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Background Takotsubo syndrome (TS) is often triggered by an acute physical or emotional stressor. We hypothesised that medium-term prognosis may be better for TS patients with an associated emotional stressor than for those with an acute physical illness. Methods We identified consecutive TS patients presenting in New Zealand (2006–2018). The clinical presentation and outcomes of TS patients according to types of stressor (physical, emotional or no stressor) were assessed. Post-discharge survival after TS was compared with age- and gender-matched patients after myocardial infarction (MI) and people in the community without known cardiovascular disease (CVD). Results Of 632 TS patients (95.9% women, mean age 65.0±11.1 years), 27.4% had an associated acute physical stressor, 46.4% an emotional stressor and 26.2% no evident stressor. In-hospital mortality was similar for each group (1.7%, 1.2%, 0.3% respectively, p=0.29). In a median 4.4 years post-discharge there were 54 deaths (53 non-cardiac). Compared with patients without known CVD, TS patients with physical stress and those with MI were less likely to survive (HR 4.46, 95%CI 3.10–6.42; HR 4.23, 95%CI 3.81–4.70 respectively) but survival for TS patients associated with emotional stress or no stressor was similar (HR 1.11, 95%CI 0.66–1.85; HR 1.08, 95%CI 0.54–2.18, respectively). Recurrence was similar among the three groups (p=0.14). Conclusion Takotsubo syndrome associated with physical stressor has a post-discharge mortality risk as high as after MI. In contrast, prognosis for TS triggered by an emotional stressor is excellent, and similar to that of those without known CVD.

Iron deficiency anaemia is highly prevalent worldwide. In the surgical patient, anaemia of any cause implies higher morbidity and mortality in the post-operative period. This is especially important in patients with peripheral artery disease, as they have very high rates of anaemia due to iron deficiency or other causes. In intermittent claudication, anaemia is a predictor of death in the medium term. Patients with critical ischaemia have higher prevalence of anaemia and it is an indicator of amputation and death in the medium term. Specific protocols need to be developed for these patients since the natural history of their disease does not allow for the correction of anaemia before surgery.

Purpose To evaluate the survival rates and technical outcomes of minimally invasive full-mouth rehabilitations in patients affected by dental erosion and attrition. Materials and methods For this retrospective study, 28 subjects (8 women, 20 men; mean age: 45.6 years) who suffered from generalized erosions and attrition and who were treated according to the 3-step technique were invited to participate. The patient records were reviewed, and the restorations were clinically and radiographically examined. This part of the study (part 1) evaluated restoration survival and technical outcomes using the modified United States Public Health Service criteria (mUSPHS). Survival analysis was performed using Kaplan-Meier survival statistics, and comparison between subgroups was made using log-rank test. For all other comparisons, cross-tabulations of occurrence were performed, and significance was tested using Pearson chi-square test. The level of statistical significance was set at P Results A total of 19 patients (3 women, 16 men; mean age: 45.6 years) agreed to participate. In these patients, 406 restorations (149 direct composites, 110 onlays, 147 veneers) supported by 365 teeth were examined. The mean time in service was 71.8 ± 28.6 months. Six failed restorations were identified; all were direct composites. The 6-year survival rates were 97.3% for direct composites, 98.2% for onlays, and 100% for veneers (P > .05). No differences were found among materials and locations of the restorations. Nineteen technical complications included 14 partial fractures, 3 fissures, 1 wear, and 1 decementation. The mUSPHS evaluation showed good technical outcomes. Presence or absence of a nightguard influenced restoration survival (P = .003). Conclusion Minimally invasive rehabilitations of patients with erosions/attrition with the 3-step technique are a reliable treatment option in the medium term. Protective nightguards are recommended.

Background. Mobile flat foot etiology and its correlations with postural imbalance remain topical issues for now, especially in children with generalized joint hypermobility. Additionally, it is poorly known that complaints prevail in children with mobile flat foot and joint hypermobility, and whether existing complaints are associated with foot deformation.Objective. The aim of the study is to estimate medium-term effects of body balance trainings on the height of longitudinal arch of the foot and on the complaints structure in primary school-aged children with generalized joint hypermobility.Methods. The study included 114 primary school-aged children (7–11 years old) with mobile symptomatic flat foot who were divided into four groups: I — control group of children who did not perform training; II — children who performed standard complex of rehabilitation exercises recommended for flat foot; III — children who performed a specially designed complex of exercises for body balance training; IV — children exercised on unstable platform. The foot examination included: clinical assessment of feet shape and position (FPI-6 scale), visual and manual mobility tests, computer scanning with calculation of anthropometric indices (basic anthropometric parameters were calculated from scanned foot images). Clinical evaluation of balance was carried out according to the BESS (Balance Error Scoring System) scale and computer pedobarometry. Assessment of complaints structure was carried out according to the Oxford Child Foot Condition Questionnaire.Results. Children of control group significantly increased the number of errors in performing tests compared to the baseline data (p = 0.034) according to the BESS scale. No statistically significant changes were obtained in children of the second group (p = 0.08). Total number of errors committed by children of third and fourth groups on unstable platform decreased by 2.9 times and 3.4 times, respectively (p = 0.022 and p = 0.044). Decrease in partial load on medial longitudinal arch of foot in step cycle in average by 2.0–3.5 times compared to baseline parameters was revealed in children of third and fourth groups. Moreover, children of third and fourth groups have shown improvement in parameters regarding the shape and position of the feet by average of 1.3–1.7 times higher compared to the parameters of the feet of children performing standard complex of rehabilitation exercises (p = 0.036).Conclusion. This study has shown the efficacy of body balance training in increasing the height of longitudinal arch of the foot and good dynamics in the structure of complaints in primary school-aged children with generalized joint hypermobility and symptomatic mobile flat foot.

Background: Few studies offer direct comparison of single-anastomosis duodenal-ileal bypass with sleeve gastrectomy (SADI-S) to established bariatric procedures such as Roux-en-Y gastric bypass (RY...

This review paper considers the disjuncture between the rapid pace of climate change and the more sluggish ability of cities to fully implement effective strategies of climate change adaptation and mitigation. We will refer to this as the ‘slow city–quick climate change’ dilemma. Climate change is accelerating, quickly rendering obsolete previous urban forms inadequate, while structural adjustments to cities are slower moving. Cities around the world were largely built for previous climate regimes. In the short to medium term, there is a mismatch between the climate regime that cities were designed for and the climate regime they now inhabit. The paper is divided into four parts: a brief review of climate change in general; climate change in cities; a review of climate change adaptation and mitigation in cities; and finally, a discussion of urban futures in the time of climate regime change.

Aims This study aims to determine procedural characteristics, acute success rates, and medium-term outcomes of consecutive patients undergoing His bundle pacing (HBP); and learning curves of experienced electrophysiologists adopting HBP. Methods and results Consecutive HBP patients at three hospitals were recruited. Clinical characteristics, acute procedural details, and medium-term outcomes were extracted from electronic medical records. Two hundred and thirty-three patients [mean age 74.6 ± 10.1 years, 48% female, 68% narrow QRS, 71% normal left ventricular ejection fraction (LVEF), 55.8% atrioventricular block] underwent HBP. Acute procedural success was 81.1% (mean procedural and fluoroscopic times of 105.5 ± 36.5 and 13.8 ± 9.3 min). Broad QRS was associated with lower HBP success (odds ratio 0.39, P = 0.02). Fluoroscopic and procedural times decreased and plateaued after 30–40 cases per operator. Implant HBP threshold was 1.3 ± 0.7 V at 1.0 ± 0.2 ms and R wave was 5.0 ± 3.9 mV. During follow-up, loss of HBP occurred in a further 12.4% and 11.3% of patients experienced a ≥1 V increase in HBP threshold. Five (2.6%) patients required HBP revision for pacing difficulties. About 8.6% of patients had a >50% decrease in R wave but lead revision for sensing issues was not necessary. On an intention to treat basis, 56.7% of patients in whom HBP was attempted had persisting HBP capture and thresholds of Conclusion Physicians adopting HBP should be cognizant of the learning curve and preferentially select non-dependent patients with normal QRS and LVEF, to minimize risk of lead revision. Further rises in HBP threshold may increase battery drain and need for reoperations, important considerations when choosing HBP for cardiac resynchronization therapy.

The Medium Term Work Plan (MTWP) in its preparation involves school supervisors, principals, school committees, teachers and other components involved in the school environment of SMAN 1 Pagaden. The purpose of preparing this MTWP is as a framework for all components at SMAN 1 Pagaden in four years. MTWP at SMAN 1 Pagaden is an effort to improve the quality of education such as curriculum development and improvement of advice and infrastructure, learning tools, management improvements, school funding and sources of funds, graduation standards, assessment systems and the role of school committees. Efforts to improve these things are by compiling the MTWP program for the period 2021-2025. This research was conducted to improve the performance or achievement of the work program of SMAN 1 Pagaden in period 2021–2025. This research was conducted at SMAN 1 Pagaden, Subang Regency, which took place from January to April 2021. The data was processed using the quality reports application published by the West Java education quality assurance institute as a measure of the achievement of the work program in the previous year. The data is processed and analyzed using the description method. The remedial/enrichment program so far has not been effective, it still uses the effective hours of teaching and learning. Improvements to the remedial/enrichment program aim to improve the quality of learning, with higher learning achievement expected to have an impact on the standard chart of content so that it can go to the national education standard 4 category. Strengthening remedial and enrichment programs can be optimized through the use of school operational assistance funds.

El mejoramiento genético de sorgo en México inició en 1944 en la oficina de Estudios Especiales. Posteriormente, las actividades de mejoramiento se realizaron en tres regiones con la introducción de material genético de donde se derivaron líneas y se generaron los primeros híbridos de sorgo adaptados. El programa se ha enfocado a la generación de material genético para diversos nichos de mercado entre los que sobresalen el de alimento balanceado, alimento para consumo humano y el de producción de biocombustibles. Entre los materiales genéticos sobresale el híbrido RB-3030 por haber sido en su momento el de mayor producción por parte de la PRONASE. A la fecha se han generado 36 híbridos y variedades de los cuales actualmente están siendo aprovechados 12, dentro de los que sobresalen los sorgos de grano rojo-naranja RB-Norteño y RB-Huasteco y la variedad de sorgo blanco RB-Paloma. Así mismo, sobresalen los sorgos forrajeros Sinaloense 202 y Gavatero-203. Por otra parte, se han formado los sorgos RB-Cañero, RB Cañaveral, RB Tehua y RB-Pirulí para la producción de bioetanol. Además, se cuenta con líneas parentales de híbridos que son adquiridas por empresas para la producción de semilla certificada. Existen varios retos como el de incrementar la producción, pero a corto plazo se requiere incrementar la promoción y mercadotecnia de los materiales genéticos, y a mediano plazo fortalecer las investigaciones en el control de enfermedades, tolerancia a sequía y sales y obtener variedades con mejor calidad nutricional y energética.

In this study we explore whether more complex economies are better shielded against exogenous shocks. We contribute to the empirical literature on determinants of output volatility by introducing a relatively new index on productive capabilities of export goods, the Economic Complexity Index (ECI), developed by Hausmann et al. (2014). The ECI measures the productive capabilities of countries by explaining the knowledge accumulated in a population based on the goods they produce and export and to which countries they export. As such, not only does this measure capture diversification but also the technology embedded in the products. Using panel data analysis for a cross section of countries from 1984 to 2016, we find variations in the effects of ECI on output volatility between high and low income countries. For high income countries, increases in ECI reduce output volatility in the short to medium term (under 3 years), whereas we observe a longer delay in output volatility moderation for low income countries. The findings suggest that low income countries have less diversified and less complex export goods which leave them open to external shocks and reduce their ability to adjust quickly to the shocks. Furthermore, disaggregation by regions reveals that economic complexity in Asia is relatively more effective at reducing output volatility than in Africa. The difference between the two regions could be due to Africa’s primary production and exports being in relatively homogenous goods with no differentiation and subject to the volatility of world markets.

Background and Objective The aim of the study is to evaluate the technical and clinical outcomes of transjugular intrahepatic portosystemic shunt (TIPS) performed with additional transabdominal ultrasound guidance. Material and Methods Patients who underwent TIPS between January 2004 to January 2020 in our center were studied. Technical, hemodynamic, angiographic, and clinical outcome were recorded up to 1 year of follow-up. Results TIPS was attempted in 162 patients (median [range] age 37[3–69] years; 105 were males and 57 were females; Etiology: Budd-Chiari syndrome [BCS] 91, cirrhosis 65, symptomatic acute portal venous thrombosis [PVT] 3, veno-occlusive disease [VOD] 2, congenital portosystemic shunt [CPSS] 1) during the study period. Indication for TIPS was refractory ascites in 135 patients (BCS 86, cirrhosis 49) and variceal bleed in 21 patients (BCS 5, cirrhosis 16). Technical success was seen in 161 of the 162 (99.4%) patients. The tract was created from hepatic vein in 55 patients and inferior vena cava (IVC) in 106 patients. Complications within 1 week post TIPS were seen in 29 of the 162 (18%) patients, of whom one developed unexplained arrhythmia and hypotension and died. Of the patients with available follow-up, clinical success was noted in 120 (81%), while 14 (9%) patients had partial nonresponse and six (4%) had complete nonresponse. Eight (5%) patients died during the follow-up period. Conclusion The technical success of TIPS creation with additional transabdominal ultrasound guidance is very high with low peri-procedural complication rate. It has enabled the inclusion of a wider spectrum of cases like acute PVT and obliterated hepatic veins which were otherwise considered contraindications.

Fei Gao,1,* Lingtong Shan,2,* Chong Wang,3,* Xiaoqi Meng,4 Jiapeng Chen,5 Lixiang Han,6 Yangyang Zhang,3 Zhi Li6 1Cardiovascular Department, Huaiyin Hospital of Huai’an City, Huai’an, Jiangsu, People’s Republic of China; 2Department of Thoracic Surgery, Sheyang County People’s Hospital, Yancheng, Jiangsu, People’s Republic of China; 3Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, People’s Republic of China; 4The Second Clinical Medical College of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China; 5Xinglin College, Nantong University, Nantong, Jiangsu, People’s Republic of China; 6Department of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, People’s Republic of China*These authors contributed equally to this workCorrespondence: Zhi LiDepartment of Cardiovascular Surgery, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, 300 Guangzhou Road, Nanjing, 210029, People’s Republic of ChinaTel +86 13770606815Email zhili_cths@163.comYangyang ZhangDepartment of Cardiac Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, 241 Huaihai West Road, Shanghai, 200120, People’s Republic of ChinaTel +86 13818132320Email zhangyangyang_wy@vip.sina.comObjective: To evaluate the powers of European Heart Surgery Risk Assessment System II (EuroSCORE II) and the Society of Thoracic Surgeons (STS) score in predicting in-hospital and medium-term mortality of patients undergoing coronary artery bypass grafting (CABG).Methods: Totally 1628 Chinese patients were included between January 2000 and January 2018. Their perioperative clinical data were collected and the patients were closely followed up. According to the length of follow-up time, the total cohort was divided into 1-year, 2-year, 3-year, 4-year and 5-year groups. The in-hospital and medium-term risk prediction of EuroSCORE II and STS score were comparatively assessed by calibration, discrimination, decision curve analysis (DCA), net reclassification index (NRI), integrated discrimination improvement (IDI) and Bland-Altman analysis.Results: About 36 (2.21%) patients died during hospitalization. Both EuroSCORE II and STS score performed extremely well in predicting in-hospital mortality (area under curve = 0.900 and 0.879, respectively). However, calibration and discrimination analyses showed gradual decrease when these two risk evaluation systems were used to predict mortality during the follow-up period. At the same time, the predictive ability of EuroSCORE II was better than STS score. DCA curves showed that the performances of the two evaluation systems were roughly equal between the threshold probability of 0% to 20%. The percentage of correct reclassification of EuroSCORE II was 21.64% higher than that of STS score in predicting 2-year postoperative mortality. The IDI index showed that the predictive capabilities of these two systems were roughly equivalent. Bland-Altman analysis showed no significant difference between the values of the two systems.Conclusion: EuroSCORE II and STS score have excellent predictive powers in predicting in-hospital mortality of patients undergoing CABG. In particular, EuroSCORE II is superior in calibration and discrimination. The prediction efficiency of the two risk evaluation systems is still acceptable for two-year postoperative mortality, but decreases year by year.Keywords: EuroSCORE II, STS score, coronary artery bypass grafting, in-hospital mortality, medium-term prognosis

The purpose of this study was to report the medium-term outcome of our index case of Descemet stripping only (DSO) in the clinical setting of Fuchs endothelial corneal dystrophy with pancorneal guttae.This was a retrospective case report.A 44-year-old woman with bilateral Fuchs endothelial corneal dystrophy was referred for consideration of DSO. At initial slit-lamp examination, widespread guttae were observed with no clear zone visible. Confocal microscopic examination also failed to isolate a population of undisturbed endothelial cells. DSO with supplemental ripasudil was performed with corneal clearance achieved at 2.5 months. A stable result was obtained for 18 months with a subsequent slow decline in vision and return of diurnal fluctuation. At 3.5 years after DSO, DMEK was performed with resolution of symptoms.Medium-term failure in this clinical setting is further evidence that DSO is likely best offered to patients with central guttae but a clear corneal periphery, indicative of a healthy cell reservoir.

The aim of this work is to study the mechanical behavior of the sediments extracted from the Koudiet Meddaouar, Timgad dam (Algeria), for a possible valorization in the field for building works in order to minimize this phenomenon which is currently a concern for the operators and the persons in charge of the mobilization of the water resources. This siltation therefore severely limits its storage capacity and consequently it’s operating life. The extraction of the sediments accumulated in the dam's reservoir is therefore imperative, on the pain of seeing it perish in the medium term. These sediments are, however, of great geotechnical and mechanical value. The results of the tests conducted in the laboratory have enabled us to identify the different sediments from a physical and geotechnical point of view In front of the difficulties noted in the control of the silting up of the dams in Algeria, a very important quantity of silt being deposited annually in the dams. In order to achieve our objective, different mixtures of silt with or without lime treatment, cement glass fibers and powdered fibers were studied for the possible manufacture of Compressed Earth Bricks (CEB). The results obtained show that some of the mixtures present very interesting results in the different tests (compression and bending), verifying the conditions of the standards in force and thus allowing their use in the field of the manufacture of building materials. Doi: 10.28991/cej-2021-03091759 Full Text: PDF

Objectives To analyze the impact of bilateral cochlear implantation (CI) on perceptual and linguistic development in hearing-impaired children with congenital Cytomegalovirus (CMV) infection. Patients and method A retrospective study was performed for the period 1991-2016 in a pediatric CI reference center. Closed Set Word (CSW) recognition scores, Categories of Auditory Performance (CAP) and linguistic level on the MT Lenormand scale (MTL) were compared between bilateral (Bi) and unilateral (Uni) groups 12, 24 and 36 months after first CI (CI-1). Results 84 patients with congenital CMV infection who underwent CI were included, in 2 groups: sequential or simultaneous bilateral CI (Bi) (N = 20), and unilateral CI (Uni) (N = 64). Twelve, 24 and 36 months after CI-1, CSW scores were 35.56%, 64.52% and 82.93% in Uni and 60.3%, 85% (P = 0.0084*), and 100% (P = 0.00085*) in Bi. CAP scores 12, 24 and 36 months after CI-1 were 2.57, 3.85 and 4.3 in Uni and 3.91 (P = 0.0068*), 5.00 (p = 0.029*) and 5.50 (P = 0.051*) in Bi. MTL linguistic level scores at 12, 24 and 36 months were 0.72, 1.25 and 1.65 in Uni, and 1.72, 3 (P = 0.033) and 3.11 (P = 0.045) in Bi. These significantly better scores in Bi at 24 and 36 months after CI-1 were also found on analysis of subgroups with no associated neurologic disorder (P = 0.046* and P = 0.032*), no associated psychiatric pathology (P = 0.0055* and P = 0.0073*), and no other associated disorder (P = 0.0018* and P = 0.035*), and for all subgroups together (P = 0.0036 and P = 0.037). Conclusion Bilateral CI is a faster way than unilateral CI for patients with congenital CMV infection to achieve structured fluent oral language. 50% of the series showed cerebral abnormalities on MRI, without difference between groups. This was not in itself predictive of poor progression of oral communication, unless associated with major neurologic disorder. Some children made little or no use of their CI in the medium term.

espanolEl presente articulo tiene por objeto trazar las trayectorias de mujeres exiliadas en Francia a partir del analisis de los mecanismos de inscripcion del colectivo exiliado y sus asignaciones desde una perspectiva de genero. Al internamiento en campos y refugios le siguieron los intentos de repatriacion o su utilizacion como contribucion a la economia nacional de la Francia en guerra y durante la Ocupacion. En la posguerra, el beneficio del estatus de refugiado junto a la renuncia a regresar a Espana en un medio plazo implicaba la consecuente necesidad de integrarse en la sociedad francesa. Con el fin de reconstruir estas trayectorias vitales y laborales, seran de gran utilidad tanto la documentacion administrativa francesa o de organismos de ayuda como las fuentes testimoniales. EnglishThe purpose of this article is to trace the trajectories of exiled republican women in France based on an analysis of the mechanisms by which the exiled group is insered in the French society and its assignments from a gender perspective. Internment in camps and shelters was followed by attempts to repatriate them or use them as a contribution to the national economy in wartime and during the Occupation. In the post-war period, the benefit of refugee status as well as the refusal to return to Spain in the medium term implied the consequent need to integrate into French society. In order to reconstruct these life and work trajectories, both French administrative or aid agency documentation and testimonial sources will be very useful to analyse.

The OECD-FAO's Agricultural Outlook and the European Commission DG AGRI's Medium-term agricultural outlook report provide price forecasts. Users of these forecasts may be interested in their accuracy. This paper measures the accuracy for values forecast for the following year. These are very accurate as regards the AO EU price of poultry, the EC outlook price of common wheat and feed barley, but not so accurate as regards the EC outlookon beef prices. In some cases, discrepancies between the forecasts follow a systematic pattern. The paper also discovers how the OECD-FAO's outlook projections for a common wheat world representative price are changing from year to year. Usually they are positively correlated, but there are certain exceptions where their correlation is significantly negative. This means that the price projections of some commodities may vary dramatically.

As a result of the global pandemic of covid-19, distance education went from being a little considered training option to the status of the main operating alternative for the school system. Educational institutions by adapting their work to the use of digital platforms have managed to keep their programs active despite reducing their training expectations. School activities at home face complex social situations that contravene the teaching precepts, cause poor learning and many cases of school dropout. Educational systems in the medium term will promote remote teaching modalities in digital and telematic versions, whose didactics will dominate the 21st century.

Introduction: Sudden cardiac death (SCD) is a clinical syndrome defined as: sudden, premature, natural death from cardiogenic causes in a cardiac patient or a person without known cardiac disease, preceded by sudden loss of consciousness and occurring within one hour of the onset of acute symptoms. (3). According to published literature, the incidence of sudden cardiac death ranges widely (15-48%), depending on geographical and demographic indicators. Objective: The aim of our study was to investigate short-term and medium-term survival after resuscitation in patients with sudden cardiac death. Methods: data from patients in two groups of sudden cardiac death were compared at hospital discharge and at 1 and 3 months after hospital discharge. We compared data from 92 patients who suffered a SCD between 1 January 2016 and 31 December 2017. Data from patients who had a proven shockable (I) or non-shockable (II) incipient rhythm following SCD were included. The main endpoint was the comparison of mortality between the two groups. For statistical analysis, we used a T-test and ANOVA to compare the data. Our exclusion criteria included inaccurate documentation and uncertain rhythm. Results: 62% of patients in the shock group had a significantly higher survival at all three observed time points than in the non-shock group. Conclusion: In our study population, the hypothesis that patients with a shockable rhythm in SCD have significantly better survival than those without shockable rhythm was confirmed by several studies. Our patients had significantly higher survival both at hospital discharge and at day 30 survival. Introducción: La muerte súbita cardíaca (MSC) es un síndrome clínico que se define como: la muerte súbita, prematura y natural por causas cardiogénicas en un paciente cardíaco o en una persona sin enfermedad cardíaca conocida, precedida de una pérdida súbita de conciencia y que se produce en la hora siguiente al inicio de los síntomas agudos. (3). Según la literatura publicada, la incidencia de la muerte súbita cardíaca varía ampliamente (15-48%), dependiendo de indicadores geográficos y demográficos. Objetivo: El objetivo de nuestro estudio fue investigar la supervivencia a corto y medio plazo tras la reanimación en pacientes con muerte súbita cardíaca. Métodos: Se compararon los datos de los pacientes de dos grupos de muerte súbita cardíaca al alta hospitalaria y a los 1 y 3 meses del alta hospitalaria. Se compararon los datos de 92 pacientes que sufrieron una MSC entre el 1 de enero de 2016 y el 31 de diciembre de 2017. Se incluyeron los datos de los pacientes que tenían un ritmo incipiente demostrable (I) o no demostrable (II) tras la MSC. El criterio de valoración principal fue la comparación de la mortalidad entre los dos grupos. Para el análisis estadístico, se utilizó una prueba T y un ANOVA para comparar los datos. Nuestros criterios de exclusión incluyeron la documentación inexacta y el ritmo incierto. Resultados: El 62% de los pacientes del grupo de choque tuvo una supervivencia significativamente mayor en los tres puntos temporales observados que en el grupo de no choque. Conclusión: En nuestra población de estudio, la hipótesis de que los pacientes con ritmo desfibrilable en la ECF tienen una supervivencia significativamente mayor que los que no tienen ritmo desfibrilable fue confirmada por varios estudios. Nuestros pacientes tuvieron una supervivencia significativamente mayor tanto al alta hospitalaria como al día 30 de supervivencia.

En un mundo en constante cambio, la transformación digital en los emprendimientos se ha vuelto una necesidad imperiosa para la sostenibilidad de los negocios, situación que debe planificarse y aplicarse en el mediano plazo. El objetivo de la presente investigación fue analizar la relación entre las variables transformación digital y emprendedores universitarios del Ecuador, para ello de forma exploratoria se realizó una revisión bibliográfica sobre las variables de interés, lo que permitió fundamentar el marco teórico del estudio, posteriormente y para aterrizar los conceptos al contexto ecuatoriano, se empleó el método Delphi con dos rondas de entrevistas a expertos, lo que a su vez permitió diseñar un cuestionario, el que posteriormente fue aplicado a 384 emprendedores universitarios del Ecuador, para recabar su opinión y percepción sobre la transformación digital y su efecto en la sostenibilidad de sus emprendimientos. Como principal resultado, los encuestados reconocen la importancia de la transformación digital en los emprendimientos, sin embargo, esto no se ve reflejado en las operaciones de sus negocios, lo cual puede deberse a una confusión entre la transformación digital y el solo hecho de usar herramientas tecnológicas de forma aislada en uno o más procesos. Esta ausencia de transformación digital también puede ser atribuida a la falta de: fuentes de financiamiento, conocimiento de herramientas de gestión y estudios a profundidad sobre el mercado.

The lifetime risk of developing symptomatic knee osteoarthritis (OA) is estimated to be 45%, with up to two thirds of patients presenting with bilateral knee symptoms. Patients presenting with end stage bilateral knee OA may benefit from single anaesthetic bilateral total knee replacement (SABTKR). Our study aim was to compare the outcomes of SABTKR with unilateral total knee arthroplasty (TKA) in a single surgeon series over a 20 year period. We performed a retrospective review of a single surgeon’s data from the New Zealand Joint Registry (NZJR) over a 20-year period from January 1999 to December 2018. This review reports on patient demographics, functional outcomes, revision rates and mortality rates. 1225 total knee replacements were performed by the senior author (995 TKAs and 115 patients underwent SABTKRs) over the 20 year period reviewed. The mean ages of the TKA and SABTKR groups were 67.7 and 66.7 years, respectively. There was 16.9% mortality rate for the TKA group versus 7.8% in SABTKR group. There were no revisions in the SABTKR group versus 17 revisions in the TKA group representing a revision rate of 0.23/100 component years which can be viewed against a 20 year revision rate of 0.48/100 component years (p

The management of massive rotator cuff tears (RCTs) remains a debated topic amongst orthopaedic surgeons, with a wide spectrum of treatment options available. In recent years, the use of sub-acromial balloon spacers has emerged as an option in the management of massive RCTs. The purpose of this study is to evaluate the clinical outcomes of patients with massive RCTs who underwent arthroscopic sub-acromial balloon spacer insertion at medium-term follow-up. All consecutive patients in our institution who had undergone sub-acromial balloon spacer insertion under the senior author from 2015 to 2020 were identified and followed up via telephone survey. Patient demographics, patient-reported outcomes, complications and subsequent surgeries were all analysed using the SPSS. Overall, 45 patients (31 males) including 36 retired (80.0%) patients, with a mean age of 70.3 ± 7.0 (40–83) years, and mean follow-up of 37.1 ± 16.4 (12–62) months were included. At final follow-up, the mean ASES score was 73.4 ± 21.8 (25–100), the mean SSV was 76.4 ± 16.0 (45–100), baseline VAS score was 0.3 ± 1.1 (0.0–6.0) and functional VAS score was 2.6 ± 2.3 (0.0–8.0), with a total of 89.9% of patients (n = 40) being satisfied at final follow-up. This series reported no intra-operative complications (0.0%), with 4 patients (8.9%) required subsequent procedures to the ispilateral shoulder post-sub-acromial balloon insertion. In selected patient cohorts, the use of sub-acromial balloon spacer insertion represents a minimally invasive, viable surgical option in the management of massive rotator cuff tears, with satisfactory patient-reported outcomes, high rates of satisfaction and a low complication rate reported at medium-term follow-up. Level of evidence: III; Retrospective Cohort Study

Pela Gandong local wisdom has played a significant role as a media for Ambon conflict resolution. The existence of dialogue and communication based on Pela Gandong culture can bring mutually battling parties to achieve peace. Therefore, the purpose of the study is to describe how SMPN 4 Salahutu Liang Central Maluku with 100% Muslim students also, SMPN 9 Ambon City with 99% of their Christian/Catholic students in implementing Panas Pela of Education as the transmission of Pela Gandong culture as an implementation of the Ambon City Regional Medium-term Development Plan (RPJMD). Panas Pela of education is an assemblage of students with different religions tore-warm the sibling relationship (Pela Gandong). This study uses descriptive qualitative research methods with a case study approach. Data collection is done by participatory observation, literature study, document analysis, and interviews. The results showed that the Panas Pela of Education activity on January 29, 2018, had succeeded in transmitting Pela Gandong culture to students to maintain peace. It can be seen by student’s ability from both schools to blend in with one another without segregation and together celebrate the Panas Pela of Education. It is expected that the field of education implementing Panas Pela of Education sustainably. It will surely be successful because the local wisdom of the Pela Gandong has been integrated into the Ambon City Local Government Medium-term Development Plan (RPJMD).

Huge quantities of pollutants are released into the atmosphere of many cities every day. These emissions, due to physicochemical conditions, can interact with each other, resulting in additional pollutants such as ozone. The resulting accumulation of pollutants can be dangerous for human health. To date, urban pollution is recognized as one of the main environmental risk factors. This research aims to correlate, through soft computing techniques, namely Artificial Neural Networks and Genetic Programming, the data of the tumours recorded by the Local Health Authority of the city of Benevento, in Italy, with those of the pollutants detected in the air monitoring stations. Such stations can monitor many pollutants, i.e. NO2, CO, PM10, PM2.5, O3 and Benzene (C6H6). Assuming possible effects on human health in the medium term, in this work we treat the data relating to pollutants from the 2012–2014 period while, the tumour data, provided by local hospitals, refer to the time interval 2016–2018. The results show a high correlation between the cases of lung tumours and the exceedance of atmospheric particulate matter and ozone. The explicit genetic programming knowledge representation allows also to measure the relevance of each considered pollutant on human health, evidencing the major role of PM10, NO2 and O3.

The natural history of moderate alcoholic hepatitis (AH) is not well known. It is a frequent disease with a probable underestimated incidence compared to its severe form. Among the different prognostic scores to predict short-term mortality in AH, MELD seems to be the most accurate one. The mortality of moderate AH is up to 3–7% in the short-medium term and 13–20% at one year, mainly due to liver-related complications including severe infections. Long-term abstinence is the main goal of the treatment. There is still a dire need for the development of new therapies for AH, including the less severe forms.

Contexto: Este estudio se lleva a cabo en las empresas publicas ecuatorianas, en el mismo se realiza un análisis de incidencia de la gestión administrativa contable, donde se incluye el control interno como el instrumento clave para mantener la seguridad de la información financiera, frente a los fraudes que se encuentra expuesta. Método: En esta investigación se realiza un análisis situacional de la gestión administrativa contable y su incidencia en las empresas públicas de Ecuador, seguido de un análisis de diferentes fuentes de información confiables. Resultados: A través del análisis situacional realizado, se identificaron problemas actuales, útiles para la toma de decisiones, destacándose así problemas potenciales. Se expone un plan de resolución que contempla; acciones, metas y responsabilidades a cumplir a corto y mediano plazo. Conclusiones: Se identificaron problemas en las empresas seleccionadas, cuyos límites no estaban claramente definidos. El análisis situacional abarcó el proceso de toma de decisiones y la solución de problemas para mejorar la gestión administrativa contable de las empresas públicas ecuatorianas, que poseen incidencia negativa en el crecimiento del PIB, después del confinamiento producido por la actual pandemia que azota el mundo.

Background: Research shows that women are more likely to move out after a separation, but the evidence is largely limited to younger ages. Little is known about short-term and medium-term mobility consequences in the case of a ‘grey divorce’. Objective: Focusing on married couples separating at ages 50 to 70, we investigate who leaves the joint home upon separation and in the years immediately following separation. Considering ex-couple characteristics, we contrast the bargaining principle, which predicts higher moving-out rates for women, and the fairness principle, which points to the opposite. Methods: Using Belgian register and census data, we study marital couples who separated in 2002 at ages 50 to 70 after a marriage of at least 15 years’ duration. We follow them for three years and estimate their moving patterns using multinomial logistic regressions and continuous-time models that account for the lagged effect of separation. Results: Older women have a relative advantage in keeping the home at separation and maintain this advantage in the years following the separation. This finding contrasts with prior findings concerning younger ex-couples. Exceptions are women who are significantly younger than their ex-partner, whose children remain with the father, who live at their husband’s birthplace, and who rent rather than own the home. Conclusions: Our findings point to a principle of fairness at play in the moving-out decision among older separating couples. Nonetheless, not all women benefit from this advantage. Contribution: We show that post-divorce moving-out patterns are different at older ages. Looking beyond the immediate moment of separation allows for firmer conclusions to be reached about whether the home is eventually kept.

The study tested the ‘uncertainty-strategy-actions’ model by K.P. Coyne and S. Subramaniam, which the authors proposed earlier as a theoretical basis for analyzing the export strategy of the Russian company PJSC Gazprom in the European gas market. The conclusion was as follows: the company will act as a balancing supplier in the European market in the medium term, maintaining a stable level of exports and diversifying supplies along three routes, and in the long term, the unified Eurasian gas transmission system created within the framework of the company’s forming strategy will become an energy ‘bridge’ between the markets of Europe and Asia.

BACKGROUND Arthroscopic debridement is a mature treatment for knee osteoarthritis (KOA). Due to the differences in the research subjects, methods, and efficacy evaluation indexes, there are great differences in the surgical efficacy reported in the literature. AIM To compare the medium-term efficacy of arthroscopic debridement and conservative treatment for KOA of Kellgren-Lawrence grades I-III. METHODS Patients with KOA of Kellgren-Lawrence grades I-III who were admitted to the orthopedic clinic of our hospital from July 2018 to December 2018 and agreed to undergo arthroscopic surgery were included in an arthroscopic debridement group, and those who refused surgical treatment were included in a conservative treatment group. Gender, age, body mass index (BMI), side of KOA, American hospital for special surgery knee score (HSS score) before treatment, visual analogue scale (VAS) score during walking and rest before treatment, conservative treatment content, and surgical procedure were recorded. Outpatient visits were conducted at the 1st, 3rd, 6th, 12th, and 24th mo after treatment in the two groups. The changes of HSS score and VAS score in each group before and after treatment were statistically analyzed, and the differences of HSS score and VAS score in different treatment stages between the two groups were also compared. RESULTS In the conservative treatment group, there were 80 patients with complete follow-up data, including 20 males and 60 females, aged 58.75 ± 14.66 years old. And in the knee arthroscopic debridement group, there were 98 patients with complete follow-up data, including 24 males and 74 females, aged 59.27 ± 14.48 years old. There was no statistically significant difference in the general data (gender, age, BMI, side of KOA, Kellgren-Lawrence grade distribution, HSS score, and VAS score) between the two groups before treatment. The HSS scores of the conservative treatment group at the 1st, 3rd, 6th, 12th, and 24th mo after treatment were significantly higher than that before treatment (P < 0.05). There was no statistical difference in HSS score of the conservative treatment group among the 1st, 3rd, 6th, 12th, and 24th mo (P > 0.05). The HSS score of the knee arthroscopic debridement group at the 1st mo after surgery was significantly higher than that before surgery (P < 0.05). HSS scores of the knee arthroscopic debridement group at the 3rd, 6th, 12th, and 24th mo were significantly higher than those before surgery and at the 1st mo after surgery (P < 0.05). There were no statistically significant differences in HSS scores at the 3rd, 6th, 12th, and 24th mo after surgery (P > 0.05). HSS scores at the 3rd, 6th, 12th, and 24th mo were significantly higher in the arthroscopic debridement group than in the conservative treatment group (P < 0.05). There was no statistical difference in HSS scores between the two groups before treatment and at the 1st mo of follow-up (P > 0.05). VAS scores during walking and rest were significantly decreased in both groups, and the VAS score during rest was significantly lower in the arthroscopic debridement group than in the conservative treatment group, but there was no significant difference in the VAS score during walking between the two groups after treatment. CONCLUSION Compared with conservative treatment, arthroscopic debridement can significantly improve the knee resting pain and knee functional status of patients with KOA of Kellgren-Lawrence grades I-III within 2 years after treatment.

The article analyzes the experience of joint use of manned and unmanned aerial vehicles by the armed forces of foreign countries. According to foreign military experts, the optimal combination of manned and unmanned aerial vehicles can increase the efficiency of combat missions, reduce the number of losses of costly manned aircraft and crews, as well as reduce material costs. However, the joint use of manned aircraft and UAVs is a difficult task, the solution of which is possible only on the basis of high-tech technical development. The joint use of unmanned and manned aircraft at the current level of control and communication technologies can be based only on the principles of interaction between unmanned and unmanned aerial vehicles, which requires detailed advance planning of hostilities. The transition to more operational forms of joint actions based on UAV control by manned aircraft, the use of a single information space will be possible with significant progress in the creation and implementation of aviation communication systems and information exchange resistant to EW, UAV systems. Therefore, the use of manned and unmanned aerial vehicles requires a well-established interaction of their forces and means, which consists in the rational distribution of tasks and coordination of actions of units in place, time and methods of combat missions. Based on this, it should be expected that the organization of joint use of unmanned and manned aircraft in the medium term will not be fundamentally different from the organization of joint use of aviation groups of different types. Planning the joint use of unmanned and manned aircraft will retain the features of centralized hierarchical planning. The analysis identified a set of factors that determine the nature and direction of joint use of aircraft and UAVs in modern hostilities, the main options for joint use of aircraft and UAVs from the experience of aviation in recent armed conflicts and local wars, outlined the tasks that it is expedient to put on subdivisions of unmanned aerial vehicles at their joint application with parts (subdivisions) of manned aviation.

Ahmad AlAraj,1,2 Ahmad AlAmeer,1,3 Samar Al-Swailem1 1Anterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, Riyadh, Kingdom of Saudi Arabia; 2Department of Ophthalmology, College of Medicine, Qassim University, Qassim, Saudi Arabia; 3Ophthalmology Division, Surgery Department, King Abdullah bin Abdulaziz University Hospital, Riyadh, Saudi ArabiaCorrespondence: Samar Al-SwailemAnterior Segment Division, Department of Ophthalmology, King Khaled Eye Specialist Hospital, P.O. Box 7191, Riyadh, 11462, Kingdom of Saudi ArabiaTel +966-11-482-1234 ext.1152Email angelofsa@yahoo.comPurpose: To compare the postoperative outcomes of deep anterior lamellar keratoplasty (DALK) and penetrating keratoplasty (PKP) for macular corneal dystrophy (MCD).Design: Single-center, retrospective, interventional case series.Methods: A chart review was performed of 100 patients (157 eyes) who underwent primary DALK (DALK group) and PKP (PKP group) for histopathologically confirmed MCD for whom at least 12 months of follow-up were available. Between-group comparisons were performed of visual acuity (VA), graft survival, and postoperative complications.Results: There were 22 eyes in the DALK group and 135 in the PKP group. Postoperative best-corrected visual acuity (BCVA) of 20/40 or better was achieved in 90.9% of the DALK group and 76.3% of the PKP group (P=0.12). At last visit, graft survival was 95.5% (21 eyes) and 91.1% (123 eyes) in DALK and PKP groups, respectively (P=0.69, Log rank test). Corneal graft rejection episodes occurred in 1 (4.5%) DALK graft and 19 (14.1%) PKP grafts. Five of the 19 graft rejections in the PKP group were irreversible. Microbial keratitis and cataract occurred in 6 (4.5%) and 15 (11.1%) PKP eyes. One (4.5%) eye in the DALK group had cataract and none of the DALK cases developed microbial keratitis. Clinically significant recurrence was observed in 4 (2.9%) PKP eyes and 1 (4.5%) DALK eye (P=0.69), respectively.Conclusion: DALK is a viable option for MCD without Descemet membrane involvement. DALK had comparable medium-term visual and survival outcomes to PKP. DALK has the advantage of lower open sky intraoperative complications and lower graft rejection episodes.Keywords: macular corneal dystrophy, keratoplasty, lamellar keratoplasty, penetrating keratoplasty

Population growth has been followed by an increase in the share of residents in urban centers, in developed countries as well as in the least developed. These areas of high population density generate an increase in commercial activity, being urban freight transport a key factor, in account of providing the goods commercialized in its stores. Urban logistics presents a series of hard-to-solve issues, and the models which seek to align the interests of the various stakeholders in the search for solutions are scarce. The aim of this article is to present a framework to understand the needs of the different stakeholders, and, in this way, to facilitate joint working with the goal of finding solutions for a better management of urban freight transport. It was found that there are many different regions that coexist within the same city, which makes evident that not all solutions are applicable to all of them. By studding deeply one of these regions, it can be inferred that not all cities are prepared for the current challenge that urban freight transport encompasses. The choice of a multi-perspective study appeared to be convenient to address the complexity these process, allowing the researcher team to gather a comprehensive view of this reality. These various aspects were shown in a workshop that included representatives of each of the stakeholders’ groups. In this workshop, the different distribution strategies and regulations that could be implemented in the short and medium term were deeply discussed.