationary wind and cable vibration characteristics. To study the characteristics of the recorded typhoon, the time-varying mean wind was extracted based on the adaptive method of the wavelet-matrix transform. The nonstationary characteristics of Typhoon Lekima, including the turbulence intensity, gust factor, and fluctuating wind power spectral density, were analyzed and compared with the stationary model characteristics of a typhoon, and the typical characteristics and parameters were obtained. In addition, the measured vibration response of the cables was analyzed. The vibration characteristics of the cables and the energy distribution of the wind speed wavelet packet were investigated. https://www.selleckchem.com/products/nb-598.html The vibrations at different positions were compared. A power spectrum analysis and a wavelet packet energy analysis of the cable were performed. The results of this study can be used as a basis for wind-resistant design and performance evaluation of bridges under similar operational conditions.Iron (Fe), copper (Cu), and zinc (Zn) are microelements essential for the proper functioning of living organisms. These elements participatein many processes, including cellular metabolism and antioxidant and anti-inflammatory defenses, and also influence enzyme activity, regulate gene expression, and take part in protein synthesis. Fe, Cu, and Zn have a significant impact on the health of pregnant women and in the development of the fetus, as well as on the health of the newborn. A proper concentration of these elements in the body of women during pregnancy reduces the risk of complications such as anemia, induced hypertension, low birth weight, preeclampsia, and postnatal complications. The interactions between Fe, Cu, and Zn influence their availability due to their similar physicochemical properties. This most often occurs during intestinal absorption, where metal ions compete for binding sites with transport compounds. Additionally, the relationships between these ions have a great influence on the course of reactions in the tissues, as well as on their excretion, which can be stimulated or delayed. This review aims to summarize reports on the influence of Fe, Cu, and Zn on the course of single and multiple pregnancies, and to discuss the interdependencies and mechanisms occurring between Fe, Cu, and Zn.Injection molding has been widely used in the mass production of high-precision products. The finished products obtained through injection molding must have a high quality. Machine parameters do not accurately reflect the molding conditions of the polymer melt; thus, the use of machine parameters leads to erroneous quality judgments. Moreover, the cost of mass inspections of finished products has led to strict restrictions on comprehensive quality testing. Therefore, an automatic quality inspection that provides effective and accurate quality judgment for each injection-molded part is required. This study proposes a multilayer perceptron (MLP) neural network model combined with quality indices for performing fast and automatic prediction of the geometry of finished products. The pressure curves detected by the in-mold pressure sensor, which reflect the flow state of the melt, changes in various indicators and molding quality, were considered in this study. Furthermore, the quality indices extracted from pressure curves with a strong correlation with the part quality were input into the MLP model for learning and prediction. The results indicate that the training and testing of the first-stage holding pressure index, pressure integral index, residual pressure drop index and peak pressure index with respect to the geometric widths were accurate (accuracy rate exceeded 92%), which demonstrates the feasibility of the proposed method.In this paper, we present the results of the research concerning extraction of informative gene expression profiles from high-dimensional array of gene expressions considering the state of patients' health using clustering method, ML-based binary classifiers and fuzzy inference system. Applying of the proposed stepwise procedure can allow us to extract the most informative genes taking into account both the subtypes of disease or state of the patient's health for further reconstruction of gene regulatory networks based on the allocated genes and following simulation of the reconstructed models. We used the publicly available gene expressions data as the experimental ones which were obtained using DNA microarray experiments and contained two types of patients' gene expression profiles-the patients with lung cancer tumor and healthy patients. The stepwise procedure of the data processing assumes the following steps-in the beginning, we reduce the number of genes by removing non-informative genes in terms of stathe use of ROC (Receiver Operating Characteristic) analysis using criteria, included as the components, the errors of both the first and the second kinds. The final decision concerning the extraction of the most informative subset of gene expression profiles was taken based on the use of the fuzzy inference system, the inputs of which are the results of the appropriate single classifiers operation and the output is the final solution concerning state of the patient's health. To our mind, the implementation of the proposed stepwise procedure of the informative gene expression profiles extraction create the conditions for the increasing effectiveness of the further procedure of gene regulatory networks reconstruction and the following simulation of the reconstructed models considering the subtypes of the disease and/or state of the patient's health.Patient satisfaction is a crucial aspect in the evaluation of the quality of health care provided by health services and units, especially in patients that require physical rehabilitation. This study aims to design and analyze the factor structure and internal consistency reliability of the Hospital Physical Therapy Perceived Satisfaction Questionnaire (H-PTPS) measuring the level of physical therapy patient satisfaction in hospital rehabilitation services. This study has a multicenter cross-sectional survey design. This study used the structural validity and internal consistency domains from COSMIN (consensus-based standards for the selection of health status measurement instruments) guideline. The H-PTPS questionnaire consists of 20 closed questions. A sample of 384 adult patients from physical therapy units from three Spanish public hospitals completed this questionnaire. A factor structure and internal consistency reliability analysis were performed. The factor analysis including the 20 items of the H-PTPS showed an adequacy index of 0.

The catalysts showed the effectiveness and relative stability for WCO trans-esterification over 3 cycles. The novelty, therefore, is the synthesis of nano-solid acid catalyst from WIF, which is cheaper and could serve as an alternative source for the ferric compound.Malignant peritoneal mesothelioma (MPeM) is a rare cancer of the mesothelial cells of the peritoneum. Computed tomography (CT) is considered the standard for first-line imaging of MPeM, diagnosis and risk stratification remains challenging. Peritoneal cancer index (PCI), as assessed by CT, is utilized in the prognostic assessment of other malignant intra-abdominal conditions; however, there is limited data concerning the utility of PCI in the diagnosis and workup of MPeM. We studied a retrospective cohort of all patients diagnosed with MPeM from 2000 to 2012 in Finland. CT and magnetic resonance imaging (MRI) were reviewed and scored by an experienced and blinded, board-certified abdominal radiologist. Additional clinical data and outcomes were obtained from Finnish Cancer Registry (FCR), the Workers' Compensations Center (WCC), and Statistics Finland (SF). Abdominal CT or MRI was available for 53 of 90 patients. The median radiographic PCI was 25. PCI score was correlated with overall survival (p = 0.004, Exp(B) = 1.064, 95% CI 1.020-1.110). PCI score ≥ 30 was associated with worse survival (p = 0.002), while PCI ≤ 19 was associated with improved overall survival (p = 0.001). Our study indicates that radiological PCI is prognostic in MPeM and should be assessed during radiographic workup and integrated into clinical decision-making.Models of quantum gravity imply a fundamental revision of our description of position and momentum that manifests in modifications of the canonical commutation relations. Experimental tests of such modifications remain an outstanding challenge. These corrections scale with the mass of test particles, which motivates experiments using macroscopic composite particles. Here we consider a challenge to such tests, namely that quantum gravity corrections of canonical commutation relations are expected to be suppressed with increasing number of constituent particles. Since the precise scaling of this suppression is unknown, it needs to be bounded experimentally and explicitly incorporated into rigorous analyses of quantum gravity tests. We analyse this scaling based on data from past experiments involving macroscopic pendula, and provide tight bounds that exceed those of current experiments based on quantum mechanical oscillators. Furthermore, we discuss possible experiments that promise even stronger bounds thus bringing rigorous and well-controlled tests of quantum gravity closer to reality.Multiple studies have found the neutrophil to lymphocyte ratio (NLR) to be associated with adverse breast cancer (BC) prognosis and survival. Very limited data exist on the role of NLR and risk of BC. The BREOGAN study is a population-based case-control study conducted in Galicia, Spain. We examined the WBC- and NLR-BC relationships. The risk of BC increased with increasing levels of neutrophils percentage (NE%) (multivariable OR for the highest category (95% CI) = 2.14 (1.39-3.32), P-trend  less then  0.001) and of the NLR (multivariable OR for the highest category (95% CI) = 1.93 (1.26-2.97), P-trend  less then  0.001). Lymphocytes absolute (L#) and percentage (L%) were associated with a decreased risk of BC (multivariable OR for the highest category (95% CI) = 0.54 (0.35-0.83), and 0.51 (0.33-0.79), P-trend = 0.001 and  less then  0.001, respectively). The NLR-BC association was more pronounced among Luminal A BC (multivariable OR for the highest category (95% CI) = 2.00 (1.17-3.45), P-trend  less then  0.001), HER2-negative BC (multivariable OR for the highest category (95% CI) = 1.87 (1.16-3.02), P-trend  less then  0.001), and those with high total cholesterol and low H2O2 levels.Ascorbate peroxidase (APX; EC 1.11.1.11) activity and transcript levels of CrAPX1, CrAPX2, and CrAPX4 of Chlamydomonas reinhardtii increased under 1,400 μE·m-2·s-1 condition (HL). CrAPX4 expression was the most significant. So, CrAPX4 was downregulated using amiRNA technology to examine the role of APX for HL acclimation. The CrAPX4 knockdown amiRNA lines showed low APX activity and CrAPX4 transcript level without a change in CrAPX1 and CrAPX2 transcript levels, and monodehydroascorbate reductase (MDAR), dehydroascorbate reductase (DHAR), and glutathione reductase (GR) activities and transcript levels. Upon exposure to HL, CrAPX4 knockdown amiRNA lines appeared a modification in the expression of genes encoding the enzymes in the ascorbate-glutathione cycle, including an increase in transcript level of CrVTC2, a key enzyme for ascorbate (AsA) biosynthesis but a decrease in MDAR and DHAR transcription and activity after 1 h, followed by increases in reactive oxygen species production and lipid peroxidation after 6 h and exhibited cell death after 9 h. https://www.selleckchem.com/products/ex229-compound-991.html Besides, AsA content and AsA/DHA (dehydroascorbate) ratio decreased in CrAPX4 knockdown amiRNA lines after prolonged HL treatment. Thus, CrAPX4 induction together with its association with the modulation of MDAR and DHAR expression for AsA regeneration is critical for Chlamydomonas to cope with photo-oxidative stress.The survival and function of brain cells requires uninterrupted ATP synthesis. Different brain structures subserve distinct neurological functions, and therefore have different energy production/consumption requirements. Typically, mitochondrial function is assessed following their isolation from relatively large amounts of starting tissue, making it difficult to ascertain energy production/failure in small anatomical locations. In order to overcome this limitation, we have developed and optimized a method to measure mitochondrial function in brain tissue biopsy punches excised from anatomically defined brain structures, including white matter tracts. We describe the procedures for maintaining tissue viability prior to performing the biopsy punches, as well as provide guidance for optimizing punch size and the drug doses needed to assess various aspects of mitochondrial respiration. We demonstrate that our method can be used to measure mitochondrial respiration in anatomically defined subfields within the rat hippocampus.

In current breast ultrasound computer aided diagnosis systems, the radiologist preselects a region of interest (ROI) as an input for computerised breast ultrasound image analysis. This task is time consuming and there is inconsistency among human experts. Researchers attempting to automate the process of obtaining the ROIs have been relying on image processing and conventional machine learning methods. We propose the use of a deep learning method for breast ultrasound ROI detection and lesion localisation. We use the most accurate object detection deep learning framework - Faster-RCNN with Inception-ResNet-v2 - as our deep learning network. Due to the lack of datasets, we use transfer learning and propose a new 3-channel artificial RGB method to improve the overall performance. We evaluate and compare the performance of our proposed methods on two datasets (namely, Dataset A and Dataset B), i.e. within individual datasets and composite dataset. We report the lesion detection results with two types of analysis (1) detected point (centre of the segmented region or the detected bounding box) and (2) Intersection over Union (IoU). Our results demonstrate that the proposed methods achieved comparable results on detected point but with notable improvement on IoU. https://www.selleckchem.com/CDK.html In addition, our proposed 3-channel artificial RGB method improves the recall of Dataset A. Finally, we outline some future directions for the research.Causal discovery is considered as a major concept in biomedical informatics contributing to diagnosis, therapy, and prognosis of diseases. Probabilistic causality approaches in epidemiology and medicine is a common method for finding relationships between pathogen and disease, environment and disease, and adverse events and drugs. Bayesian Network (BN) is one of the common approaches for probabilistic causality, which is widely used in health-care and biomedical science. Since in many biomedical applications we deal with temporal dataset, the temporal extension of BNs called Dynamic Bayesian network (DBN) is used for such applications. DBNs define probabilistic relationships between parameters in consecutive time points in the form of a graph and have been successfully used in many biomedical applications. In this paper, a novel method was introduced for finding probabilistic causal chains from a temporal dataset with the help of entropy and causal tendency measures. In this method, first, Causal Features Depwith unknown cause.Learning a Bayesian network is a difficult and well known task that has been largely investigated. To reduce the number of candidate graphs to test, some authors proposed to incorporate a priori expert knowledge. Most of the time, this a priori information between variables influences the learning but never contradicts the data. In addition, the development of Bayesian networks integrating time such as dynamic Bayesian networks allows identifying causal graphs in the context of longitudinal data. Moreover, in the context where the number of strongly correlated variables is large (i.e. oncology) and the number of patients low; if a biomarker has a mediated effect on another, the learning algorithm would associate them wrongly and vice versa. In this article we propose a method to use the a priori expert knowledge as hard constraints in a structure learning method for Bayesian networks with a time dependant exposure. Based on a simulation study and an application, where we compared our method to the state of the art PC-algorithm, the results showed a better recovery of the true graphs when integrating hard constraints a priori expert knowledge even for small level of information. Two common issues may arise in certain population-based breast cancer (BC) survival studies I) missing values in a survivals' predictive variable, such as "Stage" at diagnosis, and II) small sample size due to "imbalance class problem" in certain subsets of patients, demanding data modeling/simulation methods. We present a procedure, ModGraProDep, based on graphical modeling (GM) of a dataset to overcome these two issues. The performance of the models derived from ModGraProDep is compared with a set of frequently used classification and machine learning algorithms (Missing Data Problem) and with oversampling algorithms (Synthetic Data Simulation). For the Missing Data Problem we assessed two scenarios missing completely at random (MCAR) and missing not at random (MNAR). Two validated BC datasets provided by the cancer registries of Girona and Tarragona (northeastern Spain) were used. In both MCAR and MNAR scenarios all models showed poorer prediction performance compared to three GM models the saturated one (GM.SAT) and two with penalty factors on the partial likelihood (GM.K1 and GM.TEST). However, GM.SAT predictions could lead to non-reliable conclusions in BC survival analysis. Simulation of a "synthetic" dataset derived from GM.SAT could be the worst strategy, but the use of the remaining GMs models could be better than oversampling. Our results suggest the use of the GM-procedure presented for one-variable imputation/prediction of missing data and for simulating "synthetic" BC survival datasets. The "synthetic" datasets derived from GMs could be also used in clinical applications of cancer survival data such as predictive risk analysis. Our results suggest the use of the GM-procedure presented for one-variable imputation/prediction of missing data and for simulating "synthetic" BC survival datasets. The "synthetic" datasets derived from GMs could be also used in clinical applications of cancer survival data such as predictive risk analysis.Nowadays, the demand for segmenting different types of cells imaged by microscopes is increased tremendously. The requirements for the segmentation accuracy are becoming stricter. Because of the great diversity of cells, no traditional methods could segment various types of cells with adequate accuracy. In this paper, we aim to propose a generic approach that is capable of segmenting various types of cells robustly and counting the total number of cells accurately. To this end, we utilize the gradients of cells instead of intensity for cell segmentation because the gradients are less affected by the global intensity variations. To improve the segmentation accuracy, we utilize the Gabor filter to increase the intensity uniformity of the gradient image. To get the optimal segmentation, we utilize the slope difference distribution based threshold selection method to segment the Gabor filtered gradient image. At last, we propose an area-constrained ultimate erosion method to separate the connected cells robustly.

Our results further strengthen the hypothesis that severe COVID-19 disease might be due to an underlying dysregulated hyperimmune response. In order to identify these patients early and prioritized resources, we believe that all patients with COVID-19 should be screened for hyperferritinemia. In this preliminary cross-sectional study, elevated ferritin levels were shown to correlate with disease severity in 39 patients from Israel with confirmed COVID-19 infection. Our results further strengthen the hypothesis that severe COVID-19 disease might be due to an underlying dysregulated hyperimmune response. In order to identify these patients early and prioritized resources, we believe that all patients with COVID-19 should be screened for hyperferritinemia. Social distancing, implemented to decrease the spread of coronavirus disease-2019 (COVID-19), forced major changes in medical practices, including an abrupt transition from face-to-face to remote patient care. Pre-clinical medical studies were concomitantly switched to electronic distance learning. To explore potential implications of COVID-19 on future pre-clinical medical studies. We examined responses of pre-clinical medical students to the remote electronic learning in terms of quality of and satisfaction with teaching and technical support, attendance to classes, and the desire to continue electronic learning in the post-epidemic era. A survey of responses from first-year students at the Adelson School of Medicine was conducted. To optimize the reliability of the survey, a single research assistant conducted telephone interviews with each student, using a structured questionnaire concerning aspects of participation and satisfaction with teaching and with technical components of the remote electronic learning. With 100% response rate, the students reported high satisfaction with the electronic learning regarding its quality, online interactions, instructions given, technical assistance, and availability of recording for future studies. Most of the students (68.6%) noted a preference to continue < 90% of the learning online in the post-outbreak era. A high level of overall satisfaction and a low rate of technical problems during electronic learning were significantly correlated with the desire to continue online learning (P < 0.01). The high satisfaction and the positive experience with the electronic distance learning imposed by the COVID-19 epidemic implied a successful transition and might induce future changes in pre-clinical medical studies. The high satisfaction and the positive experience with the electronic distance learning imposed by the COVID-19 epidemic implied a successful transition and might induce future changes in pre-clinical medical studies. Channeling medical resources for coronavirus disease-2019 (COVID-19) management can potentially endanger routine healthcare practices. As a preventive measure, a department of obstetrics and gynecology in Israel constructed a separate, designated complex for its COVID-19-exposed patients. To evaluate the effect of the COVID-19 pandemic infection control measures on obstetric care in the obstetrical emergency department and delivery unit. The authors collected data retrospectively from February 2020 to March 2020 and compared it to data of a parallel period in 2019. From 1 February 2020 to 28 March 2020, 3897 women were referred to the emergency department (ED), compared to 4067 the previous year. Mean duration of treatment until decision and referral indications did not differ between 2020 and 2019 (207 vs. 220 minutes, P = 0.26; urgent referrals 58.8% vs. 59.2%, P = 0.83). A per-week comparison showed a significant reduction in ED referrals only in the last week of the period (337 [2020] vs. 515 [2019], P < 0.001). The proportion of women admitted to the delivery unit in active labor was significantly higher in the last three weeks (39.1% vs. 28.2%, P = 0.005). During February and March 2020, 1666 women delivered, compared to 1654 during February and March 2019. The proportion of types and modes of delivery did not differ. In a per-week comparison, the number of deliveries did not differ (mean 208 vs. 206, P = 0.88). With timely preparation and proper management, negative impact of COVID-19 can be reduced in obstetrical emergency departments. With timely preparation and proper management, negative impact of COVID-19 can be reduced in obstetrical emergency departments. The potential excess flow of patients into emergency departments and community clinics for testing and examination during a pandemic poses a major issue. These additional patients may lead to the risk of viral transmission to other patients and medical teams. https://www.selleckchem.com/products/i-bet-762.html To contain the spread of coronavirus disease-2019 (COVID-19), the Israeli Ministry of Health initiated a plan spearheaded by Magen David Adom (MDA), Israel's national emergency medical services (EMS) organization. To describe outbreak containment actions initiated by MDA, including a COVID-19 tele-triage center and home testing by paramedics. Retrospective analysis was conducted of de-identified data from the call management and command and control systems during the first period of the COVID-19 outbreak in Israel (23 February 2020-15 March 2020). During the study period, the total number of calls to the dispatch centers was 477,321 with a daily average of 21,696, compared to 6000-6500 during routine times. The total number of COVID-19 related calls was 334,230 (daily average 15,194). There were 28,454 calls (8.51% of all COVID-19 related calls, average 1293/day) transferred to the COVID-19 call center. Of the COVID-19 call center inquiries, 8390 resulted in the dispatch of a dedicated vehicle, including a paramedic wearing personal protective equipment, to collect samples for testing (daily average 381). Maximizing EMS during a pandemic using phone triage, in addition to dispatching paramedics to perform home testing, may significantly distance infected patients from the public and health care system. These steps can further minimize the spread of disease. Maximizing EMS during a pandemic using phone triage, in addition to dispatching paramedics to perform home testing, may significantly distance infected patients from the public and health care system. These steps can further minimize the spread of disease.

Unusually high levels of body fragmentation (FI value below 0.1) in some secondary sites may indicate that body disarticulation was most likely caused peri-mortem by explosives, land mines, mortars or tank fire, all suggesting a combat situation.A study was undertaken of all drowning deaths that occurred over a 30-year period from 1988 to 2017 in the urban section of the River Torrens, Adelaide, South Australia, an augmented waterway that runs through the central business district. Autopsy records from Forensic Science South Australia (FSSA) were reviewed. There were 34 drownings (0-5 cases/yr) with 28 males and 6 females (M;F = 4.61), with an age range for males of 18-76yrs (mean 42.0; SD 18.0) and for females of 20-84yrs (mean 69.3; SD 24.5). There were 15 (44%) accidents, 11 (32%) suicides, 1 (3%) homicide and 7 (21%) undetermined. Of the 22 cases during or after 1994 with complete toxicology reports, 10 (45%) had a blood alcohol concentration (BAC) of greater than 0.05% (g/100 mL) with an illicit substance detected in 4 (18%) cases (MDMA (3,4-methylenedioxymethamphetamine), methylamphetamine and THC (delta-9-tetrahydrocannabinol) acid). The presence of various therapeutic drugs was also detected in 10 cases (45%) including temazepam, fluoxetine, diazepam, olanzapine, amitriptyline, carbamazepine, codeine, citalopram and valproate. Although the numbers of cases were not high, the urban portion of the River Torrens had a much higher number of drowning events per kilometre compared to other inland waterways in South Australia such as the Murray River. This is most likely due to the vulnerability that exists for intoxicated individuals in the city from falls into the water and to the availability of the river as a means of suicide to members of the adjacent urban population.Folate Receptor Alpha (FRA) is a membrane protein expressed on the apical surface of epithelial cells. Its expression in increased in certain tumors, where it can serve as a target for therapy. Triple Negative Breast Carcinoma (TNBC) are a heterogeneous group of tumors, with limited therapy options and poor prognosis. https://www.selleckchem.com/products/semaxanib-su5416.html We aimed to study the expression of FRA in TNBC. Tissue microarrays were prepared from archived paraffin blocks of 300 TNBC resection specimens. Staining for FRA immunohistochemistry was carried out using the clone 26B3.F2. Clinical and pathologic details of the patients were obtained from the electronic medical records. Chi square test was performed for correlation of clinicopathological features with FRA expression. Kaplan Meir and Cox Regression analysis were carried out to study the Disease Free Survival (DFS) and Overall Survival (OS). FRA showed positivity in 43% (129/300) of TNBCs in our study. In univariate analysis, TNBC expressing FRA had a significantly better OS compared to FRA negative tumors (p - 0.035). Also, FRA positive tumors showed a trend towards longer DFS, though this was not statistically significant. In multivariate analysis however, FRA expression did not emerge as a significant factor. To conclude, TNBCs in our study showed FRA expression and though this did not emerge as an important prognostic factor, it can represent a therapeutic target for future clinical trials. Mucinous colorectal carcinoma (MC) is a rare subtype of colorectal adenocarcinoma known to be associated with bad prognosis. Lately, research has turned to identify new prognostic markers allowing the use of targeted therapy. The aim of our study is to evaluate the prognostic impact of E-cadherin and Cox-2expression in MC. A total of 40 formalin-fixed, paraffin-embedded MC specimens were collected within a period of 13years and were studied for the expression of the two proteins. We used SPSS 22 software to study associations with clinicopathological parameters and overall survival (OS). A reduced or absent E-cadherin expression was noted in 52.5% of cases. It was associated with distant metastases (p=0.049) and venous invasion (p=0.049). Cox-2 was overexpressed in 17.5% of cases. It was associated with negative lymph node status (p=0.020) and with early stage tumor (p=0.020). A significant association between the two proteins was also noted (p=0.04). No significant association with OS was found; Howeverkers and their prognostic significance in MC. Lymphangiomas are benign swellings most commonly seen in paediatric population. Head and neck are the common sites of presentation rarely can also been seen other sites as axilla, chest, abdomen, liver, spleen. Even though many different modalities have come up surgical excision remains the main stay of treatment. A 24 year male patient presented with complaints of a swelling the neck since 2 months, which was 8 × 5 cms, soft, cystic and transilluminant in the anterior triangle of the neck. MRI study showed features suggestive of a para pharyngeal lymphangioma. Patient had undergone surgical excision through trans mandibular trans cervical approach for extra cranial part and for intra cranial part has got OK-432 sclerosant therapy. Lymphangiomas are benign, hamartamatous swellings. They are mostly noticed due to their large size causing disfigurement, dyspnoea or dysphagia. They are diagnosed prenatally by using ultrasound scanning. MRI is the superior imaging technique to diagnose lymphangiomas. Surgical excision is the mainstay of treatment, other treatment modalities as scelerotherapy, laser excision, radiotherapy, unroofing, aspiration or steroids are also used. Lymphangiomas are benign, hamartamatous swellings. They are mostly noticed due to their large size causing disfigurement, dyspnoea or dysphagia. They are diagnosed prenatally by using ultrasound scanning. MRI is the superior imaging technique to diagnose lymphangiomas. Surgical excision is the mainstay of treatment, other treatment modalities as scelerotherapy, laser excision, radiotherapy, unroofing, aspiration or steroids are also used. The gallbladder volvulus is a rare surgical emergency and its defined as the rotation of the gallbladder on its mesentery along the axis of the cystic duct and cystic artery. Definitive diagnosis is usually made during surgery and a delay in treatment may result in a high mortality due to rupture of gall bladder and bile peritonitis. We report the case of an 88-year-old woman who presented with an acute torsion of gall bladder, which was treated promptly after admission by laparoscopic cholecystectomy. Acute torsion of gall bladder is a rare disease. Its pathogenesis is not well known but postulated to be multifactorial. Two anatomic variants that predispose to gall bladder torsion have been described. Clinical presentation is not specific, with symptoms and biologic signs that mimic acute cholecystitis. This condition should be suspected in elderly women with uncertain diagnosis of acute cholecystitis or acute abdominal pain of unknown origin. Gallbladder volvulus is a rare life-threatening surgical emergency that requires emergency surgical treatment.