Other important systemic features in WG patients include pyrexia

Other important systemic features in WG patients include pyrexia, weight loss, recurrent epistaxis, sinus discharge, hemoptysis, peripheral neuropathy, cerebral vasculitis, and renal failure (the major cause of death). Our patient had severe renal impairment which was irreversible even after the initiation of rituximab treatment. His treatment course suggests that the early use of rituximab in patients with severe WG is recommended to prevent irreversible systemic and ocular damage.
Cataract development in WG patients is reported to be as common as 28%. Its causes include uveitis and use of topical or systemic steroids. Literatures are lacking for studies discussing cataract surgery in WG patients and its outcome. Successful treatment of ocular involvement or complications of WG are dependent on treatment of the underlying disease with systemic immunomodulators. Precautions should be taken to achieve favorable outcomes after cataract surgery. These precautions should include quiescence of ocular rgs protein for a period of at least three months before surgery. In addition, one may use periocular steroids immediately before and after surgery. Avoiding scleral manipulation is important to prevent activating scleral inflammation. Clear corneal incision phacoemulsification is a better option than extracapsular cataract extraction. In our patient all of these measures were taken, plus timing the surgery to be within one week of rituximab infusion. It seems that all of these factors led to a favorable outcome in both eyes without exacerbation of the disease.

Declaration of interest

Acknowledgments

Introduction
Corneal refractive surgery achieves the correction of ametropias (myopia, hyperopia and astigmatism) by changing the anterior corneal curvature. Post-corneal refractive patients in need of cataract extraction face difficulties with respect to intraocular lens (IOL) power calculation; this is attributed to our difficulty in obtaining accurate corneal keratometric values (central corneal power) in such patients. Measured central keratometry in patients that have received myopic corneal refractive treatments is usually higher than the actual power, leading to underestimation of the IOL power (hyperopic refractive outcomes). On the contrary, in post-hyperopic refractive eyes, measured central keratometry underestimates actual keratometric power leading to overestimation of the IOL power (myopic refractive outcomes). To overcome this complicated problem and to avoid refractive surprises a series of approaches have been described; new IOL calculation formulas have been proposed, and these formulas aim to bypass the inherent errors of post refractive surgery subjects (i.e. keratometry). Finally, other methods based on the knowledge of the patients clinical history and change in manifest refraction may also offer an alternative approach for IOL calculation in this group of patients.
Besides excimer laser corneal refractive treatments, other corneal-based procedures (astigmatic and radial keratotomies, conductive keratoplasty, etc.) also have been performed to correct ametropias; they too alter the curvature of the anterior corneal surface in order to achieve refractive ocular changes. Circling keratorraphy is another corneal refractive procedure that has been described for the treatment of hyperopia; the procedure consists of the placement of a strongly tied, circular intracorneal suture (buried) with an optical zone of 6–8mm in diameter. The force of the suture induces central corneal steepening and thus corrects hyperopia.

Case report
A 65-year-old female presented to our institute complaining of decreased vision in both eyes. The patient had a history of bilateral hyperopia that was managed 20years ago (1994) with circling keratorraphy. Her UDVA was 20/70 and 20/60 in her right and left eyes, respectively, while her CDVA was 20/25 OD and 20/25 OS with a manifest refraction of −0.50+1.50×75 OD and +0.50+1.50×30 OS. Corneal topography (Tomey, Nagoya, Japan) demonstrated corneal astigmatism with a steep keratometry (K) [email protected] and flat [email protected] (cylinder; 2.85D) in the right eye and steep [email protected], flat [email protected] in the left eye (Fig. 1). Slit lamp examination revealed the presence of a buried intracorneal suture of circular shape (6mm diameter) and mild (+1) nuclear sclerosis in both eyes (Fig. 2). The patient was given the option to cut the intracorneal suture and present in two consecutive visits with stable keratometric readings prior to cataract surgery in order to accurately perform an IOL calculation; since this was an international patient Golgi complex refused and requested to proceed with her refractive lens exchange.

br Discussion Lp a was first isolated

Discussion
Lp(a) was first isolated by Berg in 1963. Lp(a) is a hepatocytes-synthesized lipoprotein structurally related to low-density lipoproteins (LDL) and contains, in addition to cholesterol and apolipoprotein B-100, a surface glycoprotein, apolipoprotein (a) (Apo A), responsible for its characteristic properties; in fact, the primary structure of Apo A is similar to that of plasminogen, a key player in the physiological fibrinolysis. DNA of Apo A and DNA of plasminogen are structurally similar and are both located on chromosome 6. The plasma levels of Lp(a) are genetically determined and extremely variable from one subject to another (from 0.001 to 3g/L), but very stable over life in the same individual. This rate is independent of age, sex, smoking, diet, cholesterol and triglycerides circulating and depends very few on environmental factors. Lp(a) is considered an independent risk factor for thromboembolic diseases. The pathophysiological mechanisms discussed are based on a dual role of Lp(a): an atherogenic role and an antifibrinolytic role; in fact Lp(a) and its cholesterol are taken up by macrophages that become foam cells and colonize the vascular endothelium, thus initiating the process of atherosclerosis. On the other hand, due to the structural analogy between Apo A and plasminogen, Lp(a) presents a striking homology with plasminogen and may therefore compete with binding of plasminogen at fibrin, leading to fibrinolytic system dysfunction. In addition, by inhibiting competitively the binding of plasminogen to its receptors on the surface of endothelial cells, Lp(a) prevents also the activation of plasminogen by t-PA. Due to this interaction with fibrinolytic pathway, Lp(a) has a role in thrombosis in vivo.
Many studies show that elevated levels of Lp(a) constitute a risk factor for coronary and Prostaglandin E2 thromboembolic diseases. The great interindividual variability in plasma levels of Lp(a) precludes defining normal values, but the rate of Lp(a) is generally considered pathological when it exceeds 0.3g/L, which is the threshold value beyond which the risk of heart attack increases. Regarding the risk for RVO, the threshold value could be 0.1g/L according to the literature. In our case, blood levels of Lp(a) were 1.7g/L and they represented the only significantly increased marker of a thrombotic disease. Surprisingly, RVO occurred in a no-smoker, no-hyperlipidemic and normotensive patient. Hypertension, smoking, atherosclerosis and diabetes mellitus are non-specific markers for RVO, whereas dyslipidemia and hyperhomocysteinemia are independent risk factors for the occurrence of recurrent CRVO, as shown by Sodi et al.; in fact, hypercholesterolemia, hypertriglyceridemia, fasting and postmethionine hyperhomocysteinemia are more prevalent in recurrent CRVO patients. Marcucci et al. put in evidence that also vitamins involved in methionine metabolism and alterations in the fibrinolysis pathway (elevated levels of PAI-1, deficiency of protein C, of protein S, of antithrombin III, activated protein C resistance) appear to play a significant role in the pathogenesis of this disease. Elevated levels of soluble endothelial protein C receptor also seem to be an important candidate risk factor for CRVO, as shown by Gumus et al. Lp(a) has been shown to be correlated with cardiovascular disorders and is considered as an emerging thrombophilic risk factor in the pathogenesis of RVO. In fact, circulating concentrations of Lp(a) were found to be significantly different in a large population of RVO patients when compared to healthy subjects, independently from other traditional and emerging risk factors, suggesting that Lp(a) may play an important and independent role in its pathogenesis. Our study found elevated levels of Lp(a) in one patient with ischemic CRVO, confirming the hypothesis that Lp(a) may have an independent role in the pathogenesis of this disease, presumably through its pro-atherogenic and antifibrinolytic action. Plasma levels of Lp(a) mainly depend on genetic factors and very few on environmental factors. This probably explains why the therapeutic methods used against hyperlipoproteinemias usually have no influence on plasma levels of Lp(a) (diet, bile salts chelating resins, HMG CoA reductase, fish oils, fibrates). Nicotinic acid would cause a decrease of almost 34% of the concentration of Lp(a), but only the LDL-apheresis resulted in a decrease of large amplitude. The current lack of effective treatments known to reduce levels of Lp(a) or to fight against the consequences of its pathological elevation makes the determination of systemic Lp(a) currently of limited value in clinical practice.

Other findings such as intracranial

Other findings such as intracranial calcification, hyperhidrosis, susceptibility to infections, and mental retardation have been reported (Hacham-Zadeh and Goldberg, 1982). We could not observe any of these findings in our case.
The skin manifestations of PLS are treated with emollients, with salicylic HZ-1157 manufacturer and urea added to enhance the effect. Oral retinoids including acitretin, etretinate and isotretinoin are the mainstay of treatment of both the keratoderma and the periodontitis associated with PLS. Normal dentition is observed with retinoids only when they are given before the onset of eruption of permanent teeth at 5years of age. Treatment is more beneficial if it is started during the eruption and maintained during the development, of the permanent teeth. The periodontitis in PLS is usually difficult to control. Effective treatment for the periodontitis includes extraction of HZ-1157 manufacturer the primary teeth combined with oral antibiotics and professional teeth cleaning. It is reported that etretinate and acitretin modulate the course of periodontitis and preserve the teeth. A course of antibiotics should be tried to control the active periodontitis in an effort to preserve the teeth and to prevent bacteremia and subsequently pyogenic liver abscess (Almuneef et al., 2003). Early extraction of teeth has also been advocated to prevent bone loss and allow preservation of a solid base for subsequent use in artificial dentures (Janjua and Khachemoune, 2004; Mahajan et al., 2003). Hence, we suggest that if parents notice keratotic plaques on the palms or plantar surfaces of the feet of their child, they should consult a dermatologist. Histological examination of the lesions will enable an early diagnosis of PLS so that early treatment can be instituted with retinoids, which can prevent the development of more skin lesions and modulate the course of periodontitis and, thus, preserve the teeth.

Until now there are several reports in upland

Until now, there are several reports in upland rice micropropagation such as those reported by Geng et al. (2008), Shahsavari et al. (2010), Shahsavari (2010) and Zhao et al. (2011). Several reports have shown that the exogenous application of plant growth regulators such as kinetin (Kin), benzylaminopurine (BAP), and naphthalene acetic gnrh agonists (NAA) with addition of thidiazuron (TDZ) could improve regeneration frequency in upland rice (Ge et al., 2006; Zhao et al., 2011). Other than that, sorbitol or maltose has been shown to have a promotive effect on regeneration of upland rice cultivar (Feng et al., 2011; Geng et al., 2008; Shahsavari et al., 2010). However, TDZ has been shown to improve regeneration of Handao 297 Chinese upland rice cultivar upto 81.2% (Zhao et al., 2011). Dey et al. (2012) also concluded that the addition of TDZ into the regeneration medium significantly enhanced the proliferation of multiple shoots using the shoot apex in rice (Oryza sativa).In this present study, the modified regeneration medium was applied to regulate the initiation of multiple shoots from each scutellum derived calli while the other carbon source and gelling agent were standardized to promote fast growth. To our best knowledge, this protocol for high frequency plant regeneration is still lacking in the other Malaysian upland rice cultivars using embryogenic callus cultures, hence the novelty of this study.
The purpose of this study aimed to ascertain high quality embryogenic calli from mature seeds using optimal concentration of 2,4 dichlorophenoxyacetic acid (2,4-D) and naphthaleneacetic acid (NAA) and amino acid concentrations as well as their morphological variations under SEM. Keeping in view the above statements, an attempt was made to establish an improvement regeneration protocol for Malaysian upland rice genotype (Oryza sativa) cv. Panderas.

Materials and methods

Results

Discussion
Many studies revealed the presence of synthetic auxin, 2,4-D was an important catapult factor for successful rice callus induction (Lin and Zhang, 2005; Karthikeyan et al., 2009; Joyia and Khan, 2013) but other researchers used 2,4-D combined with BAP (Sahoo et al., 2011) or NAA (Bano et al., 2005). Further, the use of 2,4-D was observed as inevitable for micropropagation through calluses. However, our studies showed that the combination of 2,4-D (3mgL−1) and NAA (2mgL−1) induced better callus induction frequency (90%). Our finding was also in contrast to previous reports on other Malaysian upland rice grown on MSB5 media consisting of 2,4-D only (Shahsavari, 2010). Nevertheless, our finding was also in agreement with Ali et al. (2004) who observed that 2,4-D combined with BAP or NAA gave better response to callus induction but in wetland rice. Trejo-Tapia et al. (2002) also suggested in their finding that a combination of auxin (NAA and 2,4-D) was a better alternative rather than using the single auxin. Castillo et al. (1998) also reported supplementation of 2,4-D alone or in combination into callus induction media enhanced callus induction. Since the same hormonal composition is not suitable for all rice varieties, the modifying media were diversified to overcome the genotypic influence for particular rice varieties. In fact, NAA function was reported to stimulate the frequency of embryogenesis in the initial culture stage of rice while Endress (1994) suggested 2,4-D could promote DNA hypermethylation in a pre-embryonic phase which was responsible to preserve the cell in highly mitotic mode. In our findings, high concentration of 2,4-D (4mgL−1) caused the callus become brown and low in quality and not favorable for in vitro regeneration. This might be due to that high dose concentration of 2,4-D could induce a suppressive effect on callusing and in vitro regeneration through the effect of the remaining 2,4-D residues on re-differentiation in the mitotic stage (Rueb et al., 1994). Similar reduction in quantity of callus induction with increasing concentration of 2,4-D was reported in indica rice (Ramesh et al., 2009) and indica rice variety PAU 201 (Wani et al., 2011). Based on our findings, we suggested that a combination of 2,4-D and NAA produced a high percentage of callus formation for upland rice.

Turgut and Bagis stated that the

Turgut and Bagis (2013) stated that the type and shade of resin cement and the thickness and shade of the ceramic influence the resulting optical color of laminate restorations. This study emphasized a high technical sensitivity of the restorations, wherein a slight contamination or procedural error can spoil the appearance. In this study, the overall incidence of failure was negligible, which may explain why 82.8% of patients were satisfied with their restorations. Good knowledge is required for the restoration procedure to be considered safe to practice by students at different levels. In the current study, color changes were the most common failure type of porcelain laminate veneers. The major cause of these failures was dentist malpractice, such aurora kinase inhibitor as removal of the glazed layer after finishing and polishing, or failing to clean the pulp chamber from sealers or gutta percha after root canal treatment on previously cemented porcelain laminate veneers.

Conclusion

Conflicts of interest

Acknowledgment

Introduction
Mandibular atrophy due to edentulism leads to decreased bone mass and increased vulnerability to fracture (Ellis and Price, 2008). Fractures of the atrophic edentulous mandible are not common and present challenges to the clinician in terms of aurora kinase inhibitor and immobilization of the fracture site (Ellis and Price, 2008; Melo et al., 2011). Such fractures occur more frequently in elderly patients, in whom anatomic and physiologic changes affect bone repair negatively. Local factors, such as dense cortical bone and inadequate blood supply, combined with an increased risk of systemic disease in this population, further complicate the outcomes of treatment (Ellis and Price, 2008; Eyrich et al., 1997; Wittwer et al., 2006). Although falls are the main etiologic events leading to fracture of the atrophic mandible, the placement of implants and interpersonal assault have also been reported (Ellis and Price, 2008; Melo et al., 2011; Mugino et al., 2005; Raghoebar et al., 2000). The basic principle of treatment for these fractures is to restore the anatomic form and function by reduction and immobilization of the fracture segments. Treatment options reported in the literature are controversial (Barber, 2001; Eyrich et al., 1997; Marciani, 2001; Wittwer et al., 2006). Unfavorable results associated with conservative management have shifted the focus toward open surgical treatment of atrophic mandibular fractures. Open reduction and internal fixation (ORIF) enables free movement of the mandible during speech and mastication. Nevertheless, treatment depends on the systemic status of the patient and the degree of fracture displacement (Eyrich et al., 1997; Luhr et al., 1996; Melo et al., 2011).
Osteogenesis imperfecta (OI), also referred to as “brittle bone” disease, is an inherited connective tissue disorder characterized by bone fragility. The overall incidence of OI is approximately one in 10,000 births (Huber, 2007). It is known to be inherited both dominantly and recessively, and is due to a mutation in the genes responsible for procollagen synthesis (Table 1). The disease is caused by the production of abnormal matrix by osteoblasts, which fails to withstand mechanical loads adequately (Gallego et al., 2010; Huber, 2007). Patients with OI are susceptible to fractures in response to mild trauma or even occurring spontaneously. Fractures of the extremities are encountered frequently, but facial bone fractures are relatively rare (Feifel, 1996; Gallego et al., 2010). Treatment of OI is essentially palliative and is aimed at reducing fractures and improving the quality of life. In the past decade, however, bisphosphonates have been used to alleviate bone pain and reduce fracture risk in patients with OI (Landesberg et al., 2009; Rauch and Glorieux, 2005). Bisphosphonates are a potent group of drugs that target osteoclasts, resulting in reduced bone resorption. Their use to manage osteoblast disorders, such as OI, is based on the hypothesis that a reduction in bone resorption might compensate for the weakness in bone formation and reduce the development of osteoporosis due to disuse (Gallego et al., 2010; Rauch and Glorieux, 2005). Moreover, their effects on bone turnover may lead to bisphosphonate related osteonecrosis of the jaws (BRONJ) following oral surgical procedures (Heufelder et al., 2012; Ruggiero et al., 2009).

br Results Mean probe forces in grams with confidence

Results
Mean probe forces in grams (with 95% confidence intervals) for the three probes and the accuracy of each group of operators were compared to a standard force of 25g. The results are arranged in ascending order according to probe type and group accuracy in Tables 2–4. The mean probe force for anterior teeth is also shown in Tables 2–4.
In most groups, the mean probe forces were lower after the 15-min break compared to the initial probe force. However, groups 1 and 4 from the experienced category produced higher probe forces with the WP and CP after the 15-min break. Interestingly, the PG group (group 1 and 2) produced lower mean probe forces compared to the other groups. The PG group was closely followed by the Hygienist/Therapist group (group 5, n=4), although the latter group had relatively few participants (Table 1). The mean probe forces on posterior teeth are shown in Tables 2–4.
When the VP was used, there was an overall anti fungal in the mean probe force, which was higher for the posterior than for the anterior teeth (Tables 2–4). The GDP group (group 4, n=9) had a higher mean probe force compared to the other groups. The overall (anterior/posterior) mean values for the VP were more reproducible than those of the other probes (⩽0.5) based on comparisons between baseline and second measurements (Table 5).

Discussion
This study compared probe forces obtained when the VP, WP, and CP are used. Hunter et al. (1994) and Gillam et al. (1998) previously compared the VP and WP. By including these probes in our study, we were able to compare the accuracy and reproducibility of these existing probes with previously published data and include comparisons to the recently introduced CP.
The probe force used by the operator may affect both pocket depth and patient comfort. The present study demonstrated that the VP was the most accurate and reproducible probe compared to a 25-g standard, consistent with previous studies (Bergenholtz et al., 2000; Gillam et al., 1998; Hunter et al., 1994). The mean probe force was generally lighter on the anterior compared to the posterior teeth, even though the examiners were asked to probe the anterior teeth before the posterior teeth. Probe force for each practitioner was determined twice, at baseline and after a 15-min break. Interestingly, the mean probe force was lighter after the 15-min break, which may suggest that improvement occurred between the evaluations. The 15-min interval was used based on data from Van der Velden and de Vries (1980), who reported that allowing a 15-minute interval between initial and repeated probes in the clinical environment reduced the risk of bleeding. We observed higher mean probe forces in the GDP group compared to the untrained group, which included dental nurses and first-year dental students.
All examiners in the study were more concerned with matching the alignment markings (indicating that the correct pressure was achieved) on the pressure-sensitive probes rather than the directions of the probes in the pockets. In clinical situations, reliance on matching alignment markings at 20/25g may lead to under- or over-estimation of the pocket depth (Larsen et al., 2009; Bulthuis et al., 1998). Examiner preferences were evaluated after the probe force evaluations. Most examiners preferred the handle design and the prominent marking system of the CP. These preferences outweighed the knowledge that the probe was not as accurate, in terms of force, as the VP. Interestingly, some of the examiners did not consider the pressure-sensitive probes to be better. Although the VP was more accurate and reproducible than the other probes, some participants did not rate ecological time probe their favorite. Practitioners reported that matching the pressure indicator markings was difficult, and that the probe was unfamiliar. It should be noted that the VP is no longer commercially available in the UK. The WP, which is the standard periodontal probe used in the dental hospital, was the practitioners’ least favorite probe.

According to the distribution of industrial accidents by industry

According to the distribution of industrial accidents by industry, the “other industries” accounted for 34.7% (32,033 people), which was the highest percentage, followed by the manufacturing industry (34.3%; 31,666 people) and the construction industry (25.3%; 23,349 people). These industries combined accounted for almost all industrial accidents throughout the whole spectrum of industries [2]. In terms of industrial accidents according to the scale of workforce or projects, the manufacturing industry showed a relatively higher occurrence rate in a workplace with less than 50 full-time employees, while the construction industry had a higher industrial accident occurrence rate in a project worth < 2 billion Won [4–7]. If we look at the distribution of industrial accident fatality tolls, the manufacturing industry accounted for 29.1% among a total of 1,864 people, followed by the construction industry (26.6%), the other industries (19.5%), the mining industry (17.2%), and the transportation, warehousing, and telecommunication industry (7.5%). In terms of IOIFR, the mining industry showed the highest occurrence rate of 243.87‱, followed by the construction industry (1.78‱); the transportation, warehousing, and telecommunication industry (1.73‱); the manufacturing industry (1.44‱); and the other industries (0.45‱) [2]. After a review of the previous studies, it Pitolisant hydrochloride can be expected that the service industry with a relatively high level of occupational diversification had a higher industrial accident occurrence rate than the manufacturing and construction industries because of the occupational diversification due to changes in industry and employment structures [8–11]. To reduce industrial accidents, this study aimed to identify the high-risk groups, which are the target points of prevention efforts. To that end, we collected and analyzed data of the past 10 years (2003–2012) in relation to the number of workplaces subject to the Industrial Accident Compensation Insurance, workforce, and industrial accident victims. The objective of this study is to find out high-risk groups by industry type, workplace scale, gender, and working period, where industrial accident prevention efforts must be concentrated, by setting up 2003 as the base year (index 100) by analyzing major industrial accident indexes such as the index of industrial accident rate (IIAR), index of occupational injury rate (IOIR), index of occupational illness and disease rate per 10,000 people (IOIDR), and IOIFR. We conducted a comparative analysis of the trends by workplace characteristics (the type of industry and the scale of workforce) and by individual characteristics (gender, age, and employment period). This study is expected to contribute to reducing industrial accidents by identifying high-risk groups, which requires concentration of resources to reduce industrial accidents.

Materials and methods

Results
Since the base year (2003), the workplace and worker indexes have shown a steadily increasing trend. As of 2012, the workplace index was recorded at 181, the worker index was 147, and the industrial accident victim was 97. The occupational accident victim index had increased until 2010 and then indicated a decreasing tendency since 2011. The occupational illness and disease victim index had peaked at 128 in 2007 and declined sharply after that. The occupational injury fatality toll index was recorded to be 86 in 2012 (Fig. 1).
According to the analysis results of major industrial accident indexes, the IOIR and IOIFR in the whole industry had shown a steady decline for 10 years since the base year (2003). As of 2013, the IIAR was recorded at 66, the IOIR was measured at 67, and the IOIFR fell by 40% to 59 from the previous year (Fig. 2).
Unlike other industries, the forestry industry\’s IIAR and IOIR increased dramatically until 2009 (by 4.2 times compared with the base year) and then dropped sharply. In 2011, it once again showed an increasing tendency. The IOIFR had declined until 2006 and then rebounded sharply until 2010 (by 2.5 times compared with the base year). We believe that as the forestry industry\’s IOIR and IOIFR were exceptionally high compared with those of the other industries, a strong policy intervention by the government is necessary (Table 1).

br Demonstrative application Stability analysis of

Demonstrative application
Stability analysis of frames at elevated temperatures can be extended to predict the critical temperature of a loaded frame, using the Unit Load Factor Method ULFM. By this method, which was firstly introduced by Wong and Patterson [15], the limiting temperature at which the frame fails by elastic buckling can be found. In the present work, the basic concept of the ULFM is extended to compute the critical temperatures associated with inelastic frame behavior. The method is described through the following illustrative examples.
The frame group GTEX shown in Fig. 27 is designed according to the Egyptian code ECP 205 [16].
Table 3 lists the outcome of design and critical temperature analysis. Stability analyses are carried out at temperature steps up to 700°C, and the temperature-dependent (λ−T) response curve is plotted.
The essence of the ULFM is to determine the critical temperature at which the frame fails under the service loads (i.e. λ=1.0).
This temperature can easily be obtained by locating the point of intersection of the horizontal line passing through λ=1.0 with the response curve, as shown in Figs. 28 and 29.

Conclusions
This research was conducted to analyze the SCH772984 performance of steel trapezoidal frames exposed to elevated temperatures. The analysis is based on the stiffness method and a simplified nonlinear numerical model developed and published earlier by the authors. The scope of the study covered various geometrical configurations of trapezoidal frames, different support conditions, and several distributions of temperature along the frame members. The study was extended to explain how to compute the critical temperature for loaded trapezoidal frames, based on the unit load factor method. The following conclusions could be drawn from the studies carried out on trapezoidal frames subjected to elevated temperatures:

Introduction

Proposed fuzzy algorithms
To build a fuzzy system, inputs and output(s) to it must be first selected. After that, they must be partitioned into appropriate conceptual categories which actually represents a fuzzy set on a given input or output domain. The conceptual partitions developed for the input and output dimensions are used to create a fuzzy rule set which determines the behavior of the fuzzy system being constructed. Changing the input variables causes the corresponding membership functions to be changed accordingly. Fuzzy inference systems (FIS) are conceptually very simple. They consist of an input, a processing, and an output stage. The input stage maps the inputs to the appropriate membership functions and truth values. The processing stage invokes each appropriate rule and generates a corresponding result. It then combines the results. Finally, the output stage converts the combined result back into a specific output value. There are two common inference processes [16]. First is called Mamdani’s fuzzy inference method proposed in 1975 by Ebrahim Mamdani [17] and the other is Takagi- Sugeno-Kang, or simply Sugeno, method of fuzzy inference introduced in 1985 [18]. These two methods are the same in many respects, such as the procedure of fuzzifying the inputs and fuzzy operators. The main difference between Mamdani and Sugeno is that the Sugeno output membership functions are either linear or constant but Mamdani’s inference expects the output membership functions to be fuzzy sets. Mamdani’s inference method is used in this research. For the first proposed fuzzy algorithm, the input stage consists of three linguistic variables. The first one is job exterior priority which is the priority assigned to the job from the outside world. The second input variable is the job waiting time. Third input parameter is job processing time. The output is the determined job processing priority. This output is fed together with job deadline time as inputs to second fuzzy algorithm and its output is final job processing priority. The expert determines the shape of the membership function for each linguistic term. Some techniques for adjusting membership functions in an optimal way are described in [19]. Fuzzy rules try to combine these parameters as they are connected in real worlds. In this research, job scheduling is accomplished by fuzzy logic techniques instead of defining sensory cortex with administrative privileges. Fuzzy logic is used to schedule jobs according to processing priorities. Job priority only affects jobs in a machines queue, not how jobs get to a job queue. It is worthily mentioned that the system will adaptively check the whole jobs in the queue after each new job is presented. Therefore job priorities are adaptively changed. The reason that the existing jobs priority might be changed is that new job priority evaluated by the fuzzy system might be higher than that of existing ones. It is necessary in such case to consider the job deadline time (the time elapsed from the time a job has been labeled with when admitted to the queue). Otherwise, a job might always be given a processing priority lower than other jobs and hence retained for a long time and not to be executed in proper user satisfaction. For the simulation purposes, two algorithms are proposed. The first is for determining processing SCH772984 priority for an arriving job. The second is for determining processing priority when considering deadline for jobs.

Previous studies demonstrate that ovariectomy produces a significant decrease in

Previous studies demonstrate that ovariectomy produces a significant decrease in animal uterus and vaginal tissue wet weight and epithelial thickness [16,19,26]. In fact, the stratified squamous epithelium, consisting of approximately six to eight layers of cyp3a inhibitors in intact rats, is reduced to one or two cell layers after ovariectomy. Estrogens, when delivered subcutaneously, restore the uterus and vaginal wet weight as well as epithelial thickness, with the same number of layers seen in the non-OVX rats [16,26].
Our study shows that a twice-a-day application of placebo, ZP-025 at 0.5% and 2.3% of colostrum to OVX rats for 4 weeks increases the thickness of vaginal epithelium compared with untreated OVX rats and a physiological estrous cycle morphological aspect of the vaginal epithelium is observed. Despite the fact that the product is not able to restore completely the epithelial thickness to the same condition as before the ovariectomy or with estrogens [26], nor it is able to significantly enhance tissue wet weight, an evident effect is present in treated animals, with an epithelium of at least five cell layers, compared with one or two cell layers in untreated animals. This effect of ZP-025 at all concentrations of colostrum could be due not only to the well-known growth factors included in the colostrum per se, but also to the other re-epithelizing components present in the formula, such as betaine, sericin, and panthenol [27,28]. Moreover, the antioxidant compound (Vitamin E) included in the product could retard biologically destructive chemical reactions in living organisms through their ability to scavenge oxidants and free radicals [29]. As a consequence, the placebo cannot be considered totally devoid of any effect, as shown in the histology analysis of vaginal epithelium, where the response to placebo indicates that it is not completely inert; however, a more complete response was obtained with the gel containing colostrum on other parameters.
Finally, the fact that uterus atrophy remains histologically unchanged in all experimental groups after a 4-week treatment indicates that the effects of the product are specifically limited to the vagina, as expected for a topical preparation. This is in contrast with estrogen preparations for topical use, that anyway lead to increased systemic estrogen levels, thus increasing the well-known risk of systemic actions [30-32].
Although many women report that they gained weight at or near the time of their menopause [33], the amplitude and even the reality of the menopause-related gain in weight is not consistent between studies [34,35].
In rats, ovariectomy is associated to body weight increase [23,36], mainly due to hyperphagia and hypoactivity [37,38]. It has been shown that 17β-estradiol hormonal replacement is able to reduce body weight gain in OVX rats [36,38], while in the present study with ZP-025 there is no significant difference between experimental groups in the animal body weight, both measured at the start of treatments and at the end (after 4 weeks of treatment).

Conclusion
Conflict of Interest: S. Vailati, E. Melloni and M. Sardina are employees of Zambon S.p.A. and E. Riscassi is an independent consultant supporting Zambon S.p.A. in the development projects.

Introduction
Vaginal atrophy is a common disorder in postmenopausal women that often occurs with urinary symptoms and causes considerable distress [1-3]. Typically, women with vaginal atrophy experience dryness, itching, irritation, burning, and dyspareunia. They also commonly present with one or more urinary symptoms, including urgency, increased frequency, nocturia, dysuria, incontinence, and recurrent urinary tract infection (RUTI). When any of these symptoms are left untreated, mold may contribute to a lower quality of life marked by vaginal discomfort, pain, and sexual dysfunction [1-3].
Nonsexual and urologic aspects of vaginal atrophy have a significant psychosocial effect separate from that of dyspareunia, which has been discussed elsewhere [4,5]. RUTI interrupts daily functioning and reduces libido, which may negatively affect personal relationships and psychosocial health. Additionally, sex is more unpleasant with urinary urgency and the possibility of incontinence because women may experience fear of odor, embarrassment, shame, and loss of self‐esteem [6]. Meanwhile, sleep loss from nocturia affects mood and social interactions, which may further affect personal well‐being and relationships. Bothersome vulvovaginal symptoms may cause significant personal distress, while related sexual dysfunction may affect a woman\’s ego and life satisfaction [7]. Symptoms of vaginal atrophy may also remind women that they are aging, and the perception that their bodies are no longer responding or acting as they used to may create anxiety and depression. Furthermore, loss of elasticity to vulvovaginal tissues, thinning of the vaginal wall, and decreased vaginal lubrication may increase the risk for microtears or genital lesions during intercourse, which could allow easier transmission of sexually transmitted infections.

br Discussion In health care services patient

Discussion
In health care services, patient satisfaction is considered as one of the main factors that help the stakeholder to improve the quality of the health services. Globally, the criteria to measure the patient satisfaction vary markedly. Different cultural settings have different needs or expectation that affect the overall satisfaction with the health care services. To our knowledge, this was the first effort to evaluate the consumer view about the pharmacy services in Eastern Region, Kingdom of Saudi Arabia. The results of this patient satisfaction survey indicated that there was good consumer satisfaction with the pharmacy encounters. The items that received high satisfaction scores were pharmacist was always available, pharmacist provides thorough explanations/clear labeling of drugs, pharmacist’s politeness, and prompt services (Kamei et al., 2001). Some of these items may not be strong factors influencing satisfaction in some other places.
An analysis of the influence of respondents’ demographics showed that patient satisfaction was found affected with a variety of issues. i.e. the age of patients significantly affecting the level of satisfaction. It was seen that the old patients were more satisfied with the pharmacy services provided than the other age groups. These findings comply with other international studies that also report age as a main factor affecting the patient’s level of satisfaction with the pharmacy service (Weiss, 1988; Hall and Durnan, 1990). In addition, other factors that were associated with the patient satisfaction were gender, nationality and education. Some international studies (Kamei et al., 2001) explore no difference in satisfaction between male and female. However, keeping in view the current findings it abscisic acid can be assumed that women may be more willing to know about their drugs from the pharmacist. This may be a reason for the higher level of satisfaction among female respondents of the current study. Future studies should explore the reasons for higher level of satisfaction with the pharmacy services among female patient. As a whole, it was surprising to notice a poor level of satisfaction among the Saudi patients. Overall, Egyptian patients were the most satisfied with the pharmacy services followed by the other expatriates. Unlike other studies (Kamei et al., 2001; Weiss, 1988; Hall and Durnan, 1990), the current study reports a low level of satisfaction among the patients with low educational background. While the satisfaction level was found improving as the education, level was improved. Further studies on pharmacy settings would be necessary to determine the exact impact of pharmacy related factors and their association with the patient’s demographics and level of satisfaction.

Conclusion

Limitation

Introduction
Science of pharmacovigilance is accountable to identify, appraise, comprehend and avert ADRs with the eventual mean to develop secure and coherent utilization of medication (Montastruc et al., 2006; Arulmani et al., 2008; Avery et al., 2011; Mehta et al., 2008). Current methods of pharmacovigilance possess certain constraints reminiscent of under reporting, inability to find the incidence rate, size of the population exposed and bias in collection of drug exposure (Montastruc et al., 2006; Wasserfallen et al., 2001; Routledge et al., 2003; Smyth et al., 2012). Pharmacovigilance gives a vital measure of the burden of drug induced morbidity and approximately half of ADRs could be averted with better prescription care (Chien and Ho, 2011; Aagaard and Hansen, 2010; Napoleone, 2010).
Most recent review of ADRs reported incidence of hospitalized ADRs in children in the range of 0.6–16.8% (Smyth et al., 2012). Children are at a higher risk of developing ADRs as they seldom express their own drug therapy experiences (Castro-Pastrana and Carleton, 2011). Consequently, medications in pediatrics have a risk of a variety of ADRs (Castro-Pastrana and Carleton, 2011; Impicciatore, 2003). This reality describes children as “therapeutic orphan” and they are at a precarious position of a high risk of therapeutic failure with additional vulnerabilities like lack of many appropriate pediatric formulations, exposure through maternal prenatal drug use and breast milk, major difference in pharmacokinetic, pharmacodynamics of drugs, “off-label use” and perhaps divergence of their illness from adult (Chien and Ho, 2011; Napoleone, 2010; Impicciatore, 2003; Leeder, 2003; Lindell-Osuagwu et al., 2009). There is an urgent need for evolving valuable methods for the early detection of ADRs in pediatrics hitherto their necessary stipulation of pharmacovigilance has not been tackled appropriately (Castro-Pastrana and Carleton, 2011) (Etwel et al., 2008).