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Resumen Introduccion La reconstruccion esofagica es un proceso quirurgico tecnicamente muy complejo, gravado por una importante morbilidad. Clasicamente se han utilizado la gastroplastia y la coloplastia, aunque la yeyunoplastia ya fue descrita por Roux en 1907. Parece demostrado que la plastia de yeyuno libre es una muy buena opcion en el tratamiento de la enfermedad del esofago cervical, pero no esta tan claro el papel de la yeyunoplastia supercharged en la reconstruccion del esofago toracico. El objetivo de este estudio es el analisis de las reconstrucciones esofagicas realizadas en nuestra unidad y que precisaron de un injerto de yeyuno. Metodos Estudio retrospectivo de las reconstrucciones esofagicas realizadas con yeyunoplastias en nuestra unidad entre enero de 2011 y diciembre de 2019. Se analizan datos epidemiologicos, indicaciones, tecnica quirurgica y morbimortalidad. Resultados Se realizaron 67 procedimientos quirurgicos de reconstruccion esofagica compleja de los que 10 fueron yeyunoplastias: 5 yeyunos libres en esofago cervical y 5 supercharged en esofago toracico con abordaje transesternal. La morbilidad, mortalidad, estancia media y tiempo de retirada de la alimentacion enteral fueron menores en los yeyunos libres que en los supercharged. Conclusiones En nuestro grupo la yeyunoplastia supercharged es la ultima opcion para la reconstruccion del esofago toracico; el acceso por esternotomia media nos permite un excelente abordaje del mediastino anterior y los vasos mamarios internos. El yeyuno libre seria la primera eleccion —con indemnidad del resto de esofago— en la reconstruccion del esofago cervical.

Resumen Objetivo Describir la experiencia del abordaje robotico en la cirugia de la acalasia en un centro de tercer nivel. Material y metodos Se analizaron los pacientes con acalasia intervenidos mediante cirugia robotica entre mayo de 2010 y abril de 2019. Las variables a estudio se recogieron en una base de datos prospectiva y se realizo un analisis descriptivo. Resultados Se incluyeron 45 pacientes (55,6% varones) con edad media de 44 anos. El sintoma principal al diagnostico fue la disfagia. Diecinueve pacientes (42,2%) habian recibido tratamiento endoscopico previo a la cirugia, mayoritariamente dilatacion neumatica (84,2%). La tecnica quirurgica empleada fue la miotomia de Heller asociada a funduplicatura tipo Toupet, con un tiempo operatorio medio de 211 minutos. La estancia media fue 5 dias. Se produjeron 2 perforaciones postoperatorias (4,4%). La mortalidad peroperatoria fue del 0%. El seguimiento medio fue de 64 meses. A 3 y 5 anos se evidencio una importante disminucion del Eckardt score y el estudio manometrico mostro una disminucion de la presion del esfinter esofagico inferior en reposo media del 58% y del 70%, respectivamente, con persistencia de hipomotilidad del cuerpo esofagico. En dos pacientes (5,4%) se diagnostico reflujo gastroesofagico patologico y 4 (10,8%) presentaron recurrencia de los sintomas, requiriendo dilataciones neumaticas endoscopicas. En 2 casos las dilataciones no fueron efectivas por lo que se planteo la realizacion de una miotomia endoscopica. Conclusiones Segun nuestra experiencia, la cirugia robotica constituye un procedimiento seguro y efectivo para el tratamiento de la acalasia.

This study aimed to describe the feasibility of the online adaptive radiation therapy (oART) method developed at the Hospital Quirónsalud Barcelona for prostate cancer, using a standard C-arm linear accelerator (linac) and without the support of artificial intelligence.The first 18 patients treated at the Hospital Quirónsalud Barcelona with the developed oART method were included. An ultrahypofractionated radiation therapy scheme consisting of 7 × 6.1 Gy was used. Patients were treated on 2 conventional Varian C-arm linacs. For each patient, a reference plan based on a planning computed tomography (pCT) scan was generated using the Eclipse system. On each treatment session, the pCT scan was rigidly registered with the daily cone beam computed tomography (CT) scan. The pCT-based target (prostate) and organs at risk were mapped onto the cone beam CT images and manually adapted to take into account the anatomy of the day. The reference plan was then copied to the cone beam CT scan, and a full reoptimization was done for the current anatomy (adapted plan). For each treatment session, the unaltered reference plan was recomputed on the daily cone beam CT scan by mimicking the soft-tissue alignment performed per our standard procedure (nonadapted plan). Over the 126 adapted sessions from the 18 patients, a dosimetric comparison of adapted against nonadapted plans was done.A significant difference in the target coverage was found between the adapted and nonadapted plans (97.1 vs 90.4; P.001) in favor of adapting. Without online adaptation, the optimal coverage of the prostate was not attained in 35% of fractions. Adapting allows for the improvement of the target coverage with compliance of all organ-at-risk dose constraints in all treatment fractions.The oART technique described in this study is technically feasible with a C-arm linac. To our knowledge, this is the first clinical experience with oART for prostate cancer including full replanning and delivered with a C-arm linac without artificial intelligence capability.

As the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread globally, it became evident that the SARS-CoV-2 virus infects multiple organs including the brain. Several clinical studies revealed that patients with COVID-19 infection experience an array of neurological signs ranging in severity from headaches to life-threatening strokes. Although the exact mechanism by which the SARS-CoV-2 virus directly impacts the brain is not fully understood, several theories have been suggested including direct and indirect pathways induced by the virus. One possible theory is the invasion of SARS-CoV-2 to the brain occurs either through the bloodstream or via the nerve endings which is considered to be the direct route. Such findings are based on studies reporting the presence of viral material in the cerebrospinal fluid and brain cells. Nevertheless, the indirect mechanisms, including blood-clotting abnormalities and prolonged activation of the immune system, can result in further tissue and organ damages seen during the course of the disease. This overview attempts to give a thorough insight into SARS-CoV-2 coronavirus neurological infection and highlights the possible mechanisms leading to the neurological manifestations observed in infected patients.

Purpose Individuals with obesity frequently regain weigh after endoscopic bariatric therapies (EBT) unless they adhere to healthy habits. The objective was to create and validate a short, self-administered questionnaire (EMOVE) to assess healthy dietary and physical activity (PA) habits’ adherence to be used in clinical practice. Materials and Methods In this prospective, unicentric study, 463 patients completed the short, Spanish EMOVE questionnaire, to be validated following the Medical Outcome Trust Criteria. Conceptual and measurement model, reliability (internal consistency and test–retest [subgroup of 93 patients]), construct validity, responsiveness, interpretability, and burden were evaluated. Patients enrolled from January 2017 through August 2018 and auto-filled the EMOVE at baseline and at 3, 6, and 12 months. Results Patients submitted to intragastric ballon for 6 and 12 months or POSE were 82.7% women with a mean age of 42.7 years, and a mean BMI of 37.1 kg/m2. Four factors were extracted with exploratory factor analysis related to intake frequency, portions and proportions, time and place of eating, and physical activity. EMOVE showed adequate internal consistency (α = 0.73), very good test–retest (r = 0.91, CI: 0.86–0.94; p r = 0.24, CI: 0.11–0.37, p r = 0.44, CI 0.30–0.58; p p p Conclusion The EMOVE is a useful tool in Spanish language to easily assess the level of adherence to healthy dietary and PA habits to be used routinely in clinical practice. Graphical abstract

Objective Multiple sclerosis (MS) is a degenerative disease of the central nervous system that can lead to lifelong disabilities. There is a significant increase in the global incidence of the disease. In Saudi Arabia (SA), the western region has the greatest number of MS cases. However, there is a lack of studies and research to assess public knowledge in the region. Thus, we aim to assess the public's knowledge of MS in Jeddah, SA. Methodology We conducted a cross-sectional study surveying 468 participants from the general population of Jeddah. A validated MS knowledge questionnaire (MSKQ-25) was used. Results Most participants were female 347 (74.1%) with a mean age of 35.73 ± 14.71 standard deviation (SD). MS was found in 14 (3%) of the participants. The average score of the (MSKQ) was 7.42 SD ± 4.568 versus the average score of people with MS with a mean of 13.92 SD ± 3.33 and a p value > 0.001. No significant variation was found in knowledge between gender and age groups, but there was a significant correlation between the educational level and the knowledge level. Conclusion The mean knowledge score was below average, which indicates poor knowledge of MS. Since the western region has the highest number of MS cases in SA, the level of understanding needs to increase. This can be improved by conducting educational programs using various types of media.

Introduction This study aimed to determine associations between health warning label content and motivation to quit waterpipe smoking by gender and smoking location. Methods Convenience samples of university students in three Eastern Mediterranean countries - Egypt (n=442), Jordan (n=535) and Palestine (n=487) - completed an online survey assessing health warning labels. Multinomial logit regression models were conducted to determine the association between different variables, particularly gender and smoking location, with motivation to quit. Results In Palestine, female smokers were more motivated to quit waterpipe smoking when seeing textual warning labels related to children (T2) and pregnancy (T6) [T2: 1.8 (95% CI: 1.1-2.8), T6: 2.7 (95% CI: 1.6-4.3)] compared to males. Similar results were found in Jordan [T2: 1.6 (95% CI: 1.0-2.6), T6: 1.8 (95% CI: 1.1-3.0)]. As for the smoking location, home-only smokers in Palestine were more likely to quit in response to the following warnings: waterpipe smoking is addictive T1: 2.3 (95% CI: 1.4-3.7), harmful for children T2: 2.3 (95% CI: 1.4-4.1), harmful for the baby during pregnancy T6: 2.4 (95% CI: 1.3-4.3), and to believe that quitting reduces the health risks T9: 1.8 (95% CI: 1.0-3.1). These results were not found in Jordan nor Egypt. Smokers reported that the most noticeable location of a HWL on a waterpipe device is the mouthpiece. Conclusions A better understanding of motivation to quit and its association with various warnings and smoking location could guide countries on which warnings to require in legislation and where best to require them particularly in relation to location.

Gastric and small intestine are the most common gastrointestinal stromal tumors (GISTs). There are few studies of patients who underwent surgical treatment with disparate findings. We aimed to evaluate the differences between groups and the risk factors for recurrence and mortality. A retrospective study of 96 gastric and 60 small intestine GIST was performed between 1995 and 2015. Both groups were compared in terms of clinicopathologic features, morbidity, recurrence, and mortality. Statistical analysis was performed with SPSS®. Eighty-one gastric GISTs and 56 small intestine GISTs underwent surgical treatment. Gastrointestinal bleeding was the most common cause of emergency surgery being more frequent in gastric GIST (P = 0.009); however, emergency surgery was indicated more frequently in the small intestinal GIST (P = 0.004) and was mostly due to perforation (P = 0.009). With a median follow-up of 66.9 (39.7–94.8) months, 28 (20.4%) patients had recurrence. A mitotic index > 5 (P ≤ 0.001) and the intestinal location (P = 0.012) were significantly associated to recurrence. Tumor size > 15 cm (P = 0.001) and an age of ≥ 75 years (P = 0.014) were associated to mortality. On univariate analysis, higher mean values of Ki-67 were associated to higher mortality (P = 0.0032). Small intestine GIST presented lower disease-free survival (DFS) than that of gastric GIST (65.7% vs 90.8%) with P = 0.003. The overall survival (OS) of gastric and small intestine GIST was 74.7% and 71.6%, respectively (P = 0.68). Small intestine GIST received emergency surgery more frequently showing lower DFS and same OS than that of gastric GIST. We found that Ki-67 could be a prognostic factor. Further studies are necessary to assess whether Ki-67 is a prognostic risk factor for GISTs.

Resumen Introduccion El quilotorax es una complicacion poco frecuente en las esofagectomias pero que se asocia a un aumento de la mortalidad posquirurgica. Se han descrito diversos factores que pueden incrementar su aparicion y el tratamiento del mismo es controvertido, siendo la linfografia con embolizacion percutanea del conducto toracico uno de los usados por varios grupos. Material y metodo Estudio retrospectivo de los pacientes a los que se les realizo una esofagectomia por cancer de esofago o de la union esofagogastrica a Siewert I/II entre enero del 2010 y abril del 2019, y desarrollaron un quilotorax como complicacion. Se analizan datos epidemiologicos, el tipo de cirugia, la morbilidad y el tratamiento. Resultados Se realizaron 274 esofagectomias por cancer en el periodo comprendido. Trece pacientes (4,7%) fueron diagnosticados de quilotorax en el postoperatorio; 3 se resolvieron con tratamiento conservador. En los 10 pacientes restantes se realizo linfografia con puncion de la cisterna de Pecquet y embolizacion del conducto toracico, con resolucion del quilotorax en 9. Un paciente (10%) presento una fistula biliar despues del procedimiento. Conclusiones La linfografia con puncion de la cisterna de Pecquet y embolizacion del conducto toracico es una tecnica con baja morbilidad y buenos resultados en la resolucion del quilotorax postesofagectomia.

Introduction Chylothorax is a rare complication in esophagectomies that is associated with increased postoperative mortality. Several factors have been described that may favor its appearance. Its treatment is controversial, and lymphography with percutaneous embolization of the thoracic duct is used by several groups. Material and method Our retrospective study included patients who underwent esophagectomy for cancer of the esophagus or the esophagogastric junction (Siewert I/II) between January 2010 and April 2019 and developed chylothorax as a complication. Epidemiological data, type of surgery, morbidity and treatment were analyzed. Results 274 cancer-related esophagectomies were performed in the study period. Thirteen patients (4.7%) were diagnosed with chylothorax in the postoperative period; 3 were resolved with conservative treatment. In the remaining 10 patients, lymphography was performed with aspiration of the cisterna chyli and thoracic duct embolization, which resolved the chylothorax in 9. One patient (10%) presented a biliary fistula after the procedure. Conclusions Lymphography with aspiration of the cisterna chyli and thoracic duct embolization is a technique with low morbidity that provides good results for the resolution of chylothorax after esophagectomy.

The significance of molecular analysis of peritoneal fluid in staging laparoscopy of oesophagogastric junction (EGJ) and gastric cancer is still controversial. METHODS: A retrospective analysis of prospective data collection of all patients diagnosed with locally advanced gastric neoplasia or Siewert II-III EGJ cancer from July 2009 to October 2019 who underwent staging peritoneal lavage prior to neoadjuvant treatment was performed. Cytology studies and molecular analysis of peritoneal lavage were performed by real-time reverse transcriptase polymerase chain reaction (RT_PCR) of carcinoembryonic antigen (CEA) and cytokeratin 20 (CK20) as tumor makers. RESULTS: 168 patients were operated. Citology and molecular analysis were performed in 138 patients. Macroscopic carcinomatosis (P+) was evidenced in 12.3% (17 patients). Of the remaining 87.7% (121 patients), 9.9% (12 patients) had positive cytology. In 21% (29 patients) disseminated macroscopic or microscopic disease (P + or Cyt+) was identified. 11.6% (16 patients) were P0Cyt- but RT-PCR+. Of these, 9 responded to chemotherapy before salvage surgery. The sensitivity of cytology and molecular analysis was 0.70 and 0.76, respectively (p = 0.67). The survival of Cyt-RT_PCR + vs. Cyt + RT_PCR + patients was similar (p = 0.1). However, there were no differences in the survival curves between Cyt-RT_PCR- patients vs Cyt-RT_PCR + patients who underwent salvage surgery (p = 0.69). CONCLUSION: Molecular analysis showed a sensitivity of 76%. In our study, the survival of P0 Cyt-RT_PCR + patients responding to chemotherapy and undergoing surgery was similar to that of P0 Cyt-RT_PCR- patients but less disease free survival.

Resumen El tumor de celulas granulares es una entidad muy infrecuente (0,03%) y con un manejo terapeutico controvertido debido a su escasa incidencia y a su comportamiento habitualmente benigno (98%). Su localizacion en el tracto digestivo es inusual (3-11%), y el esofago es el organo mas frecuentemente afectado, con unos 400 casos publicados. Sin embargo, la incidencia en el esofago cervical es anecdotica (20 casos publicados). Presentamos un paciente con un tumor de celulas granulares esofagico que invadia traquea, tiroides y partes blandas, realizandose una reseccion en bloque de esofago cervical, dos anillos traqueales, tiroides y musculatura pretiroidea. Para la reconstruccion digestiva se empleo un injerto de yeyuno libre con anastomosis microvascular y reconstruccion traqueal mediante anastomosis termino-terminal. La importancia del caso es doble: aportar mayor casuistica y describir una tecnica quirurgica altamente compleja nunca indicada en este tipo de tumores debido a su caracter raramente agresivo.

Purpose: The study examines the prevalence of Bulimia nervosa in students at King Abdulaziz University in Saudi Arabia.Bulimia nervosaisan eating disorder characterized by consumption of large amounts of food by an individual followed by an attempt such as self-induced vomiting, long periods of exercising, and diuretics to avoid gaining weight. Patients and Method: The study adopted a cross-sectional survey among King Abdulaziz University students in Saudi Arabia. A sample of 499 comprising 357 females and 142 males was randomly selectedparticipants—the age of the sample population aged between 20 to over 55 years. The participants filled questionnaires about eating behavior, smoking, body image, and psychiatrist disorders. The height and weight of the sample population were taken, and their BMI was established. Results: Based on our statistics, the prevalence of bulimia nervosa among the male was 0.3%, and that of the female was 1.4%. Extra observation revealed that those with mild or severe disorders were equally susceptible to depression and mood swing problems. The prevalence of Bulimia nervosa based on ages showed 80/50000 at 10 -30 years and 145/50000 at 31 – 80 years. The clinically prescribed healing period was idealized to be one year. Conclusion:The results show a comparatively high rate of BN among young people aged between 20 and 25, as reflected among King Abdulaziz University students in Saudi Arabia. Therefore, there is a need to increase public awareness about BN and other eating disorders in Saudi Arabia.

Pancreatic cancer (PC) is one the deadliest cancers worldwide. It is characterized by elevated mortality rates because of the lack of effective diagnostic methods, the dense stroma that shields the tumor from effective drug penetration, and the emergence of chemoresistance. Recent research has elucidated the role of PC-derived exosomes in driving and fueling PC progression, metastasis, and chemoresistance by transporting key molecules from tumor cells to recipient cells in the tumor microenvironment (TME). In this review, we delineate some of the key exosomal molecules involved in immune suppression and reprogramming of the TME, the establishment of metastatic niches, and drug resistance. We also explore the potential of exosomes as both diagnostic tools for early PC detection and management and as therapeutic targets.

The world of Image is a fertile, multidimensional world, with a variety of fields, which includes many aspects, as well as many negative aspects. As I have now become the most important media and advertising in the world, as it occupies most of our councils, there is almost no empty house, shop, restaurant, whether they are of a personal, artistic or public nature unless the display screen was the first His assets, which makes her the guest who accompanies us almost everywhere. At the same time, we sit and listen to it while we are powerless, affected by what it serves us, whether directly or indirectly. For this, the research problem boils down to the lack of a clear methodology that can be used to understand the mechanism of the recipient's perception of the artwork, especially the interior design when viewed, analyzed and tasted.And the research aims to define a clear methodology that can be used to understand the mechanism of the recipient's perception of the optical image that he watches, analyzes, and tastes through it the artwork, especially the interior design.The research will address the study and analysis of the factors affecting visual perception of the content of optical images, and then clarify the concept of perception in detail, and address the physiological aspect and the semantic signs on which the perception and perception of the optical image depends, in addition to a review of the most important psychological theories in the field of visual perception and image understanding Optical, as well as clarify the mechanism of the eye's vision of the image physiologically, and its awareness of the different bodies and shapes and how they understand the semiotic implications of the optical image to help communicate the design ideas that the interior designer wants to the recipient.One of the most important findings of the research is that it is necessary for researchers in the field of the optical image, especially (interior designers) to understand the cultural codes included in them, so that they reflect the features of the local cultural identity and the design entities required, otherwise the contradictory codes that can be mistakenly understood from the optical image can lead To a modification or change in the behavior of recipients according to their awareness of the new codes and contents are wrong, and thus the message of the interior designer does not reach the recipient as required, which also affects his awareness of the designs he sees through the optical images presented by the interior designer

Partiendo de los cambios implementados en la Facultad de Humanidades y Ciencias de la Educación (HUHEZI) de Mondragon Unibertsitatea así como de los propiciados por el desarrollo del Espacio Europeo de Educación Superior (EEES), en este artículo se presenta una experiencia de innovación educativa -en cuanto a redefinición curricular, metodológica y evaluativa- desarrollada en los Grados de Educación Infantil y Educación Primaria de esta Facultad en los cursos 2017-18 (1º) y 2018-19 (1º y 2º) con una participación de 12 tutores, 40 profesores y 365 alumnos. Se fundamenta cómo, tras los cambios curricular y metodológicos habidos en la universidad, es necesario replantear el sistema de evaluación, acorde con dichas transformaciones y con las tendencias actuales de evaluación en Educación Superior. Se detalla la estrategia de evaluación diseñada a partir del perfil profesional y de las competencias a desarrollar en ambos grados y que se articula alrededor de los Resultados de Aprendizaje. Se presenta, con detalle, cómo se implementa el nuevo modelo evaluativo en cuanto a los momentos en que se lleva a cabo, los procedimientos y acciones requeridas, los agentes implicados, los instrumentos utilizados, las interacciones y feedbacks proporcionados, y los criterios evaluativos y de obtención de calificaciones establecidos. Finalmente, y sin intención de obtener generalizaciones -al tratarse de una experiencia que está en proceso de desarrollo-, se reflexiona sobre los aspectos y temáticas clave que pueden facilitar -o bien dificultar- el asentamiento y consolidación de las transformaciones que este tipo de innovación impulsan. Based on the changes implemented at the Faculty of Humanities and Education Sciences (HUHEZI) in Mondragon Unibertsitatea, as well as those promoted by the development of the European Higher Education Area (EHEA), an experience of educational innovation – in terms of curricular, methodological and evaluative redefinition – is presented. The present experience was developed in the Degrees of Infant Education and Primary Education in this Faculty during the academic years 2017-18 (Year 1) and 2018-19 (Years 1 and 2) with a participation of 12 tutors, 40 teachers and 365 students. It shows how, after the curricular and methodological changes implemented in the university, it is necessary to rethink the evaluation system, in accordance with those transformations and with the current trends of evaluation in higher education. The evaluation strategy described, based on the professional profile and competencies to be developed in both degrees, is designed and articulated around the corresponding learning outcomes. It is presented, in detail, how the new evaluation model is implemented in terms of when it is carried out, the procedures and actions required, the agents involved, the instruments used, the interactions and feedback given, together with the evaluation and qualification criteria established. Finally, and without aiming to seek generalizations – since this is a particular experience that is still in process of development – we seek to reflect on the key aspects and themes that can facilitate -or hinder- the settlement and consolidation of the transformations that this type of innovation drives.

Objectiu múltiple; SRS; Fantasma virtual Objetivo múltiple; SRS; Fantasma virtual Multiple‐target; SRS; Virtual phantom The aim of this study was to benchmark the accuracy of the VIrtual Phantom Epid dose Reconstruction (VIPER) software for pre-treatment dosimetric verification of multiple-target stereotactic radiosurgery (SRS). VIPER is an EPID-based method to reconstruct a 3D dose distribution in a virtual phantom from in-air portal images. Validation of the VIPER dose calculation was assessed using several MLC-defined fields for a 6 MV photon beam. Central axis percent depth doses (PDDs) and output factors were measured with an ionization chamber in a water tank, while dose planes at a depth of 10 cm in a solid flat phantom were acquired with radiochromic films. The accuracy of VIPER for multiple-target SRS plan verification was benchmarked against Monte Carlo simulations. Eighteen multiple-target SRS plans designed with the Eclipse treatment planning system were mapped to a cylindrical water phantom. For each plan, the 3D dose distribution reconstructed by VIPER within the phantom was compared with the Monte Carlo simulation, using a 3D gamma analysis. Dose differences (VIPER vs. measurements) generally within 2% were found for the MLC-defined fields, while film dosimetry revealed gamma passing rates (GPRs) ≥95% for a 3%/1 mm criteria. For the 18 multiple-target SRS plans, average 3D GPRs greater than 93% and 98% for the 3%/2 mm and 5%/2 mm criteria, respectively. Our results validate the use of VIPER as a dosimetric verification tool for pre-treatment QA of single-isocenter multiple-target SRS plans. The method requires no setup time on the linac and results in an accurate 3D characterization of the delivered dose.

Recent breakthroughs in immunotherapy have revolutionized treatment for many types of cancer, but unfortunately trials of these therapies have failed to provide meaningful life-prolonging benefit for brain tumor patients, potentially due to abundant immunosuppressive myeloid cells in the tumor. Our ultimate goal is to reprogram immunosuppressive tumor associated myeloid cells to an antitumor state to enable effective immunotherapy. Towards this goal, we have deeply characterized the immune microenvironment of more than 50 primary high and low grade gliomas using high-throughput single-cell RNA-sequencing to reveal recurrent myeloid cell states and immunosuppressive programs across IDH1 wild-type and mutant tumors. We have also established a brain tumor organoid model from primary patient tissue that maintains all of the tumor microenvironment, including myeloid and other immune cells. We utilize the this model to functionally test data-driven reprogramming strategies and understand how they impact the states of tumor and immune cells in the ex vivo human tumor microenvironment.

We describe a case of Sjögren's syndrome-associated trigeminal neuropathy with mandibular nerve enhancement at the foramen ovale and Gasserian ganglion (Meckel's cave) in a patient with a prior history of breast cancer. We also explore the differential diagnosis of trigeminal neuropathy associated with mandibular nerve involvement at the foramen ovale and exclude other diseases such as Sjögren's syndrome or perineurial invasion as a result of various carcinomas. We emphasize the importance of an investigative triad of searching for a local head-and-neck malignancy that may metastasize by perineural spread or invasion, excluding a distant malignancy or paraneoplastic phenomenon and ruling out an autoimmune etiology such as Sjögren's syndrome. In the process, we briefly outline the basic immunopathologic processes.

Background: Diabetes self-management education (DSME) is an essential component of lifestyle management needed for diabetes care. Despite ranking second in the world in the prevalence of diabetes, there is no reported intervention addressing diabetes self-care in the Arab world This pilot-study tested the effect of culturally-tailored education targeting diabetes self-care on glycaemia and cardiovascular risk factors of Lebanese with type 2 diabetes (T2DM). Methods: A sample of 27 adults (Age: 61±10yrs, 59% males, HbA1c:8.98±1.38%) with T2DM was recruited from primary health care centers in Beirut. Participants received culturally tailored, multidisciplinary education. Scales assessing self-care, social support, fatalism, and diabetes knowledge, as well as anthropometric measures, and blood samples were collected at baseline, 3-months and 6-months post- intervention. Results: Diabetes self-care (Diet, Self-Monitoring Blood Glucose and foot care) improved after 6 months, which was reflected in a significant drop in glycemic level (HbA1c:-0.5%; FPG: -38 mg/dl), and cholesterol/HDL ratio (4.45±1.39 vs. 4.06±1.29). Waist circumference decreased at 6 months compared to 3 months (p

Gastric cancer (GC) remains the third leading cause of cancer-related death despite several improvements in targeted therapy. There is therefore an urgent need to investigate new treatment strategies, including the identification of novel biomarkers for patient stratification. In this study, we evaluated the effect of FDA-approved kinase inhibitors on GC. Through a combination of cell growth, migration and invasion assays, we identified dasatinib as an efficient inhibitor of GC proliferation. Mass-spectrometry-based selectivity profiling and subsequent knockdown experiments identified members of the SRC family of kinases including SRC, FRK, LYN and YES, as well as other kinases such as DDR1, ABL2, SIK2, RIPK2, EPHA2, and EPHB2 as dasatinib targets. The expression levels of the identified kinases were investigated on RNA and protein level in 200 classified tumor samples from patients, who had undergone gastrectomy, but had received no treatment. Levels of FRK, DDR1 and SRC expression on both mRNA and protein level were significantly higher in metastatic patient samples regardless of the tumor stage, while expression levels of SIK2 correlated with tumor size. Collectively, our data suggest dasatinib for treatment of GC based on its unique property, inhibiting a small number of key kinases (SRC, FRK, DDR1 and SIK2), highly expressed in GC patients.

Background:The most important goal in endoscopic pituitary surgery is bloodless field with better visualization under hemodynamic stability and good analgesia to improve the outcome, the current study was performed to evaluate the intraoperative anesthetic and postoperative analgesic effects of bilateral sphenopalatine ganglion block(SPGB)as adjuvant to general anesthesia in endoscopic transsphenoidal resection of pituitary adenoma. Patients and methods:thirty patients(ASA I-II)aged 22–55 years, randomly assigned into two equal groups. After stabilization of general anesthesia, the patients received bilateral sphenopalatine ganglion block with 2ml of either2% lidocaine: 1:200000 epinephrine(SPGB group)or sterile normal saline(control group). Mean arterial blood pressure was maintained at 60–70mmHg by using nitroglycerine. Intraoperative MAP and heart rate, Nitroglycerine and propranolol consumption, blood loss, average category scale, emergence time were recorded. Also, pre and postoperative plasma B-endorphin, VAS and time of first request for analgesia, total dose of meperidine consumption in the first 24hours postoperatively, patient’s satisfaction and post-operative complication were recorded. Results: Sphenopalatine ganglion block group showed decrease in blood loss(P

The present study investigated whether eight specific classroom practices previously shown to be significantly related to children’s achievement in prekindergarten (pre-k) classrooms were also important in kindergarten classrooms. Students were assessed in math, language, literacy, and self-regulation at the end of their pre-k year (pre-test) and again at the end of their kindergarten (K) year (post-test). Daylong classroom observations using an observation tool comprised primarily of behavioral counts were conducted in 98 classrooms in the fall and spring of students’ K year. Results provide evidence that many of the classroom practices associated with children’s success in pre-k are also predictive of children’s continued academic gains in kindergarten. The strongest of these predictors were students’ engagement in sequential activities, the amount of math students experienced, and students’ involvement in learning. In addition, there was evidence that K students benefited from receiving less behavior disapproving, and interacting with teachers who displayed a more positive tone, and listened to children more. Interestingly, teachers’ level of instruction was not predictive of students’ gains, perhaps due to the fact that teachers were rarely observed using a level of instruction higher than basic skills. These practices are concrete enough to lend themselves to coaching but future research should determine whether experimentally manipulating them would lead to more positive outcomes for children.

Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

Background: Neuraxial analgesia is the gold standard for conducting painless labor either by epidural route or combined spinal epidural. Aim of Study: This study is to evaluate the effect of adding neostigmine to levobupivacaine for epidural labor analgesia on mother and neonate. Patient and Methods: After approval from local ethical committee and obtaining written informed consent this pro-spective randomized double-blind study was conducted on 60 laboring mothers, aged between 21 to 38 years, ASA I & II, single pregnancy, gestational age >!37 weeks in active cervical dilatation (!95cm) subjected to normal labor by epidural analgesia. Parturient were randomly divided into two groups: Group L (n=30): Received 15ml of 0.125% levobupivacaine. Group N (n=30): Received 15ml of 0.125% levobupivacaine + 6mic/kg neostigmine. Onset of sensory block, duration of analgesia, maternal hemodynamics, motor block and total dose of levobupivacaine were recorded. Maternal outcome in the form of (duration of labor, mode of delivery), Apgar score at (1 and 5min) and side effects were also recorded. Results: There was faster onset of sensory block and prolonged duration of analgesia with neostigmine group compared with other group. No significant difference between both groups as regard hemodynamics. No motor blockade in both groups. There was significant reduction in the total dose of levobupivacaine with neostigmine group. There was shorter duration of labor with neostigmine group. No significant difference as regard mode of delivery, Apgar score and com-plications between the two groups. Conclusion: Neostigmine can be utilized as a safe adjuvant with levobupivacaine to provide a better quality of analgesia and reduce dose of local anesthetic during management of labor pain. Also it's safe for both mother and fetus.

Background: Breast cancer is women's most common malignancy and has steadily increased incidence over the past decade. Despite recent breast cancer surgery advances, this procedure is often associated with postoperative pain, nausea, and vomiting, contributing not only to increased patient discomfort, but also to extended hospital stays and associated costs. A significant risk factor for the development of chronic pain following breast surgery is acute postoperative pain due to insufficient or ineffective pain control.Aim of Study: Assess the effectiveness of ultrasound guided PECS block to thoracic epidural blockage in breast cancer surgery to minimize postoperative pain, analgesic requirements and complications.Patients and Methods: After Ethical Committee at Al-Zahraa University Hospital accepted, 50 female patients, age from 42-67 years, were included in the study with ASA physical status I-II patients scheduled for unilateral modified radical mastectomy and axillary lymph node dissection, randomly blind assigned, split two different groups of 25 patients in each, Thoracic epidural block (TEB group); patients were received a single shot of 15ml of 0.25% bupivacaine between T4 and T5 vertebrae. PECS group: Ultrasound-guided PECS block, the patients were received 0.25% of 10ml bupi-vacaine injected at fiscal plain between the pectoral s major and minor muscles (PECS I) also 0.25% of 20ml of pectoral-minor injection above the Serratus anterior muscle (PECS II). Primary outcome in the form of post-operative visual analogue scale (VAS) to assess pain in density. Secondary outcome in the form heart rate (HR), mean blood pressure (MBP) intra operative fentanyl consumption and, first request of analgesia, total amount of pethidine/24 hrs. were recorded and other any post-operative complication were assessed.Results: The patients of TEB group, the mean heart rate and the mean MAP were highly significant decrease than PECS group. Intra operative fentanyl consumption as statis-tically significant decrease in PECS group compared with TEB group. VAS pain scores was high statistically significant decrease immediately and at 4 hrs. post-operative in PECS group than TEB group. The time for the first request for pethidine was highly significantly longer in the PECS group than in TEB group. Amount of pethidine at 24 hrs. was high significant lower in PECS group in comparison with TEB group. Complications recorded as hypotension and bradycardia post-operative nausea and vomiting (PONV) occurrence in TEB group.Conclusion: PECS blocks provided superior post-operative analgesia, low pain scores and less total pethidine consumption in the early postoperative period and maintained hemodynamic stability compared to TEB.

Objectives To compare clinical features, laboratory data and fetal-maternal outcomes between 1000 women with obstetric APS (OAPS) and 640 with aPL-related obstetric complications not fulfilling Sydney criteria (non-criteria OAPS, NC-OAPS). Methods This was a retrospective and prospective multicentre study from the European Registry on Obstetric Antiphospholipid Syndrome. Results A total of 1650 women with 5251 episodes, 3601 of which were historical and 1650 latest episodes, were included. Altogether, 1000 cases (OAPS group) fulfilled the Sydney classification criteria and 650 (NC-OAPS group) did not. Ten NC-OAPS cases were excluded for presenting thrombosis during follow-up. All cases were classified as category I (triple positivity or double positivity for aPL) or category II (simple positivity). Overall, aPL laboratory categories showed significant differences: 29.20% in OAPS vs 17.96% in NC-OAPS (P < 0.0001) for category I, and 70.8% in OAPS vs 82% in NC-OAPS (P < 0.0001) for category II. Significant differences were observed when current obstetric complications were compared (P < 0.001). However, major differences between groups were not observed in treatment rates, livebirths and thrombotic complications. In the NC-OAPS group, 176/640 (27.5%) did not fulfil Sydney clinical criteria (subgroup A), 175/640 (27.34%) had a low titre and/or non-persistent aPL positivity but did meet the clinical criteria (subgroup B) and 289/640 (45.15%) had a high aPL titre but did not fulfil Sydney clinical criteria (subgroup C). Conclusion Significant clinical and laboratory differences were found between groups. Fetal-maternal outcomes were similar in both groups when treated. These results suggest that we could improve our clinical practice with better understanding of NC-OAPS patients.

Resumen La cirugia minimamente invasiva permite el tratamiento de los tumores de la union esofagogastrica en condiciones de seguridad, reduciendo las complicaciones respiratorias y parietales y mejorando la recuperacion postoperatoria, manteniendo ademas los principios de la cirugia oncologica que permitan obtener unos resultados optimos de efectividad a largo plazo. Para ello, es necesario un volumen de actividad suficiente y avanzar en la curva de aprendizaje de forma tutelada, para poder garantizar una reseccion R0 y una linfadenectomia adecuada. La minima invasion no puede ser un objetivo en si misma. En caso de gastrectomia total, el riesgo de afectacion del margen proximal obliga a verificarlo mediante biopsia intraoperatoria, sin descartar la cirugia abierta de entrada. Por su parte, la esofagectomia minimamente invasiva se ha ido imponiendo progresivamente. Su principal dificultad, la anastomosis intratoracica, puede realizarse mediante una sutura laterolateral mecanica o manualmente asistida por robot, gracias a la vision tridimensional y a la versatilidad del instrumental.

Minimally invasive surgery provides for the treatment of esophagogastric junction tumors under safe conditions, reducing respiratory and abdominal wall complications. Recovery is improved, while maintaining the oncological principles of surgery to obtain an optimal long-term outcome. It is important to have a sufficient volume of activity to progress along the learning curve with close expert supervision in order to guarantee R0 resection and adequate lymphadenectomy. Minimal invasiveness ought not become an objective in itself. Should total gastrectomy be performed, the risk of a positive proximal margin makes intraoperative biopsy compulsory, without ruling out a primary open approach. Meanwhile, minimally invasive esophagectomy has been gaining ground. Its main difficulty, the intrathoracic anastomosis, can be safely carried out either with a mechanical side-to-side suture or a robot-assisted manual suture, thanks to the 3-D vision and versatility of the instruments.

Mentoring has been identified as an essential component in the development and success of future faculty. As such, the purpose of this study was to gain a better understanding of the mentoring experiences of graduate students enrolled in school psychology programs. Additionally, we wanted to determine if differences were present in the mentoring experiences of self-identified racial minority students and their White peers given the lack of diversity among school psychology faculty. Quantitative analyses indicated that students enrolled in school psychology programs are fairly satisfied with their mentoring experiences. However, respondents who completed the open-ended questions indicated that they had difficulty accessing their mentor, they wanted more mentoring on careers in academia, and that they desired more support for conducting research and teaching. Therefore, there are several aspects of mentoring that need to be improved if the field of school psychology wants to increase the number of students who will peruse a career in higher education.

The security proposed for Vehicle-to-Everything (V2X) systems in the European Union is specified in the ETSI Cooperative Intelligent Transport System (C-ITS) standards, and related documents are based on the trusted PKI/CAs. The C-ITS trust model platform comprises an EU Root CA and additional Root CAs run in Europe by member state authorities or private organizations offering certificates to individual users. A new method is described in this paper where the security in V2X is based on the Distributed Public Keystore (DPK) platform developed for Ethereum blockchain. The V2X security is considered as one application of the DPK platform. The DPK stores and distributes the vehicles, RSUs, or other C-ITS role-players’ public keys. It establishes a generic key exchange/ agreement scheme that provides mutual key, entity authentication, and distributing a session key between two peers. V2X communication based on this scheme can establish an end-to-end (e2e) secure session and enables vehicle authentication without the need for a vehicle certificate signed by a trusted Certificate Authority.

Conventional cancer treatments such as chemotherapy and radiation therapy have reached their therapeutic potential, leaving a gap for developing more effective cancer therapeutics. Cancer cells evade the immune system using various mechanisms of immune tolerance, underlying the potential impact of immunotherapy in the treatment of cancer. Immunotherapy includes several approaches such as activating the immune system in a cytokine-dependent manner, manipulating the feedback mechanisms involved in the immune response, enhancing the immune response via lymphocyte expansion and using cancer vaccines to elicit long-lasting, robust responses. These techniques can be used as monotherapies or combination therapies. The present review describes the immune-based mechanisms involved in tumor cell proliferation and maintenance and the rationale underlying various treatment methods. In addition, the present review provides insight into the potential of immunotherapy used alone or in combination with various types of therapeutics.

Acral peeling skin syndrome (APSS) is a heterogenous group of genodermatoses, manifested by peeling of palmo-plantar skin and occasionally associated with erythema and epidermal thickening. A subset of APSS is caused by mutations in protease inhibitor encoding genes, resulting in unopposed protease activity and desmosomal degradation and/or mis-localization, leading to enhanced epidermal desquamation. We investigated two Arab-Muslim siblings with mild keratoderma and prominent APSS since infancy. Genetic analysis disclosed a homozygous mutation in SERPINB7, c.796C > T, which is the founder mutation in Nagashima type palmo-plantar keratosis (NPPK). Although not previously formally reported, APSS was found in other patients with NPPK. We hypothesized that loss of SERPINB7 function might contribute to the peeling phenotype through impairment of keratinocyte adhesion, similar to other protease inhibitor mutations that cause APSS. Mis-localization of desmosomal components was observed in a patient plantar biopsy compared with a biopsy from an age- and gender-matched healthy control. Silencing of SERPINB7 in normal human epidermal keratinocytes led to increased cell sheet fragmentation upon mechanical stress. Immunostaining showed reduced expression of desmoglein 1 and desmocollin 1. This study shows that in addition to stratum corneum perturbation, loss of SERPINB7 disrupts desmosomal components, which could lead to desquamation, manifested by skin peeling.

With growing awareness of problems with replicability and reproducibility within the field of genetic syndrome research, we outline why and how, as a field, we can collectively reform our practice with the goal of research improvement. We advocate that our research is of most impact when researchers investigate how developmental pathways and phenotypic profiles unfold. However, this neuroconstructivist approach and more traditional approaches bring many challenges, not least the problem of statistical power. Here, we outline the challenges to research in our field, and suggest solutions. In recognition that solutions can require substantial resource, we have also included less resource-intensive solutions where possible. The challenges and solutions discussed include sample size, individual differences, cross-disorder comparisons, multi-disciplinary expertise, measurement sensitivity and longitudinal data. Key recommendations include transparency and collaboration. For our field to produce rigorous, replicable research, researchers should strive to present protocols and data transparently (where possible) and collaborate to collect (multi-disciplinary) data as a collective effort.

Background College students tend to have eating and lifestyle habits that can lead to weight gain. Paradoxically, weight gain could also lead to calorie restriction, a practice that is common among those who are concerned about their body weight. Thus, the objective of this study was to investigate the association between habits related to overweight and obesity and dietary intake, physical activity, and BMI among college students. Methodology One hundred ninety-two participants (18–26 years; 75% female) were included in this cross-sectional study. Participants completed the ‘habits related to overweight and obesity questionnaire’ which evaluates five dimensions: the concern about caloric intake, healthy eating, physical activity, alcohol consumption, and eating for psychological well-being. Additionally, anthropometric parameters, dietary intake, and physical activity were evaluated. Linear regression models were used to examine the associations between outcome and exposure variables. Results Higher concern about caloric intake was associated with higher BMI (1.05 kg/m2 [95%CI: 0.58, 1.51]), but lower energy (-312.2 kcal/day [95%CI: -404.6, -219.8]) and fat intake (-1.88% [95%CI: -2.94, -0.83]). Furthermore, healthy eating was related to better diet quality 0.96 [95%CI: 0.47,1.44] and lower energy intake (-231.4 kcal/day [95%CI: -367.7, -95.2]). Meanwhile, higher scores in the physical activity dimension were associated with better diet quality (0.41 [95%CI: 0.16,0.66]). Conclusions College students with the highest dietary restraint had the greatest BMI and the lowest energy and fat intake. Our results highlight the importance of promoting healthy behaviors among college students.

Five- to 11-year-olds (N=91) explored virtual environments with the goal of learning where everything was within the environment (1 trial; Experiment 1) or to find six stars (5 trials/condition; Experiment 2). Participants took part in a standard condition and in an overhead map condition in which they could view their location on a map. In Experiment 1, with increasing age, participants visited more of the environment, had longer path lengths and fewer pauses. In Experiment 2, navigation success (time per target collected) increased with repeated trials and was stronger in the overhead map condition. Associations between exploration behaviour and navigation success demonstrated that fewer pauses, visiting more areas of the environment and stronger target order consistency across trials, were associated with navigation success for both conditions. Additional input was also differentially observed for each condition; age and gender impacted performance in the overhead map condition, whilst the number of revisits impacted performance in the standard condition. Individual difference analysis (Latent Profile Analysis) of the standard condition revealed three profiles. These reflected cautious explorers who were poor at navigating (profile 2), active and efficient explorers who were good at navigating (profile 1) and active and less efficient explorers who were average at navigating (profile 3). This is a first step to understanding exploration behaviour in children and how this relates to navigation success.

We conducted a controlled before-and-after trial to evaluate the impact of an onsite urban sanitation intervention on the prevalence of enteric infection, soil transmitted helminth re-infection, and diarrhea among children in Maputo, Mozambique. A non-governmental organization replaced existing poor-quality latrines with pour-flush toilets with septic tanks serving household clusters. We enrolled children aged 1-48 months at baseline and measured outcomes before and 12 and 24 months after the intervention, with concurrent measurement among children in a comparable control arm. Despite nearly exclusive use, we found no evidence that intervention affected the prevalence of any measured outcome after 12 or 24 months of exposure. Among children born into study sites after intervention, we observed a reduced prevalence of Trichuris and Shigella infection relative to the same age group at baseline (

Privatization of government services is the action that has been taken by local, state, and federal governments to allow private companies to offer their service instead. However, issues have aroused on the benefits and limitations of privatization on the well-being of its people. This study aimed at examining the impact of privatization on Lebanese economy. The paper will seek to answer if the Lebanese government can use this analogy to solve a plethora of issues that the economy is currently battling. The research used mixed method approach where data was collected following both qualitative and quantitative research strategies. A survey collecting data from the management of both privatized firms and government firms was used to come up with the results. The research also looked into the financial and operation performance of the already privatized firms to assess the performance over time. The telecommunication sector which was the first privatized industry is used as the benchmark of this study. The research found out that privatization is a double-edged sword that impacts the social wellbeing both positively and negatively. Regarding solving the ongoing financial and economic crisis, privatization seems to be an effective tool as it will reduce the administrative power of the management and thus lower the level of corruption in the economy which is one of the major contributions of the undergoing crisis. Keywords: Privatization, Lebanon, Lebanese crisis, telecommunication sector DOI: 10.7176/JESD/12-8-06 Publication date: April 30 th 2021

Objective: To evaluate the effectiveness of a university tobacco-free policy by examining differences in students’ attitudes, perceptions of compliance and policy benefits, after one year of the policy’s implementation.Methods: Cross-sectional studies were undertaken to collect data pre- and 1 year post-policy implementation. The two samples were selected using stratified random sampling.Results: The prevalence of smoking decreased from 26% pre-policy implementation to 21% 1 year after (p = 0.035). The proportion of smokers who thought the policy had contributed to a reduction in smoking frequency increased from 10% to 70% (p < 0.001). Smokers’ support for the policy rose from 42 to 58% (p = 0.007).Conclusion: Against the background of a strongly pro-tobacco environment in Lebanon, it is possible to create a positive change in the mindset of smokers at the levels of the education and smoking cessation and more efforts should be expended to bring it about.

Objectives The presence of phytosterols in vegetable-based lipid emulsions has been associated with alterations in the results of liver function tests (LFTs). Serum levels of phytosterols are under strict genetic control. T-allele carriers in rs41360247 and C-allele carriers in rs4245791 of ABCG8genes are associated with higher phytosterolemia. The objective of this study was to determine the association between these single-nucleotide polymorphisms (SNPs) and LFT result alterations in an adult hospitalized population treated with parenteral nutrition. Methods This is a substudy of a previous clinical trial (EudraCT 2014-003597-17). It included adult hospitalized patients who had received at least 7 d of parenteral nutrition with 0.8 g/kg/d of an olive/soybean lipid emulsion, randomized 1:1 to receive the same olive/soybean emulsion or 100% fish oil at a dose of 0.4 g/kg/d for 7 d. Plasma phytosterols and their fractions, rs41360247 and rs4245791 of ABCG8 genes, and LFT were determined. Analyses of variance were performed to determine the association between the SNPs and LFT values, as well as total phytosterol values and their fractions. Simple linear regressions were performed to analyze LFT variations and the different interactions of the SNPs studied with phytosterols and their fractions. Interactions of the synergic variable plasma phytosterol and its fractions with SNPs allow us to study the interaction of the SNPs with phytosterols with a regression. Results We included 19 participants. In the multivariate model, total phytosterols, sitosterol, and lanosterol were positively associated with increases in γ-glutamyltransferase. Significant increases with stigmasterol were associated with the T allele of rs41360247, whereas campesterol showed only a tendency to increase that was not significant. Increases in alkaline phosphatase were associated with T-rs41360247 independent of the presence of phytosterols. With stigmasterol, C-allele carriers of rs4245791 showed a tendency to increase, and also for sitosterol and lanosterol, although independent of the SNP analyzed. Increases in alanine aminotransferase were positively associated with total phytosterol and sitostanol, whereas lanosterol and stigmasterol were associated with the presence of the T allele of rs41360247. Conclusions With both SNPs rs41360247 and rs4245791, the alteration in parameters of liver function in adult patients with short-term parenteral nutrition is conditional.

Introduction and Objectives Surgical resection for lung cancer is physically and emotionally demanding for patients, with risks of complications and morbidity. Prehabilitation aims to maximise patients’ fitness, nutrition and wellbeing before treatment to improve outcomes. The existing literature on lung cancer prehabilitation points to improved functional capacity, post-operative length of stay & frequency of complications. As such, it is recommended in current guidelines.1 Methods Prehab4Cancer, a Greater Manchester (GM) Cancer funded project, is the first regional system in the UK to introduce large-scale prehab as a standard of care for cancer patients.2 Surgical lung cancer patients are rapidly assessed at one of 17 clinics. Tailored prehab interventions span exercise (re-HIIT: high intensity interval training and muscle strengthening), nutrition, and psychological support. It is delivered by ‘GM Active’, a collective of 12 community organisations utilising cancer rehabilitation-qualified exercise specialists. A 12-week post-op rehabilitation programme follows. Measures of fitness are recorded at baseline, pre-operatively, post-operatively, and after rehabilitation. Results Since April 2019, 380 lung cancer patients have been referred from 11 hospitals, with 75% participating. Average age was 70y; 53% were female. Median duration of prehab was 39 days, with mean 2.2 sessions/week. Physiological assessments such as incremental shuttle walk test (ISWT) improved from median 350 m at baseline to 380 m. Health-related quality of life measures also demonstrated improvement (see table 1). Conclusions Prehab4cancer has successfully implemented a regional cancer prehab programme that demonstrates feasibility and excellent uptake and improved patient experience. Collaboration has been key, between GM-wide healthcare professionals working together with the GM Cancer alliance, people affected by cancer and GM Active. Validated measures of fitness and quality of life show promising trends toward improvement among surgical lung cancer patients. References Batchelor TJP, et al.Guidelines for enhanced recovery after lung surgery: Recommendations of the Enhanced Recovery after Surgery (ERAS®) Society and the European Society of Thoracic Surgeons (ESTS). Eur J Cardio-thoracic Surg 2019;55:91–115. Moore J, Merchant Z, Rowlinson K, et al. Implementing a system-wide cancer prehabilitation programme: The journey of Greater Manchester’s ‘Prehab4cancer’. Eur J Surg OncolPublished Online First: 2020.

[EN] Introduction: Food servings are standard amounts of food stuffs or drinks to help dietetic advice to promote and preserve health. The aim is to establish the serving size of fruits and vegetables (FH) to be used in food based dietary guidelines (FBDG). Material and Methods: Methodology of the United States Department of Agriculture (USDA) was adapted to establish serving sizes for FBDG, along of the followed by the food exchange system. Data was collected from the FH portion sizes reported in nutritional surveys and common sizes available in the Spanish market, and they were adjusted to an easily recognisable quantities of food with equivalence on key nutrients: the compliance with public health goals for FH consumption was evaluated. Results: Portion sizes typically reported in Spanish nutrition surveys are scarce and not homogeneous, and no data published in scientific journals on portion sizes were available. The Spanish FBDG, in spite of showing a range of serving size for FH, do not assure that they are interchangeable nor specify the method to obtein them.The serving of vegetables was 139,44g (DS:+/- 21.98, CV:0.16), 137,68g (DS:+/- 49,61, CV:0,36) for fruits and 28.00g (DS:+/- 7,53, CV:0.27) for dried fruits. Conclusions: With the established servings, the recommendation of consuming "at least 5 servings of FH a day" would allow reaching the Public Health goals for FH established in 600g (net weight)/person/day. It is recommended that the Spanish Agency for Consumers, Food Safety and Nutrition (AECOSAN) uses this methodology to establish serving sizes for the rest of food groups that make up the FBDG for the Spanish population., [ES] Introducción: Las raciones de consumo son cantidades estándar de alimentos o bebidas sugeridas para asesorar sobre la cantidad de alimento a consumir para preservar un estado de salud adecuado. El objetivo principal de este trabajo es establecer los tamaños de ración de consumo de frutas y hortalizas (FH) para uso en guías alimentarias. Material y Métodos: Se adaptó la metodología de la United States Department of Agriculture (USDA) para el establecimiento de los tamaños de ración de consumo para guías, y la del Sistema de Intercambios. Se recopilaron datos de porción reportados en encuestas y calibres comunes en el mercado, se ajustó a cantidades de alimento fácilmente reconocibles y con equivalencia de nutrientes clave y se evaluó el grado de cumplimiento de los objetivos de salud pública para el consumo de FH. Resultados: Los tamaños de porción típicamente reportados en encuestas españolas son escasos y poco homogéneos, y no se encontraron datos publicados en revistas científicas sobre los calibres. Las guías alimentarias españolas, a pesar de mostrar un rango de tamaño de ración para FH no aseguran que sean intercambiables ni especifican el método para llegar a las mismas. La ración de hortalizas obtenida ha sido de 139,44g (DS:±21,98; CV:0,16), de 137,68g (DS:±49,61; CV:0,36) para frutas y 28,00g (DS:±7,53; CV:0,27) para frutas desecadas. . Conclusiones: Con las raciones establecidas, el mensaje ¿consume al menos 5 raciones entre FH al día¿ permitiría alcanzar los objetivo de Salud Pública para FH establecidos en 600g (peso neto)/persona/día. Se recomienda a la Agencia Española de Consumo, Seguridad Alimentaria y Nutrición (AECOSAN) que use esta misma metodología para el establecimiento de raciones en el resto de grupos de alimentos que configuran la Guía Dietética Basada en Alimentos para la población española.

In this study, we aimed to find a correlation between anxiety related to dental procedures and migraines. A cross-sectional study was performed on 171 patients who attended specific dental clinics. The patients were randomly categorized into a migraine group (83) and a control group. To determine the anxiety level, all the patients filled out a validated questionnaire (the Arabic version of the Modified Dental Anxiety Scale). All responses ranged from “not anxious” (scoring 1) to “extremely anxious” (scoring 5). Based on the patient responses, the total score was recorded and compared statistically between the two groups. The sound of drilling was one of the most vital factors causing anxiety and headaches in migraine patients. Comparing the presence or absence of headache and usage of analgesics between the two groups, migraine patients complained to have headaches during or after dental treatment more frequently than controls and used analgesics more than non-migraine controls. Migraine patients visiting dental clinics feel more anxious about the working environment and need certain modifications before, during, and after dental procedures.

Numerous studies have provided novel insights into the potential role of genetic polymorphisms as prognostic markers in gynecologic cancers, particularly cervical cancer. Cervical cancer is the second most common and primary cause of cancer-related deaths in developing countries. Deep research into single-nucleotide polymorphisms (SNPs) may help to explain potential differences in distinct cancers. Candidate SNPs may be involved in immune cell regulation, cell-cycle control, DNA damage and repair, cancer metabolism, and apoptosis. In the present chapter, we have summarized important findings of genetic association studies exploring the role of glutathione-S-transferase (GST), interleukins (ILs), p53 codon 72, tumor necrosis factor A gene (TNFA), human leukocyte antigen (HLA), Fas gene polymorphism, murine double-minute two homologs (MDM2), and interferons-γ (IFNG) gene polymorphism with cervical cancer. Genetic association studies will require further validation to provide direction for future research leading to better clinical outcomes for patients with cervical cancer.

Background Abdominal wall hernia is a common surgical condition. Patients may present in an emergency with bowel obstruction, incarceration or strangulation. Small bowel obstruction (SBO) is a serious surgical condition associated with significant morbidity. The aim of this study was to describe current management and outcomes of patients with obstructed hernia in the UK as identified in the National Audit of Small Bowel Obstruction (NASBO). Methods NASBO collated data on adults treated for SBO at 131 UK hospitals between January and March 2017. Those with obstruction due to abdominal wall hernia were included in this study. Demographics, co‐morbidity, imaging, operative treatment, and in‐hospital outcomes were recorded. Modelling for factors associated with mortality and complications was undertaken using Cox proportional hazards and multivariable regression modelling. Results NASBO included 2341 patients, of whom 415 (17·7 per cent) had SBO due to hernia. Surgery was performed in 312 (75·2 per cent) of the 415 patients; small bowel resection was required in 198 (63·5 per cent) of these operations. Non‐operative management was reported in 35 (54 per cent) of 65 patients with a parastomal hernia and in 34 (32·1 per cent) of 106 patients with an incisional hernia. The in‐hospital mortality rate was 9·4 per cent (39 of 415), and was highest in patients with a groin hernia (11·1 per cent, 17 of 153). Complications were common, including lower respiratory tract infection in 16·3 per cent of patients with a groin hernia. Increased age was associated with an increased risk of death (hazard ratio 1·05, 95 per cent c.i. 1·01 to 1·10; P = 0·009) and complications (odds ratio 1·05, 95 per cent c.i. 1·02 to 1·09; P = 0·001). Conclusion NASBO has highlighted poor outcomes for patients with SBO due to hernia, highlighting the need for quality improvement initiatives in this group., This study shows that small bowel obstruction due to abdominal wall hernia is common, typically involves a co‐morbid group of patients and has poor outcomes, including high mortality rates. High mortality from this problem

The present work assessed the effect of supplementation of 0.8% dietary Arbocel® RC Fine, a readily available commercial lignocellulose, to poultry feed. In a complete randomized design using 36 individually caged mature dubbed Hy-Line roosters (aged 55 weeks) grouped in 4 treatments with 9 birds per treatment, a digestibility trial was performed to determine apparent and true metabolizable energy values along with digestibility coefficients of protein and amino acid in Arbocel® containing diets. Results showed that 0.8% Arbocel® supplemented diets improved protein digestibility by 6% (P

Objectives Motor difficulties are often reported in individuals with attention deficit hyperactivity disorder (ADHD). The aims of this study are to detail the motor profile of children with ADHD and to determine whether the motor impairment present in a large proportion of children with ADHD represents a phenotypic characteristic of ADHD or a co-occurring deficit. Methods Participants with ADHD (N = 51; age 8 to 15 years) and typically developing (TD) motor matched control children (N = 75; age 4 to 11 years) completed the largest battery of assessments of motor function that have been used with this population to date, as well as a measure of inhibition as a behavioural measure of ADHD characteristics. Parents/caregivers also completed questionnaires relating to ADHD symptomology and a retrospective report of their child’s motor milestone achievement. Results A motor deficit was observed in 47% of our ADHD sample. Few relationships were observed between ADHD core characteristics and motor competence. Furthermore, there was an uneven profile of motor performance across different motor tasks, relative to the TD children. Interestingly, it appears that motor milestone achievement is not delayed in ADHD. Conclusions Our findings suggest that the motor deficit observed in ADHD is not inherent to ADHD. The motor deficit observed in some children with ADHD does not represent a simple delay in development and is not observed in infancy with respect to reaching motor milestones.

This paper introduces a novel visual Simultaneous Localization and Mapping (SLAM) system, which is based on image stitching technique. It is proposed to determine the position of unmanned aerial vehicles (UAVs) in GNSS-denied regions. Image stitching technique is adopted to overcome the limitations of current methods in terms of complexity and memory requirement. Also, the proposed method provides a solution to localize UAVs in unknown paths and to cope with modifications of landmarks. To evaluate the proposed method, several experiments have been conducted targeting datasets of images captured by UAVs in different environments. The obtained results demonstrate the effectiveness of the proposed method.