br Materials and methods This study

Materials and methods
This study was approved by the institutional ethics committee. A CAD-CAM (MTAB XL MILL, MTAB Engineers Private Limited, Chennai, India) die was made to simulate the partially edentulous condition of a three-unit maxillary, posterior FPD (Nejatidanesh et al., 2006). Nonanatomic patterns of 7.5mm in height and 5mm in diameter as well as 6mm in height and 8mm in diameter were made to replicate prepared teeth of the maxillary second premolar and maxillary molar, respectively. The prepared teeth simulation had a two-degree taper and supragingival chamfer finish line. A gap of 8mm in height and 10mm in width placed between the two teeth simulated the pontic space for the maxillary first molar. The precision of the anatomical form of the clinical tooth preparation could not be simulated in this study due to limitations in the use of the sample in the universal testing machine (UTM). The designed die had a rectangular platform (50cm×25cm×14cm) to facilitate holding of the aluminum dies in the UTM (Fig. 1).
A wax pattern (Krohenwachs® – Bego) of a definite size, shape, and lesser anatomic details of a three-unit resin-bonded FPD consisting of the second premolar (8mm in length×7.5mm in mesio-distal width×7mm in bucco-lingual width), first molar (7.5mm×11mm×9mm), and second molar (7mm×10.5mm×10mm) was made on the aluminum die. An impression of the wax pattern was made with polyvinyl siloxane (putty consistency; Virtual Refill®, Ivoclar Vivadent). Type 4 stone nicotinic receptor agonist (Ultrarock®, Kalabhai, India) was made from the impression. The cast obtained was used to make a vacuum-formed template using a pressure molding machine (Biostar®, SCHEU-DENTAL GmbH) (Fig. 2). The vacuum-formed template was used to standardize the specimen size and shape (Fig. 3). The materials were manipulated in accordance nicotinic receptor agonist with the manufacturer’s instructions.
Heat-cured polymerized PMMA specimens A and B were processed by an indirect technique. Impression of the CAD CAM die was made with polyvinyl siloxane (putty consistency; Virtual Refill®, Ivoclar Vivadent). Type 4 stone cast (Ultrarock®, Kalabhai, India) was made from the impression. The cast obtained was used to make the wax patterns. The wax patterns were made over the cast using the template. The fabricated wax patterns were processed by a compression molding technique, according to the manufacturer’s instructions for the materials.
The specimens were evaluated for defects. The defective specimens were discarded. The chosen specimens of all groups were trimmed and finished with abrasive stones and 300-grit sandpaper. The specimens were polished with a pumice/water mixture and finished with diamond polishing paste. The entire procedure was performed by the same person for standardization (Figs. 4 and 5).
Specimens B, D, and F were made with polyester fiber reinforcement (particle size of 100μm, Industrial use, Indian Institute of Technology, Chennai). The fibers were presilanated with methacryloxypropyltrimethoxysilane by the manufacturer to enhance adhesion with resin materials. The polyester fibers were added to the polymer or base paste of the provisional materials in a ratio of 1:10 (2% of the specimen by weight) (Kamble and Parkhedkar, 2012). The weight of the fibers was measured using an electronic machine and transferred to the polymer or base paste of the provisional FPD materials to prepare specimens B, D, and F. These specimens were then prepared in a similar manner as specimens A, C, and E. In total, 30 specimens (5 samples per group) were fabricated for this study (Fig. 6). The materials, code, and lot numbers of the materials used in this study are summarized in Table 1.
Before analysis, the specimens were stored at 37°C for 24h and air dried for 1day at room temperature. The fabricated specimens were tested in the UTM (LR 100K, Lloyd; U.K., CIPET, Guindy, India) with a cell load of 5kN. The specimens were positioned and stabilized on the testing platform with a span length of 5mm, and they were loaded compressively at the mid-pontic region with a cross head speed of 0.5mm/min (Fig. 7). Failure was marked by a perceptible crack and reconfirmed by the abrupt decrease in the recorded load–deflection curve. Fracture load and deflection were documented for all specimens (Fig. 8). The other mechanical properties were derived using formulae. The load–deflection curves were recorded using computer software (NEXYGEN™ MT).where, P=compressive load; L=length in mm; b=width in mm; d=specimen thickness (diameter); FS=flexural strength; P=(FS×bd2)/(3/2×L); compressive strength (CS)=compressive load/cross-sectional area; cross-sectional area=π·D2/4; π=22/7; and D=diameter of the sample analyzed.

br Conflicts of interest br Acknowledgments br Introduction According to

Conflicts of interest

Acknowledgments

Introduction
According to investigations on industrial accidents, human errors account for > 90% of accidents in nuclear industries, > 80% of accidents in chemical industries, > 75% of maritime accidents, and > 70% of aviation accidents [1]. Human error also constitutes one of the direct causes of some of the most shocking industrial accidents which have occurred around the world such as Bhopal in India (1984), Piper Alpha in the United Kingdom (1988), Chernobyl in Ukraine (1986), and Texaco Refinery in Wales (1994) [2].
In the worst industrial accident in world history, the Bhopal disaster, a combination of operator error, poor maintenance, failed safety systems, and poor safety management were identified as the causes of leaked methyl isocyanate gas from a pesticide plant which led to the creation of a dense toxic cloud and killed > 2,500 people. The explosion and fire accident which occurred in the Piper Alpha offshore oil and gas platform and killed 167 workers was attributed mainly to human error including deficiencies in the permit to work (PTW) system, deficient analysis of hazards, and inadequate training in the use of safety procedures. In the Chornobyl accident, operator error and operating instructions and design deficiencies were found to be the two main factors responsible for the explosion of a 1,000 MW reactor which released radioactive materials that spread over much of Europe. Finally, the main cause of the Texaco Refinery explosion, caused by continuously pumping inflammable hydrocarbon liquid into a process vessel which had a closed outlet, was the result of a combination of failures in management, equipment, and control systems, such as the inaccurate control system reading of a valve state, modifications which had not been fully assessed, failure to provide operators with the necessary process overviews, and attempts to keep the unit running when it fgfr inhibitor should have been shut down [3].
Human error has been defined as any improper decision or behavior which may have a negative impact on the effectiveness, safety, or performance system [4]. A PTW is a formal written system to control certain types of works which are identified as potentially hazardous. This system may need to be used in high-risk jobs such as hot works, confined space entries, maintenance activities, carrying hazardous substances, and electrical or mechanical isolations [5]. In this system, responsible individuals should assess work procedures and check the safety at all stages of the work. Moreover, permits are effective means of communication among site managers, plant supervisors, and operators, and the individuals who carrying out the work. The people doing the job sign the permit to show that they understand the risks and the necessary precautions [6].
Although a PTW is an integral part of a safe system of work and can be helpful in the proper management of a wide range of activities, Amphipathic structure may be susceptible to human error itself. For instance, a breakdown in the PTW system at shift change over and in the safety procedures was one of the major factors that resulted in the explosion and fire accident of the Piper Alpha oil and gas platform [7]. Also, the lack of an issued permit for the actual job was one of the reasons for the Hickson and Welch accident in 1992 [8].
Up to now, very limited studies have been conducted regarding human error analysis in the PTW system. Hoboubi et al [9] investigated the human error probabilities (HEPs) in a PTW using an engineering approach and estimated the HEP to range from 0.044 to 0.383. In another study conducted by the same authors [10], human errors in the PTW system were identified and analyzed using the predictive human error analysis technique. The most important identified errors in that study were inadequate isolation of process equipment, inadequate labeling of equipment, a delay in starting the work after issuing the work permit, improper gas testing, and inadequate site preparation measures. Moreover, findings of a study conducted by Haji Hosseini et al [11] on the evaluation of factors contributing to human error in the process of PTW issuing indicated a significant correlation between the errors and training, work experience, and age of the individuals involved in work permit issuance. However, as mentioned above, a limited number of researches have analyzed the PTW process from the human error point of view. Moreover, except for Hoboubi et al [9], other studies were descriptive in nature and failed to quantify the human errors in the PTW issuance process. In this context, the present study aimed to identify and analyze human errors in different steps of the PTW process in a chemical plant.

br RPU procedure RPU was performed

RPU procedure
RPU was performed under antibiotic coverage on the 21st postoperative day. With the patient in the lateral steep position, equal amounts of saline and l-ascorbic acid manufacturer material (76% urograffin; 1mL urograffin 76% contains 0.1g sodium diatrizoate and 0.66g meglumine diatrizoate) were injected through a small feeding tube into the pericatheter space (between the urethral lumen and the catheter). The patient was then asked to flex his right leg at the knee joint and to abduct it at the hip joint, and an anteroposterior pelvic radiograph was taken (Fig. 3).

Results
During the 5-year period, 387 male patients underwent urethroplasty for urethral stricture disease. RPU was performed in 343 patients with a mean age of 30.8 years. The duration of the symptoms at presentation was 3–7 (mean 4.8) months. The stricture length, as seen on radiography, varied from 1 to 5 (mean 2.1) cm. The location of the urethral stricture was bulbar in 142 (41.3%), bulbar and pendular in 75 (21.8%) and pendular in 56 (16.3%) patients, while a pelvic fracture urethral distraction defect (PFUDD) was seen in 70 (20.4%) patients. Forty-three patients reported a history of previous urethral surgery. 183 (53.3%) patients underwent end-to-end anastomotic urethroplasty, while 160 (46.6%) underwent substitution urethroplasty. The follow-up period ranged from 8 to 41 (mean 28) months. The demographic and operative data of the patients are summarized in Table 2. Pericatheter RGU was done three weeks following urethroplasty (Table 3). 292 patients (85.2%) showed normal urethral healing, while contrast extravasation was seen in 51 patients (14.8%). None of the patients developed contrast-medium related complications.
Re-intervention (optical internal urethrotomy, redo-urethroplasty) was needed in 7.2% (21/292) of the patients with normal urethral healing and in 74.5% (38/51) of the patients with contrast extravasation on RPU (Table 4). At the time of the last follow up, the overall success rate was 82.7% (284/343).

Discussion
There is some controversy about the best time for removal of the urethral catheter after urethral stricture repair. Many authors remove the catheter between the 7th and the 21st postoperative day, depending on the type of intervention [3–5]. However, the usual postoperative scenario provides for removal of the urethral catheter three weeks after surgery, followed by a VCUG through the suprapubic catheter tube in order to confirm the integrity of the repair. When the results are satisfactory, the SPC is removed 1–3 days later.
In our study, we performed an RPU before the removal of the urethral catheter. In cases showing a normal urethral outline, the urethral catheter was removed. The suprapubic catheter, if present, was clamped and removed after 1–3 days. In cases showing contrast extravasation, the urethral catheter was kept for another one to three weeks, depending on the degree of extravasation (Table 1).
RPU was successful in all our patients and no complications arising from the procedure were recorded. According to Santucci et al. who performed anastomotic urethroplasty for bulbar urethral stricture in 168 patients, extravasation occurred in 1% of the patients after catheter removal on the 14th postoperative day [5]. In our study, RPU showed contrast extravasation in 14.8% (51/343) of the patients, and almost half of them had grade-1 extravasation (n=25/51). 25.5% of these patients (13/51) benefitted from prolonged catheterization and reported satisfactory voiding by the end of the follow-up period.

Conclusion

Informed consent

Conflict of interests

Source of funding

Acknowledgments

Introduction
Urethral stricture is the narrowing of the calibre of the urethra caused by the presence of a scar consequent on infection or injury [1]. It is one of the commonest complications of urethral injuries. It is one of the oldest known urological diseases [2]. Ancient Egyptians treated stricture diseases 4000 years ago [3]. It is a common problem worldwide affecting mainly the male urethra [4]. Stricture disease can have profound impact on quality of life. It may lead to urinary tract infection, bladder calculi, fistulae, sepsis, and ultimately renal failure [5].

br Case report On physical examination he

Case report
On physical examination, he was pale, had lost the naso-labial fold on the right side of the face while his mouth was deviated to the left. His right eye remained opened on his attempt to clench his teeth and close his eyes (Fig. 1). He had no swelling in the peri-auricular region and his ear, nose and throat (ENT) examinations were normal. The rectal examination revealed an enlarged prostate with malignant features; clinical stage T2C. His Pack Cell Volume was 25% and hence, he was transfused two units of whole blood. The PSA was 116ng/ml and the six cores of the digital guided prostate biopsy taken all confirmed adenocarcinoma of the prostate that had the Gleason score of 7/10(4+3) (Fig. 2). His lumbosacral radiographs revealed osteoblastic bone lesions involving the lumbosacral and pelvic bones. The skull CT showed dense sclerosis at the aldose reductase which was worse in the petrous part of the right temporal bone with narrowed ipsilateral facial nerve canal (Figs. 3 and 4) but the cerebral and cerebellar hemispheres were normal. He was counselled for palliative treatment. Androgen deprivation therapy was achieved by bilateral orchidectomy. Other adjuvant treatments he had were; facial muscles physiotherapy, analgesics and oral bisphosphonates. He had significant resolution of symptoms at subsequent follow ups; he had regained good facial symmetry with the reappearance of the nasolabial fold on the right side and he could close both eyes (Fig. 5).

Discussion
Prostate cancer is the second commonest malignancy in men worldwide [10]; however, it accounts for only 6% of the metastasis from all cancers to the skull [11]. The exact mechanisms of its haematogenous spread to the skull is still poorly understood [12]. Only a few cases of facial nerve palsy following metastasis from prostate cancer to the base of the skull in patients with castration resistant prostate cancer (CRPC) have been reported in the literature. We could not find any report of facial nerve palsy as the first sole presentation of cancer of the prostate prior to ADT or before the development of CRPC. Our patient presented primarily with facial nerve palsy, which posed a significant diagnostic challenge. Because of the impact of facial nerve palsy on the patient\’s body image and quality of life [13], it was expedient to establish the cause. Metastasis to the temporal bone typically presents with the classical triad of otalgia, periauricular swelling and facial nerve palsy [14] but this patient had only facial nerve palsy.
The patient had no other lesion that could explain his facial nerve palsy. The common causes, which includes; infective, metabolic, traumatic, toxins and loco regional lesions [15] were all ruled out in the patient. The preceding LUTS and low back pain were mild and not bothersome, and thus he did not seek for their treatment in any health facility. Delayed presentation is common in our environment because of the poor health seeking behaviour and ignorance. Hence, most patients with prostate cancer are often seen for the first time with an advanced disease [16,17]. The digital rectal examination (DRE) has only 27.1% and 49% sensitivity and specificity respectively; while the use of PSA alone for screening has a sensitivity of 34.9% and specificity of 63.1%. The combination of DRE with PSA significantly improves prostate cancer detection (sensitivity and specificity of 38.0 and 87.9% respectively) [18].
The CT findings in our patient revealed predominantly osteolytic lesion at calvarium and osteosclerosis at the base of the skull with narrowed facial nerve canal on the right side. The petrous part of the temporal bone is the part of the base the skull predominantly involved in patients with facial nerve palsy resulting from secondaries [1,19], in our patient the sclerotic lesion is worse in that region.
The treatment for prostate cancer generally is on a case to case basis. Androgen deprivation therapy remains the gold standard palliative treatment for the advance prostate cancer, thus this patient had surgical castration (bilateral Orchidectomy). He was also treated with oral bisphosphonates in the form of weekly alendronate shown to increased bone mineral density and decreased the risk of skeletal related events in patients with prostate cancer on ADT [20]. Our patient might have benefitted from radiotherapy to the right temporal region, however, the response to ADT was remarkable and there was marked and sustained improvement in facial nerve palsy (Fig. 5), LUTS and the low back pain over the period of follow up.

Hay and Mabberley reported that the

Hay and Mabberley (1991) reported that the inflorescence may develop when plants are mature or replace the leaf in one season, and consists of a spathe, which usually envelops the spadix. Hetterscheid (1992) reported that most parts of the spathe will wilt and drop off, the individual female flowers develop into fruit, of a berry type, containing 1–3 seeds after successful pollination. These berries are usually green when young and change to red or orange-red, blue, white, or yellow-and-white when ripe. The corm or tuber has a dormancy period in the arid season and grows well in the rainy season.
For a long time, Thai people have used the underground stem, the petiole and the young inflorescence of many species in this genus for cooking native dishes. They have local wisdom in the selection of non-poisonous or less-poisonous species as edible vegetables (Nguanchoo et al., 2014). Medicinal application includes the use of Amorphophallus starch, glucomannan, to reduce cholesterol and blood sugar levels (Sukumolnondha, 2005). For these reasons, Amorphophallus underground stems are collected widely from the forest and used as food and in medicinal processing (Independent News Network, 2015). In addition, many attractive species are used for decoration (McPherson and Hetterscheid, 2011). Although Amorphophallus specimens in Thailand have been surveyed and classified to the species level (Hetterscheid, 2012), the systematic study of this genus still needs revision. More data and information about their characteristics and species pkg inhibitor should be obtained through systematic studies of Amorphophallus by collecting living specimens, examining herbarium specimens, cultivating reproductive parts and studying the botanical characteristics and ecological habitats for the growth of each species.

Materials and methods
Living Amorphophallus specimens were collected from protected areas with appropriate authorization and from natural areas in Kanchanaburi, Prachuap Khiri Khan, Surat Thani, Lop Buri, Sa Kaeo, Chachoengsao and Nakhon Ratchasima provinces, Thailand from November 2008 to May 2012. The habitat and environmental characteristics of each sample were recorded. Living specimens were grown under conditions of 70% sunlight in a greenhouse of the Department of Botany, Faculty of Liberal Arts and Science, Kasetsart University, Kamphaeng Saen campus, Nakhon Pathom province.
The leaf and leaflet morphology of the samples were studied. The anatomical characteristics of three fresh leaflets, with five replications of each species, were studied using the freehand section method (Johansen, 1940). The upper epidermis and lower epidermis were peeled onto separate glass slides and mounted using 10% glycerine for the observation of epidermal cell types, shapes and numbers of subsidiary cells surrounding pairs of guard cells and stomatal numbers per leaf area before being observed under a light microscope (model CX31; Olympus; Tokyo, Japan) and recorded using a digital camera (model DP20; Olympus; Tokyo, Japan) at 40×, 100× and 400× magnifications (Johansen, 1940). This research was undertaken in the laboratory and greenhouse from May 2011 to November 2013.

Results and discussion
Around 180 samples of living specimens of Amorphophallus spp. were collected from November 2008 to May 2011. The habitats of species varied with some being consistent while others differed. The habitats were in bamboo forest, deciduous dipterocarp forest, dry evergreen forest and mixed deciduous forest. Many species grew in soil pH 7–8, but some species grew in gaps of limestone. Almost all species were growing under the shade of trees, cliffs or big rocks, except for Amorphophallus paeoniifolius (Dennst.) Nicolson and Amorphophallus tenuispadix Hett. which were growing in both shade and full sunlight.

Acknowledgements
The authors thank the research fund from the Faculty of Liberal Arts and Science and the Center for Advanced Studies in Tropical Natural Resources under the Program for National Research Universities, Kasetsart University, Thailand. Thanks are also recorded to the lecturers, students, national park officers, laboratory officers and gardeners from the Faculty of Liberal Arts and Science and the Faculty of Forestry, Kasetsart University and the Department of National Parks, Wildlife and Plant Conservation, Thailand for supporting this research.

dihydroergotamine br Agradecimientos br Introducci n La forma

Agradecimientos

Introducción
La forma de cómo son aprovechados los recursos malacológicos dentro de un contexto arqueológico es actualmente un tema que cada día está tomando más consideración por los investigadores. Claros ejemplos de esto son los análisis realizados en distintos asentamientos, como el registrado en el sitio moche de Huaca de la Luna, en donde es asociado con actividades alimenticias (Jauregui, 1997; Vásquez, Rosales, Morales y Roselló, 2003), al igual que en la capital chimú de Chan Chan (Pozorski, 1980). Caso contrario ocurre en el sitio chimú de Cabeza de Vaca y en el tambo de Rica Playa, en donde se relacionan con la manufactura de bienes (Velázquez, Melgar y Hocquenghem, 2006) y lo recientemente investigado para el sitio Lambayeque de Santa Rosa, en el que se vincularon los recursos malacológicos con diversas actividades políticas, sociales e ideológicas (Navarro y Zavaleta, 2012).
En lo que respecta dihydroergotamine la metrópoli chimú de Chan Chan, el análisis es escaso, siendo solamente la investigación antes mencionada el único material publicado (se analizaron muestras provenientes de los SIAR que corresponden a la zona urbana de este complejo). Por tal motivo, la presente investigación tiene como finalidad generar nuevas luces en el conocimiento del aprovechamiento de este recurso dentro de la urbe chimú de Chan Chan y de manera específica en el palacio Uhle (también denominado Conjunto Amurallado Xllangchic-An), considerado como uno de los más tempranos y asociado a los primeros momentos de expansión (Canziani, 2012).

Metodología
El análisis malacológico se realizó durante el desarrollo del «Proyecto de Investigación Arqueológico y Conservación de los Muros Perimetrales y Áreas de los Depósitos de Sector Oeste del Conjunto Amurallado Xllangchic-An (ex Uhle) Complejo Arqueológico Chan Chan», dirigido por el arqueólogo José Dávalos García, entre los meses de enero y marzo del 2013 (fig. 1).
El material malacológico proviene del sector de almacenamientos del Conjunto Amurallado Xllangchic-An, en el cual deciduous se realizaron 36 trincheras y 81 cateos, en los 6 subsectores (SS) que se dividió el proyecto. Estos subsectores fueron excavados considerando los estratos naturales como capas de registro. Al presenciar cambios en las características del terreno, se realizó el respectivo registro y así, repitiendo este proceso por cada estrato, la excavación arqueológica se culminó con la develación del primer piso arquitectónico, definido en asociación con el ambiente en donde se interviene; de esta forma se logró determinar la existencia de depósitos, vías de circulación (callejones, corredores y pasillos), alacenas, audiencias, patios, banquetas, rampas y una plaza principal (fig. 2). Para lograr ser vinculado directamente con la funcionalidad de los ambientes, solo se tuvieron en cuenta para la interpretación los materiales provenientes 2 capas en particular: el piso del ambiente y un estrato superpuesto directamente.
Para la identificación taxonómica y la distribución geográfica de los restos se utilizaron manuales y textos especializados sobre diversas especies de moluscos: Ramírez, Paredes y Arenas (2003), Guzmán, Saa y Ortlieb (1998), Zuñiga (2002a), Uriarte (2008), Álamo y Valdivieso (1997); además de sitios web especializados en moluscos. Para los artrópodos, como los cangrejos, cuyas evidencias de mayor recurrencia son los propodito y dactilopodito (llamada también quela), se utilizaron manuales especializados: Zuñiga (2002b), IMARPE (2009). En caso de existir alguna duda con los materiales malacológicos, se realizaron análisis comparativos con la colección moderna del autor.
Teniendo en consideración que los moluscos presentan una distribución muy extensa y están presentes en diversas zonas ecológicas, algunas especies necesitan de distintas características medio ambientales para su subsistencia, siendo de esta manera posible el reconocimiento de la procedencia de las especies y la localización geográfica. Para definir las diversas zonas ecológicas se utilizó bibliografía especializada, como Álamo y Valdivieso (1997) e IMARPE (2009).

Treatment goals in sex therapy are

Treatment goals in sex therapy are addressed through individual, couples, and group therapy (see Table 4). Individual therapy is appropriate for patients without a current sexual partner or for patients with a sexual partner who may have personal treatment goals in addition to goals involving their partner. Individual therapy addresses self‐image/body image problems, depression, self‐acceptance, reframing the symptoms of PD and their associated effects on sexuality and quality of life, and development of effective coping skills to manage anxiety and frustration. Couples therapy additionally addresses psychosexual concerns, relationship distress, and expansion of the definitions of intimacy and sex. Couples learn to explore nonintercourse sexual activities/creativity, and through improved communication and trust, couples determine what sexual satisfaction means for the patient and partner. Additionally, they may learn alternative methods for achieving sexual satisfaction, given limitations imposed by PD symptoms. Group therapy, either in‐person or online, can also significantly reduce distress. Social support can be gained through group therapy among patients with PD coping with similar issues, reducing feelings of isolation and assisting in the development of effective coping skills. Furthermore, these same issues can be addressed in group therapy among the partners of patients with PD. Patients should be made aware of Internet‐based resources, such as the sexual health discussion forums dedicated to PD and coping with a partner\’s sexual health issues, which are available at http://www.sexualmed.org.

Integration of Sex Therapy and Sexual Medicine: A Collaborative Care Model
The hippo signaling
of sex therapy and sexual medicine in the evaluation and treatment of patients with PD addresses the physical aspects of patient sexual function as well as the patient\’s sexual beliefs and expectations. In addition, emotional, psychosexual, and relationship concerns may all contribute to sexual difficulties and poor quality of life. Optimal patient management necessitates a collaborative working relationship between the patient\’s mental health practitioner and physician. An ongoing dynamic collaborative model involving a mental health practitioner and a physician working with patients with PD is presented in Figure 1.
Sex therapy interventions may be directed at acute emotional, psychosexual, and relationship problems that occur during the initial diagnosis of PD, the period following minimally invasive or surgical treatment for PD, or recurring problems over the lifelong course of the disease. Studies of patients with PD who received surgical interventions to correct penile curvature, or other changes in penile shape and rigidity, support the need for a presurgical evaluation of the patient\’s readiness for surgery [41-44]. Any inappropriate or inaccurate expectations expressed by the patient during the presurgical evaluation are then targeted for intervention and are communicated to the physician performing the surgery. The mental health practitioner in the integrated collaborative care model is well positioned to assess patient readiness and to implement any needed interventions to improve patient readiness.
As previously noted, counseling for patients pursuing surgical intervention should address patient expectations for penile straightening, potential adverse events, and surgical recovery, including if the patient has someone who can help take care of him in the immediate postsurgery period. Patient expectations for postsurgery rehabilitation, including possible massage and stretch therapy, use of penile traction therapy, and refraining from sexual intercourse for 6 weeks, should also be addressed [54]. For patients receiving penile prosthetic implantation, specific counseling topics should include discussion of the patient\’s feelings about the penile changes associated with treatment and his understanding that eventually the prosthesis will need to be replaced. Additionally, patients will need to be counseled regarding permanent changes to the structure of the penis required with implantation, and they need to understand that they will never again function naturally without the help of an implant. For patients not currently in a relationship, any patient concerns or anxiety about whether and how the patient would disclose that he has an implant to a new partner should be discussed.

The average wastage and its cost were reduced significantly

The average wastage and its cost were reduced significantly under the hypothetical situation. The reduction in the cost per patient was more than the double as shown in Table 4. It should be mentioned clearly that the cost of the pen was excluded from the calculations since it is offered on a free of charge basis to the RMS from the awarded company.

Conclusion

Acknowledgment

Brief introduction on Sox2 and breast cancer stem cells
The cancer stem cell (CSC) hypothesis postulates that tumors are maintained by a self-renewing CSC population that undergoes asymmetric cell divisions to give rise both self-renewal and cell committed to differentiate to constitute the majority of tumor cells (McDermott and Wicha, 2010). There are now numerous studies which have identified cancer stem cells in leukemia (Bonnet and Dick, 1997), breast, (Al-Hajj et al., 2003) auda (Singh et al., 2003), lung (Ho et al., 2007), colon (Ricci-Vitiani et al., 2007), and others. Tumor recurrence and treatment failure are well known in cancer therapy and more recently a link gets closed to cancer stem cells. CSCs must have resistance to a given therapy to survive primary treatment. A number of factors that may govern this phenomenon, including stem cell quiescence, protected niche environment, up regulated expression of xenobiotic efflux pumps, enhanced anti-apoptotic and DNA repair pathways (Bomken et al., 2010), In breast tumors, the use of neoadjuvant regimens showed that conventional chemotherapy could lead to enrichment in CSCs in treated patients as well as in xenografted mice (Li et al., 2008; Yu et al., 2007). This suggests that many currently available cancer therapies, affected the bulk of tumor cells, but failed to eliminate CSCs, which survive to regenerate new tumors. The first identification of breast cancer stem cells was defined by the combined expression of cell surface markers CD44+/CD24−/low/lin−. As few as 200 of these cells generated tumors in NOD/SCID mice whereas 20,000 cells that did not display this phenotype failed to generate tumor (Al-Hajj et al., 2003). Later studies suggested that aldehyde dehydrogenase 1 (ALDH-1), a detoxifying enzyme responsible for oxidation of retinol to retinoic acid, may be a more potent marker of breast CSCs (Charafe-Jauffret et al., 2010; Ginestier et al., 2007; Morimoto et al., 2009). ALDH-1-positive breast CSCs can induce tumor formation with as few as 500 cells. Breast cancer cells that expressed ALDH-1 were more likely to be estrogen receptor (ER) negative, progesterone receptor (PR) negative, auda and human-epidermal growth factor receptor type 2 (HER-2) positive, and frequently developed distant metastases. ALDH-1-positive cells are resistant to conventional chemotherapy with paclitaxel and epirubicin (Tanei et al., 2009). Previous studies have shown that adult stem cells can be identified by a side population (SP) phenotype. A SP isolated from the breast cancer cell line MCF7 was found to represent small percentage of the total cell line and it contained the tumorigenic fraction, as demonstrated by transplantation experiments in NOD/SCID mice xenografts. This fraction was also able to reconstitute the initial heterogeneity of the cell line (Kondo et al., 2004; Patrawala et al., 2005).
The Sox gene family has been identified through their homology to the high-mobility group (HMG) box of sex-determining region Y, and encodes transcription factors that bind to DNA through a HMG domain and plays critical roles in cell fate determination, differentiation and proliferation (Kamachi et al., 2000; Wegner, 1999). Induction of Sox2 in mouse neural stem cells blocks their differentiation, and down regulation of Sox2 in these cells causes their premature exit from the cell cycle and differentiation into neurons (Graham et al., 2003). Pluripotency-associated transcription factors like Nanog, Sox2 and Oct4 are known as regulators of embryonic stem cell state, more recently have been identified in tumors of various origins. The expression of embryonic transcriptional factors in high degree may be associated with less differentiated cancers (Ben-Porath et al., 2008) Sox2 was detected as an immunogenic antigen in a significant percentage of small cell lung cancer patients (Gure et al., 2000), meningioma patients (Comtesse et al., 2005) and involved in invasion and metastasis of pancreatic intraepithelial neoplasia (Sanada et al., 2006). In the breast, Sox2 expression has been observed in 43% of basal cell-like breast carcinomas and was found to be strongly correlated with CK5/6, EGFR, and vimentin immunoreactivity, suggesting that Sox2 may play a role in conferring a less differentiated phenotype in these tumors (Rodriguez-Pinilla et al., 2007). Furthermore, Yupeng Chen et al. reported that by screened paraffin-embedded mammary tissue sections from 19 normal and 56 breast cancer patients, the expression of Sox2 was strongly positive in breast carcinoma cells but very weak in normal mammary epithelium cells. Moreover, Western blotting analysis of immunoreactive Sox2 in established mammary epithelial cell lines showed that Sox2 expression was higher in cancer but not normal breast cell lines, suggesting a role in tumorigenesis (Chen et al., 2008).

br Introduction Heavy metal pollution is a problem

Introduction
Heavy metal pollution is a problem associated with areas of intensive industry. Zinc, copper, and lead are three of the most common heavy metals released from road travel. Lead concentrations, however, have been decreasing consistently since leaded gasoline was discontinued [1]. The existing high-tech methods of their detection are usually expensive and laboratory based. This work is a part of ongoing research targeting the development of novel, simple, and cost effective methods for monitoring environmental pollutants, particularly pesticides, petrochemicals and heavy metals being common contaminants of water resources. It is known that microorganisms are very sensitive to heavy metals [2,3]. The use of microorganisms for assessment of general toxicity of aqueous environment was reported previously [4]. Identification of the types of pollutants in the environment and the evaluation of their concentration is much more difficult task which is impossible to solve using a single inhibition type of sensor. However, the sensor array approaches utilising several types of bacteria being inhibited differently by different types of pollutants could solve the above problem. Electrochemical measurements were successfully used for studying electrical properties of Seliciclib deposited on screen printed gold electrodes and showed great prospects of using such cell-based sensors for detection of various pollutants [5,6]. Our previous experiments went further and expanded this idea to more complex bio-objects such as bacteria. Using two types of bacteria, Escherichia coli and Deinococcus radiodurans, we confirmed the principles of inhibition sensor array which was capable of differentiation between radionuclide and heavy metal pollutants [2,7]. In this work, we used simple electrochemical measurements for establishing the correlation between conductivity of liquid bacteria samples and immobilized bacteria, and studying the effect of heavy metal ions (Hg) on them. In addition to E. coli bacteria, we used another type of bacteria, Shewanella oneidensis known by its high resistance to heavy metals. The main focus of this work is on electrical characterisation of both free bacteria in solution and bacteria immobilized on the surface of metal electrodes.

Experimental methodology

Experimental results and discussion

Conclusions and future work
The effect of heavy metals (Hg in this case) on two types of bacteria, e.g. E. coli and S. oneidensis was studied using three different optical techniques: fluorescent microscopy and flow cytometry which yields directly the ratio of live/dead bacteria, stained, respectively, with “green” and “red” fluorescent dyes as well as optical density measurements at 600nm. All three optical methods are capable of detecting the effect of heavy metals on the above bacteria, though the flow cytometry is much more reliable. The results obtained were encouraging, however the use of expensive and bulky optical instrumentation is not the way forward for portable and cost-effective sensor development.
Simple electrochemical tests, e.g. cyclic voltammograms, either on gold electrodes immersed into liquid bacteria samples or (even better) on gold electrodes with immobilized bacteria appeared to be very successful. The values of cathode current was found to correlate with bacteria concentration and thus with the concentration of HgCl2 salt acting as inhibitor for bacteria. The effect of HgCl2 on the two bacteria used was different; E. coli is strongly inhibited by HgCl2, while S. oneidensis is practically unaffected in a wide concentration range of HgCl2. The latter fact opened possibility of exploiting the principles of pattern recognition for identification of pollutants.

Acknowledgements
The authors would like to thank the Iraqi Government for sponsoring the PhD project.

Introduction
Biosensors could be defined by the need to incorporate a biological, biologically derived or biomimetic recognition element with a transducing element [1]. In a simple way a biological response has to be detected by a tool and converted in one way or another into an electrical signal.

br Follow up Patient was

Follow up
Patient was regularly followed up in the OPD. After two months there was significant resolution in the condition (Fig. 1B). Diplopia had resolved. CT scan done 6months after treatment shows no cystic lesion or nodule or any new lesion (Fig. 2B).

Discussion
Orbital cysticercosis can present with a varied signs and symptoms like acquired strabismus, diplopia, recurrent redness, and proptosis. It has to be differentiated from other benign and malignant conditions presenting as ocular mass. One or more extraocular muscles may be simultaneously involved, although a propensity for involvement of the superior muscle complex and the lateral rectus muscles has been reported. In another report of an unusual association of multiple nicergoline NCC with ocular cysticercosis involving levator palpebral superioris and superior rectus muscle has been reported. Another study has reported an unusual case of ocular cysticercosis involving the levator palpebrae superioris and superior rectus muscle of the right eye. In our case the cyst was present within the inferior rectus muscle. From that point of view the case under report is interesting and unusual. It becomes essential to diagnose and treat such cases before any severe damage results. Prompt diagnosis and treatment in this case led to an early improvement. Public health measures on a large scale are required for eradication of this disease from the area.

Conflict of interest

A 54-year-old male underwent a revision external dacryocystorhinostomy (DCR) along with lower canalicular recanalization using Sisler’s trephine (Beaver Visitec, Franklin Lakes, NJ, USA). Trephination was performed for a proximal (3mm) partial obstruction. A bicanalicular Crawford stent (ISCON surgicals limited, Jodhpur, India) was placed and retained for 12weeks. After stent removal, the Functional endoscopic Dye test (FEDT) showed free flow of dye in the ostium. A week following stent removal, patient presented with a mass protruding from the lower punctum. Examination revealed a 2mm×2mm, pinkish mass with numerous surface vessels and a tapering end near the posterior wall of the vertical canaliculus (black star) suggesting its origin from the proximal canaliculus (, Panel A). Gentle displacement with a cotton tipped applicator revealed the punctum to be 360° free without any attachments to the mass (, Panel B). The mass was carefully excised at its tapering end followed by a course of topical steroids. At one year follow up, there was no recurrence and irrigation was patent.
Comment
Demonstrable canalicular granuloma following trephination by Sisler’s trephine and intubation is rare and herbaceous case is of an educational value. Canalicular granulomas, papillomas and benign reactive lymphoid hyperplasia are reported following the use of punctal plugs for dry eye patients. Among these, pyogenic granulomas secondary to inappropriate sizing of punctal plugs were the most common. These have been successfully managed with excision and removal of punctal plugs.

Conflict of interest