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Abstract The coronavirus disease 2019 pandemic had a major impact on most medical services. Our aim was to assess the outcome of acute cholecystitis during the nationwide lockdown period. All patients admitted to our emergency department for AC were analysed. Patient characteristics, performance status, AC severity, treatment modality and outcome of AC were assessed during the lockdown period (Period II: 1 April 2020–30 November 2021) and compared to a historical control period (Period I: 1 May 2017–31 December 2018). AC admissions increased by 72.8% in Period II. Patients were younger (70 vs. 74 years, p = 0.017) and greater in number in the CCI 1 group (20.4% vs. 11.2%, p = 0.043) in Period II. The unplanned readmission rate (6.3 vs. 0%, p = 0.004) and the gallbladder perforation (GP) rate was higher (18.0 vs. 7.3%, p = 0.006) in Period II. Percutaneous transhepatic gallbladder drainage (PTGBD) was more frequent (24.1 vs. 12.8%, p = 0.012) in Period II. In addition to a drop in patient age and CCI, a significant rise in the prevalence of acute cholecystitis, GP and unplanned readmissions was observed during the nationwide lockdown due to the COVID-19 pandemic. PTGBD was more frequent during this period, whereas successful conservative treatment was less frequent.

Firn from an ice cave in the highest mountain of Greece, Mount Olympus, was sampled and analyzed to determine the tritium content in order to estimate rates of accumulation and to date the ice plug. The presence of a sharp raise of tritium content indicating the nuclear testing era was expected to be preserved into ice beds. Tritium concentrations were found to vary from 0.9 to 11 TU. This peak did not appear in the analyzed samples, providing an upper age limit of less than 50 years for the oldest sampled layer. It is suggested that the rate of melting is responsible for the absence of older firn layers.

Hydrogen may represents a good alternative fuel that can be used to fuel internal combustion engines in order to ameliorate energetic and emissions performance. The paper presents some experimental aspects registered at hydrogen use to fuel a diesel engine, different substitute ratios being use in the area of 18–34%, at 40% engine load and speed of 2000 rev/min. The engine is equipped with an open ECU and the control of the cyclic dosses of diesel fuel and hydrogen are adjusted in order to maintain the engine power performance. The in-cylinder pressure diagrams show the increase of the maximum pressure with 17%, from 78.5 bar to 91.8 bar for the maximum substitute ratio. Also, values of maximum pressure rise rate start to increase for hydrogen addition, in correlation with the increase of fuel amount burned into the premixed stage, without exceed the normal values with assure the normal and reliable engine operation. Higher Lower Heating Value and combustion speed of hydrogen assure the increase in thermal efficiency, the brake specific energy consumption decreases with 5.4%–7.8% at substitute ratios of 20–27%. The CO2 emission level decreases with 20% for maximum hydrogen cyclic dose. In terms of pollutant emission level, at hydrogen use the emission level of the NOx decreases with 50% and the smoke number decreases with 73.8% comparative to classic fuelling at the maximum hydrogen cyclic dose.

We investigate a non-supersymmetric SO(10)×U(1)PQ axion model in which the spontaneous breaking of U(1)PQ occurs after inflation, and the axion domain wall problem is resolved by employing the Lazarides-Shafi mechanism. This requires the introduction of two fermion 10-plets, such that the surviving discrete symmetry from the explicit U(1)PQ breaking by QCD instantons is reduced from Z12 to Z4, where Z4 coincides with the center of SO(10) (more precisely Spin(10)). An unbroken Z2 subgroup of Z4 yields intermediate scale topologically stable strings, as well as a stable electroweak doublet non-thermal dark matter candidate from the fermion 10-plets with mass comparable to or somewhat smaller than the axion decay constant fa. We present an explicit realization with inflation taken into account and which also incorporates non-thermal leptogenesis. The fermion dark matter mass lies in the 3×108−1010GeV range and its contribution to the relic dark matter abundance can be comparable to that from the axion.

Abstract Background The optimal prehospital fluid for the treatment of hypotension is unknown. Hypertonic fluids may increase circulatory volume and mute the pro-inflammatory response of the body to injury and illness. The purpose of this systematic review is to determine whether in patients presenting with hypotension in the prehospital setting (population), the administration of hypertonic saline (intervention), compared to an isotonic fluid (control), improves survival to hospital discharge (outcome). Methods Searches were conducted in Medline, Embase, CINAHL, and CENTRAL from the date of database inception to November, 2016, and included all languages. Two reviewers independently selected randomized control trials of hypotensive human participants administered hypertonic saline in the prehospital setting. The comparison was isotonic fluid, which included normal saline, and near isotonic fluids such as Ringer’s Lactate. Assessment of study quality was done using the Cochrane Collaborations’ risk of bias tool and a fixed effect meta-analysis was conducted to determine the pooled relative risk of survival to hospital discharge. Secondary outcomes were reported for fluid requirements, multi-organ failure, adverse events, length of hospital stay, long term survival and disability. Results Of the 1160 non-duplicate citations screened, thirty-eight articles underwent full-text review, and five trials were included in the systematic review. All studies administered a fixed 250 ml dose of 7.5% hypertonic saline, except one that administered 300 ml. Two studies used normal saline, two Ringer’s Lactate, and one Ringer’s Acetate as control. Routine care co-interventions included isotonic fluids and colloids. Five studies were included in the meta-analysis (n = 1162 injured patients) with minimal statistical heterogeneity (I 2 = 0%). The pooled relative risk of survival to hospital discharge with hypertonic saline was 1.02 times that of patients who received isotonic fluids (95% Confidence Interval: 0.95, 1.10). There were no consistent statistically significant differences in secondary outcomes. Conclusions There was no significant difference in important clinical outcomes for hypotensive injured patients administered hypertonic saline compared to isotonic fluid in the prehospital setting. Hypertonic saline cannot be recommended for use in prehospital clinical practice for the management of hypotensive injured patients based on the available data. PROSPERO registration # CRD42016053385 .

The theory that we shall seek to elaborate here puts considerable emphasis on technological features of China’s steel production, its emergence as the world’s most significant steel producer and main manufacturing base, and the transitory decline in steel demand related to the international financial crisis. The purpose of this article is to gain a deeper understanding of the global incorporation of China’s steel enterprises, its portion of worldwide steel consumption, and its industrial policy scheme for the steel sector. This research makes conceptual and methodological contributions to the steel products supply chain in China, the deficiencies of production overcapacity and atomization in China’s steel industry, and market chances for the Chinese steel sector.

The aim of the present research is to examine and evaluate the swift growth in surplus steel production capacity and international supply chain integration, the effects of steel manufacturing on U.S. employment, raising imports of unfairly traded steel and steel goods, and the global steel sector’s structural overcapacity. This paper contributes to the literature by providing evidence on the mechanisms forming the foundation of the first-rate productivity growth in the U.S. steel industry, models of growth in the international steel supply chains, and the advantages of adequate trade remedy implementation for the U.S. steel sector.

The documentation surrounding ISO 9000 in education indicates that the application of this quality management system to education is debatable; the implementation process is time-consumming. The application of ISO 9000 in education is difficult because of interpretation problems. SR ISO IWA 2: Quality management systems - Guidelines for the application of ISO 9001:2000 in education, made the standard easier to understand and implement by the education sector.

The objective of this study was to examine the alkaline, acidic phosphatase and nonspecific esterase activity in the epithelial cells of oviducts after exposure to polychlorinated biphenyls (PCBs) at the time of puerperium. PCBs were administered in the last days of pregnancy and during early puerperium. Animals in the experimental group were exposed to Delor 105 at a dose of 100 μg/kg/day and were euthanised on Day 17 postpartum (n = 4), i.e. 5 days after the termination of 30-day PCB administration; on Day 25 postpartum (n = 5), i.e. 17 days from the last PCB administration and on Day 34 postpartum (n = 5), which corresponded to Day 28 from the completion of PCB administration. Ewes in the control group were euthanised on Day 17 (n = 3), Day 25 (n = 4) and Day 34 (n = 4) postpartum. The authors demonstrated the inhibitory effect of PCB on the enzymatic system of the oviduct during the puerperal period. The alkaline phosphatase, acidic phosphatase and nonspecific esterase activity in the oviductal epithelial cells during a 34-day observation period exhibited a rising trend (P < 0.001 vs. P < 0.001 vs. P < 0.01) in the control group of animals. Experimental animals exposed to the 30-day PCB administration (Delor 105) showed a stagnant tendency (P > 0.05) in alkaline phosphatase while acidic phosphatase and nonspecific esterase activity (P > 0.05) dropped even below the level of their activity values in the control group. It is essential to continue to monitor the effect of pollutants in exposed industrial areas on reparative and regenerative processes in puerperium and their possible impact on reproductive performance.

Purpose: Men with metabolic syndrome (MetS) have an increased prevalence of erectile dysfunction (ED). Large artery stiffness is a marker of vascular wall changes associated with MetS. Aim of the study was to investigate associations between MetS, ED and changes in large artery properties. Methods: 179 consecutive men with ED were evaluated for penile vascular disease severity by Doppler ultrasonography. Lower Doppler velocities indicate impaired arterial function and vice versa. A mean PSV below 25cm/sec was considered to indicate severe arterial insufficiency (SAI). Large artery stiffness was evaluated with carotid-femoral pulse wave velocity (PWV) using high-fidelity pulse wave analysis. Results: Patients with SAI (n=56) compared to patients with non arteriogenic ED (PSV>25cm/s, n=123) had increased prevalence of MetS (49 vs.32 % respectively, P

Se realizó un experimento en invernadero para evaluar en trigo el efecto de la inoculación con las rizobacterias Sinorhizobium meliloti, Azospirillum zeae y Azospirillum canadense, y con el hongo Trichoderma harzianum. El diseño experimental fue completamente aleatorizado, con cuatro réplicas y cinco plantas por tratamiento. Se utilizó un tratamiento fertilizado con NH4NO3 (150 ppm/kg de suelo), un control absoluto y 13 tratamientos inoculados. Se evaluó el peso seco aéreo, el peso seco radical, la longitud del tallo, la germinación y el contenido de clorofila foliar. La aplicación de Trichoderma por separado tuvo un efecto positivo en la longitud del tallo (5,58 cm); pero su presencia directa en algunas combinaciones con las bacterias rizosféricas no fue positiva ni mostró resultados uniformes en las variables en el momento de la siembra, o posterior a esta. Sin embargo, se destacó el tratamiento Trichoderma + NRG34-DS2 5d en el peso seco radical (0,45 g/planta) y en el peso seco aéreo (0,58 g/planta); así como el tratamiento A2-N7, en el contenido de clorofila (40,35 spads/planta) y la longitud del tallo (5,50 cm). Se concluye que la aplicación simple de Trichoderma no ejerció un efecto positivo en la mayoría de las variables ni los tratamientos influyeron positivamente en la germinación. Se recomienda evaluar Trichoderma + NRG34-DS2 5d y A2-N7 en experimentos de campo.