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The study aimed to disclose the Accuracy of Estimate of the difficulty and distinction parameter for the item and the ability for TIMSS Test for the science subject for the second intermediate class in Kingdom of Saudi Arabia according to the two parameter Logistic model for the theory of item responding. To achieve the aim of the study, the researcher used the descriptive analysis approach. She has used the data of TIMSS 2019 Test for the science subject for a sample of 5680 male and female student. They were chosen randomly from 209 school in Kingdom of Saudi Arabia. The statistical programs SPSS and BILOG- MG3 were used to analyze the data. The results showed that: the values of the difficulty parameter ranges between (1.79 –) to (4.04) with Arithmetic average (0.42). it showed that the minimum value of the standard error in assessing the difficulty parameter which reached (0.098). the difficulty of the item value reached (- 0.69), the value of the distinction parameter ranged between (0.38) to (1.50) with Arithmetic average (0.85). The minimum value of the standard error in assessing the distinction parameter which reached (0.09). the distinction of the item value reached (0.38). As for the values of assessing the ability for the individuals in the test, it ranged between (- 3.610) to (4) with Arithmetic average (0.03). The minimum value of the standard error reached (0.49) at assessing the ability (-0.58). the study concluded many recommendations, including: establishing the training courses and workshops for male and female teachers in building the tests items according to the levels of TIMSS test, engaging the teachers in the workshops which are established by the education ministry to discuss TIMSS results and making more researches concerning TIMSS test by using the other models for the respond theory for the item.

Background and Objective Insomnia is a common symptom that is experienced by the patients post hematopoietic stem cell transplant that interfere with recovery outcomes and patients’ quality of life. Little is known about insomnia among post hematopoietic stem cell transplant in Jordan and in other Arab countries. The purpose of the current study was to identify the levels of insomnia and the related factors in post hematopoietic stem cell transplant.Methods A descriptive cross-sectional correlational design was used to guide this study. Data was collected from 163 patients by the Arabic version of the Insomnia Severity Index (ISI).Results The participant’s average ISI was 14.06 ± 7.71 indicating sub-threshold insomnia. Regarding the insomnia levels, 23.9% of the participants reported no insomnia, 27.6% had subthreshold insomnia, 31.3% had moderate clinical insomnia, and 17.2% had severe clinical insomnia. A significant difference in insomnia levels in some related factors was reported including the higher educated patients (t = 2.40, p = 0.018), patients who received allogeneic transplants (t = -2.932, p = 0.004), and patients within a 30 days’ post-transplant (F (160, 2) = 61.03, p < 0.001).Conclusions In conclusion, the overall prevalence of insomnia among post HSCT patients was 48.5% (n = 79) that suggested clinical insomnia, and it was affected by several clinical variables. Further studies are needed to provide appropriate interventions to decrease insomnia levels among patients.

Objective:The aim was to evaluate nurses’ self-efficacy, confidence, and nurse-patient interaction during caring of patients with coronavirus disease 2019 (COVID-19).Methods:A cross-sectional design with online survey was used with a Self-efficacy scale, Self-confidence scale, and Caring nurse-patient interaction scale: 23-item Version-Nurse (CNPI-23 N).Results:A sample of 120 nurses participated in the current study. The results showed that the participants had a moderate level of self-efficacy, self-confidence and interaction (M = 28.84 (SD = 7.7), M = 47.41 (SD = 9.0), and M = 93.59 (SD = 16.3), respectively). Positive relationships were found between nurse’ self-efficacy, self-confidence, and nurse-patient interaction (r = 0.81; P < 0.0001 and 0.79; P < 0.0001, respectively). Significant differences were found in self-efficacy according to years of experience, academic qualifications and position (F = 2.10; P = 0.003; F = 3.60; P = 0.002, and F = 2.60; P =0.007, respectively). Furthermore, the results indicated that there was a significant difference in self-confidence and nurse-patient interaction also.Conclusion:Nurse educators and administrators should develop and implement further strategies, such as continuing education and training, compensatory payment, organizational support, and availability of protective measures to increase their self-efficacy, self-confidence, and interaction with COVID-19 patients.

Background: Fatigue, depression and sleep disturbance are regarded as a symptom cluster associated with pregnancy. The mediation effect of sleep disturbance on the relationship between depression on fatigue is still unclear. Objective: To assess the mediation effect of sleep disturbance on the established relationship between depression and fatigue among pregnant women. Methods: This study used a cross-sectional design. Pregnant women (n = 130) at a private gynecology and obstetrics outpatient clinic in Amman, Jordan. Participants were recruited to complete the Brief Fatigue Inventory, the Insomnia Severity Index, and the Zung depression scale, in addition to the demographic questionnaire. The mediation effect was examined through a Hierarchal Multiple Regression model. Results: A total of 130 pregnant women participated (mean of ages= 27.3). Of those, 41.5% were in the first trimester, while the rest were in their second and the third trimesters (27.7%, and 30.8%, respectively). Regression analysis indicated that about 23% of the variation of fatigue was explained by depression. Nonetheless, 47% of the variance of fatigue was explained by depression after identifying the mediation effect of sleep disturbance. Conclusion: The mediation role of sleep disturbance between depression and fatigue added a new approach to the assessment and prognosis of fatigue during pregnancy.

Introduction: Sleep Quality disturbances are common among nurses especially those working in stressful situations such as emergency room. Additionally, sleep quality disturbances were found to interfere with nurses’ quality of life and work performance. No studies have found the effect of fluctuated shifts on sleep quality among nurses. Objectives: To examine the impact of shift fluctuations on sleep quality among nurses working in the emergency room. Methods: A cross-sectional, descriptive design was employed. Five emergency rooms were selected from public and private hospitals located in Amman, Jordan. The selected hospitals were also referral sites with capacity of more than 200 beds. A convenient sample of nurses who had a minimum of six months experience in the emergency room and working on rotating shifts were eligible for participation. Nurses with known chronic respiratory problems and sleep apnea were excluded. A self-administered questionnaire including a demographic and work-related questions, and the Arabic version of the Pittsburgh Sleep Quality Index were provided. Shift fluctuations were clustered based on interchanging between morning, evening and night shifts. Results: A total of 179 emergency nurses working in rotating shifts participated in the study. The majority of the nurses were poor sleepers. The study found no significant differences between different shifts interchange and sleep quality. However, interchange between morning and evening shift reported the highest sleep disturbance. Sleep quality was positively correlated with the length of experience, while negatively correlated with the age and the number of monthly shifts. Nurses who declared higher satisfaction and ability to work under pressure revealed better sleep quality. Conclusion: Emergency room nurses showed poor sleep quality. While there was no specific shift interchange cluster inducing poor sleep quality, some demographical and work-related characteristics indicated their influence on sleep quality.

Fatigue is the most reported and most distressing symptom among patients with cancer. However, no questionnaire that measures fatigue and fatigue interference with life has been translated into Arabic.This study aimed to translate and validate the Arabic version of the Brief Fatigue Inventory (BFI-A).The BFI was translated into Arabic using the forward-backward translation technique. This cross-sectional study collected data from cancer patients through a self-administered questionnaire that included the BFI-A, Insomnia Severity Index (ISI), Zung Depression Scale (ZDS), MD Anderson Symptom Inventory total score (MDASI), and Medical Outcome Study Short Form 36 (SF-36) Vitality Subscale. Descriptive and inferential statistics were used including mean, standard deviation, internal consistency, and correlation coefficient using Pearson's correlation.A total of 79 patients were recruited in Amman, Jordan, in 2015. Mean of the total BFI-A was 4.01 (2.4), showing that 83.5% had nonsevere fatigue. Cronbach's α coefficient of the BFI-A was 0.93. The correlations between total BFI-A scores and BFI-A items were significant (P0.05) and ranged from 0.75 to 0.86. BFI-A showed a significant correlation (P0.05) with the following tools: ISI = 0.70, ZDS = 0.69, MDASI = 0.75, and SF-36 Vitality Subscale = -0.57.This study suggests that the BFI-A is a reliable and valid tool to assess fatigue among Arab cancer patients.دراسة للتحقق من النسخة العربية لمقياس التعب الوجيز (BFI–A).خالد سليمان، محمود الكلالدة، لؤي أبو شحرور، برنيس ييتس، آن بيرجر، تيتو مندوزا، ملكة ملك، أيمن بني سلامة، شارلز كليلاند، أحمد المنشاوي.يُعدّ التعب أكثر الأعراض التي يشكو منها مرضى السرطان وأكثرها تكديراً لهم. ومع ذلك، لم يُترجَم إلى اللغة العربية أي استبيان يقيس التعب ومدى إعاقته لحياة المريض.كانت هذه الدراسة تهدف إلى ترجمة "مقياس التعب الوجيز" (BFI-A) والتحقق من نسخته العربية.تُرجم المقياس إلى اللغة العربية بطريقة الترجمة المباشرة والعكسية. وجمعت هذه الدراسة المقطعية بيانات من مرضى السرطان من خلال استبيان ملأه المرضى بأنفسهم وتضمَّن "مقياس التعب الوجيز" (BFI-A)، و"مؤشر شدة الأرق" (ISI)، و"مقياس زونج للاكتئاب" (ZDS)، ومجموع درجات "قائمة أعراض" (MDASI)، و"المقياس الفرعي للحيوية في دراسة النتائج الطبية المختصرة المكونة من 36 بنداً" (SF-36). واستُخدمت إحصاءات وصفية واستنتاجية، منها المتوسط، والانحراف المعياري، والاتساق الداخلي، ومعامل الارتباط باستخدام ارتباط بيرسون.استعين اجمالا بتسعة وسبعين مريضا في مدينة عمان الاردنية عام 2015. وكان متوسط مجموع درجات « مقياس التعب الوجيز (BFI-A) هو 4.1)، مما يدل على ان 83.5٪ كانوا يعانون تعبا غير شديد. وكان معامل كرونباخ الفا لمقياس التعب الوجيز هو 0.93. وكانت علاقات الترابط بين مجموع درجات « مقياس التعب الوجيز » وبنود هذا المقياس علاقات وثيقة (0.05P)، وتراوحت من 0.75 الى 0.86. وتبين وجود ترابط وثيق (0.05P) بين « مقياس التعب الوجيز BFI-A)» والمقاييس التالية: مؤشر شدة الارق (0.70) (ISI)، ومقياس زونج للاكتئاب (0.69) (ZDS)، وقائمة الاعراض (0.75) (MDASI)، والمقياس الفرعي للحيوية في دراسة النتائج الطبية المختصره المكونه من 36 بندا (0.57-) (SF-36).تشير هذه الدراسة إلى أن (BFI-A) أداة موثوقة وصالحة لتقييم التعب لدى مرضى السرطان الناطقين بالعربية.Étude de validation de la version arabe du Brief Fatigue Inventory (BFI-A).La fatigue est le symptôme le plus fréquent et le plus éprouvant chez les patients atteints de cancer. Cependant, aucun questionnaire mesurant la fatigue et son interférence avec la vie quotidienne n’a été traduit en arabe.La présente étude visait à traduire et à valider la version arabe du Brief Fatigue Inventory (BFI-A).Le BFI a été traduit en arabe à l’aide de la technique de traduction/rétro-traduction. La présente étude transversale a permis de collecter des données de patients atteints de cancer en recourant à un auto-questionnaire comprenant le BFI-A, l’index de Sévérité de l’Insomnie (ISI), l’échelle d’auto-évaluation de la dépression de Zung (ZDS), l’inventaire des symptômes M.D. Anderson (MDASI) et la sous-échelle vitalité de la forme abrégée du questionnaire généraliste SF-36 (qualité de vie) du Medical Outcome Study. Des statistiques descriptives et inférentielles ont été utilisées, y compris la moyenne, l’écart type, la cohérence interne et le coefficient de corrélation de Pearson.79 patients au total ont été recrutés à Amman (Jordanie) en 2015. La moyenne totale du BFI-A était de 4,01 (2,4), indiquant que 83,5 % des patients présentaient un état de fatigue non sévère. Le coefficient alpha de Cronbach du BFI-A était de 0,93. Les corrélations entre les scores totaux et les rubriques du BFI-A étaient significatives (p0,05) et étaient comprises entre 0,75 et 0,86. Le BFI-A affichait une corrélation importante (p0,05) avec les instruments suivants : ISI = 0,70 ; ZDS = 0,69 ; MDASI = 0,75 et la sous-échelle vitalité du SF-36 (qualité de vie) = −0,57.La présente étude suggère que le BFI-A est un outil valable et fiable pour évaluer la fatigue chez les patients arabes atteints de cancer.

Early warning Score is a bedside track and trigger system used to facilitate early detection and management of deteriorating patients. Although emergency department nurses are the key to implement this task, their interaction and contribution to provide an estimate of patients' severities is still suboptimal and neglected.This study aimed to introduce an educational programme using the Modified Early Warning Score (MEWS) to nurses working in the emergency departments and to assess the programme impact on nurses' self-efficacy and perceived role.This non-equivalent, multi-centre, quasi-experimental study, assigned two groups of emergency nurses into intervention and control. The intervention group received three interactive educational sessions totalling 12 h relevant to the application of MEWS in emergency situations using a validated programme called 'COMPASs'. The other group received no intervention. Both groups were assessed for self-efficacy and perceived role in the pre-test, immediate post-test, and three months later follow-up phase.A total of 232 participants were divided into intervention and control groups (118 and 114, respectively), having no variations in age, gender, or experience as registered nurses. The intervention group showed a significant improvement in the self-efficacy scores for the nurses (F: 152.21, df: 2, p 0.001). Similarly, the intervention nurses exhibited a significant improvement in the perceived role scores after the intervention (F: 121.20, df: 2, p 0.001). The control group showed no changes in either variable across the three phases. While older nurses with longer experience showed higher self-efficacy after the programme, the perceived role explained an additional 57.0% of the variance in self-efficacy after controlling these two demographics (Beta: 0.743, p 0.001, CI: 1.18-1.66).The existence of an early warning system in the emergency department is able to enhance nurses' self-efficacy and perceived role coinciding with nursing interactions with the multidisciplinary team.

Objectives The objective of this study is to assess quality of nursing work life (QNWL) and related factors among nurses working in emergency room (ER). Methods A cross‐sectional descriptive design was employed. Data were collected from a convenient sample of nurses working in ER Eligible participants were required to complete a demographic and work related variables sheet, the Brooks Quality of Nursing Work Survey (BQNWLS). Results A total of (186) nurses participated in the study. Study participants reported a BQNWL mean score of (M = 140.15, SD = 28.34) indicating a moderate BQNWL. Additionally, the participants scored moderate levels on all BQNWL subscales. The mean score of BQNWL was statistically better for nurses who had training courses on emergency department (t = −2.663, P = 0.008). However, no other statistically significant differences were found in BQNWL scores in regarding to demographic and work related variables. Conclusion The results of this study reported a noticeable alteration in QNWL among nurses working in ER. The nurses had a moderate QNWL levels. Also, the results emphasized on the importance of conducting further interventional research studies in the future to establish effective measures to enhance nurse QNWL. Consequently, this may improve the provided nursing care for the patients and their families.

The aim of the present study was to assess the effectiveness of implementing an educational module based on the Centers for Disease Control and Prevention guidelines on the nurses' knowledge and self-confidence regarding central line catheters (CVCs) caring, complications, and application. A pretest-posttest quasi-experimental design was used. A sample of 100 oncology nurses from oncology units participated in two groups, experimental group (N = 50) and control group (N = 50). The participants completed knowledge test and self-confidence scale before and after the educational program. The results showed that there was a significant difference between the experimental and control groups regarding knowledge related to CVC guidelines and management after the interventional sessions (t = -7.85, P = .001). The mean and standard deviation for experimental group were 15.95 (5.45) and 7.35 (2.73) for the control group. Furthermore, the results showed significant difference (t = -22.20, P = .001) between the experimental group (M = 61.50, SD = 14.20) and the control group (M = 35.50, SD = 7.20) regarding self-confidence in managing CVCs. It is concluded that using educational program strengthens nurses' skills, improves safety, and increases opportunity to learn, and thus, it will increase the self-confidence.

Subjective Idiopathic Tinnitus is a common and disturbing condition characterized by an auditory perception of sound...

Background There is still no concrete guidance for assessing malnutrition risk in the critically ill. Nutrition Risk in the Critically Ill (NUTRIC) score is undertaken cautiously compared with other validated tools such as bioelectrical impedance analysis (BIA). This study aimed to assess the malnutrition risk in the critically ill using NUTRIC score and assess its congruency with the BIA. Methods In this cross-section observational study, intensive care unit (ICU) patients from various etiologies were assessed using the earlier tools in addition to other prognostic markers (Acute Physiologic Assessment and Chronic Health Evaluation II [APACHE II] and Sequential Organ Failure Assessment [SOFA] scores), caloric attainment, and feeding complications. Results Of a total 411 assessed patients, 313 (76.2%) were enterally fed, and 318 (77.4%) were mechanically ventilated. Mean age was 60.7 years, and the median of the assessment since admission was the 12th day. Of those enterally fed patients, 57.9% attained the caloric requirements. Both APACHE II and SOFA scores were compatible in ascertaining ICU mortality at a moderate level (17.88 and 7.17, respectively). The NUTRIC score and phase angle (PA) measured by BIA revealed no differences in the malnutrition risk between patients with and without enteral nutrition. However, regression indicated that the NUTRIC score has explained only 1.1% of the variance of PA after controlling other covariates (β = -0.222, P = .009, confidence interval = -0.31 to -0.05). Conclusions NUTRIC score has a limited prediction to the urgency of aggressive nutrition therapy within the early period of ICU admission.

Grobner basis are considered one of the modern mathematical tools which has become of interest for the researchers in all fields of mathematics. Grobner basis are generally polynomials with multiple variables that has certain characteristics. it's includes two main axis: 1- The first axis we have presented the definition of Grobner basis and their properties. 2- The second axis we have studied some applications of Grobner basis, and we give some examples about its. The goal of these paper is to identify Grobner basis and some algorithms related to how to find them and talked about the most important applications, including: the issue of belonging and the issue of containment, and to reach our goal to follow the analytical and structural approach, we defined these basis and we have many results, The Grosvenor we obtained is not alone in general and to be single, some additional conditions must be set on these basis, and we conclude that Grobner basis have many applications in the solutions of algebraic equations in more than one transformer and in many fields.

Breast cancer is considered one of the main types of cancer among female worldwide and in Jordan also. Early detection of it will improve the prognosis and decrease the mortality rate also. Thus, this study was conducted to assess the predictors of breast self-examination performance among Jordanian university female students. Across-sectional design was utilised in this study. A sample of 100 participants was completed the study survey (The Champion's Health Belief Model Scale). The main results or regression analysis showed that confidence (β = .71, p

Background:Ketafol is a combination of Ketamine and Propofol in different proportions. Various gynecological techniques are short periods and need only pain relief with moderate sedation. Aim:To compare the benefit of Ketafol with different concentration in dilatation and curettage regarding onset of sedation, level of sedation, recovery time, post operative pain and surgeon satisfaction score. Methods:Our respective investigation includes 104 adult female patients, aged 20-38 years, classed I by the American Society Of Anesthesiologists and planned for elective Dilatation and Curettage procedure with a period of surgical intervention not more than 15 min, during the period Jan 2015 - Mar 2016, at Prince Hashim hospital, Zarqa, Jordan, after obtaining approval from our Ethics and research board review Committee of the Royal Medical Services and written informed consent from all participants. Patients were divided into two groups: group (I, n=51) given Ketafol containing Ketamine: Propofol (1:1) while group (II, n=53) given Ketafol containing Ketamine: Propofol (1:2) .Then we compare two groups regarding onset of sedation, level of sedation using Ramsey sedation scale, recovery time using modified Aldrete score, post operative pain using verbal rating scale and surgeon satisfaction score. Results: Ketofol in groups I and II was similar in onset of sedation (GI: 1.46 ± 0.45 min, GII: 1.47 ± 0.59 min), intraoperative Ramsey sedation scores at 10 min (GI: 5.47 ± 0.37, GII: 5.72 ± 0.24) and recovery times (GI: 3.87 ± 0.88 min, GII: 3.42 ± 0.54 min). Regarding the onset of sedation, intraoperative sedation score and recovery time, there were no remarkable differences between the groups. Conclusion:Ketofol in a proportion of 1:2 induces better sedation level in comparison to the other group, both ketofol concentrations (1:1 and 1:2) are comparable regarding sedation profile in dilatation and curettage procedures.

Behcet disease (BD) is a multisystem disorder, with vasculitis as its underlying pathological process, in contrast to the classic triad of recurrent oral and genital ulcerations, with uveitis. Vascular involvement in BD includes venous thrombosis, arterial occlusion, and pulmonary artery and aortic aneurysm formation. Cardiac involvement is rare and often obscure. It includes intracardiac thrombi formation, and is associated with a poor prognosis. Our objectives are to describe two cases with BD, complicated with vascular and cardiac involvement, and to raise awareness of these rare complications, the needed routine surveillance, and thus to prevent inappropriate interventions, serious outcomes, and mortality. We present two male patients from the Mediterranean Basin with BD. The first was diagnosed early as a BD patient. The second was diagnosed at the time of cardiovascular (CV) involvement. We recommend that patients who are diagnosed, or even suspected of suffering from BD, especially in endemic areas along the Silk Route pathway, should be followed up routinely for CV involvement, even if rare, obscure, or with a bizarre presentation.

The electrocardiogram (ECG) is the primary tool in the diagnosis of acute myocardial infarction (AMI). However, other clinical conditions, both cardiac and noncardiac originated pathologies, may result in ECG tracing of AMI. This may lead to an incorrect diagnosis, exposing the patients to unnecessary tests and potentially harmful therapeutic procedures. The aim of this report is to increase the still insufficient awareness of clinicians from multiple disciplines, regarding the different clinical syndromes, both cardiac and noncardiac, associated with ECG abnormalities mimicking AMI, to avoid unjustified thrombolytic therapy or intervention procedures. During a 9-year period, the data from six patients (five females, one male; mean age, 50 years [range, 18 to 78 years]) who were admitted to cardiac care unit (CCU) with transient ECG changes resembling AMI were recorded retrospectively. During this 9-year period, 5,400 patients were hospitalized in CCU: 1,350 patients were diagnosed as ST-elevation myocardial infarction (STEMI) and 4,050 patients were diagnosed as non-ST-elevation myocardial infarction (NSTEMI). Only two out of six patients had chest pain with ECG changes criteria suspicious of AMI. STEMI was suspected in four out of six patients. All patients, but one, had normal left ventricular (LV) function. One patient had transient LV dysfunction. All patients, but one, with perimyocarditis, had normal serum cardiac markers. In four out of six patients, who underwent coronary arteries imaging during hospitalization (by angiography or by CT scan), normal coronary arteries were documented. Two patients who underwent ambulatory cardiac CT scan imaging after being discharged from hospital documented patent coronary arteries (case no. 3), or some insignificant irregularities (case no. 4). The discharge diagnoses from CCU were as follows: postictal syndrome, pericarditis, hypothermia, stress-induced (“tako-tsubo”) cardiomyopathy, anaphylactic reaction, and status of postchemotherapy. All patients experienced full recovery with normal ECG tracing. During the 5-year follow-up, all patients were alive, and cardiac morbidity was not reported. We conclude that both cardiac and noncardiac clinical syndromes may mimic AMI. Comprehensive clinical examination and profound medical history are crucial for making the correct diagnosis in conditions with ECG changes mimicking AMI.

Understanding the mechanism and the main components involved in rheumatic mitral regurgitation (MR) associated with dominant pliable mitral stenosis (MS) may improve our ability to repair some mixed rheumatic mitral valve pathologies.To assess mitral valve structural components in pure mitral stenosis versus mitral stenosis associated with mild regurgitationUsing two-dimensional echocardiography, we performed mitral valve structural analysis in two groups of patients prior to balloon mitral valvuloplasty (BMV). The first group, consisting of 13 females and 2 males (mean age 39 +/- 5 years), suffered from pure pliable mitral stenosis (PPMS), while the second group, with 22 females and 2 males (mean age 44 +/- 5 years), had mixed mitral valve disease (MMVD) characterized by mild MR in the presence of dominant pliable MS. All echocardiographic measurements relating to the mechanism of MR were undertaken during the systolic phase.The mean Wilkins scores of the PPMS and MMVD groups were 7 +/- 1 and 8 +/- 1 respectively (P = 0.004). No significant differences were found between the MMVD group and the PPMS group regarding annular circumference (15.5 +/- 1.4 cm vs. 15.4 +/- 1.6cm, P = 0.84), annular diameter (36 +/- 4 mm vs. 38 +/- 5 mm, P = 0.18), and chordae tendinae length directed to the anterior mitral leaflet (AML) (10 +/- 2 mm vs. 11 +/- 2 mm, P = 0.137). However, anterior vs. posterior mitral leaflet length during systole was significantly lower in the MMVD than in the PPMS group (2.2 +/- 0.5 vs. 2.8 +/- 0.4, P = 0.02), whereas the AML thickness at the co-aptation point was greater in the MMVD than in the PPMS group (7 +/- 1 vs. 5 +/- 1 mm, P = 0.0004).In rheumatic valves, thickening and shortening of the AML are the main factors determining the appearance of mild MR in the presence of dominant pliable MS.

This descriptive correlational study describes the translation process and the psychometric testing of the Pittsburgh Sleep Quality Index (PSQI). The PSQI has been successfully translated into Arabic and back-translated into English by 10 Arabic bilingual translators. Then the PSQI is tested in a sample of 35 healthy Arabic bilinguals.The internal consistency reliability for the Global PSQI demonstrates borderline acceptability (Cronbach’s alpha = .65). The reliability is further supported by moderate to high correlations between five PSQI components and the global PSQI score ( r = .53 to .82, p < .01). Convergent validity is supported by the global PSQI correlating strongly with the Insomnia Severity Index ( r = .76) and moderately with the related construct of the Medical Outcome Study Short Form—36 vitality subscale ( r = —.33). Further testing of the PSQI is needed in a larger Arabic population, both clinical and healthy populations, living in their native countries.

A 44-year-old male was admitted with ST-elevation myocardial infarction and cardiogenic shock. Angiography revealed a left anterior descending artery (LAD) as well as right a coronary artery acute thrombotic occlusion and large mobile thrombi in the circumflex artery. He was treated mainly with multivessel thrombus aspiration and intra-aortic balloon insertion. Subsequent intravascular ultrasound a week later revealed mild disease of the LAD only. We suggest that in selected patients with cardiogenic shock, plaque rupture with resultant acute thrombosis in a single coronary artery may lead to low coronary perfusion pressure and consequent multivessel thrombus formation. Thrombus aspiration should be the main therapeutic modality in such unusual cases.

In previous studies, the chemokine CCL21 has shown biological activities that include T cell, natural killer (NK) cell, and dendritic cell (DC) chemoattraction. The goal of this study was to determine the effects of administering CCL21 to orthotopic mammary tumors in terms of impact on tumor growth rate, immune cell infiltration of the primary tumor and survival. We found that a single intratumoral administration of CCL21 slowed the growth of orthotopic mammary tumors and increased intratumoral infiltration by T cells, NK cells and DCs. CCL21 intratumoral administration also prolonged the survival of tumor-earing mice. Furthermore, mice that received intratumoral neoadjuvant CCL21 ior to surgical resection of tumors survived significantly longer than control mice. The urviving neoadjuvant CCL21-reated mice, when challenged again with cl-6, had significantly slower rate of tumor growth than challenged control mice. Thus, our ata indicate that CCL21 treatment prior to mammary tumor resection can significantly rolong survival and increase resistance to subsequent tumor challenge. Overall, our indings suggest that intratumoral administration of CCL21 has potential as a neoadjuvant mmunotherapy for breast cancer.

The incidence and clinical significance of immobile and 'frozen' posterior mitral leaflet (FPML) were evaluated in the pathophysiology and immediate outcome of patients with severe pliable mitral stenosis (MS) undergoing percutaneous balloon mitral commissurotomy (PBMC).During the past four years, 30 'ideal' patients (mean age 46 +/- 8 years) with Wilkins' score8, bilateral commissural fusion and absence of commissural calcification underwent peri-procedural echocardiographic analysis. Anterior mitral leaflet (AML) mobility index (MI), chordae tendineae (CT) length, and mitral valve area (MVA) were evaluated.Pre-procedure FPML was noted in 28 patients (93%). All patients achieved MVAor = 1.5 cm2. Post-procedure MVA in patients with bilateral commissural splitting was 1.9 +/- 0.2 cm2 versus 1.6 +/- 0.1 cm2 in patients with unilateral commissural splitting (p0.05). CT lengths directed to the AML and PML were 15 +/- 2 mm and 8 +/- 2 mm, respectively (p0.05). MI of the AML before and immediately after PBMC was 0.4 and 0.6, respectively (p0.05). None of the patients with FPML showed improved mobility following successful PBMC.FPML may be found in most patients with pliable MS. It is mainly a result of short, rigid and fused CT directed to the PML. A 'single-wing door' or a unicuspid valve may be used as a model for rheumatic pliable MS. It is suggested that pre-procedure leaflet morphology and functional assessment should focus on the AML.