Plasma levels of imatinib were correlated with response to the therapy, so routine monitoring of the therapeutic levels of the drug should be carried out specifically in treatment-resistant cases for determining dose escalation.

ribosomal structural protein RPS19 or transducer of erythropoietin signaling JAK2 tyrosine kinase in normal blood or in DBA. It remains to be determined whether epigenetic silencing by histone modifications plays a role in DBA as hinted by a report of a remission in a DBA patient induced by a histone deacetylase inhibitor valproic acid. 10 ACKNOWLEDGMENT

Pentalogy of Cantrell is a rare congenital anomaly involving deficiency of the following structures: anterior diaphragm, supraumbilical abdominal wall, diaphragmatic pericardium, lower sternum, and associated congenital intracardiac abnormality. We describe a 3-month-old child with this syndrome having left ventricular diverticulum along with omphalocele who presented to us with a pulsating mass in the epigastrium. The defect was evaluated and defined by computed tomography scan. A team of pediatric, cardiac, and plastic surgeons successfully repaired the defects. This case report discusses the review of literature along with management options and concludes that there must be an emphasis on early repair of left ventricular diverticulum to prevent complications. Antenatal ultrasound can also detect the anomaly, and early postnatal diagnosis of the syndrome, followed by immediate surgical repair, can prevent lethal complications.

a b s t r a c tObjectives: This report presents up-to-date evidence and expert consensus-based revisions to the ASPMN 2011 guidelines that inform interprofessional clinical decision-making for hospitalized adults receiving opioid analgesics. Design: Systematic review of the literature. Methods: A 14-member expert panel was charged with reviewing and grading the strength of scientific evidence published in peer reviewed journals and revising the ASPMN 2011 existing guidelines. Panel members formulated recommendations based on the strength of evidence and reached consensus through discussion, reappraisal of evidence, and voting by majority when necessary. The American Society of Anesthesiologists evidence categories for grading and classifying the strength of the evidence were used. Recommendations were subjected to a critical review by ASPMN members as well as external reviews. Results: The 2011 guidelines were found to still be relevant to clinical practice, but new evidence substantiated refinement and more specific recommendations for electronic monitoring. The revised guidelines present risk factors divided into three categories: patient-specific, treatment-related, and environment of care. Specific recommendations for the use of electronic monitoring are delineated. Conclusions: All hospitalized patients that are administered opioids for acute pain are at risk of opioid induced advancing sedation and respiratory depression, but some patients are at high risk and require extra vigilance to prevent adverse events. All patients must be assessed for level of risk. Adaptations to the plan of care and monitoring strategies should be driven by iterative re-assessments according to level of risk.

No abstract

Occupational and environmental lung disease is a vast topic. Therefore, this review focuses on areas that represent new clinical insights that have not been addressed recently in Current Opinion in Pulmonary Medicine. The topics are considered important for the future and emphasize diseases that strike large numbers of people or exposures that affect large segments of the population. This review highlights literature published between the years 2000 to 2001 related to air pollution, occupational asthma, lung diseases in agricultural workers, nylon flock workers lung disease, pneumoconiosis, and environmental exposure to biomass smoke, including environmental tobacco smoke. These publications highlight the changing world of occupational and environmental lung diseases. Traditionally, this field dealt with chronic diseases caused by very high levels of exposure to materials that affected virtually all workers to a similar degree. Disease could be recognized readily by characteristic symptoms, signs, and radiographic abnormalities. Dose-effect relationships were usually clear, and the solution to disease was generally to limit exposure for all workers. This approach served well for conditions such as coal workers pneumoconiosis or toxic responses to chlorine gas. The new world of occupational and environmental lung diseases often involves low levels of exposure to complex mixtures of materials that produce nonspecific or intermittent symptoms in a subgroup of exposed individuals. Interactions between genetic susceptibility, concomitant tobacco smoke exposure, and co-morbid diseases hugely complicate both diagnosis and prevention. New tools, and possibly new thought paradigms, are needed to detect, treat, and prevent occupational and environmental lung diseases in a changing world.

Diabetic Retinopathy occurs in patients who suffer from diabetes for many years and as a result of which the vision gets affected. The affect can be low to severe depending on the extent to which the disease has occurred. There are two stages of the disease. The early stage is Non proliferative diabetic retinopathy (NPDR) and later is Proliferative diabetic retinopathy (PDR). In NPDR, various problems may occur such as macular edema which is swelling in the central retina and retinal ischemia which occurs due to poor blood flow. In PDR, the advanced stage of NPDR, new blood vessels starts growing in the retina known as neovascularization. The extraction of retinal blood vessels if done at early stages can be very helpful in diagnosing the severity of the disease and accordingly the treatment can be followed. In later stages, treatment is not very effective. In this paper various blood vessel segmentation techniques are discussed. Besides segmentation techniques, retinal image enhancement techniques are also discussed. The evaluation of techniques is done on publically available databases DRIVE and STARE. These databases contain retinal images along with the ground truth images which are accurately marked by the experts for the purpose of evaluation of the techniques. The paper also discusses various metrics which are frequently used for the evaluation of image segmentation techniques.

Automatic speech recognition, which was considered to be a concept of science fiction and which has been hit by number of performance degrading factors, is now an important part of information and communication technology. Improvements in the fundamental approaches and development of new approaches by researchers have lead to the advancement of ASRs which were just responding to a set of sounds to sophisticated ASRs which responds to fluently spoken natural language. Using artificial neural networks (ANNs), mathematical models of the low-level circuits in the human brain, to improve speech-recognition performance, through a model known as the ANN-Hidden Markov Model (ANN-HMM) have shown promise for large-vocabulary speech recognition systems. Achieving higher Recognition accuracy, low Word error rate, developing speech corpus depending upon the nature of language and addressing the issues of sources of variability through approaches like Missing Data Techniques & Convolutive Non-Negative Matrix Factorization, are the major considerations for developing an efficient ASR. In this paper, an effort has been made to highlight the progress made so far for ASRs of different languages and the technological perspective of automatic speech recognition in countries like China, Russian,