Atopic eczema is a common and distressing disease. This study aims to review PubMed indexed research statistics on atopic eczema over a-10 year period to investigate the clinical relevance and research interest about this disease.PubMed  was searched for the terms “atopic dermatitis” and “eczema”, with limits activated , and editorials, letters, practice guidelines, reviews, and animal studies excluded. Journal impact factor (IF) is in accordance with Journal Citation Report (JCR) 2009, a product of Thomson ISI (Institute for Scientific Information).p = 0.0001), which includes such prestigious journals as the New England journal of Medicine , the Lancet  and BMJ . There was no publication in any family medicine or general practice journal. The British Journal of Dermatology (n = 78), Pediatric Allergy and Immunology (n = 49) and Journal of Allergy and Clinical Immunology (n = 46) had the highest number of publications on the subject. Atopic eczema ranked higher in impact factors in allergy/immunology although more publications appeared in the dermatology category.A total of 890 articles were retrieved. Taking out publications that were irrelevant and those without an impact factor, 729 articles were obtained. These articles were grouped into dermatology , allergy/immunology , pediatrics  and miscellaneous subject categories . The impact factors were highest in the miscellaneous category (Atopic eczema is a multidisciplinary disease. Its clinical relevance and research interests are definitely beyond that of a mere cutaneous disease. Investigators may consider allergy/immunology and miscellaneous journal categories for higher impact of their research. Childhood eczema is a distressing disease associated with atopy -6. Diseap-values less than 0.05 were considered to be statistically significant.PubMed  was searched for the terms “atopic dermatitis” and “eczema”, with limits activated , and editorials, letters, practice guidelines, reviews, and animal studies excluded. These limits were set so that the data could be manageable. Journal impact factor (IF) is in accordance with Journal Citation Report (JCR) 2009, a product of Thomson ISI (Institute for Scientific Information). Data was expressed as mean and standard deviation (SD) unless otherwise stated. ANOVA was used to compare means. All comparisons were made two-tailed, and Between 2001 and 2011 (as of April 2011), a total of 890 articles were retrieved. Each article/journal was reviewed for relevancy and for an impact factor by Journal Citation Report JCR 2009. Taking out publications that are irrelevant and those without an impact factors, 729 articles were obtained. They were classified into dermatology, allergy/immunology, pediatrics, and miscellaneous categories (Table p = 0.0001). There were a number of prestigious journals in the miscellaneous category, which included the New England journal of Medicine , the Lancet  and BMJ .These articles were grouped into dermatology (n = 337), allergy/immunology n = 215), pediatrics (n = 118) and miscellaneous subject categories (n = 142) , Psychosomatic Medicine (n = 3), The Journal of Behavioral Medicine (n = 1) and Journal of Psychosomatic Research (n = 3). Five publications were under integrative and complementary medicine: Complementary Therapies in Medicine (n = 2), American Journal of Chinese Medicine (n = 2), Journal of Alternative and Complement Medicine (n = 2) and Journal of Ethnopharmacology (n = 1). There was no publication in any family medicine or general practice journal. The British Journal of Dermatology (n = 78), Pediatric Allergy and Immunology (n = 49) and Journal of Allergy and Clinical Immunology (n = 46) had the highest number of publications on the subject. Atopic eczema ranked higher in impact factors in allergy/immunology although more publications appeared in the dermatology category.Childhood eczema is a common chronic relapsing disease ,2,12 TheThe limitations of this study are that many advances in basic research are not represented due to selection bias of only clinical categories. For instance, filaggrin and related genome wide studies are published in top science journals in recent years -17. The In dermatology, the “brick-and-mortar hypothesis” states the stratum corneum (the outermost layer of the epidermis) normally consists of fully differentiated corneocytes surrounded by a lipid-rich matrix containing cholesterol, free fatty acids, and ceramide; the structure of this matrix closely resembles that of bricks and mortar in a wall. In eczema, lipid metabolism is abnormal, causing a deficiency of ceramide that leads to transepidermal water loss -20. The In oriental medicine principles, eczema is considered as a systemic disease with imbalances of Qi or internal energy . Many AsThe authors declare that they have no competing interests.VY carried out the Pubmed search. KLH provided guidance about the search, performed the statistical analysis, and drafted the manuscript. TFL was responsible for reviewing and editing of the manuscript. All authors read and approved the final manuscript.


Few days ago our advisory editorial board member Prof. Gholam A. Peyman was named as one of the 12 eminent researcher recipients of the National Medal of Technology and Innovation in US. Eleven extraordinary inventors were also named recipients of the National Medal of Technology and Innovation. This award and the National Medal of Science designations are the uppermost honors bestowed by the federal government upon scientists, engineers, and inventors. On behalf of editorial board we would like to congratulate Prof. Peyman for his great achievement.Unless additional ophthalmic services are made available universally, the number of people suffering from vision loss due to chronic ocular diseases would rise as a result of increased life expectancy and population growth thus new innovation and discoveries are requires.Hypotheses originate from real data, and drive the development of new data . On the “Scientific progress depends on the existence of creative tension between ideas and observations. An observation is made which cries out for explanation. A hypothesis is proposed to account for the observation. The hypothesis is tested by making more observations which almost invariably require the abandonment of some part of the hypothesis. The physical and chemical sciences long ago recognized that observations are not superior to hypotheses in generating scientific progress nor are hypotheses superior to observations. Both are necessary ”.In fact, with globalization fast approaching, those of us in visual sciences must be able to quickly respond in this era of ongoing swift and sweeping change. During 2012 we received overwhelmingly positive endorsement from our readers, reviewers, and editorial board members to continue the work on our journal although we faced with financial difficulties. After one year of publication with four regular issues, we received considerable feedback from around the world and gained many new colleagues. At this time, we are asking our readers to reply to a short and simple survey. The purpose of this survey is to identify our readers’ needs. The results would be used to help drive content and make improvements in future issues. We ask for responses from the readers, reviewers and editorial team to the following questions:1. What do you hope to see in our journal?2. What would encourage you to participate ?3. How do you envision using this journal?4. How would new ideas contribute to the successful operation of this journal?The answerers would be analyzed by our statistical consultant and the best responses would receive USD 700 award and an appreciation letter. The award would be a coupon for free advanced editing services to manuscripts. It is estimated that this money would subsidize the editing of approximately two manuscripts or 12 abstracts.We anticipate our journal evolving over time as we update features to meet readers’ needs. Manuscripts, participation, and insights will shape the future of this journal. We recommend that authors explain ideas and hypotheses clearly and coherently and include guidelines for testing their ideas. We are not looking for detailed responses to this question; general explanations will suffice. This journal intends to publish papers that offer solutions in the context of individual socioeconomic status, focusing on those in the lower financial strata as well describes in former editorials.One of the areas of great interest to us is the current controversy in ophthalmology regarding the many treatments and studies in visual sciences. As of yet, no consensus has been reached and we are planning to publish scientific papers in 2013 on the subject. It is our contention that MEHDI Ophthalmology Journal will definitely be one of the journals that has the potential to engender collaborative research publication with similar journals such as Medical Hypotheses, Medical Hypotheses and Research (MHR), and Journal of Medical Hypotheses and Ideas. Ideally, at some point in the not too distant future, all journals will work together to provide a forum for developing thoughts and publishing hypotheses and become a cohesive unit for constructive interactions. In general, a future collaboration of this nature would seem to be ideal. We cannot forget when an Asian researcher who was naturally innovative minded wrote us with awe that in the current issue of ophthalmology journal a study had been performed the idea of it had stricken him 20 years before. Another PhD candidate said that he had a hypothesis in mind but found out later that the same idea had been published in another part of the world. Needless to say, that potential author regretted not having his idea patented in his own name. Therefore, this is of great benefit to those of you looking to publish: by making your hypotheses public, you are avoiding the potential trap of finding your idea or study in a current issue of another ophthalmology journal.A philosopher of science puts hypotheses alongside experimentation as the correct scientific method . Given tWe would appreciate readers in choosing this issue; a medium where information can be made available to all ophthalmology professionals very quickly. In this issue and in the editorial section of upcoming issues, we will discuss the possible short term strategies of the journal and look forward to reviewers or authors continuing to improve us. The last but not least, the MEHDI ophthalmology journal continue to play a constructive role in upholding focused on becoming a peer-reviewed, rigorous, and open-minded forum for new ideas and hypotheses in the field of visual sciences. We wish adhere to multilateralism and welcome your participation in this endeavor.


International Journal of Cancer [Journal of Experimental & Clinical Cancer Research and the grant reference number stated in the acknowledgements was incorrectly applied to this article.The authors have retracted this article  as theref Cancer . Dr Lu S


Annals of Occupational and Environmental Medicine (AOEM). The AOEM is an open access, peer-reviewed, online journal that considers original research in occupational and environmental medicine. The online manuscript submission has been successfully implemented for the journal and is now open for new submissions at http://www.aoemj.com.On behalf of the editorial board, I am pleased to announce the launch of a new international journal – The AOEM is aimed at clinicians and researchers in the wide-ranging discipline of occupational and environmental medicine and health. The topics include but are not limited to the interactions between work and health, that is, subjects like occupational and environmental epidemiology, toxicology, hygiene, diagnosis & treatment of diseases, management, organization and policy.the Korean Journal of Occupational and Environmental Medicine (KJOEM) as the official journal of the Korean Society of Occupational and Environmental Medicine (KSOEM). The KJOEM has been published only in Korean every year since 1989, started biannual publication in 1989, triannual publication in 1996, and quarterly publication in 1998. The KSOEM has endeavored to make the KJOEM a high-quality journal in occupational and environmental medicine mainly for researchers, workers, employers, and the government in Korea.The AOEM under its new name, will succeed In line with recently changes in research boundaries and recommendations of the National Research Foundation (NRF) of Korea, we made the important decision to transform the KJOEM into an English language, high quality, international journal in occupational and environmental medicine. In order to meet the goal, we have created the Advisory Editorial Board of the AOEM, consisting of world-class, excellent and experienced professors and researchers in occupational and environmental medicine. We have also implemented a very efficient administrative system in the AOEM for streamlining the whole process from manuscript submission to on-line publication for authors.Annals of Occupational and Environmental Medicine for your newest and most interesting research.I would like to thank my colleagues for their support and suggestions to make the launch of this new journal possible. I hope you will consider the The author, Sang Baek Ko, has given permission for his photo to be used as the cover page.


CXCL1 rs4074 polymorphism on the occurrence of alcohol induced liver cirrhosis and hepatocellular carcinoma (HCC).CXCL1 (CXC chemokine-ligand-1) is a ligand for CXC chemokine receptor 2 expressed on hepatic stellate cells (HSC). Thus, CXCL1 might contribute to HSC activation and fibrogenesis. In the present study, we investigated the influence of the CXCL1 rs4074 polymorphism and CXCL1 serum levels of 132 patients were measured. In vitro CXCL1 secretion in TLR-transfected cell lines were studied by ELISA.The study involved 458 patients with alcoholic cirrhosis (170 with HCC), 115 alcoholics without liver disease and 342 healthy controls. All subjects were genotyped for the CXCL1 genotypes (GG/GA/AA) was 159/219/80 in patients with alcoholic cirrhosis, 52/44/19 in alcoholic controls and 158/140/44 in healthy controls. Patients with alcohol-induced cirrhosis were significantly more often carriers of the CXCL1 rs4074 A allele (65.3%) than alcoholics without liver disease  and healthy controls . Accordingly, the frequency of the CXCL1 rs4074 A allele was significantly higher in the cirrhotic patients than in the subjects without cirrhosis . Furthermore cirrhotic carriers of the CXCL1 rs4074 A allele had significantly higher CXCL1 serum levels than carriers of the GG genotype. In contrast to sera from healthy controls, sera from patients with alcoholic cirrhosis induced CXCL1 secretion in TLR2- (p=0.016) and TLR4- (p=0.008) transfected HEK293 cells. This finding indicates that sera from patients with alcoholic cirrhosis contain soluble ligands that can induce CXCL1 production via stimulation of TLRs.Distribution of the CXCL1 rs4074 A allele as a genetic risk factor for alcoholic cirrhosis.The enhanced CXCL1 serum levels in carriers of the rs4074 A allele together with their increased frequency in patients with alcohol induced cirrhosis suggest the  In Western industrialized countries, alcoholic liver disease represents the premier cause of liver cirrhosis. Chronic exposure to harmful amounts of alcohol and its toxic intermediates  causes steatosis, necroinflammation and fibrotic remodeling via the release of pro-fibrogenic factors and subsequent functional alterations of innate immune cells  and hepatic stellate cells (HSC) ,2.CXCL1 gene (rs4074) has recently been identified as an independent factor predisposing to cirrhosis in patients of European descent with chronic hepatitis C  aAlcoholics without apparent liver disease were selected from a previously reported cohort ,21 of paGenomic DNA was extracted from 200 μL EDTA-blood using the QIAamp Blood Mini Kit  according to the manufacturer’s protocol. CXCL1 rs4074 polymorphism was performed by LightCycler real-time PCR using a LightSNiP (SimpleProbe) assay from TIB-MolBiol . Samples were set up in a final volume of 10 µl, containing 1 µl of DNA solution, 2 µl of LightCycler FastStart DNA MasterPLUS HybProbe Mix , and 1µl of LightSNiP reagent mix . The cycling conditions were as follows: initial denaturation at 95°C for 10 min, followed by 45 cycles of denaturation at 95°C for 10 sec, annealing at 60°C for 10 sec, and extension at 72°C for 15 sec. Fluorescence was monitored at the end of each annealing phase at 60°C. After completion of the PCR, a melting curve of the amplification products was plotted by denaturation at 95°C for 20 sec, holding the sample at 40°C for 20 sec, and then slowly heating the sample to 85°C with a ramp rate of 0.2°C/sec and continuous fluorescence acquisition.Determination of the CXCL1 concentrations in patient sera and in cell culture supernatants were assessed by the human CXCL1/GROalpha Quantikine ELISA .2). TLR-transfected and control HEK293 cells were kindly provided by G. Szabo, University of Massachusetts, Worcester, MA. CXCL1 concentrations in the supernatants were determined by ELISA, and measurements were done in duplicates. To investigate whether CXCL1 induction in patients with alcoholic cirrhosis is triggered via TLR´s, 200,000 TLR2- or TLR4-transfected and un-transfected HEK293 cells were incubated over 24h with sera (50% v/v) from healthy controls and patients with alcoholic cirrhosis on 48-well plates (500 µL/well) in a humidified atmosphere (37°C with 5% CO2). After 2 hours 5µg/ml brefeldin A  were added to block secretion of collagen and αSMA. After CXCL1 stimulation, cells were permeabilized  and intracellularly stained with Anti-Collagen Type I-FITC Antibody  or goat anti-human α-SMA  with secondary anti-goat-NL577-conjugated antibody  on a BD FACSCanto flowcytometer using the CellQuest Pro (BD Biosciences) and FlowJo 7.2.2 software packages . Expression was analyzed in comparison to un-stimulated HSC.Stimulation experiments were performed to check if CXCL1 can induce pro-fibrotic genes such as collagen I and alpha smooth muscle actin (α-SMA). Isolated human primary HSCs  were used between passage 2 and 6, and cultured in defined medium supplemented with 2% fetal bovine serum and 50  U/ml penicillin and 50  μg/ml streptomycin . 50,000 pHSCs were incubated over 16h with 250 pg/ml recombinant CXCL1  on 48-well plates (500 µL/well) in a humidified atmosphere . Data are given as means ± SD, unless stated otherwise.2 test and Armitage's trend test, respectively (http://ihg.gsf.de/cgi-bin/hw/hwa1.pl). For the statistical comparison of carriers and non-carriers we used Fisher’s exact test. Sample size calculation was done using Lenth, R. V. (2006-9) Java Applets for Power and Sample Size [Computer software], retrieved from http://www.stat.uiowa.edu/~rlenth/Power. We hypothetically extrapolated data from our previous publication [CXCL1 rs4074 variants in HCV-related liver disease. With 342 controls, a sample size of 452 cases was calculated to ensure 80% statistical power at 5% alpha error.Genotype frequencies were determined and tested for consistency with Hardy-Weinberg equilibrium using an exact test. Allele and genotype frequencies were compared between cases and controls by Pearson's goodness-of-fit Chilication  concerniPNPLA3 genotype were assessed by univariate comparisons (ANOVA and chi2-statistics) followed by multivariate logistic regression with forward conditional variable selection. Parameters with effects at p<0.1 were entered into the multivariate analysis.To take into account further potential confounding risk factors of liver cirrhosis the effects of age, gender and CXCL1 rs4074 gene polymorphism was determined in all 915 participants and genotype frequencies were consistent with the Hardy–Weinberg equilibrium in all study groups. Distribution of CXCL1 genotypes  was 159 (34.7%), 219 (47.8%), 80 (17.5%) in cirrhotic patients with or without HCC, 52 (45.2%), 44 (38.3%), 19 (16.5%) in alcoholic controls and 158 (46.2%), 140 (40.9%), 44 (12.9%) in healthy controls. Thus carriage of the CXCL1 rs4047 A allele was observed significantly more frequently among patients with alcoholic cirrhosis (65.3%) than in alcoholic controls  or healthy controls . .The =0.001). . The freCXCL1 rs4047 A allele is an independent risk factor for alcoholic cirrhosis when other known risk factors such as age, gender, and the PNPLA3 rs738409 risk variant were also taken into account, we calculated a Cox regression model . Furthermore, age, gender and PNPLA3 risk variant were confirmed as risk factors for alcoholic cirrhosis.To check if carriage of the on model . This anCXCL1 rs4074 G/A polymorphism influences the CXCL1 expression in patients with high alcohol consumption (>300g per week), we measured CXCL1 serum levels in 66 samples of patients with alcoholic cirrhosis and healthy controls, respectively . Our cross-sectional study revealed that the CXCL1 A allele is more frequent among patients with alcoholic cirrhosis compared to healthy controls and to patients with alcohol abuse in the absence of liver damage. Multivariate analysis confirmed the CXCL1 rs4074 risk variant as independent risk factor for alcoholic liver cirrhosis in addition to age, gender and the PNPLA3 148M risk variant. Unlike the PNPLA3 148M variant which increases the risk for cirrhosis as well as HCC [Alcohol is a major cause of chronic liver disease worldwide and comprises various grades of liver damage, ranging from steatosis and steatohepatitis, either with or without fibrosis, to fully established cirrhosis and eventually HCC. The present study addressed the question, whether the l as HCC , the CXCl as HCC . This dil as HCC ,25. In ll as HCC . Apart fl as HCC ,26. Simil as HCC . Thus, gl as HCC . CXCL1 gene is associated with increased CXCL1 blood levels and increased risk for development of cirrhosis in alcoholics. Besides the statistical association, our analysis provides mechanistic findings that yielded a potential way by which the CXCL1 rs4074 polymorphism may contribute to fibrotic remodeling. Sera from alcoholic patients, but not from healthy controls, were able to stimulate TLR2- and TLR4-transfected HEK293 cells to secrete CXCL1, suggesting that CXCL1 up-regulation is dependent on soluble factors found in alcoholic liver disease, and involves TLR2 and TLR4 signaling. A potential TLR4 ligand in the serum of alcoholic patients could be LPS, which can be found both in blood of alcoholic patients as well as in rodents exposed to ethanol [The present study suggests that the rs4074 single nucleotide polymorphism within the  ethanol . LPS can ethanol  and dire ethanol ,32. Pote ethanol . Accordi ethanol . CXCL1 rs4074 polymorphism remains unknown. However, we recently discussed an additional transcription factor binding site for interferon-regulatory factor-3 (IRF-3) and signal transducer and activator of transcription (STAT) 5a [The molecular mechanism responsible for the different levels of CXCL1 expression as a function of the CXCL1 rs4074 polymorphism modulates the risk for cirrhosis in Caucasian patients with high alcohol consumption. Thus it provides the rationale to warrant a prospective controlled long-term study to define this risk more precisely. In addition, our findings may contribute to a deeper understanding of liver fibrosis and the development of antifibrotic drugs.Although our study is limited by its cross-sectional design it nevertheless provides first experimental evidence suggesting the


Brain and Behavior 2013; 3(2): 145–158On page 149, the sentence “In these cisterns the sigma-1 receptor is present to buffer calcium entry overload ” should be changed to the following: “At these cisterns, the sigma-1 receptor may play an indirect action modulating intracellular calcium release .”We regret this misinterpretation. It has no consequences for the reported analyses and conclusions.


Multidetector computed tomography (MDCT) angiography represents the standard of reference in the follow-up of patients after endovascular abdominal aortic aneurysm repair (EVAR), being effective in the detection of the full spectrum of possible complications on both axial and 3D images.The purpose of this article is to review the normal CT angiography findings of the different types of stent-grafts and to describe the radiological findings of early and late complications after EVAR on axial and reconstructed images. A selection of cases of post-EVAR MDCT angiography is presented to learn the techniques most commonly used for endovascular treatment, the correct CT scanning technique to acquire the data, the full gamut of possible procedure-related complications and how these complications usually appear on CT images.MDCT angiography is an effective and specific technique in both the pre- and postoperative settings of EVAR procedures. A better understanding of the procedure, the devices, the normal postoperative imaging features and the possible procedure-related complications ensures optimal planning and follow-up of patients undergoing an EVAR procedure. Endovascular aortic aneurysm repair (EVAR) has developed into a feasible and successful alternative to open surgery for the treatment of abdominal aortic aneurysms. EVAR can be offered to many patients with a suitable anatomy of the aorta and iliac arteries, regardless of comorbid conditions –3. DespiRegardless of the scanner available , a thick-slice unenhanced acquisition can be performed to visualize the position of the stent-graft to reveal calcifications and to plan the following contrast-enhanced examination by selecting the acquisition volume and placing a region of interest in the aorta at the level of the celiac trunk (if bolus-tracking software is used). Contrast-enhanced images in the arterial phase are obtained during bolus intravenous injection of 90–130 ml of iodinated high-concentration non-ionic contrast medium, administrated with an automated injector at a flow rate of 3–4 ml/s through an antecubital vein. CT acquisition protocol parameters and scanning coverage ranges are illustrated Table An aortic stent-graft is a device composed of a metallic portion  and graft material . On CT images only the metallic portion is visualized. On the basis of the general morphology, there are three types of stent-grafts available for treating abdominal aortic aneurysms: straight, aorto-uni-iliac grafts and bifurcated. Straight aortic tube grafts have the proximal and distal attachment sites in the aorta, above the aortic bifurcation (aorto-aortic). The aorto-uni-iliac device is a stent-graft that is deployed from the supra-aneurysmal aorta to one iliac artery only; the opposite iliac artery is then occluded with an endovascular occlusion device in order to prevent retrograde blood flow into the aneurysm sac, and a femoro-femoral crossover graft maintains blood flow into the opposite limb Fig. . BifurcaStent-graft and distal branches are considered patent if a uniform and homogeneous contrast enhancement is detected within them. On the other hand, graft thrombosis is recognized as an intraluminal, concentric or eccentric hypodense area within the stent-graft on CT images obtained after contrast-media injection. Angulation of the prosthesis could lead to a stenosis or thrombosis with consequent reduction of either the inflow or outflow, with increased possibility of in-stent thrombosis and stenosis, which can be manifest in about 3–19 % of cases , 9. ThisFractures or distortions of the metallic stent-graft structure are rare but important complications: these complications are better visualized on 3D rather than axial images Fig. . AnotherStent-graft migration usually requires urgent treatment. Unless the graft can be extended proximally, treatment is usually carried out by conversion to open repair. Only migration of more than 4 mm is generally considered significant. This is related to a number of factors, including inadequate proximal fixation , progressive dilatation of the proximal neck and aneurysm size, as well as iliacal fixation –12. MDCTSince aneurysm exclusion is expected to be correlated with shrinkage, surveillance of aneurysm dimensions is mandatory for asserting the adequacy of aneurysm exclusion from the blood flow and for guiding the need for reintervention in selected cases. The aneurysm volume may increase slightly immediately after EVAR (3–4 mm), given the additional volume and the external force exerted by the stent-graft or, alternatively, the swelling of the aneurysm sac induced by perigraft thrombosis . On the Type I is caused by separation of the device from the arterial wall, resulting in leaks originating at the proximal and/or distal attachment sites of the graft because of a technical  or anatomical  problems, or to its caudal migration. On CTA images, it often appears as a huge and circumferential leak, adjacent to the proximal or distal end of the prosthesis Figs.  and 10.Type II endoleaks are caused by back-filling of the aneurysm sac via branch vessels, such as the lumbar arteries and inferior mesenteric artery excluded by the stent-graft. On CTA images, the type II endoleak is most pronounced at the periphery of the aneurysmal sac, with little or no contact with the prosthesis, is commonly located in a posterior or lateral position, and is associated with opacification of the lumbar arteries. If an endoleak is located in the anterior position, a retrograde flow into the sac by the inferior mesenteric artery must be suspected Fig. .Type III endoleaks arise from a fabric tear, modular or graft disconnection, and are more likely when multiple prostheses with short overlapping areas are used. On CTA images, the leak is strictly adjacent to the prosthesis, with little or no contact with margins of the aneurysmal sac, without opacification of the lumbar arteries or inferior mesenteric artery Fig. .Type IV involves vascular flow caused by the high porosity of the graft, most likely created by the numerous suture holes holding the graft material to the stent. They are usually only detected on conventional angiograms performed at the end of the procedure.Type V or endotension refers to a growth of the aneurysm sac but without demonstrable reperfusion defects Fig. .Endoleak is defined as a persistent blood flow within the sac excluded from the stent-graft, and it occurs in 2.4–45.5 % of patients after EVAR . On CTA Type I and type III endoleaks require prompt treatment as they are associated with a high risk of sac rupture. However, the most common endoleak found in endovascular stent-grafting is the type II endoleak.Renal artery stenosis, occlusion and dysfunction represent the main concern with EVAR, especially in patients with inadequate anatomy of the proximal aneurysm neck, pre-existing renal disease or in whom suprarenal fixation was used. Axial CT images are commonly used to monitor the patency of these arteries following stent-graft placement and to detect renal infarction following suprarenal stent grafting. However, both MIP and CPR are useful and complementary to axial images for the detection of stenosis and occlusions because of the tortuous course of the renal arteries. The additional views provided by CT angiography allow displaying the renal arteries in multiple planes and projections, which is often necessary for depiction of stenosis. In renal infarction, contrast-enhanced CT scans demonstrate a sharply demarcated, wedge-shaped area of decreased attenuation in the kidney [18] Fig. . HoweverUsually a transfemoral approach is used to perform EVAR, exposing the femoral artery by a vertical groin incision. The large-caliber delivery sheaths used for EVAR, up to 26 Fr, increase the morbidity rate compared to the usual catheter size used for routine diagnostic angiography. The minimum vessel diameter required to allow passage of the EVAR device is 7–8 mm. Access site complications include dissection, demonstrated by a linear endoluminal hypodense area  Fig.  or arterMDCT is the method of choice both in the pre- and postoperative setting of EVAR procedures. A better understanding of the procedure followed, the devices used, the normal postoperative imaging features and the possible procedure-related complications ensures an optimal planning and follow-up of patients who undergo an EVAR procedure. Finally, in order to better determine the long-term performance of these devices, strict surveillance of all patients is mandatory.


Surgical Innovation in the current The life sciences in the 21st century are evolving from a descriptive or phenomenological discipline to extrapolative one. Rapid development has transpired dramatically in biological studies in the last few years, much of which encompasses concepts more familiar to engineers and physicists rather than physicians [Innovation has vast morphological meanings but is simply defined as the act of announcing something new or the use of a novel idea or technique. In some cases, it is practiced as replacement to invention, though innovation is further accurately outlined as something thought up or mentally fabricated. Although innovation in surgery has a less than perfect tradition, the field and research of surgical innovation are new . In surgApplication of formal processes to include innovative surgical procedures into hospitals or health services has long been integrated into the healthcare system, while protecting the interests of patients, physicians and the organization . Most coFrequently the assessment as to whether a new surgical method should be introduced is between the desire to enhance knowledge and increase surgical experience against the potential risks of novel procedures. As a matter of fact, a substantial amount of sensory data is filtered through the eyes, they are our actually windows to the world hence the aim is to protect the visual system healthy against any risky procedure. Furthermore, the present and future costs of the new techniques and procedures should be estimated as precisely as possible. New methods must prove to be lower in cost than the older methods and both the morbidity and mortality rates should be demonstrably lower.Scope of the journal in surgical techniquesOur journal intends to introduce new methods and instruments or convey the idea of creating them. A major difference between this journal and fiction is that the ideas should be evidence-based and must have been written based on scientific principles and logical procedures. Although the authors bear the responsibility for any datum they publish, we do not recommend using an idea or hypothesis in clinical setting only because they have been published in this journal. This journal is merely a pathway to more studies. It is absolutely necessary to run more laboratory and clinical studies and other research to show the reliability and feasibility of those findings. We recommend that researchers who are willing to publish new surgical methods or instruments point out the advantages and disadvantages of the discussed methods in a special section in their manuscript.Another issue is training. That is, how to assess the amount of time needed for learning a new method, and if learning that method will be time-saving. The authors should clearly answer the questions that address the scope of training required for the instrument or new surgical techniques ? Who is the audience of the new technique or an instrument ? What resources are available ? Has the method been evaluated before? And how wide-ranging or complicated is the procedure? The other important subject is the ethical issues. It is important that a new method be evaluated for its ethical principles and whether there are any conflicts of interest. If a company has already started investing in a specific product, it should disclose its material interest to the journal. Researchers should also disclose how many patients the new ideas or devices have been tested upon and, more importantly, whether the animal studies had been performed beforehand. Furthermore, the researcher should declare his/her informed consent and obtain the ethics committee’s confirmation for a new technique or device. It is the patient’s right to choose and select his surgical methods based on their safety. The journal might ask for original confirmation of ethics committee. If a new method is introduced, the author should provide an explanation of which group of surgeons and with what level of surgical skills could use that method, and whether trainees would be able to perform them. If the author describes monitoring and the long term follow-up of the new technique, the manuscript would have a much greater chance of being published. Spiritual ownershipSpiritual ownership starts from the development of an idea. The registration of a new idea requires some tests that are both time-consuming and costly. Registry of the idea or technique in a journal such as ours gives the idea developer the opportunity to have his idea patented. As well, if he does not have the facilities to perform the necessary confirmations, the idea’s presence in the journal will allow others to do so.The journal would publish papers even if the author does not have the opportunity to perform clinical researches. Since the researcher has generated the first spark for the idea, by publishing it, he can patent the idea or technique for himself. Having said that, we do declare that in legal terms, as patenting ideas and hypotheses has not become operational in many countries, we are unable to undertake the legal responsibility of the patent registration. The researcher should arrange for registering the patent for his idea, thought, instrument or medication by him/herself solely or with the collaboration of the university and scientific centers in his/her own country.Future directionsIn future issues we will continue to focus on original research and would also report important, timely information about innovation and ideas in ophthalmology and possible standards. However, ophthalmology and visual sciences manuscripts from perspectives such as ethics, ocular healthcare reform, and interactive comments from round table features are most welcome.The scientific societies strongly oppose traditional methods and seek changes. Changes must be directed towards progress and address at least one of the problems facing humanity today. We thank those who make up this community: numerous individuals, authors and peer reviewers who have worked through the start-up process to ensure that our peer-review system is rigorous and sound. Finally, thanks to the editorial board members for their continuous guidance, trust, and support. We should endeavor to work together in order to create ideas to form a healthier and safer world for everybody!The authors report no conflicts of interest in this work.


Purpose. To report outcomes of graft refractive surgery (GRS) along with clear-cornea phacoemulsification and intraocular lens (IOL) implantation in penetrating keratoplasty (PKP) eyes. Methods. Fourteen eyes of 13 patients who had received PKP underwent simultaneous GRS (relaxing incisions with or without counter-quadrant compression sutures) and clear-cornea phacoemulsification with IOL implantation. To calculate IOL power, preoperative keratometry readings and the SRK-T formula were used. Results. Mean patient age and follow-up period were50.5 ± 14.4 years and 14.6 ± 7.1 months, respectively. A significant increase was observed in best spectacle-corrected visual acuity . There was a significant decrease in vector keratometric astigmatism by 6.22 D (P = 0.03). Spherical equivalent refraction was reduced from −3.31 ± 3.96 D to −1.69 ± 2.38 D (P = 0.02) which did not significantly differ from the target refraction . No complications developed and all the grafts remained clear at the final examination. Conclusion. Simultaneous phacoemulsification and GRS is a safe and effective method to address post-PKP astigmatism and lens opacity. IOL power can be calculated from preoperative keratometry readings with an acceptable accuracy. However, patients should be informed about the possibility of high refractive errors postoperatively. The most common complication of penetrating keratoplasty (PKP) is astigmatism . SeveralA stepwise intervention in which GRS is performed first, followed by cataract extraction and IOL implantation after a few months when refraction becomes stable, can also be considered in patients developing both complications. This sequential surgery is more expensive and delays visual rehabilitation. Other options are toric IOL implantation at the time of cataract surgery or laser refractive surgery thereafter. The advantages of GRS coupled with cataract extraction are correcting the astigmatism in a single-stage surgery without additional cost and addressing the astigmatism at its origin while preserving the original graft profile. Since graft refractive power and possibly optical chamber depth and axial length are changed by GRS, however, accurate IOL power calculation can be a matter of concern in such a combined intervention . The aimIn this retrospective interventional case series, 14 eyes of 13 patients (6 men and 7 women), aged between 14 and 60 years , that underwent simultaneous cataract and GRS between October 2003 and July 2010 were included. The participants had all sutures removed at least 3 months before entering the study. The primary indications for corneal transplantation were keratoconus (10 eyes), macular corneal dystrophy (1 eye), lattice corneal dystrophy (1 eye), chemical burn (1 eye), and old corneal scar (1 eye). Preoperatively, a comprehensive ocular examination including uncorrected and best spectacle-corrected visual acuity , manifest refraction, keratometry using a manual Javal-Schiötz keratometer , slit-lamp examination, intraocular pressure measurement, and dilated funduscopy was performed. To determine the exact location of steep meridians, computerized corneal topography analysis  was used, and the IOL power was calculated by an A-scan ultrasound device  using the SRK-T formula in all cases. For IOL power calculation, preoperative keratometry readings measured by the manual keratometer were considered, and postoperative refraction was targeted at −0.76 ± 0.14 D, on average . All patients underwent surgery under retrobulbar anesthesia. The indication and technique of GRS was previously described . BrieflyThis step was followed by the creation of a single-plane 2.8-mm clear corneal incision just in front of the vascular arcade. As a 2.8-mm clear corneal tunnel at considerable distance from the recipient-donor interface should have no impact on graft astigmatism, the site of main incisions was selected irrespective of the steep meridians, superotemporal in right eyes and superonasal in left eyes. The clear corneal tunnel, intended to be 1.5 to 2.0 mm in length, entered the anterior chamber before reaching the recipient-donor interface. After the injection of a dispersive ophthalmic viscosurgical device , a 5.0- to 5.5-mm central continuous capsulorhexis was created, and phacoemulsification was performed using the divide and conquer technique. This step was followed by cortical cleanup and implantation of a foldable one-piece monofocal IOL  in the capsular bag using the C cartridge (Alcon Laboratories Inc.). At the conclusion of phacoemulsification, the anterior chamber was formed and the clear corneal incision hydrated to become self-sealed. Then, intraoperative keratoscopy was performed using a handheld keratoscope, and interrupted 10-0 nylon counter-quadrant compression sutures were added in the recipient-donor interface if round keratoscopic mire was not achieved by relaxing incisions alone, and the axis of preoperative astigmatism remained unchanged (12 eyes). In these cases, the tension of compression sutures was adjusted to have an astigmatism of 4-5 D at the sutured meridian. These sutures were selectively removed, based on the keratometry readings, starting 2 weeks after surgery, and were completed over 4 to 6 weeks.Postoperatively, the patients were medicated with sulfacetamide 10% eye drops every 6 hours and betamethasone 0.1% eye drops every 3 hours. The antibiotic drop was discontinued after 10 days, while the corticosteroid drop was tapered off over 4 to 6 weeks. Follow-up examinations were performed at days 1, 3, and 7, and months 1, 3, and 6, and then repeated every 6 months. During followup examinations, UCVA, BSCVA, keratometry, manifest refraction, and intraocular pressure were reevaluated.t-test. A P-value less than 5% was considered statistically significant.Data were analyzed using SPSS (v15) statistical software . Normality was checked by the Kolmogorov-Smirnov test, and normally distributed data were expressed as mean ± standard deviation. Refractive and keratometric spherical equivalent (defined as sphere + (1/2) cylinder and flat keratometry reading + (1/2) keratometric astigmatism, resp.) and astigmatisms were compared before and after GRS using the paired A is the magnitude of vector change in astigmatism in plus cylinder format calculated by the vector analysis method [Changes in astigmatism were evaluated by vector analysis  and simps method  and ΔSE P < 0.001) and 0.33 ± 0.18 logMAR , respectively. Of the 14 eyes, 9 (64.3%) had a postoperative UCVA ≥ 20/50 and 9 (64.3%) achieved a postoperative BSCVA ≥ 20/40, with an improvement of two lines or more in Snellen BSCVA in 50% of the cases. Mean postoperative intraocular pressure was 14.6 ± 4.7 mmHg  which did not significantly differ from the preoperative value .The mean followup period after PKP was 145.2 ± 54.1 months  and after combined phacoemulsification, and GRS was 14.6 ± 7.1 months . Mean preoperative UCVA and BSCVA was 1.15 ± 0.24 logMAR  and 0.55 ± 0.18 logMAR , respectively. Mean recipient and donor trephine size were 7.75 ± 0.42 mm  and 8.10 ± 0.34 mm , respectively, with a recipient-donor disparity of 0.25 mm in 10 eyes and 0.50 mm in 4 eyes. The IOL power varied from +8.0 to +25.0 D, averaging +17.64 ± 5.39 D. Postoperatively, mean UCVA and BSCVA significantly increased to 0.50 ± 0.19 logMAR . The mean achieved postoperative spherical equivalent refraction did not significantly differ from the mean target refraction . The insignificant change in overall graft curvature was consistent with the CR close to 1 and the CC near 0  which did not reach a significant level  and BSCVA (3 lines) as well as a significant decrease in both manifest refraction and keratometric astigmatism. Additionally, no complications developed intraoperatively or postoperatively, and all grafts remained clear at the final followup examination, which means phacoemulsification and intraocular lens implantation neither affects endothelial cell count, nor increases the rate of future graft rejection episodes . In spite of these advantages, however, there is an important drawback for the simultaneous approach, which is the inability to precisely determine the IOL power. Accurate IOL power prediction in standard cataract surgery requires valid and reproducible biometric data pertaining to the corneal curvature, anterior chamber depth, and axial length. In contrast to standard cataract surgery, GRS combined with phacoemulsification and IOL implantation may significantly alter these factors, as graft curvature and perhaps anterior chamber depth and axial length change in an unpredictable manner which could make it difficult to calculate the IOL power accurately. The results of the current study demonstrate that graft astigmatism significantly decreased, whereas keratometry spherical equivalent and mean keratometry increased. However, the increase in graft curvature was not statistically significant, which is attributable to the coupling ratio close to 1 (0.70 ± 1.24) and coupling constant close to 0 (0.04 ± 0.58), indicating that the flattening of the steep meridians was roughly equal to the steepening of the flat meridian. This explains why 78.6% of the eyes had a postoperative refraction within ±2.0 D of the expected value, and the postoperative spherical equivalent refractive error did not significantly differ from targeted values , despite use of preoperative keratometry values. However, it should be noted that the absolute difference between the postoperative spherical equivalent and target refraction varied substantially from 0.13 D to 5.77 D, and a residual refractive error of >−5 D was observed in 2 eyes. These changes in graft refractive power, as well as possible alterations in anterior chamber depth and/or axial length can be the reason for unexpectedly high refractive outcomes in some cases.The results of the present study should be interpreted in the context of its limitations. First, the sample size is small. The second limitation arises from the design of the study which was retrospective. A prospective comparative study recruiting a control arm to receive other interventions  can help find the best approach. Third, the time of followup was short, and regression of astigmatism may occur after long-term followup. Forth, we relied only on changes in anterior graft curvature. To better understand the effect of GRS on the IOL power prediction, a study is now underway in our center to determine any alterations in anterior chamber depth, total axial length as well as posterior graft curvature after GRS.In conclusion, the present study found combined phacoemulsification with IOL implantation and GRS a safe and effective method in PKP eyes with significant lens opacity and graft astigmatism. In spite of significant change in the graft astigmatism and some increase in the graft steepness, the IOL power can be calculated with acceptable certainty using preoperative keratometry readings and the SRK-T formula. However, patients should be informed about the possible postoperative high refractive error necessitating additional surgical intervention. A prospective study on a larger sample is necessary to achieve a better conclusion.


Journal of Conservative Dentistry, which is the official journal of the Federation of Conservative Dentistry of India, was founded in 1998 to serve as a portal for dissemination of knowledge in the field of conservative dentistry and endodontics in India.The The journey of our journal began under the guidance and leadership of Dr. Vimal Sikri who brought out the first seven volumes of the journal and was the Editor-in-Chief from 1998 till 2004. Dr. D. Kandaswamy took over the reins as the next Editor-in-Chief from 2005 to 2008, and the journal grew immensely in scope and content during his tenure. I have been the Editor-in-Chief since 2008 till date and was entrusted with the responsibility of continuing the good work started by both these stalwarts. I started my journey with the following twin objectives:[To make our journal online and have an official journal website at par with any other international journalTo make our journal indexed with PubMedwww.jcd.org.in. The submission, reviewing, and tracking of manuscript submissions were made into a completely online process in 2008. This helped in making the long-drawn reviewing process into a simple, efficient, and totally paper less procedure with a faster decision time.[Medknow Publications played a very supportive role in our growth and with their guidance, we hosted our journal online at ion time.I would like to place on record the excellent support and help given to me by my Associate Editors, Dr. Krithika Datta and Dr. Nandini Suresh. The role played by our eminent Editorial Board and Reviewer Panel is commendable and is instrumental in improving the academic output of our journal.sixfold increase in the article submission rate in the past 3 years [The growth of our journal has been momentous and truly commendable which can be gauged by the  3 years . This ca 3 years ;. In ord 3 years . We haveth National Conference of Federation of Operative Dentistry of India (FODI) is being held at Chennai in December 2010. On this occasion; it gives me great pleasure in bringing out this special issue to commemorate the silver jubilee celebrations of FODI. This silver jubilee issue comprises of invited review articles on important clinical and exam-oriented topics. The invited authors include the previous editors of our journal along with the leading academicians from across the country. We have also added a research article, which highlights the contribution of Indian authors to the world endodontic and conservative dentistry literature in the past two decades.The 25Journal of Conservative Dentistry, a globally recognized journal with an international content and reach.We have already started getting article submissions from countries such as Brazil, Turkey, Iran, Malaysia, Pakistan, Japan, Senegal, Syria, and Poland. Our efforts would be to make J. Conserv. Dent. the premier resource journal of our specialty in Asia by 2015.We will strive to make As an immediate measure, we will increase the number of pages of our journal to 100 pages per issue in order to accommodate at least 25 articles per issue and to have an average of more than 100 article publications per year from 2011 onwards.Looking forward for your support and inputs in making this journal an enriching academic fountainhead…


Retrovirology has moved to the forefront of virology journals in Impact Factor.Nine years after its founding,  Retrovirology employing the then “new way” of publishing [Retrovirology was not the first journal that I helped found. Ten years earlier, in 1994, I was one of nine editors, led by Dr. Chuan C. Chang, who started the Journal of Biomedical Science[Journal of Biomedical Science originated as a subscription-based journal; thus, when Retrovirology began I understood the difference between a publishing model based on subscription (readers/subscribing libraries and institutions pay) versus Open Access .In 2004, during the early days of Open Access, I had the opportunity to start blishing . RetroviRetrovirology’s success. The first was whether Open Access would be a sustainable business model. In those days, this was an unknown. Today, the increasing popularity of journals like PLoS ONENature’s Scientific Reports (http://www.nature.com/srep/index.html)Cell Reports (http://www.cellreports.cell.com)Cell and Bioscience[Journal of the International AIDS Society (http://www.jiasociety.org/index.php/jias), and the recent migration of journals such as EMBO Molecular Medicine from a subscription to an Open Access format indicate that the latter business model has achieved financial traction, if not overt profitability.At the outset, there were two challenges to ioscience, JournalRetrovirology will never reach the Impact Factors of the Journal of Virology, Virology, and the Journal of General Virology!” In retrospect, they were wrong; Retrovirology achieved and surpassed those metrics. Indeed, in the 2011 tabulation of Impact Factor and Immediacy Index, Retrovirology placed ahead of the Journal of Infectious Diseases, AIDS, JAIDS, J Virol., Virology, J Gen Virology; and two established standards of molecular biology and biochemistry, the Journal of Molecular Biology and the Journal of Biological Chemistry  [Retrovirology’s Open Access format was particularly instrumental in permitting interested individuals, who were not career scientists, to freely, rapidly, and fully access those paradigm-changing peer-reviewed publications.Impact Factor and Immediacy Index are two of several proxies of a journal’s quality, and one should interpret cautiously their meaning . Arguablme (CFS) -10. In tRetrovirology’s strong progress forward is owed to the efforts of its board members (http://www.retrovirology.com/about/edboard).Increasing data support the absence of inherent reasons for qualitative difference between papers published in subscription versus Open Access journals . In my v


All researchers want to do well planned study and their trial to be published and globally read. However, most of researchers feel there is generally a lack of guidance on how to prepare good papers and what the rules of ethics at the beginning of study. Thus, they seek to learn medical publication rules and find out the advices of the Helsinki Declaration which is prepared in line with WHO policies and also guidelines on publication ethics  ,4,5,6,7.The requirement for ethics approval during submission to publish is depended on the local and international publication guidelines, some international and national journals ask it for all submitting papers, even retrospective studies, but some of them not. Many journals generally present to authors whether ethics approval is necessary or not. However, sometimes clear explanation cannot be achieved and authors raised the question which frequently occurs for the retrospective studies and case reports. In this paper, we wish to discuss this controversial issue and to share last codes published by government in our country and international guidelines such as Consolidated Standards of Reporting Trials (CONSORT) and Uniform Requirements for Manuscripts Submitted to Biomedical Journals (URM) which state the ethical principles in the conduct and reporting of research and provide recommendations relating to specific parts of publishing ,7.According to international guides, ethics approval is legally required when human and animals are to be used for teaching or new intervention research, however, it is not receiving informed consent from all participitants accompanied with ethics approval is necessary for a prospective randomised trial. Last version of the Declaration of Helsinki published at Oct. 2008 has described that physicians should consider the ethical, legal and regulatory norms and standards for research involving human subjects in their own countries as well as applicable international norms and standards. And also, it says that the research protocol must be submitted for consideration, comment, guidance and approval to a research ethics committee before the study begins. This committee must take into consideration the laws and regulations of the country or countries in which the research is to be performed as well as applicable international norms and standards but these must not be allowed to reduce or eliminate any of the protections for research subjects set forth in this Declaration . The lacIn Turkey, founding of the national and local ethics committees and regulation of the rules for publication ethics became actual with respect to the National Code of Clinical Research which is recently published on 13th April, 2013 . This orAnother important issue for good medical publication is informed consent process. The ethical meaning of informed consent is the principle of respect for persons. Receiving informed consent is based on the international guidelines and national standards, like ethics approval. Informed consent must be read and signed by the patient who accepts to enter the study, by a witness who is a relative or friend of the patient, and also by a staff member having a part in the study. However, depending on National Code on the Patient Rights , all patients must sign informed consent forms not only for specific trials but also for each medical application (diagnostic or therapeutic) in our country  without any doubt. However, recently published The National Code on Clinical Trials has declared that ethics approval is not necessary for real retrospective studies. After publishing this last version of ethics code, retrospective studies and cases which do not have ethics committee approval are acceptable to be reviewed in the most of medical journals though rarely it may not be the case. On the other hand, publication ethics rules are likely to be changed by ethics committees and ethics approval may be asked for all studies in the future, like informed consent. To avoid stumbling block during publication process later, all trials even retrospective ones are advised to be submitted to a proper ethical committee before beginning.


S. epidermidis is the most common infectious organism in biomedical-centred infection. Objective. This study was designed to evaluate the effect of zirconia concentrations in hydroxyapatite on the growth of S. epidermidis. Methods and Materials. The subjects of this study were twenty hydroxyapatite discs, divided into four groups in which one was the control and the other three were the treatment groups. Zirconia powder with the concentrations of 20%, 30%, and 40% was added into the three different treatment groups. Scanning electron microscope analysis was performed according to the hydroxyapatite and hydroxyapatite-zirconia specimens. All discs were immersed into S. epidermidis culture for 24 hours and later on they were soaked into a medium of PBS. The cultured medium was spread on mannitol salt agar. After incubation for 24 hours at 37°C, the number of colonies was measured with colony counter. Data obtained were analyzed using the ANOVA followed by the pairwise comparison. Result. The statistical analysis showed that different concentrations of zirconia powder significantly influenced the number of S. epidermidis colony (P < 0.05). Conclusion. The addition of zirconia into hydroxyapatite affected the growth of S. epidermidis. Hydroxyapatite with 20% zirconia proved to be an effective concentration to inhibit the growth of S. epidermidis colony.Synthetic hydroxyapatite (HA) has been widely used and developed as the material for bone substitute in medical applications. The addition of zirconia is needed to improve the strength of hydroxyapatite as the bone substitute. One of the drawbacks in the use of biomedical materials is the occurrence of biomaterial-centred infections. The recent method of limiting the presence of microorganism on biomaterials is by providing biomaterial-bound metal-containing compositions. In this case,  The system was operated at frequency of 2.45 GHz. After the hydrothermal reaction, reacted sample was washed with distilled water to remove residual ion and dried. The conversion of gypsum to L-HA was estimated from the ratio of X-ray intensities of gypsum peak (d = 7.261) and the HA peak (d = 2.787) using powder X-ray diffractometry.The synthesis of hydroxyapatite was conducted and modified  to produPowder of hydroxyapatite (0.4 gr) was put in a mould of compaction instrument . Powder The disc specimens were mounted with silver paste on metallic stub. The specimens were then gold coated with a sputtering system under vacuum desiccation. Examination was performed under scanning electron microscope at an acceleration voltage of 7 to 10 KV. S. epidermidis  was cultured in mannitol salt agar (MSA) and incubated for 24 hours at 37°C. The cultured bacteria was then transferred into 2 mL of brain heart infusion (BHI) and incubated for 24 hours at 37°C. Solution of NaCl was added into the BHI. Five discs of hydroxyapatite-zirconia from each group of concentration were put into 3 mL culture of S. epidermidis in BHI (Brown standard III of 108 CFU/mL). Incubation was followed for 24 hours at 37°C. After incubation, all discs were transferred into 1 mL phosphate buffer saline (PBS) and put on a vibrator to remove the attached S. epidermidis. Without taking measurement, all discs were then taken out from the PBS solution, and the solution was diluted up to 10−4. Next step, 0.1 mL medium of BHI was transferred into the MSA at the petri dish, using a spreader. The petri dish was incubated for 24 hours at 37°C. The number of colonies was counted using colony counter.The S. epidermidis number of colony on MSA when reacted with hydroxyapatite mixed with zirconia at concentrations of 20%, 30%, and 40% are presented at The average and standard deviations of theS. epidermidis is consistently influenced by zirconia concentrations in the hydroxyapatite. It is shown that the number of colonies of S. epidermidis was smaller as the concentration of zirconia in the hydroxyapatite was increased. In the group of hydroxyapatite without zirconia, it shows the most number of colonies, whereas the concentration of 40% shows the smallest number of colonies. Statistical analysis of this data is carried out using the one-way analysis of variance. This analysis proved whether the different concentrations of zirconia have significant influence on the growth of S. epidermidis, and it is indicated by the numbers of the colonies of S. epidermidis. The probability from the ANOVA is 0.001, and this value is less then 0.05 confidence levels. From this result it was proved that hydroxyapatite with different concentrations of zirconia had a significant influence on the number of colonies of S. epidermidis. The result of this study coincided with the research which stated that the factors influencing bacteria adherence to a biomaterial surface include the surface roughness or physical configuration of the material [On material . The micmaterial . Furthermaterial . This stS. epidermidis (P < 0.05). The number of colonies in hydroxyapatite-zirconia was influenced by the addition of zirconia. This situation related to the statement which mentioned that the present invention provides a method of limiting the presence of a microorganism by contacting the microorganism with material-bound metal-containing compositions [S. epidermidis in hydroxyapatite-zirconia might be assumed due to the toxicity of zirconia as metal. ANOVA analysis was followed by the pairwise comparisons.It can be understood that hydroxyapatite-zirconia has less pores compared to hydroxyapatite without zirconia. Material with least pores among particles gives smoother surface of the material. The result of the ANOVA proved that there was significant relation between the zirconia concentrations and the colonies growth of ositions . One of ositions . The smaS. epidermidis. Moreover, as 20% becomes the effective concentration, a detailed research is still needed. It is important to find out the most effective concentration of zirconia to be added into hydroxyapatite.The data in S. epidermidis. Local hydroxyapatite with 20% zirconia proved to have been an effective concentration in inhibiting the growth of S. epidermidis. Scanning electron microscopy examination showed that zirconia filled in the hydroyapatite pores, whereas the less pores the less number of S. epidermidis attached.From this study, it can be concluded that concentration of zirconia influenced the number of colonies of


To investigate (1) effects of endplate removal and bone mineral density (BMD) on biomechanical properties of lumbar vertebrae (2) whether the distributions of mechanical strength and stiffness of endplate are affected by BMD.A total of thirty-one lumbar spines (L1-L5) collected from fresh cadavers were used in this study. Bone density was measured using lateral DEXA scans and parts of samples were performed with partial or entire endplate removal. All the specimens were divided into three BMD groups. According to endplate integrity of the lumbar vertebrae, each BMD group was then divided into three subgroups: subgroup A: intact endplate; subgroup B: central region of endplate removal; subgroup C: entire endplate removal. The axial compression test was conducted with material testing system at a speed of 2mm/min. The experimental results were statistically analyzed using SPSS 17.0.P<0.05). (2) Spearman analysis showed that BMD was positively correlated with the failure load and stiffness of lumbar vertebrae. (3) For each BMD group, significant differences of biomechanical properties were found between subgroup A and C, and between subgroup B and C (P<0.05). (4) For each BMD group, there was no statistical difference of biomechanical properties between subgroup A and B (P>0.05).(1) Significant differences of biomechanical properties occurred among normal BMD, osteoporotic and serious osteoporotic group (Entire endplate removal can significantly decrease the structural properties of lumbar vertebrae with little change in biomechanical properties by preservation of peripheral region of the endplate. BMD is positively correlated to the structural properties of the lumbar vertebrae. During the interbody fusion, structural struts such as prosthetic devices, autografts and allografts are implanted between two adjacent vertebrae to provide structural support following removal of diseased or damaged tissue from the spinal column . The imp In addition to the mechanical strength of the endplate, the vascular ingrowth into the graft has also been considered important for successful interbody fusion without implant subsidence . The bioThis clinical study has been approved by the institutional review board of our hospital and the written informed consent has been obtained from each deceased subject's family.P>0.05). A total of thirty-one lumbar spines L1-L5,  were obt The specimens in each BMD group were divided into 3 subgroups: subgroup A: preservation of intact endplate; subgroup B: removal of central region of the superior and inferior endplate; subgroup C: entire removal of the superior and inferior endplate. To make removal of central region of different endplates have comparability, coordinate system was created directly on the surface of the lumbar endplate . The med After removing the posterior elements of each vertebra using a bone saw, the specimens were placed at the fixture of the material testing system  indicating the linear relationship between a dependent-variable and an independent variable was determined [The relationship between the failure load or stiffness and BMD was analyzed by analysis of variance (ANOVA). Spearman correlation assay was also used to investigate the correlation between them and the coefficient of correlation (rtermined . Data ofP<0.05) and significant differences of the failure load and stiffness were also found by multiple comparisons among three BMD groups using SNK test (P<0.05). For lumbar specimens with partial or entire endplate removal, there were also significant differences of the failure load and stiffness among three BMD groups (P<0.05) and the SNK test also revealed significant differences of the failure load and stiffness in multiple comparisons (P<0.05).Tabular summaries of all failure load and stiffness data were included in s=0.836 P<0.05, s=0.793 P<0.05, s=0.854 P<0.05) and entire endplate removal (rs=0.905 P<0.05) were also observed. Stiffness was found to be positively correlated to BMD in lumbar vertebrae with partial endplate removal (rs=0.875 P<0.05) and entire endplate removal (rs=0.891 P<0.05), respectively. According to the Spearman correlation analysis, the failure loads of lumbar vertebrae with intact endplates were positively correlated with BMD , and this showed that removal of central region of the endplate did not influence the failure load and stiffness of lumbar vertebrae.  According to ANOVA and SNK results, significant differences of the failure load and stiffness were found between subgroup A and C, and between subgroup B and C P<0.05, , 7 in eaP<0.05). The magnitudes of decreases in failure load and stiffness were found to be significantly different between the normal group and the osteoporotic group, and between the normal group and seriours osteoporotic group by SNK test(P<0.05). No statistical difference was found between the osteoporotic group and the serious osteoporotic group . These findings indicate that the endplate has biomechanical function of sharing loading of vertebrae and the mechanical strength of endplate mainly concentrate in its peripheral region, which is consistent with our previous finding that the central regions are thinner and weaker than the peripheral regions of lumbar endplates [ Most interbody implants do not span the entire surface of the vertebrae. During the interbody fusion, the interbody cages are sometimes placed on either side of the vertebral body to decompress areas with the greatest neuroforaminal stenosis or in the anterior segments of the vertebral body to correct kyphosis. However, whether these implant placements biomechanically contribute to the postoperative subsidence has not been well investigated. This study aimed to address this issue and attempted to establish a baseline for future studies in this area. The results of this study showed that no statistical difference of the strength and stiffness was found between lumbar vertebrae with intact endplate and those with removal of central region of endplate. Compared with the former two groups, the strength and stiffness of the lumbar vertebrae with removal of entire endplate were significantly lower (ndplates . The current study demonstrates that removing the central region of the endplate does not affect the tested biomechanical parameters. The possible clinical relevance is that during the interbody fusion, the balance between the vascular ingrowth into the graft and maintenance of the biomechanical property of endplate can be addressed by removing the central region of endplate without significant influence of mechanical strength of endplate and thus can reduce graft subsidence as much as possible. However, the behavior of the implants was not directly tested in this study and the subsequent research is required to validate the efficacy of the implant placement based on these findings in the future. Osteoporosis is characterized by rapid and irreversible loss of trabecular bone tissue leading to increased bone fragility and implant subsidence occurs when the vertebrae become fragile. Belkoff et al  found thThe limitation of this study is that we did not consider the degenerative status of the specimens which may also have influence on the biomechanical properties of lumbar vertebrae. Endplate failure occurs frequently in osteoporotic vertebral fractures and may be related to the development of high tensile strain. In this study, we did not test the tensile strains in the endplates, which may be related to the vertebral fractures. Recently, Fields et al  found thIn this study, no difference of failure load and stiffness was found between the normal and osteopenic vertebrae, so we included the osteopenic vertebrae within the normal group to facilitate comparison with other groups. The positive correlation between BMD and biomechanical properties of vertebrae suggests that patients with low BMD may have higher risks of subsidence after interbody fusion. For vertebrae with entire endplate removal, the magnitude of decreases of the failure load and stiffness in low BMD group is much higher than the normal group, which indicates that compared with patients with normal BMD, graft placement and maintenance of biomechanical function of endplates may be more important for patients with low BMD to prevent subsidence. However, the distribution of biomechanical properties did not change with BMD decrease and the peripheral region of endplate still undertook majority of axial loading of lumbar vertebrae, which may provide more strength to resist against subsidence postoperatively. The fact that the lumbar vertebrae with entire endplate removal are significantly weaker than those with intact endplate suggests that the endplate plays an important part in maintaining biomechanical properties of lumbar vertebrae. In addition, removal of the central region of endplate does not significantly influence the mechanical strength of vertebrae, which indicates that the peripheral portion of endplate shares the major loading of lumbar vertebrae. The fact that BMD is positively correlated to biomechanical properties of lumbar vertebrae indicates that patients with low BMD may have higher risks of subsidence. With the decrease of BMD, the peripheral region of endplate still undertook majority of axial loading of lumbar vertebrae and may provide more strength to resist against subsidence after interbody fusion.


Objective: Split skin graft reconstruction of scalp defects often leaves an obvious contour defect. Here, we aimed to demonstrate the use of a decellularized extracellular matrix biomaterial, termed ovine forestomach matrix (OFM), as a substrate for split-thickness skin grafts (STSGs) for scalp reconstruction. Methods: Following full-thickness tumor excision, OFM was applied directly to skull periosteum, and then an STSG was applied. Participants were monitored for graft take, epithelialization, and cosmetic outcomes. Results: Participants responded well to the procedure with more than 95% graft take in 4 participants, and 100% epithelialization of the grafts after 2 weeks. A 30% graft take was observed in the fifth participant due to local infection and partial necrosis of the graft. Ovine forestomach matrix was remodelled with time and the regenerated dermis was well vascularized and had robust and ordered collagen deposition. Conclusions: This series demonstrates that OFM can serve as a temporary dermal scaffold to support an overlying STSG and allow for a single-stage grafting procedure. Full-thickness skin grafts result in a more durable reconstruction due to the larger proportion of dermis placed into the defect than split-thickness skin grafts (STSGs). Because of limited full-thickness skin graft donor sites, STSGs are used in larger defects. Two-stage grafting procedures have been developed whereby a dermal substitute is grafted into the defect under an artificial epidermis, which is subsequently replaced by an STSG. There is a clinical need to replace the relative complexity of 2-stage grafting procedures with robust single-stage procedures without compromising clinical outcomes. However, the feasibility and success of single-stage procedures is dependent on the vascularity of the underlying tissue. To overcome these limitations, collagen-based dermal substitutes have been investigated as temporary substrates for an overlying STSG. This approach creates a composite graft, whereby the underlying dermal substitute is rapidly vascularized and therefore can support epithelial proliferation of the STSG, leading to closure of the defect and dermal regeneration. The dermal substitute, human acellular dermal matrix  has been investigated for STSG composite grafting in the treatment of burns,1Ovine forestomach matrix (OFM) is a decellularized extracellular matrix biomaterial developed for wound healing and tissue regeneration applications and is cleared by the US Food and Drug Administration for dermal indications. Ovine forestomach matrix comprises mainly collagens I and III arranged as native fibres that retain the 3-dimensional architecture seen in tissue ECM.http://www.anzctr.org.au/). Five participants were selected on the basis of the inclusion and exclusion criteria listed in The case series was approved by an institutional review board  and registered with the Australian New Zealand Clinical Trials Registry , while the fifth participant, B001, had a 30% graft take. The low graft take in participant B001 resulted from a local infection and partial necrosis of the graft (Participants (B001 through B005) enrolled in the study were all male, 61 to 83 years old, presenting with either an squamous cell carcinoma (SCC) (n = 4) or basal-cell carcinoma (BCC) (n = 1), located on the scalp . The tumhe graft , which wParticipants B001, B002, and B003 were available for long-term follow-up . The epiTwo of the participants (B004 and B005) had the original surgical site further excised 4 weeks postsurgery to gain adequate  excision of the tumors at the deep margin. The subsequent procedure excised the original graft as well as the margins and underlying periosteum leaving exposed skull. Therefore, the defects were closed with scalp rotation flaps. The excised tissues containing the original graft were fixed, stained, and imaged . Remnant,12,Scalp reconstruction is especially challenging given the limited blood supply of the underlying calvaria, the relatively thin cutaneous tissue, and the lack of redundant skin. Split-thickness skin grafts take well on the underlying periosteum; however, this leaves an obvious contour defect. Skin flaps and expanders have been traditionally used, but these approaches are complicated by the minimal laxity of the scalp and the complexity of these multistage procedures. As an alternative, collagen-based biomaterials that function as temporary dermal scaffolds have become increasingly useful as part of a single- or 2-stage procedure for surgical reconstruction. These materials allow direct grafting to the underlying calvaria, usually following removal of the outer portion of exposed bone to allow vascularization of the dermal scaffold.7,Previous preclinical studies have shown OFM is remodelled, and importantly the remodelling phenotype resolves with time, with concomitant deposition of new tissues.10While the current application of this procedure was in the reconstruction of tissue deficits following tumor resection, there is the potential for this approach to be applied to the treatment of burns and traumatic skin loss. This initial study also suggests OFM as a candidate substrate for autologous cell seeding, whereby suspensions of dermal cells  or stem cells  are applied to the substrate. This strategy has many similarities to the composite STSG procedure described here, as it relies on rapid vascularization of the underlying dermal scaffold to support the transplanted cells.


Objective: The objective of this study was to compare microhardness of resin cements under different thicknesses of zirconia and the light transmittance of zirconia as a function of thickness.Study design: A total of 126 disc-shaped specimens (2 mm in height and 5 mm in diameter) were prepared from dual-cured resin cements . Photoactivation was performed by using quartz tungsten halogen and light emitting diode light curing units under different thicknesses of zirconia. Then the specimens (n=7/per group) were stored in dry conditions in total dark at 37°C for 24 h. The Vicker’s hardness test was performed on the resin cement layer with a microhardness tester. Statistical significance was determined using multifactorial analysis of variance (ANOVA) . Light transmittance of different thicknesses of zirconia  was measured using a hand-held radiometer . Data were analyzed using one-way ANOVA test .Results: ANOVA revealed that resin cement and light curing unit had significant effects on microhardness (p < 0.001). Additionally, greater zirconia thickness resulted in lower transmittance. There was no correlation between the amount of light transmitted and microhardness of dual-cured resin cements .Conclusion: Although different zirconia thicknesses might result in insufficient light transmission, dual-cured resin cements under zirconia restorations could have adequate microhardness. Key words:Zirconia, microhardness, light transmittance, resin cement. The optical property of high strength ceramic materials such as glass infiltrated spinell and alumina or fused alumina or zirconia core materials plays an important role in matching the affected shade of the artificial restorations with the natural appearance of teeth ,2. AdditTraditional luting agents (such as zinc-phosphate or resin-modified glass ionomer cements) might provide adequate retention for cementation of zirconium oxide restorations. However, adhesive cementation with adhesive luting agents is necessary for ensuring better retention and marginal adaptation .Until recently, conventional quartz tungsten halogen (QTH) light curing units (LCUs) were widely used to polymerize resin cements. In the last few years, other technologies, such as xenon plasma arc (PAC) and light-emitting diodes (LED) are also available . AlthougThe polymerization of resin cements is critical, because inadequate polymerization is usually associated with poor mechanical and biological properties of the resin cements. Furthermore, modified light polymerization protocols can lead to the resulting polymer having different structures and properties, such as hardness, tensile strength, and water solubility and sorption. Surface hardness is one of the most important physical properties of dental materials, and is defined as the resistance of a material to indentation or penetration. Hardness testing is commonly used as a simple and reliable method to indicate the degree of conversion of resin-based cements ,8.Based on these considerations, the first aim of this study was to compare the microhardness of resin cements polymerized with different LCUs under different thicknesses of zirconia. Additionally, the second aim was to evaluate the translucency of zirconia as a function of the thickness. The tested null hypothesis was twofold: 1- Polymerization of resin cements with different LCUs significantly affects the microhardness values. 2- Light transmittance of zirconia and as a result microhardness of resin cements under zirconia decrease when the thickness of zirconia is increased.The experimental set-up is given in figure The tested resin cements  their manufacturers and compositions were shown in The specimens were polished with 220, 360, and 600 grit silicone carbide abrasive paper (Federation of European Producers of Abrasives (FEPA) under water-cooling with a grinding machine  and placed on the platform of the tester with the surface being tested facing the diamond indenter. The Vicker’s hardness number (VHN) test was performed on the cement layer with a microhardness tester  with 200 g of load application for 15 seconds. Three indentations were taken for each of the top and the bottom surfaces of each resin cement specimen. These indentations were not closer than 1 mm to the margin and were averaged to determine the hardness value for each specimen. VHN was calculated using the following formula:  disc-shaped specimens (n=24) (in A1 shade) were fabricated by the manufacturer using a computer aided design/computer-aided milling (CAD/CAM) process in three different thicknesses  (n=8/per group). Before measurement of translucency, the zirconia discs were ultrasonically cleaned in distilled water for 10 minutes and then dried with compressed air. The thickness of the discs was measured using a digital micrometer . The accuracy of the micrometer was ±10μm.The light transmission value of each thickness was measured by placing the disc on the aperture of the hand-held radiometer  and recording the average of resultant light readings through the disc. Then transmittance percentage was calculated for each thickness.-Statistical analysisMultifactorial analysis of variance (ANOVA) was performed to determine the effects of different resin cements, LCUs and zirconia thicknesses on the Vicker’s microhardness of resin cements. Paired-Samples T test was used to compare the microhardness values of resin cements in top and bottom surfaces. A p value less than 0.05 was considered statistically significant. But, for all possible multiple comparison tests, Bonferroni Adjustment was applied to control Type I error. The transmittance data were analyzed using one-way Anova and Tukey’s post-hoc tests . A non-parametric Spearman’s correlation analysis and Spearman’s coefficient (rho) was used to assess the correlation between the microhardness of resin cements and light transmission through zirconia ceramics.The mean microhardness values and standard deviations for specimens are shown in The results of the microhardness test indicated significant differences based on the surface of resin cements (top and bottom surface) (p < 0.004). The top surface microhardness values of Rely X Unicem and Clearfil SA cement when polymerized with QTH LCU were higher than the results when polymerized with LED LCU (p < 0.001). Moreover, the bottom surface microhardness values of Rely X Unicem and Panavia F when polymerized with QTH LCU were lower than the results when polymerized with LED LCU (p < 0.001). However, the microhardness of Clearfil SA cement wasn’t detectable on the bottom surface. The impression of the indenter couldn’t be clearly identified on the surface of the Clearfil SA cement specimens polymerized under three different thicknesses of zirconia discs. In addition to this, the top surface microhardness values of Panavia F when polymerized with QTH LCU were similar to the results when polymerized with LED LCU (p = 0.102).The microhardness of the tested materials in the upper surface can be rank as follows: Rely X Unicem > Panavia F > Clearfil SA cement (p < 0.001). Furthermore, statistically significant ranking for microhardness was obtained in the bottom surface as follows: Rely X Unicem > Panavia F (p < 0.001).Transmittance percentage values of various zirconia discs are displayed in figure It is known that to reach optimum physical properties of resin cements under ceramic restorations; degree of conversion should be as high as possible . In the The first null hypothesis was accepted after statistical analysis revealed differences in microhardness among the resin cements after light curing with different LCUs. The hardening of resin cements was investigated to ensure the efficacy of different LCUs. Previous studies showed hardness as a good indicator of conversion of double bonds ,11 and wConflicting results are often indicated in the literature when the effects of different LCUs on resin based materials are reported ,15. PrevA previous study by Aguiar et al.  evaluateFurther on the comparison of microhardness values of the resin cements, Rely X Unicem showed higher microhardness values than Panavia F and Clearfil SA cements . This coKnowledge of the optical properties of dental restorative materials is very important to achieve esthetic restorations, and this study attempts to analyze optical properties of the zirconia ceramics. The second null hypothesis that the light transmittance of zirconia decreases when the thickness is increased should be partially accepted, as the different thicknesses of zirconia had a significant effect on light transmittance values of the tested zirconia specimens. This finding is according to the results of a previous study by Lee et al. , suggestPrevious studies have reported an inverse relationship between the thickness of ceramic inlays and the surface hardness of resin cements ,25. HoweAs microhardness of the resin based material might give an idea about the polymerization process, further investigations are required to test the microhardness of resin cements in vitro and in vivo. Additionally, further investigations about optical properties should be studied before and after the application of veneering porcelain on zirconia core materials. Within the limitations of this in-vitro study, the following conclusions could be drawn:1. High-power LED LCUs might be considered as effective as QTH LCU or more effective than QTH LCU for polymerization of the resin-based materials.2. Greater thickness of zirconia results in lower light transmittance.3. There might be insufficient light transmission through zirconia restorations for adequate microhardness. Thus, use of dual-cured resin cements might be preferred under zirconia restorations.


With this volume, Emerging Infectious Diseases (EID) turns 10—a time probably between childhood and adolescence in journal years. All of us associated with the journal are very proud of this milestone, but at the same time we are aware of the need to continually assess progress toward original goals and make changes when and where needed.EID’s genesis stems from advice to the Centers for Disease Control and Prevention (CDC) promulgated by the 1992 Institute of Medicine report, Emerging Infections: Microbial Threats to Health in the United States  has grown from 3,000 subscribers in 1995 to >45,000 . Submissions are increasing and number >120 per month. Although most submissions come from scientists in the United States and Western Europe, manuscripts continue to arrive in substantial and increasing numbers from every part of the globe. The journal, which is widely indexed, has a consistently high impact factor .Electronic publishing, the dynamic concept driving Emerging Infectious Diseases, has made huge strides during the journal’s first decade. Ahead-of-print publication, a founding feature of Emerging Infectious Diseases, is now common practice in the scientific journal community. Online-only publication of technical and lengthy but valuable parts of articles has also been adopted by many journals. Multiple links to references, databases, and other relevant information have become standard. Interactive features and instant access to authors and editors have revolutionized scientific dialog. EID’s impulse to swiftly provide urgent information free of charge to a global audience has been reaffirmed by several recent movements toward free access to scientific data.During its 10-year journey, Emerging Infectious Diseases has had some advantages. Providing unrestricted access to all content has allowed the journal to reach its intended audience of public health professionals around the globe. In-house production has made possible timely posting of articles on the Web as soon as they are cleared for publication. A small but uniquely competent and flexible production team, dedicated associate editors and editorial board, and thousands of volunteer expert reviewers have energized our journal’s growing contribution to the public health community.Like all anniversaries, our journal’s 10th is a combination of reflecting on the past and looking into the future. From the public health perspective, the world’s current situation is every bit as volatile as it was 10 years ago, perhaps even more so. New infectious diseases and etiologic agents  continue to surface relentlessly. Other diseases are finding new niches. West Nile virus encephalitis, endemic to the Eastern Hemisphere, became established in the northeastern United States in 1999 and continues to spread each year. As predicted within the public health community, multidrug-resistant bacterial infections have become increasingly commonplace, yet development of new antimicrobial drugs has failed to keep pace. Against this backdrop of naturally occurring problems, intentional release of pathogenic organisms has surfaced as a threat to public health and global security. The Institute of Medicine revisited the issue they brought to the world’s attention in 1992 with another report in 2003 (http://wwwnc.cdc.gov/eid/content/10/2/contents.htm). The technology that allowed these and other cases of expedited publication continues to advance. However, the ability to collect and interpret data on unknown diseases and uncharacterized agents follows a different timetable, in which quality must continue to take precedence over speed.From the journal publishing perspective, continued emergence of new diseases and agents compels rapid dissemination of relevant scientific and public health information on the Web. As electronic access has become more commonplace, Web audiences have increased, and while in 1995 we had to educate readers on how to access our electronic journal, now we strive to keep up with their increased sophistication and need for additional research tools. In the ever-changing world of electronic publishing, speed is no longer the greatest challenge. Traditional publishing bottlenecks are diminishing. Web-based submission and peer review shrink the time from manuscript submission to publication. Online editing and production have advanced to the benefit of the final product. The question is no longer how fast information can be published but how content quality can keep up with technologic speed (Electronic publishing provides solutions and poses challenges. Online-only publication for selected sections of journal materials may, in the short term, ease space constraints that threaten the journal’s ability to remain inclusive. Expansive indexing will further refine electronic search capabilities, increase links to large electronic databases, and improve the pace and quality of emerging infections and other research. The breadth and complexity of online activities will continue to demand increased technical expertise and exceptional flexibility from all involved with the journal—authors, reviewers, editors, and production staff.As Emerging Infectious Diseases begins its second decade, its primary goal remains to communicate the threat of emerging infections worldwide and reduce the global impact of these infections, particularly among the young, the old, and the immunocompromised. The principal difference between 1995 and now is the pace, both of current events and of expected publication. Our challenge for the coming decade is not only to keep up with an increasing pace, but also to set the pace whenever we can, or in the words of one track coach, “Start off as fast as you can, and then gradually pick up speed.”