br Conclusion br Introduction Apoptosis is


Apoptosis is a process of programmed cell death, that is involved in keeping selective serotonin reuptake inhibitor by maintaining cell populations in tissues. Physiologically, apoptosis is essential for embryonic development, cell turnover, proper development of the immune system and hormone-dependent atrophy [1]. It takes place through sequence of steps: disruption of cellular membranes, breakdown of cytoplasmic and nuclear skeleton, degradation of chromosomes, extrusion of cytosol and nuclear fragmentation [2]. Balance between cell proliferation and apoptosis is critical for normal development of organisms and it is kept under tight control of group of pro and antiapoptotic proteins [1]. Loss of this balance is a main characteristic of wide variety of diseases; excess apoptosis leads to Alzheimer\’s and Parkinson\’s diseases, AIDS and cardiovascular diseases, while loss of balance in favor of proliferation is common feature of various types of cancers [3,4]. Thus, apoptotic machinery pathways and the involved proteins have evaded as targets for rational therapeutic approaches against several diseases.



IAPs are attractive targets for anticancer therapy, as their inhibition, mainly XIAP, promotes apoptosis of cancerous cell and increase its sensitivity to chemotherapeutic agents. In this review, different types of Smac mimetics that antagonize the action of IAP were discussed. Several peptidomimetics and small molecule Smac mimetics were synthesized and biologically evaluated, where the poor pharmacokinetic properties were the main barrier to their clinical application. Several types of Smac mimetics were developed that belonged to monovalent (that target BIR3 on IAP) or bivalent (that concurrently target BIR2 and BIR3 regions) IAP inhibitors. Currently, several Smac mietics are in clinical trials including GDC-0152 2, GDC-0917 3, SM-406 7 and birinapant 12. Ongoing efforts are being exerted to further explore this field of targeted anticancer therapy.

Cancer is a major concern nowadays for research, although a range of therapies based on chemotherapy are available, but they are of limited efficacy or of serious adverse effects and associated with high levels of toxicity. Hence, many research are being performed for the aim to develop new chemotherapies with minimal side effects on mammalian cells. That was reachable through natural product compounds which were found to be a good source for both novel and potent bioactive compounds with minimal side effects in vivo [1–10].
Curcumin [1,7-bis(4-hydroxy-3-methoxyphenyl)-1,6-heptadien-3,5-dione] Fig. 1, is a turmeric powder, extracted from the rhizome of the plant curcuma longa. Curcumin was found to be a highly pleiotropic molecule that interacts with a diverse range of molecular targets and hence it possess anti-proliferative activities against tumor cells in vitro, anti-inflammatory, antibacterial, antiviral and anti-hepatotoxic activities [11–14]. Since cancer is a result of the dys-regulation of multiple cell signaling pathways so curcumin\’s multi-targeting ability may be the key to its therapeutic potential against cancer. On the other hand, recent research revealed that chalcones possess cytotoxic activity, where tubulin inhibition and interference with microtubule formation were believed to be the main reason for this cytotoxicity; tubulin protein and microtubule formation are essential in cellular processes such as mitosis and cell replication and hence, the great similarity in structure between curcumin analogs and chalcones inspired their testing against tubulin activity [15].

Results and discussion



I would like to express my sincere thanks for the Future University in Egypt for funding my MSC study at Ain Shams University –Cairo- Egypt, also, Professor J.Gullbo; Department of Medical Sciences, Uppsala University Hospital, SE-751 85 Uppsala, Sweden for the great collaboration in this study.

Urban greenways Greenways also referred to

Urban greenways
Greenways, also referred to as linear landscapes and landscape corridors in popular discourse, acquired a distinct body of knowledge developed through key contributions of Little (1990, 1995), Fábos (1995), Fábos and Ahern (1996), Flink et al. (2001), Jongman and Pungetti (2004), Fábos (2004) and Hellmund and Smith (2006), over time. Little (1990, 1995) explained the idea of a greenway as a combination of greenbelt and parkway, to quote “…if you take a syllable from each of these terms – green from greenbelt and way from parkway, the general idea of greenway emerges: a natural, green way based on protected linear corridors which will improve environmental quality and provide for outdoor recreation (Little, 1995: 4).” (±)-Nutlin-3 The President’s Commission on Americans Outdoors (1987) envisioned “a Living Network of Greenways… to provide people with access to open spaces close to where they (±)-Nutlin-3 live , and to link together the rural and urban spaces in the American landscape… threading through cities and countrysides like a great circulating system.” Fábos (1995, 2004) emphasized that “greenways are ecologically significant corridors, recreational greenways and, or greenways with historical and cultural values” and thus advocated for greenway planning as a comprehensive multipurpose, multi-objective effort. Ndubisi et al. (1995) observed, that “environmentally sensitive areas when interconnected could serve as greenway corridors.” Ahern (1995) explained, “(that) greenways do not attempt to transform or control the entire landscape—but by focusing on riparian corridors and other environmentally sensitive areas, greenways are more modest in their ambitions, while exploiting selected linear elements in a strategic and synergistic manner.” My own research concurs with Ahern’s idea and defines greenways as “synergistic landscapes that create harmony amongst the urban system with broader biophysical system” (Sharma, 2010).
Many offshoots of the greenway concept have simultaneously emerged and thus led to confusion about the identity of greenways. In addressing this identity crisis, the comprehensive greenway nomenclature by Hellmund and Smith (2006: 2) is reviewed and reinterpreted here to highlight the following definitive and distinctive features:
The current perception of or design attitude toward greenways, especially urban greenways, is that they are physical connectors between places with green cover. Lindsey et al. (2008) described greenways as linear open spaces or parks along rivers, streams, ridgelines, or historical infrastructure corridors, such as canals or railroads, with the potential to shape the urban form and connect people to places (53). Within this view of urban greenways, the paper investigates the varieties of design approaches and language, currently being generated.

Inquiry into design syntax of urban greenways
Syntax is mostly used in linguistics, but Hillier and Leaman (1974) reintroduced the concept to architecture and urban design through space syntax. Conceptualization of space syntax originated from questioning of critical thinking in design and most prevalently used to map and understand physical connectivity (Hillier and Leaman, 1974; Baran et al., 2008). Lynch (1960) offers a matrix for reading and assessing form. The matrix alludes to clarity in terms of figure background, contrast, and dominance; visible form or geometry, visual scope, and joints or nodes; and continuity, directionality, and motion awareness. This matrix serves as a structure for organizing forms, patterns and spaces to design a city (1960) and Alexander’s (1977) too for designing and retrofitting places, however, not a direct framework for design and planning of an urban greenway. The inquiry into design syntax, presented in this paper, considers previous studies on connectivity and syntactic investigations of Alexander (1977) and Lynch (1960), but focuses exclusively on understanding the design syntax of urban greenways. The paper uses the term “design syntax” to imply the composites of urban greenway with reference to the resultant spatial form. The intention is not to compare the design syntax with linguistics syntax as in this paper since that should follow this investigation in collaboration with a linguistic syntax expert, but to derive an operational understanding of design syntax first. Urban greenways, would be referred to as those designed primarily for humans; approaches that aim to reconcile the design for humans and other biodiversity are beyond the scope of this paper but are discussed in forthcoming text by Sharma (in press).

br Description of the planning process in the studio

Description of the planning process in the studio

Discussion and conclusion
The planning process that was developed in the metropolitan planning studio shows that both plans relate to the tension between planning at the individual level (community and ideology) and are involved in comprehensive planning. Both alternative plans indicate that vital and extensive information related to ideologies and a regional way of life may be lost in classic comprehensive planning approach, including information that deals with the needs and desires of individuals. In addition, both alternative plans began by assuming that this STA-4783 personal information needs to be at the core of the planning process, and a future approach to decision-making and planning models should keep this information throughout the planning process until the formulation of the plan (Ho et al., 2010).

In the 21st century, large cities in China are confronted with great challenges related to environment and development. China has its own strategy for urban growth that is different from urban growth management in developed countries. The local government depends on urban planning and land use planning to manage urban growth. The urban and rural planning law is formulated to strengthen urban and rural planning administration; harmonize urban and rural spatial layout; improve people׳s living environment and promote the integrated, harmonious, and sustainable development of urban and rural society and economy. Most construction activities follow urban and rural planning. However, this situation leads to current development problems in large cities in terms of the following aspects. First, the urban planning is periodically affected by leadership changes. Second, the changing adjustment of administrative area influences the sequence of construction (Chen et al., 2009). Third, the management and control objectives of land use are not the same in different administrative sections. Fourth, the inflexible management system cannot adapt to the economic and social development of the expanded city (Qiu, 2006).
Two types of planning have a potential effect on the construction of cities: urban planning and land use planning. Urban planning, is laid down by the urban planning bureau of a particular city. If the population of a city is over 0.5 million, the urban planning, which is supervised by the local government, needs to be approved by the State Department of China (Figure 1). If the city population is less than 0.5 million, the plan needs to be approved by the government at a higher level. The land use planning of the city is laid down by the land use management sector of the local government and needs approval by the Land and Resources Bureau of China. Compared with land use planning, the city urban planning has the force of law while the other has not.
The central planning practice in China is helpful for the compact urban form, but it presents a challenge to farmland protection and does not address unsustainable environmental practices (Xi et al., 2012). Scientifically setting the urban planning is critical for urban growth management in China׳s political system. The SLEUTH urban growth and land cover change model is an effective decision-support tool to analyze and provide rich exploratory knowledge for evaluating the effects of possible local government decisions (Clarke et al., 1997, 2007; Dietzel and Clarke, 2007; Jantz et al., 2010). Under the SLEUTH model, the simulation of Asian cities always obtains a lower correlation value because of the changing policies of urban development; this condition is different from that of North American or European cities, whose simulations provide a high correlation (Silva and Clarke, 2002), Still, the model can simulate most implementation scenarios in Northeast China and West China except the displacement, shrinkage, and disappearance of urban and rural construction land (Xi et al., 2012).

Materials and methods

The above investigation indicates that

The above investigation indicates that discrete and continuous models are common for layout representation. Most approaches adopt a 2-D layout representation. Approaches that directly modify three-dimensional (3-D) spaces are rare. This trend may be explained by conventional and technical reasons. First, generated layouts represented by 2-D geometries can easily be converted into common architectural drawings. Second, 2-D computer graphics algorithms are stronger and faster than 3-D algorithms. Generating 2-D layouts is faster because the rooms in most buildings have the same height and can be directly extruded from the plan. However, such strategy may limit the solution space when designers intend to find novel combinations of building spaces. The strategy also encounters difficulties in dealing with situations such as multi-story buildings with different room heights or vertical rooms that cross several floors. Thus, we proposed an approach for spatial architectural layout design to directly modify architectural spaces. Our approach to the modeling of spatial layout improves the efficiency of topology finding. The major challenges of this work include (1) introducing a model for spatial layout representation, because few approaches directly modify architectural spaces, and (2) guaranteeing the efficiency of the program, because the number of possible arrangements in 3-D graphics is greater than that in 2-D ones. These challenges are tackled through the combination of a multi-agent system, which is inspired by Li (2012), and an evolutionary strategy. The former enhances the latter by providing it with topology-satisfied layouts. The latter, which is based on a grid system, improves the layouts to satisfy user-specified architectural criteria.

Agent-based topology finding

Spatial layout optimization
The spatial layout generated by the multi-agent system is optimized through an evolutionary approach to satisfy architectural criteria. The multi-agent system represents rooms as points and segments and does not contain information such as volumes and shapes. The generated layout cannot be further optimized without conversion. Under the consideration of the parp inhibitors of results and the difficulty of implementation, we adopt a grid system for the conversion. The comparison between the grid (discrete) model and the continuous model will be in Section 5. This optimization process continues running until amphibians manually stops or all criteria are satisfied.

Several cases are provided for demonstration. The figures that show the layouts generated by the multi-agent system are captured from the screen. For illustration, the figures that show the optimized building layouts are rendered based on automatically generated 3-D models, without exterior walls or division into layers. The adopted architectural programs contain multiple floors and several cross-floor rooms and are manually encoded and written as an xml file. All cases are run on an Intel Core i7 clocked at 1.7GHz with 8GB memory. The program is written in JAVA 1.7 without multithread implementation.
The first case is a three-level house that includes 17 rooms and 1 staircase. Three of its rooms in different floors are connected with one other, and two of them are two-floor high. For the considerations of pipeline distribution and structure stability, all the halls and bathrooms in different floors are required to be aligned. One of the results is shown in Figs. 7 and 8 and implies that the proposed method performs well when dealing with cross-floor spaces. The room position generated by the multi-agent system is preserved in the optimized layout. The result satisfies the architectural criteria well, though few parts of the layout overhang.
Another case is a three-level office building that includes 1 staircase, 20 rooms, and 3 corridors. Half of the rooms are located on the first floor, and the other half are equally distributed on the second and third floors. This case aims to test corridors connected by a large number of rooms. Fig. 9 shows that the corridors are dragged by the rooms, extended, and shaped into capsules. A failure case exists on the first floor. Two rooms are collinear, and the outer one is blocked by the inner room. This error is fixed through the latter optimization process. However, it narrows the corridor and produces irregular architectural spaces (Fig. 10).

br Discussion Vascular invasion is a

Vascular invasion is a critical prognostic factor for patients with HCC. Previous articles from the literature have reported that the median survival time of patients with major vascular invasion is 9–12 weeks if left untreated. To improve the dismal prognosis, various treatments have been applied to patients with advanced HCC. Pawlik and colleagues reported results from a multicenter study which suggested that patients with HCC and major vascular invasion derived survival benefit from surgical resection, with an overall 5-year survival rate of 10%.
TACE has been shown to improve survival compared with supportive care in recent meta-analyses. Although TACE has been frequently used in the treatment of unresectable HCC, its limitations are also well known, especially in large tumors. Previous studies have suggested a benefit of combining motilin receptor agonist therapy (RT) and TACE in patients with advanced HCC.
Historically, RT has played a minor role in the management of patients with unresectable liver cancer, primarily because of the low tolerance of the whole liver to RT. However, recent advances have allowed the safe delivery of higher dose external beam RT to liver tumors, such as advanced imaging to improve tumor definition, three-dimensional radiation planning techniques to deliver high doses that conform tightly to the tumor, image-guided radiotherapy to localize the tumor at the time of treatment, tumor immobilization and organ tracking to account for organ motion due to breathing, and improved knowledge of the partial volume tolerance of the liver to radiation. These advances have revived RT as an additional treatment option in primary liver malignancies.
The resected specimen in our case showed 95% necrosis in the main tumor while the left sided tumor, which did not receive any downsizing treatment, only showed 30% tumor necrosis attributed to the natural tumor biology. The fact that the main tumor received both TACE and RT makes the causative factor for tumor shrinkage and necrosis difficult. However, the IVC-TT showed 100% necrosis with significant shrinkage after RT. Furthermore, microscopic examination of the irradiated non-tumor liver tissue showed sinusoidal lining cell injury causing so-called veno-occlusive disease in the microcirculation. This effect might block tumor angiogenesis and be responsible for tumor shrinkage. These facts have led us to believe that RT was the main causative factor for downsizing and tumor necrosis.
The anterior approach is the preferred technique for extended right-sided hepatic resection for large HCC. This is because of the challenging right side liver mobilization with an increased risk of tumor rupture and higher blood loss associated with the classic approach. Our blood loss was limited to 400 mL with no need for transfusion because of this approach. Furthermore, we resected a part of the right diaphragm to limit the risk for tumor spillage and blood loss.
The patient died of leukemia 3 years postoperatively. Whether this was linked to RT remains controversial but secondary cancers induced by RT have become a clinically significant issue. This increase in risk has to be balanced against the generally high spontaneous cancer risk in these individuals and the benefits accruing from radiotherapy.


Case report
A 59-year-old female patient presented with a 3-year history of recurrent and symptomatic UTIs. She had been receiving antibiotics at a local clinic during this time. Unfortunately, dysuria and lower abdominal soreness were not resolved by this treatment and her symptoms continued to bother her. Because of her continued symptoms, she visited our urology outpatient department (OPD) for a second opinion. Urinalysis revealed microscopic hematuria [red blood cell count: 21–25/high-power field (HPF)] and pyuria (white blood cell count: 31–35/HPF), both of which are indicative of cystitis. An abdominal X-ray of the kidney–ureter–bladder (KUB) revealed a radiopaque shadow in the right pelvic cavity (Figure 1); therefore, a cystoscopy was performed, which revealed a bladder stone about 3 cm in size that was located in the right lateral wall of the urinary bladder (Figure 2). The stone was immobile and appeared to be fixed to the bladder wall; the patient was then admitted for a cystolithotripsy. The stone was cracked in to pieces using a pneumatic Swiss lithoclast (EMS, Swiss). During the operation, a blue thread was determined to be the core of the stone at one end; this thread was attached to the bladder wall at the other end. After the complete removal of the stone fragments, the blue thread was extracted from the bladder wall using foreign body forceps (Olympus, Germany). Some resistance was encountered during the extraction process. Because the patient had undergone a sling operation for stress incontinence approximately 20 years previously, the blue thread was believed to be a part of the sling material that had since migrated and eroded through the bladder wall, thus resulting in the formation of the stone. Careful examination showed that the extracted thread was a type of nonabsorbable braided suture such as Ethibond, i.e., a nonabsorbable suture made of polyester polyethylene terephthalate and coated with polybutilate. The patient’s UTI symptoms were resolved within a few days following the operation, and the patient was uneventfully discharged. Follow-up urinalysis at OPD was normal and the patient was symptom-free.

gli protein Jeng and others and Frederic and coleagues suggested double free

Jeng and others and Frederic and coleagues suggested double free flaps (fibula osteocutaneous flap plus a composite anterolateral thigh-tensor fascia lata flap) for large lip defects with mandibulectomy. Such a procedure achieves excellent results if the tumor has been excised completely. Double flap reconstruction will be destroyed or should be sacrificed if tumors recur or osteonecrosis developed after radiotherapy. We planned in all cases to reconstruct the bone defect in the second stage after completing radiotherapy. In our case, oral competence could be resumed by adequate fascia lata sling without bone grafts or osteal flaps. Consequently, we prefer to employ a single free flap in one stage reconstruction for a large lower lip defect in advanced oral cancer patients. Our first choice is the composite anterolateral thigh-tensor fasciae latae free flap. However, relatively few patients reported in the literature have undergone reconstructive surgery using this approach. Further studies with more cases are needed in order to support our findings.

If an elderly person has a bulging mass on the head, a primary bone tumor or metastatic tumor is first considered. A review of the literature shows that a meningioma originating in an extradural location presenting as an intraosseous mass is very rare. In most cases such a tumor is characterized by osteoblastic or mixed osteoblastic-osteolytic changes without invading soft tissue. We report a rare case of an atypical osteolytic intraosseous meningioma with scalp and gli protein invasion in a 68- year-old woman.

Case report
A 68-year-old woman was brought to the emergency room with the chief complaint of headache and dizziness, which she had been experiencing for several weeks. Noncontrast computed tomography (CT) of the head showed an osteolytic mass (5×5cm) in the left frontal area of the head (Fig. 1). Under the impression of a metastatic tumor, a series of studies was performed. Tumor marker values, including those for cancer antigen 125 (CA-125; 14.7 U/mL), CA 15-3 (5.8 U/mL), CA 19-9 (13.4 U/mL), squamous cell carcinoma antigen (SCC Ag; 0.3ng/mL), alpha-fetoprotein (AFP; 5.9ng/mL), and carcinoembryonic antigen (CEA; 2.4ng/mL), were within normal ranges. A complete systemic evaluation revealed no evidence of other disease.
The patient underwent Simpson grade I resection via the left frontotemporal approach followed by cranioplasty with bone cement. Craniotomy exposed a soft, mildly vascular tumor invading the subcutaneous layers of the scalp, skull bone, and cerebral parenchyma (Fig. 2). No new neurologic deficits developed after the surgery.
Pathologic examination revealed atypical meningioma (World Health Organization [WHO] grade II) (Fig. 3). The patient was discharged from the hospital on postoperative day 15. Three weeks after surgery, adjuvant fractionated conformal radiotherapy was initiated (dose, 5400cGy in 30 fractions), covering the entire tumor bed. The patient is currently undergoing regular follow-up at the outpatient department, and no recurrence has so far been observed.

In adults, the differential diagnosis of osteolytic skull lesions depends on the patient\’s age, clinical presentation, and imaging study. Metastasis is usually the first impression if the patient is older than 40 years. However, primary bone tumors should also be considered.
Most meningiomas are thought to be primary intradural lesions and located in the subdural space. Extradural meningiomas arising in locations other than the dura mater, such as the skin, nasopharynx, or neck, also have been reported. A meningioma originating at an extradural location was first reported in 1904 by Winkler. The incidence of primary extradural meningiomas is approximately 1–2% of all meningiomas.
Primary intraosseous meningioma is a term used to describe a subset of extradural meningiomas that arise in bone. This type of meningioma approximately accounts for two-thirds of all extradural meningiomas. Even when intraosseous meningiomas invade the dura mater and/or brain parenchyma, some authors insist on using the term ”intraosseous meningioma” or “primary extradural meningioma”. Other authors, however, would say that dural invasion precludes a diagnosis of intraosseous meningioma. In our case, the main part of the tumor was located in the skull, so we considered that this tumor was primarily an intraosseous meningioma.

br Conclusion br Introduction Spigelian hernia accounts for only


Spigelian hernia accounts for only about 2% of all hernias. It occurs as a defect formed in the Spigelian aponeurosis and can be congenital or acquired. In 1645, Adriann van der Spieghel, a Flemish anatomist, was the first to describe a defect in the semilunar line (linea Spigeli). In 1764, Josef Klinkosch defined the Spigelian hernia as a defect in the semilunar line. In most cases, the hernial sac contains the omentum, and in some cases may also contain a segment of AZD8055 or colon that may cause intestinal obstruction. Several cases of congenital Spigelian hernia with undescended testis also have been reported. Preoperative diagnosis is very difficult, because the sac is usually located between muscle layers of the abdominal wall, and therefore abdominal computed tomography (CT) or ultrasound is usually the first choice for confirming the diagnosis. As the incarceration rate of Spigelian hernia is very high, prompt surgery should be performed, either by open or laparoscopic repair. We report a male patient presenting with left lower abdominal pain and a palpable mass, which was later diagnosed as incarcerated Spigelian hernia. He underwent conventional surgery without mesh repair. After surgery, he recovered well without complications or recurrence.

Case Report
A 57-year-old man presented at our hospital with a mass in the left lower abdomen. His body height is 162 cm and body weight is 69 kg (body mass index: 26.29 kg/m²). He had had pain in this area for about 1 month, but without nausea or vomiting. He worked as a gardener and had to lift heavy things before he had symptoms. On physical examination, an ill-defined mass measuring about 3 cm was palpable, accompanied with mild tenderness. It was more prominent while standing up. Abdominal echography was performed and it revealed a hypoechoic cystic lesion protruding through the muscle layer of the abdominal wall (Fig. 1). Abdominal CT was then performed and it showed a herniation of omentum through the fascial defect of the left lower abdominal wall (Fig. 2).
An impression of incarcerated Spigelian hernia was made and surgery was performed. Intraoperatively, a herniated sac with part of the omentum incarcerated inside the muscle layers through a 1 cm × 1 cm fascial defect was noted (Figs. 3 and 4). The defect was closed with interrupted sutures after reduction of the hernia. The patient was uneventfully discharged from the hospital 5 days later.

These hernias are frequently seen between the 4th decade and 7th decade. The male to female ratio is 1:1.18. Certain conditions such as obesity, rapid weight loss, multiple pregnancies, chronic obstructive pulmonary disease, chronic constipation, ascites, traumas, and previous surgery are all predisposing factors, because they not only increase the intra-abdominal pressure, but also cause a greater weakness of the abdominal wall. Patients most often present with swelling in the mid-to-lower abdomen just lateral to the rectus muscle. They may complain of a sharp pain or tenderness at this site. The hernia is usually reducible in the supine position. The reducible mass may be palpable, even if it sits below the external oblique musculature.
The physical findings are usually equivocal, and imaging studies are needed for confirming the diagnosis. Ultrasound can provide detailed images of the abdominal wall defect, the hernia sac and its contents, and the relationship of the contents to the Spigelian fascia, as well as the rectus, external oblique, and internal oblique muscles. CT of the abdomen will also confirm the presence of a Spigelian hernia. CT is reported to have a sensitivity of 100% and a positive predictive value (PPV) of 100%, whereas ultrasonography has a sensitivity of 90% and a PPV of 100%, and clinical assessment alone has a sensitivity of 100% and a PPV of 36%. The hernia sac of Spigelian hernias consists of extraperitoneal fat and peritoneum; it may or may not have splanchnic contents. Spigelian hernias usually contain only the small bowel or omentum, but the large bowel, stomach, gallbladder, Meckel\’s diverticulum, ovary, testis, leiomyoma of the uterus, and even urinary bladder have also been reported to be contained in the hernia sacs. The incidence of incarceration is about 20%, and therefore once Spigelian hernia is diagnosed, surgery for immediate hernia repair is mandatory. Our case was diagnosed by means of ultrasound and confirmed by a CT scan. A visible fascial defect can be seen in both studies.

Whether calcium supplements can be

Whether calcium supplements can be beneficial or harmful to the health of people is still controversial. Although the effects of calcium supplements or casual calcium uptake on health outcomes have been systematically reviewed [99], the risks of calcium supplements for cardiovascular diseases have not been completely understood [116]. High calcium intake can slightly improve BMD in children and pregnant woman. There is no consistent conclusion between calcium intake and cardiovascular diseases, except blood pressure. Similarly, although some studies show that people with high calcium intake has lower chance of overweight and obesity [117], the relationship between calcium and obesity is still controversial. Calcium supplementation in diets can contribute to the reduced rate of bone loss and fracture incidence in elders; however, it can also increase the risks of acute gastrointestinal events, kidney stone, and cardiovascular diseases such as myocardial infarction and stroke [118,119]. Based on the meta-analysis, only 10% fracture incidence is reduced due to the calcium supplementation, but the incidences of myocardial infarction and stroke are increased up to 27%–31% and 12%–20%, respectively [119]. Moreover, high calcium intake for men also has the potential for the risk of advanced and fatal prostate cancer [17,120,121].


Conflict of interest

This work is financially supported by the National Natural Science Foundation of China (No. 31571228), Chutian Scholar Program from Education Department of Hubei Province and Innovative Start-up Foundation from Wuhan Sports University to NC.

Experimental evidence has shown that elevated concentration of uric acid, otherwise known as hyperuricaemia, leads to the deposition of monosodium urate monohydrate crystals in tissue, especially joints, thereby resulting in gouty arthritis or uric CA-074 Me nephrolithiasis [1,2]. Gout is a chronic inflammatory arthritis characterized by elevated concentration of uric acid in body fluids, resulting from the over-activity of xanthine oxidase (XO) [3]. It is also characterized with severe and episodic painful inflammation [4]: erythema and swelling [5]. Epidemiological studies have shown that the overall burden of the disease is increasing globally [2]. It is more prevalent in men above 30 years of age and in women older than 50 years [2,6]. Moreover, it has the propensity to reduce the quality of life of these individuals [7]. In addition to gouty arthritis, hyperuricaemia is also a well-established causative factor for uric acid kidney stones and acute kidney failure [8]. Recent epidemiologic studies have also implicated chronic mild hyperuricaemia in the development of interstitial nephritis and progressive renal failure [9]. Furthermore, it is an independent risk factor for metabolic syndrome, cardiovascular disease, hypertension, obesity, obstructive sleep apnea, stroke, vascular dementia, and preeclampsia [10].
Xanthine oxidase (XO) (EC catalyzes the oxidation of hypoxanthine to xanthine and subsequently to uric acid [11] in the purine nucleotides catabolism. Its re-oxidation involves molecular oxygen which acts as electron acceptor, and during this reaction, superoxide radical (O2−) and hydrogen peroxide (H2O2) are produced [12]. The O2− is transformed into H2O2 and O2 either spontaneously or by the catalytic action of superoxide dismutase. Thus, the over-activity of XO leads to the deposition of uric acid in the susceptible tissues, and this triggers the inflammatory pathways with a concomitant release of reactive oxygen species. Hence, gouty arthritis and other inflammatory diseases associated with hyperuricaemia are characterized by oxidative stress. The kidney, liver and lungs are three major organs in mammals involved in metabolism and excretion, and previous studies have reported XO activity in the tissues of these organs [6,13,14]. Functionally, in these organs materials are chemically biotransformed and the metabolic wastes, such as carbon dioxide, water, salt, urea and uric acid, are removed from the body.