History Habits Research Articles

Metabolic syndrome in hypertensive women

The metabolic syndrome (MetS) is recognized as a cluster of cardiovascular risk factors. Appropriate treatment can reduce cardiovascular morbidity and mortality. However, cardiologists may not routinely diagnosis the MetS. To identify the prevalence of MetS among hypertensive women and to study the characteristics of this population. We studied 248 hypertensive women, of median age 61(range: 18–86) years. Ten percent of them only were diagnosed as MetS. A health questionnaire was completed for all participants, including personal history of hypertension, diabetes mellitus (DM), smoking habits and medication. The waist circumference and blood pressure were measured as well as plasma glucose and the complete lipid profile. One hundred twenty two patients (49.19%) met the criteria for MetS. We divided our patients in three groups according their age (< 40, 40–65and > 65 years). There was no statistical significant difference in the prevalence of MetS in these 3 groups (50.7%, 43.6% and 53% respectively). Concerning MetS related factors; increased waist circumference was by far the most common one (86.88%). There was no significant difference in the prevalence of MetS between women with controlled or uncontrolled HTA. One hundred eight out of 248 females (43.54%) were diabetics, and the majority of them 92 (85.18%) met the criteria for MetS. Our results suggest that the prevalence of MetS is dramatically increased among hypertensive women and this prevalence is not influenced by age. Interventions should be planned to increase the awareness of cardiologists to diagnose and treat the MetS.

Indigenous peoples’ habitation history drives present‐day forest biodiversity in British Columbia's coastal temperate rainforest

Abstract Long‐term human habitation has transformed the earth's surface. The combination of time and complex human–environment interactions in remote regions of North America has likely resulted in modified landscapes, though we often consider these regions free of human influence due to the absence of industrial development. We examined long‐term impacts of human resource‐use on British Columbia's coastal rainforest communities. We focused on the region's widespread habitation sites with extensive shell middens to test the legacy of ancient human occupation in present‐day plant communities. Ten habitation sites and 10 control sites in similar locales were selected for floristic surveys and soil sampling. We tested whether plant communities at habitation sites reflected a ‘cultural plant‐use legacy’, with greater presence of culturally significant plant species, and/or a ‘marine nutrient subsidy legacy’ from human use, with increases in species that prefer nutrient‐rich soils. We found that the habitation sites had different plant assemblages than the control sites and were dominated by plants with both higher nutrient requirements and cultural significance. We demonstrate that long‐term occupation has led to strong differences in plant community structure between sites, countering the notion that this is a pristine landscape. We emphasize the value of interdisciplinary approaches and considering past human resource‐use when examining current plant communities. A plain language summary is available for this article.

Habit History in Oral Submucous Fibrosis: Have We Over Emphasized?

Aim:Correlation of habit duration and frequency with clinical grading and histopathologic grouping of oral submucous fibrosis (OSMF).Materials and methods:48 patients with OSMF were included in the study. Detailed history of each patient, clinical profile and habit history were recorded. Biopsy was performed for histopathological correlation. All the findings were correlated with Kerr et al and Khanna and Andrade classification. Statistical Analysis:Kruskal-wallis test was performed to assess the correlation between the study findings. Results:Out of 48 OSMF cases majority were males. Maximum cases were in clinically and histopathologically respectively. Mouth opening was directly proportional with histopathological grouping as per Khanna et al. No correlation between frequency and habit duration with respect to different stages or severity of the OSMF was noted. Conclusion:Disease staging of OSMF clinically and histopathologically is not directly impacted by habit duration and frequency. Rather than habit centered history and management accordingly, more focus should be given to genetics and susceptibility of patient for OSMF development and progression.

Study of Causative Factors and Clinical Patterns of Periorbital Pigmentation.

Introduction:Periorbital hyperpigmentation (POH) is one of the common conditions seen in outpatient department. Despite of its huge prevalence, clinical data regarding its etiology and associations are still insufficient.Materials and Methods:We conducted a clinico-investigational study in 50 patients of periorbital pigmentation. A detailed clinical history was recorded, clinical examination and laboratory investigation including complete blood count, vitamin B12 level, and thyroid profile are done.Results:The mean age of the patients presenting with periorbital hyperpigmentation was 29.5 years, out of 50 patients 42 (84%) were females and 8 (16%) were males. About 14% patients give positive family history of POH, history of atopy was positive in 30% of patients. History of various other habits like lack of adequate sleep, prolonged exposure to computers, rubbing eyes, and application of various cosmetics were also found to be positive in these patients. The other associated clinical findings were freckles (12%), telengectesia (2%), erythema (2%), and melasma (2%). In maximum (90%) number of patients, both upper and lower eyelids were involved and pigmentation involving >1 cm of eyelid margin was seen in 62% of patients. Laboratory investigations showed anemia in 10% of patients and low serum vitamin B12 in 12%; however, none of the patients has deranged thyroid profile.Conclusion:POH has a multifactorial etiology and role of correcting various faulty habits is important factor in its management. Presence of anemia and low serum vitamin B12 levels also points toward need of detailed laboratory evaluation in these patients.

Obesity Prevalence in Primary School Children in Baghdad City

Childhood obesity has reached epidemic levels in developed as well as in developing countries. Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. Overweight and obese children are likely to stay obese into adulthood and more likely to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age. Environmental factors, lifestyle preferences, and cultural environment play pivotal roles in the rising prevalence of obesity worldwide. In general, overweight and obesity are assumed to be the results of an increase in caloric and fat intake. On the other hand, there are supporting evidence that excessive sugar intake by soft drink, increased portion size, and steady decline in physical activity have been playing major roles in the rising rates of obesity all around the world. In this study a survey on the prevalence of obesity among primary schoolchildren using CDC (Center of Disease Control and Prevention) criteria in Baghdad city was investigated, A total of 6368 children in the 6 - 13-year-old age were included (from six primary schools) as the target population, the results indicated that the obese boys percent were more than girls in these six primary schools, for boys it was (64.28%) and for girls it was (35.72%). Also it has been found that the diet habit and family history were the most important factors that can play major role in obesity induction in children.

Optical Coherence Tomography as an Oral Cancer Screening Adjunct in a Low Resource Settings

Oral cancer is the sixth most common cancer worldwide, predominantly seen in low and middle-income countries (LMIC). Two thirds of all cases are detected at a late stage when prognosis and treatment outcomes are poor. Oral lesions are commonly detected by visual inspection, followed by invasive surgical biopsy and time-consuming histopathological analysis. Optical coherence tomography (OCT), a minimally invasive tomographic imaging technology, can be used to non-invasively identify premalignant or malignant change in the oral mucosa. In this study, a mobile OCT imaging system was designed, constructed, and tested for its performance as a point-of-care oral diagnostic device in an LMIC. 20 patients with suspicious oral lesions and 10 healthy subjects were enrolled in this pilot study. Two-dimensional (2-D) OCT images as well as clinical examination data, risk habit history, and histopathology were collected. OCT images for healthy oral mucosa, dysplasia, and malignancy were evaluated in a blinded fashion by visual scoring and computed image processing techniques. It was found that the OCT image processing algorithm performed at or exceeded the performance of visual observer scoring of OCT images.

A correlation between oral mucosal lesions and various quid-chewing habit patterns: A cross-sectional study.

Quid-chewing habit is a common and old tradition in India. It causes various potentially malignant disorders. Therefore, a study was undertaken to analyze the association of various quid-chewing habit patterns and different oromucosal lesions. A cross-sectional study was conducted on 150 cases, where all the individuals selected were having quid-chewing habit and oromucosal lesions. Detailed habit history was taken through preformed questionnaire, clinical examination was done, and the lesion was subjected to incisional biopsy and confirmed histopathologically. The male to female ratio of various quid-chewing habit and oromucosal lesions was 9:1. The middle aged were more commonly involved. Of the various types of quids chewed, a combination of processed betel and processed tobacco which is commercially available was used by majority of the individuals. Oral submucous fibrosis (OSMF) was seen in majority of the cases. The present study confirms the association between betel, tobacco, and various lesions such as OSMF, leukoplakia, chewer's mucosa, lichenoid reaction, and chemical burn. It also confirms the strong association of betel to OSMF and tobacco to leukoplakia.

CHARACTERISTICS OF THE CLINICAL COURSE OF NON-TRAUMATIC SUBARACHNOID HAEMORRHAGE IN ACUTE PHASE OF THE DISEASE

The purpose of the study was to investigate the clinical and statistical characteristics of the course of the disease, to assess the dynamics of the results according to the neurological scales, and to reveal the structure of complications in patients hospitalized for subarachnoid haemorrhage of non-traumatic aetiology. Materials and methods. 87 patients with subarachnoid haemorrhage were examined, 38 of them (43.68%) had isolated subarachnoid haemorrhage, 14 (16.09%) had subarachnoid parenchymal, 29 (33.33%) had subarachnoid ventricular, and 6 (6.9%) had subarachnoid-parenchymal ventricular haemorrhage. The total number of mixed haemorrhages made up 56.32%. In the routine clinical examination the C.S. Ogilvy et B.S. Carter Scale and the GOSE Scale were additionally included. Results. The majority of patients, 33 patients (37.93%), had subarachnoid haemorrhage of a mild severity according to the classification of the World Federation of Neurosurgeons that corresponded to 15 scores by the Glasgow Coma Scale and the absence of motor and speech deficit. The second degree of the severity was diagnosed in 37 people (42.53%) that corresponded to 13-14 scores according to the Glasgow Coma Scale and no motor and speech deficit. The next small group of patients, 14 patients (16.09%), had the 3 degree of the severity, i.e. 13 - 14 scores according to the Glasgow Coma Scale and a certain degree of motor and / or speech deficiency. Two individuals (2.30%) were assessed as having the 4 degree that was 7–12 scores by the Glasgow Coma Scale and the presence / absence of motor and / or speech deficit. One patient (1.15%) belonged to the 5 category, whose condition was assessed as extremely severe, 3-6 scores by the Glasgow Coma Scale and the presence / absence of motor and / or speech deficit. 76 patients with the subarachnoid haemorrhage assessed as having from 0 to 2 scores had 78-80% likelihood of successful outcomes according to the generalizing classification scale for the assessment of the subarachnoid haemorrhage result forecast (CSU. Ogilvy ET B.S. Carter). 10 patients (11.49%) with 3 scores demonstrated a less successful outcome. One patient (1.15%) was found to have 25% risk of adverse outcome and a total of 4 scores. Conclusion. The following risk factors for the development of subarachnoid haemorrhage were identified: the presence in of subarachnoid haemorrhage among relatives in the family history; history of bad habits including smoking, alcohol abuse; history of hypertension, atherosclerosis and hypercholesterolemia; concomitant diseases, including coronary heart disease, peptic ulcer and diabetes mellitus.

Raet1e Polymorphisms Are Associated with Increased Risk of Developing Premature Coronary Artery Disease and with Some Cardiometabolic Parameters: The GEA Mexican Study.

In an animal model, new evidence has been reported supporting the role of raet1e as an atherosclerosis-associated gene. Our objective was to establish if raet1e polymorphisms are associated with the risk of developing premature coronary artery disease (CAD) or with the presence of cardiometabolic parameters. After an informatic analysis, five polymorphisms were chosen and determined in 1158 patients with premature CAD and 1104 controls using 5′ exonuclease TaqMan genotyping assays. Standardized questionnaires were applied to all participants to obtain family medical history, demographic information, history of nutritional habits, physical activity, alcohol consumption, and pharmacological treatment. The functional effect of the rs7756850 polymorphism was analyzed by luciferase assays. Under different models, adjusted by age, gender, body mass index, current smoking, and type 2 diabetes mellitus, the rs6925151 (OR = 1.250, pheterozygote = 0.026; OR = 1.268, pcodominant1 = 0.034), rs9371533 (OR = 1.255, pheterozygote = 0.024), rs7756850 (OR = 1.274, pheterozygote = 0.016; OR = 1.294, pcodominant1 = 0.031), and rs9383921 (OR = 1.232, pheterozygote = 0.037) polymorphisms were associated with increased risk of premature CAD. When compared to the rs7756850 G allele, the C allele showed a decreased luciferase activity. In premature CAD patients, associations with low levels of adiponectin, with a high presence of hypertension, and with high levels of gamma-glutamyltransferase and total cholesterol were observed. In healthy controls, associations with a decrease in LDL pattern B, aspartate aminotransaminase, and hypo-α-lipoproteinemia were detected. An association of the raet1e polymorphisms with an increased risk of developing premature CAD and with cardiometabolic parameters has been shown for the first time. In addition, the functional effect of the rs7756850 polymorphism was defined.

EFFICACY AND SAFETY OF TETRAHYDROCURCUMINOID IN THE TREATMENT OF ORAL LEUKOPLAKIA: A PILOT STUDY

Objective: The objective of this study is to evaluate the efficacy and safety of tetrahydrocurcuminoid (THC) in the treatment of oral leukoplakia. Methods: Patients with oral mucosal lesions with clinical features of leukoplakia were selected, and an incisional biopsy of the lesion was performed to confirm the diagnosis. Demographic data, habit history, and complete medical history were documented. Subjects were given 2% THC gel (Sami Labs, Bengaluru) with advice to apply the gel to the affected areas, 5 times daily for 12 weeks. The lesion was examined, and its characteristics were documented in a standard manner at baseline, 3, 6, 9, and 12 weeks. Results: Of the eight patients, 6 were males with age range from 40 to 70 years (mean age of 56 years). All the patients reported a reduction of burning sensation within 3 weeks of starting treatment and were completely asymptomatic by the end of the study. There was a decrease in the size of the lesion during the follow-up period. Reduction in thickness of the lesion was found in six of eight patients. Histological improvement a stage better was seen in three patients after completion of treatment. However, there was no histological improvement in four patients, and one patient progressed to mild dysplasia from hyperkeratosis without dysplasia. Conclusion: THD when topically applied in gel form is remarkably effective in alleviating clinical symptoms. The remarkable histological improvement was seen in 3 of 8 patients.

Polybrominated diphenyl ethers (PBDEs) in plasma from E-waste recyclers, outdoor and indoor workers in the Puget Sound, WA region

Polybrominated diphenyl ethers (PBDEs) were widely used as flame retardants in consumer products including electronic devices. Important routes of human exposure are contaminated food and contact with dust. In this study, we measured twelve PBDEs in household/workplace dust and blood plasma samples provided by 113 volunteers living in the Puget Sound region, WA and working at electronic waste (E-waste) recycling sites (n = 29) or non-specific indoor (n = 57) or outdoor occupations (n = 27). The volunteers in the outdoor group were also selected because of a history of high seafood consumption habits. Results indicated the sum PBDE levels varied between <2.5 and up to 310 ng g−1 lipid. E-waste recyclers were predominantly men, generally consumed low amounts of seafood, and had PBDE blood levels (geometric mean, GM = 26.56 ng g−1 lipid) that were similar to indoor workers (GM = 27.17 ng g−1 lipid). The sum PBDE levels were highest in the outdoor group (GM = 50.63 ng g−1 lipid). Dust samples from E-waste sites were highly enriched with BDE-209 and BDE-153 relative to non-E-waste businesses and homes. The concentrations of these BDE congeners in dust at E-waste sites were ∼32–39 times higher than in dust from other sites. However, the detection rate of BDE-209 in plasma was low across all groups (13%) and no statistical comparisons were made. Our results suggest that E-waste recyclers in this study population did not have elevated PBDE levels in comparison to volunteers working in other types of occupations.

The Application of Buried Soil Properties for Reconstruction of Various Stages of Early Habitation at Archaeological Sites in Moscow Kremlin

Combined archaeological and pedogenetic study allows reconstructing the history of early habitation in Moscow Kremlin (Moscow, Russia). The area is confined to the third terrace of Moskva River with Podzols as native soils formed in fluvioglacial sandy deposits under virgin broad-leaved forests with conifers. From the Early Iron Age (1500–2000 BP) to the 12th century, alternating stages of agricultural land use and abandonment resulted in human-induced transformation of natural ecosystems into agricultural landscapes. Agricultural land use provoked soil erosion that lead to truncation of the upper soil horizons. Sediments deposited due to slope erosion and mineral materials transported by ancient people enhanced initial lithic discontinuity of soil parent material. Ancient agricultural practices included melioration of soils by mineral and organic fertilizers. During the Early Iron Age the pasture was fertilized by ash and limed by crushed dolomite. Melioration of the 12th century included not only ash and dolomite but also crushed bones, manure and household waste. A change from the agricultural to urban land use after 15th century resulted in the accumulation of cultural layers. A few interruptions in their accumulation, which were caused by accidental fires or other phenomena, were accompanied by regeneration of natural vegetation cover and the formation of shallow soils imprinted on cultural layers.

Preliminary checklist of the naturalised and pest plants of Timor-Leste

Timor-Leste is one of the world’s newest nations, but the island of Timor has a long history of human habitation and land use which has played a significant role in shaping the 15 current vegetation and flora. Movement of people, plants and materials has seen the introduction of hundreds of plants to Timor from foreign lands, many of which have established naturalised populations, with some exerting detrimental impacts on Timorese agriculture, the environment and livelihoods. Plant health surveys conducted by Timorese and Australian biosecurity agencies have enabled compilation of an inventory of more than 20 500 naturalised and pest plant species based largely on recent field collections (now lodged in herbaria) supplemented by observational and literature records. The composition of the naturalised flora in terms of plant family and life form is described and the origin status of introduced plant species is referenced and summarised by continental region and likely mode of introduction.

Characteristics of Patients with End-Stage Renal Disease at Dialysis Unit Dr. Soetomo General Hospital Surabaya

Introduction: The prevalence of end stage renal disease (ESRD) in Indonesia is increasing over the last decade. Most cases highest risk factor are Diabetes Mellitus (DM) and hypertension. Other factors such as lifestyle and environment; both play important role in the development of ESRD. Thus, this study aimed to assess the characteristic of patient with ESRD.Methods: This was a descriptive study acquired by interviewing 126 patients with ESRD who have been undergoing continuous hemodialysis in dialysis unit of Dr. Soetomo General Hospital Surabaya for at least 3 months using questionnaire about history of disease, smoking habit, sex, and ethnic group. All data was analyzed using frequency distribution and percentage.Results: Form 126 patients, consist of 61 male patients (48.4%) and 65 female (51.6%). 45 patients (35.7%) have the history of DM; 98 patients (77.0%) of hypertension; 35 patients (27.8%) of hypertension and DM; and 19 patients (15.1%) have none of them. Later age adult (36-45 years old) has the largest group proportion (34.13%). There are 36 patients (28%) who are smokers. 108 patients (85.7%) are Javanese.Conclusion: Most of the patients have hypertension as the risk factor and in later age group adult. Characteristics of patient with ESRD is caused by multifactorial factors. Therefore, patient with high risk factor should be aware and do preventive steps in progressiveness of the disease.

Personalized risk assessment for dynamic transition of gastric neoplasms

BackgroundTo develop an individually-tailored dynamic risk assessment model following a multistep, multifactorial process of the Correa’s gastric cancer model.MethodsFirst, we estimated the state-to-state transition rates following Correa’s five-step carcinogenic model and assessed the effect of risk factors, including Helicobacter pylori infection, history of upper gastrointestinal disease, lifestyle, and dietary habits, on the step-by-step transition rates using data from a high-risk population in Matsu Islands, Taiwan. Second, we incorporated information on the gastric cancer carcinogenesis affected by genomic risk factors (including inherited susceptibility and irreversible genomic changes) based on literature to generate a genetic and epigenetic risk assessment model by using a simulated cohort identical to the Matsu population. The combination of conventional and genomic risk factors enables us to develop the personalized transition risk scores and composite scores.ResultsThe state-by-state transition rates per year were 0.0053, 0.7523, 0.1750, and 0.0121 per year from normal mucosa to chronic active gastritis, chronic active gastritis to atrophic gastritis, atrophic gastritis to intestinal metaplasia, and intestinal metaplasia to gastric cancer, respectively. Compared with the median risk group, the most risky decile had a 5.22-fold risk of developing gastric cancer, and the least risky decile around one-twelfth of the risk. The median 10-year risk for gastric cancer incidence was 0.77%. The median lifetime risk for gastric cancer incidence was 5.43%. By decile, the 10-year risk ranged from 0.06 to 4.04% and the lifetime risk ranged from 0.42 to 21.04%.ConclusionsWe demonstrate how to develop a personalized dynamic risk assessment model with the underpinning of Correa’s cascade to stratify the population according to their risk for progression to gastric cancer. Such a risk assessment model not only facilitates the development of an individually-tailored preventive strategy with treatment for H. pylori infection and endoscopic screening but also provides short-term and long-term indicators to evaluate the program effectiveness.

Patient-related Risk Factors for Nausea and Vomiting with Standard Antiemetics in Patients with Breast Cancer Receiving Anthracycline-based Chemotherapy: A Retrospective Observational Study

PurposeThe aim of this study was to identify a high-risk or low-risk population for chemotherapy-induced nausea and vomiting among patients with breast cancer treated with a current standard 3-drug antiemetic regimen and receiving anthracycline. MethodsWe analyzed data from chemotherapy-naive Japanese patients with breast cancer, who had received the first cycle of anthracycline-based regimen and were treated with a 3-drug combination of aprepitant, palonosetron, and dexamethasone. This study was carried out at Ehime University Hospital (Toon, Japan) using electronic medical records from May 2011 to June 2017. The primary end point was complete response (CR), which was defined as no emesis and no use of rescue medication. FindingsA total of 103 patients were included in this study. The percentages of patients who had a CR in the overall, acute, and delayed phases were 35.0%, 40.8%, and 50.5%, respectively. Multivariate logistic regression analysis revealed that age <55 years and body mass index <27.5 kg/m2 were significantly associated with an increased risk for CR failure in the overall and acute phases. In contrast, a history of alcohol habit was significantly associated with a decreased risk for CR failure in overall phase. ImplicationsThe present findings suggest that, among patients with breast cancer receiving anthracycline and treated with aprepitant, palonosetron, and dexamethasone, patients younger than 55 years and having a body mass index <27.5 kg/m2 are high-risk populations for chemotherapy-induced nausea and vomiting, whereas those with a history of habitual alcohol consumption is a low-risk one.

The basin of Ioannina in central Epirus, northwestern Greece, from the Early Iron Age to the Roman period

This article offers an overview of the habitation history of the basin of Ioannina Epirus, from the Early Iron Age to the Roman period. The numerous settlements in this region experienced continuous, often uninterrupted, habitation from the Late Bronze Age to the Hellenistic or even Roman Imperial period. The foundation of fortified settlements/acropoleis in the late fourth to early third century BC should no longer be interpreted as a result of a synoecism, since unfortified villages continued to flourish. From the Augustan period onwards, Romans seem to have settled in the area, although it is also possible that the local population adopted Roman habits.

The Unexpected Non-Functional Pancreatic Cyst

The diagnosis of cystic tumors of the pancreas can pose a major challenge. Pancreatic neuroendocrine tumors (PNET) represent 1%-2% of all pancreatic neoplasms and less than 10% of all PNETs are cystic in nature (cPan-NET). Endoscopic ultrasound (EUS) evaluation with fine-needle aspiration (EUS-FNA) has emerged as integral part of the evaluation of pancreatic cysts. A 58-year-old woman with obesity, hypothyroidism, and non-functional microadenoma was consulted to our service after an abnormal CT scan. Images revealed an incidental 3.1 cm x 2.9 cm hypodense lesion in the tail of the pancreas with thick peripheral enhancement. The patient denied unintentional weight loss, abdominal pain, history of pancreatitis or toxic habits. EUS-FNA depicted a 3 cm x 2.2 cm septated cystic lesion with thick walls and no solid component suggestive of mucinous cystic neoplasm. Cytology exam showed aggregates of epithelial cells with nuclear atypia, small nucleoli and granular chromatin. Immunoperoxidase studies demonstrated atypical cells positive for chromogranin and synaptophysin and negative for pankeratin and neuron specific enolase favoring the diagnosis of cPan-NET. Serum chromogranin and gastrin levels were within normal limits. An indium-111 pentetreotide scan showed no somatostatin avid lesion throughout the whole body. The patient was referred for resection of this non-functional cPan-NET. PNETs are an uncommon pancreatic malignancy. The reported incidence rate is approximately 5 to 10 cases per 1 million persons per year. They typically present as a solid lesion or as large solid tumors with focal areas cystic degeneration. Rarely, as in our case, a purely cystic presentation without a solid component can occur mimicking other pancreatic cystic lesions such as mucinous cystic neoplasms. There are no unique CT or EUS imaging features for cPan-NET although others have suggested that c-Pan-NETs exhibit thicker walls than mucinous neoplasms. The sensitivity of pentetreotide scans for all PNETs ranges from 70-90% but varies with tumor type and diminishes particularly for sub-centimeter lesions. Aspiration of cyst fluid via EUS-guided FNA provides an important advantage to establish an accurate diagnosis through immunocytology with staining of neuroendocrine markers. Whether solid, solid-cystic or purely cystic, functional or non-functional, all PNETs have a malignant potential and surgery is the only curative treatment.

Pacifiers, Thumb Sucking, Breastfeeding, and Bottle Use: Oral Sucking Habits of Children with and without Phonological Impairment

Aims: The aim of this study was to describe the nutritive and non-nutritive oral sucking habits (breastfeeding, bottle use, pacifier/dummy/soother use, thumb/finger sucking) of preschoolers with and without phonological impairment, and to determine whether oral sucking habits are associated with the presence and severity of phonological impairment. Methods: We conducted a cross-sectional study of 199 Australian English-speaking preschoolers with and without phonological impairment. Preschoolers’ speech was directly assessed, and parents/caregivers completed a questionnaire. Chi-square (χ²) tests were used to examine relationships between oral sucking habits and the presence and severity of phonological impairment. Results: Based on caregiver reports, 79.9% of participants had been breastfed (33.3% for >12 months), 58.3% had used a pacifier (74.2% for ≥12 months), 83.9% had used a bottle (73.4% for > 12 months), and 15.1% sucked their thumb/fingers. There was no association between a history of oral sucking and the presence and severity of phonological impairment. Conclusion: The majority of preschoolers had been breastfed and bottle-fed, and more than half had used a pacifier. The findings support an understanding that phonological impairment is not associated with a history of nutritive and non-nutritive sucking habits. Research is needed to examine the association between oral sucking habits and other types of speech sound disorders.

Robotic low anterior resection plus transanal natural orifice specimen extraction in a patient with situs inversus totalis

BackgroundSitus inversus totalis (SIT) refers to an unusual condition involving reversal of abdominal and thoracic viscera, with an incidence rate of 1/5000–20,000 adults. Minimally invasive surgeries for SIT patients are technically challenging, while the surgical experience for SIT patients is quite limited.Case presentationA 61-year-old man, previously diagnosed as SIT, came to our hospital for 6 months history of hematochezia and altered bowel habit. A diagnosis of rectal cancer was made in view of colonoscopic biopsy which confirmed an irregular circumferential lump of well differentiated adenocarcinoma at 10 cm from the anal verge. The computed tomography contrast-enhanced (thorax + abdomen + pelvis) scan revealed a total transposition of abdominal and thoracic organs and an enhanced eccentric mass of rectal but with no evidence of distant metastasis. Robotic low anterior resection (LAR) plus transanal natural orifice specimen extraction (NOSE) was performed after obtaining informed consent. The procedure was performed successfully and the patient convalesced nicely without any complications. The postoperative pathological diagnosis revealed a 4x4x0.6 cm3 moderately differentiated adenocarcinoma and circumferential clearance.ConclusionsRobotic LAR plus transanal NOSE for rectal cancer patients with SIT can be performed safely and may be an effective approach in contrast to open or laparoscopic approach, despite the unconventional anatomy.