The Special Olympics IX National Games were held in Adelaide, South Australia in April 2010. Podiatrists and podiatry students were invited to participate in the healthy athletes program to assess the feet of athletes with intellectual disability. The World Health Organisation has found that people with an intellectual disability form the largest disability population in the world. Special Olympics (SO) is an international not-for-profit organisation. Globally, SO now supports 3.1 million people in 220 countries. Each year there are 30,000 SO competitions throughout the world. Affiliated with the International Olympic Committee, SO is held in the manner of all Olympic games. There are over 500,000 Australians living with an intellectual disability. Special Olympics Australia supports around 4000 athletes in over 250 sports clubs across metropolitan and rural Australia. SO Australia offers fourteen official national sports: alpine skiing, aquatics, athletics, basketball, bocce, cricket, figure skating, football (soccer), golf, gymnastics, sailing, softball, tennis and tenpin bowling. People with intellectual disability are often overrepresented in areas of preventable health problems, SO provides invaluable opportunity for identifying the frequent health care needs. Podiatry is an essential and core element of any sports and wider mobility issues.Approximately 850 participating athletes registered for the National Games in Adelaide. ‘Fit Feet’ managed to see over 400 athletes; notable as other programs have seen 10% of athletes. Screening of athletes investigated: foot and ankle problems, footwear adequacy. Referral and education were provided as required. In addition to podiatry, the athletes were also availed dental, audiology and optometry health screenings. The Australian Podiatry Association (SA), Special Olympics Australia and the University of South Australia cooperated to provide the screening program for the SO athletes. The University of South Australia acknowledged this project with a commendation at the 2010 Chancellor’s awards for community engagement. The next SO National Games will be held in Melbourne in 2014, where podiatrists and students could have the exciting and rewarding opportunity to participate in the healthy athletes program. The Special Olympics athletes’ oath is: 'Let me win. But if I cannot win, let me brave in the attempt.'


The following scientsts assisted the journal by reviewing manuscripts during the period October 1, 2010 to September 30, 2011. We gratefully acknowledge their critical evaluation and assistance in selecting articles for publication.


A 44-year-old man, right hand dominant, presented to the emergency department with a chief complaint of left hand pain status post crush injury to left hand between heavy metal objects at the workplace. The patient was found to have a left long finger distal tip amputation with concomitant transverse distal phalangeal fracture and intact sterile and germinal matrix.How does a composite graft differ from other available methods of repairing distal fingertip injury?What are the advantages of using a composite graft to repair distal fingertip?What factors play a role in predicting graft success or failure?What techniques can be used to ensure optimum survival of the composite graft?Distal fingertip amputations can be repaired using various described methods. Replantation is an effective, although technically challenging, method.3,3In composite grafting, both the severed tip and the distal end of the injured finger are prepared for reattachment of the tip, which is sutured directly onto the finger . Prepara2In a study by Heistein and Cook,4,3,5In terms of what can be done to improve the chances of graft survival, Friedman et al2Results from composite grafts in distal fingertip injuries have been quite good. In the study of 31 cases of composite grafts by Chen et al,In the patient described earlier, the distal tip amputation was prepared by minimal shortening of the remaining distal phalanx, removing some fatty tissue and all of the bone from the amputated portion, and securing the graft in place with precise orientation of the nail bed. Nonadherent gauze was used to keep the nail fold completely open. Four weeks postoperatively, the composite graft was noted to be viable with brisk capillary refill .


IJMS[i.e., the galectins. These errors have been amended in an amended version of the manuscript, which is available from the International Journal of Molecular Sciences website. The authors and publisher apologize for the inconvenience.The authors wish to add this correction on their paper published in IJMS. Galectihttp://www.mdpi.com/1422-0067/13/12/17294/s1.The corrected version can be accessed at:


Dear Colleagues,Journal of Gynecological Endoscopic Surgeries published was due to the responsibility given by Dr. H D Pai, IAGE immediate past President, to me to work hard as a Managing Editor with the support of others.We stand today due to the untiring efforts of the founders of IAGE, the past Presidents, office bearers and members of the Managing Committee of IAGE over decades. The first volume of Journal of Gynecological Endoscopic Surgeries with a changing scenario of receiving articles from most experienced to amateur authors and from large centers to small places in India. There is one section of gynecological endoscopists, who, in spite of presenting their large amount of work in talks, fail to write articles of great benefit, may be because a skilled endoscopist does not necessarily mean that he/she is equipped with proper skills of journal article writing. Few others are not interested and few apparently have no time, all the excuses are correctible as there are persons good at writing articles and who can help them. The Indian endoscopist has to learn to rise to report, write, and share, even if it means to take help from the juniors or seniors, for a global impact of Journal of Gynecological Endoscopic Surgeries with more contributors.It is indeed an exceptional responsibility and pleasure to be the Managing Editor of the second volume of We should remember that the busiest consultant and the one with greatest skills in the world always has time to share their experience with thousands of IAGE members.This second volume has a good blend of endoscopic surgical excellences of laparoscopic myomectomy, scientific comparative evaluation of urinary incontinence correction, cost-effective slings, hysteroscopy in abnormal uterine bleeding, laparoscopic removal of ovarian cysts in rural set up, and excellent unusual cases. The advent of new energy sources for laparoscopic hysterectomy, along with its glamour and cost, can cause major ureteric injuries with experts and amateurs alike.A special touch is given on the legal expectation of Care or Cure by an expert. A good journal has an eye into future not only with techniques/new gadgets but also with law.Journal of Gynecological Endoscopic Surgeries.The newly found bonding of IAGE office bearers and managing committee members makes us comfortable and confident that we will reach close to international standards, and I thank all for their continuous confidence in assigning the job of Managing Editor of


The names of the fourth and fifth authors are incorrectly merged. Please view the correct list of authors, affiliations and Citation below:1*, Md Amir Hossain3, Mahtab Uddin Hassan3, Sophie Osbourne1, Katherine Langan1, Abu Sayeed3, Mohammed Rezaul Karim3, Rasheda Samad3, Shyamanga Borooah4,Bal Dhillon4, Nicholas P. J. Day1,2, Arjen M. Dondorp1,2, Richard J. Maude1,2,4Rapeephan R. Maude1 Mahidol-Oxford Tropical Medicine Research Unit, Rajthewi, Bangkok, Thailand2 Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom3 Chittagong Medical College Hospital, Chittagong, Bangladesh4 College of Medicine and Veterinary Medicine, University of Edinburgh,Edinburgh, United KingdomMaude RR, Amir Hossain M, Hassan MU, Osbourne S, Langan K, et al. (2013) Transorbital Sonographic Evaluation of Normal Optic Nerve Sheath Diameter in Healthy Volunteers in Bangladesh. PLoS ONE 8(12): e81013. doi:10.1371/journal.pone.0081013


To evaluate the prevalence and associated factors of steep cornea/keratoconus in the adult Chinese population.The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range: 50–93 years). A detailed ophthalmic examination was performed including optical low-coherence reflectometry. Steep cornea/keratoconus were defined as an anterior corneal refractive power exceeding 48 diopters.P<0.001), smaller interpupillary distance (P = 0.038), lower best corrected visual acuity (P = 0.021), higher cylindrical refractive error (P<0.001) and more myopic refractive error (P<0.001). It was not significantly associated with gender, body height, psychic depression, cognitive function, blood concentrations of glucose, lipids, creatinine and C-reactive protein, blood pressure and quality of life score, nor with intraocular pressure, dry eye feeling, and lens thickness.Mean refractive power of the cornea was 43.16±1.45 diopters  and 43.98±1.52 diopters . A steep cornea/keratoconus defined as corneal refractive power of ≥48 diopters and ≥49 diopters was detected in 27 subjects  and 6 (0.2± 0.1%) subjects, respectively. Presence of steep cornea/keratoconus was associated with shorter axial length (A steep cornea/keratoconus defined as corneal refractive power of 48+ diopters has a prevalence of 0.9±0.2% among Chinese aged 50 years and above. Its prevalence was significantly associated with the ocular parameters of shorter axial length, smaller interpupillary distance, higher cylindrical and myopic refractive error and lower best corrected visual acuity, however, with none of the systemic parameters tested. Keratoconus is a conical deformation of the anterior corneal surface leading to refractive myopia, irregular astigmatism and eventually to a marked reduction in visual acuity The Medical Ethics Committee of the Beijing Tongren Hospital approved the study protocol and all participants gave informed written consent, according to the Declaration of Helsinki.The Beijing Eye Study 2011 is a population-based cross-sectional study in Northern China All examinations were carried out in the communities, either in schoolhouses or in community houses. All study participants underwent an interview with standardized questions on their family status, level of education, income, quality of life, psychic depression, physical activity, known major systemic diseases such as arterial hypertension and diabetes mellitus, and quality of vision. Cognitive function was assessed using the MMSE  scale Using the biometric measurements of the anterior corneal curvature, the corneal refractive power was calculated assuming a refractive index of the cornea of 1.3315 as proposed by Olsen P-values were 2-sided and were considered statistically significant when the values were less than 0.05.Statistical analysis was performed using a commercially available statistical software package . In a first step, we examined the mean values (presented as mean±standard deviation) of the systemic and ocular parameters in the steep cornea/keratoconus group versus the non-keratoconus group. The Gaussian distribution of the parameters was tested using the Kolmogorov-Smirnov test. We calculated the significance of the differences between both groups using the student-t-test for non-paired samples for the parametric parameters, and the Mann-Whitney-U test for non-paired samples for the non-parametric parameters. In a second step, we performed a binary logistic regression analysis with the presence of steep cornea/keratoconus as dependent parameter and those parameters as independent parameters which were significantly associated with steep cornea/keratoconus in univariate analysis. 95% Confidence intervals (CI) and odds ratios (OR) were presented. All P<0.001) older did not vary significantly in gender (P = 0.994).Out of the 3468 participants, keratometric measurements were available for 3166 (91.3%) subjects (1792 (56.6%) women). The mean age was 64.2±9.8 years , the mean refractive error  was −0.19±2.13 diopters . The group of subjects without keratometric measurements as compared with the group of subjects with keratometric measurements was significantly  and in the steepest meridian 7.55±0.26 mm . Correspondingly, the mean refractive power of the cornea in the flattest meridian was 43.16±1.45 diopters  and it was in the steepest meridian 43.98±1.52 diopters . A steep cornea/keratoconus  was detected in 27 subjects. The prevalence rate was 0.9±0.2% . A steep cornea/keratoconus with a corneal refractive power of ≥49 diopters was detected in 6 subjects resulting in a prevalence rate of 0.2±0.1% . Two subjects showed a corneal refractive power of ≥50 diopters .P = 0.32 for flattest meridian; P = 0.09 for steepest meridian).In the whole study population, 2 eyes had undergone perforating keratoplasty for corneal ulceration and trauma. Corneal refractive power in these 2 eyes ranged between 43.9 and 44.5 diopters. Cataract surgery had been performed in 162 subjects of the study population. Their mean corneal refractive power was 43.04±1.52 diopters  in the flattest meridian and 44.20±1.69 diopters  in the flattest meridian. In two of the eyes after cataract surgery, the corneal refractive power exceeded 48 diopters. The eyes after cataract surgery and the phakic eyes did not differ significantly in corneal refractive power (P = 0.006), shorter body height (P<0.001), lower level of education (P<0.001) and lower income (P<0.001), rural versus urban region of habitation (P = 0.008), lower cognitive score (P = 0.029), higher psychic depression score (P = 0.012), shorter axial length (P<0.001), smaller pupil diameter (P = 0.031), shorter interpupillary distance (P<0.001), smaller central corneal thickness (P = 0.033), larger cylindrical refractive error (P = 0.014), and lower best corrected visual acuity (P = 0.004) (P = 0.99), body mass index (P = 0.33), systolic (P = 0.23) or diastolic (P = 0.46) blood pressure, quality of life index ( P = 0.33), blood concentrations of glucose (P = 0.87), cholesterol (P = 0.84), creatinine (P = 0.51) and C-reactive protein (P = 0.92), smoking (P = 0.11) or alcohol consumption (P = 0.39), dry eye feeling (P = 0.15), intraocular pressure readings (P = 0.37), lens thickness (P = 0.12) and optic disc size (P = 0.39)  , 2. The  = 0.39) ,2.P = 0.006), but not with age (P = 0.79). In a second step of the analysis with the additional parameters of body height and weight, only shorter body height (P = 0.001) was significantly associated with steep cornea/keratoconus, while age (P = 0.46), gender (P = 0.65) and body weight (P = 0.73) were not significantly associated. If body mass index was added, the result was similar. In a next step, the parameters of age, gender, body weight, or body mass index were dropped and the level of education was added. It revealed significant associations between the presence of steep cornea/keratoconus and lower body height (P = 0.001) and lower level of education (P = 0.04). If the region of habitation was added, prevalence of steep cornea/keratoconus was associated only with lower body height (P<0.001) and rural region (P = 0.04), while level of education was no longer significantly (P = 0.38) associated. In the next step of the statistical analysis, the parameter of package years of smoking was added. It showed that the presence of steep cornea/keratoconus was only associated with lower body height (P = 0.001) and rural region of habitation (P = 0.004), while package years of smoking (P = 0.152) was not significantly correlated with steep cornea/keratoconus. In a similar manner, the depression score (P = 0.10) and the cognitive score (P = 0.69) were not significantly associated with the presence of steep cornea/keratoconus. In a last step of the multivariate analysis, those ocular parameters were added which were significantly different between the steep cornea/keratoconus group and the non-keratoconus group in the univariate analysis. It revealed that after adjustment for body height and region of habitation, presence of steep cornea/keratoconus was significantly associated shorter axial length (P<0.001), smaller interpupillary distance (P = 0.038), lower best corrected visual acuity (P = 0.021), higher cylindrical refractive error (P<0.001) and more myopic refractive error (P<0.001) (P = 0.49) and area of habitation (P = 0.59) were no longer significantly associated with the prevalence of steep cornea/keratoconus.The multivariate binary logistic regression analysis was carried out in several steps. A first step included the presence of steep cornea/keratoconus as dependent parameter and age and gender as independent parameters. It confirmed that the presence of steep cornea/keratoconus was significantly associated with female gender (P<0.001) . In thatIf steep cornea/keratoconus was defined as a corneal refractive power of 49+ diopters or of 50+ diopters, the study groups were statistically too small for a meaningful multivariate analysis.If the corneal refractive power was calculated assuming a refractive index of the cornea of 1.3375 instead of 1.3315, the mean refractive power of the cornea in the flattest meridian was 43.9±1.5 diopters  and it was in the steepest meridian 44.8±1.5 diopters . Using the corneal refractive index of 1.3375, a steep cornea/keratoconus  was detected in 71 subjects , a steep cornea/keratoconus as corneal refractive power of ≥49 diopters in 23 subjects , and a steep cornea/keratoconus as corneal refractive power of ≥50 diopters in 5 subjects .Steep cornea/keratoconus defined as corneal refractive power of 48+ diopters had a prevalence of 0.9±0.2% among Chinese aged 50+ years and living in Greater Beijing. In multivariate analysis, the presence of steep cornea/keratoconus was significantly associated with shorter axial length, smaller interpupillary distance, higher cylindrical and myopic refractive error and lower best corrected visual acuity. It was not significantly associated with any systemic parameter tested, including age, gender, body height and body mass index, consumption of alcohol and smoking, psychic depression and cognitive function, level of education and self-reported income, quality of life, blood pressure and blood concentrations of lipids, creatinine, glucose and C-reactive protein. A steep cornea/keratoconus defined as corneal refractive power of >49 diopters was detected in 6 (0.2%) eyes, and a steep cornea/keratoconus defined as corneal refractive power of >50 diopters was detected in 2 (0.06%) eyes.Since the present study is the first population-based investigation on the prevalence of steep cornea/keratoconus in a population outside of rural central India, the results of our study cannot directly be compared with findings of other studies. Most investigations on the frequency of keratoconus examined the relative frequency of keratoconus as reason for penetrating keratoplasty or assessed the prevalence of the diagnosis of keratoconus in the Medicare population of the U.S.A 2) and the Beijing Eye Study with a markedly more urban population with an average body mass index of 25.6±3.8 kg/m2, one may infer that the prevalence of steep cornea/keratoconus may not show marked inter-ethnic differences.In the Central India Eye and Medical Study CIEMS, the prevalence of steep cornea/keratoconus defined as a corneal refractive power of ≥48 diopters  was 2.3±0.2%  P = 0.004), and in which the presence of a steep cornea/keratoconus was not significantly associated with alcohol consumption (P = 0.99) or smoking (P = 0.08) nor with questions relating to the psychiatric status. In contrast to the present study, steep cornea/keratoconus in the CIEMS was additionally associated with lower body height (P<0.001) and lower level of education (P = 0.03). In previous studies, associations between keratoconus and Down syndrome, Leber’s congenital amaurosis, and mitral valve prolapse were reported In the present study, presence of steep cornea/keratoconus was significantly associated with shorter axial length, smaller interpupillary distance, higher cylindrical and myopic refractive error and lower best corrected visual acuity. Similar results were obtained in the CIEMS, in which the prevalence of steep cornea/keratoconus was significantly  associated with higher myopic refractive error . Again, it is in agreement with the CIEMS, however not in agreement with a recent hospital-based study by Spoerl and colleagues, in which a significant correlation was reported between non-smokers and keratoconus (P<0.001) In the present study, the prevalence of steep cornea/keratoconus was not related with smoking  and in false negative results (eyes with mild keratoconus). Third, in a similar manner, another limitation is the definition of steep cornea/keratoconus as a corneal refractive power of 48+ diopters. One has, therefore, to keep in mind that the reported prevalence figures and the associations refer to this definition.In conclusion, in adult Chinese aged 50+ years and living in Greater Beijing, a steep cornea/keratoconus defined as corneal refractive power of 48+ diopters had a prevalence of 0.9±0.2%. Prevalence of steep cornea/keratoconus was significantly associated with the ocular parameters of shorter axial length, smaller interpupillary distance, higher cylindrical and myopic refractive error and lower best corrected visual acuity, however, with none of the systemic parameters tested.


Chiropractic & Manual Therapies. This new partnership will enable the journal to grow and flourish and further improve access to high quality research publications for interested researchers and clinicians worldwide.From January 2013, The UK College of Chiropractors joins the partnership between the Chiropractic and Osteopathic College of Australasia (COCA) and the European Academy of Chiropractic (EAC) to publish  Chiropractic & Manual Therapies. COCA is an Australian based professional college for chiropractors and osteopaths and the EAC is the academic committee of the European Chiropractors’ Union (ECU) [. This new partnership will enable the journal to grow and publish more quality research articles relating to chiropractic and other manual therapies. It will provide the three joint venture partners with a world class journal of their own which has the capacity to disseminate knowledge worldwide using the free full text online open access format with BioMed Central as publishers.From January 2013 The UK College of Chiropractors (TCoC), a professional chiropractic membership body [on (ECU) . This ne‘need for a professional journal as a means of communication within the profession and to allied disciplines, as a forum for debate and as a focal point for the rich diversity of practitioners in the UK’[Clinical Chiropractic, aimed at an international audience and specifically intended ‘to provide authoritative information of use to the clinical chiropractor in advancement of their professional career, clinical skills and performance, and ability to deliver optimal patient care’[. Throughout its 15-year history, the journal has been edited by Martin Young whose understanding and vision of the importance of evidence-based chiropractic practice has shaped every issue, and whose personal dedication to the encouragement of others to publish chiropractic research has been remarkable.Ever since its initial inception as the British College of Chiropractic, the organisation currently known as The College of Chiropractors (TCoC) has produced a professional journal. Volume 1, Issue 1 of The British Journal of Chiropractic was published in September 1997 to meet the n the UK’. Five voent care’. ThroughClinical Chiropractic although all back issues will remain accessible on the Elsevier Science Direct platform. The Royal Chartered college sees the open access nature of CMT as reducing the barriers to research literacy and providing the strongest platform from which to publish excellence in chiropractic and manual therapy research, hence the decision to join forces with COCA and the EAC to publish Chiropractic & Manual Therapies.Recently, TCoC has entered a new era as a Royal Charter-incorporated organisation . In the All of the journal’s joint venture partners and its editorial team are excited about the opportunity to expand the journals offerings to all readers but particularly to members of the three partner organisations and their affiliates. The journal has gone from strength to strength and this new development augurs well for the future.


The efficacy of dynamic anterior cervical plates is somewhat controversial. Screws in static-plate designs have a smaller diameter and can cut through bone under load. While not ideal, this unintended loosening can help mitigate stress shielding. Stand-alone interbody devices with integral fixation have large endplate contact areas that may inhibit or prevent loosening of the fixation. This study investigates the load sharing ability of a novel dynamic plate design in preventing the stress shielding of the graft material compared to the non-dynamic devices.An experimentally validated intact C5-C6 finite element model was modified to simulate discectomy and accommodate implant-graft assembly. Four implant iterations were modeled; InterPlate titanium device with dynamic surface features (springs), InterPlate titanium non-dynamic device, InterPlate titanium design having a fully enclosed graft chamber, and the InterPlate design in unfilled PEEK having a fully enclosed graft chamber. All the models were fixed at the inferior-most surface of C6 and the axial displacement required to completely embed the dynamic surface features was applied to the model.InterPlate device with dynamic surface features induced higher graft stresses compared to the other design iterations resulting in uniform load sharing. The distribution of these graft stresses were more uniform for the InterPlate dynamic design.These results indicate that the dynamic design decreases the stress shielding by increasing and more uniformly distributing the graft stress. Fully enclosed graft chambers increase stress shielding. Lower implant material modulus of elasticity does not reduce stress shielding significantly. Neck pain is one of the most common musculoskeletal conditions and affects 70% of adults at some point in their lives . SubstanThe purpose of these ACP systems is to maintain alignment after deformity correction, retain graft material, prevent graft collapse and kyphotic deformity, promote arthrodesis, allow early mobilization, and prevent excessive post-operative immobilization. The first generation of ACP devices had unlocked and non-rigid bicortical screws with noted complications such as screw backout and breakage, graft subsidence, and excessive fluoroscopy exposure time. Second-generation devices featured rigid locking unicortical screws that presented new complications such as screw placement challenges, screw-bone interface failure, and graft subsidence with resultant pseudoarthrosis. The introduction of polyaxial screws and partial screw locking mechanisms in the third generation resulted in “windshield wipering” of screws due to screw-bone interface failures -12.A later generation of plates with rotational and translational screws was intended to prevent the screw-bone interface failures ,13. HoweInterbody devices with integral fixation  have been developed to overcome some inherent anterior plate design problems, namely their high profile on the anterior surface of the vertebrae and the potential for plate and screw impingement on adjacent levels known to cause disease. Interbody devices with integral fixation typically have a large endplate contact area that may promote stress shielding of graft material to a greater extent than static anterior plates. No provision for dynamic performance is included in most of the currently available interbody device designs.This study investigates the load sharing ability of a novel dynamic interbody fusion implant design Figure , the IntAn intact C5-C6 ligamentous cervical functional spinal unit (FSU) model comprising 5,577 elements and 4,219 nodes was used for this study  hexagonal elements (C3D8). The posterior bone regions were constructed of C3D8 elements, all of which were assigned a single set of material properties, as shown in the following table Table . The facThe fissure of Luschka’s joint was modeled similarly using gap elements. When the gap across the fissure was closed, all resulting deformation came from compression of the elements of the annulus fibrosus. The intervertebral disc was modeled as a composite of a solid matrix with embedded fibers, via the REBAR parameter, in concentric rings around a pseudo-fluid nucleus. Seven concentric rings of ground substance each contained two evenly spaced layers of fibers (plus one ground substance ring with one layer of fibers) oriented at ± 65° to the vertical axis. Fiber thickness and stiffness increased in the radial direction. Implementing the “no compression” option restricted the annulus fibers to resisting tension only.The nucleus pulposus was modeled as an incompressible fluid with a very low stiffness (1 MPa) and near incompressibility . All seven major spinal ligaments were represented and assigned nonlinear material properties. Nonlinear ligament stiffness (low stiffness at low strains followed by increasing stiffness at higher strains) was simulated through the “hypoelastic” material designation, which allowed the definition of the axial stiffness as a function of axial strain. Three dimensional 2-noded truss elements were used to construct the ligament.The intact model was modified to simulate discectomy and accommodate the implant-cortical bone graft assembly. Four iterations  were modeled Figure :• The InterPlate titanium design, as commercially available (dynamic).• The InterPlate design without teeth representing a non-dynamic device.• The InterPlate design in titanium without teeth and having a fully enclosed graft chamber.• The InterPlate design in unfilled PEEK without teeth and having a fully enclosed graft chamber.The titanium  and PEEK  material properties were assigned to the respective implants. Bone compaction caused by teeth penetrating bone was modeled as follows. For the dynamic titanium device, the surface features were replaced with springs in order to accurately represent tooth penetration and screw sliding. The spring constants reproduce the load-deflection curve for the InterPlate alone, as determined by ASTM F2267 - Test of Load Induced Subsidence .The top and bottom surfaces of the cortical bone graft were tied to the respective top and bottom endplates of the vertebrae. Sliding contact was simulated using the contact pair option in Abaqus between the InterPlate and the anterior portion of the C5-C6 motion segment. All models were fixed at the inferior-most surface of C6 and the displacement required to completely embed the surface features of the plate was applied to the C5 superior surface of the model. Three-dimensional plots of graft stresses were generated for each iteration using scientific visualization software .Graft stresses were higher and more symmetrically distributed for the InterPlate titanium device having dynamic surface features than for the other modeled implants Figure a. MaximuOther cases with fully enclosed graft chambers (Both Titanium and PEEK implants) significantly stress shielded the graft material contained within. The titanium implant with an enclosed graft chamber uniformly decreased the graft stress by about 75% Figure c. The PEFinite element and animal studies of cage designs indicate that excessive stress shielding can inhibit fusion ,17. HoweSome anterior plates address stress shielding by incorporating dynamic load-sharing design features. A biomechanical study comparing load sharing of static and dynamic plate configurations was conducted using a C4-C7 finite element model . The stuThe in vitro studies comparing static and dynamic plates are controversial because of the fusion rates observed clinically for static plates. However, a study by Han et al. found that static plates promote clinical fusions by dynamizing due to screw migration through the vertebral bodies . In addiStudies have shown interbody devices with integral fixation can provide stabilization comparable to anterior devices. Scholz et al. suggested that the integrated plate-spacer provided comparable stability to traditional spacer and plate constructs while preventing several aspects of perioperative and postoperative morbidity . Other sHowever, because the interbody devices with integral fixation are located within the disc space and have relatively large contact areas on the endplate, they may not permit dynamization by screw migration through cancellous bone as occurs with anterior plates Figure .Even screws with rotational degrees of freedom may essentially be locked if the interbody device inhibits vertebral movement. This suggests the potential need for an integrated plate-spacer system that has dynamic features to enable load sharing with the graft in addition to the inherent advantages over anterior plates.As noted previously the InterPlate is an interbody device with integral fixation that accommodates screw rotation and translation with backout prevention. Like an anterior plate system, the fixation component and graft are not attached. In order to provide a direct comparison in this study, the same shape made of titanium without dynamic performance and similar shapes with enclosed graft chambers constructed of titanium and PEEK were also analyzed.The fixation means employed by current static interbody designs could be fins, staples, or two to four screws and, except for the InterPlate, the screws are either locked or rotational. To simplify the analyses, it was assumed that whichever fixation means the static designs incorporated did not inhibit load transfer. Screws or staples were not modeled. Locked screws or limited fixation degrees of freedom  will further inhibit load transfer. The experimental ASTM F 2267 test data used to model InterPlate stiffness includes screw fixation, so differences between the dynamic InterPlate case and hypothetical static cases likely would be magnified.However, FE model used in this study has some limitations. First, the endplate in our model is uniform, with a thickness of 0.5mm, whereas, in reality, the endplate thickness varies from the center to the periphery. However, the variation in thickness is very small and hence would not affect the outcome of our study. Secondly, our model simulates single geometry of the spine model and thus does not account for variations in the patients/cadavers.It has been shown that interbody devices with integral fixation provide adequate biomechanical stability compared to conventional systems under quasi-static loading . ResultsThe results indicated that graft stress is more uniformly distributed for the dynamic InterPlate design. Fully enclosed graft chambers increase stress shielding, and lower implant material modulus of elasticity does little to reduce stress shielding. The most effective way to increase load sharing in interbody devices with integral fixation is to design-in some dynamic mechanism. None of these observations are counterintuitive.While it is difficult to predict the implications of these observations on clinical performance, this finite element study indicates that the InterPlate dynamic design may reduce the graft stress shielding and thus provide more favorable conditions for successful fusion without graft failure.The authors declare that they have no competing interests.VP carried out the finite element study, analyses of the results and drafted the manuscript. AK participated in the finite element analysis. VG mentored the finite element analysis and provided valuable suggestions in drafting the manuscript. He was overall responsible for the project and the manuscript. JM provided device files required to carry out the finite element analysis and helped in drafting the manuscript. All authors read and approved the final manuscript.


Papers in medical journals are often difficult to understand and tedious to read. An editor's first loyalty should be to readers, by prioritising readability over merely producing a repository of data for the scientific community generally.The web now provides infinite repository space so there is even less excuse for journals to be unreadable. I give examples of how I attempted to improve one journal, despite external pressures and regardless of how it might affect the Impact Factor. As a postscript I outline increasing involvement in promoting honesty and integrity in publishing through the auspices of the Committee on Publication Ethics (COPE). Archives of Disease in Childhood came pretty well out of the blue. True, I had reviewed papers for the journal and, for a couple of years, had been an associate editor assisting with final decisions on whether to accept individual papers. However, there were others far more senior and more to the point, much more academic.The invitation to edit I had no academic pretensions, having spent 25 years of my working life as a full-time UK National Health Service paediatrician in secondary care hospitals. Decades ago I spent 18 months as a research fellow at London's Institute of Child Health neonatal research unit, but my contribution to the sum of scientific knowledge in neonatology was soon eclipsed by others and had vanished into obscurity  was Philosophical Transactions of the Royal Society of London. In introducing the journal, its publisher declared:The first scientific journal published in the English language :The sentence may be a little longer than is now fashionable but compare it with an extract from the Although concern about the impact of current housing policy on public health was shown by a substantial number of directors, the main activity was still allocation of increasing housing need and homelessness. The underlying need is for greater advocacy to produce a healthy housing policy for all and the annual public health report could be used to promote this objective.It has been established that the curtailed treatment schedule may offer perceived social and medical advantages for patients, with the additional benefit of it becoming moiré economical.I guess the first of these authors was trying not to say something straightforward like:Many directors of public health were concerned about how housing policy might affect health but spent most of their time dealing with who should get the few houses available. They could use their annual reports to promote a housing policy that took health into account.Patients prefer the shorter treatment and it's cheaper.Artisan countrymen don't speak like the original quotations, so what happened and how does it fit in with my perceptions of editorship? Medical writing has been infected with what a distinguished UK editor, Dr Michael O'Donnell, called ‘decorated scientific gothic’ . Think oprimary loyalty to be to my journal's readers rather than to aspirant authors, the demands of the publishers, the requirement of the co-owner the Royal College of Paediatrics and Child Health or even to the scientific record itself. What I felt important was not so much that the journal should simply provide a repository for data but rather that its readers might look forward eagerly to its arrival every month and even go so far as to open the cover page, let alone take off the wrapper  data storage devices. Scientists can store as much as they like in whatever form they wish in cyberspace and those who really need to study their work in depth can do so with ease. But the large majority of medical journal readers, especially those of the general journals, do not need to do so. Sophisticated readership surveys and the sort of straw poll you might undertake amongst your colleagues, will show that an individual reader may ignore much, skim some and read little of the content. As I see it, my editorial task was to grab them by the eyeballs and make sure they do more of the last than the first. My motives were partly altruistic and partly egotistical: altruistic, because I truly believe that having well-informed clinicians, public health doctors and basic scientists is good for patients. Egotistical, because I gain pleasure in hearing acquaintances say how much they enjoyed reading a particular issue, series or editorial.Journal of the American Medical Association, the New England Journal of Medicine and the Canadian Medical Association Journal.  than Brain (regarded as the epitome of tradition)  . His suc provoke . As an aAny editor will tell you that with the present day electronic copy flow structures, most papers move smoothly, albeit not always rapidly, through the system. Every now and again, however, one comes up against a problem. A paper may detail experiments, which appear unethical or for which there may not have been properly informed patient consent. A reviewer may allege an attempt at redundant or duplicate publication. An editor may discover plagiarism of another's work. Worst of all there may be suspicion of dishonest manipulation of data. The more one looks for such misconduct the more one discovers them and every case takes up a lot of time and emotional energy.When I left my editor's chair, I hoped that, whatever I had done or not done, I had nonetheless protected the scientific record against corruption and dishonesty. My interest in the subject and my outrage at some of the behaviour I encountered has led to my taking up a task as Chairman of the Committee on Publication Ethics (COPE) and to joining the board of the UK Panel on Research Integrity .So whatever else being an editor meant to me, it has opened up new doors at a time of life when many of my colleagues are firmly closing theirs. What's more, as an editor, I could do something I could rarely do as a doctor - say ‘No’.If there are any new or budding editors reading this, here is what you could do to make the biomedical publishing world a happier place. Don't regard your reviewers as editors. Their opinions may help you come to a decision, but just because they would like to see something published it does not necessarily mean it is right for your journal. The easiest way to decide what is right for your journal is to make sure you have a mission statement: ideally this has one sentence, but if that is asking too much I will allow you two, provided each includes a verb and tells you, your authors and your readers what you are there for. For example, ‘We aim to publish original research and reviews about the inguinal ligament which will help our readers better manage its problems.’ If a paper does not satisfy the mission, no matter how careful the methodology or precise the statistics, suggest it goes somewhere else. Keep an eye on your competitors and if you can't beat them, join them by adopting techniques that look successful in improving the flow of communication from your authors to your readers. Be tough on papers you intend to accept to make sure they hit the spot but be kind with your rejection letters. Finally, never get downhearted by criticism or lack of recognition from your peers. In general the only people who love editors are their wives, husbands, children and parents.Biomedical journal editors control the final gateway to publication. So they must protect the integrity of the scientific record by being knowledgeable (or knowing whom to ask), fair and frank. They are not there just to curate a database but rather to help get their authors’ messages across to readers. That means it is not enough to be a skilled and experienced researcher or clinician. Journalism, too, has its knowledge base and best evidence. By tapping into the skills of this non-scientific specialty, editors will reap rewards for themselves, their readers and the scientific community at large.rd edn, BMJ Books, 2003) and Medicine for Lawyers . In 2006 he became chairman of the Committee on Publication Ethics (COPE) an organisation with over 300 editor and publisher members from Europe, Asia and elsewhere. He is on the board of the UK Panel for Research Integrity and a member of the editorial policy committee of the Council of Science Editors (US). He also chairs fitness to practice panels of the UK General Medical Council.Harvey Marcovitch was a consultant paediatrician from 1977-2001, latterly at the Oxford Radcliffe Hospitals NHS Trust. From 1994-2002 he was editor of Archives of Disease in Childhood and is currently syndication editor for the BMJ Publishing Group and Associate Editor of the BMJ. He is editor of Black's Medical Dictionary and a chapter author of ‘How to Write a Paper’ (ed Hall G, 3


Skeletal Muscle [The beginning of 2012 marks the first anniversary of In its first year, the journal had excellent support, publishing 20 original articles and 16 reviews. We are quite grateful to the expert reviewers who gave their time to increase the quality of these papers - and are proud that all of the submissions received reviews from truly the top experts in our field, almost in every case members of our Editorial Board.Skeletal Muscle began to be indexed by PubMed [In addition, in August, y PubMed , increasSkeletal Muscle's visibility, which will then in turn improve its Impact Factor - which will help every author who publishes in the journal.Going forward in 2012 we do hope you will submit your findings to the journal. As you can imagine, Impact Factor is only achieved by first adopters who are willing to support the journal early, before a factor is established. Further, your letters to the journal and citation of journal articles will also help to increase Skeletal Muscle is here for the scientist interested in this dynamic tissue. Like its namesake, it can only gather strength with use and exercise - perhaps you can start by including us in your New Year's Resolution for 2012... to help grow the journal by your support.The bottom line is that this is truly a group endeavour; Thanks and best of luck with your research and education this year!


The We have solved the X-ray crystal structure of CusC, the outer membrane component of the Cus heavy metal efflux pump, to 2.3 Å resolution. The structure has the largest extracellular opening of any outer membrane factor (OMF) protein and suggests, for the first time, the presence of a tri-acylated N-terminal lipid anchor.The CusC protein does not have any obvious features that would make it specific for metal ions, suggesting that the narrow substrate specificity of the pump is provided by other components of the pump, most likely by the inner membrane component CusA. Escherichia coli, is also extremely toxic, requiring mechanisms to regulate its levels inside the cell. In E. coli, three systems are known that mediate tolerance to copper ions. The first of these, CopA, is an inner membrane P-type ATPase that actively pumps excess copper out of the cytoplasm cus system is responsible for copper and silver resistance in E. colicus system consists of two operons. The first of these, cusRS, encodes the histidine kinase CusS and the response regulator CusR. The second operon, cusCFBA, encodes the actual efflux pump. Transcription of cusCFBA is dependent on the concentration of copper (I) and silver (I) ions within the cell cusCFBA operon, CusA encodes an inner membrane protein belonging to the resistance-nodulation-division (RND) family. Phylogenetic analysis shows that CusA belongs to a subgroup of RND proteins involved in heavy metal extrusion E. coli and the MexAB-OprM multidrug efflux pump from Pseudomonas aeruginosa. CusF is a small periplasmic protein that binds copper(I) and silver(I) and may subsequently transport these ions to CusB E. coli.Copper, while being required for the function of a number of enzymes in E. coli. Crystal structures are available for all three components individually. AcrB is an inner membrane proton antiporter and forms a trimer with large periplasmic domains P. aeruginosa ortholog of AcrA (58% sequence identity), shows an extended structure with four domains that can likely adopt multiple conformations Much is known about the multidrug efflux pumps, exemplified by the AcrAB-TolC system from E. coli AcrB, explaining the previously noted differences in crystallization behavior between AcrB and CusC For the Cus heavy atom efflux pump, less data are available. Regarding structural information, X-ray crystal structures were recently solved for CusF and the adaptor/fusion protein CusB E. coli has seven RND efflux systems cus system is required for copper(I) ion resistance cusC knockout While Here we present the 2.3 Å X-ray crystal structure of CusC, the first structure of an outer membrane component of a heavy metal efflux pump. We have compared the CusC structure with the structures of other OMF proteins to obtain insight in whether CusC is likely to contribute to the observed substrate specificity of the Cus metal efflux pump.E. coli membranes using dodecyl-β-maltoside (DDM). Based on its elution position on gel filtration columns, CusC forms a trimer, analogous to all other OMF proteins. CusC was crystallized by hanging drop vapor diffusion from ∼35% PEG200/20 mM Na-acetate pH 4.0/0.2 M ammonium sulphate/20 mM NaCl. The structure of CusC was solved by molecular replacement with Pseudomonas aeruginosa OprM, which has 45% sequence identity to CusC, as the search model (3 (∼90×20×20 Å), which is filled with water. Generally low B-factors indicate that the α-barrel is well-ordered, which is likely due to extensive interactions between the helical domains in the crystal lattice  was purified from ch model . The finch model  [21]. Thch model . Each of lattice . By cont lattice . The cryLike other OMF proteins of solved structures, CusC has an interesting charge distribution. The outside surface of the protein has no extensive positively or negatively charged patches. By contrast, the interior of the entire barrel is strikingly electronegative . This fei.e. with a thioester bond). In our structure of CusC, density is clearly visible for three partial acyl chains attached to Cys1 of each CusC monomer  is a triacylated OM lipoprotein is not clear. Like other OM proteins, CusC and OprM have a hydrophobic region of 20–25 Å wide that serves to anchor the protein in the OM. Interestingly, CusC has an outward-facing serine residue in the center of the OM, raising the possibility that the hydrophobicity of the TM segments may not be entirely sufficient to drive Bam-assisted insertion into the OM. However, it is not clear if the somewhat polar character of the CusC OM transmembrane segment is the reason for the presence of lipid anchors, since OprM does not have a polar residue exposed to lipid. Another possible reason for the requirement of membrane-anchoring acyl chains could be the presence of very large periplasmic domains in CusC and OprM, possibly affecting the insertion of the channel into the OM as mediated by the Bam complex. However, the fact that TolC, which does not get acylated, has a very similar architecture compared to CusC/OprM strongly suggests other reasons for the presence of additional membrane-anchors in CusC and OprM.in vivoe.g. by having a narrow channel). The CusC structure shows that this possibility is unlikely. First, the α-barrels are very similar for CusC, TolC and OprM  by PCR and inserted into the pB22 expression vector E.coli C43 (DE3) cells via induction with 0.1% arabinose for 16–20 hrs at 20°C. Cells were ruptured by a single pass at 15,000–20,000 psi in a microfluidizer (Avestin Emulsiflex C-3), followed by membrane pelleting by ultracentrifugation. Inner membrane proteins were pre-extracted by 0.5% sarkosyl in 10 mM Hepes/50 mM NaCl pH 7.5 for 30 mins at room temperature, followed by centrifugation. The resulting pellet was extracted with 1% LDAO in 20 mM Tris/300 mM NaCl/10% glycerol pH 8 (TSB buffer) for 2 hrs at 4°C. After ultracentrifugation, the extract was loaded onto a 10 ml nickel column . The column was washed with 15 volumes of TSB containing 0.2% LDAO and 20 mM imidazole, followed by elution with TSB containing 0.2% LDAO and 200 mM imidazole. CusC was further purified by gel filtration (Superdex-200) in 10 mM Na-acetate/50 mM NaCl/10% glycerol/0.05% dodecyl-β-maltoside (DDM) pH 5, followed by concentration  and overnight dialysis against the same buffer. The final yield of CusC was ∼3 mg per 12 liter of cells.The gene encoding for full-length 4)2SO4, 50 mM Na-acetate pH 4.0; they grew to maximum dimensions of ∼0.1×0.1×0.05 µm in two months. The crystals belong to space group R32 and have one molecule in the asymmetric unit . A native dataset was collected at NSLS beamline X6A on a crystal that diffracted to 2.2 Å resolution. Diffraction data were processed in HKL2000 P. aeruginosa OprM as the search model, since MR efforts using TolC were not successful. The likely reason for the MR failure using TolC likely lies in the low sequence identity to CusC . Model building was done in COOT work/Rfree of 19.8/24.3%  at 18 and 22°C. Small diamonds were obtained in MemGold 2/#23. These crystals were optimized in ∼35% PEG200/0.2 M (NH.8/24.3% . The fin


Objective: To study nanostructural dentinal changes produced by endodontic irrigants. Study Design: Experimental study. Nanoindentations were performed on peritubular (PD) and intertubular dentine (ID) with an atomic force microscopy. Stiffness and adhesion force were determined before and after application of 5.25% sodium hypochlorite (NaOCl) and 17% ethylenediaminetetraacetic acid (EDTA). Normalized differences before and after treatment for stiffness and adhesion forces were calculated. A paired T-test was used to compare stiffnes and adhesion force before and after irrigants application. Results: After treatment with EDTA there was a 29.80% reduction in stiffness in ID and a 63.53% reduction in PD. Adhesion force was reduced by 21.22% and 8.21% respectively. After treatment with 5.25% NaOCI stiffness was reduced by 2.49% in ID and increased by 15.01% in PD. Adhesion force increased by 25.11% and 23.97% respectively. Conclusions: 17% EDTA reduced stiffness and adhesion force in ID and PD. Treatment with NaOCI at 5.25% had no significant effect on stiffness but did affect adhesion force in ID and PD. Key words:Atomic force microscope, stiffness, adhesion force, peritubular dentine, intertubular dentine. Knowledge of the mechanical properties of dentin is important for understanding how oclusal forces are distributed through the tooth and to predict how the absorption of these stresses is modified by age, pathological processes and restorative procedures -3The microstructure of the dentin-pulp complex consists of dentinary tubules which go from the pulp chamber to the dentino-enamel-junction in the crown portion and to the dentino-cementum-junction in the radicular aspect. And its microstructure consists of a hydrated type I collagen matrix reinforced with nanocrystalline carbonated apatite. The tubule lumens are about 1 µm in diameter and are surrounded by a 0.5-1.5 ?m hypermineralised layer of peritubular dentine which seems to be non-collagenous -6.The atomic force microscope (AFM) is a mechanical-optical instrument that is able to detect forces at piconewtons level. It can scan the sample with a pyramidal tip, registering its topography, and produce indentations in dentin. The probe is connected to a microscopic flexible lever. When a nanoindentation is made, stiffnes of the studied material is registered, as well as the adhesion force, measured as the tip´s resistance to be extracted.AFM can be used to specify the precise area for performing nanoindentations and to evaluate changes in stiffness and adhesion force in peritubular dentin (PD) and intertubular dentin (ID). ID is mainly responsible for the mechanical properties of dentin ,3-8 becaIrrigant solutions used in endodontic treatments can produce changes in biomechanical properties of dentin. Any change in the calcium/phosphate ratio alters the proportion of organic and inorganic components and consequently affects the characteristic hardness, permeability and solubility of dentin -14. ManyAs, in endodontic practice, many authors recommend the combined use of EDTA and NaOCI in the irrigation process, more knowledge about related changes that could interest dentin biomechanical properties is needed. The null hypothesis is that there are not biomechanical dentin changes in both ID or PD after treatment with EDTA or NaOCl at a nanostructural level. The aim of our study was to assess changes in stiffness and adhesion force in ID and PD caused by 5.25% NaOCI and 17% EDTA, using an atomic force microscope.Human mandibular premolars (n=20) extracted for orthodontic reasons, were randomly selected and stored for a maximum period of 20 days in Hank´s Balanced Salt Solution at 4ºC. Cleaned teeth were introduced into epoxy resin . A 1-2 mm thick disc of root dentine  was cut using an IsoMet Linear Precision Saw  with a 15LC blade  on a 0.381 thickness setting at 3000 rpm. Each slice were meticulously polished with P600, P800 and P1200 discs used consecutively .Samples were randomly distributed into two groups for the different treatments (n=10). The first group was submerged in 5.25% NaOCI for one minute. The second group was submerged in 17% EDTA also for one minute.Nanoindentations were performed with a NanoScope Illa version 5.30r2 atomic force microscope (AFM)  using a square pyramidal tip OTR8  with a 0.57 N/m spring constant and a tip half angle of 35º on the buccal side. Calibration of the tip sensitivity was performed in the same conditions as the experiments with a flat surface sample made of the same material as the tip and was calculated to be 5.721 nm/V after at least 10 repetitions. Sensitivity of the tip was used to correct the deflection of the tip caused by the vertical movement of the sample without penetration. Stiffness and adhesion force were calculated with the AFM as previously described by Forner, et al. .These experiments allows to get information about the local mechanical properties of the system, tests were performed in each sample (before and after treatment) in 200 points located on a 10x10 matrix, with rows and columns separated 10 nm from each other. Thus, stiffness is measured over a square of 1x1 µm2. The nanoindentation area was selected after several imaging steps for each specimen. First, a region with homogeneously distributed dentin tubules (free of defect or impurities) was selected using an optical microscope (400x) coupled to the AFM. Afterwards, several images of increasing resolution were acquired (AFM) until a single dentin tubule in a 5x5 µm area was visualized. The nanoindentation areas (intertubular and peritubular dentin) were then selected from this high-resolution image. Nanoindentation experiments provide the adhesion force and the stiffness for each sample as the mean value of 200 points (100 in both ID and PD). These measurements can be used to assess adhesion force and stiffness.Adhesion force and stiffness measurements of the 200 nanoindentations were calculated for each sample before and after treatment. The normalized difference between the two magnitudes (before and after treatment) was calculated. Mean values before and after treatment was performed by paired T-test. Statistical significance was assessed at p < 0.05.The mean values of normalized differences for stiffness and adhesion force for both ID and PD were represented in figure The samples treated with 5.25% NaOCI showed no significant differences in stiffness before and after treatment in ID or PD (p>0.05) whereas adhesion force increased 25.11% in ID and 23.97 in PD (p<0.05) .In our study we used samples from buccal root dentin from mandibular premolars in order to standardize the samples since, according to results obtained by Brauer, et al. , buccal There is no information available in the current scientific literature about changes in stiffness and adhesion force at nanostructural levels in intertubular and peritubular dentin after the use of different products to irrigate root canals during biomechanical preparation. The use of AFM is a suitable technique for this study and has been used previously to evaluate the effects of other products on dentin ,21, as iAFM measures the mark left by the indenter tip (coupled to the microscope) where it comes into contact with the dentin (entry stiffness), providing information on the capacity of the dentin to withstand the force applied by the nanoindentor, that is, dentin stiffness. The resistance offered by the tip as it comes off the dentin provides the value known as adhesion force .In the conditions of our experiment, the null hypothesis was rejected because 1 minute application of 17% of EDTA reduces stiffness and adhesion force in both ID and PD dentin, as well as 1 minute application of 5,25% NaOCl increases adhesion force.The reduction in stiffness and adhesion force found after applying 17% EDTA for 1 minute may be due to demineralisation. This reduction is more significant in PD because PD is more mineralised than ID. Other techniques used to evaluate the effect of EDTA at the same concentration on dentin are microindentation techniques which observe reductions in dentin hardness ,10,13-17NaOCI is essential for eliminating organic components during root canal treatment . 5.25% NWe can conclude that both 17% EDTA and 5% NaOCI cause nanostructural changes in intertubular and peritubular dentin. Further studies on these lines are needed to establish the effects of other concentrations and other application times and to determine the biomechancial significance of these changes.


Croatian Medical Journal for the last twenty years. We will probably never stop doing this, even when we become an august journal, because the world of scientific publishing rapidly changes. This year, we present a new design of the journal’s website and remind our readers about new editorial policies on declaring authorship and conflict of interest.Just as for people, a new year is a good time for a journal to stop, look back, and start a new beginning, hoping for a good season ahead. This is what we have been doing each year in the http://www.icmje.org/updated_coi.pdf. We have been asking our authors to fill out the form since 2009 but starting from this year we will publish their declaration in the journal. You will find it at the end of each article, together with other declarations and acknowledgments. We believe that conflict of interest, both of authors and editors, is an important issue  ,2, we annt issue ,5, and wFrom this issue on, we will also publish authors’ declaration on their authorship contributions. Since the first proposal for contributions disclosure in medical journals , we havehttp://www.cmj.hr/Guidelines/Guidelines.pdf. We thank both the authors and the readers for their extra effort in supplying and assessing these new pieces of information – they will hopefully contribute to the quality and transparency of health research.All details on new policies are available in our revised Guidelines for Authors, which are published in this issue  and are


It has been claimed that osteopathic manipulative treatment (OMT) is able to enhance the immune response of individuals. In particular, it has been reported that OMT has the capability to increase antibody titers, enhance the efficacy of vaccination, and upregulate the numbers of circulating leukocytes. Recently, it has been shown in human patients suffering chronic low back pain, that OMT is able to modify the levels of cytokines such as IL-6 and TNF-α in blood upon repeated treatment. Further, experimental animal models show that lymphatic pump techniques can induce a transient increase of cytokines in the lymphatic circulation. Taking into account all these data, we decided to investigate in healthy individuals the capacity of OMT to induce a rapid modification of the levels of cytokines and leukocytes in circulation. Human volunteers were subjected to a mixture of lymphatic and thoracic OMT, and shortly after the levels of several cytokines were evaluated by protein array technology and ELISA multiplex analysis, while the profile and activation status of circulating leukocytes was extensively evaluated by multicolor flow cytometry. In addition, the levels of nitric oxide and C-reactive protein (CRP) in plasma were determined. In this study, our results show that OMT was not able to induce a rapid modification in the levels of plasma nitrites or CRP or in the proportion or activation status of central memory, effector memory or naïve CD4 and CD8 T cells. A significant decrease in the proportion of a subpopulation of blood dendritic cells was detected in OMT patients. Significant differences were also detected in the levels of immune molecules such as IL-8, MCP-1, MIP-1α and most notably, G-CSF. Thus, OMT is able to induce a rapid change in the immunological profile of particular circulating cytokines and leukocytes. Osteopathic medicine is based on the premise that the primary role of the physician is to facilitate the body's inherent ability to heal itself. Osteopathic physicians view diseases as a disruption of the normal interactions of anatomy, physiology and behavior. One unique aspect of osteopathic medicine is treatment by manually applied procedures, often referred to as manipulative therapies. These therapies have been successfully used by osteopathic physicians for more than a hundred years in order to treat dysfunctions of the neuromusculoskeletal, lymphatic, or vascular tissue. As described in Foundations for osteopathic medicine et al in 1998 et alOf the few published studies that have examined changes in leukocyte counts following osteopathic lymphatic techniques Streptococcus pneumoniae colony-forming units in the lungs of rats with acute pneumonia et al. on human patients suffering chronic low back pain showed that repeated OMT treatment was able to modify the levels of TNFα in circulation In more recent years, exciting studies on the effect of OMT on immune parameters have been performed. Firstly, three publications from the Hodge lab have shown that abdominal lymphatic pump can significantly modify the leukocyte population in lymphatic circulation Herewith, in this pilot study, we decided to investigate rapid responses on several human circulating leukocyte populations and cytokines. To this end, human volunteers were subjected to a combination of lymphatic, splenic and hepatic pump osteopathic treatments and blood samples were collected at different times pre and post-OMT. Then, the proportion of different leukocyte populations was determined by hematological techniques combined with thorough flow cytometry analysis. Further, the presence of several chemokines, cytokines and growth factors were determined in our samples by means of antibody array technology and multiplex ELISA analysis.This study was approved by the Ohio University Institutional Review Board Ethics (protocol 09F007) Committee and informed consent was obtained from all volunteers. The research process, including the collection and storage of blood, isolation of immune cells and determination of cytokine levels in plasma samples, was explained in detail to every participant. Every participant provided written informed consent.Healthy volunteers were enrolled for these studies following an institutional review board approved human subjects' blood collection protocol as described above. Selection of volunteers was with the help of the Clinical Research Unit of the Heritage College of Osteopathic Medicine, Ohio University. As described in other studies As previously described for similar studies For the first series of studies, 21 participants were recruited. In this group, two of the participants withdrew due to problems with recovering blood during the second or third venipuncture. Ten participants fell in the OMT group and 10 in the sham group. For the second group of studies a total of 36 participants were recruited. In this group, three participants withdrew before the treatment or after due to problems with recovering blood during the second or third venipuncture. Sixteen participants fell in the OMT group and 17 in the sham group.et al. (1998), the time length of OMT on each participant was 7 minutes As previously described in detail by Jackson For the sham treatment group, we used light touch to the similar region as described previously For these studies we perform a simple random sampling. For each group of 10 participants, the clinician prepared 5 closed papers with OMT and 5 with sham labels in a closed box. At the day of the treatment, and after the participants signing the consent forms, the clinician drew one paper in order to determine to which group the participant was allocated. The participants were not informed whether they were subjected to OMT or sham treatment.All outcome analyses were performed in a blinded fashion. The researchers in charge of performing the hematological and immunological techniques did not receive any information regarding whether the samples belong to an OMT or sham-treated participant until the stage of statistical analysis, and did not witness the protocol treatments.Blood was drawn by research nurses from OMT and sham-treated participants at −1 h (baseline), 5 and 30 min after treatment ; or at −1 h, 30 min and 1 h after treatment . Two 8-ml VACUTAINER CPT (Cell Preparation Tube) and one 8-ml VACUTAINER PPT (Plasma Preparation Tube) , containing citrate as the anti-coagulant, were collected from each subject. Samples were treated according to the manufacturer's instruction in order to obtain plasma for nitrite determinations and mononuclear cells for different studies.Total and differential leukocyte numbers were determined in an automatic cell counter in triplicate . To confirm differential leukocyte counts, peripheral blood smears were made and stained with Wright Giemsa stain for each specimen. Two hundred white blood cells were counted at a 1000× magnification. Then, differences in the numbers and types of leukocytes among samples recovered from OMT and sham treated individuals were determined.+MHC-II (HLA-DR)+ and CD19(HIB19)+ cells. Monocytes were detected by means of CD14 (M5E2) staining; and different monocyte subpopulations identified by their expression of CD16 (CB16). DCs were identified by staining together with CD11c  or CD123 . Different myeloid DC populations were identified by their expression of CD1c (L161), CD16 (CB16) and CD141 . The activation status of circulating APCs  was defined based on the levels of expression of HLA-DR, CD80 (2D10.4) or CD86 (IT2.2). All antibodies except where indicated were acquired from eBioscience .In order to analyze the phenotype of circulating leukocytes from OMT and sham treated participants, mononuclear cells were stained with specific fluorochrome-labeled antibodies and analyzed by flow cytometry. All samples were stained with CD45 (2D1) antibody  a pan leukocyte marker. In order to define T lymphocyte subsets, CD3 (HIT3a), and CD8 (HIT8a) antibodies were used. Further staining with CD45RA and CCR7 (3D12) helped to identify naïve and memory lymphocytes within the T cell population. CD56 (B159) was used to detect NK cells, and NKT cells were defined as cells co-expressing CD56 and CD3. The activation status of T cells, NK cells and NKT cells was defined due to the levels of expression of the early activation antigen CD69 (FN50). B cells were defined as CD45Presence of cytokines, chemokine and growth factors in plasma samples obtained from OMT and sham participants was analyzed using a cytokine antibody array  following the manufacturer's instructions. Briefly, samples were seeded on glass microarrays and upon following incubation and washing procedures fluorescence signal intensities were measured in an Agilent microarray B-scanner . Once the fluorescent intensity data was obtained, the background was subtracted and the values normalized to the provided positive control signals before proceeding to analysis. Then, comparison of signal intensities for antigen-specific antibody spots was used to determine the relative differences in expression levels of each analyte between samples. As per manufacturer's instructions, any ≥1.5-fold increase or >0.65-fold decrease in signal intensity for a single analyte between samples was considered a measurable and significant difference in expression. This assay, as followed, is not able to assess absolute or relative concentrations of different analytes in the same sample. Plasma samples (pretreatment and 30 min post-treatment) from OMT and control subjects were compared for changing levels of 40 different cytokines and chemokines associated with inflammatory responses.In another set of experiments, plasma samples obtained from OMT and sham participants  were analyzed for the presence of chemokines and cytokines by using a MILLIPLEX MAP Human Cytokine/Chemokine Panel  according to manufacturer's specifications. The chemokines and cytokines chosen for analysis were Eotaxin, G-CSF, IL-1α, IL-1β, GM-CSF, IL-2, IL-8, IL-4, IL-6, IL-10, MCP-1, and MIP-1α.The levels of C-reactive protein (CRP) in plasma samples were determined by using a human CRP ELISA kit  following the manufacturer's instructions.Nitrate levels in plasma samples, a measure of nitric oxide metabolism, were determined by using the Nitrate/Nitrite Fluorometric Assay Kit  following the manufacturer's instructions. Briefly, fluorescent emissions were evaluated in a Synergy HT microplate reader , using a 360 excitation filter and a 420 emission filter.For this pilot project, multiple comparisons we performed ANOVA analysis with post-analysis comparisons by the Tukey-Kramer multiple comparisons test. When samples did not follow normal distribution, non-parametric statistics were used for analysis. When comparing the levels of a particular molecule within the OMT or sham group at different time-points, we used paired-sample statistics analysis. A value of p<0.05 was considered significant. Data are expressed as mean ± SD. Data was analyzed using Graph Pad Instat software .de novo synthesis” of particular immune factors, but rather an effect of changes in the secretion rates of preformed or constitutively produced molecules. Likewise, differences in the percentages of activated immune cells would surely reflect mobilization of populations rather than synthesis of markers of activation during this period of time. It is important to highlight that no adverse effects were reported due to OMT in any of the participants of these studies.The focus of our research was to analyze rapid responses to OMT. Thus, samples were obtained for analysis within an hour of treatment. This has the benefit of “homogenizing” the volunteer behavior, since during that time they were not allowed to eat food or drink and were monitored to by our research team. On the other hand, due to the short period of time after OMT, we do not expected to observe changes due to “de novo by the liver, very important changes in the levels of this molecule are usually observed after 4 h of stimulation. Nevertheless, taking into account some reports that indicate a small but significant increase of CRP at very early time points after stimulation In order to investigate the effect of OMT on the level of circulating metabolites and leukocytes, healthy volunteers were subjected to a mixture of lymphatic and hepatic pump treatments while a sham group received a “light touch” treatment. In order to determine the basal levels of circulating metabolites and leukocytes, 1 h prior treatment blood was extracted from the volunteers. To evaluate immediate response to OMT, blood was drawn at 5 and 30 min post-treatment. It has been previously reported that OMT can induce production of nitric oxide (NO) In order to further investigate the rapid response of the immune system to OMT, we evaluated the levels of various chemokines, cytokines and growth factors in the plasma of OMT and sham treated subjects using antibody array technology . Plasma samples (pretreatment and 30 min post-treatment) from 4 OMT and 4 control subjects were compared for changing levels of 40 different factors associated with inflammatory responses. Expression levels of four cytokines  were significantly increased (≥1.5× increase at 30 minutes vs. pretreatment level) only in OMT subjects (4 of 4 OMT subjects vs. 0 of 4 control subjects) Table 1.Taking into account this qualitative modification in the levels of some circulating cytokines without affecting leukocyte populations, we decided to change our time points for blood collection after OMT, selecting 30 min and 60 min post-treatment. We hypothesize that this would encompass the possibility of a modification in leukocyte levels in response to changes in the cytokine profile. As shown in + DC subpopulation was present at significantly lower levels in the PBMC fraction recovered from the OMT group. The significance of this observation is very important. DCs are the most powerful APCs present in the body, and as such have the capability to stimulate specific T cell responses +CD11c+HLA-DR+ population has been described as a subset of DCs involved in inflammatory responses, since they are characterized by high expression of TNFα (and low levels of IL-10) upon stimulation We then performed an exhaustive flow cytometry analysis of PBMCs recovered from OMT and sham-treated groups 1 h post-treatment. hi monocytes between OMT and sham groups , no differences in the activation levels of B cells, DCs or plasmacytoid DCs were observed in our samples upon OMT  were evaluated. Long-term effects involving de novo synthesis of immune molecules could be surely observed due to the limited time lapse between treatment and sampling. Even under these stringent conditions we were able to detect some modification in immune parameters in our studied population. This argues for future studies investigating the effect of OMT at later time points in order to observe effects on the synthesis of circulating immune molecules or the upregulation of activation markers in immune cells.In closing, our data show for the first time that OMT exerts a modification in the distribution of a particular blood DC population. This was possible due to thorough flow cytometry analysis and multiplex technology. This could help interpret data indicating that OMT can help fight infections, or can increase the efficacy of vaccinations. Furthermore, this argues for extended immunological studies aiming to determine that OMT might help some conventional anti-infectious therapies. In this context, combination of OMT with conventional therapeutic treatments has the potential of lowering healthcare costs which will result in a great benefit for both the patient and the healthcare system. Finally, this study focused in changes induced by OMT in which little or no effect from File S1Patient consent form regarding the studies described herewith. Each participant read and signed the consent form document.(DOC)Click here for additional data file.


P > 0.05) in the cultivars studied while heating resulted in a significantly high reduction in the TIA level than in unheated condition. Polygonal or round shaped starch granules were in the range of 16.8–23.5 μm and low level of starch digestion was shown in cultivars containing larger granules. Total amylose content lies in the range 15.4–19.6% and cultivars having higher percentage of amylose showed higher level of in vitro pancreatic digestion . The starch digestibility of sweet potato flour was in the range of 36–55% and the highest digestion was observed in swp7. Orange fleshed cultivars (swp4 and swp7) were comparatively rich in nutrients and digestibility than the other three studied cultivars.Nutritional attributes of flours obtained from five different cultivars of sweet potato roots commonly available in Sri Lanka showed significant differences in the tested parameters. The starch level ranged between 33% and 64% on the dry basis and the extractability from fresh tubers was governed by the quantity of starch. The crude fiber level ranged between 2.1% and 13.6% on dry basis and the highest level was observed in swp7 (CARI 273) and resistant starch ranged from 14.2% to 17.2%. Higher percentage of resistant starch from total starch was found in Wariyapola red (swp1) cultivar resulting in lower digestion level while higher levels of digestion was evident in cultivars with lower levels of resistant starch with high level of total starch. Low levels of calcium and significant levels of iron were found in the five cultivars studied. Crude protein level was in the range of 1.2–3.3% on dry basis and trypsin inhibitor activity level (TIA) was significantly different ( Ipomea batatas (L) Lam) is a tuberous-rooted perennial plant belonging to the Convolvulaceae or morning glory family. This family includes about 45 genera and 1000 species, but only Ipomea batatas is of economic importance as food , SWP 3 (Wariyapola white), SWP 4 , SWP 5 , and SWP 7 (CARI 273) were randomly collected from Dhambulla, Horana, and Gokarella areas in Sri Lanka and prepared for analysis 2–3 days after harvesting.The tubers were washed, hand peeled, and trimmed to remove defective parts. Then the tubers were grated into thin chips (∼5 mm) and dried in an air convention oven at 40°C for 30 h up to 14% moisture. The dried chips were powdered using a laboratory scale grinder and sifted through a 300 μm sieve. The flour samples were sealed and packed in airtight containers for further analysis and percentage extractability from fresh tubers at 14% moisture for each sample was determined.Starch separation was carried out according to the method described by Takeda et al. Protein (N × 6.25) and fibre were determined according to Association of Official Analytical Chemistry AOAC , 7.015 , 7.065 . Flour sMineral elements (Ca and Fe) were determined by dry ashing method. The ash was dissolved in conc. HCl, filtered, and diluted to 50 mL with distilled water. Prepared solutions were analyzed with standards for elemental analysis using Atomic Absorption Spectrophotometer .Trypsin inhibitor activity (TIA) levels were analyzed in unheated and heated flour samples heated at 100°C by using the method described by Smith et al. . TIs wer2,, 30 mg gelatin, and 30 mg pancreatin . The capped tubes were placed in a shaking water bath at 37°C with a sufficient speed to keep the flour in suspension for 12 h and the reaction was stopped with addition of 5 mL of 1% H2SO4. The suspension was centrifuged at 20,000 g for 10 min and the supernatant was decanted and the residue pellet was dispersed with 15 mL of 80% ethanol and re-centrifuged for 5 min. The supernatant was decanted and the tubes with the residue pellet were dried at 50°C for 6 h, then at 80°C to constant weight, cooled, and weighed. Starch digestibility was expressed as percent weight loss after digestion. A blank without pancreatin was included for each sample to adjust the results.Flour and starch digestibility was measured based on the method described by Zhang et al. . A sampln-propanol for 7 h in a Soxhlet extractor  and the mean particle size diameter of granules appeared on a field was determined.P ≤ 0.05) to examine samples in triplicates for each parameter tested in different cultivars.Minitab software (Version 14) was used for Analysis of variance (ANOVA) with Tukey's honestly significant difference test (Flour extractability from fresh tubers lies in the range 40.2–55.1% at 14% moisture and starch level ranged between 33% and 64% on the dry basis Table . The meaP > 0.5) in the crude fibre level in all the studied cultivars. Cellulose and lignin contents were gravimetrically measured in crude fibre determination and thus high level of RS in swp5 cultivar indicates the presence of high amount of dietary fibre in the particular cultivar.The crude fibre level ranged between 2.1% and 13.6% on dry basis and the highest level was observed in swp7 and the lowest level seen in swp5. The level of crude fibre content in the roots was reported to range from 2.5% to 5.0% on dry basis . RS is significant as a functional food component as it is responsible for slow liberation and absorption of glucose in blood due to reduced digestion in the lower parts of the human gastrointestinal tract. This aids in the reduction in the risks of diabetes, obesity, and other related diseases  in all the cultivars studied. Highest and lowest levels were reported in swp7 and swp1, respectively. Total amylose content ranging from 14.9% to 25.1% in 114 genotypes of sweet potatoes was reported by Zhang et al.  and digestion level was similar though there was a significant difference (P > 0.05) in the granular sizes . The degree of digestibility depends on the chemical nature of the starch, physical form, the presence of possible inhibitors, and the physical distribution of starch with relation to dietary fibre components such as cellulose, hemicelluloses, and lignin . As a whole, from the tested parameters, swp7 can be considered as the most nutritionally significant cultivar than the four others tested with regard to nutrient richness and digestibility. However, for a more conclusive study it is suggested to analyze these cultivars obtained from different locations of this country during varied months of the year.Flours and starches separated from commercially available different cultivars of sweet potatoes in Sri Lanka showed obvious differences in macro- and micronutrients, TI levels, and total amylose content. There was no significant difference in the digestibility level and granular size of certain cultivars at


To investigate the outcome and prognostic factors for corneal graft recovery after severe corneal graft rejection following penetrating keratoplasty (PKP) treated with topical and systemic steroids.Fifty-eight eyes in 58 patients with severe corneal graft rejection following PKP were treated with topical and systemic steroids. Factors affecting the reversibility and maintenance of graft transparency were analyzed.P = 0.0093). Corneal decompensation after the recovery of corneal transparency tend to occur in cases of regraft .Graft transparency was restored in 37 of 58 eyes (63.8%). Clarity of the graft was maintained in 25 of 37 eyes after transparency was restored, while corneal decompensation developed at a mean of 6.0 ± 4.3 months in the remainder. The interval between rejection and treatment with systemic steroids was shorter in cases that recovered graft transparency (OR, 0.88, 95% CI. 0.80–0.97, Severe corneal graft rejection after PKP was reversible in approximately two-thirds of the cases, with graft transparency being maintained in two-thirds of them when treated with both topical and systemic steroids. Early treatment confers a benefit in terms of the recovery of graft transparency. Corneal graft rejection is a severe complication that can follow penetrating keratoplasty (PKP), possibly leading to severe endothelial cell loss and corneal decompensation ,2. Risk This study investigated the outcome in severe corneal graft rejection treated with a standardised protocol including topical and systemic steroids and factors affecting the reversibility and maintenance of graft transparency.We retrospectively studied 58 eyes in 58 patients who developed severe corneal graft rejection following PKP and were treated with topical and systemic steroids at Tokyo Dental College Ichikawa General Hospital between January 2005 and December 2010. Only patients with severe endothelial rejection defined as severe graft edema with an endothelial rejection line or five or more keratic precipitates appearing after attaining postoperative graft transparency were enrolled. All patients were hospitalised. Patients with a follow-up period of less than 6 months were excluded. Central corneal endothelial cell density (ECD) was measured using the EM-3000 , and the value measured within 1 year before or after graft rejection were assessed. This study was conducted in accordance with the tenets of the Declaration of Helsinki and approval was obtained from ethics committees at our institution. All patients provided written informed consent for treatment with topical and systemic steroids.Postoperatively, the patients received medication with topical steroid to prevent graft rejection, according to the following protocol. Dexametasone phosphate 0.1% was administered five times daily and tapered over a period of 6 months, and fluorometholone 0.1% was continued unless infection or an uncontrollable increase in IOP occurred.All patients diagnosed with graft rejection were treated with topical and systemic steroids. Dexamethasone phosphate 0.1% hourly was commenced immediately after diagnosis of a rejection and tapered according to the clinical response over several weeks. Treatment with systemic steroids was started in a few days after diagnosis of a rejection with intravenous dexamethasone phosphate or methylprednisolone. In the former, 8 mg/day dexamethasone phosphate was administered for 3 days, after which it was tapered to 6 mg/day for 3 days and 4 mg/day for 3 days. In the latter, 500 mg/day methylprednisolone was administered for 3 days, followed by oral 2 mg/day dexamethasone phosphate, which was then tapered over 2 weeks. Patients over 70 years old were given half of the steroid dose. Patients with a systemic disease, including infection, gastric ulcer and poorly controlled diabetes mellitus, were not treated with this protocol and not included in this study.The main outcome measure was the rate of reversibility of corneal graft rejection. Rejection was considered reversible when the clinical signs had disappeared after treatment. The patients were divided into two groups: cases in which transparency was (Group 1) and was not (Group 2) restored. Parameters of interest included age, sex, diagnosis before PKP, type of surgery, history of glaucoma, previous episodes of rejection, ECD before corneal graft rejection, the interval between PKP and rejection, type of systemic steroid treatment and interval between rejection and treatment with systemic steroids. These factors were assessed and compared between Groups 1 and 2. In Group 1, the interval between treatment and the recovery of transparency, and whether transparency was maintained over the observation period, were also assessed. Cases in which transparency was maintained after recovery from rejection  and cases wherein decompensation occurred after transparency was recovered  were also compared.P-value of <0.01 was considered statistically significant. All statistical analyses were performed with SSRI software .Statistically significant differences between the two groups were determined using logistic regression. A The patient demographics are shown in Table 2 before rejection versus 772 ± 464 cells/mm2 after rejection (P < 0.001). Graft transparency was restored in 37 of 58 eyes (63.8%). Nineteen of 41 cases that were observed for more than 1 year after rejection had a clear graft at 1 year and 4 of 7 cases that were observed for more than 3 years after rejection had a clear graft at 3 years. Graft clarity was maintained in 25 of 37 eyes , with corneal decompensation occurring 6.0 ± 4.3 months after the recovery of transparency in the remainder.The mean best-corrected visual acuity (Log MAR) was 0.66 ± 0.75 before corneal graft rejection, 1.33 ± 0.87 before treating the corneal graft rejection and 1.03 ± 1.04 after treatment. Data on the ECD before rejection were obtained in 29 eyes (50.0%). In 18 of these eyes, data on the ECD after rejection were also obtained. The ECD in 18 eyes was 1556 ± 840 cells/mmP = 0.093). No differences were observed in age, sex, diagnosis before PKP, type of surgery, history of glaucoma, previous episodes of rejection, ECD before rejection, interval between PKP and rejection or treatment method.Groups 1 and 2 are compared in Table P = 0.091). No differences were observed in age, sex, type of surgery, history of glaucoma, previous rejection episodes, ECD before rejection, interval between rejection and treatment, treatment or interval between treatment and recovery of transparency.Groups 1A and 1B are compared in Table The side effects of topical and systemic steroids are shown in Table et al. investigated 152 cases of severe endothelial rejection following PKP treated with topical steroids with or without systemic steroids and reported that graft survival was 42.6% at 1 year and 36.1% at 3 years [Severe endothelial rejection was treated with topical and systemic steroids in all cases and the rate of reversibility was 63.8%. The rate of reversibility was reported to be 51–63.3% in previous studies ,8. Wagon 3 years . AlthougIn this study, a longer interval between corneal graft rejection and treatment with systemic steroids was associated with an increased risk of corneal decompensation after graft rejection. Risk factors for irreversibility after graft rejection reported in previous studies included donor age, patient age, diagnosis of BK, history of rejection or graft failure episodes ,9. Earlyet al. reported that the ECD decreased by 11.8% [et al.[The endothelial cell density decreased significantly after corneal graft rejection. Musch et al.[et al.[et al.[The interval between PKP and corneal graft rejection was 31.5 ± 36.7 months, which was longer than that in previous studies, including 15.4 ± 20.9, 10.4 ± 9.3 and 15.3 ± 14.4 months reported respectively by Epstein l.[et al.. If no sThis study demonstrated that severe rejection was reversible in two-thirds of the cases reviewed, with graft transparency being maintained in two-thirds of them. A longer interval between corneal graft rejection and treatment was associated with an increased risk of corneal decompensation after graft rejection. Regraft as a diagnosis before previous PKP was associated with corneal decompensation after the recovery of corneal transparency.There are no competing interests for any authors for this manuscript.KY, SS and JS contributed the study design, the data analysis, interpretation and manuscript writing. KY, KY and SS contributed ophthalmologic data collection. All authors read and approved the final manuscript.The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-2415/13/5/prepub