Diagnosing and treating hypercalcemia during pregnancy can be challenging due to both the physiological changes in calcium homeostasis and the underlying cause for the hypercalcemia. During pregnancy and lactation there is increased mobilization of calcium in the mother to meet the fetus' calcium requirements. Here we discuss the diagnostic challenges, management, and patient perspective of hypercalcemia during pregnancy in two particular cases and in other rare conditions causing hypercalcemia.Patients' perceptions on quality of care and gaps in diagnosis/management of rare endocrine diseases (RED) were collected in a 21-item questionnaire, answered on-line in the patients' language. There were 598 (66% females) responses from 29 countries reflecting pituitary, adrenal, thyroid, parathyroid, gonadal, genetic and autoimmune diseases. While in 36% a diagnosis was made in 50% a specialist/specific treatment was available within 1 month; 60% were satisfied with current treatment. Most (59-67%) would have liked access to psychological support, social worker, dietician or physiotherapist/rehabilitation specialists. Half were satisfied with information received, treatment and health care follow-up; 87% contacted patient/support groups; 78% agreed that "The personal limitations related to the disease, impact on my everyday quality of life". Conclusion Diagnostic delay in RED is still unsatisfactory in Europe, as well as specific needs impacting QoL.
Recent advances in the field of immunotherapy have significantly prolonged the survival of patients with aggressive carcinomas, but the role of immunotherapy in neuroendocrine neoplasms (NENs) remains to be elucidated.

We report a patient diagnosed with a well-differentiated grade 3 pancreatic NEN (pNEN) and type 3 liver metastases who received compassionate nivolumab as a fifth line treatment and achieved a durable partial response of more than 34 months. We have performed a systematic review to the literature on tumor microenvironment and potential biomarkers in the field of NEN including the tumor mutational burden, the tumor infiltrating lymphocytes, the programmed cell death ligand 1, and the mismatch repair system. The potential role of the immune system modulation together with a critical assessment of the recent phase II clinical studies in NEN including monotherapy with anti-PD-1/PD-L1 monoclonal antibodies, and combination therapies including anti-PD-1 along with anti-CTLA-4 monoclonal antibodies are also provided.

Immunotherapeutics are gaining a post in the field of NENs in cases progressing during the course of the disease, dictating urgently the identification of biomarkers that will enable selection of NEN patients who may benefit from this treatment.
Immunotherapeutics are gaining a post in the field of NENs in cases progressing during the course of the disease, dictating urgently the identification of biomarkers that will enable selection of NEN patients who may benefit from this treatment.
To determine agreement in keratometric readings obtained using rotating Scheimpflug imaging with Pentacam, biograph with Lenstar LS900, and Topcon KR-8100P auto-keratorefractometer in eyes with different stages of keratoconus.

A total of 89 eyes of 58 patients with keratoconus were examined in this study, retrospectively. The eyes were divided into two groups mild group (group 1 42 eyes) (Amsler-Krumeich stage 1) and moderate-to-severe group (group 2 47 eyes) (Amsler-Krumeich stage 2, 3, 4). The keratometric readings measured using the Pentacam Scheimpflug system, Lenstar LS900, and Topcon KR-8100P auto-keratorefractometer were compared between the groups. The effects of the measurements of anterior chamber depth, Q value, axial length, central corneal thickness (CCT), and maximum value of keratometry (Kmax) on the differences of devices for keratometric readings were investigated.

The mean values of the keratometric readings obtained using the Lenstar were steeper than with the Pentacam and Topcon, esp stages of keratoconus. The keratometric readings of Lenstar were found steeper than the other devices with increasing grades of keratoconus. None of these devices can be used interchangeably in moderate-to-severe stages of keratoconus.
To clarify the clinical features of uveitis in elderly patients in central Tokyo.

We retrospectively identified 1424 patients with uveitis who visited the Uveitis Clinic of the University of Tokyo Hospital between January 2013 and December 2018. The patients were categorized into two groups based on their ages at the time of disease onset patients aged 65years or older were included in Group A, whereas those younger than 65years were included in Group B. The etiological classification of uveitis and its causes were investigated for each group.

Group A presented significantly higher rates of infectious uveitis (35.5% vs. 17.8%, p < 0.0001) and masquerade syndromes (17.9% vs. 5.0%, p < 0.0001) than Group B. https://www.selleckchem.com/products/midostaurin-pkc412.html Furthermore, Group A had significantly higher rates of sarcoidosis (23.1% vs. 9.3%, p < 0.0001), intraocular lymphoma (16.6% vs. 4.6%, p < 0.0001), cytomegalovirus iritis (11.0% vs. 5.6%, p = 0.0043), and cytomegalovirus retinitis (5.2% vs. 1.5%, p = 0.0020) than Group B.

Our results demonstrate a clear difference in the causative diseases of uveitis between elderly and non-elderly patients. These findings may support ophthalmologists in their diagnostic process for elderly patients with uveitis.
Our results demonstrate a clear difference in the causative diseases of uveitis between elderly and non-elderly patients. These findings may support ophthalmologists in their diagnostic process for elderly patients with uveitis.There are few studies on mercury content in hypersaline waters. Mercury content was studied in Bay Sivash (the Sea of Azov), the world's largest hypersaline lagoon with a strong salinity gradient from 36 to 90 g l-1. The dissolved mercury compounds ranged from 120 to 250 ng l-1, Hg varied from 60 to 450 ng l-1 in the suspended matter, and total mercury in the water ranged from 200 to 600 ng l-1. Salinity and the total suspended matter had practically no effect on the amount of dissolved and suspended forms of mercury separately, but their growth significantly increased total mercury content in water. Only the concentration of dissolved forms of mercury in water significantly correlated with dissolved organic matter. The Hg concentration in the bottom sediments averaged 13.8 ng g-1 wet weight. Both high salinity and human activities on the Sivash drainage area are responsible for high Hg content in lagoon water.Pollution of the atmosphere is known that may lead to adverse obstetric outcomes, including fetal growth restriction, gestational hypertension, and preeclampsia. Such disorders are correlated with imbalances in angiogenic factors, which may also be involved in the pathological mechanism as the pollutants impact placental and maternal physiology. In the first trimester of gestation, this study assessed the outcomes of personal maternal short period exposure to air pollution on soluble fms-like tyrosine kinase 1 (sFlt1) and placental growth factor (PLGF) of pregnant women blood concentrations. This was a cross-sectional study, held in the city of São Paulo, Brazil, and conducted with low-risk pregnant women, who carried personal passive nitrogen dioxide (NO2) and ozone (O3) monitors for about a few days preceding the ultrasound evaluation, and on this day, the venous blood sample was collected to measure the angiogenic factors sFlt1 and PLGF and their ratio (sFlt1/PLGF) by enzyme-linked immunosorbent assay (ELISA). By means of multiple regression models, the effect of the studied pollutants on the log-transformed concentrations of the angiogenic factors was evaluated. One hundred thirty-one patients were included. The log of the sFlt1/PLGF ratio increased with rising NO2 levels (p = 0.021 and beta = 0.206), and the log of the PLGF concentration showed a negative correlation with NO2 (p = 0.008 and beta = - 0.234). NO2, an indicator of the levels of primary air pollutants, presented significant positive correlation with an increased sFlt1/PLGF ratio and diminished PLGF levels, which may reflect an antiangiogenic state generated by air pollution exposure.Antibiotic resistance is a mushrooming pandemic at national and international levels which if not controlled at this very moment, can lead to global problems. Main reason for emerging bacterial resistance is repeated exposure of bacteria to antimicrobial agents and access of bacteria to increasingly large pools of antimicrobial resistance genes in mixed bacterial populations. A total of 51 villages were sampled in the current study contributing to a total of 153 farms. A total of 612 samples comprising 153 each of raw pooled milk samples, slurry, animal drinking water and human drinking water were gathered from small, medium and large farms located in all seven tehsils of Ludhiana district of Punjab. In addition to that, 37 samples of village pond water were also collected from the targeted villages. Out of total 153 slurry, raw pooled milk samples, animal drinking water and human drinking water samples (each), the prevalence of 24.8%, 60%, 26.7% and 16.3% was found for E. coli respectively. On the other hand, for Klebsiella, the overall prevalence of 19.6%, 51%, 20.2% and 5.8% was found from slurry, raw pooled milk samples, animal drinking water and human drinking water respectively. In all matrices, the comparative frequency of resistance genes in positive isolates of E. coli and K. pneumoniae was tetA > tetB > tetC, qnrS > qnrB > qnrA, sulII > sulI > sulIII. The highest proportion of resistance genes was found in slurry (193 genes) followed by milk (71 genes). The overall pattern of resistant genes was tetA > sulII > qnrS. In conclusion, data from the present study suggested that commensal E. coli and Klebsiella may act as reservoirs of antimicrobial drug resistance genes which may be mobilised into human populations and untreated animal waste may be considered an important source of resistant bacteria leading to environmental pollution.This study examines the role of technological innovation and economic progress on environmental pollution by using STRIPAT and EKC theoretical frameworks in 25 developing Asian countries from the period 1998 to 2019. For technological advancement, the energy intensity has been used to gauge how much of the quantity of energy is employed to produce the additional unit of gross domestic product at domestic level. Therefore, the volume of the energy used in the production process is highly important as it is documented through the energy intensity. To capture the impact of innovation, the sum of total patent applications and trademark applications for the sampled countries has been used. This study applied second-generation unit root and panel cointegration techniques to estimate the results. To estimate the long-run relationship of variables and the cross-sectional interdependence, Pedroni Residual and Westerlund Cointegration tests are applied. Further, the Hausman-Taylor-type test has been used to check the efficiency of the pool mean group (PMG).