Metronidazol is not known to be effective against Ancylostoma nor did LH show in vitro sensitivity. This suggests either a pathogenic role of B hominis, sensitive to this agent, or the possibility of an occult Gardiasis selleck screening library (despite a negative PCR). Finally, when recognizing the reactive hypereosinophilic syndrome at an early stage, immunosuppressant therapy could be considered to prevent further organ damage.[4] We treated a 55-year-old man with complicated traveler’s diarrhea and eosinophilia, who was infected with three pathogens, including A duodenale and LH. We hypothesize that the high

eosinophilia caused by the acute hookworm infection resulted in both neurological and gastrointestinal symptoms, resembling a hypereosinophilic syndrome. The authors state they have no conflicts of interest to declare. “
“Rhinoscleroma is a chronic indolent granulomatous infection of the nose and the upper respiratory tract

caused by Klebsiella rhinoscleromatis; this condition is endemic to many regions of the world including North Africa. We present a case of rhinoscleroma in a 51-year-old Egyptian immigrant with 1-month history of epistaxis. We would postulate that with increased travel from areas where rhinoscleroma is endemic to other non-endemic areas, diagnosis Selleckchem XL184 of this condition will become more common. Though rarely observed, rhinoscleroma has to be taken into consideration in travelers returning with ear, nose, and throat presentations, particularly Amisulpride after traveling to developing countries or regions where this condition is endemic.[1, 2] A 51-year-old Egyptian male immigrant presented on May 14, 2010 at our hospital, with a 25-day history of light epistaxis from his left nostril. He had lived in Italy for 8 years and not traveled back to Egypt. Nasal endoscopy revealed a spontaneously bleeding nodule occupying the left nasal fossa. Blood tests including full blood count, coagulation screen, glucose, bone profile, and renal and liver function were all normal; inflammatory markers were not requested for. Lymphocyte subset analysis revealed a CD4/CD8 ratio at the upper limit of normal (2.9; normal

range 0.70–2.90); CD4 lymphocyte count was 778 cells/μL. He tested positive for hepatitis C (HCV-RNA 2 443 IU/mL; Abbott RealTime HCV assay Abbott Molecular, Wiesbaden, Germany), HBsAg was absent, and anti-HIV was negative. Computed tomography (CT) scanning and magnetic resonance imaging (MRI) showed a mass in the nasal fossae and ethmoid sinuses with complete bony destruction of bilateral nasal turbinates (Figure 1). Endoscopic biopsy was performed under local anesthesia. Histopathologic examination revealed numerous foamy macrophages (Mikulicz cells) containing bacteria (Figure 2); no fungal hyphae were found.[3] Staphylococcus aureus and Klebsiella rhinoscleromatis were isolated by culture of the tissue biopsy. A diagnosis of rhinoscleroma was made. Staphylococcus aureus was sensitive to all antibiotics tested.

The Keio deletion mutant library, which consisted of 3985 defined, single gene deletions of all nonessential genes in E. coli K-12, was grown in LB medium containing 30 μg mL−1 kanamycin in 46, 96-well plates. The library was replica-transferred with 96-well replicator to fresh LB medium in 96-well plates and grown to stationary phase

at 37 °C overnight. Ampicillin (25 μg mL−1) was added to each well of the overnight stationary phase cultures and the plates were further incubated at 37 °C for 24 h and 5 days. The antibiotic-exposed library Enzalutamide solubility dmso was then replica-transferred to LB plates following 24-h and 5-day exposure, respectively. After overnight incubation at 37 °C, the plates were scored for clones that did not grow or had reduced growth after ampicillin exposure. We did not use shaking cultures in the screens because it is not feasible to shake

all the 4000 mutants from the library in 46, 96-well microtiter plates. We also tested the identified ubiF and sucB mutants www.selleckchem.com/hydroxysteroid-dehydrogenase-hsd.html under nonshaking conditions in subsequent antibiotic and stress susceptibility tests to be consistent with the screening condition. Competent cells of sucB and ubiF mutants were prepared as described (Ausubel et al., 1987). Plasmid pCA24N containing sucB and containing ubiF genes were prepared from the corresponding clones of the ASKA library using the PureLink™ Quick Plasmid Miniprep Kit (Invitrogen, Carlsbad, CA) according to the manufacturer’s protocol. The plasmids containing the sucB and ubiF genes and a vector control were used to transform sucB and ubiF mutant competent cells by electroporation using MicroPulser™

Electroporation Apparatus (Bio-Rad). Transformed cells were plated on LB plates containing 30 μg mL−1 kanamycin and 30 μg mL−1 chloramphenicol. The desired complemented strains were identified by plasmid isolation and restriction digestion followed by electrophoresis on DNA agarose gels. MIC and MBC were determined using serial twofold microdilution of the antibiotics in LB broth. The MIC was recorded as the minimum drug concentration that prevented visible growth. MBC was defined as 99.9% killing of the starting inoculum and was determined as described. The susceptibilities of log- and stationary-phase sucB and ubiF deletion mutants and the parent strain BW25113 to various antibiotics, including ampicillin Metalloexopeptidase (100 μg mL−1), norfloxacin (3 μg mL−1), gentamicin (20 μg mL−1), trimethoprim (20 μg mL−1) and tetracycline (20 μg mL−1), were evaluated in drug exposure experiments in M9 minimal medium (pH 5.0). The cultures exposed to drugs were incubated without shaking at 37 °C for up to a week. Aliquots of cultures exposed to antibiotics were taken at different time points and washed in saline and plated for CFU determination on LB plates. For carbon starvation, overnight cultures of sucB and ubiF mutants and the parent strain BW25113 in M9 minimal medium were washed twice and resuspended in saline.

Improving mouth opening also favours phonation and swallowing. Performing exercises half an hour before dental treatment helps improving access22. Limited mouth opening has been reported as the greatest clinical difficulty for providing dental treatment23,24 as well as complicating intubation (Image 6)25. In this context, the consulted literature provides no definitive solutions. Slight increments in the maximum oral aperture have been obtained with mechanical techniques. Four techniques have been

described. In one patient, resin plugs of progressively increasing calibre increased maximal mouth opening from 19 to 23 mm after 10 min of exercise and to 30 mm at the end of a treatment session22. Unfortunately, this parameter returned to the initial values on discontinuing mechanical therapy. Other suggestions include daily exercises with wooden spatulas26, mouth trainer, and threaded acrylic cone. When prescribing

medications Selleck PTC124 in tablet form to patients with RDEB, it is important to consider that swallowing them could be difficult because of oesophageal stenosis or could cause oesophageal trauma. Therefore, prescriptions should be in soluble or liquid form. If sugar-free preparations are not available, parents should be advised of the sugar content and advised ideally to brush or at least rinse Trichostatin A cell line the child’s teeth with water directly after administration of the medication to reduce the risk of decay. Frequency of dental review should be scheduled on an individual

basis according to the amount of plaque present and risk of caries. Every 3–6 months may be sufficient for some patients, and for others, monthly appointments may be necessary3,5,15,22,27. The review sessions should be aimed at3,7,15,19,22: (a)   Caries prevention/early diagnosis. As the predisposition to develop intraoral squamous cell carcinoma (OSSC) increases with age, cancer screening must be considered a very important aspect of the review appointment in patients with RDEB from the second decade on19,28. Any unusual ulcer or white or red patches Cyclic nucleotide phosphodiesterase should be biopsied to ensure that these do not represent pre-cancer or cancer in the mouth. Frequent recall visits have shown to be useful to maintain dental health in patients with EB6,7,15. There are examples of patients who previously had extensive carious teeth who remained caries free when attending frequent review appointments6,7. On the other hand, clinical cases have been reported showing that patients who failed to attend the review visits developed several caries within 2 years, despite a preventive programme being explained11,16. As many patients have to commute long distances, review appointments should be scheduled together with other health care appointments. A shared care approach can be considered. Even though patients with milder oral involvement do not require many treatment modifications, a careful approach benefits every patient.

However, at face value, it seems that the IDF predictions for diabetes in China in 2010 failed to take account of the true prevalences measured in 2000–2001. That subsequent diabetes prevalence measured by glucose PD0332991 solubility dmso estimates in a large representative sample in 2007–20085 would be greater than the IDF prediction was perhaps entirely predictable, given that diabetes prevalence has been increasing, rather than reducing, everywhere else. Indeed, published data available in 1997 suggest that China had already experienced a three-fold rise in diabetes prevalence in the

preceding decade.8 It seems implausible to think that with increasing Westernisation in China, a factor known to influence increased diabetes prevalence, subsequent diabetes prevalence would fall as predicted by the IDF in 2010. It is possible that in setting the 2010 estimate there were concerns that the prevalence found in the 2000–2001 study was exaggerated. This seems improbable, however, given that another large prevalence study in 1995 of 29 859 subjects aged 30–64 years in Beijing found a measured diabetes prevalence of 3.63%,9,10 and is thus entirely consistent with the 5.2–5.8% prevalence found in the InterASIA study some five

to six years later given the rising diabetes rates in China at that time. Is there evidence that the apparent underestimate for China was repeated for other countries and regions? Unfortunately, the answer appears MG132 to be yes. In Sri Lanka, for example, the IDF predicted an 11.5% prevalence

in 2010. This was despite a publication which showed in 2005 that true measured prevalence in 6447 subjects was 14.2% for men and 13.5% for women,11 and a rather ironic comment in the Ceylon Medical Journal in 2006 that ‘The PFKL World Health Organization and International Diabetes Federation estimates and forecasts are much lower than the available local prevalence rates’.12 In the United Kingdom, the introduction of incentive payments in general practice led to the development of reasonably robust data on, among other things, diabetes prevalence. Thus, whilst the IDF Atlas was predicting a 4.9% prevalence in 2010, the data published annually by the NHS Information Centre, and freely available on the internet, showed that in 2008/09 the diabetes prevalence was 5.1% whereas in 2009/10 it had increased to 5.4%.13 In the Middle East, the gap between the IDF prediction and published actual prevalences may be greater. For instance in Iran, the IDF prediction for 2010 was a 6.1% prevalence,14 whereas meta-analysis of available data between 1996 and 2004 suggests that the figure in those aged >40 years was already 24% at least six years before the IDF prediction of only a quarter of that value.

However, at face value, it seems that the IDF predictions for diabetes in China in 2010 failed to take account of the true prevalences measured in 2000–2001. That subsequent diabetes prevalence measured by glucose SAHA HDAC datasheet estimates in a large representative sample in 2007–20085 would be greater than the IDF prediction was perhaps entirely predictable, given that diabetes prevalence has been increasing, rather than reducing, everywhere else. Indeed, published data available in 1997 suggest that China had already experienced a three-fold rise in diabetes prevalence in the

preceding decade.8 It seems implausible to think that with increasing Westernisation in China, a factor known to influence increased diabetes prevalence, subsequent diabetes prevalence would fall as predicted by the IDF in 2010. It is possible that in setting the 2010 estimate there were concerns that the prevalence found in the 2000–2001 study was exaggerated. This seems improbable, however, given that another large prevalence study in 1995 of 29 859 subjects aged 30–64 years in Beijing found a measured diabetes prevalence of 3.63%,9,10 and is thus entirely consistent with the 5.2–5.8% prevalence found in the InterASIA study some five

to six years later given the rising diabetes rates in China at that time. Is there evidence that the apparent underestimate for China was repeated for other countries and regions? Unfortunately, the answer appears learn more to be yes. In Sri Lanka, for example, the IDF predicted an 11.5% prevalence

in 2010. This was despite a publication which showed in 2005 that true measured prevalence in 6447 subjects was 14.2% for men and 13.5% for women,11 and a rather ironic comment in the Ceylon Medical Journal in 2006 that ‘The Docetaxel solubility dmso World Health Organization and International Diabetes Federation estimates and forecasts are much lower than the available local prevalence rates’.12 In the United Kingdom, the introduction of incentive payments in general practice led to the development of reasonably robust data on, among other things, diabetes prevalence. Thus, whilst the IDF Atlas was predicting a 4.9% prevalence in 2010, the data published annually by the NHS Information Centre, and freely available on the internet, showed that in 2008/09 the diabetes prevalence was 5.1% whereas in 2009/10 it had increased to 5.4%.13 In the Middle East, the gap between the IDF prediction and published actual prevalences may be greater. For instance in Iran, the IDF prediction for 2010 was a 6.1% prevalence,14 whereas meta-analysis of available data between 1996 and 2004 suggests that the figure in those aged >40 years was already 24% at least six years before the IDF prediction of only a quarter of that value.

The etiologies distribution according to the visited region is showed in Table 4. Diagnosis was confirmed in 42 cases (75%). In 12 cases (21.5%), P. falciparum was confirmed by thin blood smear. A micro-organism was demonstrated in CSF in 19 cases, of which 16 by polymerase SP600125 molecular weight chain reaction (PCR) (eight enteroviruses and eight Herpesviridae). Blood cultures were positive in three cases: brucellosis, typhoid fever, and a P. falciparum–Salmonella enteritidis coinfection. Three patients had a positive viraemia [HIV (n = 2)

and enterovirus (n = 1)]. Significant plasma seroconversion was reported in six cases (dengue, Toscana, HIV (n = 2), M. pneumoniae, and brucellosis). Throat and stool cultures were positive for enteroviruses in 11 cases. Among the confirmed diagnoses, viral CMI accounted for 57% (24 cases). Enteroviruses, herpes group viruses, and HIV represented 91.5% of identified viral CMI. There were only four bacterial infections (N. meningitidis, M. pneumoniae, B. Selleck PLX3397 melitensis, and S. typhi) and one fungal disease (cryptococcosis). The 14 other undetermined cases were considered as

possible viral CMI due to their clinical presentation, biological parameters (86% had a lymphocytic or mixed CSF profile), and spontaneously favorable outcome. Sixteen patients (28.5%), including 10 cases of severe malaria, were admitted in an intensive care unit with median stay duration of 9.5 days (range: 1–63 d). The mean hospitalization duration for the whole study population was 14 days. Malaria-related CMI had a significantly higher median stay duration than the other causes (18.5 vs 8 d, p < 0.05). One patient died of herpes simplex virus 1 (HSV-1) meningoencephalitis and four (7%) had sequelae (severe malaria, enteroviral encephalitis, brucellosis, and undetermined encephalitis, respectively). Little is known about the etiological

spectrum of travel-related CMI. Along with the recent travel-associated studies,1–8 we found that CMI are uncommon, accounting for 4.5% of all our hospitalized travelers, selleck all etiologies included and 3.5% excluding malaria. On a recent traveler’s health problems scale, tick-borne encephalitis and meningococcal infections have monthly incidence rates of 1/10,000 and 1/1 million, respectively.9 Travel-related CMI represented the third of all CMI. Thus, when examining a patient presenting with fever and/or neurological and/or psychiatric features, a history of recent travel should always be sought. As for the health care itinerary, we would like to emphasize the difficulties in diagnosis, the late management, and the important number of medical evacuations that are due to the atypical presentation rate (21%) and the unfamiliar etiologies of travel-related CMI.

It is important to accurately record discussions and disclosure strategy in difficult cases. Simultaneous partner testing during the original antenatal HIV test should be encouraged wherever possible, as couples will frequently choose to receive their HIV test results together, providing simultaneous disclosure. Reassurance about confidentiality is extremely important, especially regarding family members and friends GSI-IX supplier who may not know the diagnosis but are intimately involved with the pregnancy. Women from communities with high levels of HIV awareness may be concerned about HIV ‘disclosure-by-association’ when discussing

certain interventions, including taking medication during pregnancy, having a CS, and avoiding breastfeeding. Possible reasons such as the need to ‘take vitamins’, or having ‘obstetric complications’ and ‘mastitis’ may help the women feel more confident in explaining the need for certain procedures to persistent enquirers [11]. Between 20% and 80% of newly diagnosed HIV-positive pregnant women may have partners who are HIV negative, depending on the setting [6, 12]. Such couples

require advice regarding condom use and PEP following sexual exposure [13]. Many HIV-positive women will have issues relating to social support needs and/or immigration issues. In both cases, it is important to identify the issues as early as possible so that women can be referred for appropriate specialist advice and support. Women with very limited funds should have access to supplementary formula selleck compound feed [3, 14]. Dispersal is an issue that oxyclozanide arises and is generally felt to be inappropriate in pregnant women, especially if they are late in pregnancy or are recently delivered [15-17]. The testing of existing children should be raised with all newly diagnosed pregnant women. In practice, if the children are asymptomatic the testing is often most easily done when the newborn is attending paediatric follow-up for HIV diagnostic tests

[18]. Adherence to medication is of vital importance for the success of therapy, and pregnant women may need extra support and planning in this area, especially if there are practical or psychosocial issues that may impact adversely on adherence. Referral to peer-support workers, psychology support and telephone contact may all be considered [19]. Legislation concerning eligibility to free NHS healthcare in the UK changed in 2004. Patients who have been resident in the UK for 12 months do not have an automatic entitlement to free care in the NHS. There is an exclusion for ‘immediately necessary care’ and it has been argued that treatment of an HIV-positive pregnant woman falls within this category. Unfortunately, this has been interpreted differently within different Trusts, in some cases denying free treatment and thereby putting the health of mothers and their unborn babies at risk. No hospital should refuse treatment for HIV-positive pregnant women to prevent transmission of HIV to the baby.

“
“The aim of the study was to demonstrate the noninferiority of polyacrylamide

hydrogel (PH) vs. polylactic acid (PLA) for the treatment of facial lipoatrophy in HIV-infected adults. A randomized, blinded, multicentre, noninferiority 96-week study was carried out. Patients with facial lipoatrophy were randomly assigned to receive intradermal injections with PH or PLA, and were blinded to the filler. The primary efficacy endpoint was patient this website satisfaction at week 48 assessed using a visual analogue scale score (VAS). Secondary efficacy end-points included cheek thickness and skin-fold, lipoatrophy grading and quality of life. Safety was assessed by the reporting of adverse events. A total of 148 patients were included in the

study; 93% were men, the median age was 47 years, the median CD4 count was 528 cells/μL, and the median duration of antiretroviral therapy was 12 years. Mean VAS increased from 2.8 at baseline to 7.1 and 7.5 in the PLA and PH arms, respectively, at week 48 (P = 0.0002 for noninferiority) and was sustained at week 96 (6.7 and 7.9 in the PLA and PH arms, respectively; P = 0.003 for noninferiority). Cheek thickness and skin-fold increases and lipoatrophy improvement were similar in the two arms. Quality of life remained unchanged or improved depending on the questionnaire used. In injected patients, subcutaneous nodules emerged Pexidartinib in 28 (41%) and 26 (37%) patients in the PLA and PH arms, respectively (P = 0.73). Four patients in the PH arm developed severe inflammatory nodules, a median of 17 months after the last injection. PH and PLA have similar efficacies in the treatment of facial lipoatrophy, but PH may be associated with more delayed inflammatory nodules. “
“Smoking is the most

prevalent modifiable risk factor for cardiovascular diseases among HIV-positive persons. We assessed the effect on smoking cessation of training HIV care physicians in counselling. The Swiss HIV Cohort Study (SHCS) is a Cyclin-dependent kinase 3 multicentre prospective observational database. Our single-centre intervention at the Zurich centre included a half day of standardized training for physicians in counselling and in the pharmacotherapy of smokers, and a physicians’ checklist for semi-annual documentation of their counselling. Smoking status was then compared between participants at the Zurich centre and other institutions. We used marginal logistic regression models with exchangeable correlation structure and robust standard errors to estimate the odds of smoking cessation and relapse. Between April 2000 and December 2010, 11 056 SHCS participants had 121 238 semi-annual visits and 64 118 person-years of follow-up. The prevalence of smoking decreased from 60 to 43%. During the intervention at the Zurich centre from November 2007 to December 2009, 1689 participants in this centre had 6068 cohort visits. These participants were more likely to stop smoking [odds ratio (OR) 1.23; 95% confidence interval (CI) 1.07–1.

“
“The aim of the study was to demonstrate the noninferiority of polyacrylamide

hydrogel (PH) vs. polylactic acid (PLA) for the treatment of facial lipoatrophy in HIV-infected adults. A randomized, blinded, multicentre, noninferiority 96-week study was carried out. Patients with facial lipoatrophy were randomly assigned to receive intradermal injections with PH or PLA, and were blinded to the filler. The primary efficacy endpoint was patient BKM120 concentration satisfaction at week 48 assessed using a visual analogue scale score (VAS). Secondary efficacy end-points included cheek thickness and skin-fold, lipoatrophy grading and quality of life. Safety was assessed by the reporting of adverse events. A total of 148 patients were included in the

study; 93% were men, the median age was 47 years, the median CD4 count was 528 cells/μL, and the median duration of antiretroviral therapy was 12 years. Mean VAS increased from 2.8 at baseline to 7.1 and 7.5 in the PLA and PH arms, respectively, at week 48 (P = 0.0002 for noninferiority) and was sustained at week 96 (6.7 and 7.9 in the PLA and PH arms, respectively; P = 0.003 for noninferiority). Cheek thickness and skin-fold increases and lipoatrophy improvement were similar in the two arms. Quality of life remained unchanged or improved depending on the questionnaire used. In injected patients, subcutaneous nodules emerged selleck in 28 (41%) and 26 (37%) patients in the PLA and PH arms, respectively (P = 0.73). Four patients in the PH arm developed severe inflammatory nodules, a median of 17 months after the last injection. PH and PLA have similar efficacies in the treatment of facial lipoatrophy, but PH may be associated with more delayed inflammatory nodules. “
“Smoking is the most

prevalent modifiable risk factor for cardiovascular diseases among HIV-positive persons. We assessed the effect on smoking cessation of training HIV care physicians in counselling. The Swiss HIV Cohort Study (SHCS) is a not multicentre prospective observational database. Our single-centre intervention at the Zurich centre included a half day of standardized training for physicians in counselling and in the pharmacotherapy of smokers, and a physicians’ checklist for semi-annual documentation of their counselling. Smoking status was then compared between participants at the Zurich centre and other institutions. We used marginal logistic regression models with exchangeable correlation structure and robust standard errors to estimate the odds of smoking cessation and relapse. Between April 2000 and December 2010, 11 056 SHCS participants had 121 238 semi-annual visits and 64 118 person-years of follow-up. The prevalence of smoking decreased from 60 to 43%. During the intervention at the Zurich centre from November 2007 to December 2009, 1689 participants in this centre had 6068 cohort visits. These participants were more likely to stop smoking [odds ratio (OR) 1.23; 95% confidence interval (CI) 1.07–1.

Clinical outcomes were satisfactory in all 10 cases of HBV reactivation. Hepatitis B virus reactivation was found in 15 (12.3%) patients among the 122 HBsAg-positive patients with rheumatic diseases treated with anti-TNF agents or DMARDs. “
“Endothelial progenitor cells (EPCs) are unique populations which have reparative potential in overcoming endothelial damage and reducing cardiovascular risk. Patients with ankylosing spondylitis (AS) have increased risk

of cardiovascular morbidity and mortality. The aim of this study was to investigate the endothelial progenitor cell population in AS patients and its potential relationships with disease variables. Endothelial progenitor cells were measured in peripheral blood samples from 20 AS and 20 healthy controls by flow cytometry on the basis selleck chemicals of CD34 and CD133 expression. Disease activity was evaluated by using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). Functional ability was monitored by using Bath Ankylosing Spondylitis Thiazovivin price Functional Index (BASFI). EPCs were depleted in AS patients as compared to healthy controls (CD34+/CD133+: 0.027 ± 0.010% vs. 0.044 ± 0.011%, P < 0.001). EPC depletions were significantly associated with disease duration (r = −0.52, P = 0.01), BASDAI (r = −0.45, P = 0.04) and C-reactive protein (r = −0.5, P = 0.01). This

is the first study to demonstrate endothelial progenitor cell depletion in AS patients. EPC depletions inversely correlate with disease duration, disease activity and inflammation, suggesting the pivotal role of inflammation in depletion of EPCs. EPC would possibly also serve as a therapeutic target for preventing cardiovascular disease in AS. “
“To provide a critical evaluation of quality and quantity regarding scientific efforts on antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides (AAV) during the past 20 years. Scientometric benchmark procedures,

density-equalizing mapping and large-scale data analysis were used to visualize bi- and multilateral research cooperation and institutional Acyl CoA dehydrogenase collaborations, and to identify the most successful countries, institutions, authors and journals concerned with AAV. The USA are the most productive supplier and have established their position as center of international cooperation with 22.5% of all publications, followed by Germany, the United Kingdom, France and Japan, respectively. The most successful international cooperation proved to be the one between the USA, Germany and the UK. A distinct global pattern of research productivity and citation activity was revealed, with the USA and Germany holding both the highest h-index and the highest number of total citations, but Denmark, Sweden and the Netherlands leading with regards to the citation rate. Some large and productive countries such as Japan, China and Turkey show only a few international cooperations.