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OBJECTIVE To establish a pathoepidemiological model to evaluate the role of SARS-CoV-2 infection in the first 10 companion animals that died while infected with SARS-CoV-2 in the US. ANIMALS 10 cats and dogs that tested positive for SARS-CoV-2 and died or were euthanized in the US between March 2020 and January 2021. PROCEDURES A standardized algorithm was developed to direct case investigations, determine the necessity of certain diagnostic procedures, and evaluate the role, if any, that SARS-CoV-2 infection played in the animals’ course of disease and death. Using clinical and diagnostic information collected by state animal health officials, state public health veterinarians, and other state and local partners, this algorithm was applied to each animal case. RESULTS SARS-CoV-2 was an incidental finding in 8 animals, was suspected to have contributed to the severity of clinical signs leading to euthanasia in 1 dog, and was the primary reason for death for 1 cat. CONCLUSIONS AND CLINICAL RELEVANCE This report provides the global community with a standardized process for directing case investigations, determining the necessity of certain diagnostic procedures, and determining the clinical significance of SARS-CoV-2 infections in animals with fatal outcomes and provides evidence that SARS-CoV-2 can, in rare circumstances, cause or contribute to death in pets.

Recently, the role of carbon nanomaterials has been widely demonstrated in various industrial applications. Due to their unique chemical, physical, mechanical, and thermal properties, they have been utilized to improve drilling fluids' efficacy and operational cost. The graphene-based nanomaterials are employed as a powerful alternative for oil and gas industry issues. This review compiles the role of various carbon-based nanomaterials and their impact on the oil and gas industry, particularly on the rheological properties of drilling fluids. A comprehensive explication of recent progress in carbon-based nanomaterials for the drilling industry is presented. It entails important features of drilling fluids, such as the effects of temperature, pH, and chemical additives. The effects of these carbon-based nanomaterials were also evaluated for enhanced oil recovery (EOR) and rheological behavior. Rheological properties, such as plastic viscosity (PV), yield point (YP), gel strength (GS), filtrate loss (FL), and mud cake thickness (MCT), were analyzed using various types of graphenoids, such as graphene, graphene oxide and carbon nanoplates. Finally, the current challenges and future perspectives of the carbon based nanomaterials applications are outlined.

Background Germ cell tumors represent highly curable disease even in metastatic stage. However, poor-risk patients with an unfavorable serum tumor marker (STM) decline after the first cycle of chemotherapy represent a subgroup with dismal prognosis, with approximately 50% cure rate using bleomycin, etoposide, and cisplatin (BEP). Objective The aim of this study was to determine the efficacy and safety of paclitaxel, ifosfamide, and cisplatin (TIP) in this patient population. Design, setting, and participants This was an open-labeled, nonrandomized, single-center phase II trial to study the efficacy and toxicity of TIP in the first-line treatment of germ cell tumor patients with an unfavorable decline of STMs. Nineteen patients with a poor prognosis according to the International Germ Cell Cancer Collaboration Group classification and an unfavorable STM decline after the first cycle of chemotherapy were included in this phase II study (NCT02414685). The treatment regimen consisted of paclitaxel 250 mg/m2 on day 1, ifosfamide 1200 mg/m2 on days 1–5, and cisplatin 20 mg/m2 on days 1–5, totally for four cycles. Outcome measurements and statistical analysis The primary endpoint was complete response (CR) rate. An optimal Simon two-stage design was used with a type I error of 5% and study power of 80%. If fewer than six CRs to study therapy have been observed among the first 19 patients, the study was to be terminated. Results and limitations A CR was achieved in four (21.1%) patients; therefore, the study was terminated in the first stage. A favorable response rate (CR or partial remission with negative tumor markers) was observed in 14 (78.9%) patients. At a median follow-up period of 35.2 mo (range, 5.6–62.1 mo), ten (52.6%) patients experienced disease progression and eight patients (42.1%) died. The 2-yr progression-free and overall survival was 41.2% (95% confidence interval [CI] 16.8–65.7) and 72.7% (95% CI 48.9–96.4), respectively. TIP was well tolerated, and no unexpected toxicity was observed. No informative biomarkers, including miR-371a-3p was identified. Conclusions Treatment modification from the BEP to the TIP regimen in patients with an unfavorable STM decline after the first cycle of chemotherapy was not associated with improved outcome, and four cycles of BEP remain the standard treatment option in this patient population. Patient summary Poor-risk patients with an unfavorable serum tumor marker decline after the first cycle of chemotherapy represent a subgroup with dismal prognosis, with an approximately 50% cure rate using bleomycin, etoposide, and cisplatin (BEP). Treatment modification from the BEP regimen to the paclitaxel, ifosfamide, and cisplatin regimen in patients with an unfavorable serum tumor marker decline after the first cycle of chemotherapy was not associated with improved outcome, and four cycles of BEP remain the standard treatment option in this patient population., Take Home Message Poor-risk patients with an unfavorable serum tumor marker (STM) decline after the first cycle of chemotherapy represent a subgroup with dismal prognosis, with approximately 50% cure rate using bleomycin, etoposide, and cisplatin (BEP). The aim of this study was to determine the efficacy and safety of paclitaxel, ifosfamide, and cisplatin (TIP) in this patient population. Treatment modification from the BEP to the TIP regimen in this patient population was not associated with an improved outcome, and four cycles of BEP remain the standard treatment option in this group of patients.

Most head and neck paragangliomas (PGLs) are biochemically silent and often present with recurrence and metastases in association with hereditary syndromes. Whole-body functional imaging is increasingly used to detect tumor extent and guide treatment planning of PGLs. [68Ga]-DOTATATE, which targets somatostatin receptor 2 (SSTR2) overexpression, has emerged as a sensitive functional imaging modality in PGLs. We present a patient with metastatic glomus caroticum PGL in whom [68Ga]-DOTATATE PET/MRI provided a more accurate characterization of metastatic extent, as compared to gadolinium-enhanced MRI of the neck and whole body [18F]-FDG PET/CT. We then review the current literature and discuss the imaging implications of [68Ga]-DOTATATE PET/MRI in PGLs.

BACKGROUND/AIM Systemic immune-inflammation index (SII) predicts survival of patients with various malignancies. This study explored the prognostic value of SII in metastatic urothelial carcinoma (MUC) subjects. PATIENTS AND METHODS We evaluated 181 consecutive MUC patients treated with first-line platinum-based therapy. Karnofsky performance status

We report the impact of a Gentle Touch Stimulation (GTS) program. Forty-three mothers provided daily 10-min GTS with C-tactile (CT) afferent optimal stroking touch, for 4 weeks to their 3-12 weeks old infants. CT-afferents are cutaneous unmyelinated, low-threshold mechanosensitive nerves hypothesized to underly the regulatory impact of affective touch. We compared physiological and behavioral responses during a no-touch-baseline (BL), static-touch-baseline (BL-T), intervention/control (GTS/CTRL), Still Face (SF) and Reunion (RU) condition for GTS-infants versus a control-group (CTRL) at the start (T1) and end of (T2) of the program. We collected mother-infant ECG, respiration, cortisol, video-recordings, and diary-reports. At T1, physiological arousal significantly increased during SF in both groups, that is, decreased respiratory sinus arrhythmia (RSA) and R-R interval (RRI). At T2, GTS-infants showed significantly increased RSA, RRI, decreased respiration during GTS, buffering SF-arousal and allowing complete recovery during RU; CTRL-infants showed higher SF-arousal and small recovery, under initial BL-levels. Maternal cardio-respiratory showed a metabolic investment during RU. Cortisol and behavioral analyses showed higher arousal in CTRL-infants than GTS-infants at T2. We suggest that the combination of phasic short-term and tonic long-term responses to CT-optimal stroking touch, delivered in a structured daily manner, contribute to the building of infant stress regulation and resilience.Reportamos el impacto del programa de Estimulación Táctil Suave (GTS). Cuarenta y tres madres les dieron a sus infantes de 3-12 semanas 10 minutos de GTS con un toque táctil-C (CT) aferente óptimo de caricias por 4 semanas. Los aferentes CT son nervios cutáneos amielínicos mecano-sensibles de bajo impacto que según hipótesis rigen el impacto regulatorio del toque afectivo. Comparamos las respuestas fisiológicas y de comportamiento durante un momento de referencia no táctil (BL), un momento de referencia táctil estático (BL-T), intervención/control (GTS-CTRL), la Cara Seria (SF) y la condición de Reunión (RU) para infantes GTS versus un grupo de control (CTRL) al principio (T1) y al final (T2) del programa. Recogimos información ECG de madre-infante, respiración, cortisol, grabaciones en vídeo, y reportes de un diario. Al T1, la estimulación fisiológica significativamente aumentó durante SF en ambos grupos, v.g., una baja en la arritmia respiratoria paranasal (RSA) y el intervalo R-R (RRI). Al T2, los infantes GTS significativamente mostraron un aumento de RSA, RRI, una baja en la respiración durante GTS, amortiguando la estimulación SF y permitiendo un completo recobro durante RU; los infantes de CTRL mostraron una más alta estimulación SF y un pequeño recobro, bajo los niveles BL iniciales. El aspecto cardio-respiratorio materno mostró inversión metabólica durante RU. Los análisis de cortisol y de comportamiento mostraron más altas estimulaciones de infantes de CTRL que en infantes GTS al T2. Proponemos que la combinación de las respuestas fásicas a corto plazo y tónicas a largo plazo a las caricias táctiles óptimas CT, ofrecidas de una manera estructural diaria, contribuyen a moldear la regulación del estrés y capacidad de resistencia del infante.Cet article fait état de l'impact du programme Stimulation Toucher en Douceur (an anglais Gentle Touch Stimulation, que nous abrégeons ici GTS). Quarante-trois mères ont procédé chaque jour à un GTS de 10 minutes avec un toucher par caresse optimale C-tactile (CT) afférent, pendant 4 semaines à leurs nourrissons de 3-12 semaines. Les afférents CD sont des nerfs cutanés amyéliniques, à faible seuil et mécano-sensibles, dont on pense qu'ils sous-tendent l'impact régulatoire du toucher affectif. Nous comparons les réponses physiologiques et les réponses comportementales durant la condition à un niveau de référence NR sans toucher, un niveau de référence toucher statique (NR-T), un contrôle/intervention (GTS/CTRL), Visage Impassible (Still Face, soit SF) et la Réunion (RU) pour les bébés GTS par rapport aux bébés du groupe de contrôle (CTRL) au commencement (T1) et à la fin (T2) du programme. Nous avons recueilli l’électrocardiogramme mère-bébé, la respiration, le niveau de cortisol et les rapports-journaux. Au T1 la stimulation physiologique a augmenté de façon importante durant le SF pour les deux groupes, c'est-à-dire une arythmie des sinus respiratoires (RSA) décrue et un intervalle R-R décru (RRI). Au T2 les bébés GTS ont fait preuve d'une RSA et d'un RRI bien plus élevés, une respiration décrue durant le GTS, un éveil SF tampon et ont fait preuve d'un rétablissement complet durant la RU. Les bébés contrôle ont fait preuve de plus d’éveil SF et d'un petit rétablissement, moins élevés que les niveaux BL initiaux. La cardio-respiration maternelle a fait preuve un investissement métabolique durant la RU. Les analyses de cortisol et les analyses comportementales ont montré un éveil plus élevé chez les bébés-CTRL que chez les bébés GTS au T2. Nous suggérons que la combinaison de réactions phasiques à court terme et de réponses toniques à long terme au toucher caresse CT-optimal, donné chaque jour de manière structurée, contribue à la construction de la régulation du stress du bébé et de sa résilience.Warum sehnen wir uns nach Berührung? Die Auswirkungen täglicher sanfter Berührungsstimulation auf die physiologische und verhaltensbezogene Regulation sowie Resilienz von Mutter und Kind Wir berichten über die Auswirkungen eines Programms zur sanften Berührungsstimulation (Gentle Touch Stimulation; GTS). Dreiundvierzig Mütter wendeten bei ihren 3-12 Wochen alten Säuglingen 4 Wochen lang täglich 10 Minuten GTS an, d.h. eine C-taktile (CT) afferente optimale streichelnde Berührung. Bei den CT-Afferenzen handelt es sich um kutane, nicht-myelinisierte, niedrigschwellig mechanosensorische Nerven, von denen angenommen wird, dass sie den regulierenden Auswirkungen affektiver Berührungen zugrunde liegen. Wir verglichen die physiologischen und verhaltensbezogenen Reaktionen von GTS-Säuglingen im Vergleich zu einer Kontrollgruppe (CTRL) zu Beginn (T1) und am Ende (T2) des Programms während einer berührungsfreien Baseline (BL), einer statischen Berührungsbaseline (BL-T), einer Interventions-/Kontrollbedingung (GTS/CTRL), einer „Still Face“ Bedingung (SF) und einer Wiedervereinigung (RU). Erhoben wurden Mutter-Kind EKG, Atmung, Cortisol, Videoaufzeichnungen und Tagebucheinträge. Zu T1 nahm die physiologische Erregung während der SF in beiden Gruppen signifikant zu, d. h. die respiratorische Sinusarrhythmie (RSA) und das R-R-Intervall (RRI) nahmen ab. Zu T2 zeigten die GTS-Säuglinge signifikant erhöhte RSA, RRI und verringerte Atmung während der GTS, was die SF-Erregung abpufferte und eine vollständige Erholung während der RU ermöglichte. Die CTRL-Säuglinge zeigten eine höhere SF-Erregung und eine geringe Erholung unter den ursprünglichen BL-Werten. Die mütterliche kardio-respiratorische Aktivität zeigte eine metabolische Investition während der RU. Cortisol- und Verhaltensanalysen zeigten eine höhere Erregung bei CTRL-Säuglingen als bei GTS-Säuglingen zu T2. Die Ergebnisse weisen darauf hin, dass die Kombination von phasischen Kurzzeit- und tonischen Langzeitreaktionen auf CT-optimale streichelnde Berührungen, die täglich strukturiert durchgeführt werden, zum Aufbau der Stressregulation und Resilienz von Säuglingen beitragen.なぜ私たちはタッチングを希求するか−毎日の優しいタッチングの刺激が、母Ȁ子の身体生理および行動の調節と レジリエンス(復元力)に及ぼす影響 ジェントルタッチスティミュレーション(GTS)プログラムの効果について報告する。 43人の母親が、生後3〜12週の母親の乳児に、C-tactile(CT)求心性の最適ななでるタッチングを含む10分間のGTSを4週間毎日行った。CT求心性神経は、情緒的なタッチングの調整的な影響を過小評価していると仮定される皮膚の無髄鞘の低閾値のメカノセンシチブ神経である。GTSの非タッチベースライン(BL)、静的タッチベースライン(BL-T)、介入/制御(GTS / CTRL)、スティルフェイス(SF)、および再会(RU)状態での身体生理および行動の反応を、GTS-乳児と対照群(CTRL-乳児)で、プログラムの開始時(T1)と終了時(T2)に比較した。母と子の心電図、呼吸の状態、コルチゾール、ビデオ録画、および日記を記録した。T1では、両グループとも、SF中において身体生理的に有意に覚醒した。つまり、呼吸性洞性不整脈(RSA)とR-R間隔(RRI)が減少した。T2では、GTS-乳児は、RSA、RRIが有意に増加し、GTS中に呼吸数が減少し、SF覚醒は緩まり、RU中に完全に回復を示した。一方、CTRL-乳児は、初期のBLレベル下で、より高いSF覚醒とわずかな回復を示した。母親の心肺系は、RU中に代謝投資を示した。コルチゾールと行動分析では、T2ではGTS-乳児よりもCTRL-乳児でより高い覚醒を示した。構造化され毎日提供されるCT最適なストロークタッチングに対する相性の短期的および強壮性の長期的反応の組み合わせが、乳児のストレス調節と回復の構築に寄与するとした。.我们报告了一项“温和触摸刺激” (GTS) 项目的影响。43位母亲利用“C组触觉 (CT) 传入神经”的最佳轻抚触摸方式每天为其3-12周大的婴儿提供10分钟的GTS, 为期4周。C组触觉传入神经是皮肤无髓鞘、低阈值的机械敏感性神经, 被认为是情感触摸调节影响的基础。我们在项目开始 (T1) 和结束 (T2) 阶段比较了GTS-婴儿与对照组在无接触基线 (BL)、静态接触基线 (BL-T)、干预/对照 (GTS/CTRL)、静止面孔 (SF) 以及重聚 (RU) 条件下的生理和行为反应。我们收集了母婴心电图、呼吸、皮质醇、录像和日记报告。在T1阶段, 两组婴儿在SF期间的生理唤醒显著增加, 即呼吸性窦性心律不齐 (RSA) 和R-R间期 (RRI) 减少。在T2阶段, GTS-婴儿的RSA、RRI显著增加, GTS期间呼吸减少, SF-唤醒减缓, 并在RU期间呈现完全恢复;在初始BL水平下, CTRL-婴儿表现出更高的SF-唤醒和微小恢复程度。在RU期间, 母亲的心肺功能显示出代谢消耗。皮质醇和行为分析显示, 在T2阶段, CTRL-婴儿的唤醒程度高于GTS-婴儿。我们建议, 对CT的最佳轻抚触摸方式应结合阶段性短期反应和强直长期反应, 以结构化的日常方式开展, 这有助于建立婴儿压力调节和复原力。.لماذا نتوق إلى اللمس؟ تأثير تحفيز اللمسة اللطيفة اليومية على التنظيم الفسيولوجي والسلوكي للأم والطفل والمرونة نعرض في هذه الدراسة تأثير برنامج تحفيز اللمسة اللطيفة (GTS). اشتركت مجموعة من 43 أمًا في الدراسة حيث طلب منهم تقديم 10 دقائق يومياً من اللمسة المثالية مع التمسيد لمدة 4 أسابيع لأطفالهن الذين تتراوح أعمارهم بين 3-12 أسبوعًا. المستقبلات العصبية منخفضة العتبة في الحساسية الميكانيكية و يُفترض أنها تتحكم في التأثير التنظيمي لللمس العاطفي. قمنا بمقارنة الاستجابات الفسيولوجية والسلوكية خلال حالة عدم وجود اللمس (BL) ، واللمس الثابت (T-BL) ، ومجموعة التدخل / المجموعة الضابطة (GTS / CTRL) ، والوجه الثابت (SF) ، ومجموعة Reunion (RU) للأطفال في برنامج اللمسة اللطيفة (GTS) مقارنة بالمجموعة الضابطة (CTRL) في نقطة البداية (T1) ونقطة النهاية (T2) من البرنامج. قمنا بجمع بيانات رسم القلب ، والتنفس ، والكورتيزول ، وتسجيلات الفيديو ، وتقارير اليوميات. في نقطة البداية (T1) ، زادت الاستثارة الفسيولوجية بشكل ملحوظ خلال حالة الوجه الثابت (SF) في كلا المجموعتين ، أي انخفاض عدم انتظام ضربات القلب التنفسي (RSA) و (RRI). وفي نقطة النهاية (T2) ، أظهر الرضع في برنامج (GTS) زيادة ملحوظة في RSA ، RRI ، وانخفاض التنفس أثناء GTS ؛ بينما أظهر الرضع في المجموعة الضابطة استثارة أعلى للوجه الثابت (SF) وفترة انتعاش قصيرة ، تحت مستويات BL الأولية. وأظهرت تحليلات الكورتيزول والسلوكية إثارة أعلى عند الرضع في المجموعة الضابطة عن الرضع في مجموعة التدخل عند نقطة النهاية (T2). تقترح الدراسة أن الجمع بين الاستجابات المرحلية قصيرة المدى وطويلة المدى للمس التمسيدي الأمثل الذي يقدم بشكل يومي ونظامي ، يمكن أن يساهم في بناء المرونة وتنظيم الإجهاد لدى الرضع.

Based on analysis of 819 human biopsies, essential derangement in diabetic nephropathy consists of accumulation of worn-out glomerular basement membrane in the mesangium that may advance to global sclerosis. The most frequent pathway to nephron dropout starts with the penetration of glomerular capillaries into Bowman’s capsule (BC), delivering an exudate into BC that spreads around the entire glomerular circumference and via the glomerulotubular junction onto the tubule, resulting in glomerular sclerosis and chronic tubulointerstitial damage.

18F-Fluorodeoxyglucose positron emission tomography (FDG-PET) underperforms in detecting prostate cancer (PCa) due to inherent characteristics of primary and metastatic tumors, including relatively low rate of glucose utilization. Consequently, alternate PCa PET imaging agents targeting other aspects of PCa cell biology have been developed for clinical practice. The most common dedicated PET imaging tracers include 68Ga/18F prostate-specific membrane antigen (PSMA), 11C-Choline, and 18F-fluciclovine (Axumin™). This review will describe how these agents target specific inherent characteristics of PCa and explore the current literature for these agents for both primary and recurrent PCa, comparing the advantages and limitations of each tracer. Both 11C-Choline and 18F-Fluciclovine PET have been shown to detect nodal and osseous disease at higher rates compared to FDG-PET but offer no additional benefit in detecting prostate disease, especially in primary staging. As a result, PSMA PET, specifically 68Ga-PSMA-11, has emerged as a key imaging option for both primary and recurrent cancer. PSMA PET may be more sensitive than MRI at the local level and more sensitive than 11C-Choline and 18F-Fluciclovine PET for distant disease. Furthermore, compared to 11C-Choline and 18F-Fluciclovine PET, 68Ga-PSMA-11 PET has higher detection rates at low PSA levels (

Purpose Ketogenic dietary therapies (KDT) are high-fat and low-carbohydrate diets that may achieve seizure control and improve cognitive state. We describe our KDT experience in infants (children less than two years of age). Research methods & procedures We conducted a retrospective, descriptive and observational study of 42 infants treated with KDT between 2000-2018. Results The types of KDT started were: classic ketogenic diet ratio 3:1 (40), ratio 4:1 (1) and modified ketogenic diet with medium-chain triglycerides (1). Four patients switched to a modified Atkins diet. During follow-up, 79%, 57%, 38% and 17% of infants remained on KDT at 3, 6, 12 and 24 months, respectively. Seizure reduction ≥50% compared to baseline was achieved in 50%, 45%, 38% and 17% at 3, 6, 12 and 24 months, respectively. Seizure control was excellent (reduction >90%) in 33%, 31%, 26% and 12%, and seizure-free infants were 9, 9, 10 and 4, at different follow-up intervals, respectively. Sixty-three percent of infants with West syndrome were responders to KDT. Mean length of KDT was 390 days (16 days-4.9 years). Ineffectiveness was the reason for withdrawal in 50% of patients. Early adverse effects (during first month) occurred in 40% of infants. The most frequent early side effects were asymptomatic hypoglycemia and gastrointestinal disturbances. Late-onset side effects occurred in 55-14% of infants during therapy, and most frequent were hypercalciuria and dyslipidaemia. Conclusion KDT are useful and effective treatments in infancy. Side effects are frequent but mild and easy to manage.

Background and Aims. COVID-19 pandemic has impacted on all endoscopy centers in the Czech Republic, that belongs to the most affected countries in the world. The aim of our study was to analyze all procedures following routine RT-PCR testing in our tertiary center during the peak of the pandemic. Methods. We retrospectively analyzed all procedures performed from October 2020 to January 2021 after a new RT-PCR center had been set up. Main outcomes were type of scheduled procedure, indication, rate of therapeutic interventions and rate of new relevant and malignant findings. Comparison to the same period before the pandemic and SARS-CoV-2 infection in endoscopy staff are also reported. Results. A total of 1,953 procedures were performed. 624 patients were referred with a negative RT-PCR test and the remaining 1,346 patients were tested in the new center. 1,293 negative tests led to 1,329 procedures. A new relevant finding was reported in 589 (44.3%), including new malignancy in 56 (4.2%). 53 patients tested positive (3.9%). There was a reduction by 9% in the number of all procedures compared to the same period before the pandemic and an increase in the number of screening colonoscopies and ERCP procedures. In the study period, 9 of 54 staff members contracted SARS-CoV-2 infection. Conclusions. Routine RT-PCR testing of patients scheduled for elective endoscopy during the peak of COVID-19 pandemic enabled us to essentially maintain our unit productivity, including activities such as screening colonoscopy, endoscopic resection and pancreatobiliary endoscopy.

BACKGROUND: Inborn errors of immunity (IEI) are rare diseases, which makes diagnosis a challenge. A better description of the initial presenting manifestations should improve awareness and avoid diagnostic delay. Although increased infection susceptibility is a well-known initial IEI manifestation, less is known about the frequency of other presenting manifestations.OBJECTIVE: We sought to analyze age-related initial presenting manifestations of IEI including different IEI disease cohorts.METHODS: We analyzed data on 16,486 patients of the European Society for Immunodeficiencies Registry. Patients with autoinflammatory diseases were excluded because of the limited number registered.RESULTS: Overall, 68% of patients initially presented with infections only, 9% with immune dysregulation only, and 9% with a combination of both. Syndromic features were the presenting feature in 12%, 4% had laboratory abnormalities only, 1.5% were diagnosed because of family history only, and 0.8% presented with malignancy. Two-third of patients with IEI presented before the age of 6 years, but a quarter of patients developed initial symptoms only as adults. Immune dysregulation was most frequently recognized as an initial IEI manifestation between age 6 and 25 years, with male predominance until age 10 years, shifting to female predominance after age 40 years. Infections were most prevalent as a first manifestation in patients presenting after age 30 years.CONCLUSIONS: An exclusive focus on infection-centered warning signs would have missed around 25% of patients with IEI who initially present with other manifestations.

Souhrn: Včasná detekce karcinomu pankreatu je považována za nejúčinnější způsob, jak zvýšit míru přežití u pacientů s tímto onemocněním. Jedinci s familiárním výskytem nebo syndromy genetické náchylnosti mají prokazatelně zvýšené riziko vzniku karcinomu pankreatu. Současná odborná doporučení vycházejí z důkazů o přínosech systematického sledování těchto rizikových jedinců a zdůrazňují potenciál screeningu k ovlivnění tohoto onemocnění. Takový screeningový program nebyl v České republice zatím zaveden, nicméně v ně­kte­rých zemích se tomu tak již děje. Cílem naší přehledové práce je shrnout poznatky o hereditárním a familiárním karcinomu pankreatu a vyzvat ke spolupráci na pilotním screeningovému programu. Klíčová slova: karcinom pankreatu – hereditární karcinom pankreatu – onkologický screening

European spine journal 31(4), 1013-1021 (2021). doi:10.1007/s00586-021-07035-4, Published by Springer, Berlin ; Heidelberg ; New York

Objective: To investigate reproductive and neonatal outcomes in women with unicornuate uterus. Study design: Data from the Health Care Cost and Utilization Project-Nationwide Inpatient Sample database were extracted from 2010 through 2014 to create a delivery cohort using ICD-9 codes. Code 752.33 was used to identify cases with unicornuate uterus and reproductive outcomes were compared to pregnancies without unicornuate uterus. A multivariate logistic regression model was used to adjust for statistically significant variables (P-value

Studies on primary agricultural production in Slovakia aimed mainly at biological, economic, or market point of view and there is a lack of managerial approach providing a specific recommendation for farmers according to their production lines or planning process. As a reaction, we are providing a practically oriented study based on the selected livestock producer, which is aimed at statistical significances as an establishment for further recommendations for management and marketing of this entity. The paper aims to analyze the views and preferences of customers of the monitored company, which sells its meat and dairy products in its stores and verify the expected success of the planned expansion of the product lines. Regarding this, the online questionnaire study was conducted on a sample of 202 respondents. Realized statistical analysis based on the Kruskal-Wallis nonparametric test and subsequent Bonferroni post hoc correction signify that meat products, fresh meat, and slaughter specialties are the most favorite products among customers of the monitored company. Fresh milk, on the other hand, is not as attractive as a meal for them. However, selling it from vending machines placed out of the store would increase the sales. Dairy products of own production should be even more successful, as we assume they would be as interesting for customers as the currently expanding portfolio of meat products. The benefit of this study lies in the consideration of the practical use of the obtained results in the business practice of the monitored company. Regarding this, we are providing a set of recommendations, according to the planning of their product lines and connected marketing tools for their successful placement on the market.

Multicriteria decision-making methods are widely spread and used to assist the decision-makers to resolve problems. Many of the methods are simple to deploy (WSA, TOPSIS), which is an advantage and because of the computer boom, there is no problem with calculations. However, more sophisticated methods are evolving. The modelling of preferences is improved (from linear in WSA to Gaussian in PROMETHEE), multilevel decision-making (such as AHP) is extended to modelling of dependencies between individual criteria (ANP). The presented method, two-stage weighted PROMETHEE, combines the advantages of generalized preferential functions in PROMETHEE methods, unambiguous arrangement (PROMETHEE II) and hierarchical approach (AHP). In addition, this paper demonstrates the application of the method to evaluate the order of 14 regions of the Czech Republic in regard to economic indices such as the unemployment rate, economic activity, average age, wages, free working places, income, consumption and investments. Data are taken from the Czech Statistical Office web and include the years 2012-2019. In the first stage, the position of each region is calculated; in the second stage, all years mentioned are considered, including the aspect of the weighted time series. Result visualization is made possible using the Visual PROMETHEE software.

Current evidence for the effects of radiotherapy (RT) on implant-based immediate breast reconstruction (IBR) is limited by short follow-up and lack of patient-reported outcomes (PROs). It is central to integrate long-term comprehensive outcome data into the preoperative decision-making process. The aim of the present study was to determine long-term surgical outcomes and PROs in relation to RT after implant-based IBR.This was a longitudinal cohort study of PRO data obtained in surveys conducted in 2012 and 2020 using the BREAST-Q questionnaire. All women undergoing therapeutic mastectomy and implant-based IBR between 1 January 2007 and 31 December 2011 at four breast centres in Stockholm, Sweden, were identified. The endpoint was implant removal owing to surgical complications or patient preference.Median follow-up was 120 (range 1-171) months. After 754 IBRs in 729 women, implant removal occurred in 128 (17 per cent): 34 of 386 (8.8 per cent) in the no-RT group, 20 of 64 (31.3 per cent) in the group with previous RT, and 74 of 304 (24.3 per cent) in the postoperative RT group (P 0.001). Implant removal was because of surgical complications in 60 instances (7.9 per cent), and patient preference in 68 (9.0 per cent). The BREAST-Q response rate was 72.2 per cent. Women with previous RT scored lower than those without RT on all scales, apart from psychosocial well-being. Women with postoperative RT scored lower only on physical well-being. No scores in the two RT groups had deteriorated between the survey time points, whereas satisfaction with breasts and overall outcome had decreased in the no-RT group.Although RT was significantly associated with higher implant removal rates, PROs remained stable over 8 years despite irradiation.Current evidence for the effects of radiotherapy (RT) on implant-based immediate breast reconstruction (IBR) is limited by short follow-up. The aim was to determine surgical outcomes and patient-reported outcomes (PROs) in relation to RT up to 13 years after implant-based IBR. After 754 implant-based breast reconstructions in 729 women in Stockholm, Sweden, implant removal was more common in irradiated than non-irradiated patients (P 0.001). The response rate to the BREAST-Q questionnaire was 72.2 per cent. Women with previous RT scored lower than those without RT on all scales apart from psychosocial well-being. Women who had postoperative RT scored lower only on physical well-being. Although RT was significantly associated with higher implant removal rates, PROs remained stable despite irradiation.

Purpose The objective of this study was to evaluate the usability of a mobile health (mHealth) system designed for dysphagia exercise in persons with a history of stroke. Method Five participants with a history of stroke were recruited from a tertiary health center and assessed for their ability to use and interact with the system. After being introduced to the technology, participants were asked to independently complete five tasks, one at a time. Assistance was available when required or requested. Usability was evaluated with respect to effectiveness, efficiency, and user satisfaction when completing the prespecified goals. Results Four men and one woman between the ages of 50 and 83 years ( M = 65.4) completed the usability testing. Time from stroke onset varied from 1 month to 2.5 years. Additional poststroke challenges related to the usability of the mHealth system included reduced range of motion or mobility, vision, and short-term memory difficulties. Independent success (system effectiveness) varied in this user subgroup, and the research clinician or the family member was required to adjust the level and type of support they provided (system efficiency). All participants reported satisfaction with the use of the system. Conclusion Usability of and satisfaction with this mHealth system and others like it can be achieved in individuals who have had a stroke, either as an independent user or as a patient–caregiver dyad.

Context Adipose tissue distribution is a key factor influencing metabolic health and risk in obesity-associated comorbidities. Objective Here we aim to compare the proteomic profiles of mature adipocytes from different depots. Methods Abdominal subcutaneous (SA) and omental visceral adipocytes (VA) were isolated from paired adipose tissue biopsies obtained during bariatric surgery on 19 severely obese women (body mass index > 30 kg/m2) and analyzed using state-of-the-art mass spectrometry. Differential expression analysis and weighted gene co-expression network analysis (WGCNA) were performed to investigate proteome signature properties and to examine a possible association of the protein expression with the clinical data. Results We identified 3686 protein groups and found 1140 differentially expressed proteins (adj. P value < 0.05), of which 576 proteins were upregulated in SA and 564 in VA samples. We provide a global protein profile of abdominal SA and omental VA, present the most differentially expressed pathways and processes distinguishing SA from VA, and correlate them with clinical and body composition data. We show that SA are significantly more active in processes linked to vesicular transport and secretion, and to increased lipid metabolism activity. Conversely, the expression of proteins involved in the mitochondrial energy metabolism and translational or biosynthetic activity is higher in VA. Conclusion Our analysis represents a valuable resource of protein expression profiles in abdominal SA and omental VA, highlighting key differences in their role in obesity.

Background: Heart failure in women associated with pregnancy and the peripartum period is now recognized as a distinctive form of cardiomyopathy. Its prevalence and mortality vary in different geographical locations. There is a paucity of data from our group of the population regarding peripartum cardiomyopathy hence we conducted the study to determine the incidence, aetiology of PPCM in our study group along with treatment and maternal outcomes. Methods: Patients with any parity and age, which are in their peripartum period i.e. one month before delivery or within five months of delivery. Patients presenting with moderate to severe breathlessness at rest or on exertion with palpitations, ankle oedema, or with signs and symptoms of heart failure. Documented systolic dysfunction with the echocardiographic finding of Ejection fraction of

Cholangiocarcinoma and pancreatic cancer are the most common causes of malignant biliary obstruction. The majority of patients are diagnosed at a late stage when surgical resection is rarely possible. In these cases, palliative chemotherapy and radiotherapy provide only limited benefit and are associated with poor survival. Radiofrequency ablation (RFA) is a procedure for locoregional control of tumours, whereby a high-frequency alternating current turned into thermal energy causes coagulative necrosis of the tissue surrounding the catheter. The subsequent release of debris and tumour antigens by necrotic cells can stimulate local and systemic immunity. The development of endoluminal RFA catheters has led to the emergence of endoscopically delivered RFA, a treatment mainly used for malignant biliary strictures to prolong survival and/or stent patency. Other indications include recanalisation of occluded biliary stents and treatment of intraductal ampullary adenoma or benign biliary strictures. This article presents a comprehensive review of endobiliary RFA, mainly focusing on its use in patients with malignant biliary obstruction. The available data suggest that biliary RFA may be a promising modality, having positive impacts on survival and stent patency and boasting a reasonable safety profile. However, further studies with better characterised and stratified patient populations are needed before the method becomes accepted within routine clinical practice.

Pressure waves from explosions or other traumatic events can damage the neurons of the eye and visual centers of the brain, leading to functional loss of vision. There are currently few treatments for such injuries that can be deployed rapidly to mitigate damage. Brain-derived neurotrophic factor (BDNF) and activation of its receptor tropomycin-related kinase B (TrkB) have neuroprotective effects in a number of degeneration models. Small molecule activators of TrkB, such as N-[2-(5-hydroxy-1H-indol-3-yl)ethyl]-2-oxopiperidine-3-carboxamide (HIOC), cross the blood–brain and blood-retina barriers after systemic administration. We characterize the effects of blast-induced ocular trauma on retinal and visual function. We show that systemic administration of HIOC, a potent small molecule activator of the BDNF/TrkB receptor, preserves visual function in mice exposed to ocular blast injury. The HIOC treatment for one week preserves visual function for at least four months. The HIOC treatment effectively protected vision when the initial dose was administered up to 3 h after blast, but not if the initial treatment was delayed for 24 h. We provide evidence that the therapeutic effect of HIOC is mediated by activation of BDNF/TrkB receptors. The results indicate that HIOC may be useful for managing ocular blast injury and other forms of traumatic optic neuropathy.

BackgroundDifferential exposure to public activities may contribute to stark deprivation-related inequalities in SARS-CoV-2 infection and outcomes but has not been directly investigated. We set out to investigate whether participants in Virus Watch—a large community cohort study based in England and Wales—reported differential exposure to public activities and non-household contacts during the autumn–winter phase of the COVID-19 pandemic according to postcode-level socioeconomic deprivation.MethodsParticipants (n=20 120–25 228 across surveys) reported their daily activities during 3 weekly periods in late November 2020, late December 2020 and mid-February 2021. Deprivation was quantified based on participants’ residential postcode using English or Welsh Index of Multiple Deprivation quintiles. We used Poisson mixed-effect models with robust standard errors to estimate the relationship between deprivation and risk of exposure to public activities during each survey period.ResultsRelative to participants in the least deprived areas, participants in the most deprived areas exhibited elevated risk of exposure to vehicle sharing (adjusted risk ratio (aRR) range across time points: 1.73–8.52), public transport (aRR: 3.13–5.73), work or education outside of the household (aRR: 1.09–1.21), essential shops (aRR: 1.09–1.13) and non-household contacts (aRR: 1.15–1.19) across multiple survey periods.ConclusionDifferential exposure to essential public activities—such as attending workplaces and visiting essential shops—is likely to contribute to inequalities in infection risk and outcomes. Public health interventions to reduce exposure during essential activities and financial and practical support to enable low-paid workers to stay at home during periods of intense transmission may reduce COVID-related inequalities.

Detection, localization, and tracking of people in 2D or 3D space using Ultra-wideband (UWB) short-range sensors is a subject of worldwide intensive research. In this paper, we describe a proposal for a novel software called UWB-PerLoc-2D3D. This software has been created in a MATLAB programming environment and designed to process UWB radar signals for the purpose of movement monitoring of human targets in 2D and 3D space. We present an evaluation of the proposed software properties as well as examples of its utilization in practice.

This paper deals with the possibility of using pumice aggregates into thermal insulation lining of industrial chimneys. It introduces the construction of modern chimneys and mentions possible risks and degradation processes associated with condensate penetration. In the experiment, mixtures with pumice as aggregate were prepared. The thermal insulation properties, compressive strengths and the resistance to sulphates in a 5% sodium sulphate solution were evaluated and compared.

Background Severe Crohn’s disease [CD] can result in extensive bowel resections and need for creation of an ileostomy. Faecal calprotectin [FC] is well studied in CD management, though its role in patients who have an ileostomy is unclear. Our aim is to understand if FC is a useful adjunct to radiographic or endoscopic studies in identifying recurrent CD after surgery in patients with an ileostomy. Methods Between January 1, 2017, and September 30, 2020, we searched the Mayo Clinic electronic medical record retrospectively for adult patients with ICD-10 code for CD, and a surgical history of an ileostomy. Patients were included in the analysis if they had at least one FC measured and a concomitant radiographic imaging and/or endoscopic procedure. An abnormal FC was defined as greater than 60 µg/g. Results Of 51 patients who met our inclusion criteria, 17 had an FC level >60 µg/g. Of these 17 patients, 14 had imaging and/or an ileoscopy confirming the presence of small bowel inflammation, with a sensitivity of 87.5%. Of the remaining 34 patients with an FC level ≤60 µg/g, 32 patients had imaging and/or ileoscopy demonstrating no small bowel inflammation, with a specificity of 91.4%. FC from an ileostomy effluent had a positive predictive value of 82.3%, a negative predictive value of 94.1% and test diagnostic accuracy of 90.1%. Conclusion FC from an ileostomy effluent is a highly sensitive and specific test for the assessment and monitoring of small bowel inflammation and disease recurrence in patients with CD.

Turner syndrome (TS) is characterized by partial or complete loss of a sexual chromosome, resulting in an incomplete development of the body, gonadic failure, cardiac and renal abnormalities, oro-dental changes, etc. In our study, we proposed to perform a histological and immunohistochemical (IHC) study of the periodontium changes in patients with TS. The biological material under study was represented by fragments of gingival mucosa harvested from 18 patients with TS who presented advanced periodontal lesions and required dental extractions. The fragments of gingival mucosa were processed by the classical histological technique of paraffin inclusion, subsequently the obtained sections being stained by the Hematoxylin–Eosin (HE) and examined under the optical microscope. For the IHC study, there were performed serial sections incubated with anti-cluster of differentiation (CD) 3, anti-CD20 and anti-CD68 antibodies for highlighting immune cells, as well as with anti-matrix metalloproteinase (MMP) 2 and anti-MMP8 antibodies for highlighting MMPs (MMP2 and MMP8) involved in the periodontal tissue lesions. In the present study, during the histological examination, there were observed morphological changes, both in the epithelium and in the gingival mucosa chorion. Epithelial changes consisted in the onset of acanthosis processes, in the thickening of the epithelium due to the increase of the spinous layer, as well as in the parakeratosis phenomenon. In the chorion, there was observed the presence of inflammatory infiltrates in various stages, presence of fibrosis (extended in some cases) and the presence of an important vascularization in some cases, with a high number of immunocompetent cells involved in the inborn immune response, but also in the adaptive one, as well as a more or less intense immunoexpression of MMP2 and MMP8. Our study suggests that TS may contribute to the development of some inflammatory processes in the marginal periodontium.

Periodontitis is a chronic inflammatory disease caused by pathogenic dental plaque which causes microbial dysbiosis leading to destruction of supporting structures of teeth with a consequent tooth loss. Diabetes mellitus and periodontitis are non-communicable diseases with a bidirectional relation. The awareness of the medical community about potential effect of periodontal infections on systemic health is important. The aim of this study was to understand the physician’s knowledge, practice behavior, and awareness about periodontal disease and its association with diabetes. A cross-sectional study was undertaken among 210 endocrinologists and diabetologists based on the selection criteria. A validated questionnaire was sent to the participants wherein the respondent demographic characteristics, awareness about the periodontal disease, and information about their practice was collected. Descriptive analysis was done for the collected data and was presented as frequency counts and percentages. The association between categorical variables was done by Pearson’s chi-square test. The response rate for the study was 90.3% (p

When it comes to cognitive architecture and human information processing, chunks are one of the best known and most recognized constructs. Nevertheless, the nature of chunks is still very elusive, especially when it comes to chunks in procedural knowledge. This study deals with basic features of procedural information processing and examines the manifestation of chunks in procedural knowledge. The participants' task was to reconstruct sequences of chess moves. Chess was chosen as an experimental domain, because of its complexity, well-defined rules and standardized measure of chess player strength. From the results we conclude that short-term memory capacity is determined by the combination of the size and amount of procedural chunks recalled to the short-term memory. We have shown that on average, participants with more specialized knowledge operated faster and with larger chunks of procedural information than participants with less specialized knowledge. We have shown that in procedural information processing, the level of expertise and the sorting order of the retrieved information are important factors that influence the amount of procedural chunks retained in the short-term memory. Therefore, the capacity of short-term memory in complex situations cannot be expressed as a simple concept.

Objectives Persons with MS (PwMS) are frequently affected by fatigue and depression. Mindfulness-based interventions may reduce these symptoms in PwMS and consequently their application has been extended to various settings. Only few efforts have been made to explore effects of short-term mindfulness training during brief periods of hospitalization. In the current study, the feasibility and potential effects of short-term mindfulness training on depression, fatigue, rumination and cognition were explored in PwMS in an acute-care hospital setting. Based on previous work, it was further examined whether the relation between trait mindfulness and fatigue prior to and following the intervention was mediated by depression and whether a mediation effect was also observable throughout the intervention. Methods A short-term mindfulness training protocol was developed, tailored to the requirements of the acute-care setting. Subsequently, 30 PwMS were recruited sequentially and received mindfulness training during the routine clinical process (median duration in hospital: eight days, number of sessions: four). Participants completed relevant self-report measures (depression, fatigue, rumination) and a neuropsychological assessment before and after training. Results Participants reported significantly increased trait mindfulness and decreased depression and fatigue following the intervention. Respective change scores were highly correlated so that increased trait mindfulness was associated with decreased symptoms. In the rumination domain, patients reported a tendency for an increased adaptive ability to engage in distractive behavior during arising negative mood. Other measures of trait rumination and cognition remained relatively stable. Results of the mediation analyses indicated that depression mediated the negative relationship between trait mindfulness and fatigue symptoms at pre and post assessments. With regards to the change scores, an association between mindfulness and cognitive fatigue ceased to be significant when depression was controlled, albeit in this case, the mediation effect did not reach significance. Conclusion Results of the current study indicate that short-term mindfulness training during brief periods of hospitalization may be beneficial for PwMS. They further complement previous work by identifying depression as a potential mediator of the antagonistic relationship between mindfulness and fatigue. Based on the current exploratory study, future trials are warranted to address this mechanism of mindfulness training in more detail.

As nursing education searches for ways to advance the simulation experience for students, improving methods of prebriefing are essential. Student anxiety is commonly reported in and around the simulated learning experience. The aim of this study was to determine if a brief mindfulness exercise could influence anxiety for students entering the simulation laboratory. In this mixed-methods study, a visual analog scale (VAS) was used for students to self-report anxiety. Data analysis revealed that a brief guided meditation in the simulation prebriefing decreased self-reports of anxiety in the simulated learning experience. Students reported lowered anxiety, reported a feeling of “being in the moment”, but were also distracted by what others thought about the exercise. As we work towards a theoretical framework for the prebriefing phase of simulation, incorporating mindfulness may be as important as some of the other established best practices.

Introduction Reports on the use of computer-assisted trauma surgery of comminuted scapula fracture are still quite rare. In this article, we present a case of comminuted scapula fracture, the surgical reconstruction of which was pre-operatively planned using a complex software solution. Materials and methods For surgical planning of the fracture, we used the TraumaTech software facilitating virtual reconstruction (both manual and automatic), surgery planning, design of the implant, planning of screw placement and lengths, and production of a 3D print model of the fracture and the implant. The software also supported ordering such custom-made plate from a plate producer who was capable of fast and precise production of the plate. Results The surgery using the custom-ordered plate was successful. The actual used screw lengths did not differ from the planned ones by more than 2 mm. One year after the surgery, the patient was capable of more demanding activities and doing sports activities. Conclusion This approach provides a great way to prevent complications of the surgery and to shorten its duration. To the best of our knowledge, this is the first description of the treatment of a scapula comminuted fracture utilizing computer-assisted preoperative planning.

Numerous studies show that stock markets are often impacted by various calendar anomalies that disrupt the “random walk” behavior of stock prices. These anomalies contradict the Efficient markets theory and can be exploited to generate abnormal returns. This paper investigates the presence of two of them, namely the January effect and the January barometer, on the stock markets of 12 Central and Eastern European (CEE) countries. The paper examines the statistical significance of differences in returns recorded over the month of January and returns recorded over the other months (the January effect), as well as the statistical significance of differences between returns recorded during the remainder of year after a positive January return and after a negative January return (the January barometer). The results show, among other things, that the statistically significant January effect affects the Estonian, Lithuanian, Czech, Romanian, and Latvian stock markets. On the Romanian and Lithuanian stock markets, statistically significantly higher January returns are accompanied by statistically significantly higher January price volatility. On the other hand, we can speak of a statistically significant January barometer only in the case of the Latvian, Lithuanian, and Ukrainian stock markets. The presence of these anomalies is contrary to the Efficient market theory. It can be assumed that proper investment strategies based on these calendar anomalies should be able to generate abnormal returns. AcknowledgmentThis paper is an outcome of the science projects VEGA (1/0613/18) and VEGA (1/0221/21).

The aim of the study was to determine kidney survival and validate the novel international immunoglobulin A nephropathy (IgAN) prediction tool (PT) in the Latvian population. Adults with morphologically confirmed IgAN were included. Kidney survival was analysed with the Kaplan–Meier method. PT-assigned risk was compared with calculated risk by the Cox regression model. The Kaplan–Meier analysis included 95 patients. The five-year kidney survival Q3 was 24 months. Women had longer median kidney-survival time (> 60 months) than men (58 months). Median kidney survival in participants with MEST T0 was longer than 60 months; T1 and T2 were 40 and 18 months, respectively. Median kidney survival in participants with diastolic blood pressure (DBP) < 99 mmHg was longer than 60 months, whereas in patients with DBP 100–109 and 110 mmHg, it was 40 and 24 months, respectively. Cox regression analysis included 68 patients. A moderate degree of correlation was found between predicted and observed five-year risk (p = 0.001). Gender, tubular atrophy/interstitial fibrosis, DBP are significant factors affecting kidney survival. Since there was statistically significant correlation and reliability between PT and follow-up analysis data, we conclude that PT could be applied for use in the Latvian population.

BACKGROUND When Echinococcus multilocularis infects humans as a false intermediate host, alveolar echinococcosis (AE) usually manifests primarily intrahepatically and is initially asymptomatic. If the disease remains undiagnosed and untreated, progressive growth occurs, reminiscent of malignant tumours. The only curative therapy is complete resection, which is limited to localised stages, and palliative drug therapy is used otherwise. Consequently, early diagnosis and reliable detection of AE lesions are important. For this reason, abdominal ultrasonography, as the most common primary imaging for AE, relies on classification systems. AIM To investigate how hepatic AE lesion sonomorphology changes over time in the Echinococcosis Multilocularis Ulm Classification (EMUC)-ultrasound (US) classification. METHODS Based on data from Germany’s national echinococcosis database, we evaluated clinical and US imaging data for 59 patients according to the AE case definition in our preliminary retrospective longitudinal study. There had to be at least two liver sonographies ≥ 6 mo apart, ≥ 1 hepatic AE lesion, and complete documentation in all US examinations. The minimum interval between two separately evaluated US examinations was 4 wk. The AE reference lesion was the largest hepatic AE lesion at the time of the first US examination. To classify the sonomorphologic pattern, we used EMUC-US. In addition to classifying the findings of the original US examiner, all reference lesions at each examination time point were assigned EMUC-US patterns in a blinded fashion by two investigators experienced in US diagnosis. Statistical analysis was performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, United Stated). P values < 0.05 were considered statistically significant. RESULTS The preliminary study included 59 patients, 38 (64.5%) women and 21 (35.6%) men. The mean age at initial diagnosis was 59.9 ± 16.9 years. At the time of initial ultrasonography, a hailstorm pattern was present in 42.4% (25/59) of cases, a hemangioma-like pattern in 16.9% (10/59), a pseudocystic pattern in 15.3% (9/59), and a metastasis-like pattern in 25.4% (15/59). For the hailstorm pattern, the average lesion size was 67.4 ± 26.3 mm. The average lesion size was 113.7 ± 40.8 mm with the pseudocystic pattern and 83.5 ± 27.3 mm with the hemangioma-like pattern. An average lesion size of 21.7 ± 11.0 mm was determined for the metastasis-like pattern. Although the sonomorphologic pattern remained unchanged in 84.7% (50/59) of AE reference lesions, 15.3% (9/59) showed a change over time. A change in pattern was seen exclusively for AE lesions initially classified as hemangioma-like or pseudocystic. A total of 70% (7/10) of AE lesions initially classified as hemangioma-like showed a relevant change in pattern over time, and 85.7% (6/7) of these were secondarily classified as having a hailstorm pattern, with the remainder (1/7; 14.3%) classified as having a pseudocystic pattern. A total of 22.2% (2/9) of AE lesions initially classified as pseudocystic showed a relevant change in pattern over time and were classified as having a hailstorm pattern. For AE lesions initially classified as having a hailstorm or metastatic pattern, no pattern change was evident. All patients with pattern change were on continuous drug therapy with albendazole. CONCLUSION The sonomorphology of hepatic AE lesions may change over time. The hemangioma-like and pseudocystic patterns are affected.

Pluralistic agricultural advisory systems comprise diverse actors, including public and private research, development, and extension (RDE Increasing farm advisor capacity to engage with digital agricultural technologies; Improving career pathways for new entrants in the advisory and extension sector; and Improving knowledge flows in the advisory and extension system. We found that co-innovation requires potentially profound social change; a shaking up of expectations about roles, responsibilities, and institutionalised processes. The research also suggests that the requirement for social change is underacknowledged in current co-innovation practice, with implications for the success or failure of co-innovation partnerships. Applying a practice theory perspective, our research highlights features of practice that constrained and enabled co-innovation in the four pilots. In doing so, the research provides insights to assist in successful operationalisation of co-innovation involving the private sector in pluralistic agricultural advisory systems.

BACKGROUND: Acute poisoning, a common, yet an important preventable cause of morbidity and mortality in children, is a paediatric emergency globally, responsible for 0.33% to 7.6% of the total paediatric admissions among various hospitals of India. This study was done to assess the changing trends, in the pattern and outcome of poisoning among 1-12 years children. METHODS: This is an institution-based descriptive epidemiological study with cross-sectional design that includes a hundred children of one to twelve years age, conducted over a period of one and half years in the paediatric department of a tertiary care hospital in India. RESULTS: In the study period, majority of the patients out of 100 admitted, were male (65%).Most of those (68%) belonged to the 1-3 years age group. The share of hydrocarbon poisoning (46%) was highest with 26 cases of Kerosene ingestion being the most in it. Important presenting complaints were vomiting, pain abdomen, tachypnoea, and pneumonitis. Only 1 patient died during the course, the cause of which remained unknown. CONCLUSION: The pattern and outcome of acute poisoning in children was quite similar when compared to other studies from different hospitals in India. Survival rates have been increasing due to ongoing improvement in medical infrastructure, which one hopes, shall keep improving along with focus on preventive measures at community levels.

Subdural hematoma (SDH) was initially reported in 20% to 30% of patients with glutaric aciduria type 1 (GA1). A recent retrospective study found SDH in 4% of patients, but not in patients identified by newborn screening (NBS). 168 MRIs of 69 patients with GA1 (age at MRI 9 days - 73.8 years, median 3.2 years) were systematically reviewed for presence of SDH, additional MR and clinical findings in order to investigate the frequency of SDH and potential risk factors. SDH was observed in eight high-excreting patients imaged between 5.8 and 24.4 months, namely space-occupying SDH in two patients after minor accidental trauma and SDH as an incidental finding in six patients without trauma. In patients without trauma imaged at 3 to 30 months (n = 36, 25 NBS, 27/9 high/low excreters), incidence of SDH was 16.7% (16% in NBS). SDH was more common after acute (33.3%) than insidious onset of dystonia (14.3%) or in asymptomatic patients (5.9%). It was only seen in patients with wide frontoparietal CSF spaces and frontotemporal hypoplasia. High excreters were over-represented among patients with SDH (6/27 vs 0/9 low excreters), acute onset (10/12), and wide frontoparietal CSF spaces (16/19). Incidental SDH occurs despite NBS and early treatment in approximately one in six patients with GA1 imaged during late infancy and early childhood. Greater risk of high excreters is morphologically associated with more frequent enlargement of external CSF spaces including frontotemporal hypoplasia, and may be furthered aggravated by more pronounced alterations of cerebral blood volume and venous pressure.

In recent years, disruptive legal technology has been on the rise. Currently, several AI-based tools are being deployed across the legal field, including the judiciary. Although many of these innovative tools claim to make the legal profession more efficient and justice more accessible, we could have seen several critical voices against their use and even attempts to ban these services. This article deals with the use of artificial intelligence in legal technology and offers a critical reflection on the current state of the art. As much as artificial intelligence proved that it could improve the legal profession, there are still some underlying risks connected to the technology itself, which may deem its use disturbing.

Image quantitation methods including quantitative MRI, multiparametric MRI, and radiomics offer great promise for clinical use. However, many of these methods have limited clinical adoption, in part due to issues of generalizability, that is, the ability to translate methods and models across institutions. Researchers can assess generalizability through measurement of repeatability and reproducibility, thus quantifying different aspects of measurement variance. In this article, we review the challenges to ensuring repeatability and reproducibility of image quantitation methods as well as present strategies to minimize their variance to enable wider clinical implementation. We present possible solutions for achieving clinically acceptable performance of image quantitation methods and briefly discuss the impact of minimizing variance and achieving generalizability towards clinical implementation and adoption.

This study explored the extent to which emotion regulation dimensions statistically mediate the association between sleep disturbance and suicide risk among firefighters.Participants were 865 firefighters working for a fire department in an urban area in the southern U.S. Bootstrapping was used to test the indirect effects of sleep disturbance on suicide risk through emotion regulation dimensions, after controlling for depression and trauma exposure.The effect of sleep disturbance on suicide risk was significantly statistically mediated by emotion regulation difficulties (Results suggest that suicide interventions for firefighters who suffer from sleep disturbance should focus on the development of emotion regulation strategies.

PurposeThe purpose of this paper is to offer improvement in routing and collection load decisions for a green logistics system that delivers lunch boxes.Design/methodology/approachA mathematical model is introduced into the literature for the 130 years old logistics systems whose delivery accuracy is better than the Six Sigma standard without using sophisticated tools. A simulated annealing (SA) approach is then used to find the routing and collection load decisions for the lunch box career.FindingsThe findings establish that we can improve the world-class lunch box delivery (LBD) system. The suggested improvement in terms of reduction in distance travel is nearly 6%. This could be a huge relief for thousands of lunch box careers. The uniformity in collection load decisions suggested by the proposed approach can be more effective for the elderly lunch box carriers.Research limitations/implicationsThe research provides a mathematical framework to study an important logistics system that is running with a supreme level of service accuracy. Collecting primary data was challenging as there is no scope for recording and maintaining data in the present logistics system. The replicability of the system for some other city in the world is a challenging question to answer.Practical implicationsBetter routing and collection load decisions can help many lunch box careers save time and bring homogeneity in workload into the system.Social implicationsAn efficient routing decision can help provide smoother traffic movements, and uniformity in collection load can help avoid unwanted injuries to about 5,000 lunch box careers.Originality/valueThe originality of this paper lies in the proposed mathematical model and finding the routing and collection load decisions using a nature-inspired probabilistic search technique. The LBD system of Mumbai was never studied mathematically. The study is the first of its kind.

Summary Congenital malformations of the inner ear consist of many different anomalies of the labyrinth. They often cause hearing loss, mostly of the sensorineural type. Eighty percent of hearing loss is caused by an anomaly of the membranous labyrinth, and 20% by an anomaly of the bone labyrinth. The role in pathogenesis is played by hereditary factors and influence of the environment. The treatment depends on the severity of the hearing loss, abnormalities of the external and middle ear, associated defects, and presence and function of the auditory nerve. We have modern hearing aids or implantable systems. Another options include a sign language and mouth-reading. The article includes a retrospective analysis of patients with congenital inner ear malformations at our tertiary center in 2010–2020. In conclusion, our patients clearly prove that even children with profound hearing loss are successfully implanted and restored hearing can be achieved in most of them. Key words congenital ear malformation – inner ear – hearing loss – anomalies of bony labyrinth – anomalies of membranous labyrinth – rehabilitation

Background Reduced access to maternity care in rural areas of the United States presents a significant burden to pregnant persons and infants. The objective of this study was to estimate the impact of family physicians (FPs) on access to maternity care in rural United States hospitals, especially where other providers may not be available. Methods We administered a survey to 216 rural hospitals in 10 US states inquiring about the number of babies delivered from 2013 to 2017, the types of delivering physicians, and the maternity services offered. We calculated the percentage of rural hospitals in our sample where FPs performed vaginal deliveries, cesareans, and vaginal births after cesarean (VBACs), and the percentage of all babies delivered by FPs. We estimated the distance patients would have to travel for care if FPs were not providing care locally. Results The final study population consisted of 185 rural hospitals. FPs delivered babies in 67% of these hospitals and were the only physicians who delivered babies in 27% of these hospitals. FPs provided VBAC at 18% and cesarean birth services at 46% of the rural hospitals, but with wide geographic differences. Many patients would have to drive an average of 86 miles round-trip to access care if those FPs were to stop delivering. Conclusions Family physicians are essential providers of maternity care in the rural United States. Family Medicine residency programs should ensure that trainees who intend to practice in rural locations have adequate maternity care training to maintain and expand access to maternity care for rural patients and their families.

Amputace dolni koncetiny znamena vždy važný zasah do pacientova života. Cil: Cilem výzkumneho setřeni bylo zjistit, znalosti vseobecných sester o spravně volených postupech při osetřovani pahýlu po amputaci dolni koncetiny.Metodika: Pro výzkumne setřeni byla zvolena metoda kvantitativniho výzkumu s využitim nestandardizovaneho dotazniku. Výsledky a diskuze: Na zakladě dotaznikove setřeni bylo zjistěno, že vseobecne sestry maji velmi nizke znalosti o spravně volených postupech při osetřovani pahýlu po amputaci dolni koncetiny. Nedostatky byly identifikovany zejmena v oblasti hygienicke pece o pahýl a při volbě obvazove techniky bandažovani.Zavěr: Adekvatni postupy při osetřovani pahýlu po amputaci dolni koncetiny v pooperacnim obdobi zasadně ovlivňuji proces hojeni, proto je žadouci, aby vseobecne sestry znaly a aplikovaly spravne postupy.

Zusammenfassung Ziel der Studie Betroffene mit chronisch entzündlicher Darmerkrankung (CED) sind durch die spezifische Krankheitssymptomatik oftmals in ihrer beruflichen Teilhabe und Arbeitsfähigkeit beeinträchtigt. Ziel war eine Exploration ihrer berufsbezogenen Problemlagen und Unterstützungswünsche sowie die Ableitung bedarfsgerechter Unterstützungsangebote für den rehabilitativen Sektor. Methodik 235 CED-Patienten (97 Rehabilitanden, 138 in ambulanter fachärztlicher Betreuung) bearbeiteten einen Selbstausauskunftsfragebogen, der krankheitsspezifische Belastungen, arbeitsbezogene Sorgen und den Bedarf an Unterstützungsangeboten ermittelte. Die subjektive Prognose der Erwerbsfähigkeit (SPE) wurde mit der SPE-Skala erfasst. Ergebnisse Die Studienteilnehmer waren im Mittel 46 Jahre alt, 60% waren Frauen, 45% litten an Morbus Crohn, 67% waren in Vollzeit erwerbstätig. 72% (N=170) wiesen Anzeichen einer negativen Erwerbsprognose anhand der SPE-Skala auf. Sie berichteten im Durchschnitt 12 krankheitsspezifische und 22 arbeitsbezogene Probleme und Sorgen im Berufsleben. Krankheitssymptome, die das Berufsleben von etwa jedem zweiten Befragten fast täglich belasten, waren Beeinträchtigungen durch Müdigkeit (66%), Schwäche (55%) sowie Stuhldrang (55%). Zu den drei häufigsten arbeitsbezogenen Problemen, von denen mehr als jeder zweite Teilnehmer beinahe jeden Tag betroffen ist, zählen: eine verringerte Leistungsfähigkeit (56%), die Sorge nicht mehr voll leistungsfähig zu sein (55%) sowie Arbeitsdruck und Stress am Arbeitsplatz (53%). Als wichtigste arbeitsbezogene Unterstützungsangebote nannten die Befragten Informationen, Beratungen oder Schulungen zu den Themen Krankheitswissen (91%), Behandlungsmöglichkeiten (88%), sozialrechtliche Leistungen (85%) sowie Bewegungsangebote zur Steigerung der körperlichen Fitness (84%). Schlussfolgerung Die Studienergebnisse zeigen eine große Bandbreite von Problemen im Arbeitsleben von CED-Betroffenen und veranschaulichen die Vielfalt körperlicher und psychosozialer Beeinträchtigungen. Die Daten liefern wichtige Anhaltspunkte für die Entwicklung von bedarfsgerechten Unterstützungsangeboten, die in einem multimodalen und interdisziplinären Setting wie dem Rehabilitationssektor gut adressiert werden können. Dazu sollte das Spektrum bestehender Angebote in der CED-Reha erweitert, ein stärkerer Berufsbezug während der Rehabilitation hergestellt sowie ein standardisiertes Screening auf berufsbezogene Probleme implementiert werden.