Search

Arrhythmia is an abnormality often encountered in patients with cardiac problems. The presence of arrhythmia can be detected by an electrocardiogram (ECG) test. Automatic observation based on machine learning has been developed for long time. Unfortunately, only few of them have capability of explaining the knowledge inside themselves. Thus, transparency is important to improve human understanding of knowledge. To achieve this goal, a method based on cascaded transparent classifier is proposed. Firstly, ECG signals were separated and every single signal was extracted using feature extraction method. Several of extracted feature’s attributes were selected, and the final step was classifying data using cascade classifier which consists of decision tree and the rule based classifier. Classification performance was evaluated with publicly available dataset, the MIT-BIH Physionet Dataset. The methods were tested using 10-fold cross validation. The average of both accuracy and number of rules generated was considered. The best result using rule-based classifier achieves the accuracy and the number of rules 92.40% and 40, respectively. And the best result using cascade classifier achieves the accuracy and the number of rules 92.84% and 80, respectively. As a conclusion, transparent classifier shows a competitive performance with reasonable accuracy compared with previous research and promising in addressing the need for interpretability model.

Background The African Surgical OutcomeS-2 (ASOS-2) trial tested an enhanced postoperative surveillance intervention to reduce postoperative mortality in Africa. We undertook a concurrent evaluation to understand the process of intervention delivery. Methods Mixed-methods process evaluation, including field notes, interviews, and post-trial questionnaire responses. Qualitative analysis used the framework method with subsequent creation of comparative case studies, grouping hospitals by intervention fidelity. A post-trial questionnaire was developed using initial qualitative analyses. Categorical variables were summarised as count (%) and continuous variables as median (inter-quartile range [IQR]). Odds ratios (OR) were used to rank influences by impact on fidelity. Results The dataset included eight in-depth case studies, and 96 questionnaire responses (response rate 67%) plus intervention fidelity data for each trial site. Overall, 57% (n=55/96) of hospitals achieved intervention delivery using an inclusive definition of fidelity. Delivery of the ASOS-2 interventions and data collection presented a significant burden to the investigators, outstripping limited resources. The influences most associated with fidelity were: surgical staff enthusiasm for the trial (OR=3.0; 95% confidence interval [CI], 1.3–7.0); nursing management support of the trial (OR=2.6; 95% CI, 1.1–6.5); performance of a dummy run (OR=2.6; 95% CI, 1.1–6.1); nursing colleagues seeing the value of the intervention(s) (OR=2.1; 95% CI, 0.9–5.7); and site investigators' belief in the effectiveness of the intervention (OR=3.2; 95% CI, 1.2–9.4). Conclusions ASOS-2 has proved that coordinated interventional research across Africa is possible, but delivering the ASOS-2 interventions was a major challenge for many investigators. Future improvement science efforts must include better planning for intervention delivery, additional support to investigators, and promotion of strong inter-professional teamwork. Clinical trial registration ClinicalTrials gov NCT03853824.

Various in vitro preconditioning strategies have been implemented to increase the regenerative capacity of MSCs. Among them are modulation of culture atmosphere (hypoxia or anoxia), three-dimensional culture (3D), addition of trophic factors (in the form of growth factors, cytokines or hormones), lipopolysaccharides, and pharmacological agents. Preconditioning mesenchymal stem cells by culturing them in a hypoxic environment, which resembles the natural oxygen environment of the tissues (1% –7%) and not with standard culture conditions (21%), increases the survival of these cells via Hypoxia Inducible Factor-1α (HIF-1a) and via Akt-dependent mechanisms. In addition, the hypoxic precondition stimulates the secretion of pro-angiogenic growth factors, increases the expression of chemokines SDF-1 (stromal cell-derived factor-1) and its receptor CXCR4 (chemokine receptor type 4) - CXCR7 (chemokine receptor type 7) and increases engraftment of stem cell. This review aims to provide an overview of the preconditioned hypoxic treatment to increase the therapeutic potential of adipose-derived mesenchymal stem cells.

Introduction: There is limited knowledge on the sensitization patterns to peanut proteins and food allergy in the Middle East. The objective of this study is to analyze the relationship between sensitization patterns to peanut proteins and clinical symptoms in a group of patients with physician-diagnosed peanut allergy (PA) in Kuwait. Methods: PA patients were evaluated by the skin prick test (SPT), serum total IgE, peanut-specific IgE (sIgE), and sIgE against Ara h 1–3, 8, and 9, and clinical data were collected. Results: Sixty-nine patients were included. A positive correlation between peanut SPT and sIgE was detected for all 3 storage proteins (Ara h 1–3) in patients p = 0.0046 and p = 0.0378). The levels of Ara h 1 and 2 were also significantly higher in patients with systemic reactions compared to those with a local reaction, with those differences being especially relevant for Ara h 2 (15.9 vs. 0.4) (p = 0.0005). Conclusions: The pattern of sensitization to peanut proteins in the Middle East is similar to that of the Western world. Measurement of sIgE antibodies to Ara h 1, 2, and 3 is useful in the diagnosis of PA and in the investigation of reactions to raw and roasted peanuts.

Objetivo: analizar la razón de muerte materna (RMM), sus características sociodemográficas y obstétricas de las muertes maternas (MM) ocurridas entre años 2012 y 2018 en el Hospital Regional Docente de Cajamarca (HRDC). Métodos: Estudio descriptivo sobre datos obtenidos del registro de muertes maternas de la Oficina de Epidemiología de la DIRESA Cajamarca. Resultados : 42 MM, RMM promedio 171.4/100000 NV; 42.8% de 20 a 29 años de edad, 30.9% de 36 años a más. Procedieron de provincia de Cajamarca: 50%. Tuvieron estudios de primaria: 47.6%; analfabetas: 4.8%. Amas de casa: 80.9%; convivientes: 71.4%. Edad gestacional: 47.1% entre 28-36 semanas, 26.2% entre 37-40 semanas. 42.8% fueron multíparas, 4.8% gran multípara. Control prenatal: 69% inadecuado; afiliadas al SIS: 95%. MM directas: 76.2% y 23.8% indirectas; hipertensión inducida por embarazo: 65.6%; 21.9% sepsis obstétrica, 12.5% hemorragia obstétrica. Ocurrió en puerperio: 85.7%. Referidas: 85.7%, 44.4% de provincia Cajamarca. Fallecieron en UCI: 59.6%, causa de ingreso a UCI (56%): hipertensión asociada al embarazo. Estancia promedio: 5.4 días. 54.8 % fueron parto por cesárea; 91.3% de cesáreas se realizaron en HRDC. RMM hospitalaria en el periodo de estudio fue “muy alta”. Conclusiones: las características sociodemográficas serían la causa de las causas de la elevada RMM en HRDC. La mayoría de MM fueron directas (76.2%), mayormente asociadas a enfermedad hipertensiva del embarazo (65.6%). Analizar la estancia hospitalaria, servicio donde ocurrió la MM y tipo de parto, ayuda a evidenciar el grado de capacidad resolutiva del HRDC. Palabras clave. Mortalidad materna, razón de mortalidad materna, causas sociodemográficas. DOI: http://dx.doi.org/10.17268/rmt.2021.v16i03.10

Objetivo: analizar los factores relacionados con la suspensión de cirugías electivas como tasas, edad, sexo, causas, especialidades que suspenden, en el Hospital Regional Docente de Cajamarca (HRDC) durante años 2014 a 2018. Material y métodos: El presente estudio es de tipo observacional, transversal y retrospectivo, analizando 983 cirugías electivas suspendidas en el HRDC en los años de estudio. La información se obtuvo de la base de datos del Centro Quirúrgico y de la Oficina de Estadística e Informática del HRDC, resaltando el número de cirugías programadas, realizadas, suspendidas y las causas agrupadas en categorías. Resultados: La tasa de suspensión fue de 10.21%. La categoría de causa con mayor suspensión fue la relacionada con la instalación (50.86%), luego con el paciente (25.73%) y con la evaluación preoperatoria (23.39%). Las principales causas generales fueron: Tiempo operatorio prolongado de cirugía previa (18.61%), mala condición clínica del paciente (14.24%), cirujano indica reevaluación (8.74%), paciente desiste de operación (8.34%). Las especialidades con mayor índice de suspensión fueron Cirugía General, Traumatología, Ginecoobstetricia. Conclusión: La tasa de suspensión es mala, las principales causas se relacionan con la instalación: institución, su sistema administrativo y proceso de atención. Siendo que la suspensión de las cirugías es un indicador de calidad, se deben generar intervenciones para brindar una atención oportuna en los servicios quirúrgicos del hospital. Palabras clave: Cirugía suspendida, cirugía electiva, centro quirúrgico DOI: http://dx.doi.org/10.17268/rmt.2021.v16i03.11

OBJECTIVES The aim of this study was to identify risk factors associated with mortality in patients with systemic sclerosis (SSc), particularly those with interstitial lung disease (ILD), over a long-term follow-up in a large Brazilian SSc cohort. METHODS We conducted a medical records review study of 380 scleroderma patients from 1982 to 2019. Systemic sclerosis ILD was considered in those with evidence of ILD on chest high-resolution computed tomography (HRCT). Causes of death were determined. RESULTS Among the 380 SSc patients, SSc-ILD on chest HRCT was observed in 227 patients (59.7%). Seventy-two patients (18.9%) died during a mean follow-up of 7.2 years since the SSc diagnosis; among them, 57 (79.2%) had SSc-ILD, compared with 15 (20.8%) without SSc-ILD (p < 0.001). Of the 72 deaths, 51.4% were considered related to SSc, and ILD was the leading cause of death. The overall survival rates at 5, 10, and 15 years were 87.9%, 81.5%, and 74.9%, respectively. Kaplan-Meier analysis showed a significantly worse prognosis among patients with SSc-ILD than among those without ILD (p < 0.001). Among patients with SSc-ILD, disease duration of less than 4 years (p < 0.001), forced vital capacity

This paper presents a new model for the task of scene text visual question answering, in which questions about a given image can only be answered by reading and understanding scene text that is present in it. The proposed model is based on an attention mechanism that attends to multi-modal features conditioned to the question, allowing it to reason jointly about the textual and visual modalities in the scene. The output weights of this attention module over the grid of multi-modal spatial features are interpreted as the probability that a certain spatial location of the image contains the answer text the to the given question. Our experiments demonstrate competitive performance in two standard datasets. Furthermore, this paper provides a novel analysis of the ST-VQA dataset based on a human performance study., Comment: This paper is under consideration at Pattern Recognition Letters

Introduced less than two decades ago, glucagon-like peptide-1 receptor agonists rapidly reshaped the field of Type 2 diabetes mellitus (T2DM) care by providing glycaemic control in tandem with weight loss. However, FDA-approved GLP-1 receptor agonists are often accompanied by nausea and emesis and, in some lean T2DM patients, by undesired anorexia. Importantly, the hypophagic and emetic effects of GLP-1 receptor agonists are caused by activation of central GLP-1 receptors. This review summarizes two different approaches to mitigate the incidence and severity of nausea and emesis related to GLP-1 receptor agonists: conjugation with vitamin B(12), or related corrin ring-containing compounds (‘corrination’), and development of dual agonists of GLP-1 receptors with glucose-dependent insulinotropic polypeptide (GIP). Such approaches could lead to the generation of GLP-1 receptor agonists with improved therapeutic efficacy, thus decreasing treatment attrition, increasing patient compliance and extending treatment to a broader population of T2DM patients. The data reviewed show that it is possible to pharmacologically separate the emetic effects of GLP-1 receptor agonists from their glucoregulatory action.

Introduction/Main Objectives: This study estimates how much economic value will be lost from contact activities within the coastal areas in the research location. Background Problems: The area of Semarang City has flood and tidal problems, the damage to the mangrove forests in Semarang City began with the boom in shrimp farming between 1980 and 1990. Hopefully, this valuation can provide an overview of the current health of the ecosystem and become the basis for a mangrove management strategy in the future. Novelty: The novelty of this study is that it uses a sharper satellite (Image Pleades Resolution 0.5 m) to calculate the mangrove area in the research location. Research Methods: This research uses a total economic valuation, an estimation of the mangrove’s carbon stock and heavy metals, the replacement cost to prevent tidal flooding, and the willingness to pay. Findings/Results: We find that the existing economic value in the study area is very large and should be preserved for conservation. Conclusion: The environment cannot produce something instantly, but it needs to be preserved as a balance to nature.

Glucagon-like peptide 1 receptor (GLP-1R) agonists decrease body weight and improve glycemic control in obesity and diabetes. Patient compliance and maximal efficacy of GLP-1 therapeutics are limited by adverse side effects, including nausea and emesis. In three different species (i.e., mice, rats, and musk shrews), we show that glucose-dependent insulinotropic polypeptide receptor (GIPR) signaling blocks emesis and attenuates illness behaviors elicited by GLP-1R activation, while maintaining reduced food intake, body weight loss, and improved glucose tolerance. The area postrema and nucleus tractus solitarius (AP/NTS) of the hindbrain are required for food intake and body weight suppression by GLP-1R ligands and processing of emetic stimuli. Using single-nuclei RNA sequencing, we identified the cellular phenotypes of AP/NTS cells expressing GIPR and GLP-1R on distinct populations of inhibitory and excitatory neurons, with the greatest expression of GIPR in γ-aminobutyric acid-ergic neurons. This work suggests that combinatorial pharmaceutical targeting of GLP-1R and GIPR will increase efficacy in treating obesity and diabetes by reducing nausea and vomiting.

BACKGROUND: Brachial plexus injury (BPI) is one of the most devastating nerve injuries to the extremities. BPI in adults is an increasingly common clinical problem due to road traffic accident. Injury patterns, the timing of surgery, priority on the recovery of function, and patient’s understanding about the expectations of the prognosis are things that are important to consider before deciding on surgical management. The coronavirus pandemic coronavirus disease 2019 (COVID-19) has significantly affected all sectors, one of which is a surgical practice both in terms of medical personnel and equipment, also patient perceptions of hospital services. AIM: This study will analyze epidemiological data on BPI patients who underwent surgery during the COVID-19 pandemic. METHODS: A retrospective descriptive study of BPI profile in Prof. Soeharso Orthopedic Hospital before (2019) and during (2020) the COVID-19 pandemic. Demographic data, the total number of surgery, type of surgical procedure, and patient origin were collected. We compared to the same period in 2019 before pandemic started. RESULTS: In the data obtained from patients treated or undergoing BPI surgery before pandemic (March 1, 2019 to December 31, 2019) and during the pandemic (March 1, 2020 to December 31, 2020), Indonesia first confirms case was on March 2, 2020, until today. There were 51 and 43 cases, respectively. Panplexal type before the pandemic there were 27 patients (52%), and during the pandemic were 20 patients (46%), the upper type before: during the pandemic was 24 (48%): 23 (54%), and lower type 0 cases. Primary reconstruction before: during the pandemic was 26 (55%): 27 (62%) case, and secondary reconstruction before: during the pandemic was 25 (49%): 16 (38%) case, respectively. CONCLUSION: COVID-19 pandemic has no significant effect in the term of the number of BPI surgery performed. Better outcome in BPI surgery is influenced by the timing of the operation, therefore primary reconstruction remains the main choice for BPI patients with safety concern or health protocols. Pre-operative screening applied in our hospital includes laboratory examination, chest radiograph, and polymerase chain reaction swab test. Surgical personnel using personal protective equipment such as protective suit, face shield, google, shoes and medical mask during the COVID-19 pandemic. Patients with significant axon loss and limited clinical recovery are considered “urgent”, as surgery should be performed within 6 months or sooner (depending upon the distance to recipient’s muscle) to avoid irreversible muscle atrophy and degradation of motor endplates.

Consultation with traditional healers (THs) is common among people living with HIV in sub-Saharan Africa. We conducted a prospective longitudinal study to determine the association between consultation with THs and HIV outcomes following 12 months of antiretroviral therapy (ART). HIV-infected individuals presenting for care and initiation of ART in Dakar and Ziguinchor, Senegal were eligible for enrollment. Data were collected using interviews, clinical evaluations, laboratory analyses, and chart reviews at enrollment, 6 months after ART initiation, and 12 months after ART initiation. Among the 186 participants, 35.5% consulted a TH. The most common reason for consulting a TH was “mystical” concerns (18%). Those who consulted a TH before ART initiation were more likely to present with a CD4 count < 200 cells/mm3 (44% versus 28%; P = 0.04) and WHO stage 3 or 4 disease (64% versus 46%; P = 0.03), and they were less likely to disclose their HIV status (44% versus 65%; P = 0.04). Those who consulted a TH more than 6 months after ART initiation were more likely to report poor adherence to ART (57% versus 4%; P < 0.01). The strongest predictor of virologic failure was consulting a TH more than 6 months after ART initiation (odd ratio [OR], 7.43; 95% CI, 1.22–45.24). The strongest predictors of mortality were consulting a TH before ART initiation (OR, 3.53; 95% CI, 1.25–9.94) and baseline CD4 count < 200 cells/mm3 (OR, 3.15; 95% CI, 1.12–8.89). Our findings reveal multiple opportunities to strengthen the HIV care cascade through partnerships between THs and biomedical providers. Future studies to evaluate the impact of these strategies on HIV outcomes are warranted.

Summary Background Risk of mortality following surgery in patients across Africa is twice as high as the global average. Most of these deaths occur on hospital wards after the surgery itself. We aimed to assess whether enhanced postoperative surveillance of adult surgical patients at high risk of postoperative morbidity or mortality in Africa could reduce 30-day in-hospital mortality. Methods We did a two-arm, open-label, cluster-randomised trial of hospitals (clusters) across Africa. Hospitals were eligible if they provided surgery with an overnight postoperative admission. Hospitals were randomly assigned through minimisation in recruitment blocks (1:1) to provide patients with either a package of enhanced postoperative surveillance interventions (admitting the patient to higher care ward, increasing the frequency of postoperative nursing observations, assigning the patient to a bed in view of the nursing station, allowing family members to stay in the ward, and placing a postoperative surveillance guide at the bedside) for those at high risk (ie, with African Surgical Outcomes Study Surgical Risk Calculator scores ≥10) and usual care for those at low risk (intervention group), or for all patients to receive usual postoperative care (control group). Health-care providers and participants were not masked, but data assessors were. The primary outcome was 30-day in-hospital mortality of patients at low and high risk, measured at the participant level. All analyses were done as allocated (by cluster) in all patients with available data. This trial is registered with ClinicalTrials.gov , NCT03853824 . Findings Between May 3, 2019, and July 27, 2020, 594 eligible hospitals indicated a desire to participate across 33 African countries; 332 (56%) were able to recruit participants and were included in analyses. We allocated 160 hospitals (13 275 patients) to provide enhanced postoperative surveillance and 172 hospitals (15 617 patients) to provide standard care. The mean age of participants was 37·1 years (SD 15·5) and 20 039 (69·4%) of 28 892 patients were women. 30-day in-hospital mortality occurred in 169 (1·3%) of 12 970 patients with mortality data in the intervention group and in 193 (1·3%) of 15 242 patients with mortality data in the control group (relative risk 0·96, 95% CI 0·69–1·33; p=0·79). 45 (0·2%) of 22 031 patients at low risk and 309 (5·6%) of 5500 patients at high risk died. No harms associated with either intervention were reported. Interpretation This intervention package did not decrease 30-day in-hospital mortality among surgical patients in Africa at high risk of postoperative morbidity or mortality. Further research is needed to develop interventions that prevent death from surgical complications in resource-limited hospitals across Africa. Funding Bill & Melinda Gates Foundation and the World Federation of Societies of Anaesthesiologists. Translations For the Arabic, French and Portuguese translations of the abstract see Supplementary Materials section.

El presente artículo está basado en la metodología de la Investigación Acción, en el análisis documentario de los instrumentos de gestión del proceso de la gestión escolar en las instituciones educativas públicas y del proceso de planificación, para ello centrándonos en la planificación estratégica situacional de Carlos Matus. Se puede ver que la carencia y la diversidad de modelos empleados en la formulación de instrumentos de gestión en las instituciones educativas no permite la consecución del objetivo institucional deseado, solo por avocarse al cumplimiento documentario de momento, esto se repite cada año, acción que no se refleja en resultados tal como se espera por ser un objetivo nacional que es elevar el nivel académico, que como parte implícita está la gestión escolar, también se refleja la falta de articulación de los instrumentos de gestión institucional con la gestión pedagógica, administrativa y en algunos aspectos con los objetivos estratégicos regionales y nacionales, para lo cual se analizan los procesos de la gestión educativa, a fin de determinar la pertinencia del modelo de la planificación estratégica situacional aplicado a la gestión escolar.

This case report showed an AOT in a 12-year-old female patient referred for orthodontic-surgical of both impacted right mandibular canine and lateral incisor. Cone beam computed tomography revealed a well-defined mixed hyperdense/hypodense lesion, involving the crown of the mandibular lateral incisor. The surgery consisted in surgical exposure of the mandibular right canine and lateral incisor, bonding of the lateral incisor for orthodontic traction and curettage of the mandibular lesion. Histopathological examination revealed several columnar epithelial cells with minimal stromal connective tissue, lobular pattern and rosettes and duct-like structures, confirming the diagnosis of AOT. After, the patient was referred for orthodontic traction of the impacted teeth. At 1 and 3-year postoperatively, follow-ups examinations showed extensive bone repair, resolution of the tooth-retention and absence of recurrence. Although AOT is an uncommon lesion in the mandible, it should be considered in the differential diagnosis of the mixed profile lesions in this region.

BACKGROUND: Early diagnosis of vulvar squamous cell carcinoma (SCC) is directly related to better prognosis and higher survival rate. Missed gynecologist follow-up, some cultural traditions and refrain from facing with a problem that involves intimacy and sexual sphere can be the cause of delayed diagnosis and treatment. Radical surgery still represents the gold standard, but narrow excision margins can progressively lead to local recurrence, even after years. CASE REPORT: The case we present is a rare case of misdiagnosed metastatic SCC of the vulva after radical excision and groin dissection 2 years before. After a full-through discussion with patient on treatment options and prognosis, a multidisciplinary surgical approach was planned, consisting in wide surgical resection of groin, part of mons pubis and right pelvic iliac-obturator lymphadenectomy. Femoral artery excision was performed due to absence of a clear margin, and reconstruction was accomplished with interposed great saphenous vein graft. The plastic reconstruction consisted in harvest of transverse rectus abdominal flap (TRAM), that was transposed inferiorly to repair right groin. Pathologist confirmed free margins of excision and pelvic lymph nodes resulted negative (pT1b, N3, M0 – stage IV A). DISCUSSION: When deep structures of the groin - such as femoral vessels - are involved by relapse, the condition is potentially life-threatening. A multidisciplinary approach consents to perform a radical surgery with free margins and likewise to achieve a satisfying functional reconstruction. CONCLUSION: This case should emphasize that skin ulceration on a non-weight-bearing surface is always suspicious for skin malignancy, an incisional biopsy is easy to perform and consents a rapid diagnosis. A history of recurrent vulvar SCC should always warn about the risk of late lymph node metastasis even years after a radical excision of the primary tumor and concomitant lymphadenectomy.

Open lobbying, as mechanism for citizen participation, it was seen promoting in application of the General Law of Municipalities; it implies that the neighbors of that community a reintegrated into the objectives for the development of the district, it ervining directly with opinions and suggestions at a public hearing convened to discuss or discuss a specific topic that, with the participation of the neighbors and rulers, would contribute to making wise decisions for the good of the good. With this research, it is intended to analyze how open lobbying is a mechanism of participation in the district. The present research is of qualitative approach, from a phenomenological perspective, based dose on personal experience; it has as ample of 18 people: 02 neighbors representing the 09 sectors that counts the district. It is concluded that open lobbying is a mechanism of citizen participation formed under the Political Constitution of Peru and developed through the General Law of Municipalities; however, this medium, mainly, is used for accountability, neglecting educational issues of neighborhood incidence; that is, it ignores the importance of intervention by neighbors for cooperative work that allows the development of the district.

Background Major depressive disorder (MDD) affects millions of people worldwide. While the exact pathogenesis is yet to be elucidated, the role of neuro-immune signaling has recently emerged. Despite major advances in pharmacotherapy, antidepressant use is marred by limited efficacy and potential side effects. Cannabidiol (CBD), a phytocannabinoid, exerts antidepressant-like effects in experimental animals. This study investigated the impact of CBD on sickness behavior (SB), a measure of depressive-like response, and neuro-immune changes induced by lipopolysaccharides (LPS) in mice. Methods Socially isolated rodents were administered with LPS to trigger SB. and treated with CBD or its vehicle. Animals were submitted to forced swimming test, to evaluate depressive-like behavior, and to open field test, to evaluate locomotory activity. Immediately after behavioral analyses, animals were euthanized and had their hypothalamus, prefrontal cortex and hippocampus dissected, to proceed neurotrophins and cytokines analyses. ELISA was used to detect IL-1β, BDNF and NGF; and cytometric beads array to measure IL-2, IL-4, IL-6, IFN-γ, TNF-α and IL-10 levels. Results CBD effectively prevented SB-induced changes in the forced swim test without altering spontaneous locomotion. This phytocannabinoid also partially reversed LPS-evoked IL-6 increase in both the hypothalamus and hippocampus. In addition, CBD prevented endotoxin-induced increase in BDNF and NGF levels in the hippocampus of SB animals. Conclusions Apparently, CBD prevents both behavioral and neuro-immunological changes associated with LPS-induced SB, which reinforces its potential use as an antidepressant which modulates neuroinflammation. This opens up potentially new therapeutic avenues in MDD. Supplementary Information The online version contains supplementary material available at 10.1007/s43440-021-00301-8.

Background Lung cancer screening (LCS) reduces lung cancer mortality, but it also carries a range of risks. Shared decision-making (SDM) is a process of engaging patients in their health care decisions and is a vital component of LCS. Research Question What is the quality of SDM among patients recently assessed for LCS? Study Design and Methods Cross-sectional study of screened patients recruited from two academic tertiary care centers in the South Central Region of the United States. Self-reported surveys assessed patient demographics, values related to outcomes of LCS, knowledge, SDM components including receipt of educational materials, and decisional conflict. Results Recently screened patients (n = 266) possessed varied LCS knowledge, answering an average of 41.4% of questions correctly. Patients valued finding cancer early over concerns about harms. Patients indicated that LCS benefits were presented to them by a health care provider far more often than harms (68.3% vs 20.8%, respectively), and 30.7% reported they received educational materials about LCS during the screening process. One-third of patients had some decisional conflict (33.6%) related to their screening decisions, whereas most patients (86.6%) noted that they were involved in the screening decision as much as they wanted. In multivariate models, non-White race and having less education were related to lower knowledge scores. Non-White patients and former smokers were more likely to be conflicted about the screening decision. Most patients (n = 227 [85.3%]) indicated that a health care provider had discussed smoking cessation or abstinence with them. Interpretation Among recently screened patients, the quality of decision-making about LCS is highly variable. The low use of educational materials including decision aids and imbalance of conveying benefit vs risk information to patients is concerning. A structured approach using decision aids may assist with providing a balanced presentation of information and may improve the quality of SDM.

The treatment of large segmental defects of long bones resulting from trauma, infection, or bone tumor resections is a major challenge for orthopedic surgeons. The reconstruction of bone defects with acellular allografts can be used as an osteoconductive approach. However, devitalized allografts are associated with high rates of clinical failure as a result of poor intrinsic osteoinduction properties and a lack of further remodeling. Nevertheless, evidence suggests that due to its anabolic properties, teriparatide (PTH1-34) could be effective as an adjuvant therapy for massive allograft healing. Therefore, our goal was to investigate in a murine critical-sized defect model whether the intermittent administration of PTH1-34 improves the incorporation and revitalization of acellular structural bone allografts. Thus, a 2.5-mm critical-sized defect was established in the right femur of C57BL/6 mice, followed by the reconstruction with a devitalized cortical structural allograft. A titanium micro locking plate was applied to the anterior femoral surface and secured in place with self-tapping locking screws. Subsequently, daily doses of PTH1–34 (30, and 40 µg/kg) or saline were administered to the mice for 14 days after surgery. The mice were maintained without PTH1–34 therapy for an additional 7 days before being euthanized at 3 weeks post-surgery. Bone graft consolidation was assessed on radiographic images and by histomorphometric analysis. Additionally, to determine the frequency of osteoprogenitor cells in the bone marrow and their in vitro osteogenic capacity, stromal cells were isolated from the bone marrow of animals treated with 30 or 40 µg/kg/day of PTH1-34 following the same protocol used for the experimental animals. Our results suggest that intermittent PTH1-34 treatment at 30 µg/kg/day after femoral allograft reconstruction surgery accelerated the healing process as evidenced by new bone formation induced on endosteal and periosteal surfaces, enhanced revitalization of allogeneic graft, and increased frequency and osteogenic capacity of bone marrow stromal cells (BMSC). These findings should encourage further studies aimed at investigating the potential therapeutic use of intermittent PTH1-34, specifically with regards to the optimal dosing regimen in clinically challenging orthopedic scenarios.

BACKGROUND The primary element of a crooked nose is a midline deviation of the nasal pyramid. To date, no surgical strategies have been described as compatible with the philosophy of dorsal preservation. The dorsal preservation technique differs from the Joseph structured rhinoplasty because it preserves both the keystone area and the continuity of the cartilaginous vault. The authors focused on the versatility of the dorsal preservation technique even for the deviated nose, introducing the "Pisa Tower concept." METHODS From January of 2015 to June of 2019, 280 patients diagnosed as having a crooked nose underwent primary septorhinoplasty with dorsal preservation through an asymmetric bony wedge resection and lowering of the bony pyramid onto the frontal process of the maxilla (the let-down osteotomy), in accordance with the Pisa Tower concept. Inclusion criteria were a preoperative computed tomography examination, nasal axis deviation, a complete photographic examination preoperatively, and at least a 1-year follow-up. RESULTS The mean nasal axis deviation was 7.62 degrees preoperatively and 1.15 degrees postoperatively (p < 0.05). Of the 84 patients, 47 (55.95 percent) were very satisfied, 33 (39.28 percent) were satisfied, and four (4.76 percent) were unsatisfied with surgical results and required revision surgery. CONCLUSIONS The authors' opinion is that the association of "swinging door" septoplasty with the Pisa Tower concept can be a valid alterative to other techniques when working with the structured rhinoplasty philosophy in patients with a crooked nose. Although this is only a preliminary study, the decreased use of spreaders graft and less aggressive reconstructive methods look very promising. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

Made available in DSpace on 2022-04-28T19:47:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-12-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) The aim of this study was to investigate the filling ability of a new premixed bioceramic sealer in comparison with an epoxy resin-based sealer in curved root canals using different segmentation methods and voxel sizes in micro-CT images. Twelve curved mesial roots of mandibular molars with two separated canals were selected. All root canals were prepared by using HyFlex EDM files size 25/.08 and filled by the single cone technique and Bio-C Sealer or AH Plus (n = 12). The samples were scanned by micro-CT at 5 μm. The images were analyzed at 5, 10, and 20 μm for the volumetric analysis of voids in filling. Visual image segmentation was performed by two examiners, and the automatic segmentation was accomplished for comparison. Radiopacity of the sealers was evaluated by radiographic analysis. Data were submitted to the two-way ANOVA and non-paired t tests at a significance level of 5%. AH Plus had the highest radiopacity (p .05). There was no difference interobserver, which had similar results to those obtained with automatic segmentation for all voxel sizes evaluated (p >.05). Bio-C Sealer had appropriate filling ability. Visual and automatic segmentation can be applied to micro-CT images with voxel sizes from 5 to 20 μm to evaluate the filling of sealers with adequate radiopacity. Automatic segmentation should be used as a faster method. Department of Restorative Dentistry Sao Paulo State University (UNESP) School of Dentistry Sao Carlos Institute of Physics University of Sao Paulo Department of Restorative Dentistry Sao Paulo State University (UNESP) School of Dentistry CAPES: 001 FAPESP: 2016/00321-0 FAPESP: 2017/19049-0 FAPESP: 2018/19665-6

In the activities of Computer subjects especially the material "Computer Hardware and Software" subject teachers are less than optimal in utilizing and empowering learning resources. Students are less able to develop themselves and tend to be forced to memorize or remember the material presented. The ability of students who are still low in identifying the types and functions of computer hardware, the habit of playing games after school, so that learning outcomes in computer subjects the material "Knowing Computer Hardware and Software" has not been satisfactory. The system development method uses the System Development Life Cycle (SDLC) method and the system design uses UML. The implementation of this system uses Construct 2, as well as system testing using the Black Box. The results achieved are Android-based Educational Game applications to facilitate students in understanding the learning process at school. Keyword s Game, System Development Life Cycle, UML.

To compare prehospital time for patients with suspected stroke in Florida with the American Stroke Association (ASA) time benchmarks, and to investigate the effects of dispatch notification and stroke assessment scales on prehospital time.A retrospective analysis was performed using data from Florida's Emergency Medical Services Tracking and Reporting System database. All patients with suspected stroke transported to a treatment center from January 1, 2018, through December 31, 2018, were analyzed. Time intervals from 911 call to hospital arrival were evaluated and compared with ASA benchmarks.In 2018, 11,577 patients with suspected stroke were transported to a hospital (mean age, 71.5±15.7 years; 51.5% women). The median alarm-to-hospital time was 33.98 minutes (27.8 to 41.4), with a total emergency medical services (EMS) time of 32.30 minutes (26.5 to 39.478). The on-scene time was the largest time interval with a median of 13.28 minutes (10.0 to 17.4). Emergency medical services encounters met the ASA benchmarks for time in 58% to 62% of the EMS encounters in Florida (recommended 90%; P.001). The total EMS time was reduced when a stroke notification was reported by the dispatch center (32.00 minutes vs 32.62 minutes; P=.006) or when a stroke assessment scale was used by the EMS personnel (31.88 minutes vs 32.96 minutes; P=.005).This study reveals a substantial opportunity for improvement in stroke care in Florida. Two prehospital EMS stroke interventions seem to reduce prehospital time for patients with suspected stroke. Adoption of these interventions might improve the stroke systems of care.

Forest and land fires in Riau Province for the period of 2019 caused enormous losses, many aspects were disturbed by the fires, namely economic, health and bilateral relations which were most affected. Meanwhile, the government seems slow in dealing with forest and land fires and resolving their impacts. The slow pace of government action has prompted groups outside the government to participate in efforts to accelerate the handling of forest and land fires in Riau. From this background, this study looks at the role of groups outside the government (pressure groups) in encouraging the acceleration of forest and land fire prevention in Riau in 2019. This study uses a qualitative approach with descriptive data analysis. Sources of data were obtained from interviews, review of legal products, articles, related documents and news sources from the mass media. This research shows that the existence of the student action movement, environmental activists and other civil society organizations, is able to accelerate the government to take preventive and curative actions to tackle forest and land fires in Riau Province. The presence of this pressure group is also a bridge of interests between the people and the state so that corrections to inappropriate state policies can be immediately carried out to prevent forest and land fires.

Transcatheter aortic valve replacement (TAVR) for severe aortic stenosis in older adults may be challenging because of additional aortic comorbidities such as aortic coarctation (CoA). We report successful snared-assisted transfemoral TAVR in a patient with an extremely horizontal ventriculoaortic axis that was worsened by a previous endovascular repair of complex CoA. (Level of Difficulty: Advanced.), Central Illustration

The short nose represents one of the greatest challenges in rhinoplasty. It is characterized by a reduced distance from the nasal radix to the tip-defining points, often associated with inadequate tip projection. Several techniques have been described for correction of short nose with the common objective of replacing and rebuilding the osteocartilaginous framework. One of the most effective method to correct the short nose is the septal extension graft. The authors describe the caudal septum pivot (CSP) technique, a simple method to elongate short noses by using a graft inserted in the dorsal septum after its division using as pivot the caudal portion, without detaching it from its natural anchorage to the anterior nasal spine. A retrospective analysis was performed reviewing the clinical charts and the operative records of 315 patients who underwent revision rhinoplasty from January 2015 to June 2019; among this group, 34 were considered eligible for the study. The patients (8 men, 26 women; mean age: 25.4 years; age range: 22–53 years) were divided into two groups: in 12 patients (Group 1) the CSP technique was performed, while Group 2 was composed of 22 patients who received a more classic treatment with a septal extension graft. To evaluate the outcomes, nasal length, tip projection, and tip rotation were measured pre- and 1 year postoperatively on digital photographs of each patient. Nasal anthropometric measurements revealed, at 12-month visit follow-up, an improvement in nasal length, tip projection, and nasolabial angle was achieved in all the patients. The comparison of the pre- and postoperative values showed a statistically significant reduction in the nasolabial angle (p

The purpose of this study was to determine the effect of digital marketing and product variety on purchasing decisions at Juragan Fashion Shop in Bengkulu City. The sample in this study is 100 consumers who shop at Juragan Fashion Shop in Bengkulu City. Data collection using a questionnaire and the analysis method used is multiple linear regression, test of determination and hypothesis testing.The results of multiple linear regression calculations obtained the multiple linear regression equation Y = 5.995 + 0.355X1 + 0.353X2. The coefficient of determination of the R square value is 0.521. This means that X1 (Digital marketing) and X2 (product variety) affect the purchase decision (Y) by 52.1% while the remaining 47.9% is influenced by other variables not examined in this study. The results of the F test show that the significance is 0.000 0.05. Because the significance level is below 0.05, it indicates that together X1 (digital marketing) and X2 (product variety) have a positive and significant effect together on purchasing decisions (Y). Digital marketing has a positive and significant influence on purchasing decisions, product variety has a positive and significant impact on purchasing decisions because the significant value is smaller than 0.05.

In the metal machining process, especially in the milling process, the parameters that affect the quality milling process results are cooling media because it affects the tool life used. This paper aims to determine the performance of using fan chips as the coolant in the dry milling process area. The method used is the computational fluid dynamic (CFD) method and the experimental milling process on a workpiece made from aluminum alloy 5086. In experimental testing using a variation of the milling machine spindle rotation. The simulation test results on the fluid flow character on fan chips with a protector producing a central character with a small area. In contrast, fan chips without a protector make a central character with a broader area. The wind speed data in simulation testing and experimental testing produced the same trend graph. The results of the performance of fan chips after experimented with variations in spindle rotation, cooling process on area occurs when the motor spindle rotates above 1120 Rpm on the fan chips with a protector, and the engine spindle rotates above 770 Rpm on the fan chips without a protector. The effect of fan chips on tool life affects increasing tool life by 8 minutes on installing fan chips with a protector and increasing tool life by 12 minutes on installing fan chips without a protector.

Cekungan Sumatera Selatan merupakan cekungan batubara dengan sumber daya batubara terbesar kedua di Indonesia. Hal ini membuka peluang untuk dapat memanfaatkannya dengan eksplorasi gas metana batubara. Gas content dan nilai permeabilitas sangat mempengaruhi potensi gas metana batubara pada suatu wilayah. Permeabilitas batubara sangat dikontrol oleh sistem cleat yang berkembang pada lapisan batubara tersebut. Studi mengenai karakteristik cleat pada batubara sangat diperlukan untuk melihat kemungkinan jalur keluarnya gas metana dalam batubara. Penelitian ini dilakukan untuk mengetahui hubungan antara karakteristik batubara, sistem cleat yang berkembang, dan pendekatan nilai permeabilitasnya. Anggota M3 dari Formasi Muaraenim diambil sampel batubaranya untuk dilakukan analisis microcleat. Anggota M3 ini merupakan lapisan batubara yang tidak dalam, memiliki ketebalan yang cukup baik, dan merupakan target selain anggota M2 yang telah terbukti mempunyai potensi gas metana batubara. Analisis microcleat dilakukan untuk mengamati face cleat, butt cleat, aperture, dan spasi. Korelasi dari hasil perhitungan permeabilitas terhadap gas content dan kedalaman lapisan batubara memberikan gambaran bahwa dengan semakin besar nilai permeabilitas maka semakin besar gas content.

This study aims to examine and to analyze the legal protection of exporters and importers in international trade transactions using Letter of Credit (L/C) as a payment system at PT. Bank Maybank Indonesia Tbk branch of Bengkulu. The type of this study was normative legal research with descriptive analytical research design. The result of this study indicated that in an international payment system that used L/C, both exporters and importers were protected, thus exporters did not have to worry about their goods not being paid for, while importers did not need to worry that the goods they bought did not arrive or that they would lose payment, because the bank would guarantee this matters if the required documents were appropriate. PT. Bank Maybank Indonesia Tbk branch of Bengkulu, in protecting its customers, must have considerations both based on the provisions of national banking regulations and based on the applicable banking practices. The efforts made by banks to protect exporters and importers were such as banks have to implement good corporate governance, apply Know Your Customer principles including the principle of prudence in providing L/C facilities, apply the Know Your Employee principle. Moreover, it was necessary to apply optimal sanctions in case of violation of procedures. The L/C arrangements at PT. Bank Maybank Indonesia Tbk branch of Bengkulu adheres to UCP 600 so that it can avoid differences or misinterpretation between the transacting parties as far as possible.

In this work we propose to use Deep Learning to automatically calculate the coordinates of the vertebral corners in sagittal x-rays images of the thoracolumbar spine and, from those landmarks, to calculate relevant radiological parameters such as L1–L5 and L1–S1 lordosis and sacral slope. For this purpose, we used 10,193 images annotated with the landmarks coordinates as the ground truth. We realized a model that consists of 2 steps. In step 1, we trained 2 Convolutional Neural Networks to identify each vertebra in the image and calculate the landmarks coordinates respectively. In step 2, we refined the localization using cropped images of a single vertebra as input to another convolutional neural network and we used geometrical transformations to map the corners to the original image. For the localization tasks, we used a differentiable spatial to numerical transform (DSNT) as the top layer. We evaluated the model both qualitatively and quantitatively on a set of 195 test images. The median localization errors relative to the vertebrae dimensions were 1.98% and 1.68% for x and y coordinates respectively. All the predicted angles were highly correlated with the ground truth, despite non-negligible absolute median errors of 1.84°, 2.43° and 1.98° for L1–L5, L1–S1 and SS respectively. Our model is able to calculate with good accuracy the coordinates of the vertebral corners and has a large potential for improving the reliability and repeatability of measurements in clinical tasks.

Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder in children. A severity index was recently proposed to identify the stable from the progressive scoliosis at the first standardized biplanar radiographic exam. The aim of this work was to extend the validation of the severity index and to determine if curve location influences its predictive capabilities. AIS patients with Cobb angle between 10° and 25°, Risser 0–2, and no previous treatment were included. They underwent standing biplanar radiography and 3D reconstruction of the spine and pelvis, which allowed to calculate their severity index. Patients were grouped by curve location (thoracic, thoracolumbar, lumbar). Patients were followed up until skeletal maturity (Risser ≥ 3) or brace prescription. Their outcome was compared to the prediction made by the severity index. In total, 205 AIS patients were included; 82% of them (155/189, 95% confidence interval [74–90%]) were correctly classified by the index, while 16 patients were unclassified. Positive predictive ratio was 78% and negative predictive ratio was 86%. Specificity (78%) was not significantly affected by curve location, while patients with thoracic and lumbar curves showed higher sensitivity (≥ 89%) than those with thoracolumbar curves (74%). In this multicentric cohort of 205 patients, the severity index was used to predict the risk of progression from mild to moderate scoliosis, with similar results of typical major curve types. This index represents a novel tool to aid the clinician and the patient in the modulation of the follow-up and, for progressive patients, their decision for brace treatment. • The severity index of adolescent idiopathic scoliosis has the potential to detect patients with progressive scoliosis as early as the first exam. • Out of 205 patients, 82% were correctly classified as either stable or progressive by the severity index. • The location of the main curve had small effect on the predictive capability of the index.

Las lesiones de mancha blanca son efectos adversos frecuentes en los pacientes con tratamiento de ortodoncia. Son producto del ataque de ácidos orgánicos capaces de desorganizar la estructura del esmalte y su formación está asociados a la presencia de factores de riesgo como el tiempo prolongado de tratamiento ortodóntico, la mala higiene bucal y edades tempranas de inicio de tratamiento. En la literatura existen diversos métodos de diagnóstico para este tipo de lesiones, así como diversas propuestas para su prevención y/o tratamiento. El objetivo de esta revisión de literatura es presentar la evidencia científica relacionada a la formación de las lesiones de mancha blanca, su prevalencia, factores de riesgo asociados a su formación, así como describir los métodos de diagnóstico más frecuentes y los mecanismos de prevención y de tratamiento.

In implementing the local lockdown, a good communication relationship must be established between the Central Government and Regional Governments in preventing the spread of Covid-19 at the local level. (Sedarmayanti, 2018) explained that at least there are several elements in government communication, including; Communicators, Messages, Media, Communicate and Feedback. Based on the background above, the problem formulation that the writer will raise is how the communication patterns of the central government and local governments: the case of the dynamics of implementing local lockdowns in preventing the spread of COVID-19, the purpose of writing this article is to find out the communication between the central government and local governments: the case of dynamics. implementation of a local lockdown to prevent the spread of covid-19. This research uses qualitative research methods with this type of research, namely literature study data collection through documentation, books, journals, and mass media. The results of this study are: the communication between the Central Government and the Regional Government does not run harmoniously, indicated by the presence of several regions implementing local lockdowns, including the City of Tegal, the City of Tasikmalaya, and the Province of Papua.

Nausea and vomiting are consistently identified among the most distressing side effects of chemotherapy. In recent years, Olanzapine (OLZ) treatment was added to anti-emetic guidelines as a treatment for chemotherapy-induced nausea and vomiting (CINV), despite little available data supporting a mechanism behind the positive benefits of the drug. Here, we examine whether OLZ reduces cisplatin chemotherapy-induced side effects on food intake and pica behavior in rats (i.e., kaolin intake, a proxy for nausea/emesis). Behavioral experiments tested whether systemic or hindbrain administration of OLZ ameliorated cisplatin-induced pica, anorexia, and body weight loss in rats. We also tested whether systemic OLZ reduces cisplatin-induced neuronal activation in the dorsal vagal complex (DVC), a hindbrain region controlling emesis. Lastly, given their role in regulating feeding and emesis, circulating ghrelin levels and central mRNA expression levels of serotonin (HT) receptor subunits, including 5-HT2C, were measured in brain regions that regulate CINV and energy balance in an exploratory analysis to investigate potential mediators of OLZ action. Our results show that both systemic and hindbrain administration of OLZ attenuated cisplatin-induced kaolin intake and body weight loss, but not anorexia. Systemic OLZ decreased cisplatin-induced c-Fos immunofluorescence in the DVC and prevented cisplatin-induced reductions in circulating ghrelin levels. IP OLZ also blocked cisplatin-induced increases in Htr2c expression in DVC and hypothalamic micropunches. These data suggest hindbrain exposure to OLZ is sufficient to induce reductions in cisplatin-induced pica and that central serotonergic signaling, via 5-HT2C, and changes in circulating ghrelin may be potential mediators of olanzapine anti-emetic action.

Patients with multiple myeloma (MM) experience substantial cancer/treatment-related symptom burden during maintenance therapy. This is a phase II randomized, double-blinded, placebo-controlled clinical trial to examine the effect of minocycline for symptom reduction by its potential anti-inflammatory effect. Eligible MM patients for maintenance therapy were randomized to receive minocycline (100 mg twice daily) or placebo. The MD Anderson Symptom Inventory for MM (MDASI-MM) was used to assess multiple symptoms weekly during the trial. Clinician-rated toxicities and blood samples were prospectively collected. The effect size, area under the curve (AUC), and t tests were used to determine the symptom burden between treatment groups and identify the 5 most-severe MDASI-MM symptoms. The longitudinal analysis compared the changes in symptom severity and associated inflammatory markers between groups over time. Sixty-nine evaluable MM patients (33 from the intervention group and 36 from the placebo group) were included. No grade 3+ adverse events related to study medication were noted. The AUCs for the 5 worst MDASI-MM symptoms (fatigue, pain, disturbed sleep numbness/tingling, and drowsiness) were not significantly different between two arms. Regardless of group assignment, pain reduction was positively associated with decreased serum levels of soluble tumor necrosis factor-α receptors 1 and 2 during therapy (all P < 0.05). This pPhase II randomized study observed no statistically significant positive signal impact from minocycline on symptom reduction or inflammatory markers during maintenance therapy for MM, although using minocycline was feasible and had a low toxicity profile.

A rare case of agranulocytosis due to Methimazole administration for Basedow disease is presented. After 30 days since the therapy beginning a 45 year old female patient has developed a necrotizing fasciitis on both legs, with muscle bellies and Achille’s tendon exposure. Immediate surgical debridement was necessary to save her life and control the progression of infection. Several plastic surgery procedures were performed to accomplish wounds healing (vacuum-assisted closure therapy, dermal substitute, free flap, skin graft), and after 75 days the patient was discharged. An intensive rehabilitation program permitted a complete functional recovery. After 12 months a reshaping procedure was performed to improve right leg and ankle contour. The close cooperation between endocrinologist and surgeon revealed to be essential to perform a safe surgery and to permit the return to the job and daily activities.

This report describes the case of a 64-year-old woman with a previous diagnosis of obstructive hypertrophic cardiomyopathy who underwent surgical myectomy but who had a persistent midventricular residual gradient. The patient was symptomatic despite medical treatment and chose to undergo percutaneous radiofrequency (RF) ablation focused on the gradient. RF delivery was performed, and the gradient was reduced from the initial 105/68 mm Hg (during Valsalva maneuver/at rest before ablation) to 24/10 mm Hg. This reduction was sustained for the next 12 months. Percutaneous RF ablation may be a reasonable option for second surgical myectomy, and the protocol can be easily reproduced.

Purpose: To investigate the toxicity profile and establish an optimal dosing schedule of zotiraciclib with temozolomide in patients with recurrent high-grade astrocytoma. Patients and Methods: This two-stage phase I trial determined the MTD of zotiraciclib combined with either dose-dense (Arm1) or metronomic (Arm2) temozolomide using a Bayesian Optimal Interval design; then a randomized cohort expansion compared the progression-free survival rate at 4 months (PFS4) of the two arms for an efficient determination of a temozolomide schedule to combine with zotiraciclib at MTD. Pharmacokinetic and pharmacogenomic profiling were included. Patient-reported outcome was evaluated by longitudinal symptom burden. Results: Fifty-three patients were enrolled. Dose-limiting toxicities were neutropenia, diarrhea, elevated liver enzymes, and fatigue. MTD of zotiraciclib was 250 mg in both arms and thus selected for the cohort expansion. Dose-dense temozolomide plus zotiraciclib (PSF4 40%) compared favorably with metronomic temozolomide (PFS4 25%). Symptom burden worsened at cycle 2 but stabilized by cycle 4 in both arms. A significant decrease in absolute neutrophil count and neutrophil reactive oxygen species production occurred 12–24 hours after an oral dose of zotiraciclib but both recovered by 72 hours. Pharmacokinetic/pharmacogenomic analyses revealed that the CYP1A2_5347T>C (rs2470890) polymorphism was associated with higher AUCinf value. Conclusions: Zotiraciclib combined with temozolomide is safe in patients with recurrent high-grade astrocytomas. Zotiraciclib-induced neutropenia can be profound but mostly transient, warranting close monitoring rather than treatment discontinuation. Once validated, polymorphisms predicting drug metabolism may allow personalized dosing of zotiraciclib.

Cancer is a public health problem worldwide, and one of the crucial steps within tumor progression is the invasion and metastasis of cancer cells, which are directly related to cancer-associated deaths in patients. Recognizing the molecular markers involved in invasion and metastasis is essential to find targeted therapies in cancer. Interestingly, about 50% of the discovered drugs used in chemotherapy have been obtained from natural sources such as plants, including isoflavonoids. Until now, most drugs are used in chemotherapy targeting proliferation and apoptosis-related molecules. Here, we review recent studies about the effect of isoflavonoids on molecular targets and signaling pathways related to invasion and metastasis in cancer cell cultures, in vivo assays, and clinical trials. This review also reports that glycitein, daidzein, and genistein are the isoflavonoids most studied in preclinical and clinical trials and displayed the most anticancer activity targeting invasion-related proteins such as MMP-2 and MMP-9 and also EMT-associated proteins. Therefore, the diversity of isoflavonoids is promising molecules to be used as chemotherapeutic in invasive cancer. In the future, more clinical trials are needed to validate the effectiveness of the various natural isoflavonoids in the treatment of invasive cancer.

Background To evaluate outcomes and survival rates in patients with metastatic adrenocortical carcinoma (ACC) who were treated with image‐guided locoregional treatments (IGLTs). Purpose To evaluate the overall survival (OS) and clinical impact of IGLT in the management of patients with advanced metastatic ACC. Methods Retrospective review of 39 patients treated with IGLT between 1999 and 2018 was performed. Short‐ and long‐term efficacy of treatments were defined based upon imaging and clinical data. Subgroup survival analysis was performed on patients with metastatic disease at diagnosis (N = 17) and compared with the same stage group from the most recent National Cancer Database (NCDB) report. Statistical analysis was performed using Cox proportional hazards model. Results Treatments were performed at different anatomic sites including liver (N = 46), lung (N = 14), retroperitoneum (N = 5), bone (N = 4), subcutaneous (N = 2), and intracaval (N = 1). Radiofrequency, microwave, cryoablation, or a combination of two modalities (45, 18, 3, 3, respectively) were used in 69 ablation sessions. Intra‐arterial procedures were performed in 12 patients in 18 treatment cycles (range 1–3 per patient). As of a 2019 analysis, 11 patients were alive with a mean follow‐up of 169 months (range 63–292 months) from diagnosis. Two‐ and 5‐year OS rates for all patients were 84.5% and 51%, respectively, and 76.5% and 59% for patients with metastatic disease at diagnosis (N = 17). This compares favorably with an NCDB report of 35% 5‐year survival rate for patients with metastatic disease. Female gender and longer time from diagnosis to first IGLT were found to be predictors of prolonged survival with hazard ratios of 0.23 (p, Treatment of patients with advanced adrenocortical carcinoma with image‐guided locoregional therapies may be associated with prolonged survival, especially in females. Challenging clinical decisions for this rare disease with few effective treatment options may be informed by our two‐decade experience with locoregional therapies. Such a combined approach with surgery, ablation, and/or embolization may be associated with better than previously reported long‐term patient survivals.

Fatigue is the most prevalent symptom of cancer and its treatments. Changes in the intestinal microbiome have been identified in chronic fatigue syndrome and other neuropsychiatric disorders, and cancer patients. However, the association between intestinal microbiome and fatigue in patients with advanced cancers has not been evaluated. Understanding the connection between intestinal microbiome and fatigue will provide interventional and therapeutic opportunities to manipulate the microbiome to improve fatigue and other patients’ reported outcomes. In this project, we aimed to identify associations between microbiome composition and fatigue in advanced cancer patients. In this cross-sectional observational study at a tertiary cancer care center, we included 88 patients with advanced, metastatic, unresectable cancers who were in a washout period from chemotherapy. We measured fatigue using the MD Anderson Symptom Inventory—Immunotherapy fatigue score, and used 16srRNA to analyze intestinal microbiome. Using correlation analysis we found that Eubacterium hallii was negatively associated with fatigue severity scores (r = − 0.30, p = 0.005), whereas Cosenzaea was positively associated with fatigue scores (r = 0.33, p = 0.0002). We identified microbial species that exhibit distinct composition between high-fatigued and low-fatigued cancer patients. Further studies are warranted to investigate whether modulating the microbiome reduces cancer patients’ fatigue severity and improves their quality of life.

BACKGROUND: Frozen shoulder is a musculoskeletal disorder resulting from chronic inflammation of the capsule subsynovial layer and characterized with capsular thickening, progressive fibrosis, and contracture of the glenohumeral joint capsule. This condition is a relatively common condition that mimics other condition and its management requires deliberate consideration of patient’s condition. REVIEW ARTICLE: This article reviews and summarize latest findings of frozen shoulder. The diagnosis of frozen shoulder is described from the patient history, physical examination in look, feel, and move sequence to the supporting examinations. The current evidence of managements of frozen shoulder is described, from the nonoperative to the surgical approach. CONCLUSION: Most of frozen shoulder cases resolve spontaneously thus conservative treatment should be the first choice of frozen shoulder. However, for cases that failed with conservative treatment and had a debilitating effect to patient’s daily life or cases with history of surgery, operative treatment should be considered. Operative treatment is aimed to release the capsule either by manipulation under anesthesia, by arthroscopy, or by open surgery. Physical rehabilitation following every procedure is mandatory and key to maintain range of motion years following the surgery.

Indonesia is the largest palm-oil producing country, covering almost 80 percent of global production. With the extensive production capacity, this research seeks to analyze the linkages between palm oil production and its impact on the economy by the individual monthly expenditure. To reveal the connections, this research analyzes the Dutch Disease phenomenon in Indonesia, which explains how the non-tradable sector, palm-oil industry, affects the tradable sector like the manufacturing industry. The panel data variables are selected from 2011 to 2015 within 22 provinces to see the Dutch Disease's implications. As the model is suffered from the endogeneity, the correlation of explanatory variables with the error term, the research uses the Instrumental-Variable Regression method. The analysis indicates that Indonesia was not suffered from Dutch Disease. Therefore, palm oil production could increase individual expenditure. Finally, the extension of palm oil plantations could benefit Indonesia's economy without affecting other sectors.JEL Classification: E21, E24, O13, O44How to Cite:Siregar, C. D. T., & Sihaloho, E. D. (2021). Could Palm Oil Plantation Increase Individual Expenditure? The Dutch Disease Implication in Indonesia. Signifikan: Jurnal Ilmu Ekonomi, 10(1), 77-92. doi: http://doi.org/10.15408/sjie.v10i1.15831.