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BACKGROUND: Gait deficits and functional disability are persistent problems for many stroke survivors, even after standard neurorehabilitation. There is little quantified information regarding the trajectories of response to a long-dose, 12-month intervention. OBJECTIVE: We quantified treatment response to an intensive neurorehabilitation mobility and fitness program. METHODS: The 12-month neurorehabilitation program targeted impairments in balance, limb coordination, gait coordination, and functional mobility, for five chronic stroke survivors. We obtained measures of those variables every two months. RESULTS: We found statistically and clinically significant group improvement in measures of impairment and function. There was high variation across individuals in terms of the timing and the gains exhibited. CONCLUSIONS: Long-duration neurorehabilitation (12 months) for mobility/fitness produced clinically and/or statistically significant gains in impairment and function. There was unique pattern of change for each individual. Gains exhibited late in the treatment support a 12-month intervention. Some measures for some subjects did not reach a plateau at 12 months, justifying further investigation of a longer program (>12 months) of rehabilitation and/or maintenance care for stroke survivors.

BACKGROUND Soccer is one of the most popular sports in the world involving about 200 million athletes. Injury management in soccer is crucial for performance and for the costs related to rehabilitation and absence from official matches. While there is quite an exhaustive literature regarding injuries in professional soccer, for amateur soccer the incidence of injuries remains unknown. The purpose of this study was to analyse the prevalence of injuries in the fourth Italian soccer division during the competitive season. METHODS Medical staff completed an injury report every two months during the competitive season of the fourth Italian soccer division (14 teams, n = 278). The specific description of the problem, player field-position, number of training losses and number of match losses were collected for each player. The time periods were September/October (T1) November/December (T2), January/February (T3). RESULTS A significant association between injury type and the period of the season was observed: muscle and tendon injuries were the most prevalent injury type (48.9 %) in all three periods (χ2 (10) = 33.86, p < 0.001). Overall, 108 (39.7 %) injuries occurred at T1, 90 (33.1 %) at T2 and 74 (27.2 %) at T3 (χ2 (12) = 20.32, p = 0.071). CONCLUSIONS Coaches and athletic trainers should be aware of this greater injury risk when preparing a training program for the season, to implement injury prevention protocols for the most prevalent injury types.

The aim of this study was to analyze the relationship between the concentration of hormones in the seminal plasma, the bull maintenance system in the insemination station, and the regularity of sperm donation and the response to the phantom (libido level). An additional goal was to determine whether there is a relationship between the hormonal profile in the blood, the sperm plasma, the oxidative and antioxidant profile in the blood of bulls and the biometry of their testicles and scrotum, as well as the quality of their sperm in both different seasons and intensities of reproductive use. For the study, 220 healthy and sexually mature Polish Holstein–Friesian bulls were used. They all had normal libido and were fed equally. The animals were grouped according to the scheme: young (16–20 month/n = 60) and old (26–30 month/n = 60) including: individually housed (n = 30) and group housed (n = 30) young, old individually housed (n = 30) and group housed (n = 30) (n total animals = 120); young animals donating semen once a week (every Thursday) (n = 25) and sporadically (once every two months on a random day of the week) (n = 25), old animals donating semen once a week (every Thursday) (n = 25 ) and sporadic donors (once every two months on a random day of the week) (n = 25) (n total animals = 100). When analyzing the results of this study, it should be stated that regular use has a positive effect on the secretion of sex hormones in bulls. Higher levels of testosterone and lower levels of estradiol and prostaglandins resulted in higher sexual performance, expressed by a stronger response to the phantom. The differences in favor of regular use were independent of the bull's age. The results of our research illustrate that the quality of semen and its freezing potential may depend on the season and frequency of its collection, as well as on the age of the males.

Summary Introduction Endonasal dacryocystorhinostomy (DCR) is a surgical procedure that aims to increase tear drainage to treat epiphora caused by nasolacrimal obstruction by creating a bypass through the bone between the lacrimal sac and the nasal cavity. A silicone stent is temporarily put in place for 2 months to avoid early obstruction of the rhinostomy. One of the causes of surgical failure is related to progressive stenosis of intranasal ostium, due to fibrosis and new bone growth, inducing a relapse of epiphora and/or dacryocystitis. Few studies have described changes in the size of the intranasal ostium on direct post-DCR measurement or kinetics of its shrinkage. The purpose of this study is to determine whether changes in the size of intranasal ostium might be a predictor of final functional efficacy. Materials and methods A prospective cohort of eighteen consecutive patients undergoing endonasal DCR for chronic epiphora or chronic dacryocystitis between January 2017 and April 2018 was analyzed. Eight patients who underwent bilateral DCR, and twenty-six intranasal ostia were finally analyzed. Follow-up took place every two months for 1 year, with the silicone tube removed at 2 months. Functional success was defined as absence of recurrent epiphora or dacryocystitis. Ostium size was systematically measured on photos taken during intranasal endoscopy performed every 2 months for 1 year. Results At 2 months after endonasal DCR, 23 of the 26 ostia (88.5%) were functional, but only 19 (73.1%) of them were directly measurable. The mean horizontal diameter at 2 months was 1.44 (SD 0.61) mm, and the mean vertical diameter was 0.86 (SD 0.37) mm, which corresponded to a mean area of 10 (SD 0.84) mm2. We noted a statistically significant decrease in ostium size and area between 2 and 4 months after the procedure (P −0.001), followed by a stabilization period with no statistical correlation between the size of the ostium and its final functional efficacy. At 6 months after DCR, of the 7 ostia that were not initially measurable, 3 were immediately non-functional at 2 months, 3 had a relapse of epiphora at 4 months, and 1 had a relapse of dacryocystitis at 6 months, i.e., 100% clinical failures at 6 months. The other procedures all remained functional after 1 year of follow-up. Conclusion The intranasal ostium of an endonasal DCR shrinks significantly within the 2 months after removal of the silicone tube and remains stable thereafter. There is no correlation between the size or area of intranasal ostium and its final functional efficacy. However, when the ostium is not measurable at the time of 2-month stent removal, all patients experienced a relapse of epiphora or dacryocystitis within 6 months.

Background & Objective:Migraine is an occasional headache that represents neurological and gastrointestinal symptoms, as well as changes in the autonomic nervous system. Biofeedback is a non-pharmacological technique used to treat migraine headaches and is proven to reduce headaches and improve performance. The present study aimed to compare the efficacy of biofeedback and pharmacological treatments to find the best treatment strategy for migraine headaches. Materials & Methods:This randomized clinical trial was performed on 86 patients who referred to Noor Psychiatric Clinic and Neurology ClinicofValiasr Hospital, Zanjan, Iran. Patients were divided into two groups of daily treatment with medication and treatment with medicine and biofeedback. Cases were monitored every two months using interviews and questionnaires. Results:The study was carried out on 86 migraine patients with the age range of 31-45 years for 3 months. Most of the patients were female, including 90.7% of the individuals in the case group and 81.4% of the control group. The frequency distribution of medication use was not different between the two groups (P=0.744). Most of the participants had a history of more than 1 year of headache. During the treatment, the frequency and severity of attacks reduced obviously until the 8thweek. The decrease in the Migraine Disability Assessment (MIDAS) score was more significant in the biofeedback group, except in the 10thand 12thweeks. However, the decline in the MIDAS score was not significant. Moreover, the reduction in the frequency of attacks remained significant until the end of the study. Conclusion:It can be concluded that the combination of biofeedback treatment and medication therapy provides a more rapid response than pharmacological treatment alone. Therefore, biofeedback is an effective add-on therapy, which can be taken into consideration for diminishing all aspects of migraine headache attacks.

This clinical analysis of 125I seed implantation combined with Apatinib in the treatment of locally advanced lung cancer with negative driving genes was retrospectively performed on 19 patients in the Department of Thoracic Surgery, Tianjin First Central Hospital, from January 2018 to May 2019. Twelve cases were treated with Apatinib after 125I implantation, while the other seven were treated with 125I implantation only. IL-2R, IL-6 and TNF-α before and after the treatment, imaging changes every two months and related side effects were recorded. After the treatment, IL-2R, IL-6 and TNF-α of all the patients decreased in the first month, which was more obvious in combined therapy patients; the total effective rate in combined therapy patients was significantly higher than the others. There were no fatal complications, and all the side-effects were well tolerated by medical treatment. It shows that 125I seed implantation combined with Apatinib is effective and safe in the treatment of locally advanced lung cancer.

International audience; With intermittent vitamin D supplementation, serum 25-hydroxyvitamin D (25OHD) levels may remain stable only if the dosing interval is shorter than 3 months, the ideal perhaps being about 1 month. Recent data support moderate daily vitamin D doses instead of high intermittent doses, notably in elderly patients prone to falls. The level of evidence is low, however, with no head-to-head comparisons of clinical outcomes such as fractures and falls in groups given identical dosages daily versus intermittently. A challenge to daily vitamin D supplementation in France is the absence of a suitable pharmaceutical formulation. In addition, daily dosing carries a high risk of poor adherence. Until suitable vitamin D3 formulations such as tablets or soft capsules each containing 1000 or 1500 IU become available, we suggest intermittent supplementation according to 2011 GRIO guidelines. Among the available dosages, the lowest should be preferred, with the shortest possible interval, e.g., 50,000 IU monthly rather than 100,000 every two months.

Javan rusa (Cervus timorensis russa) stags are usually slaughtered after the age of fifteen months, when animal handling problems and decline in carcase quality may occur. In three trials the effects of castration and age on carcase and meat quality were investigated. Nineteen entire and sixteen castrated male Javan rusa deer were raised on pasture, and slaughtered at the age of 13, 19 or 25 months. Live weight gain was recorded monthly and backfat (ultrasound) every two months. At slaughter, carcasses were electrically stimulated and body components were estimated. After chiller assessments, carcasses were jointed, and separated into muscle, fat and bone. M longissimus dorsi (LD), m. biceps femoris (BF), m. semimembranosus (SM), m. semitendinosus (ST) and m. psoas major (PM) were evaluated for pHu, colour, cooking loss, Wamer-Bratzler shear force, sensory properties and muscle fibre types. Muscles and soft tissues of joints were analyzed for moisture, fat, ash, protein and cholesterol. The nature and amounts of fatty acids (FA) in LD, fat depots and duodenal content were determined. Rusa males grew rapidly in their first ten months, 67 kg in their first year (63 % of two-year live weight), but there was little growth in winter. Deposition of subcutaneous fat (SF) started after twelve months of age. Both castrates and entire male had thin subcutaneous fat (maximum 14 mm) in their second year and it varied seasonally. Live weights and carcase weights of castrates were significantly lower than those of entire males killed at 25 months (P< 0.03). Dressing percentage was high (55.2 to 64.7%) and increased with age and castration (P

The Iranian society of cardiac surgeons (ISCS) has been holding a regular meeting every two months since 2005. This is the report of one of the mentioned meetings in which three interesting cardiac surgery cases were presented and discussed.

Since 2014, stony coral tissue loss disease (SCTLD) has led to large-scale mortality of over 20 coral species throughout the Florida Reef Tract. In 2019, in-water disease intervention strategies were implemented to treat affected corals. Two treatment strategies were employed: (1) topical application of an amoxicillin paste directly to disease margins, and (2) application of a chlorinated epoxy to disease margins as well as an adjacent “disease break” trench. Effectiveness of treatments on 2,379 lesions from 725 corals representing five species was evaluated using mixed effects logistic regression models which demonstrated substantially greater effectiveness of amoxicillin compared to chlorine-treated lesions across all species up to 3 months post-treatment. As a result of the failed chlorinated epoxy treatments, any new lesions that appeared during subsequent monitoring events were treated with amoxicillin paste, and all corals were monitored and treated as needed approximately every 2 months for up to 24 months. The health status of 1664 amoxicillin-treated corals during each monitoring event was used to model the probability of a coral being uninfected over time. Models included species and geographic regions as variables. The appearance of new lesions (reinfection rates) varied by species, and offshore sites showed greater reinfection rates than inshore sites; however, all sites and species exhibited a decreased probability of reinfection with time since initial treatment. We conclude that topical amoxicillin treatments are highly effective at halting SCTLD lesions and that through initial and follow-up treatments as needed, colonies and reef sites will progress toward a lower prevalence of SCTLD.

The Pfizer-BioNTech vaccine’s efficacy against SARS-CoV-2 peaked at 96.2% at seven days to two months after the second dose and then declined to 83.7% at four months, a preprint from Pfizer has reported.1 The preprint, which contains the latest data from the original clinical trial, found an average decline in vaccine efficacy of 6% every two months. Researchers have said that trials to evaluate the efficacy of booster trials after a longer interval are under way. A booster vaccine in …

Introduction This single-center study aimed to compare the 12-month treatment outcomes of ranibizumab with that of aflibercept in routine clinical practice. Methods Cohort of patients diagnosed with treatment-naive neovascular age-related macular degeneration (AMD), treated using either ranibizumab (n = 33 eyes) or aflibercept (n = 44 eyes) monotherapy over a 12-month follow-up period was analyzed. Anonymous data were extracted from the electronic database dedicated to the drug program. Results In the ranibizumab group, there were no statistically significant changes in best-corrected visual acuity (BCVA) (Early Treatment Diabetic Retinopathy Study [ETDRS] letters) and central retina thickness (CRT) (µm), between baseline (67.9 ± 8.6 & 384.9 ± 97.9) and at 12 months (67.9 ± 12.1 & 398.9 ± 127.1; P = 0.372 & P = 0.884, respectively). In the aflibercept, there was an improvement in BCVA and reduction in CRT between baseline (64.2 ± 8.1 & 414.3 ± 97.8) and at 12 months (70.7 ± 7.4 & 342.3 ± 71.6; P < 0.001 & P < 0.001, respectively). There was no difference in BCVA between the two groups at either diagnosis (P = 0.101) or 12 months (P = 0.917). Mean number of injections in the ranibizumab group was significantly lower (4.9 ± 1.5) than in the aflibercept group (6.7 ± 1; P < 0.001). Conclusions One initial injection of ranibizumab and then pro re nata (PRN) regimen resulted in stabilization of disease progression. Drug selection and treatment scheme could influence twelve-months outcomes. In the aflibercept group, three initial monthly injections and then every two months provided both significant BCVA improvement and CRT reduction at 12 months of treatment.

Background To evaluate the effect of screening for sepsis using an electronic sepsis alert vs. no alert in hospitalized ward patients on 90-day in-hospital mortality. Methods The SCREEN trial is designed as a stepped-wedge cluster randomized controlled trial. Hospital wards (total of 45 wards, constituting clusters in this design) are randomized to have active alert vs. masked alert, 5 wards at a time, with each 5 wards constituting a sequence. The study consists of ten 2-month periods with a phased introduction of the intervention. In the first period, all wards have a masked alert for 2 months. Afterwards the intervention (alert system) is implemented in a new sequence every 2-month period until the intervention is implemented in all sequences. The intervention includes the implementation of an electronic alert system developed in the hospital electronic medical records based on the quick sequential organ failure assessment (qSOFA). The alert system sends notifications of “possible sepsis alert” to the bedside nurse, charge nurse, and primary medical team and requires an acknowledgment in the health information system from the bedside nurse and physician. The calculated sample size is 65,250. The primary endpoint is in-hospital mortality by 90 days. Discussion The trial started on October 1, 2019, and is expected to complete patient follow-up by the end of October 2021. Trial registration ClinicalTrials.gov NCT04078594. Registered on September 6, 2019

Topicality of the study is stipulated by the importance of objective data for medicine concerning formation of the structure and topographic-anatomical interrelations of the uterine tubes with adjacent organs and structures during the prenatal period of human ontogenesis. Objective: to find and compare tendencies of changes of the uterine tube morphologic parameters in the two groups of fetuses remote in time, and determine age peculiarities of their topography during perinatal period of development. The experimental material (specimens of fetuses) was divided into two groups: І group – 35 specimens of fetuses deceased during 2017-2019; ІІ group – 105 specimens of fetuses taken from the Museum of the Departments of Anatomy, Clinical Anatomy and Operative Surgery at Higher State Educational Establishment of Ukraine “Bukovinian State Medical University”, collected during 1970-1990. Every group was subdivided into 7 subgroups according to 10 months of the fetal period of development (from the 4th to the 10th months). The results obtained were statistically processed in the licensed statistical package “Statistica 6.0” using nonparametric methods to evaluate the results. Regular changes in the topography of the right and left uterine tubes, changes in their shape and histological structure are observed. Both uterine tubes were found to occupy an ascending position in thirty cases out of sixty examined specimens of early fetuses (4-6 months of age). In twenty cases one uterine tube was found to be in an ascending position, and in ten cases both uterine tubes were placed practically horizontally. The study of uterine tube morphogenesis in 7-month fetuses found that the structure and topography of the uterine tubes in different age periods differ. In two 7-month fetuses the uterine tubes were found to be in an ascending position, in eight cases one uterine tube (the left one – in six cases out of eight) was in a horizontal position, and in ten cases two uterine tubes were directed practically horizontally. During the 8th month of the antenatal development one uterine tube was found to be in an ascending position out of eight cases; in ten cases both uterine tubes were in the position close to a horizontal one; and in two cases the left uterine tube was in a descending position. In 9-month fetuses both uterine tubes were found to be in a horizontal position in twelve cases, in eight cases one of the uterine tubes was in the position close to a descending one. In fourteen fetuses 10 months of development one uterine tube was in a descending position, and only in six cases both uterine tubes were located horizontally. The length of the uterine tubes of 4-7-month fetuses deceased during 2017-2019 was not found to differ reliably. Similar regularity was found in the group of fetuses aged from 9 to 10 months. The length of the uterine tubes of the archival specimens increases reliably every two months. In this group of fetuses the parameters of the uterine tube length aged from 9 to 10 months were found to differ reliably contrary to the length of the uterine tubes in the group of modern specimens of a similar age. Comparison of dynamics in changes of the uterine tube length in the two groups of fetuses remote in time showed that within the frame of one group differences in the morphometric parameters between the right and left uterine tubes are not considerable. Therefore, the study of peculiarities in the structure of the uterine tubes at every stage of the perinatal period found certain peculiarities and regularities of their development.

Seeds of Buxus wallichiana Baillon are dormant and not much information is available on their shelf life under storage conditions. Therefore, this study was conducted to investigate the seed storage behaviour of B. wallichiana, an important woodcraft species of the Indian Himalayan Region. Healthy matured fruits of B. wallichiana were collected from Matkangra block, Chakrata Forest Division of Uttarakhand. The seeds were extracted, cleaned, processed manually and their initial viability was tested through germination test. After initial viability determination, seeds were processed and placed in air-tight plastic boxes for storage at four temperatures viz., ambient room temperature (Control), 5°C, 15°C and -20°C. Thereafter, at every two months interval, germination test was conducted to assess the viability of the stored seeds. The results revealed that the initial viability of freshly collected seeds was 26.66 per cent and it took 7.83 days to complete germination. After two months of storage the germination percentage increased in the seeds stored at all the temperatures going up to maximum (73.33%) in the ones stored at -20°C followed by 15°C (66.67%) as compared to 50% in the seeds stored at room temperature. Similarly, the mean germination time also increased proportionally, longest being 44 days for seeds stored at -20°C. Seeds stored at ambient room temperature lost viability completely at 6 months storage duration while almost half the viability was lost in seeds stored at 15°C (36.67%) and -20°C (26.67%). From present study, it can be concluded that the longevity of the B. wallichiana seeds is around 12 months when the seeds are stored at lower temperatures, maintaining the viability about 23% at 5°C and 15°C and 16.67 % at -20°C.

In selected patients, long-term systemic chemotherapy could be performed with a 1–3-month drug-free interval. Our maintenance strategy with cytotoxic drugs may become one of the options for long-term disease control., Objective Aiming to achieve long-term disease control, maintenance systemic chemotherapy (MSC) with a 1–3-month drug-free interval is continued in selected patients. We report our experience of MSC for metastatic urothelial carcinoma (UC). Methods Of 228 metastatic UC patients treated with systemic chemotherapy, 40 (17.5%, 40/228) had continuously undergone MSC. Data on the regimen, cycle number, and reason for the discontinuation of MSC were also collected. We analyzed OS from the initiation of MSC until death or the last follow-up, using the log-rank test to assess the significance of differences. Results The median number of cycles of chemotherapy was 6, and the responses were CR in 6, PR in 20, SD in 13, and PD in 1 before MSC. Gemcitabine plus CDDP or carboplatin was mainly performed as MSC (70%, 28/40). MSC was repeated quarterly in 30 (75%, 30/40), every two months in 8 (20%, 8/40), and with other intervals in 2 (5%, 2/40). Overall, a median of 3.5 cycles (range: 1–29) of MSC was performed. The reason for the discontinuation of MSC was PD in 24 (60%, 24/40), favorable disease control in 9 (22.5%, 9/40), and myelosuppression in 3 (7.5%, 3/40), and for other reasons in 2 (5%, 2/40). MSC was ongoing in 2 (5%, 2/40). The median OS was 27 months from the initiation of MSC. PS0 (P = 0.0169), the absence of lung metastasis (P = 0.0387), and resection of the primary site (P = 0.0495) were associated with long-term survival after MSC. Conclusions In selected patients, long-term systemic chemotherapy could be performed with a drug-free interval. Our maintenance strategy with cytotoxic drugs may become one of the treatment options for long-term disease control.

Aim: The aim of this study was to investigate the clinical effect of planned endovascular therapy (EVT) for critical limb ischemia (CLI) patients with tissue loss. Although several rounds of EVT for CLI patients are required for complete wound healing, time required for complete wound healing depends on the wound severity. We hypothesized that planned EVT might reduce the time to wound healing. Methods: A total of 89 limbs of 76 CLI patients with tissue loss, who had undergone more than at least two EVTs were included in this study. From January 2013 through December 2015 (Conventional-EVT-group, 52 limbs), indication of target lesion revascularization (TLR) was decided based on decreased skin perfusion pressure (SPP) values or delayed wound healing. From January 2016 through October 2016 (Planned-EVT-group, 37 limbs), TLR were done every two months regardless of the SPP values until complete wound healing was obtained. Time to wound healing and complete wound healing rates were compared between the two groups. Results: No significant differences existed in baseline patients and lesion characteristics between the two groups. There was no significant difference in total EVT numbers between the two groups (2.0; interquartile range, 2.0–3.0 versus 2.0; interquartile range, 2.0–3.0; P = 0.9). Although complete wound healing rate was similar in both groups (71.2% versus 73.0%, p = 1.0), time to wound healing was significantly shorter (95 days versus 143 days, p = 0.025) in the Planned-EVT-group than in the Conventional-EVT-group. Conclusions: Planned-EVT is a useful strategy to shorten the time to wound healing for CLI patients with tissue loss.

Background: Allergen-specific immunotherapy is an important therapeutic modality for the management of allergic rhinitis and allergic asthma. Objective: To assess the effectiveness and safety of allergen-specific subcutaneous immunotherapy in patients with respiratory allergies at the University Hospital of Puebla after twelve months of treatment. Methods: A longitudinal, sequential, analytic, quasi-experimental, prolective study. The study was carried out for twelve months with patients of both sexes, aged four to sixty-five years, diagnosed with asthma and/or rhinitis, and with sensitization to aeroallergens. The CARAT and Portnoy questionnaires were collected every two months in order to assess the effectiveness and safety respectively. Results: 47 patients were included: 37 (78.7 %) of them were female. The average age was 29.8 years. 76.6 % of them were diagnosed with allergic rhinitis, and 23.4 % of them were diagnosed with both asthma and allergic rhinitis. The comparison of averages of the initial CARAT questionnaire against the final average by means of a student’s t-test showed a t-value of -8.86 and a p-value of < 0.05. A total frequency of local adverse reactions of 19 % and systemic adverse reactions of 2.1 % was reported after 6 and 12 months of treatment. Conclusions: The assessed scheme of immunotherapy, derived from the Mexican clinical practice guidelines of immunotherapy 2011, is effective with a desirable safety profile.

International audience; The measurement of liver stiffness (LS) shows promise as a follow-up tool after alcohol withdrawal, but it has mainly been studied in the early phase or in patients with severe liver disease. A 6-month ancillary study of a specific psychiatric cohort of alcoholic patients without known liver disease followed after withdrawal was conducted (Clinical Trial NCT01491347). Clinical and biological data and LS values were collected every 2 months. A total of 129 patients were included in the study; 93 had an LS assessment within the first 7 days, and 37 had all four LS measurements. Only seven (7.5%) patients had an initial LS > 12.1 kPa, the threshold used to define severe fibrosis. Abstinence was not associated with changes inLS at the various median-term follow-up periods. However, LS of abstinent subjects decreased significantly relative to that of non-abstinent subjects between M0 and M2. CAP™ values were not associated with abstinence. The systematic median-term follow-up of withdrawn patients does not appear to be contributory. However, LS could help to detect relapse in the first 2 months after withdrawal for subjects treated in a psychiatric hospital for dependence. It thus could serve as a motivation tool. Prospective studies with various and higher baseline LS values are warranted for simultaneous longitudinal assessment, including for very short- and long-term LS after withdrawal.

Mohamed and colleagues explain well the varied presentation and diagnostic difficulties of pernicious anaemia.1 I write as a retired physician, who has had pernicious anaemia for 28 years. The authors repeat the standard guidance that maintenance treatment for patients without neurological symptoms should be 1000 μg hydroxocobalamin every three months; every two months for those with neurological symptoms. Some patients, however, myself included, …

A prospective cohort study on zero-grazed smallholder dairy farms was conducted to determine factors associated with onset and counts of gastrointestinal parasitism in heifer calves. The researchers recruited 187 newborn heifer calves from 150 farms in Kenya. Over 16 months, farm visits every two months were used to collect rectal fecal samples and animal- and farm-level measures. Fecal samples underwent centrifugal fecal flotation with Sheather's sugar to determine counts of strongyle-type eggs and coccidia oocysts. Cox proportional hazard (Cox PH) analysis and mixed-effects negative binomial (MeNB) regression determined factors associated with time-to-onset and counts of strongyle-type eggs and coccidia oocysts, respectively (P 0.05). The incidence rate of strongyles was 0.0011 cases/animal-day while coccidia was 0.0073 cases /animal-day. Incidence risks of strongyles and coccidia over the study period were 28.3 % (53/187) and 87.7 % (164/187), respectively. For infected calves, median time-to-onset for strongyles and coccidia was 78 (interquartile-range: IQR 38-117) and 43 (IQR 29-92) days, respectively. In the final Cox PH model for strongyles, breed (Ayrshires and Jerseys) and weaned calves had a greater hazard of infection than Friesians and preweaned calves, respectively. Calf tethering outside the pen was associated with a higher hazard of strongyle infection. In the final Cox PH model for coccidia, calves with watery and/or hemorrhagic diarrhea had a higher hazard compared with those with hard or soft feces. Weaning status and birth weight (kg) were time-varying covariates, leading to increased hazard over time. In the final MeNB model for strongyles, weaned animals had higher counts than those still on milk. In an interaction variable, the predicted strongyle-type egg counts increased with longer duration of farm operation when herd size was less than five cattle, but decreased when herd size was more than five. In the final MeNB model for coccidia, calves sometimes tethered outside their pens had higher counts than those continuously enclosed in the pen. Calf pen floors with either scant manure or moderate slurry had higher predicted counts than those on a clean pen floor. Calves with watery or hemorrhagic diarrhea and fed fresh Napier grass (Pennisetum purpureum) had higher counts compared with soft or hard feces and those not given fresh Napier, respectively. In an interaction variable, calves experiencing diarrhea and raised on elevated slatted floors had lower oocyst counts compared with those having diarrhea but not on elevated floors. The identified management practices associated with onset and counts of gastrointestinal parasitism should be considered in control efforts.

Highlights • Bos indicus crossbred females had higher fecal eggs as calves than as yearlings. • More Bos indicus background had higher eggs per gram of feces through 1 year of age. • Cooperia and Haemonchus species predominated through 1 year of heifer age. • Ostertagia and Trichostrongylus species were detected mostly after 1 year of age. • Eggs per gram of feces correlated with few production traits of heifers., Gastrointestinal nematodes (GIN) do not detrimentally affect cattle to the extent of small ruminants. However, they are developing resistance to drugs used to treat them. Genetic strategies to control the nematodes and/or their detrimental effects could be a sustainable alternative to treatment with drugs. An essential first step in development of such a strategy is characterization of nematode populations in commonly used breed types of cattle in local conditions. Fecal egg counts (FEC) were obtained every two months on a cohort of 53 crossbred Nellore-Angus heifers grazing Central Texas pastures from an average heifer age of 3 months to approximately 2 years of age. For 10 of those 12 sets of samples, coprocultures were set up to characterize gastrointestinal nematode species present. Heifers were ½ Nellore ½ Angus (n = 18) or ¾ Angus ¼ Nellore (n = 35). They were born in the spring of 2014 to cows that were from 3–5 years old. They were maintained as a group throughout weaning, postweaning, exposure to bulls as yearlings, and as pregnant cows through the birth of their first calves. An interaction of breed group with sampling time (P < 0.0001) highlighted favorable FEC of ¼ Nellore heifers as compared to ½ Nellore in all but two sampling times. Fecal egg count means were, in general, higher for heifers of both groups in sampling times up to one year of age. Season effects on FEC may be important, but the effect of age may have obscured their detection. There were few significant correlation coefficients for FEC traits with a variety of production traits of these females. Average FEC residuals were positively correlated (r = 0.28 and 0.41; P < 0.05) with winter coat shedding score evaluated at approximately 17 and 24 months of age. Residual correlations of average FEC with calf weaning weight and incidence of shedding with calf age at weaning (r> 0.3) may be indicative of the increased susceptibility of females that lactate heavily or longer to internal parasite infection. Proportions of GIN genera by sampling day differed from χ2 expectation (P < 0.0001). Cooperia and Haemonchus species were detected in large proportions in sampling dates that corresponded to heifers less than one year of age. Ostertagia and Trichostrongylus species predominated in sampling dates after heifers reached one year of age.

Strategies for parasite control have undergone major changes in recent years, especially in Europe and the United States, replacing traditional approaches by schemes based on surveillance and selective therapy. A first step in helminth control planning is to understand and demonstrate how horse owners or trainers currently control nematodes. The aim of this study was to collect information, through a survey, about important aspects of routine anthelmintic strategies in sport horses in Argentina and other regional countries. A total of 100 surveys were sent. Sixty nine were responded, 53% of the surveys were answered by veterinarians and 47% by managers. The majority of the respondents (58%) worked in Thoroughbred studs, followed by Throroughbred farms (23%), Horse Riding Centers (10%) and other types of centers (9%). Most respondents treated horses at fixed time every 3 months (48%). Twenty-two percent of them did it at fixed time every 6 months, 16% at fixed time every 4 months and 6% at fixed time every 12 months; 6% dewormed on individual basis while 4% did not treat at all; 2% dewormed every two months. When asked about the rationale for deworming, the majority (41%) did so based on the time elapsed since the last treatment, followed by the time of the year (22%), according to the age of the animals (15%), according to previous diagnosis (12%), 9% treated for no particular reason and 1% when the horses reached the stud. Almost half of respondents (48%) did not rotate anthelmintic drug on. In a smaller proportion, others did it every 3 months (26%), every 12 months (11%), every 6 months (9%) and finally every 4 months (6%). Half of the respondents (50%) treated horses 4 times a year, 32% did 2 times a year, 15% 3 times and 3% did not deworm at all. Regarding making a diagnosis prior to treatment, 76% of the respondents answered negatively, while 24% did so. Only 20% of respondents performed the anthelmintic efficacy test. It can be concluded that there is little participation and planning of the veterinary professional regarding the control of internal parasites in horses of Argentina. Performing coprologic tests are practices not usual in our region. Practices of parasite management seem to be reduced almost exclusively to the administration of anthelmintic drugs at fixed times, often indiscriminately.

Introduction: There is low evidence regarding the effect of slow palatal expansion in the treatment of bilateral posterior cross-bite. In adults the treatment had always been directed to surgical maxillary expansion. Therefore, this study aimed at evaluating corticotomy-assisted slow palatal expansion using cone beam computed tomography (CBCT). Subjects and Methods: The study included six females, 19-20 years old, with bilateral posterior cross-bite and Class III malocclusion. CBCT was taken pretreatment (T0), immediately post-expansion (T1) and three months following the end of orthodontic treatment (T2). Four banded quad-helix appliance assisted with buccal corticotomy and bone allograft was used for expansion. The expansion was activated every two months. Fixed orthodontic appliance was performed to continue the treatment of the cases. CBCT was used to measure and record amount of expansion and tipping of premolars and first molars. The bone fenestrations were also recorded as scores. Data were statistically analyzed. Results: The bilateral posterior cross-bite was treated in 8.5 months. The amount of expansion increased significantly from T0-T1; 5.58±0.77mm, yet it was non-significant from T1-T2; 1.16±0.34mm. There was a significant increase in mean tipping angle from T0-T1 without a significant increase from T1-T2. Regarding buccal bone fenestrations, there was a significant increase from T1-T2 (1.59±1.19,1.79±1.18mm respectively). An inverse correlation was found between bone fenestration and cervical and middle buccal cortical bone thicknesses at T1 and T2. Conclusions: Corticotomy-assisted expansion with quad-helix was an efficient treatment modality of bilateral posterior cross-bite in young adults. Moderate bone fenestration was recorded at the end of expansion.

International audience; In male donkeys, puberty and the related events have been poorly characterized. The aim of this study was to evaluate the age at which male donkeys reach puberty, and characterize age associated changes in testicular size, testicular blood flow, serum testosterone concentration and semen quality. Every two months, starting at 6 months and finishing at 24 months of age, five male donkeys born in May to July were subjected to B-mode ultrasound examination to assess testicular size and scrotum content and blood serum sampling for testosterone concentration. From the age of 8 months, pulsed Doppler was employed to evaluate blood flow in the testicular artery. Testosterone serum concentration was evaluated via RIA. From the age of 12 months, monthly semen collections were attempted and semen was evaluated for sperm number, motility and morphology. Onset of puberty was defined as the first ejaculate containing >= 50 x 10(6) spermatozoa with >= 10% total motility. One of the donkeys was excluded from the statistical analyses due to a hydrocele presented during the study. Testes width was affected by age (P < 0.0001) and after an initial plateau increased linearly from 10 months of age. Pulsatility and resistivity indexes were also affected by age (P < 0.01), being significantly higher at 14 months than at 24 months. Testosterone serum concentration was affected by age (P < 0.0001) and was significantly lower at 6 months (0.1 ng/ml) compared to 22-24 months (>= 0.8 ng/ml). Spermatozoa appeared in the ejaculate at a mean age of 18.7 months and puberty was attained between 19 and 20 months of age (mean: 19.5 months), between January and February. In conclusion, late spring born Amiata donkey colts reached puberty at 19-20 months of age. Puberty was accompanied by changes in testicular size, testicular blood flow and serum testosterone concentration.

A 37-year-old man with anti-muscle-specific tyrosine kinase (MuSK) antibody-positive myasthenia gravis (MG) presented with subacute progressive dysphagia and muscle weakness of the neck and bilateral upper extremities. Conventional immune-suppressive treatments and high-dose intravenous immunoglobulin were ineffective. He then displayed repeated exacerbations and remissions over the course of two years, despite two to four sessions of plasma exchange (PE) every two months. The patient was successfully treated with outpatient periodic weekly blood purification therapy with alternative PE and double-filtration plasmapheresis using an internal shunt. This case report suggests the benefits of blood purification therapy with an internal shunt against anti-MuSK antibody-positive MG.

Objective The feasibility of continuous geriatric assessments (GAs) has not been evaluated fully in elderly patients with cancer. We prospectively investigated this issue by administering a recommended-GA set (r-GA) repeatedly to patients undergoing chemotherapy for gastrointestinal cancer on an outpatient basis. Methods We administered the r-GA before chemotherapy and every two months thereafter. Continuous GAs was defined as the completion of at least two assessments, including the pre-treatment evaluation. The r-GA included the Barthel Index [Basic Activities of Daily Living (BADL)], Mini-Mental State Examination-Japanese (MMSE-J), Instrumental Activities of Daily Living (IADL) scale, Vitality Index (VI), and Geriatric Depression Scale-15. We also used the Vulnerable Elders Survey (VES)-13 to screen overall vulnerability. We analyzed the correlations between each baseline GA score and the overall survival (OS) and the association between the OS and changes in each patient's GA scores over time. Patients Patients ≥65 years of age who presented to our department for initial consultation were enrolled and followed between December 2012 and January 2017. Results Twenty-one elderly patients (median age, 76 years old) were enrolled. GAs were completed within 20 minutes. In an age- and performance status (PS)-adjusted Cox proportional hazards analysis, the baseline BADL, MMSE-J, and VI scores correlated significantly with the OS (p=0.012, p=0.032, and p=0.012, respectively). During the clinical course, decreases in the MMSE-J and VES-13 scores were correlated with the OS (p=0.022 and p=0.019, respectively). Conclusion Outpatient GA administration is feasible. Low baseline BADL, MMSE-J, and VI scores and decreased MMSE-J and VES-13 scores over time may prognosticate the OS.

Background This study aims to investigate the effect of metronidazole for the treatment of recurrent and persistent bacterial vaginosis (BV). Methods Stored vaginal swabs of 80 African American (AA) women were randomly selected from a previously conducted clinical trial for this pilot study. Women with BV were treated with metronidazole. Vaginal smears were categorized by the Nugent score (NS) [0–3, normal; 4–6, intermediate state; 7–10, BV]. Women were classified as recurrent BV (RBV), persistent BV (PBV) or no BV based on three consecutive NS. RBV occurs when an episode of BV occurs after successful treatment of a prior episode. PBV occurs in instances when BV treatment fails to restore healthy Lactobacillus levels. All women were asymptomatic for BV at baseline and followed every two months for four months. Results After four months, 22.5% (CI: 13%, 32%) of women did not have BV, 7.5% (CI: 2%, 13%) had RBV and 70% had PBV (CI: 60%, 80%). 30% of treated women did not have BV compared to 15% of untreated women (p=0.18). BV recurred among 12.5% of treated women and 2.5% of untreated women (p=0.2). BV persisted among 57.5% of treated women and 82.5% of untreated women (p=0.03). Women that were treated had 0.33 decreased odds (95%CI: 0.12, 0.92, p≤0.05) of having PBV as compared to untreated women. The mean age was 21.4 years (SD: 2.11 years). Prior antibiotic use among the sample was low (3.8%), and 75% of women were not treated for BV during their lifetime. Among those who were previously treated for BV, 60% were treated more than five times. Douching was reported by 49% of the sample. Conclusion These preliminary findings suggest, standard BV treatment may not be effective among women with RBV or adherence to treatment may be low among women with asymptomatic BV. Disclosure No significant relationships.

Background The study aimed to assess if adherence to a total-neoadjuvant-treatment (TNT) protocol followed by observation(watch-and-wait) led to the successful nonoperative-management of low-rectal-cancer. Methods In this study, patients with primary, resectable-T3-T4, N0–N1 distal-rectal-adenocarcinoma underwent-chemoradiotherapy + consolidation-chemotherapy (TNT). During the-TNT-period, endoscopy, MRI, and FDG-PET/CT were performed. We allocated patients with complete-clinical-tumor-regression, who underwent endoscopy every two months, MRI every-four-months, and PET/CT every-six-months-after-treatment, to the observation-group(OG). All other patients were referred for surgery. The OG was followed-up. The primary endpoint was local tumor-ecurrence after allocation to the OG. Results Between 2015 and 2018, we enrolled 66-patients. Of 60-patients who were eligible to participate, 39 had complete-clinical-response(cCR) and were allocated to the OG, six underwent local-excision (LE), and 15 underwent total-mesorectal-excision (TME). The median follow-up duration was 22 (9–42) months. The local-recurrence-rate in the OG was 15.3%, and the LE and TME rates were 16.6% and 0%, respectively. All recurrence cases were salvaged through either LE or TME. The-distant-metastasis rate was 5.1%, 16.6%, and 12.5% in the OG, LE, and TME groups, respectively. The endoscopic negative-predictive-value(NPV) was 50%, and the positive-predictive-value(PPV) was 76.9% in the surgery group (LE + TME). MRI; NPV-50%, PPV-76.9%. PET/CT; NPV-100%, PPV-93.3%. Six patients(28.57%) from surgery group achieved complete pathological response (cPR). Conclusion Our results indicated a high proportion of selected-rectal-cancers with-cCR after neo-adjuvant-therapy could potentially be managed non-operatively, and major surgery may be avoided.

Este trabalho foi desenvolvido com o objetivo de avaliar a composição químico-bromatológica de duas variedades de mandioca em função de cinco intervalos entre podas. O ensaio foi implantado em dezembro de 2008, no município de Vitória da Conquista, BA, utilizando-se o delineamento experimental em blocos casualizados, com 10 tratamentos, arranjados segundo um esquema fatorial 2 x 5, com três repetições, constituídos por duas variedades de mandioca (Caitité e Sergipe) e cinco intervalos entre podas (poda a cada 2, 4, 6, e 8 meses após o plantio e sem poda – testemunha). A colheita foi realizada aos 19 meses após plantio. A variedade Caitité apresentou maior conteúdo de matéria seca e de matéria mineral da parte aérea. As raízes da variedade Sergipe apresentaram maiores teores de fibra e de matéria seca. Observou-se, para as duas variedades, redução dos teores de matéria seca e de fibras da parte aérea e aumento dos teores de matéria seca e de proteína das raízes para plantas podadas a cada dois meses., Revista de Ciências Agrárias, vol. 40 n.º 1 (2017)

Aim: The purpose of the study was to assess the oral health status among the under five children. Study revealed to find out selected dental conditions like dental caries, gingival and periodontal conditions and DMFT score and socio-demographic background.Methods: A descriptive type of cross sectional study was conducted at Dhaka Dental College Hospital at children OPD.A total 120 under five children’s parents were interviewed through a structured questionnaire followed by oral examination through a checklist.Results: Among 120 children, 44.17% were male and 55.83% were female. Most of the children (94.17%) were found to clean teeth regularly by themselves. 70.83% children clean their teeth themselves with brush and paste once daily spending 1-3 minutes. Maximum children (73.33%) clean their teeth before breakfast. Fluoridated toothpaste was being used by most of the children (85.84%). Only 4.17% child change their toothbrush every month and 55.83% every two months and 40% after 3-6 months. Regarding feeding history, it was found that 58.33% children were given exclusive breast feeding. Most of the children (63.33%) take soft drinks. It was found from the study that 87.50% children had pink color oral mucosa and their gingival condition was normal. Though prevalence of dental caries was 96.67% but overall oral hygiene status was good (86.67%).Conclusion: The study revealed that, dental caries among the under five children was a major health concern creating awareness among the people about their own and their children’s oral health through appropriate plan can reduce the dental diseases. Moreover mass media and general education of the people create vital role in this regards.Update Dent. Coll. j: 2015; 5 (2): 09-17

In order to study the effect of potassium humate on yield and some fruit properties of seedling papaya plant, an experiment was conducted at an organic private orchard located in El Mamoura at Alexandria Governorate, Egypt during 2013/2014 and 2014/2015 seasons .The experiment included four complete treatments (Soil application of 5 or 10 ml potassium humate every two months to each plant from first of March to end of August), (Soil application of 2.5 or 5 ml potassium humate every month to each plant from first of March to end of August), and control (without application of potassium humate). The yield per plant per period from September to next May (kg) and some fruit characteristics, such as fruit weight (g), length (cm), width (cm), flesh thickness (cm), total soluble solids ( % ), total sugar ( % ), total acidity (%) and content of β carotenes (mg / 100 g of fresh) were recorded Results indicated that Soil application of (10 ml potassium humate every two months) and Soil application of (5 ml potassium humate every month) of both seasons gave the highest yield (kg) and the differences were being significant among them and the three other treatments. Also Soil application of (10 ml potassium humate every two months) gave the highest fruit weight, length and width and significantly increased compared with the other investigated treatments in most cases, in addition the differences between flesh thickness values were not big enough to be significant between treatments in most cases. According to chemical fruit properties, the highest TSS values were obtained under Soil application of (10 ml potassium humate every two months) and significantly increased compared with the other treatments, also Soil application of (10 ml potassium humate every two months) gave the highest total sugar and significantly increased compared with the other treatments except the difference between Soil application of (10 ml potassium humate every two months) and Soil application of (5 ml potassium humate every month), was slightly not significant. A according to total carotenes, (control) gave the lowest values and significantly decreased compared with the other treatments Conclusively, the obtained results give basis to conclude that, soil applying seedling papaya plant with potassium humate had a positive effect on yield and fruit quality. The most beneficial treatment in this concern is applying with 10 ml potassium humate every two months started from beginning of March to end of August which gave a reasonable yield and high fruit weight and dimensions with high content of TSS and total sugar and could be considered as a recommended treatment under the conditions of this experiment.

Background. We investigated the feasibility and safety of a video-based telemedicine system, delivered via a tablet, in Parkinson’s disease (PD).Methods. In a randomized, crossover, open-label pilot trial, we compared a telemedicine period (regular visits every two months with intermediate video calls via an iPad mini) with a control period (regular visits every two months), both lasting 6 months. We included 10 patients diagnosed with PD according to the British Brain Bank criteria, aged 20–75 years. The primary outcome was the PD questionnaire summary index (PDQ-39 SI). Secondary outcomes included the Hoehn and Yahr Stage and scores on the Unified PD Rating Scale (UPDRS) part I–IV, Beck Depression Inventory (BDI), and visual analog scale for satisfaction.Results. Both study periods were completed by 10 patients with PD. Friedman’s test revealed that there were no significant differences between the two periods in primary and secondary outcomes (p>0.05). With respect to visual analog scale scores for satisfaction, participants indicated high satisfaction with the telemedicine system. The number of extra hospital visits and phone calls did not differ between the periods. There were no adverse events or side effects.Conclusions. We observed that a telemedicine system delivered via a tablet could successfully be used by patients as a part of their care. Further studies investigating the use of telemedicine to replace in-person visits are warranted. This trial is registered withUMIN000015536.

This study aimed to evaluate the storage potential of SCS426 Venice apples under different storage technologies. Fruits were harvested in an experimental orchard located in Fraiburgo, SC and stored for up to eight and ten months in 2013 and 2014, respectively. Apples were treated or not with methylcyclopropene (1-MCP) and stored under air atmosphere (AA, 0.5±0.5 °C/RH 85±5%) or controlled atmosphere (CA; 1.5 kPa of O2 and 1.5 kPa of CO2 at 0.7±0.5 °C/RH of 93±3%). Fruits were evaluated every two months of storage, after one and seven days of shelf life (23 ± 0.3 °C/RH 93±3%). The storage period of ‘SCS426 Venice’ apples under AA without 1-MCP application should not extend beyond six months. Under this storage condition, fruits had higher incidence of decay, ethylene production and respiratory rates, higher skin degreening, lower flesh firmness, titratable acidity and soluble solids content than fruits stored under CA or AA with 1-MCP. ‘SCS426 Venice’ apples develop flesh browning and superficial scald after long-term storage. ‘SCS426 Venice’ apples under AA treated with 1-MCP or under CA (regardless of 1-MCP application) can be stored for more than eight months, keeping flesh firmness above 14 lb and low incidence of physiological disorders even after ten months of storage. Resumo O objetivo deste trabalho foi avaliar o potencial de conservação de maçãs da cultivar ‘SCS426 Venice’ submetidas a diferentes tecnologias de armazenagem. Os frutos foram colhidos em um pomar experimental localizado no município de Fraiburgo-SC, e armazenados por até oito e dez meses, nos anos de 2013 e 2014, respectivamente. As maçãs foram tratadas ou não com 1-metilciclopropeno (1-MCP) e armazenadas em atmosfera do ar (AA; 0,5±0,5 °C/UR de 85±5%) ou em atmosfera controlada (AC; 1,5 kPa O2 e 1,5 kPa CO2 a 0,7±0,5 °C/UR de 93±3%). Os frutos foram analisados a cada dois meses de armazenagem, logo após a retirada da câmara e após sete dias em condição ambiente (23±0,3 °C/UR de 68±0,6%). O armazenamento de maçãs ‘SCS426 Venice’ sob AA e sem aplicação de 1-MCP não deve estender-se além de seis meses. Nessa condição de armazenagem, as maçãs apresentam maior incidência de podridões e maiores taxas respiratória e de produção de etileno, bem como uma coloração da epiderme mais amarelada, menor firmeza de polpa e menor acidez titulável e teor de sólidos solúveis, em comparação aos frutos armazenados em AC ou em AA tratados com 1-MCP. Maçãs ‘SCS426 Venice’ podem desenvolver escurecimento de polpa e escaldadura superficial depois de longos períodos de armazenagem. Maçãs ‘SCS426 Venice’ em AA, tratadas com 1-MCP ou em AC, independentemente da aplicação de 1-MCP, apresentam potencial de armazenagem superior a oito meses, mantendo firmeza superior a 14 lb e baixo índice de distúrbios fisiológicos, mesmo após dez meses de armazenagem.

Objective: To assess the impact of diabetic health education on glycemic control for diabetic patients in Bisha province, Saudi Arabia. Subjects and Methods: A prospective study was conducted among adult 465 diabetic patients attending at the Diabetic and Endocrine Center in Bisha, Saudi Arabia, between August 2016 and July 2017. Personal and demographic characteristics were recorded and then each patient underwent 30 min regular diabetic education program every two months along one-year period. Two blood samples were taken (immediately and after one year) from each patient during program to estimate the HbA1c level. A paired t-test was used to compare the level of HbA1c before and after health education program. Results: 465 patients were enrolled in our health education program. The majority of them was Saudi (93%), married (86.9%) and educated with undergraduate level (94.5%). There was significant improvement in glycemic control after one year completion of 30 min diabetic education program (HbA1c 10.41 ± 1.89 to 8.22 ± 1.68 (P

Objectives To assess the placement, surveillance management and long-term outcomes of the tracheobronchial (TB) balloon expandable metallic stent (BEMS) managed by therapeutic flexible endoscopy (TFE). Methods This is a retrospective review and analysis of all computerized medical records and related flexible endoscopy videos of pediatric patients who received TB BEMS during 20 years period, from January 1997 to December 2016. TFE techniques with forceps debridement, balloon dilatation and laser ablation were used to implant stents, perform regular surveillance, maintain their functions, and expand the diameters of BEMS. Short-length (30cm-36cm) endoscopes of OD 3.2mm to 5.0mm coupled with the noninvasive ventilation, without ventilation bag, mask or airway tube, supported the whole procedures. Results 146 BEMS were implanted in 87 consecutive children, including 84 tracheal, 15 carinal and 47 bronchial stents. At the time of placement, the mean age was 35.6 ± 54.6 month-old (range 0.3–228) and the mean body weight was 13.9 ± 10.6 kg (range 2.2–60). Surveillance period was 9.4 ± 6.7 years (range, 0.3–18.0). Satisfactory clinical improvements were noted immediately in all but two patients. Seventy-two (82.8%) patients were still alive with stable respiratory status, except two patients necessitating TFE management every two months. Fifty-one stents, including 35 tracheal and 16 bronchial ones, were successfully retrieved mainly with rigid endoscopy. Implanted stents could be significantly (< .001) further expanded for growing TB lumens. The final stent diameters were positively correlated to the implanted duration. Altogether, 33 stents expired (15 patients), 51 were retrieved (40 patients), and 62 remained and functioning well (38 patients), with their mean duration of 7.4 ± 9.5, 34.9 ± 36.3 and 82.3 ± 62.5 months, respectively. Conclusion In pediatric patients, TFE with short-length scopes coupled with this NIV support has provided a safe, feasible and effective modality in placing and subsequently managing TB BEMS with acceptable long-term outcomes.

Background EGFR mutation subtype is a recognised factor impacting outcomes of patients receiving oral tyrosine kinase inhibitors (TKIs) in non-small-cell lung cancer (NSCLC). Evidence for the effect of this factor on outcomes in patients receiving pemetrexed is limited. Methods We completed a study comparing pemetrexed-platinum combination versus oral TKI in EGFR mutation-positive patients in lung cancer. We analysed the impact of EGFR mutation subtype, specifically, exon 19 and 21 on the PFS and OS of patients treated with pemetrexed (500 mg/m2 on day 1) and carboplatin (AUC 5 on day 1) as first-line therapy. Patients underwent axial imaging for response assessment on D42, D84, D126 and subsequently every two months till progression. Patients post-progression were treated with gefitinib. Results Fifty-one patients (36%) had exon 21 mutation, while 92 patients (64%) had exon 19 mutation. Response rates in evaluable patients was 47.7% in exon 19 patients (41 patients, n = 86) and 42.9 % in exon 21 patients (18 patients, n = 42). There was a significant increase in median overall survival for patients with exon 19 mutations (24.5 months, 95% CI: 21.3-27.7 months ) over the exon 21-mutated patients (18.1 months, 95% Cl: 13.5-22.6 months, p = 0.002). This differential impact was due to second-line gefitinib having a differential outcome on these mutations. Conclusion Pemetrexed-based chemotherapy does not have a differential impact on exon 19- or exon 21-mutated patients. However, second-line treatment with gefitinib has a favourable response and outcome in exon 19-mutated patients.

This research investigates the effect of natural dust accumulation on the glass cover of solar thermal energy conversion systems. Four similar, locally manufactured, flat plate solar collectors are used. All collectors are South oriented with tilt angle of . The glass cover of one collector is kept clean of dust during the experimental period while the second collector is cleaned at the beginning of each month. The third collector is cleaned every two months while the fourth collector is kept un-cleaned throughout the experimental period of four months. The calculated parameters are the solar heat gain rates and the corresponding values of the thermal efficiency. The result of the present work indicates that the percentage of fractional reduction of the useful heat gain rate due to dust accumulation during a period of one and two months is 11.4% and 17.0%, respectively. The percentage decrease of thermal efficiency during the same duration periods is 4.0% and 6.1%, respectively. The percentage of fractional reduction of the useful heat gain rate due to dust accumulation during a period of three and four months is 27.8% and 31.9%, respectively. The percentage decrease of monthly thermal efficiency during the same duration period is 10.2% and 11.3%, respectively.

Aim: The value of frequent Carcino-Embryonic Antigen (CEA) measurements and CEA-triggered imaging for detecting recurrent disease in colorectal cancer (CRC) patients was investigated in search for an evidence-based follow-up protocol.Methods: This is a randomized-controlled multicenter prospective study using a stepped-wedge cluster design. From October 2010 to October 2012, surgically treated non-metastasized CRC patients in follow-up were followed in eleven hospitals. Clusters of hospitals sequentially changed their usual follow-up care into an intensified follow-up schedule consisting of CEA measurements every two months, with imaging in case of two CEA rises. The primary outcome measures were the proportion of recurrences that could be treated with curative intent, recurrences with definitive curative treatment outcome, and the time to detection of recurrent disease.Results: 3223 patients were included; 243 recurrences were detected (7.5%). A higher proportion of recurrences was detected in the intervention protocol compared to the control protocol (OR = 1.80; 95%-CI: 1.33-2.50; p = 0.0004). The proportion of recurrences that could be treated with curative intent was higher in the intervention protocol (OR = 2.84; 95%-CI: 1.38-5.86; p = 0.0048) and the proportion of recurrences with definitive curative treatment outcome was also higher (OR = 3.12, 95%-CI: 1.25-6.02, p-value: 0.0145). The time to detection of recurrent disease was significantly shorter in the intensified follow-up protocol (HR = 1.45; 95%-CI: 1.08-1.95; p = 0.013).Conclusion: The CEA watch protocol detects recurrent disease after colorectal cancer earlier, in a phase that a significantly higher proportion of recurrences can be treated with curative intent. (C) 2015 Elsevier Ltd. All rights reserved.

Resumo Introdução: a doença de Gaucher é um erro do metabolismo enzimático que leva ao acúmulo de glicocerebrosídeo nas células, o que caracteriza os sinais e sintomas da doença. No momento do diagnóstico, além de outros sinais e sintomas, é observado retardo no crescimento em crianças e adolescentes. O tratamento é realizado por meio de reposição enzimática, que pode ocasionar ganho de peso no paciente pela diminuição do metabolismo energético. Descrição: dois irmãos com diagnóstico de doença de Gaucher tipo I foram avaliados antes de iniciarem a reposição enzimática e depois a cada 2 meses de tratamento, por um período de 6 meses. A composição corporal foi avaliada por impedância bioelétrica, que avaliou a quantidade de massa livre de gordura e massa de gordura; o consumo energético e a relação de macronutrientes foram avaliados por registro alimentar de 3 dias. Discussão: os dois pacientes apresentavam baixa estatura para idade ao diagnóstico e tiveram aumento de massa de gordura durante o tratamento, sendo que um paciente também apresentou aumento da massa livre de gordura. O consumo energético e a relação de macronutrientes mantiveram-se semelhantes durante todo o período de acompanhamento para ambos os pacientes.

The approval of aflibercept for the neovascular form of age-related macular degeneration has opened up the possibility of treating patients with fewer injections, since the drug can be administered once every two months. Aflibercept can also be used as rescue therapy in patients with suboptimal response to other antiangiogenic treatments. The present study reviews the scientific evidence on aflibercept, both in treatment-naive patients and in those with an unsatisfactory response to conventional treatments.

"The Protimisis" study was a multicenter, cross-sectional study investigating the relative importance and economic value that patients assign to different characteristics of systemic psoriasis treatments. Treatment preferences were investigated with the DCE methodology and patients had to decide over the most important aspects of different psoriasis treatments. A questionnaire regarding demographic data/medical history and the DLQI and EQ-5D-3L questionnaires were also completed. A total of 310 patients were included. Out of those, 37.4% reported using oral medications for psoriasis as their most recent treatment, while the remaining patients reported treatment with injections once per week (14.8%), injections twice per week (7.4%), injections once every three months (29.4%) and intravenous injections every two months (8.4%) as their most recent treatment. Mean DLQI score was 6.6 (SD 6.5), and in the EQ-5D-3L index, 71.0% of patients reported having problems with anxiety or depression. DCE analysis showed a clear preference for treatments with longer dosing intervals, rapid onset of action, lasting clinical response, low risk of SAEs and lower cost. The risk of SAEs was the most important treatment characteristic (54% of patients). Older patients showed less concern for safety matters than younger patients. The highest willingness-to-pay was recorded for treatments with longer dosing intervals and for safer treatment options.

Background Dose optimization, such as dose reduction or dose spacing, is nowadays presented as a therapeutic strategy to be followed in patients with rheumatoid arthritis (RA) who have managed to reach and maintain clinical remission for a while. This strategy reduces the frequency of adverse effects and promotes cost savings Methods Patients with RA (Criteria ACR 1987) of the CREATE registry (patients who was treated in real life conditions) who had clinical remission (DAS28 A multidisciplinary team of rheumatologists and clinical pharmacists in a third-level hospital was involved in decision-making on treatment and dose reduction, which involved the application of protocols and the follow-up of patients at least every two months. Results A prospective follow-up of 70 patients with RA who had received optimized doses of biological therapy for 3 years, with a mean age of 56.9 (13.7) years, of which 78.6% were women, 68.8% were positive rheumatoid factor and 66.7% ACPA +. The relapse occurred in 41.8% (at first year), 56.7% (at second year) and 62.7% (at third year). There were no statistical differences between these last 2 percentages. The median survival time of the optimization regimen was 15.24 (4.65) months (95% CI: 4.66–25.83). No statistically significant differences were found when comparing patients according to the optimized drug (antiTNF versus non-anti-TNF) (test log.rank: 0.239, p: 0.625). When relapse occurs, the patient returns to normal doses prior to optimization of the drug. Our data show that 62.7% of the patients in whom the relapse occurs at 3 years, maintains DAS28 The 37.3% (95% CI: 26.72%, 49.28%) patients maintained the optimization pattern throughout the follow-up without relapse, with an average DAS28 of 1.99 (1.07) at 3 years. Comparing these patients with those who relapse, they achieved significantly lower DAS28 values at both (p: 0.028) and at three years (p: 0.025) Conclusions The strategy of dose reduction of biological therapies in patients with established RA that achieve sustained remission is possible in 37.3% of cases in real clinical practice (CREATE Registry) and it was maintained for 3 years. The probability of occurrence of relapse decreases after 2 years of treatment with an optimized regimen in those patients who have not relapsed before. This strategy is possible in patients with persistently controlled disease and in view of our results, it is independent of the drug administered (antiTNF versus non-antiTNF). After 3 years of follow-up, all patients maintained clinical remission (DAS 28 Patients who maintain clinical remission for 3 years achieve DAS28 values statistically lower than those who did not after 2 years. Disclosure of Interest None declared

This study was designed to analyze the chronical responses of the hormonal and immune systems after a CrossFit&reg, training period of six months as well as to compare these results between genders. Twenty-nine CrossFit&reg, practitioners (35.3 &plusmn, 10.4 years, 175.0 &plusmn, 9.2 cm, 79.5 &plusmn, 16.4 kg) with a minimum CrossFit&reg, experience of six months were recruited, and hormonal and immune responses were verified every two months during training. The training was conducted in five consecutive days during the week, followed by two resting days. Testosterone (T) values were significantly higher at the last measurement time (T6 = 346.0 &plusmn, 299.7 pg&middot, mL&minus, 1) than at all the other times (p &lt, 0.002) and were higher in men than in women (p &lt, 0.001). Cortisol (C) levels were lower at all times compared to the initial level before training, and differences were observed between men and women, with men having a lower value (T0: p = 0.028, T2: p = 0.013, T4: p = 0.002, and T6: p = 0.002). The TC ratio in women was lower at all times (p &lt, 0.0001) than in men. Significant effects on CD8 levels at different times (F(3.81) = 7.287, p = 0.002, &eta, p2 = 0.213) and between genders (F(1.27) = 4.282, p = 0.048, p2 = 0.137), and no differences in CD4 levels were observed. CrossFit&reg, training changed the serum and basal levels of testosterone and cortisol in men (with an increase in testosterone and a decrease in cortisol).

Background In an effort to reset the immune system, individuals with multiple sclerosis (MS) have undergone autologous hematopoietic stem cell transplant; this approach has produced promising results in terms of feasibility, efficacy and safety, however, the role of post-transplant adjuvant therapeutic agents needs to be further clarified. Methods Consecutive patients autografted using the "Mexican method" (ClinicalTrials.gov NCT02674217) to graft persons with MS were prospectively accrued in the study. All autografts were carried out on an outpatient basis, using cyclophosphamide (Cy) and filgrastim as mobilization regimen, the cumulative dose of Cy being 200 mg/kg, delivered on two separate blocks, nine days apart. After granulocyte recovery, all individuals received a rituximab infusion (375 mg/m2) and at discharge, patients were recommended to continue a follow-up period with additional rituximab infusions (100 mg) every two months for 1 year. Results Eighty two subjects were prospectively enrolled between June 2015 and November 2016. Twenty nine were male (35%). Median age was 45 y (range, 28-66 y). Nineteensubjects (23%) had primary progressive MS, 37 (45%) relapsing remitting MS and 26 (32%) secondary progressive MS. Median EDSS score was 5.5 (range, 0 - 7). After recovering hematopoiesis and receiving the initial dose of rituximab, 41 patients were administered rituximab in their residence countries every two months during one year, whilst 41 did not. There were not significant differences in clinical and demographic data among both groups. In order to analyze data comparatively, the EDSS values prior to and 12 mo. after the HSCT were compared in the groupswith and without additional rituximab; the median change in the EDSS score in the rituximab group was 0 (CI -3.5 to 4), and in the no rituximab group was also 0 (CI -1.5 to 3); accordingly, the change in the EDSS score between patients receiving or not rituximab was not statistically significant (P = 0.93, 95% CI -0.5 to 0.5). We found no short-term difference in MS-relapse free survival (RFS). Conclusion The 12-month period therapy with rituximab in patients with MS who underwent autologous transplant was not effective to prevent relapses nor to cause reduction in the EDSS score.

A total of 32 children aged 6–12 years with attention deficit hyperactivity disorder (ADHD) were monitored during prolonged (6–8 months) treatment with Pantogam (homopantothenic acid) at daily doses of 500–1000 mg. Treatment results were assessed using the DSM-IV core ADHD symptom scales and the WFIRS-P (parental) scale every two months. Decreases in core symptoms on the DSM-IV core ADHD symptom scale were seen at two months of treatment. Significant changes on the WFIRS-P scale took longer: improvements in self-concept, socialization, and social activity were seen at four months and in behavior and schoolwork, basic life skills, along with decreases in risk-associated behavior, at six months. Thus, in contrast to regression of core ADHD symptoms, overcoming impairments in social-psychological adaptation required longer treatment periods.

This study aimed to investigate remission following the treatment of schizophrenia patients with risperidone. Clinically stabilized patients with schizophrenia (n = 374) were randomly assigned to 4-week, 26-week, or no-dose-reduction groups, in which the baseline risperidone dose was continued for 4, 26, or all weeks during 1-year period. The 'Positive and Negative Syndrome Scale' (PANNS) was assessed at baseline and monthly for six months, followed by every two months until the last recruited patient completed 1-year follow-up. Symptomatic remission was defined according to criteria established by the Schizophrenia Working Group. A Generalized Linear Mixed Model indicated significant variation in remission over time, which increased after baseline in the entire group (F = 49.32, df = 1, 3114, P < 0.001). The overall length of risperidone treatment (F = 4.34, df = 1, 416, P = 0.038) and the duration of illness (F = 8.51, df = 1, 359, P = 0.004) had significantly negative effects upon remission. Baseline remission patients were associated with a significantly increased time to relapse compared with the baseline of non-remission patients over a one year follow up period (F = 5.74, df = 1, 367, P = 0.017). One-year risperidone maintenance treatment increased remission rates in schizophrenia. A shorter illness duration, risperidone treatment length, and a lower total PANSS score were clinically useful predictors of remission. Achieving remission may postpone relapse.

Neuromyelitis optinca (NMO) represents a serious demyelinating disease of the central nervous system selectively attacking the spinal cord and optic nerve. Early differential diagnosis from multiple sclerosis is of vital importance, as NMO mandates immunosuppressive and not immunomodulatory treatment. Rituximab has been recently introduced as a treatment option for NMO. However, optimal surrogate measures and treatment intervals are still unclear. Five patients (females, mean age 54 ± 10.21 years) with NMO and NMO spectrum disorders (NMOSD) were evaluated with respect to disability and relapse rate. All patients were found positive for NMO IgG. All patients (three with NMO and two with NMOSD, 1 patient with recurrent optic neuritis and 1 patient with recurrent myelitis) had received rituximab treatment for six years. One patient with NMOSD received cyclophosphamide prior to rituximab while two were misdiagnosed as multiple sclerosis and had received interferon treatment. All received rituximab infusion of 375 mg/m 2 once per week for 4 weeks and then every two months for the first two years and then every six months. B-cell counts were measured every two months and were kept in almost undetectable levels. No relapse was noted during the treatment period while EDSS score was improved in all patients. No severe adverse effects occurred during RTX treatment. Rituximab treatment on NMO and NMOSD patients showed significant improvement in disability and relapse-rate without any significant adverse effects.

Introduction. Immunosuppressant and steroid therapy in systemic lupus erythematosus (SLE) increases the risk of human papillomavirus (HPV) infections, one of which is giant condyloma acuminata (GCA). To our knowledge, there is no report evaluating the correlation between immunosuppressive and steroid therapy in patients with SLE and the prevalence of GCA. Case Report. A 42-year-old female was diagnosed with SLE a year ago and has been treated with steroids and immunosuppressive drugs. In the last few months she presented GCA involving the genital area recurring almost every two months. Type 6 and 11 HPVs were identified in vulva, vagina, and cervix. Methods. PubMed, EBSCO, and Cochrane Library literature were searched from inception to July 2015. Authors screened all titles and abstracts and read full text article, and two case-control studies were found relevant. Results. SLE patients in both studies were under immunosuppressive and steroid therapy. Condyloma acuminata was diagnosed at 108 months (latest) and 1 month (earliest) after SLE. Type 6, 11, 16, 42, and oncogenic group of HPV were identified. Conclusions. GCA is a type of HPV infection seldom observed in SLE patients. Therefore, their correlation is still unclear. Period of time since SLE was diagnosed and GCA varies from months to years. A more thorough physical and laboratory examination leading to HPV and other infectious disease is recommended.

Two groups of adult Mutton snapper fish Lutjanus analis captured in the wild, each one of three females and four males, were kept during eight months under controlled temperature and photoperiod conditions in the lab in order to stimulate their sexual maturation which was in a state of latency because of the effects of confinement. The first group was maintained under an artificial cycle with temperature manipulation and the second under a control cycle, in which this parameter was left at natural conditions. Every two months blood samples from all females were taken for the analysis of plasma testosterone (T) and oestradiol (E2) levels, taking ovarian biopsies simultaneously to register the mean diameter of the oocytes. After six months, a significative increase in the mean diameter of the oocytes of the three females of the artificial cycle was observed, with coincidence and statistic relationship with the increase in the T and E2 (r = 0.62 y 0.82 respectively). No oocyte growth was observed in the females under the control cycle. In both, artificial and control cycles, T and E2 levels showed a close relationship with photoperiod (r = 0.84 y r = 0.61) while temperature showed a lower or non significant relationship (r = 0.40 y r = 0.20). Statistical differences (P