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An array of antennas mounted on vehicles, ships, aircraft, satellites, and base stations is expected to play an important role in fulfilling the increased demand of channel requirement for these services. In this paper toolboxes of MATLAB will use for the phased array system for different purposes of extraction of information about a validate results for antenna array and a comparison is made between different antenna array geometries, also this paper provides the background of the newly developed MATLAB Phased Array Toolbox. So, some effective parameters like the changing element spacing and the number of elements and the geometrical shape of the array on the antenna array radiation pattern along with the gain have been studied. The Phased Array Toolbox of MATLAB has also been used to validate the results.

Resumen Introduccion y objetivos La enfermedad digestiva es una de las comorbilidades mas frecuentes en ninos con paralisis cerebral infantil (PCI). Nuestro objetivo es analizar el estado nutricional de los pacientes con PCI, la prevalencia de disfagia segun la afectacion motriz (GMFCS) y su repercusion en la calidad de vida. Material y metodos Estudio descriptivo transversal y abierto en pacientes con PCI seguidos en un hospital terciario de la Comunidad de Madrid mediante una entrevista estructurada y la clasificacion de la disfagia segun la escala Eating and Drinking Ability Classification System (EDACS). Recogimos datos demograficos y antropometricos y relacionamos el nivel de disfagia con el nivel funcional segun el Gross Motor Function Classification System (GMFCS). Resultados La muestra incluyo 44 pacientes (65,9% varones), con una edad media de 9,34 ± 5 anos y un IMC de 18,5 ± 4,9. El 43% tenia limitaciones en seguridad y/o eficiencia (EDACS > II). El porcentaje de pacientes afectados fue mayor cuanto mas extensa desde el punto de vista topografico fue la PCI (tetraparesia 60%), mas variada la semiologia clinica (87% en formas mixtas) y peor el nivel funcional (100% en GMFCS V). La repercusion nutricional aumento con puntuaciones mas altas en EDACS y GMFCS. Conclusiones Presentamos el primer estudio sobre la utilidad de la escala EDACS en una muestra representativa de ninos y adolescentes espanoles con PCI. Los resultados deben hacernos reflexionar sobre la importancia del cribado de disfagia en estos pacientes, independientemente del grado de afectacion motriz y la necesidad de una intervencion precoz para evitar sus principales consecuencias: desnutricion (hipocrecimiento, deficit de micronutrientes, osteopenia, etc.), microaspiraciones o infecciones de repeticion que empeoran el estado neurologico.

Anatomic-contour zirconia prostheses are usually cemented with resin cement. However, information regarding the effects of the zirconia shade and thicknesses on the translucency of the prosthesis, the intensity of the transmitted light beneath the prosthesis, and the subsequent degree of conversion in the resin cement is sparse.The purpose of this in vitro study was to investigate the translucency parameter in 3 anatomic-contour zirconia specimens of 2 shades at 5 different thicknesses and to investigate the transmitted light intensity and degree of conversion of the resin cement beneath the ceramic specimens by using a traditional zirconia and a lithium disilicate glass ceramic as controls.Ceramic specimens from 1 anatomic-contour zirconia in a generic shade (CAP FZ) and 2 anatomic-contour zirconias in A2 shade (Zirlux and Luxisse) were used. Lithium disilicate in HT A2 shade (IPS e.max CAD) and traditional zirconia in a generic shade (CAP QZ) were used as controls. A total of 125 ceramic specimens (n=25) were fabricated to a final specimen dimension of 12×12 mm and in thicknesses of 1.0, 1.25, 1.5, 1.75, and 2.0 mm according to the manufacturers' recommendations. The CIELab color space for all specimens placed against a white and black ground was measured with a spectrophotometer (CM-2600D), and the translucency parameters were calculated for the materials at various thicknesses. A light-polymerizing unit (DEMI LED) was used to polymerize the resin cement (Variolink II) placed beneath the ceramic specimens. Transmitted light intensity from the polymerization unit beneath the ceramic specimens was measured by using a spectrophotometer (MARC Resin Calibrator), and the transmittance of each specimen was calculated. The coefficient of absorption of each material was calculated from the regression analysis between the natural log of transmittance and specimen thickness. The degree of conversion of resin cement was measured by using a Fourier transformation infrared (FTIR) spectrophotometer. The results were analyzed by using 2-way ANOVA (α=.05). The relationship between the transmittance and the translucency parameter was evaluated by plotting the transmittance against the translucency parameter value of each specimen.The translucency parameter decreased with increasing thickness in all 5 material groups. All anatomic-contour zirconia had lower translucency parameters than e-max CAD (P.001). The same results were found for the intensity of the transmitted light (P.001). Both A2 shade anatomic-contour zirconia (Zirlux and Luxisse) showed significantly lower light transmittance than a generic shade anatomic-contour zirconia (CAP FZ) (P.001). The coefficients of absorption were found to range from 0.63 to 1.72 mmThe translucency parameter and the transmitted light intensity of ceramic material were influenced by the type of ceramic and the shade and thickness of the ceramic. The combined effects of layer thickness and the intensity of the transmitted light in the A2 shade anatomic-contour zirconia (Zirlux and Luxisse) resulted in a lower degree of conversion in resin cement than in a generic shade anatomic-contour zirconia (CAP FZ) at layer thicknesses of 1.75 and 2 mm.

Background The rs1344706 single nucleotide polymorphism in the ZNF804A gene has been associated with risk for psychosis in multiple genome-wide association studies, yet mechanisms underlying this association are not known. Given preclinical work suggesting an impact of ZNF804A on dopamine receptor gene transcription and clinical studies establishing dopaminergic dysfunction in patients with schizophrenia, we hypothesized that the ZNF804A risk single nucleotide polymorphism would be associated with variation in dopamine receptor availability in the human brain. Methods In this study, 72 healthy individuals genotyped for rs1344706 completed both [18F]fallypride and [11C]NNC-112 positron emission tomography scans to measure D2/D3 and D1 receptor availability, respectively. Genetic effects on estimates of binding potential for each ligand were tested first with canonical subject-specific striatal regions of interest analyses, followed by exploratory whole-brain voxelwise analyses to test for more localized striatal signals and for extrastriatal effects. Results Region of interest analyses revealed significantly less D2/D3 receptor availability in risk-allele homozygotes (TT) compared with non-risk allele carriers (G-allele carrier group: TG and GG) in the associative striatum and sensorimotor striatum, but no significant differences in striatal D1 receptor availability. Conclusions These data suggest that ZNF804A genotype may be meaningfully linked to dopaminergic function in the human brain. The results also may provide information to guide future studies of ZNF804A-related mechanisms of schizophrenia risk.

Background The success of Mohs micrographic surgery depends on the surgeon's ability to correctly interpret intraoperative frozen sections. Objective This retrospective study analyzed the rate of concordance between Mohs surgeons and dermatopathologists in reading slides from Mohs surgery cases. Methods A dermatopathologist reviewed all the frozen sections and the corresponding Mohs map for every 30 th Mohs case at a practice employing 6 different Mohs surgeons from 2001-2017. Cases in which the dermatopathologist and the Mohs surgeon disagreed on the interpretation were noted. Results The concordance rate between Mohs surgeons and dermatopathologists was 99.79%. The three discordant cases included one case each of squamous cell carcinoma, superficial basal cell carcinoma, and hypertrophic squamous cell carcinoma in situ. Limitations This analysis is limited to fellowship-trained Mohs surgeons and therefore may not be applicable to all physicians who perform Mohs. Conclusions Fellowship-trained Mohs surgeons show very high concordance with board-certified dermatopathologists in the accurate and precise interpretation of histology slides in the setting of Mohs micrographic surgery.

While the dimensional accuracy of the intaglio surface of a removable complete denture is key to its adaptation, comfort, and clinical performance, information on the ability of milling and 3D-printing workflows to accurately reproduce this surface is lacking.The purpose of this clinical study was to compare the trueness of the intaglio surface of milled and 3D-printed removable complete digital dentures.Intraoral scans were obtained from 14 participants for a total of 20 edentulous arches. Ten maxillary and 10 mandibular denture bases were then designed and fabricated with a completely digital workflow, both with milling and 3D-printing. Fabricated dentures were digitized with the same intraoral scanner used to obtain intraoral digital scans of the edentulous arches. Standard tessellation language (STL) files of the printed and milled denture bases were used for 3D analysis and comparisons with the STL file of the corresponding designed denture base. Specifically, a reverse engineering software program was used to trim and extract intaglio surfaces, align them, and measure their global mean 3D distance. In order to evaluate the homogeneity of production accuracy of each manufacturing process, the intaglio surfaces were also divided into several regions of interest and the corresponding 3D distances measured. Within- and between-group differences and maxillary and mandibular dentures differences were assessed with parametric and nonparametric tests (α=.05).Milling showed a global better trueness of the entire intaglio surface (-0.002 mm) than 3D-printing (0.018 mm), both for the whole data set (P.001) and for maxillary (P=.032) or mandibular (P=.049) denture base subgroups. Within each fabrication technology, maxillary (P.11) and mandibular dentures (P=.2) showed no significant difference in trueness. Measured deviations were significantly different from zero for the 3D-printed dentures (P.001), but not for the milled dentures (P=.487). Additionally, for milled dentures, no significant difference in trueness was found among the 11 regions of interest identified for the maxillary dentures (P=.085) and the 13 regions of interest for the mandibular dentures (P=.211). Conversely, 3D-printing showed significant variations in trueness among the same zones of interest, both in maxillary (P.001) and mandibular (P=.004) dentures.Within the limits of the manufacturing methodologies used for complete dentures, milling can provide a slightly better trueness of the intaglio surface than 3D-printing, with less variation across several zones of interest. However, given the magnitude of such differences, they may be reasonably considered to be of limited, if any, clinical significance.

Data on predictors and time to relapse in patients with psoriasis who discontinue therapy in a real-world setting are scarce.To investigate predictors of relapse after withdrawal of ustekinumab in patients with psoriasis.This study screened 500 patients with psoriasis who received ustekinumab (669 treatment episodes) between 2011 and 2018. Overall, 202 patients (accounting for 304 treatment episodes) who had responded to therapy and were withdrawn from ustekinumab treatment were included.The cumulative probabilities of being relapse-free at 6, 12, 18, 24, and 36 months after withdrawal from ustekinumab treatment were 49.3%, 12.6%, 5.3%, 4.7%, and 1.6%, respectively. Multivariate regression analyses with a generalized estimating equation showed that after adjustments, biologic-naive status, maximum improvement in Psoriasis Area and Severity Index during ustekinumab treatment, time to achieve a 50% improvement in baseline Psoriasis Area and Severity Index score after initiation of ustekinumab, family history of psoriasis, chronic kidney disease, and immunosuppressant use while not taking ustekinumab were significant predictors of time to relapse following discontinuation of ustekinumab.Nonrandomized allocation of duration of treatment and follow-up.Given the high rates of relapse, withdrawal of ustekinumab from patients with well-controlled psoriasis cannot be recommended.

Resumen Introduccion y objetivos Los nodulos tiroideos requieren con frecuencia evaluacion mediante ecografia y puncion aspiracion con aguja fina (PAAF). No obstante, la PAAF no permite la diferenciacion entre adenoma y carcinoma folicular en lesiones de tipo IV segun la clasificacion de Bethesda. Esto provoca numerosas intervenciones quirurgicas innecesarias porque no es posible garantizar el caracter benigno de las lesiones, ni siquiera cuando la mayoria de las muestras corresponden a adenomas o incluso a otras lesiones benignas. El objetivo de este estudio es establecer si hay caracteristicas ecograficas que nos ayudarian a pronosticar el riesgo de malignidad de los nodulos con un diagnostico anatomopatologico de neoplasia folicular para conseguir un abordaje mas conservador de los nodulos sin sospecha de malignidad. Material y metodos Estudiamos 61 nodulos en 61 pacientes (51 mujeres y 10 varones) que se habian sometido a intervencion quirurgica de la glandula tiroides y tenian resultados histopatologicos de adenoma o carcinoma folicular. Se analizaron diversas caracteristicas ecograficas de los nodulos (composicion, ecogenicidad, borde, estado de calcificacion, presencia de halo y sospecha general de malignidad segun el observador) y se establecio su correlacion con el analisis histopatologico. Resultados Observamos una relacion estadisticamente significativa entre el carcinoma folicular y la presencia de calcificaciones, bordes mal definidos y la sospecha o impresion general del observador (definida por sospecha clara de signos ecograficos de malignidad, como calcificacion, borde mal definido y un nodulo solido marcadamente hipoecoico; y signos ecograficos de benignidad, como composicion ecogenica predominantemente quistica y presencia de halo hipoecogenico perinodular). Sin embargo, todas estas caracteristicas han mostrado una sensibilidad baja en el estudio que nos ocupa (30%, 30% y 50%, respectivamente). En cambio, la ausencia del signo de halo ha demostrado una sensibilidad del 100% y un valor predictivo negativo del 100% en nuestro estudio. Conclusiones La presencia de calcificaciones, los bordes mal definidos y la impresion o sospecha general de malignidad se asocian con un riesgo mayor de carcinoma folicular en nodulos tiroideos de tipo IV segun la clasificacion de Bethesda, pero su ausencia no permite pronosticar el caracter benigno de estos nodulos. En cambio, cuando se observa una lesion con signo de halo, deberia considerarse una neoplasia folicular benigna.

The aim of the study was to investigate whether jerk cost (JC) can discriminate between swimming levels. Nine elite and nine non-elite swimmers swam a 50-m front-crawl sprint wearing a 3D accelerometer on their back between the inferior angles of the scapulae. Lap times and JC were calculated from the acceleration signal and compared between groups and between swimmers within a group. The elite swimmers swam significantly faster lap times than the non-elite swimmers (p < 0.001). They did so with significantly lower levels of JC compared to the non-elite swimmers (p = 0.005). Furthermore, a stepwise multiple linear regression showed JC accounted for 32.9% of the variation in lap time of the elite swimmers. These results indicate that it is possible to discriminate elite from non-elite swimmers using JC: elite swimmers swim with lower JCs than non-elite swimmers. Additionally, swimming at higher speed is associated with more accelerations and decelerations in both elite and non-elite swimmers, which is reflected by higher JCs and lower smoothness. In sum, JC provides an index of swimming technique that is easy to use in training practice.

While we instantaneously recognize a face as attractive, it is much harder to explain what exactly defines personal attraction. This suggests that attraction depends on implicit processing of complex, culturally and individually defined features. Generative adversarial neural networks (GANs), which learn to mimic complex data distributions, can potentially model subjective preferences unconstrained by pre-defined model parameterization. Here, we present generative brain-computer interfaces (GBCI), coupling GANs with brain-computer interfaces. GBCI first presents a selection of images and captures personalized attractiveness reactions toward the images via electroencephalography. These reactions are then used to control a GAN model, finding a representation that matches the features constituting an attractive image for an individual. We conducted an experiment (N=30) to validate GBCI using a face-generating GAN and producing images that are hypothesized to be individually attractive. In double-blind evaluation of the GBCI-produced images against matched controls, we found GBCI yielded highly accurate results. Thus, the use of EEG responses to control a GAN presents a valid tool for interactive information-generation. Furthermore, the GBCI-derived images visually replicated known effects from social neuroscience, suggesting that the individually responsive, generative nature of GBCI provides a powerful, new tool in mapping individual differences and visualizing cognitive-affective processing.

Objective To investigate the effect of electromyography (EMG)-driven robotic therapy on the recovery of the hand in a stroke case lasting 9 years. Case An 18-year-old patient with hemiparesis due to the ischemic lesion was admitted to our clinic with hand impairment. Fifteen sessions (5 weeks x 3 times) of robotic rehabilitation were applied with the Hand of Hope. Average EMG (mV) of flexor digitorum superficialis (FDS) muscle, average force (N) and the rate of force development (RFD)(N/s) were also assessed before and after the treatment following the 5th and 10th sessions and at the end of treatment. Also, Fugl-Meyer Assessment of Upper Extremity Scale (FMU-UE), Motor Activity Log (MAL), Canadian Occupational Performance Score (COPM) and Visual Analog Scale (VAS) were used for assessment before and after the treatment. Results The average EMG measured from FDS increased from 0.093-0.133 mV. The average force and average RFD increased from 45.6-97.7 and from 135.6-172.6 respectively. While affected and/or unaffected side force ratio increased dramatically from 54%-82%, the FMA-UE score increased from 56-59. The MAL quality of use score increased from 3.93-4.13. Performance and satisfaction scores of COPM changed from 5.25-7.25 and 4.5-8.25 respectively. VAS score for fatigue changed from 6 to 4. Discussion The improvement achieved 9 years later with 15 sessions of rehabilitation suggests that improvement may be possible for chronic stroke patients.

A typical conversion process of a complete-arch immediate loading protocol entails preparing holes in a complete denture for connection to interim copings, which reduces the strength of the prosthesis. The excellent mechanical properties of milled polymethyl methacrylate (PMMA) disks may provide interim prostheses with improved strength.The purpose of this in vitro study was to measure the flexural strength and failure load of simulated acrylic resin immediate implant-supported interim prostheses fabricated by conventional processing and computer-aided manufacturing.A master patient model was created with an acrylic resin base and 2 BioHorizons Internal 4.5-mm-diameter implants placed with a 21.5-mm span and multiunit abutments (MUA) tightened to place. Two groups with different prosthodontic designs were used: one represented the standard fixed prosthesis with support at each end (noncantilever, NC), and the other group represented the cantilever portion of the prosthesis (cantilever, C). Two connection designs of prosthesis blocks to MUA abutments were evaluated: one with typical holes in the prosthesis for capturing interim copings and one with a low-profile coping. For the heat-processed PMMA groups (HP/NC and HP/C), wax patterns were milled, and heat-polymerized denture base PMMA prostheses were processed. The milled PMMA groups (M/NC and M/C) were milled from a tooth-shaded PMMA disk for the prosthesis blocks. The milled low-profile groups (Mlp/NC and Mlp/C) had identical dimensions except that connection to the low-profile coping was designed with a cement space and a narrow diameter screw access hole and was milled from a PMMA disk. The failure load (N) of the cantilever prostheses was recorded, and for NC groups, the 3-point flexural strength formula (MPa) was calculated. The Weibull modulus, characteristic strength, and summary statistics were computed, and the groups were statistically analyzed with ANOVA and the post hoc Tukey test (α=.05).The mean flexural strengths (MPa) were HP/NC=91.35 ±18.92; M/NC=143.94 ±36.79; Mlp/NC=117.06 ±13.86. Significant differences were found among groups (P.001). Mean failure loads (N) and Weibull modulus (WM) of cantilever prosthesis strengths were for HP/C=512.66, WM=5.597; M/C=695.06, WM=4.875; Mlp/C=254.97, WM=1.797 (P.001).Implant fixed interim structures milled from high-density PMMA blanks had a 35% higher flexural strength for both the standard prostheses and the cantilever prostheses than heat-processed denture base PMMA. The low-profile coping design was stronger than the heat-processed material, and the failure point was relocated from the lateral walls to the cervical margin area.

Therapeutic mechanisms targeting multiple mental health disorders are key for providing treatment services with high-disparity, low-resource populations. Rumination, a cognitive response style, is a well-recognized transdiagnostic factor across disorders in the general population (Arditte et al., 2016; Nolen-Hoeksema, 1991). This study explored the influence of rumination, and mediational effect of mental health disorder, on Quality of Life among a sample of 585 Northern Plains Indian (NPI) women and men. Using secondary data from a Mood Disorder Assessment Validation study, parallel mediation path analyses indicated rumination did not have a direct influence on quality of life. However, rumination indicated higher anxiety (R² = .38, p < .001), depression (R² = .60, p < .001), and substance use symptoms (R² = .14, p < .001). As rumination increased, significant increases occurred in severity of symptoms reported for women and men for all diagnoses- but lower perceived quality of life occurred only in the presence of depressive symptoms (women, B = -28.19, p < .001; men, B = -20.15, p < .001). Significant differences arose between NPI women and men, with women reporting higher rumination, anxiety, and depression and men reporting higher substance use. Based on these results, rumination is useful as a transdiagnostic factor for NPIs, as rumination helped uncover maladaptive coping mechanisms among NPIs in the sample. In addition, quality of life assessments can help target maladaptive coping in treatment by taking a holistic view of well-being that accounts for risk factors while supporting traditional views of healing. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Poly methyl methacrylate (PMMA) is one of the most widely used materials in modern prosthodontics. It is widely known due to its simplicity in use and acceptable aesthetic. A new concept of polymerization fluid resin technique was instead of heat and gypsum material. Forty specimens were prepared from two brands of fluid acrylic resin. The samples were divided into two groups, the first one was the control while the other group was incorporated with silver nanoparticles(modified). The tests performed were impact strength, transverse strength, color stability and candida retention ability on the samples. 10 samples for each test were used. The results showed that modified group had significantly higher impact strength than the control group. There was non-significant difference between group of modified fluid acrylic and control group. Regarding color stability, there were highly significant color change after 10 days of immersion in the tea solution for the modified group the results of the biological test showed that the candida retention of the control group was significantly higher than modified group. Within the limitation of this study it can be concluded that addition of silver nanoparticles has resulted in significant difference between control and modified group for impact strength test. While non-significant difference was seen for transverse strength test. In regard to color stability, showed enhancement in color stability for both before and after placement in tea solution. Addition of silver nanoparticles also caused reduction in candida albicans retention in the added samples.

AimsTo identify risk factors for rebubbling, and early graft failure after Descemet membrane endothelial keratoplasty (DMEK).MethodsIn this prospective registry study, all consecutive DMEK procedures registered in the Netherlands Organ Transplant Registry were assessed (n=752). Univariable and multivariable analysis was performed using logistic regression. The effect of rebubbling on endothelial cell density was analysed using a linear mixed model.Results144 of 752 (19%) eyes underwent rebubbling. Rebubbling was successful in 101 eyes (70%). In eyes that underwent rebubbling, the graft failure rate was significantly higher than eyes that did not undergo rebubbling (30% vs 9%, respectively; OR: 4.28, 95% CI 2.72 to 6.73, pConclusionsThis Dutch registry study identified independent risk factors for DMEK graft detachment leading to rebubbling, namely recipient age and surgical complication, and early graft failure, namely transplantation before 2016 and surgical complication. Rebubbling was associated with significantly higher endothelial cell loss in the first year after surgery.

Resumen Introduccion Las enfermedades infecciosas pueden beneficiarse de la aplicacion de la telemedicina (TM). Este estudio realiza una descripcion de las enfermedades infecciosas atendidas por el Servicio de Telemedicina del Hospital Central de la Defensa Gomez Ulla (STM-HCDGU). Metodos Analisis de las e-consultas realizadas por miembros de las Fuerzas Armadas de Espana desplazados a zona de operaciones en el periodo comprendido entre el 1 de enero del 2015 y el 31 de diciembre del 2018 que desarrollaron sintomatologia infecciosa. Resultados Se diagnosticaron 127 enfermedades infecciosas, siendo las mas frecuentes las de etiologia respiratoria y posteriormente la malaria. Geograficamente, Africa y los contingentes embarcados fueron los mas significados. Fue necesario evacuar a 18 pacientes al HCDGU, siendo el diagnostico de malaria el motivo de evacuacion mas frecuente, causa del unico caso mortal. Conclusiones Las enfermedades infecciosas se benefician de la aplicacion de la TM, siendo una herramienta importante para el diagnostico y tratamiento de estas, constituyendo una oportunidad para ampliar a otras poblaciones desplazadas o remotas.

Postcoital bleeding is a worrying, for both women and health care provider. This study aimed to evaluate the prevalence of abnormal cervical cytology among patient with PCB in the private outpatient care setting, and to identify risk-factors for cervical pathology among these patients. A cross sectional study of 90 patients presented to the privet clinic, during the period 1st feb-1st Des. 2019. Inclusion criteria include married women presented with post coital bleeding, non-pregnant, all patients undergo Pap Smear Cytology. The commonest age presented with PCB was 40-44 years old 22(24.4%), followed by (45-49) years and (25-29) years 18(20%). Those aged ≥40 years 44(48.9%), and those aged ≤34 34(37.8%). The mean parity was 4.7±2.8, hormonal contraception was commonly used by those with PCB followed by intra uterine contraceptive device (IUCD), 30(33.3%), 18(20) respectively. Most of the patient were House wives 78(86.7%), The physical examination show that most patient had cervical erosion 68(75.5%), followed by healthy cervix in 12(13.3%), while suspicious features was found among 6(6.7%), Moderate and sever dysplasia was found more among those aged ≥40 years 10(22.7%), while it was 4(8.7%) among those aged < 40 years. there is higher prevalence of High-grade squamous intraepithelial lesions among females with PCB, and non- significant difference among those aged less or more than 40 years. Therefore it’s important to examine any patient complaining of PCB with PAP smear cytology and colposcopy examination.

Cutaneous endometriosis is not a very often seen condition and is broadly classified as primary (spontaneous) and secondary. While perineal endometriosis arising in a previous scar has been reported, spontaneous cutaneous endometriosis in perineum is extremely rare and only three cases occurring in mons pubis have been reported in literature. We report a case of 34-year-old lady presented with a swelling in pubic region and associated dull aching pain of 1-year duration with no history of cyclical variation of symptoms. Investigations finally concluded a diagnosis of endometriosis and a Complete excision with clear margins. Clinicians should be aware that a spontaneous endometriosis in the perineum can occur and can have atypical presentation with no increase in size or pain during menstruation.

Introduction Attention deficit/hyperactivity disorder (ADHD) has genetic and environmental aetiological factors. There are few publications on the environmental factors. The objective of this review is to present the role of psychosocial adversity in the aetiology and course of ADHD. Methods A search was carried out in the following databases: PubMed, ScienceDirect, SciELO, ClinicalKey, EMBASE, Lilacs, OVID, APA and PsycNET. English and Spanish were selected without being limited by type of study or year of publication. Finally, a qualitative synthesis was conducted. Results ADHD development could be related to exposure to adverse factors in the family, school or social environment. It has been proposed as an explanatory mechanism that adversity interacts with genetic variants and leads to neurobiological changes. There may also be a gene-environment correlation whereby individual hereditary characteristics increase the risk of exposure to adversity, and indirectly increase the probability of developing ADHD. Research on psychosocial adversity represents a big challenge, not only due to the complexity of its construct, but also to the effect of subjective perception of a given event. Conclusions ADHD aetiology is complex and involves the interaction of both genetic and environmental factors, in which these factors correlate and cause the disorder. The study of the role of psychosocial adversity in ADHD is fundamental, but it remains a task that entails great difficulties.

Photovoltaic panels are used to generate electricity directly or indirectly. in the case of indirect, the energy should be saved in batteries and then it can be used and in this case, the inverter is required to change the direct current of the batteries(DC) to operate alternating current(AC) loads. This paper concentrates on saving energy in batteries and investigating the process of charging and discharging the batteries to operate selective loads in the paper. Using the photovoltaic panels to store energy in batteries, the results reveal that one photovoltaic panel of( 80 W) is placed towards south at a tilt angle of 36o; it could generate (224 W.hr) of energy that was obtained by charging a( 65 A.hr) lead-acid battery for 13 hours in April. Using two solar panels each of( 80 W )is connecting parallel,( 915.6 W.hr) of energy generated in May while using three units in parallel connection the electricity generated was near to that of two panels as the battery reaches nearly the full charge. Ambient temperature rise harms solar panels and leads to a decrease in the efficiency of the solar panel.

Selective laser melting (SLM), an additive manufacturing technology, is expected to replace the traditional lost-wax casting process used in producing removable partial denture (RPD) frameworks. However, studies comparing the accuracy of RPD frameworks and the effects of process parameters are lacking.The purpose of this in vitro study was to optimize SLM process parameters and use a quantitative analysis method to improve the accuracy of 3D-printed RPD frameworks.The orientation and support structure of Kennedy Class II RPDs were designed in various ways by using 2 different software programs, CAMbridge and Magics. The optimum melt-pool parameters, including laser power, scan speed, hatch distance, and layer thickness, were determined empirically before manufacturing 12 RPD frameworks with 4 different process designs by using SLM (n=3). The accuracy of the RPD frameworks was determined by 3D scanning and comparing the 3D scan data with the original standard tessellation language (STL) RPD design with the best-fit algorithm of the Geomagic software program.Optimum melt-pool parameters were found with the function of density, surface roughness, and productivity (P=180 W, v=1200 mm/s, h=60 μm, t=30 μm). RPD frameworks fabricated by the optimized process parameters (167 ±105 μm) showed significantly better (P.05) mean ±standard deviation accuracy than the 3 other groups of RPD frameworks manufactured by using the nonoptimized process parameters (180 ±121 μm to 222 ±136 μm). The best accuracy was found with the transverse orientation and interconnected support structure.With the optimized design of process parameters, clinically acceptable RPD frameworks were produced. The accuracy of RPD frameworks fabricated by using SLM varied according to the design of the process parameters, indicating that SLM technology can replace the traditional lost-wax casting process.

Malaria, Zika virus, West Nile virus, Dengue fever, and Lyme disease are common causes of morbidity and mortality around the world. While arthropod bites may cause local inflammation and discomfort, a greater concern is the potential to develop deadly systemic infection. The use of insect repellents (IR) to prevent systemic infections constitutes a fundamental public health effort. Cost-effectiveness, availability, and high-efficacy against arthropod vectors are key characteristics of an ideal IR. Currently, numerous IRs are available on the market, with DEET (N,N-diethyl-3-methylbenzamide) being the most widely used. DEET has an excellent safety profile and remarkable protection against mosquitoes and various other arthropods. Other EPA-registered IR ingredients (permethrin, picaridin, IR3535, oil of lemon eucalyptus, oil of citronella, catnip oil, and 2-undecanone) are alternative IRs of great interest due to some having efficacies comparable to that of DEET. These alternative IRs possess low toxicity and favorable customer experiences in utilization (e.g., cosmetically pleasant, naturally occurring). This review summarizes currently available EPA-registered IRs: the origins, mechanisms of action, side effect profiles, and available formulations will be discussed. This review will enable the clinician to select the best IR option to meet patients' needs and provide the greatest protection from arthropod bites and sequelae.

Bladder cancer is an aggressive and lethal disease. Even when presenting as localized muscle-invasive disease, the 5-year survival rate is about 70%, and the recurrence rate after radical cystectomy is approximately 50%. Neoadjuvant chemotherapy (NAC) has the potential to downstage the primary tumor and treat micrometastases, leading to a decrease in recurrence rates and an increase in cure rates. There is level 1 evidence in favor of neoadjuvant cisplatin-based chemotherapy prior to radical cystectomy. However, data from clinical trials evaluating NAC for patients undergoing bladder-sparing treatments are less robust, so this strategy remains controversial. The response to NAC is prognostic and patients with favorable pathological response have better overall survival. Strategies to select patients based on molecular biomarkers have the potential to guide treatment decisions and even de-intensify treatment, avoiding local treatment for those with complete responses to systemic therapy. This review outlines the current literature on the use of NAC in the context of bladder preservation for muscle-invasive bladder cancer, highlights neoadjuvant studies in patients ineligible for cisplatin-based NAC, and discusses novel bladder-preservation strategies, including multimodality combinations and biomarker-driven studies of definitive chemotherapy.

We propose a simple and effective method to inject word-level information into character-aware neural language models. Unlike previous approaches which usually inject word-level information at the input of a long short-term memory (LSTM) network, we inject it into the softmax function. The resultant model can be seen as a combination of character-aware language model and simple word-level language model. Our injection method can also be used together with previous methods. Through the experiments on 14 typologically diverse languages, we empirically show that our injection method, when used together with the previous methods, works better than the previous methods, including a gating mechanism, averaging, and concatenation of word vectors. We also provide a comprehensive comparison of these injection methods.

Compared with the widely studied negative emotions in which different classes are easy to distinguish, nowadays less attention is paid to the recognition of positive emotions that are not fully independent. In this paper, we propose to recognize multiple positive emotions by analyzing brain activities and explore the neural representation of different positive emotions. Thirty-seven participants volunteered to participate in our study, in which their brain activities were recorded when watching five selected film clips. First, 150 well-known power features extracted from Electroencephalography (EEG) signals and 105 multimedia content analysis features were collected as the pool of candidate features. Second, based on the collected features, we propose to use a linear model and a nonlinear model to predict the percentage of five positive emotions. Then, percentage values were converted to ranking numbers and Kendall rank correlation coefficients were calculated. Our results showed that (1) ensemble of regressor chains using LSTM as unit regressor obtained both the best regression results and the best Kendall rank correlation coefficient on EEG features merely, and (2) top features from alpha frequency bands of EEG signals could represent different positive emotions. These results demonstrate the effectiveness of selective EEG features on recognizing different positive emotions.

Resumen Introduccion La profilaxis preexposicion (PrEP) es una intervencion biomedica dirigida a prevenir la infeccion por el VIH en personas seronegativas con alto riesgo de contraer la infeccion. Esta estrategia fue aprobada por el Ministerio de Salud de Espana en octubre de 2019. Objetivo Presentar la experiencia inicial de la PrEP en la Unidad de VIH del Hospital Clinic de Barcelona, poniendo especial atencion en el analisis de los factores de vulnerabilidad de la cohorte. Materiales y metodos Estudio retrospectivo, descriptivo. Se analizan las caracteristicas epidemiologicas, sociodemograficas y clinicas basales de los usuarios incluidos en el programa durante el primer ano de funcionamiento, prestando particular atencion a las infecciones, las practicas de riesgo y el consumo de sustancias. Resultados Se incluyeron 190 individuos, 177 hombres y 12 mujeres transexuales con una edad media de 35 anos (8 DE). El 70% tenia estudios superiores y la mitad nacionalidad espanola. Informaron de tener 10 parejas de media al trimestre y el 60% de practicar sexo anal desprotegido. El 31% presento al menos una PCR positiva para ITS, siendo la N. gonorrhoeae el germen mas prevalente (51%) y la muestra rectal la mas afectada (21%). El 63% reporto el uso de chemsex, el 19% policonsumo y el 8% slamming. La mitad expreso su preocupacion por el consumo y/o practicas sexuales y un 25% la necesidad de ayuda. Conclusiones El perfil del usuario de PrEP visitado en nuestra unidad hospitalaria justifica la creacion de equipos multidisciplinares que permitan prestar una atencion holistica de la vida sexual de estas personas.

Summary Purpose Medialization laryngoplasty can be performed to treat glottic incompetence after endoscopic laser cordectomy. The aim of this study is to evaluate vocal outcome after this phonosurgical procedure and to analyze the critical aspects of the Montgomery and Gore-Tex laryngoplasty technique. Methods A retrospective observational study of patients with glottic incompetence after endoscopic laser cordectomy, underwent medialization laryngoplasty with Montgomery or Gore-Tex implant between January 2013 to December 2018 at the Bufalini Hospital of Cesena, Italy. The pre- and postphonosurgery evaluation included videolaryngostroboscopy, perceptual, evaluation of dysphonia with the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, Voice Handicap Index-10, Maximum Phonation Time. The outcome was evaluated 6 months after the phonosurgical treatment. Results We treated 22 patients, 19 males and 3 females. Eight cases were treated with Montgomery implant and fourteen with Gore-Tex implant. The postphonosurgical videolaryngostroboscopy showed an improvement of the glottic closure in all patients; the scores of the Voice Handicap Index-10 and of the Maximum Phonation Time showed a statistically significant improvement after phonosurgery. The GRBAS scale scores showed a statistically significant improvement of Global Grade, Breathiness, and Asthenia; the parameter Strain remained unaltered both in pre- and postoperative evaluations, because the voice was never pressed due to glottic insufficiency, especially in preoperative observation. The parameter Roughness (R) did not show a significant difference between pre- and postoperative evaluation. Conclusion Medialization laryngoplasty is an effective phonosurgical procedure to improve voice outcome, after extended endoscopic laser cordectomies, in patients with unacceptable results after voice therapy and injection laryngoplasty. In our experience the Gore-Tex implant allows the surgeon to perform a safer and more “tailored” phonosurgery in cases of cordectomies type IV and V, associated or not with radiotherapy and in revision surgery.

Multiple studies have reported a high prevalence of mental health problems among male and female physicians. Although doctors are reluctant to seek professional help when suffering from a mental disorder, specialised services developed specifically to treat their mental health problems have reported promising results. The purpose of this article is to describe the design and implementation of the Professional Wellbeing Programme (Programa de Bienestar Profesional) of the Uruguayan Medical Association (Colegio Medico del Uruguay). The context, inputs, activities and some of the outputs are described according to a case study design. The main milestones in the implementation of the programme are also outlined, as well as the enabling elements, obstacles and main achievements. Emphasis will be placed on the importance of international collaboration to share experiences and models, how to design the care process to promote doctors' access to psychiatric and psychological care, the need for them to be flexible and dynamic in adapting to new and changing circumstances, such as the COVID-19 pandemic, and to work in parallel with the medical regulatory bodies. It is hoped that the experience described in this work may be of use to other Latin American institutions interested in developing mental health programmes for doctors.

The regional techniques for axillary analgesia are well established. However, few studies have investigated surgical anesthesia. In this report, extensive debridement of axillary necrotizing fasciitis, including the posteromedial region of the right arm, performed under exclusive regional anesthesia in a patient with probable difficult airway is described. The procedure was performed under a Serratus Plane Block (SPB) and supraclavicular brachial plexus block, guided by ultrasound, and performed with venous sedation. We observed satisfactory anesthesia 15-minutes after the intervention and efficient intraoperative pain control within the following 24 hours. Surgical axilla anesthesia is feasible with the described blocks.

Non-muscle-invasive bladder cancer is one of the most common malignancies. Patients with intermediate-risk or high-risk disease can be treated with intravesical Bacillus Calmette-Guerin, a vaccine against tuberculosis. However, many of these patients will experience tumor recurrence, despite appropriate treatment. 1 The standard of care in these patients is radical cystectomy (RC) with urinary diversion. 2 Patients diagnosed with muscle-invasive bladder cancer (MIBC) have traditionally faced 2 main treatment options: RC and urinary diversion, as in Bacillus Calmette-Guerin-unresponsive Non-muscle-invasive bladder cancer, or alternatively, trimodal therapy comprising maximal transurethral resection of bladder tumor plus chemoradiation. 3 For patients with MIBC and clinical (c)T2-T4a, neoadjuvant chemotherapy (NAC) preceding RC is supported by Level 1 evidence with a modest 5-year overall survival benefit of 5% with cisplatin-based regimens. 4-9 A number of factors preclude MIBC patients from standard treatment options. For example, patients with serious comorbidities might be unable to tolerate general anesthesia, while others might be unwilling to adapt to the lifestyle changes after RC. 10-12 Likewise, patients with extensive carcinoma in situ or poor bladder function might not be optimal candidates for trimodal therapy or be prepared for the ongoing risk that salvage RC might be ultimately required. Reasons for the underuse of NAC range from the fear of delaying potentially curative surgery in nonresponders to patient ineligibility to cisplatin-based NAC. 13,14 Despite best efforts, in both surgical and bladder-sparing approaches, the 5-year overall survival in treated patients with MIBC is only 35% to 50%. 3,15 Strategies to improve overall prognosis as well as to reduce the indications of RC are desperately needed. Trial results have demonstrated the unprecedented ability of immune-checkpoint inhibitors to induce durable remissions in some patients with metastatic urothelial carcinoma. 16-20 Furthermore, immune-checkpoint inhibitors have shown to be better tolerated than traditional chemotherapy. 16 These successful results have spearheaded the research on these agents in earlier curative settings, with the shared goal of improving overall outcomes, and potentially avoid surgery in patients who show complete response (pT0). Strategies to enhance the immune response by combining immunotherapy with immune sensitizers such as chemotherapy, immunotherapy, targeted therapy or radiation are on the rise.

Summary Introduction The purpose of the study was to assess acoustic measures of fundamental frequency (fo), standard deviation of fo (SD of fo), jitter%, shimmer%, noise-to-harmonic ratio (NHR), smoothed cepstral peak prominence (CPPS), and acoustic voice quality index analyzed through multiple Praat versions automatically by VoiceEvalU8 or manually by two raters. In addition, default settings to calculate CPPS in two Praat versions manually analyzed by two raters were compared to Maryn and Weenik 20 procedures for CPPS automatically analyzed by VoiceEvalU8. Methods Nineteen vocally healthy females used VoiceEvalU8 to record three 5-s sustained /a/ trials, the all voiced phrase “we were away a year ago,” and a 15-s speech sample twice a day for five consecutive days. Two raters manually completed acoustic analysis using different versions of Praat and compared that analysis to measures automatically generated through a version of Praat used by VoiceEvalU8. One-way analyses of variance were run for all acoustic measures with post-hoc testing by the Bonferroni method. For acoustic measures that demonstrated significant differences, intraclass correlation coefficients were conducted. Results Results showed no significant differences across automatic and manual analysis for different versions of Praat for all acoustic measures during /a/, for fo, jitter%, shimmer%, and NHR during the phrase, for jitter%, shimmer%, NHR, and CPPS during speech, and for acoustic voice quality index calculated from both sustained /a/ and the phrase. The default Praat settings for CPPS were not significantly different from the Maryn and Weenik 20 procedures for sustained /a/ and speech. Significant differences were present for SD of fo and CPPS during the phrase and fo and SD of fo during speech. SD of fo and CPPS in the phrase were moderately correlated and fo and SD of fo during speech demonstrated good to excellent correlations across the different versions of Praat. Conclusions Acoustic measures analyzed through sustained /a/ and some of the acoustic measures during the phrase and speech were not different across multiple versions of Praat. Automatic analysis by VoiceEvalU8 produced similar mean values as compared to manual analysis by two raters. Even though SD of fo and CPPS in the phrase and fo and SD of fo in speech were different across the versions of Praat, the measures demonstrated moderate to excellent reliability.

Resumen Objetivos Analizar la supervivencia en el grupo de pacientes con gliomas de alto grado tratados de forma consecutiva en un mismo centro a lo largo de 10 anos. Establecer la relevancia de los factores asociados y el papel de la cirugia de rescate en el momento de la progresion. Metodos Fueron analizados de forma retrospectiva los pacientes con gliomas grado III y IV de la Organizacion Mundial de la Salud (OMS) diagnosticados en el Hospital Gregorio Maranon desde el 1 de enero de 2008 hasta el 31 de diciembre de 2017. Se obtuvieron de la historia clinica los datos clinicos, radiologicos y anatomopatologicos. Resultados Se completo el seguimiento en 233 pacientes con diagnostico de glioma de alto grado (III o IV de la OMS). La edad media fue de 62,2 anos. La mediana de supervivencia se situo en 15,4 meses. De los 133 pacientes (59,6%) que habian sido intervenidos mediante cirugia resectiva en el momento del diagnostico, en 43 (32,3%) se efectuo cirugia de rescate en el momento de la progresion. La supervivencia global, asi como la supervivencia tras la progresion, resulto mayor en este subgrupo de pacientes. Otras variables relacionadas con una mayor supervivencia fueron la puntuacion en la escala de Karnofsky, el grado de reseccion quirurgica y el diagnostico inicial de grado III de la OMS. Conclusiones Alrededor de una tercera parte de los pacientes con gliomas de alto grado pueden ser candidatos a una cirugia de rescate en el momento de la progresion. Ello esta asociado a una mayor supervivencia.

International Dermatology Outcome Measures and the American Academy of Dermatology recently agreed on a physician-reported global severity measure to demonstrate quality of care in inflammatory dermatoses.Because patient-reported outcome measures are also important, we aimed to achieve consensus on 1 of these measures for clinical practice.Patients and providers participated in a consensus-building study involving a modified-Delphi technique. Voting was focused on identifying a minimal set of assessments for clinical practice, patient global assessments (PtGAs), Skindex instruments, and final instrument selection for quality improvement.Among 53 stakeholders,70% agreed that identification of patient goals, assessment of treatment harm, and assessment of the adequacy of treatment response were the minimal assessments needed for clinical practice. The most preferred PtGA was a 5-point PtGA (scale 0-4; 0 = clear, 4 = severe) having an optional check-box for worst ever. A new metric to assess change since treatment initiation, which we called a trajectory measure, was proposed. Stakeholders preferred Skindex instruments over PtGAs and a trajectory measure for clinical practice.A small number of patients and caregivers were involved and a consensus was not reached on all items.PtGAs as standalone measures do not adequately capture the patient's assessment of disease severity or the effect of care. The combination of a PtGA with a Skindex instrument or another measure of health-related quality of life might provide a more comprehensive evaluation of patients in clinical practice.

Pregnant women are a risk group vitamin D insufficiency found among greater than 50% of pregnant females. Actually, there few researches and knowledge which associate the Maternal 25(OH) D level and premature labour, and no one carried in Iraq. The aim of this research is to find out any relation between the maternal plasma 25(OH) D levels of females who have gave birth to premature (< 36 weeks) in comparison to females with full-term neonates in both groups . The current study is a case control research was carried out between January-August 2020, at the department of gynecology and obstetrics at Azadi Teaching Hospital in Kirkuk Governorate. A convenient sample was randomly selected consist of 30 Mothers with premature delivery, compared with 30 mothers term pregnancy delivery, the newborns were weighing >2500g and appropriate for gestational age. Revision of maternal ANC cards were carried out for investigations, ultrasonography, date of LMP of mothers’, as well as fetal anthropocentric measurements through the conception period. The mean Vitamin D level was (18.6±6.7) among preterm deliveries, which is lower significantly from those with full term delivery (27.5±6.2), P value < 0.0001, as represented in figure 1. Deficient vitamin D level was reported among 15(50%) of preterm delivered mothers versus 6(20%) of full term mothers. insufficient vitamin D level was reported among 12(40%) of preterm delivered mothers versus 9(30%) of full term mothers. sufficient vitamin D level was reported among 3(10%) of preterm delivered mothers versus 15(50%) of full term mothers. The low levels Vitamin D level is significantly associated with premature deliveries.

Summary Introduction Inducible laryngeal obstruction is a common and challenging cause of exertional dyspnea. We report a case of an unanticipated cardiac condition that presented with symptoms suggestive of inducible laryngeal obstruction. Discussion A 55-year-old man was evaluated for progressive exertional dyspnea and throat tightness, unexplained after multiple medical evaluations. Resting laryngeal examination was suspicious for laryngopharyngeal reflux and mild vocal fold adduction during quiet expiration. Given progressive and refractory symptoms, maximal cardiopulmonary exercise testing with intermittent laryngeal examination was performed. This study excluded laryngeal causes of exercise limitation and led to an unexpected diagnosis of persistent atrial flutter and hypertrophic cardiomyopathy. Conclusion Cardiopulmonary exercise testing with laryngeal examination can identify unexpected and life-threatening mimics of inducible laryngeal obstruction that may be missed by unmonitored exercise challenges. Suspicion for inducible laryngeal obstruction at rest may not predict the true nature of exercise limitation on cardiopulmonary exercise testing.

Background: Hyaluronic acid fillers are known for a reliable safety profile, but complications do occur, even serious vascular adverse events. Objective: To improve the treatment outcome after a vascular adverse event with use of hyaluronic acid filler treatments.Methods: Duplex ultrasonography is used to detect the hyaluronic acid filler causing the intra-arterial obstruction. Results: If treated in time, 1 single treatment of ultrasonographically guided injections of hyaluronidase into the filler deposit will prevent skin necrosis. Conclusion: Because the use of duplex ultrasonography adds extra essential information, its use may become an integral part of the prevention and treatment of injection adverse events.

Background Chronic wounds are of many etiologies and difficult to treat. Many commercial products to manage such wounds are available, which claim to have good outcomes. Aim of this study was to compare the efficacy of Ionic Silver Solution and Super Oxidized Solution in the management of chronic wounds. Methods Patients with chronic wounds were randomly placed in two groups-Group A (Ionic Silver Solution) and Group B (Super Oxidized Solution) with 30 patients each. The dressings were continued until the wound healed completely or the wound was ready for a definitive procedure. Wound parameters were recorded as per Bates Jensen Wound Assessment Tool (BJWAT) Score. Results FIfty patients completed the study. The scores were compared at the initiation and endpoint of treatment. The pretreatment total for BJWAT was 916 and 924 in group A and group B respectively, which was not statistically significant. Post-treatment improvement was noticed in both the groups and the score decreased to 510 and 675 in group A and group B respectively (p = 0.001). Ionic Silver Solution and Super Oxidized Solution both were found to be effective in improving the overall wound condition. However, Ionic Silver Solution was found to be more effective than Super Oxidized Solution in the healing of chronic wounds. Complete healing was noticed in a small number (6%) of patients. These agents can therefore best prepare the wounds for early surgical intervention. Conclusion Both the agents were found to be safe and useful in the management of chronic wounds. However, Ionic Silver Solution was found to be more effective than the super oxidized solution in this study.

Background Course of Alcohol Dependence Syndrome (ADS) is studded with multiple relapses. Personality factors are implicated as one of the influencing factors in the course of this disorder. Keeping in view of scarcity of Indian data available, the study was planned with the aim to find Personality traits more commonly associated with ADS patients, and identify specific traits, associated with relapses of ADS. Method With sample size of 100 consecutive cases and 100 controls, socio-demographic data was collected. Alcohol Use Disorder Identification Test (AUDIT) and Severity of Alcohol Use Disorder Test (SAD-Q) were administered to each of these patient. Personality dimensions were assessed with NEO-five factor inventory (NEO-FFI) (Costa and McCrae), for both groups and further compared for differences in the dimensions in each of its subscale. Results The NEO scores, showed statistically significant difference with Cases having higher scores in Neuroticism and control group in Openness and Conscientiousness. Neuroticism linked to higher scores of AUDIT and SADQ and also associated with relapses. Other traits also showed statistically significant association which are discussed. Conclusion As new factors are being explored for effective management, routine personality profiling is easily accomplished and can give delightful insight into focused and designed management plan.

Owing to its rarity and non-specific clinical features, a diagnosis of obturator hernia is often delayed until the patient presents with intestinal obstruction. Often the diagnosis is made on a Computed Tomography (CT) scan or during exploratory laparotomy. While a laparoscopic approach is well described in an elective scenario, open surgery through a midline laparotomy has been the preferred approach for obturator hernia with intestinal obstruction. However, a few cases of obstructed obturator hernia have been reported that have been managed laparoscopically. We present our experience of two elderly patients who presented with intestinal obstruction. A CT scan helped clinch the diagnosis of obturator hernia as the cause and both were managed laparoscopically.

Introduction Paediatric acquired brain injury (ABI) causes cognitive and behavioural difficulties and alters the course of child development. The ABI unit at Hospital Infantil Universitario Nino Jesus is the first within the public Spanish health system to provide comprehensive coverage to these patients and their families. Objective This study aims to show the working methodology followed with patients and their families, and to describe the clinical characteristics of the patients treated and the outcomes of treatment. Patients Fifty-three patients aged between three months and 16 and a half years received treatment. The conditions treated were brain tumours, stroke, traumatic brain injury, damage secondary to epilepsy surgery, and hypoxia. Methods All patients were evaluated at admission and at discharge. Treatments were adapted to each patient's difficulties and their severity, as well as to the patient's age. Families received individual and group therapy. Results Older age was associated with better cognitive recovery and shorter duration of treatment. Different conditions show differential impact on intelligence quotient and developmental quotient scores at the beginning of treatment, with hypoxia and encephalitis being associated with greatest severity. Intelligence quotient and developmental quotient scores and visual memory and attention scores at discharge improved significantly after the faceted neuropsychological treatment with respect to scores registered at admission. Conclusions The care of patients with ABI should include neuropsychological rehabilitation programmes and provide emotional support to the family so that they may actively participate in the recovery of the child or adolescent.

Objective To analyse the available literature on the prognostic value of preoperative 18F-FDG PET/CT metabolic parameters and their usefulness in risk stratification in patients with endometrial cancer (EC). Material and methods Pubmed searches used “(endometr* OR uter*) AND (PET OR FDG)” as keywords from January-2000 to June-2020. References in included articles were checked for possible publications not included in the first search. Studies evaluating the prognostic value of preoperative 18F-FDG PET/CT and its role for risk stratification in patients with EC were included. Non-original articles (reviews, editorials, letters, legal cases, interviews, case reports, etc.) were not included. Results Twenty-six studies (1918 patients) were selected according to the inclusion criteria in this review. Thirteen studies (939 patients) related to the prognostic role of preoperative 18F-FDG PET/CT and 14 studies (1036 patients) related to its role in risk stratification were included. Parameters such as SUVmax, metabolic tumour volume (MTV) and total lesion glycolysis (TLG) of the primary tumour were analysed. Conclusions Preoperative SUVmax is useful for non-invasive diagnosis and for deciding the appropriate therapeutic strategy, as it could be used as an independent prognostic marker for recurrence and survival in EC. In addition, both preoperative VTM and GTL could be independent prognostic factors for predicting recurrence and survival, but there is still insufficient scientific evidence. The usefulness of SUVmax for risk stratification is limited (there is insufficient literature that 18F-FDG PET/CT can replace surgical staging), although VTM and GTL are more accurate and have a valuable role in risk stratification of EC. However, larger multicentre studies with adequate follow-up time are needed to confirm these findings.

Summary Objective Dysphonia is a reduction in vocal quality that impacts communication and is often an early sign of a voice disorder. There is little information regarding the effects of auditory feedback control of loudness and pitch on voice quality. In this study, we used both loudness-shift and pitch-shift paradigms to study the relationship between auditory feedback control and vocal quality as measured by smoothed cepstral peak prominence (CPPS), which reflects the harmonicity of the voice signal. Study Design Experimental, mixed design. Methods We applied 200 ms loudness-shifts (± 0, 3, or 6 dB) and pitch-shifts (± 0, 50, and 100 cents) to auditory feedback during sustained vowel production in 25 healthy adults. We then measured CPPS before and after the loudness-shift or pitch-shift to investigate the effect of changes in auditory feedback on vocal harmonicity. Results & Conclusions Results showed that, on average, CPPS significantly decreased between the first half of the measured segment and the last half of the segment in the absence of auditory feedback shifts, suggesting that voice quality may be reduced across longer vowels over time. Upward and downward shifts in loudness auditory feedback caused a relative increase in CPPS, indicating an improvement in vocal harmonicity, even in cases when vocal intensity was reduced. Pitch alterations had inconsistent and minimal effects. We propose that there may be a control mechanism for voice quality that increases harmonicity of the voice signal to improve voice audibility (ie, ability to be heard) in the presence of unpredictable variability in voice intensity.

Resumen Objetivo Contribuir con la presentacion de los resultados de nuestro estudio a ampliar la evidencia cientifica sobre el empleo de la radioembolizacion en el manejo de pacientes con hepatocarcinoma. Material y metodo Se trata de una revision retrospectiva realizada en nuestro centro que incluye a 53 pacientes con hepatocarcinoma tratados con radioembolizacion. Los pacientes fueron clasificados segun el algoritmo del BCLC (Barcelona Clinic Liver Cancer) y de forma pormenorizada por su estado funcional siguiendo la clasificacion de Child-Pugh. Se realizo un estudio de supervivencia siguiendo la metodologia de Kaplan-Meier. Se empleo el metodo de regresion de Cox para la determinacion de parametros clinicos significativos, incluyendo dosis administradas en los parametros estudiados. Resultados La serie evaluada comprende a pacientes con una media de edad de 60 anos (rango 28-86). Se llevaron a cabo un total de 61 procedimientos. La actividad media administrada fue de 2,8 GBq (0,7-6,4 GBq), administrando una dosis media en tumor de 229,9 Gy (74-425,9 Gy). El tiempo libre de progresion fue de 6,7 meses desde el momento del tratamiento y la supervivencia global fue de 12,8 meses. La clasificacion de los pacientes segun BCLC (p = 0,848) y Child-Pugh (p = 0,252) no resulto significativa respecto al tiempo libre de enfermedad. Los parametros clinicos que resultaron con diferencias significativas en cuanto a supervivencia global fueron los niveles de bilirrubina (p Conclusiones La radioembolizacion es un procedimiento seguro y eficaz en el tratamiento de pacientes con hepatocarcinoma. La funcion hepatica y las dosis recibidas por el tumor son parametros claves en la eficacia del tratamiento. El incremento de la evidencia cientifica apoya su inclusion en guias terapeuticas.

Resumen Antecedentes y objetivo El manejo actual de la diverticulitis aguda de colon izquierdo requiere pruebas con alto valor pronostico. Los objetivos del estudio son analizar la utilidad de la ecografia como metodo diagnostico inicial y evaluar la validez de las clasificaciones actuales de gravedad de dicha enfermedad. Pacientes Estudio observacional retrospectivo de pacientes con diverticulitis aguda de colon izquierdo. Se solicito ecografia o tomografia computarizada (TC) siguiendo un algoritmo clinico. Tras los hallazgos de imagen, se clasifico la enfermedad como leve, localmente complicada y complicada. Se evaluaron la eficacia de la ecografia como herramienta diagnostica inicial y las razones por las que se realizo una TC como tecnica inicial. Se compararon los hallazgos con las clasificaciones de diverticulitis publicadas. Resultados De 311 pacientes con diverticulitis aguda, se seleccionaron 183 con diverticulitis aguda de colon izquierdo, que fueron clasificadas por imagen como leves (104), localmente complicadas (60) y complicadas (19). En 98 pacientes, el diagnostico se realizo por ecografia, en 77 por TC y en 8 mediante ambas. Las principales razones de utilizacion inicial de TC fueron falta de experiencia del radiologo en ecografia abdominal y falta de disponibilidad de un radiologo de guardia. A 6 pacientes diagnosticados por ecografia se les realizo una nueva evaluacion por TC, pero solo en 3 cambio la clasificacion. Ninguna de las clasificaciones publicadas recoge todos los hallazgos en imagen. Conclusiones La ecografia deberia ser la primera tecnica a utilizar para el diagnostico de diverticulitis aguda de colon izquierdo. Para establecer el pronostico de la enfermedad, son utiles diversos parametros analiticos y hallazgos de imagen. Para una apropiada toma de decision terapeutica se necesitarian nuevas clasificaciones de gravedad.

Objective The Inventory of Interpersonal Problems–Personality Disorders (IIP-PD-47) has a controversial factor structure, as some studies have provided support for 5 correlated factors, and others have suggested the existence of a general second-order dimension. One approach of data modelling that reconciles multidimensionality and the existence of a general factor is the bifactor analysis. We used unrestricted exploratory-confirmatory bifactor modelling to validate the Brazilian version of the IIP-PD-47. Methods The sample consisted of 1,091 subjects aged 18-64 years who answered the IIP-PD-47 and a collateral measure of pathological traits, the Dimensional Clinical Personality Inventory 2 (IDCP-2). Results After testing many candidate models, our data were best represented by a bifactor model with one general factor and five specific uncorrelated factors. Nevertheless, a closer inspection of the discriminant validity of each IIP-PD-47 factor revealed strong support for the general factor and a factor capturing aggressive behaviours, but less support for the additional four specific factors. Conclusions The theoretical and practical implications of these findings are discussed, and some recommendations are offered about the need for controlling response styles when assessing PD traits via self-report inventories. Our findings indicate that the Brazilian version of IIP-PD has promising psychometric properties.

Radical cystectomy with bilateral pelvic lymphadenectomy and trimodality bladder-sparing therapy or TMT, are both curative options for patients with nonmetastatic muscle invasive bladder cancer. Patients should be afforded the opportunity for a multidisciplinary evaluation with equipoise in discussing these options for eligible patients. We discuss the barriers to broader acceptance and utilization of TMT and encourage support of clinical trials of TMT.

Resumen Introduccion La distonia focal de la mano es un trastorno del movimiento cuya sintomatologia produce una alteracion en el desempeno de tareas que requieren un nivel de destreza alto. Actualmente no se dispone de un modelo de interpretacion de la enfermedad y son escasos los estudios que identifican las dificultades de las personas con distonia al desempenar las actividades de la vida diaria (AVD). Por todo ello, el objetivo del estudio es describir la destreza manipulativa y su influencia en las AVD de los pacientes con distonia focal de la mano. Material y metodo Se realizo un estudio observacional, transversal, tipo casos y controles. Se reclutaron 24 participantes: 12 pacientes y 12 sujetos control. Los pacientes fueron derivados por el Servicio de Neurologia del Hospital Ramon y Cajal. Se obtuvieron datos sociodemograficos y clinicos retrospectivos en el grupo de casos. Posteriormente, se administraron pruebas de evaluacion, en el siguiente orden: Nine Hole Peg Test (NHPT), Box and Blocks Test (BBT), Purdue Pegboard Test (PPT) y Jebsen-Taylor Test of Hand Function (JTTHF). Resultados En la muestra del estudio participaron un total de 24 personas, siete mujeres y 17 hombres, con una media de edad de 50,79 ± 14,40 anos. Del total de participantes con distonia focal se observo que, aunque la mitad de la muestra no identifico signos de afectacion neuromuscular, ni problemas psicoemocionales, un menor porcentaje de estos pacientes identificaron dificultades asociadas con el hombro derecho (25%) y el estado ansioso (33,3%). Conclusiones Los hallazgos encontrados en el presente trabajo senalan que la distonia focal de la mano afecta a la destreza manipulativa de estos pacientes, presentando una peor ejecucion y requiriendo mas tiempo para su ejecucion.

ZusammenfassungTabakrauchen ist die wichtigste vermeidbare Krebsursache in Deutschland. Je mehr und je länger jemand raucht, desto stärker steigt sein Krebsrisiko. Wird Tabakrauch kombiniert mit Alkohol, vervielfacht sich das Krebsrisiko. Bis zu 30 % der Krebstodesfälle können auf das Rauchen zurückgeführt werden. 23,3 % der 18- bis 64-jährigen Bevölkerung rauchen und weitere 11 % sind hierzulande regelmäßig einer Passivrauch­belastung ausgesetzt. Zu den Tabakrauch-assoziierten Malignomen zählen Karzinome der Mundhöhle, der Nase, der Nebenhöhlen, des Pharynx, des Larynx, der Lunge, des Ösophagus, des Magens, des Pankreas, der Leber, der Gallenwege, des Dickdarms, der Nieren, der Ureteren, der Harnblase, der Zervix und der Eierstöcke sowie Leukämien. Bei stattgehabter Tabakexposition soll den Betroffenen frühzeitig zu etablierten Krebsfrüh­erkennungsmaßnahmen geraten werden. Rauchern soll eine professionelle Tabakentwöhnung angeboten werden. Das tabakbedingte Krebsrisiko wird durch den Rauchstopp effektiv und zeitabhängig gesenkt.

Background Elevated serum progranulin (PGRN) levels have been associated with a wide range of different human malignancies. However, data available on the role of PGRN in hematological malignancies are limited. Methods Measurement of the PGRN level in serum of adult de novo acute myeloid leukemia (AML) patients using enzyme-linked immunosorbent assay (ELISA) was performed. Results The mean serum PGRN level in AML patients was higher than that in controls (346.08 pg/ml ± 64.46 vs 155 pg/ml ± 63 respectively; p = 0.001). After a mean duration of follow-up equaling 140 days, patients with high serum PGRN (i.e., higher than 370.5 pg/ml) had inferior overall survival (OS) in comparison to patients with low serum PGRN (i.e., lower than 370.5 pg/ml) (OS = 25% vs 60.7%, mean survival = 107 days vs 256.5 days, p = 0.007). On the other hand, remitted patients on day 28 with high serum PGRN (i.e., higher than 307.5 pg/ml) did not differ from those with low serum PGRN (i.e., lower than 307.5 pg/ml) regarding disease-free survival (DFS) (DFS = 78.6% vs. 87.5%, mean survival = 301.3 days vs. 283.5 days, p = 0.789). Moreover, the serum PGRN level was associated with inferior OS (p = 0.024) on multivariate analysis. Conclusion Adult de novo AML patients have elevated serum PGRN levels and a high PGRN level is associated with an inferior OS.

The Micro-expressions (MEs) are very important nonverbal communication clues. However, due to their local and short nature, spotting them is challenging. In this paper, we address this problem by using a dedicated local and temporal pattern (LTP) of facial movement. This pattern has a specific shape (S-pattern) when ME are displayed. Thus, by using a classical classification algorithm (SVM), MEs are distinguished from other facial movements. We also propose a global final fusion analysis on the whole face to improve the distinction between ME (local) and head (global) movements. However, the learning of S-patterns is limited by the small number of ME databases and the low volume of ME samples. Hammerstein models (HMs) are known to be a good approximation of muscle movements. By approximating each S-pattern with a HM, we can both filter outliers and generate new similar S-patterns. By this way, we perform a data augmentation for S-pattern training dataset and improve the ability to differentiate micro-expressions from other facial movements. The spotting results, performed on CASME and CASME, show that our proposed LTP outperforms the most popular spotting method in terms of F1-score. Adding the fusion process and data augmentation improve even more the spotting performance.