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The recent literature has highlighted the needs for surgical systems to develop antifragile strategies in recovering from the COVID-19 crisis. Building on crisis management theory, our paper explores antifragility principles and their possible practical applicability to the surgical system.

Introduction: Licorice ingestion is well-described with its hypokalemic and hypertensive effects in the literature. To our knowledge, up to now, hypocalcemia due to licorice ingestion has not been described. Our aim is to create awareness for hypocalecemia concomittant with hypokalemia in patients with chronic licorice ingestion.Case Report: A 51-year old male patient presented to our Emergency Department (ED) with complaint of numbness on his whole body. On anamnesis, it was determined that he has been consuming licorice to regulate his hypertension for 3 months. Laboratory analysis revealed hypokalemia and hypocalcemia. After replacement therapy, the patient was discharged from the hospital with full recovery.Conclusion: Focusing on hypokalemia may lead to misdiagnosis of hypocalcemia in patients with chronic licorice ingestion. Physicians must be aware of other electrolyte disturbances not described in the literature yet.

International audience; Purpose: Scopolamine, an alkaloid found in certain plants, has become a drug of use for recreational and predatory purposes. We present here the case of an attempted scopolamine-facilitated robbery, via inhalation, with full recovery of the victim. We also performed a review of toxicological findings for scopolamine poisoning cases in available scientific literature. Methods: Whole blood and urine samples were collected 4 h after the assumed poisoning. Concentrations of scopolamine were determined in both samples by a validated and accredited method using liquid chromatography–tandem mass spectrometry. Results: Scopolamine was the only substance found in both whole blood and urine samples, at 7 and 510 ng/mL, respectively. Conclusions: Scopolamine poisoning remains rare, as its half-life is short; blood and urine should be collected as soon as possible for toxicological analysis. This case is, to our knowledge, the first described case of inhaled scopolamine robbery attempt, with quantitative toxicological findings. © 2019, Japanese Association of Forensic Toxicology.

For the first time, we report a correspondence between microplastics (MP) ingestion and ecotoxicological effects in gelatinous zooplankton (Cnidarian jellyfish). The ephyra stage of the jellyfish Aurelia sp. was exposed to both environmental and high concentrations of fluorescent 1–4 μm polyethylene MP (0.01–10 mg/L). After 24 and 48 h, MP accumulation, acute (Immobility) and behavioral (Frequency pulsation) endpoints were investigated. MP were detected by confocal and tomographic investigations on gelatinous body and mouth, either attached on the surface or ingested. This interaction was responsible for impairing ephyrae survival and behavior at all tested concentrations after 24 h. Acute and behavioral effects were also related to mechanical disturbance, caused by MP, triggering a loss of radial symmetry. Contaminated ephyrae exposed to clean seawater showed full recovery after 72 h highlighting the organisms without the microspheres, attached on body jellyfish surface around the mouth and lappets. In conclusion, short-term exposure to MP affects ephyrae jellyfish health, impairing both their survival and behavior. Polyethylene MP temporarily affect both Immobility and Frequency of pulsation of Aurelia sp. jellyfish. This study provides a first step towards understanding and clarifying the potential impacts of MP contamination in gelatinous zooplankton.

The most recent International Consensus Statement on Concussion in Sport reports that full recovery of symptoms following sport-related concussions (SRC) typically occurs approximately 10–14 days after injury. Delayed recovery occurs when symptoms persist beyond the expected time frames (i.e., >10–14 days in adults and > 4 weeks in children). Demographic characteristics such as younger age ( 5 days has negative correlation with recovery, early progression of physical activity within the first week (guided by the symptom exacerbation threshold) shows an inverse relationship. Screening for the presence of prognostic risk factors is recommended to initiate earlier intervention and/or appropriate referrals. Return-to-activity/play programs need to be individualized for each patient in order to achieve better outcomes.

espanolEsta tesis examina el reflejo de concepciones decimononicas de diferencia etnica y geo-cultural en la representacion de encuentros interraciales en la literatura espiritista victoriana. En concreto, propone cuestionar la recepcion de la alteridad racializada en obras influidas por el ocultismo decimononico, ya que estas no siempre hacian eco de los aspectos acogedores de la doctrina espiritista. Con el fin de ahondar en las complicaciones planteadas por esta disparidad, se plantea un analisis comparativo de la huella del pensamiento espiritista en textos britanicos y americanos, observando analogias y contrastes en la representacion de la identidad femenina birracial a ambos lados del Atlantico. Tambien se explora la incorporacion de dichos temas a la literatura neo-victoriana para asi evaluar reinterpretaciones contemporaneas de elementos espiritistas con relacion a interacciones interculturales. El primer capitulo considera el impacto transatlantico del movimiento espiritista, prestando atencion a su vinculo con las transformaciones socioculturales del siglo diecinueve. Toma en cuenta las implicaciones teoricas de practicas espiritistas como como la mediumnidad desde el punto de vista de la hospitalidad narrativa y la critica feminista, estableciendo asi el marco para el analisis de las novelas. El segundo capitulo examina la adaptacion de motivos espiritistas en la obra panafricanista de Pauline Hopkins Of One Blood (1902-1903). Se argumenta que su uso del ocultismo en la redefinicion de la identidad afroamericana se basa en correlaciones preestablecidas entre los circulos espiritistas y abolicionistas, desafiando asi la discriminacion racista. El tercer capitulo continua la exploracion de figuras marginales en la novela gotica de Florence Marryat The Blood of the Vampire (1897). Afirma que la autora espiritista adopta un acercamiento fundamentalmente hostil a la ascendencia afro-jamaicana de la protagonista, expresado mediante alusiones recurrentes a la ideologia eugenesica, mostrando asi las conexiones problematicas entre la comunidad espiritista y teorias bio-deterministas de la epoca. Finalmente, el cuarto capitulo investiga la inclusion del espiritismo en la novela neo-victoriana The Goddess and the Thief (2013), de Essie Fox. Se especula sobre los limites y ventajas del uso del ocultismo en la revision del discurso imperialista, demostrando como la presencia de elementos espiritistas en la ficcion historica contemporanea no siempre garantiza la recuperacion completa de voces no occidentales. Por ultimo, las conclusiones reunen las deducciones de dichos capitulos, ponderando sobre los dilemas planteados a lo largo de esta investigacion para confirmar el caracter paradojico de las relaciones interraciales en la cultura literaria espiritista. EnglishThis thesis examines the extent to which the interracial encounters depicted in Victorian spiritualist literature mirror the period’s wavering conceptions of ethnic and geo-cultural difference. More specifically, it proposes that the reception of racialized Otherness in works affected by the nineteenth-century Occult revival does not always echo the allegedly everwelcoming tenets of the spiritualist movement. In order to delve into the controversies posed by this disparity, it provides a comparative investigation of the influence of spiritualist thought on British an American Gothic texts, observing analogies and variations in the representation of mixed-raced female identity across the Atlantic. It also explores the incorporation of such motifs into Neo-Victorian fiction so as to evaluate contemporary reconfigurations of spiritualist imagery with relation to cross-cultural interactions. Chapter One considers the transatlantic impact of the spiritualist movement, paying attention to its linkage to the socio-cultural transformations of the long nineteenth century. It takes into account the theoretical implications of spiritualist practices such as mediumship from the point of view of narrative hospitality and feminist criticism, thus laying the ground for the subsequent analysis. Chapter Two examines Pauline Hopkins’ adaptation of spiritualist tropes into her Pan-Africanist novel Of One Blood (1902-1903). It argues that her use of the Occult in the redefinition of African-American personhood draws on previously established philosophical correlations between spiritualist and abolitionist circles in order to challenge racial discrimination. Chapter Three continues the exploration of racially liminal figures in Florence Marryat’s The Blood of the Vampire (1897). It asserts that the spiritualist author endorses a fundamentally hostile approach to the Creole protagonist’s heredity, expressed through recurrent allusions to eugenic ideology, thus demonstrating the problematic connections between nineteenth-century bio-determinist theories and the often seemingly progressive spiritualist community. Lastly, Chapter Four inquires into Essie Fox’s inclusion of Spiritualism into her Neo-Victorian novel The Goddess and the Thief (2013). It seeks to speculate upon the advantages and limitations of Fox’s use of the Occult in her revision of imperialist discourse, proving how the presence of spiritualist elements in contemporary historical fiction does not necessarily guarantee a full recovery of forgotten non-Western voices. The conclusion draws together the main findings of the abovementioned chapters, pondering on the dilemmas encountered throughout this investigation and confirming the paradoxical nature of interracial relations in spiritualist literary culture.

Anorexia nervosa is a potentially life-threatening eating disorder, characterized by an abnormally low body weight. This case report illustrates a 22-year old female with cardiac arrest due to a refeeding syndrome in a patient with anorexia nervosa. It features the successful use of extracorporeal cardiopulmonary resuscitation in a case of severe left ventricular dysfunction resulting in a favorable outcome.Conclusion. We present the first case of a cardiac arrest due to a refeeding syndrome in anorexia nervosa featuring the successful use of an extracorporeal cardiopulmonary resuscitation approach as a bridge to full recovery.

Concussion occurs in childhood across the age span from very young children to young adults, with each population having special considerations. Children may sustain a concussion from multiple different mechanisms of injury, not just sports participation, and an adequate clinical index of suspicion for the diagnosis of concussion in all settings where injury may occur is necessary. In addition, school is a primary vocation for children and concussion, with its associated cognitive, visual, and vestibular disturbances, may particularly impact their ability to fully participate in academics. Special consideration must be taken for academic adjustments and accommodations during the recovery from a concussion. Management goals include a full recovery and return to activity in school, sports, and life. For those with prolonged persistent concussion symptoms, there are emerging active therapeutic approaches that may be utilized in order to optimize the full return of children to the broad range of their life activities in a timely fashion.

In rehabilitation, emotional aspect is one key factor to motivate patients to reach their full recovery. Our previous study developed wireless PAM driver as walking-support device and experimentally evaluated its effectiveness in physical ability, but has not performed evaluation on emotional aspect yet. Therefore, this study experimentally evaluates cognitive load and its relationship with physical ability (i.e. performance and joint motion) on walking support using our PAM driver with variations of walking conditions. We obtained tendency of double-blink rate as rapid serial blinks to evaluate cognitive load during walking. In addition, we obtained correlations between gait velocity and blink rates, indicating that cognitive load was affected by walking speed (performance) more than joint motion (swing support).

We report the case of a pregnant female presenting with behavioral change and hallucinations followed by focal seizures with impaired awareness. EEG revealed generalized slowing interspersed with extreme delta-brush pattern and MRI brain was normal. Both Serum and CSF anti-N-methyl-d-aspartate receptor (NMDAR) antibodies were positive. Patient had a prolonged hospital stay with full recovery and delivered a healthy baby, highlighting the significance of early diagnosis and management in this disorder.

12 h after the implant of a S-ICD the patient accused an inappropriate shock due to noise oversensing. ICD interrogation showed undersensing of ventricular signals on primary vector and significative noise on alternative vector. Surprisingly, 2 days full recovery of sensing of primary vector was observed. Trapped air was likely to be the cause of malfunctioning.

We present Shewanella algea infection in a chronic suppurative otitis media (CSOM) patient with cholesteatoma in terms of clinical course and treatment. This is the first time S. algea is found as solely pathogen in a CSOM patient without history of contact with seawater in Turkey. The patient admitted to the hospital several times with complaints of otorrhoea, was diagnosed as otitis media and treated. He was hospitalized to the otorhinolaryngology department for further evaluation of recurrent infections. The patient was diagnosed as cholesteatoma according to computed tomography scan findings and was operated for cholesteatoma. As a result of surgical and medical treatment he was discharged with full recovery. Physicians must be aware of rarely seen pathogens and their unexpected ways of transmission and underlying causes such as cholesteatoma when treating patients for CSOM.

Introduction: Laryngospasm is a partial or complete closure of the vocal cords, causing stridor and then complete airway obstruction. We present an unusual case of recurrent laryngospasm following cervical spine trauma. Case report: A 41-year-old pedestrian was hit by a car sustaining several spine fractures including a comminuted fracture of C1. These were initially unrecognised, and his cervical spine was not immobilised. During this time the patient experienced three episodes of laryngospasm requiring intubation. On day 11 his fractures were identified, and a Philadelphia collar was placed. He made a full recovery without any neurological sequelae. Discussion: Laryngospasm is a recognised complication of anaesthesia and intubation. This case illustrates that this life-threatening complication can also follow cervical fractures, and reinforces the need for prompt and careful review of imaging to identify such fractures in trauma patients, especially those with stridor. Keywords: Laryngospasm, Cervical spine fracture

Background Unfavorable outcomes occur in 15–20% of patients with mild traumatic brain injury (mTBI). Early identification of patients at risk of unfavorable outcome is crucial for suitable management to be initiated, increasing the chances of full recovery. Many studies have been published on prognostic factors, but are not of a high level of evidence and certainty. A number of factors have been proposed and predictive models have been constructed that, although attractive, have not yet been externally validated. Objectives A review of literature (systematic search of PubMed and Google Scholar) assembled relevant available information about prognostic factors for unfavorable outcome after mTBI. We discuss the consistency of these findings, and the possibility and difficulty of using these factors in a daily practice. Results It appears that the strongest and most consistent predictors are the number, severity and duration of symptoms present in the first few days after the trauma.

In February 2017, a 52-year-old woman was brought to our clinic after abrupt right vision loss. Four days later, both eyes were affected, bilateral optic neuritis (ON) was diagnosed, and the patient was treated with a short course of corticosteroids. Her medical history revealed she was admitted at the age of 18 years with severe paraparesis, followed 4 weeks later by right vision loss. With a short course of corticosteroids, the patient achieved full recovery, but no etiology was found. Myelin oligodendrocyte glycoprotein (MOG)-IgG positivity and aquaporine-4 antibodies (AQP4-IgG) absence (cell-based immunoassay, analysed by microscopy) were confirmed in the present attack (figure for case description).

Status epilepticus is a medical emergency characterized either by continued seizures or by a lack of full recovery between seizures. It is relatively common, with a reported annual incidence of bet...

Over half of a human’s brain circuits are devoted to vision and eye movements, making it a system that can be easily compromised by a mild traumatic brain injury (mTBI). Changes in a patient’s eye movements could be a sensitive and objective biomarker of injury, and could also be useful for assessment of the pathways affected by the damage. Here, we discuss the specific dysfunctions found in afferent, efferent, and visual association pathways that may be useful for making a diagnosis of mTBI. Early diagnosis is critical to prevent further injury and to allow appropriate physical and cognitive rest to ensure full recovery, but more research is greatly needed in this area, since diagnosis of mTBI currently relies heavily on subjective complaints.

The spotted deer Axis axis is a Cervidae mammal that lives in most parts of Southeast Asia. Spotted deer attacks on humans are scarcely reported in the literature and are a rare phenomenon. A 31-y-old man was attacked by an unprovoked male spotted deer while supervising maintenance inside a deer enclosure. The victim received deep lacerations in the lower limbs and puncture wounds in the chest and abdomen. The victim made a full recovery after prompt management at a tertiary care hospital. The potential factors leading to this uncommon attack are discussed.

Perinatal mental illnesses are one of the challenging aspects of public health. If not taken care of, then they can have a serious impact on women as well as their families. They constitute one of the major reasons behind the maternal mortality during pregnancy or in the later period after child birth with prevalence ranging from 10 to 20 %. The brighter side is that with proper care and support, women can make full recovery from such illness. However, in many places in the world, the perinatal mental health is not given its due recognition and as a result of which it is usually undiagnosed, undertreated and leads to suffering of women. This review article focuses on the global burden of perinatal mental illness and discusses a comprehensive approach to address the perinatal mental health in a community setup. In addition, it provides a comprehensive overview of public health approaches to find a sustainable solution to the mental health issues faced by millions of women throughout the world.

Carbon monoxide (CO) is a colorless, tasteless, odorless, dangerous gas, which exists anywhere people live, and it is slightly lighter than air. The prognosis of CO poisoning varies depending on the exposure situation of CO gas, and some suffer from disorientation, urinary incontinence, energy loss, or even death after a full recovery from CO poisoning. The pathogenesis of acute CO poisoning has not been clearly identified, and the treatment protocol has also not been established.

Background: Physiological rhythms in mammals are essential for maintaining health, whereas disruptions may cause or exacerbate disease pathogenesis. As such, our objective was to characterize how cigarette smoke exposure affects physiological rhythms of otherwise healthy mice using telemetry and cosinor analysis. Methods: Female BALB/c mice were implanted with telemetry devices to measure body temperature, heart rate, systolic blood pressure, and activity. Following baseline measurements, mice were exposed to cigarette smoke for approximately 50 min twice daily during weekdays over 24 weeks. Physiological parameters were recorded after 1, 4, 8, and 24 weeks of exposure or after 4 weeks cessation following 4 weeks of cigarette smoke exposure. Results: Acute cigarette smoke exposure resulted in anapyrexia, and bradycardia, with divergent effects on systolic blood pressure. Long term, cigarette smoke exposure disrupted physiological rhythms after just one week, which persisted across 24 weeks of exposure (as shown by mixed effects on mesor, amplitude, acrophase, and goodness-of-fit using cosinor analysis). Four weeks of cessation was insufficient to allow full recovery of rhythms. Conclusion: Our characterization of the pathophysiology of cigarette smoke exposure on physiological rhythms of mice suggests that rhythm disruption may precede and contribute to disease pathogenesis. These findings provide a clear rationale and guide for the future use of chronotherapeutics.

The environmental disasters are each time more frequent, which cause huge impact on society, economic and environment. In order to properly take care of it and have the full recovery, it should be considered physical, mental and social dimensions of the actions developed. The present study aimed to know the possible psychologist actions in environmental disasters situations and describe the impacts of the disasters on the health of the populations exposed to them. For this purpose, a bibliographic research was carried out from publications made by renowned institutions and official organizations. In the field of Psychology, the debate on the subject has grown over the years, as well as the quantity of publications about it. However, there are still few publications with specific orientations for the psychologists in situations of environmental disasters. It is a common sense that the actions related to the disasters should not be restricted to the assistance given during and after the event. It is essential to take preventive practices that guide and aware the population to be capable to help to minimize the impact of the disasters. The psychologist at all stages should not only act to promote and protect human rights, but also help the population to bring their experiences a new meaning. It is necessary to broaden the debates and structure the researches on the subject, so orientations and solid directives can be produced for an effective assistance to the affected population.

We present a case of an unusual delayed multi-systemic reaction, following treatment with pamidronate. Although serious adverse reactions have been reported with pamidronate use, such a severe reaction, late in the course of pamidronate treatment, has not been described before. An 11-month-old boy with severe and complex osteogenesis imperfecta (OI) presented with hyperpyrexia and respiratory distress 10 days after his fifth cycle of pamidronate. He had significant derangement of his biochemical parameters including a positive urine myoglobin. His respiratory distress was out of proportion to his chest radiograph changes. Bilevel positive airway pressure (BiPAP) and paediatric intensive care (PICU) admission were required. He was extensively investigated to exclude other diagnoses, but all of these investigations were negative. The reaction resembled rhabdomyolysis. He made a full recovery with only supportive management.

During the 2019 IAAF World Championships in Athletics in Doha and the 2020 Olympic Games in Tokyo, minimum daily temperatures are expected to be in excess of 30°C. Due to the metabolic demands of the sporting events and the high environmental temperatures, the risk of exertional heat stroke (EHS) is high. Careful planning by event organizers are needed to ensure that athletes are protected from irreversible long-term health damage, or even death during sporting competitions in the heat. Efforts typically have included standard medical plans, equipment, protocols, and expert medical teams. In addition, the importance of responding quickly to a hyperthermic athlete cannot be understated, as minimizing treatment time will greatly improve the chances of full recovery. Treatment time can be minimized by notifying medical personnel about the health status of the athlete and the extent of any pre-competition heat acclimatization. Technology that allows the live transmission of physiological, biomechanical, and performance data to alert medical personnel of potential indicators of EHS should be considered. Real time monitoring ecosystems need to be developed that integrate information from numerous sensors such as core temperature-monitoring "pills" to relay information on how an athlete is coping with competing in intense heat. Medical/support staff would be alerted if an athlete's responses were indicating signs of heat stress or EHS signs and the athlete could be withdrawn under exceptional circumstances. This technology can also help provide more rapid, accurate and dignified temperature assessment at the road/track side in medical emergencies.

Background Mental fatigue, as part of cognitive dysfunction, has been reported to be common after subarachnoid hemorrhage and it significantly affects quality of life. Aims of the Study The aim of this study was to assess mental fatigue one year after an aneurysmal subarachnoid hemorrhage and to correlate the degree of mental fatigue to functional outcome assessed with the Extended Glasgow Outcome Scale (GOSE). Methods One year after an aneurysmal subarachnoid hemorrhage, the GOSE was assessed and a questionnaire for self‐assessment of mental fatigue, the Mental Fatigue Scale, was distributed to all included patients. The maximum score is 42 and a score of ≥10.5 indicates mental fatigue. Results All patients with GOSE 8, indicating full recovery, had a mental fatigue score of

Although the power conversion efficiency (PCE) of perovskite solar cells (PSCs) reached up to 23%, their short lifetime and fast degradation still remain as the main challenges. In this work, a new facile optical method based on the high power UV-irradiation is presented for the recovery of the degraded PSCs. Addition to the full recovery of the performance, about 20% PCE enhancement and hystersis reduction are also achieved by UV-irradiation. UV-treatment causes modifications in both the bulk properties of the perovskite layer and the energy equilibrium at the interfaces. It is shown that UV-treatment effectively passivates the surface and grain boundaries defects in different types of the devices comprising normal and inverted configurations that is confirmed by the reduction of the density of defect states (DOS). It is proposed that UV-light passivates the shallow and deep defects by dissociation of adsorbed hydroxyl groups and water molecules during the device storage.

Background Eating disorders have the highest mortality rate of mental disorders and a high incidence of morbidity, but if diagnosed and treated promptly individuals can benefit from full recovery. However, there are numerous problems at the healthcare interface (i.e. primary and secondary care) for eating disorders. It is important to examine these to facilitate appropriate, seamless treatment and improve access to specialist care. Aims To examine the current literature on the experiences and perspectives of those across healthcare interfaces for eating disorders, to include individuals with eating disorders, people close to or caring for those with eating disorders such as family and friends, and health professionals. Method To identify relevant papers, a systematic search of electronic databases was conducted. Other methods, including hand-searching, scanning reference lists and internet resources were also used. Papers that met inclusion criteria were analysed using a systematic methodology and synthesised using an interpretative thematic approach. Results Sixty-three papers met the inclusion criteria. The methodological quality was relatively good. The included papers were of both qualitative (n = 44) and quantitative studies (n = 24) and were from ten different countries. By synthesising the literature of these papers, three dominant themes were identified, with additional subthemes. These included: ‘the help-seeking process at primary care’; ‘expectations of care and appropriate referrals’ and ‘opposition and collaboration in the treatment of and recovery from eating disorders’. Conclusions This review identifies both facilitators and barriers in eating disorder healthcare, from the perspectives of those experiencing the interface first hand. The review provides recommendations for future research and practice. Declaration of interest None.

Purpose To assess the role of anatomic reconstruction of the posterolateral corner (PLC) of the knee arthroscopically in cadaveric knees with simulated isolated grade III posterolateral instability. Methods A total of 12 nonpaired, fresh-frozen cadaveric knees were biomechanically subjected to a 10-Nm varus moment, 5-Nm external and internal rotation torques, and 134-N posterior tibial load at 0°, 15°, 30°, 60°, and 90° of knee flexion (0° for varus loading only). Testing was performed with an intact and sectioned PLC and after anatomic reconstruction of the PLC by an arthroscopic technique. Kinematics of each knee under various loading conditions was determined with a robotic universal force/moment sensor testing system. Results After sectioning, significant increases were found in varus rotation at 0°, 15°, 30°, 60°, and 90° of knee flexion; in external rotation at 15°, 30°, 60°, and 90° of knee flexion; in internal rotation at 60° of knee flexion only; and in posterior translation at 15° and 30° of knee flexion. After reconstruction, full recovery of knee stability was observed in varus rotation, external rotation, internal rotation, and posterior translation at all selected flexion angles without any overconstraint of knee kinematics. Conclusions Anatomic reconstruction of the PLC can be performed arthroscopically with isolated grade III posterolateral instability of the knee, and nearly normal stability of the knee can be restored. Clinical Relevance PLC reconstruction by an anatomic, all-arthroscopic technique achieves optimal stability control and kinematics of the knee.

The extent of spontaneous recovery in patients with a spinal cord injury (SCI) has not been thoroughly investigated. It is essentially not known whether SCI animals exhibit full recovery from both motor and sensory deficits as well. Here, we developed an appropriate condition to produce a mild SCI in mice. Mice given a mild contusion SCI showed transient low performances in the Basso Mouse Scale for locomotion (BMS), rotarod and beam walking tests after the SCI, which was followed by complete restoration in a short time. The SCI mice also showed functional full recovery from low sensitivity to light touch using dynamic touch test. Nevertheless, the fully-recovered SCI mice still exhibited significant loss of myelin in the spinal cord. These results suggest a high potential of adaptation of motor and sensory systems in mice and might provide insight into the prognoses of SCI patients.

Changes in collagen mass in rats were studied under the conditions of local cold injuries. A method for quantitative determination of collagen in the dermis was developed and applied for the first time. Cold injury was replicated in mongrel male and female rats weighing 180–200 grams by applying a metal weight 2.5 cm in diameter, cooled in liquid nitrogen, to depilated skin on the back. A statistically significant decrease in collagen content was recorded in rats on day 3 after cold damage. Starting with the 14th day after the cold injury, an increase in collagen content was observed due to the restored activity of fibroblasts. By the 21st day, collagen content continued increasing, but full recovery was not observed.

Aims: Observational studies have suggested that beta cell functional mass inevitably decreases over time. We assessed this after 2 years in a geographically defined subgroup of DiRECT who achieved initial remission after diet-induced weight loss. Methods: A Stepped Insulin Secretion Test with Arginine (SISTA) was used to quantify functional beta cell mass (maximum insulin secretory response during hyperglycemia). Insulin secretion rates were estimated by de-convolution; 40 subjects initially achieved remission (HbA1c Results: In the responder group, median (IQ range) maximum rate of insulin secretion increased from 0.58 (0.48 to 0.81) at baseline to 0.74 (0.54 to 1.00) at 5 months, 0.94 (0.57 to 1.24) (p=0.017 from baseline) at 12 months, and 0.94(0.64 to 1.44) (p=0.030 from baseline) nmol/min/m2 at 24 months. This was comparable to NDC (1.02(0.86 to 1.51) nmol/min/m2) by 12 (p=0.064) and 24 months (p=0.244). Median first phase insulin response increased in responders from 0.042 (0.004 to 0.0637) at baseline to 0.108 (0.058 to 0.163) nmol/min/m2 (p Those who failed to maintain remission were characterized by more weight regain 5-24 months (11. 3±1.9 vs. 6.6±1.0 kg, p=0.036). In responders mean HBA1C was 6.0±0.0% at 24 months. Conclusion: Provided weight regain is minimized, remission of type 2 diabetes is durable over 2 years, with a gradual increase to normal beta cell functional mass. Disclosure S.V. Zhyzhneuskaya: None. A. Al-Mrabeh: None. A.C. Barnes: None. B. Aribisala: None. K.G. Hollingsworth: None. H. Pilkington: None. N. Sattar: Advisory Panel; Self; Amgen Inc., AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk A/S. Consultant; Self; NAPP Pharmaceuticals Limited. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc. Speaker's Bureau; Self; Amgen Inc., Eli Lilly and Company, Mitsubishi Tanabe Pharma Corporation, Novo Nordisk A/S, Roche Diagnostics France, Sanofi. M.E. Lean: Consultant; Self; Counterweight Ltd., Novo Nordisk A/S. Research Support; Self; Novo Nordisk A/S. R. Taylor: Advisory Panel; Self; Wilmington Healthcare. Speaker's Bureau; Self; Lilly Diabetes, Novartis AG. Funding Diabetes UK

Background. The aetiology of trigger digits has been debated since Notta first described them in 1850. Aetiology has been segregated for adult and paediatric presentations. While an adult trigger digit is most likely an acquired inflammatory process, the same is not true for cases in children: no inflammatory reaction is seen on microscopic evaluation. We wish to add strength to a genotypical aetiology for paediatric cases. Methods. We present two cases of monozygotic twins with trigger digits managed in our institution. A comprehensive review of literature was conducted for cases of trigger digit in monozygotic twins to support our theory. Results. Our two sets of twins enjoyed a full recovery from surgery at one-month follow-up. A total of seven other cases of monozygotic twins were found in literature. Conclusion. Our cases add to the growing body of evidence supporting a genotypical aetiology for paediatric trigger digit.

Psychosis is a relatively common psychiatric phenomenon seen in patients with Prader-Willi Syndrome (PWS). However, the presentation is atypical and difficult to classify within currently defined affective or psychotic disorders. This distinct presentation may be better understood as a phenomenon called "cycloid psychosis," described as an episodic psychosis with rapid full recovery between episodes. This study retrospectively analyzed the cases of 12 patients with genetically confirmed PWS who presented to an ambulatory psychiatric center for a change in behavior consistent with psychosis. Each case was then assessed for symptoms of cycloid psychosis, bipolar disorder, depression with psychotic features, schizophrenia, and schizoaffective disorder. Out of the 12 patients, 11 (91.7%) met the currently described diagnostic criteria for cycloid psychosis. Of the 12 patients, 7 (58.3%) also met the diagnostic criteria for bipolar disorder, and 1 (8.3%) also met the diagnostic criteria for schizoaffective disorder. None of the patients met the criteria for schizophrenia or depression with psychotic features. The findings in this study suggest that cycloid psychosis and bipolar disorder may both be comorbid with PWS. Psychiatric comorbidities in patients with PWS are atypical and clinicians should be aware of conditions such as cycloid psychosis when managing this vulnerable population.

Background: Hyperosmolar hyperglycemic state is a life-threatening endocrine disorder that most commonly affects adults with type 2 diabetes mellitus. The condition results from an osmotic diuresis-induced loss of water exceeding that of sodium. Altered mental status, hypernatremia and hyperglycemia are characteristic features at presentation. Abnormal electroencephalogram findings have been reported. Successful therapy requires judicious fluid replacement and close monitoring. Case: A 78-year-old Hispanic female with a significant past medical history of type 2 diabetes mellitus was admitted with altered mental status, severe hypernatremia and hyperglycemia. She was diagnosed with hyperosmolar hyperglycemic state, and fluid therapy was started. A continuous electroencephalogram revealed left frontocentral and temporal periodic lateralized epileptiform discharges that resolved as her hypernatremia and dehydration were treated. She survived and was discharged after 1 week of treatment. Conclusion: Abnormal electroencephalogram findings consistent with nonconvulsive seizure activity may be temporary and reversible and do not suggest a poor prognosis in an elderly patient suffering from hyperosmolar hyperglycemic state and altered mental status.

OBJECTIVE: Currently, no treatments exist for patellar tendinopathy (PT) that guarantee quick and full recovery. Our objective was to assess which treatment option provides the best chance of clinical improvement and to assess the influence of patient and injury characteristics on the clinical effect of these treatments.DESIGN: A secondary analysis was performed on the combined databases of 3 previously performed double-blind randomized controlled trials.PATIENTS: In total, 138 patients with PT were included in the analysis.INTERVENTIONS: Participants were divided into 5 groups, based on the treatment they received: Extracorporeal shockwave therapy (ESWT) (n = 31), ESWT plus eccentric training (n = 43), eccentric training (n = 17), topical glyceryl trinitrate patch plus eccentric training (n = 16), and placebo treatment (n = 31).MAIN OUTCOME MEASURES: Clinical improvement (increase of ≥13 points on the Victorian Institute of Sport Assessment-Patella score) after 3 months of treatment.RESULTS: Fifty-two patients (37.7%) improved clinically after 3 months of treatment. Odds ratios (ORs) for clinical improvement were significantly higher in the eccentric training group (OR 6.68, P = 0.009) and the ESWT plus eccentric training group (OR 5.42, P = 0.015) compared with the other groups. We found evidence that a high training volume, a longer duration of symptoms, and older age negatively influence a treatment's clinical outcome (trend toward significance).CONCLUSIONS: Our study confirmed the importance of exercise, and eccentric training in particular, in the management of PT. The role of ESWT remains uncertain. Further research focusing on the identified prognostic factors is needed to be able to design patient-specific treatment protocols for the management of PT.

Negative-pressure wound therapy (NPWT) involves the application of subatmospheric pressure to a wound to help in the healing process. The objective of this case series was to evaluate the clinical experience using ultra-portable NPWT devices on high-risk closed incisions after surgical management of complex non-healing wounds. Data were available for eight dogs and three cats. Wound aetiologies varied from traumatic, neoplastic and foreign body. Application and maintenance of the portable device were technically easy in most cases, finding some difficulties when applied to curved body surfaces. All patients’ outcome was highly rewarding. This case series suggests that portable NPWT helps in achieving full recovery, increases comfort allowing early ambulation and feeding, and reduces hospitalisation time. Their reduced size is suitable for smaller animals, enhancing their therapeutic use in veterinary medicine.

This chapter examines roles, structures, processes and bureaucratic behaviors within that part of the United States (U.S) government engaged in making foreign policy and defense policy is that little is known about these bureaucracies or anybody else's bureaucracies. The 1976-77 presidential election and transition period served as the next occasion for an outburst of publications on bureaucratic decision making and related organizational matters in the context of foreign and defense policies. The one most important actor to study and to emphasize in trying to understand US foreign and defense policy is the President of the US President Jimmy Carter is in fact a weak leader, and may have been permanently injured beyond the possibility for full recovery by all of the apparent zigzags in foreign and defense policy matters thus far. The harder line of White House national security adviser Zbigniew Brzezinski seemed to be in the ascendancy.

Background Posterior reversible encephalopathy syndrome (PRES) is a benign disorder of reversible subcortical vasogenic cerebral edema. Case characteristics A 13-yr-old girl presented 4 days after complete recovery from diabetic ketoacidosis with symptoms of headache, altered sensorium, seizures, and visual loss. There was no hypertension or biochemical abnormalities identified. MRI brain showed hyperintense areas in subcortical and periventricular white matter of bilateral fronto-parieto-occipetal lobes, with possible diagnosis of normotensive PRES. Outcome Full recovery without sequelae, following neuro-protection and expectant treatment. Message Identifying PRES in diabetic ketoacidosis assists appropriate treatment and prognostication.

Background: The restoration of hand function is an important goal for patients with stroke. This study investigated the relationship between corticospinal tract (CST) integrity and the functional status of the hand in patients with stroke 6 months after onset and evaluated which of the following values would be useful for predicting hand function: fiber number (FN), fractional anisotropy (FA) at the mid-pons, and FA at the pontomedullary junction. Methods: The present retrospective cross-sectional observational study assessed 44 patients with stroke who were able to walk without using a walking aid or orthosis. The final hand function results were classified into three groups: no recovery (unable to grasp), partial recovery (able to grasp, unable to oppose), and full recovery (able to grasp and oppose). All subjects underwent diffusion tensor imaging (DTI) at 6 months after stroke onset. Values for FA at the mid-pons and pontomedullary junction and CST FN were measured. The normalization ratio for FN and FA was calculated using the following formula: data for affected hand/data for non-affected hand. Results: The normalized FN, FA (mid-pons), and FA (pontomedullary junction) DTI values differed significantly. The FA (mid-pons) value for the full recovery group was higher than those for the other groups. The FA (mid-pons) value for the partial recovery group was higher than that for the no recovery group. The normalized FA (mid-pons) value differed significantly among all three groups. Conclusions: The present study showed that CST integrity (at 6 months after onset) in patients with chronic stroke was related to functional hand status. In addition, the mid-pons FA value was more predictive of functional restoration of the hand than the FN or FA value at the pontomedullary junction. These results may be useful in predicting the functional restoration of the hand and understanding the functional prognosis of stroke.

Video-assisted thoracoscopic surgery can be a useful tool in selected penetrating chest trauma patients for diagnostic and therapeutic purposes. It is currently a safe and feasible alternative to thoracotomy in the management of chest trauma especially for hemodynamically stable patients.Penetrating chest trauma with retained bullet was removed successfully in a 25 years old patient using double-port VATS technique in combination with fluoroscopy, he made full recovery, hospital stay was very short. Keywords: Fluoroscopy, Penetrating chest trauma, Thoracoscopy, VATS

Background Widespread devastation to structures and households in Mosul occurred during the three years of ISIS control and the military liberation campaign by Iraqi forces assisted by coalition forces. Military operations, particularly airstrikes, resulted in a greater loss of life than during ISIS control. In 2016/17, we assessed living circumstances in Mosul immediately following defeat of ISIS. In September 2018, we reassessed many of the same indicators in Mosul households to determine the extent of recovery. Methods For the 2018 survey, a random selection of 20 clusters were drawn from the 40 clusters surveyed in 2016/17. Of these 20 clusters, 12 were in east Mosul and 8 in west Mosul, the same proportion as the original survey. In each cluster, 30 households were interviewed. No households were included in both surveys. A team of four interviewers collected information using questions adapted from the 2016/17 questionnaire. Results Among the 3375 persons from the 600 households in the 2018 survey, there had been 18 deaths reported in the year since the end of ISIS control, a mortality rate of 6.1/1000 (CI95% [2.4–9.8]). This compares with a mortality rate of 30.7/1000 (CI95% [28.3–33.2]) during ISIS control and liberation. Fifteen deaths were from disease, one from a non-intentional injury and two deaths due to intentional violence. Damage to dwellings had been fully repaired in only 22 (5.5%) of houses, mostly in less damaged east Mosul. Dramatic improvements in access to water and electricity have occurred, with three quarters of households reporting uninterrupted access to both. The previously reported large number of early marriages among household members stopped with the departure of ISIS. Of the 31 household marriages reported over a 12-month follow on study, 6 (19.4%) involved a female member of the household. This compares with 131 household males and 688 household females married during ISIS occupation. If marriages had continued at the same rate as for ISIS years during our one-year follow-on study, there would have been and expected 24 marriages of household males and 126 marriages of household females (OD 32.8, CI95%[10.5102.8]) p < 0.001. There were 657 children reported by households to be in primary school. However, by household listing there were only 380 of children in the usual primary school age range (6–11), suggesting older children are catching up on primary schooling missed during ISIS years. One report of physical violence between spouses occurred. By comparison, the adjusted number of reported violent spousal events during ISIS control and military action would have been 72.7 (OR 316.7, CI95% [44.42259.9]), p < 0.001. Reported complications of pregnancy also declined (OR 10.3, CI95% [5.4,19.4], p Conclusions Substantial improvements in household measures have occurred since the end of ISIS control and military action, though much remains for full recovery. Many household members are now employed, primary school attendance is high and early marriage of girls was not found. There are fewer reported complications of pregnancy than in the previous study.

Breast cancer is the second leading causes of disease in women. In practice effective ways to prevent breast cancer is still researched for a better solution, since the cause is not yet organised completely. Early detection is an effective way to diagnose and manage breast cancer can give better chance of full recovery. This work focuses on detection of breast cancer in digital mammograms. In this paper various preprocessing methods, segmentation process and classifier were discussed. In our work, Support Vector Machine is used to show accuracy on the breast cancer image. The accuracy test we had undergone using three SVM techniques.

Endocochlear potential (EP) is essential for cochlear amplification by providing the voltage source needed to drive outer hair cell (OHC) transducer current, which leads to OHC electromechanical force. An early study using furosemide to reversibly reduce EP showed that distortion product otoacoustic emissions (DPOAEs) recovered before EP. This indicated that cochlear amplification may be able to adjust to a new, lower EP. To investigate the mechanism of this adjustment, the extracellular OHC voltage, which we term local cochlear microphonic (LCM), was measured simultaneously with DPOAE and EP while using intraperitoneal (IP) and intravenous injection of furosemide to reversibly reduce EP. With IP injection, the DPOAEs recovered fully, whereas the EP was reduced, but LCM showed a similar time course as EP. The DPOAEs failed to accurately report the variation of cochlear amplification. With intravenous injection, for which both reduction and recovery of EP are known to occur relatively quickly compared to IP, the cochlear amplification observed in LCM could attain nearly full or even full recovery with reduced EP. This showed the cochlea has an ability to adjust to diminished operating condition. Furthermore, the cochlear amplifier and EP recovered with different time courses: cochlear amplification just started to recover after the EP was nearly fully recovered and stabilized. Using a Boltzmann model and the second harmonic of the LCM to estimate the mechanoelectric transducer channel operating point, we found that the recovery of cochlear amplification occurred with recentering of the operating point.

A 10-year-old boy struck a car bonnet following which his left shoulder got pinned under the wheel. No life-threatening injuries were identified. However, the patient sustained extensive abrasions to the back and the left shoulder, a closed deformity of the left clavicle and a swollen, but stable right knee. The patient was neurovascularly intact globally and all joints had a full range of motion. Plain radiographs suggested a possible greenstick fracture of the left clavicle, but also free gas within the left glenohumeral joint. Concern was raised of an unidentified open injury to the joint. CT was supportive of the finding of gas within the left glenohumeral joint, but ruled out the possible greenstick fracture as a spurious finding. There were no other injuries. The gas was within the left glenohumeral joint and was consistent with vacuum phenomenon. The injury was treated expectantly and the child made a full recovery.

A 39-year-old male commercial diver developed cutis marmorata after a dive. He had a full recovery after therapy in a hyperbaric oxygen chamber. Transthoracic echocardiography revealed an atrial septal aneurysm and a large shunt during normal respirations. This form of decompression sickness may progress to type II DCS, thus is important to identify and treat. Cutis marmorata as a result of diving is highly associated with an atrial septal defect or a large patent foramen ovale. It is particularly important to assess these patients for a right-to-left shunt as part of a medical evaluation prior to returning to diving.

Hereby, we report a case of a 75-year-old man who presented with a 3-day history of facial swelling and choking sensation. The only history of note was an insect bite on the left parotid gland area 3 days prior. The patient was later diagnosed with insect-bite-induced Ludwig’s angina. Enterococcus faecalis was detected on blood cultures and was presumed the source of infection. Intravenous antibiotics and corticosteroids were initiated. The patient was intubated and was subsequently made to undergo a tracheostomy insertion to establish a definitive airway. He was admitted to the intensive care unit and when his condition improved, he was transferred to the ward for full recovery. The patient spent a total of 66 days in hospital before being discharged. This case suggests that Ludwig’s angina can be caused by insect bites. However, further similar cases are needed to be documented to explore this theory.

This study aims at recovering manganese from a low-grade mining waste and valorizing it through the synthesis of manganese ferrite (MnFe2O4). Full recovery of manganese from the low-grade waste was obtained by heat treatment (700 °C), and leaching optimization of the waste in a reductively promoted sulfuric acid medium. Subsequently, the Fe: Mn molar ratio (2:1) of the leachate was adjusted to prepare the precursors for the MnFe2O4 synthesis through co-precipitation. The optimization of the synthesis parameters including temperature (15–90 °C), aging time (0–120 min), and calcination temperature (800–1200 °C) was investigated. The optimum condition suggested by the response surface method (RSM) led to the synthesis of pure plate-like MnFe2O4. Additionally, nano-sized particles (45 nm) were obtained at the 90 °C synthesis temperature, 120 min aging time, and without any calcination. Both nano-sized and plate-like MnFe2O4 particles with the saturation magnetization of 34.47 and 51.03 emu g−1 presented superior magnetic properties.