The DIC is a generalization of the Akaike Information Criterion and is suitable for assessing mixed-effects models like ours. There is no established test for assessing differences in DIC. The model with the lowest DIC can be considered to be the most predictive, in a similar manner to Akaike’s criterion. In accordance with Spiegelhalter et al. [15] we considered that a difference of at least 3 is indicative of a difference in the quality of the adjustment obtained for two different models. In addition, the comparison between predicted and observed indicates the average direction and bias in estimates of individual antibody titres. Fitted models were used to predict

individual antibody titres up to 25 years after vaccination. We also used the accepted threshold titre of 1:10 [2] and [9] for determining at different time points the proportion of subjects still protected against JE. Finally,

we calculated Icotinib chemical structure each individual’s duration of protection on the basis of this threshold. Given the model’s individual and population-level parameter estimates, we set Yij = log(10) and solved for t, which represents the point in time when the subject’s titre wanes to below 10. This gave a distribution of duration of protection for our 99 subjects. Table 1 gives the parameter estimates and fit statistics Alectinib ic50 for the three models. The DIC was smaller for the piecewise linear model indicating it best fit the observed data. Fig. 2 and Fig. 3 illustrate the ability of this model to reproduce the observed titres and seroprotection rates. The scatterplot in Fig. 4 confirms the ability of the piecewise linear model to provide a good fit to most of the observed data with the possible exception of outlying antibody titres (>1000 or <10). On the basis of these results, we chose the piecewise linear model. For this model, the first period slope parameter suggests an average annual rate of titre

decay of 5.81 (log units). This rate of decay continues for only 0.267 years or 3.2 months. After this initial period of rapid decline, the second period slope parameter indicates a 50-fold slower rate of decay of 0.109 (log units). Fig. 2 illustrates the population and individual-level (N = 99) predictions of titre from day 28 to year 10, based on the piecewise linear model. The population Ketanserin average can be seen to closely match the observed median titres to year 5. We did not detect in Fig. 2a bias in the ability of the model to fit observed antibody titres for specific timepoints. The long-term antibody decay rate can also be seen to be strongly linear in log units. Table 2 gives the predicted and observed median antibody titre and 5th to 95th inhibitors percentile range at several time points up to year 10. Fig. 3 illustrates the predicted evolution of the seroprotection rate. Unlike antibody titres, the predicted decline in the seroprotection rate is not linear.

A previous study of our group also

suggested that alterations in early periods after birth could be involved in behavioral deficits in adulthood (Moreira et al., 2010). The exact mechanism involved in the long-term effects of KA-induced seizures on behavioral performance in adulthood is still unknown, but appears to involve impairment of the long-term potentiation, enhanced long-term depression and reduction on synaptic proteins levels (Cognato et al., 2010, Cornejo et al., 2007 and Sun et al., 2009). Apparently, astrogliosis PARP inhibitor is not persistent up to adulthood in this model (Cognato et al., 2010). The early periods of brain development are of great relevance and determine adequate brain function late in lifespan. Our study indicates that a single convulsive event in early life could induce short-term alterations in relevant parameters involved in the homeostasis of inhibitors glutamatergic neurotransmission in the hippocampus, which could be involved in the

behavioral alterations in adulthood animals. Our findings can contribute to better understand the role of glutamate transporters in seizures during childhood. From clinical point of view, our data suggest that interventions on the glutamatergic system during seizures in children may be relevant for prevention of brain impairment in adulthood. This work was support by CAPES, FAPERGS, INCT.EN-CNPq/INCT and IBN.Net FINEP/FADESP (Proc. No. 01.06.0842-00). Special thanks to Jocemar Ilha and Henrique Beck Biehl for the support. None of the authors has any conflict of interest to disclose. “
“Monoamine transporters SAR405838 clinical trial for serotonin (SERT), norepinephrine (NET) and dopamine (DAT) belong to the family of Na+/Cl−-dependent neurotransmitter transporters and remove their substrates to end synaptic transmission (Kristensen et al., 2011). Apart from this physiological role, these transporters

are the targets of illicit drugs like cocaine or amphetamines (Rothman and Baumann, 2003). Amphetamines lead to a reverse action of all of these transporters and to a number of other intracellular effects which Linifanib (ABT-869) actively increase the concentration of neurotransmitters in the synaptic cleft (Sitte and Freissmuth, 2010). In contrast, cocaine raises the synaptic concentration of monoamines by inhibiting the activity of these transporters. Both classes of compounds are sold on the street market for illicit drugs at the risk of the users because both the quality and identity of the purchased drugs are without any control. This situation is alleviated by the government-supported Viennese drug prevention project ‘checkit! Check your drugs’, which offers cost-free and anonymous analyses of drugs. Thereby drug consumers gain information about the contents of their drug as well as possible risks of those compounds. Importantly and often to the great surprise of the user, the purchased drug does not contain the compound under the name it was sold.

In Germany about 5% of young adults have used these drugs at least once.1 However, this percentage is 5 to 10 times higher among people who regularly attend parties and raves, and seems to be generally higher in other countries such as the UK and USA.2-5 Figure 1 Chemical structures of amphetamines and ring-substituted methylenedioxyamphetamines (ecstasy). MDMA, methylenedioxymethamphetamine; MDE, 3,4-methylenedioxy-Nethylamphetamine; MDA, 3,4-methylenedioxyamphetamine; MBDB,

3,4-methylenedioxy-alpha-ethyl-N-methylphenethylamine … Both ecstasy and amphetamines are easy to manufacture in underground laboratories. Ecstasy Inhibitors,research,lifescience,medical is almost always sold as tablets or pills with various imprinted logos Figure 2. The pills typically contain 70 to 120 mg of MDMA, although the concentration may sometimes be higher or lower. Occasionally ecstasy tablets will contain similarly acting analogues (3,4-methylenedioxy-Nethylamphetamine [MDE], 3,4-methylenedioxyamphetamine [MDA], or 3,4-methylenedioxy-alpha-ethylN-methylphenethylamine Inhibitors,research,lifescience,medical [MBDB], Figure 1) or amphetamines, and more rarely they

may also contain substances from different classes. Amphetamines are mostly sold as powder which can be inhaled, smoked, Inhibitors,research,lifescience,medical ingested, or injected, although intranasal use (“snorting”) is now particularly common. Figure 2 Ecstasy pills from the illicit market. The acute pharmacology of MDMA and amphetamines has been widely studied.“ Among other actions, both drug groups bind to presynaptic monoamine Selleck Capmatinib transporters, Inhibitors,research,lifescience,medical and act as inhibitors on these sites and releasers of the endogenous monoamines from presynaptic terminals. The main mechanism of amphetamines is the enhanced release of dopamine (DA), particularly in the striatal system, and norepinephrine (NE). MDMA binds most strongly to the serotonin (5-HT) transporter (SERT) and induces rapid and powerful

release of both 5-HT and DA. Depending on the dose and route of administration, effects of stimulants may last from 3 to about 8 hours. They Inhibitors,research,lifescience,medical include increased drive, hypervigilance, pressure of ideas and speech, euphoria, and expansive behavior, but sometimes dysphoric mood, agitation, and aggression may occur. The psychological effects of MDMA last about 3 to 5 hours, and are more complex: they include relaxation, feelings of happiness, empathy, and closeness to other people, along with stimulant-like effects, alterations Cell press of perception, and other mild hallucinogenic effects.7 The addictive potential of amphetamines is generally lower than that of cocaine or heroin, but it becomes high when the drugs are used intravenously. MDMA is considerably less addictive, and is mostly used as a recreational drug during weekends; however, a minority of about 15% to 20% of users develop a more frequent or compulsive use pattern, and they may ingest 10 or even more pills per occasion.

Not surprisingly, the hedonic value of a stimulus is substantially influenced by its context. For example, in a decisionmaking situation, unexpected outcomes have greater hedonic impact than expected ones, and any given outcome is perceived as less pleasant if an unobtained outcome is perceived as being better.21 That is, surprise, which strongly activates the ventral striatum,22 and comparison with nonexperienced alternatives, contribute strongly to the experience of pleasure. Similarly, anticipation of pleasure has a profound influence on decisionmaking,

and can explain why individuals make risky choices.23 For example, people feel displeasure when the outcomes Inhibitors,research,lifescience,medical of selected actions fall short Inhibitors,research,lifescience,medical of the counterfactual alternative, and increased pleasure when their outcomes exceed the counterfactual alternative.24 Moreover, predictions of future hedonic I-BET151 ic50 reactions result from a complex interplay between the current state of the individual and the changes that occur as the individual is getting

closer in time to experiencing the stimulus. Specifically, initially the hedonic experience is based on the atemporal imagination of the stimulus, Inhibitors,research,lifescience,medical which is subsequently corrected with information about the time at which the event will actually occur.25 The experience of the hedonic aspects of a rewarding stimulus itself Inhibitors,research,lifescience,medical has profound consequences of subsequent behaviors. In many instances individuals show deteriorating performance when they are anticipating the hedonic quality of a future experience.26,27 Thus, to speak of the pleasurable property of a stimulus without referring to the contextual and individual state is to fundamentally misunderstand the way the brain processes hedonic aspects of reward. Animal experiments have shown that an area within the medial caudal subregion of the nucleus accumbens shell, as well as rostral ventral pallidum, are necessary to process the hedonic reward properties of food.28,29 Moreover, it appears that the ventral pallidum, an area adjacent Inhibitors,research,lifescience,medical to and connected with the insular

cortex, 17 is a key structure in brain mesocorticolimbic reward circuits that mediate “liking” or hedonic reactions. these Specifically, firing patterns of neurons within this structure selectively track the hedonic values of tastes, even across hedonic reversals caused by changing the homeostatic state of the animal30 One possible way to examine the brain structures necessary to process the hedonic aspects of reward is to study individuals who are unable to experience pleasure due to an underlying psychiatric condition, ie, depressed subjects with profound anhedonia. In humans, neuroimaging investigations with depressed individuals have shown altered activation in midline cortical structures as well as putamen and thalamus that were directly related to the degree of anhedonia.

39 A designated hybrid operative room will allow

performing a single-session procedure at one place without the need to transfer the patient from the operating room to the catheterization laboratory. ROBOTIC-ASSISTED CABG The surgical robot is an elegant microprocessor-controlled, electromechanical instrument that allows the surgeon to remotely manipulate fully articulating videoscopic instruments by way of master–slave servos and microprocessor control. These long, thin instruments, which can be inserted into the closed chest through half-inch incisions, are designed to allow multiple degrees of freedom and can precisely emulate Inhibitors,research,lifescience,medical the surgeon’s movements at the control console.40 A clear benefit to the robotic approach over other methods, however, has not been demonstrated. Since the introduction of surgical robotics in the 1990s, there has been a progressive increase Inhibitors,research,lifescience,medical in utilization for thoracic surgical procedures. Although mitral valve and

non-cardiac thoracic procedures account for the majority of cases, there are increasing reports of robotic-assisted coronary revascularization procedures. These reports include robotic LIMA harvest followed by a traditional MIDCAB41 or left thoracotomy off-pump CABG,45 totally endoscopic coronary artery bypass (TECAB) on the arrested heart,42,43 Inhibitors,research,lifescience,medical and totally Inhibitors,research,lifescience,medical endoscopic bypass without CPB (OP-TECAB).43 Although most TECABs and OP-TECABs involve only a LIMA–LAD graft, recent reports described a series of multivessel

revascularization procedures.42 These series have demonstrated that each of these methods of limited access off-pump coronary bypass is associated with a shorter hospital stay, less time on mechanical ventilation, fewer transfusions, and a more rapid return to full activity. Inhibitors,research,lifescience,medical The operative times are considerably longer than for open procedures, but improved time efficiency with experience is the norm. Also, questions related to graft patency and long-term results persist. Several earlier reports suggested a Tanespimycin in vitro conversion to an open for procedure in > 50% of cases, but with increased experience conversion in the ≤10% range is more common.43 Because of the added expense and difficulty with learning the technique, the routine use of surgical robotics in CABG surgery does not seem likely in the near future. The robot has and will continue to evolve. Improved video resolution, lower-mass arms, the addition of a fourth tele-manipulator, and the availability of an elegant robotic coronary stabilizer will likely increase its effectiveness and extend its application. Refinement of automated distal anastomotic devices may further increase the growth of robotic coronary revascularization surgery.

Among the younger patients (aged 19 to 44), outpatient mental health treatment consumed approximately 50% of the annual expenditures ($10 244 in outpatient costs, 20 066 in total costs). In contrast, in those patients aged 75 and older, only 5% of the annual expenditures were for outpatient, care ($1755 of $34 320), and the vast majority of expenditures were for nursing home care ($28 395

or 83%). Even in old age, schizophrenia is expensive. The costs of treating schizophrenia increase with age, across the entire adult life span. The need for this level of care is a reflection #www.selleckchem.com/products/abt-199.html keyword# of the degree of symptomatology and disability in these patients. As Bartels et al point, out, interventions Inhibitors,research,lifescience,medical that optimize functioning and decrease use of nursing homes are particularly needed for

older patients with schizophrenia. Course of schizophrenia in late life The clinical presentation of older persons with schizophrenia differs somewhat from that of younger persons, and the course of this disorder into old age sheds light, on some unresolved cognitive and social issues. In this section, we discuss the clinical differences between patients with early- versus late-onset schizophrenia, review the emerging Inhibitors,research,lifescience,medical research describing changes in symptoms and neuropsychological deficits over time, and consider a new perspective on remission from schizophrenia. Age of onset of schizophrenia Since the Diagnostic and Statistical Manual of Mental Disorders, Third Edition-Revised (DSM-III-R), “lateonset” schizophrenia has been defined as onset of symptoms after the age of 44,3 and accounts for approximately Inhibitors,research,lifescience,medical 15% to 20% of all cases of schizophrenia.4 Most patients with late-onset schizophrenia have onset of illness during middle age. Onset after age 65 usually signifies Inhibitors,research,lifescience,medical very-lateonset

schizophrenia-like psychosis, which is typically secondary to general medical conditions, such as dementia or other also neurodegenerative disorders.5 Women are more likely to have late-onset schizophrenia than men. In addition, persons with late-onset schizophrenia tend to have better premorbid functioning, fewer negative symptoms, and less severe neurocognitive impairments. Although the conventional wisdom has been that, the symptoms of schizophrenia progress with age, recent investigations have found that many symptoms of schizophrenia improve with age. Older patients typically have fewer and less severe positive symptoms than their younger counterparts6; negative symptoms, however, tend to persist, into late life.5 Finally, patients with late-onset schizophrenia typically require lower daily doses of antipsychotics compared with patients with an early onset of the disorder.

Upon in vivo administration of

a PLGA based injectable depot, water interacts with the polymer and hydrolysis of the ester bonds commences. As the polymer degrades, its hydrophobicity decreases and the number of hydrophilic hydroxyl and carboxylic acid end groups in the www.selleckchem.com/screening/tyrosine-kinase-inhibitor-library.html matrix increases. An accumulation of hydrophilic acidic end groups has a twofold effect: (1) it increases the amount of water incursion into the polymer and (2) initiates autocatalysis Inhibitors,research,lifescience,medical of the polymer matrix [47]. Therefore, polymer degradation and, consequently, drug release from PLGA is a very complex and dynamic process. This is of particular significance as it provides the researcher a scientifically sound approach to select an appropriate polymer specific

to a therapeutic need or treatment regimen. When plotted as a function of time, drug release from a PLGA matrix occurs in three phases [32]. The first phase of release is known as “initial burst” Inhibitors,research,lifescience,medical and occurs as a result of detachment of surface associated drug or drug that is easily dissociated Inhibitors,research,lifescience,medical from accessible pores in the polymeric microspheres. Depending on the surface area and porosity, a high or low initial burst may be observed. The second phase of release, that is, diffusional release, is a consequence of initial polymer hydration and is followed by “erosional release” or the final phase of drug release. Once the polymer is hydrated, polymer autocatalysis ensues causing bulk hydrolysis, that is, complete polymer degradation and erosion (mass loss). Previous reports have also documented that properties

of the formulation have Inhibitors,research,lifescience,medical an impact on drug release kinetics [48]. Therefore, depending on the properties of the polymer and the microsphere dosage form, the rate and extent of each of these phases can be altered to customize drug release profiles. Hence, in this study, two PLGA copolymers having varying molecular weights and lactide:glycolide Inhibitors,research,lifescience,medical ratios as well as drug loading were evaluated with an aim to obtain Risperidone PLGA microspheres having varying duration of action. Results and discussions related Adenosine to the findings of the study demonstrate the suitability of this approach in developing sustained release formulations where in vivo behavior can be customized to meet patient needs. 2. Materials and Methods 2.1. Materials Risperidone was purchased from Cipla Ltd., India, and PLGA 50:50 (45 and 74kDa) and 75:25 (54 and 65kDa) from Boehringer Ingelheim (Ingelheim, Germany) and Alkermes (Cambridge, MA). All other chemicals were obtained commercially as analytical grade reagents. 2.2. Preparation of Microspheres The four formulations evaluated were 45kDa PLGA, 50:50 lactide:glycolide (Formulation A), 74kDa PLGA, 50:50 lactide:glycolide (Formulation B), 54kDa PLGA, 75:25 lactide:glycolide (Formulation C), 65kDa PLGA, 75:25 lactide:glycolide (Formulation D).

He had been treated with oral immunosuppressive agents, including prednisolone (10 mg daily), tacrolimus (4 mg, bid) and mizoribine (50 mg, qd). Vital signs on arrival included a blood pressure of 162/98 mmHg and a regular pulse rate of 73 bpm, and body temperature of 36.5℃. The initial electrocardiogram showed LVH with a strain pattern, ST-T changes in leads II, III, aVF, V3-V6 and short PR interval (Fig. 1). Chest radiography demonstrated cardiomegaly (cardiothoracic Inhibitors,research,lifescience,medical ratio = 70%) and blunting of both costophrenic angle (Fig. 2). Laboratory studies revealed that hemoglobin was 6.2 g/dL, BUN 64.2 mg/dL, creatinine 6

mg/dL, sodium 134 mEq/L, potassium 6.1 mEq/L, and serum N-terminal pro-B type natriuretic peptide level 126043 pg/mL. On hospital day two, two-dimensional transthoracic SB203580 echocardiography revealed Inhibitors,research,lifescience,medical concentric LVH (interventricular septal dimension 23 mm, LV posterior

wall dimension 22.8 mm), mimicking non-obstructive HCM (Fig. 3). The interventricular septal dimension and posterior wall dimension was thicker than 3 years ago (interventricular septal dimension 17 mm, LV posterior wall dimension 17 mm). And left atrial enlargement was seen (4.5 cm). Left ventricular systolic function was preserved (ejection fraction = 59%), but diastolic dysfunction was present. Pulsed-wave Doppler recording of mitral inflow revealed Inhibitors,research,lifescience,medical a phase resembling an abnormal relaxation diastolic filling pattern, with an ratio between early (E) and late (A) mitral inflow velocity (E/A) of 0.82 (Fig. 4A). The mitral annulus early diastolic tissue Doppler velocity (E’) and the E/E’ index were 2.64 cm/s and 26.4, respectively, indicating

increased LV filling pressure and a pseudonormal pattern (Fig. 4B). Inhibitors,research,lifescience,medical The patient was prescribed diuretics for dyspnea and epokine for anemia. And the patient’s condition improved. The patient’s history of early onset ESRD and echocardiographic findings were suggestive of Fabry cardiomyopathy as well as idiopathic HCM. Alpha-galactosidase Inhibitors,research,lifescience,medical activity assay was performed. The assay was performed by fluorescence assay with 4-methylumbelliferyl and sequencing. The patient was confirmed FD by demonstration of a low plasma α-Gal A activity of 3.8 nmoles/hr/mg (normal mean, 7.5-12.5 nmol/hr/mg). Sequent analysis of genomic DNA showed c.639 + 5G > A [IVS4 (+5)G > A] mutation in the α-Gal A gene leading to a low plasma α-Gal A activity. Family screening was PAK6 done, and his brother was also confirmed FD by α-Gal A enzyme activity test and renal biopsy. Enzyme replacement therapy with recombinant α-Gal A was started on an out-patient basis. Fig. 1 The initial electrocardiogram showed left ventricular hypertrophy with a strain pattern, ST-T changes in leads II, III, aVF, V3-V6. Fig. 2 Chest radiography. Chest radiography demonstrated cardiomegaly (cardiothoracic ratio = 70%) and blunting of both costophrenic angle. Fig. 3 Two dimensional echocardiography.

Therefore, we recommend a second interval image to more accurately gauge GR and indicate the need for intervention depending on patient suitability for AS.

Percutaneous renal biopsy (PRB) can determine SRM pathology and impact the decision for AS or intervention. Historical series demonstrate variable accuracy on the order of 70%, nondiagnostic rates around 30%, and rates of serious complications around 5%, preventing its widespread acceptance. A recent meta-analysis by Volpe and colleagues reviewed 49 publications regarding the use of PRB in the diagnosis and management of renal tumors.33 They found a low rate of complications and improved rates of detection with sensitivity ranging from 70% to 100%, specificity at 100%, and a cumulative Inhibitors,research,lifescience,medical accuracy Inhibitors,research,lifescience,medical > 90% for needle core biopsies. A recent publication by a center performing a high-volume of PRB found biopsy tissue to aid in the diagnosis of nearly 90% of patients.34 However, PRB is unreliable for tumor grade35 and performs less well in tumors < 3 cm.36 Because most SRMs are low-grade indolent RCC and can safely undergo a period of AS, one could

argue that there is little clinical utility in PRB for patients with a clear indication for AS or intervention. However, we find that PRB may Inhibitors,research,lifescience,medical provide additional information in patients without a clear indication for surgery or AS (DISSRM score 3–7) to aid in the decision and consultation process. In addition, we recognize that PRB provides tissue which, in addition to blood and urine, may provide biomarkers to improve the detection and surveillance of SRM. Conclusions SRMs ≤ 4 cm are commonly seen in clinical practice and represent a Inhibitors,research,lifescience,medical large proportion of newly diagnosed renal masses. Given recent epidemiologic trends and studies of the natural history of SRMs, most are believed Inhibitors,research,lifescience,medical to be indolent tumors with little potential for metastatic progression. AS has emerged as an alternative to extirpative or ablative treatments for these masses and should involve an informed decision by patient

and physician based on patient and tumor characteristics and the calculated risk of metastatic progression. Ongoing prospective studies, including the DISSRM Registry, will provide additional information regarding the use and timing of serial imaging in all patients undergoing AS. Main Points Small renal masses (SRMs; ≤ 4 cm in dimension) are an increasingly common clinical scenario for practicing urologists and physicians with contemporary epidemiological studies indicating that SRMs account for nearly one-half of all renal masses diagnosed. SRMs are biologically heterogeneous with 20% to 30% being benign lesions; 70% to 80% of malignancies are low-grade; early stage lesions are believed to behave in an indolent manner; and 20% to 30% are potentially aggressive tumors. Active surveillance (AS) has emerged as a viable IOX1 option for the management of SRMs with < 2% of patients progressing to metastatic disease in retrospective and prospective studies.

According to table 2, the overall scores of publication ethics, impact factor, and indexing level in the English language journals were significantly higher than those in the Farsi language ones, but their ranking was identical. Table 2 Comparison of the overall scores of publication ethics, ranking, impact factor, and indexing level between the English and Farsi journals There

was a significant positive correlation between the overall score of the publication ethics of the journals and their ranking (P<0.001) and impact factor according to the Kendall correlation (P=0.02). Furthermore, there was a significant difference Inhibitors,research,lifescience,medical between the overall score of publication ethics in different levels of indexing using the ANOVA (P<0.001). Discussion In this study, we evaluated the quality of publication ethics in the instructions Inhibitors,research,lifescience,medical to the authors of Iranian journals of medical sciences. Inhibitors,research,lifescience,medical As was demonstrated, the most frequently mentioned Crizotinib principles of publication ethics

in the instructions to authors were “redundant publication” (85%), “author’s responsibility for data accuracy” (83.8%), “aim and scope” (81.9%), “principles of medical ethics in the use of human samples” (74.4%), “review process” (74.4%), and Inhibitors,research,lifescience,medical “copyright” (71.2%). The Iranian journals of medical sciences, included in the present study, were of high quality in terms of editorial leadership

vis-à-vis the aforementioned ethical considerations as expressed in their instructions to authors. Nevertheless, the editors need to upgrade their instructions to authors regarding “principles of advertising” (1.2%), “authorship criteria” (15%), “integrity in reporting clinical trial results” (30.6%), “conflict of interest” Inhibitors,research,lifescience,medical (53.8%), and “principles of medical ethics in the use of animal samples” (65.6%). One of the most frequently mentioned ethical considerations was “redundant publication”, many which was significantly of a higher frequency in the English language journals than in their Farsi language counterparts (P<0.01). Kim et al.7 in Korea, showed that 5.93% of the index articles were associated with 29 duplicate articles, which exceeded expectations. Thus, they suggested that researchers receive further education on publication ethics. One way to overcome such a problem is to augment instructions to authors of journals. In a similar vein, a study by Kitagawa,8 in Japan suggested that raising awareness about duplication publication among researchers requires the understanding of publication ethics.