Testicular heat stress (HS) can lead to testicular tissue destruction and spermatogenesis disturbances. Royal Jelly (RJ) has been introduced as a potent antioxidant. We investigated the effects of RJ on testicular tissue, oxidative stress and sperm apoptosis in HS-exposed rats. Compared to HS-exposed groups, RJ co-treatment could improve testosterone reduction and histopathological damages. The RJ co-administration decreased MDA level in testicular tissue, while TAC and CAT levels were remarkably increased compared to HS-exposed groups. Moreover, significant higher expression level of Bcl-2 and lower expression levels of P53 and Caspase-3 were seen following RJ co-administration compared to HS-exposed groups. Our data suggest that RJ can effectively ameliorate experimental HS-induced testiculopathies in rats through testicular antioxidant defense system restoration and germ cells apoptosis regulation.Mosquitoes are regarded as one of the most dangerous animals on earth. Because they are responsible for the spread of a wide range of both human and animal pathogens, research of the underlying mechanisms of their feeding behavior and physiology is critical. Among disease vector mosquitoes, Culex quinquefasciatus, a known carrier of West Nile virus and Western Equine Encephalitis, remains relatively understudied. As blood-sucking insects, adaptations (either at the molecular or physiological level) while feeding on warm blood are crucial to their survival, as overheating can result in death due to heat stress. Our research aims to determine how Cx. quinquefasciatus copes with the heat associated with warm blood meal ingestion and possibly uncover the adaptations this species uses to avoid thermal stress. Through the use of thermographic imaging, we analyzed the body temperature of Cx. quinquefasciatus while blood feeding. Infrared thermography has allowed us to identify a cooling strategy, evaporative cooling via the production of fluid droplets, and an overall low body temperature in comparison to the blood temperature during feeding. Understanding Cx. quinquefasciatus’ adaptations and the strategies they employ to reduce their body temperature while blood feeding constitutes the first step towards discovering potential targets that could be used for their control.Infrared thermal imaging is currently used in almost every field of medicine. This paper presents the novel use of thermography in ophthalmology – using a thermal camera to assess correct intraocular pressure measurement depending on the position of the patient’s head during non-contact tonometry. For the analysed group of 10 healthy subjects, thermographic images of the face were recorded before and after intraocular pressure testing. Pressure was tested with a non-contact tonometer with a Scheimpflug camera. For the acquired 20 2D images (thermograms), an analysis of the characteristic areas of the face determined temperature changes of the patient’s face in contact with the tonometer frame. Analysis and processing of the acquired thermograms was carried out in MATLAB® with the Image Processing Toolbox. The results clearly showed a decrease in the patient’s face temperature where the face was in contact with tonometer supports. Temperature changes in the patient’s face provide valuable information about the correct position of their head in the device, which directly translates into measurement quality. Therefore, the analysis of changes in the patient’s face temperature both before and after the examination can be a tool for assessing correct patient positioning in the tonometer supports.Climate change is one of the most important causes of the decline in amphibians. Changes in temperature have an important effect on the growth and development and energy metabolism of amphibians. The aim of this study is to unravel the effects of temperature on the leptin signaling pathway of Bufo gargarizans and its molecular mechanisms. Our results showed that high temperature accelerated the development rate of tadpoles, but reduced body size and mass, while low temperature deferred the development of tadpoles, but increased size and mass. Both high temperature and low temperature exposure caused pathological damage of the liver in B. gargarizans. The results of RT-qPCR revealed that the high temperature treatment significantly upregulated the transcript levels of genes related to thyroid hormone (DIO2 (D2), Thyroid Hormone Receptor-α (TRα)) and the leptin signaling pathway (Leptin Receptor (LepR), Janus kinase 1 (JAK1), Janus kinase 2 (JAK2), Tyrosine kinase 2 (TYK2), Signal Transducer And Activator Of Transcription 3 (STAT3), Signal Transducer And Activator Of Transcription 3.1 (STAT3.1), and Signal Transducer And Activator Of Transcription 6 (STAT6)), while there was a decrease of mRNA expression of these genes (TRα, Thyroid Hormone Receptor-Beta (TRβ), LepR, JAK1, and TYK2) in the liver of tadpoles exposed to high temperature compared with the intermediate temperature treatment. Therefore, our results suggested that temperature extremes might interfere with the thyroid and leptin signaling pathways and affect the growth and development of B. gargarizans. Furthermore, tissue injury of the liver could occur due to exposure to temperature extremes. This work promotes public awareness of environmental protection and species conservation needs, also provides valuable experimental data and a theoretical basis for the protection of amphibians.Under relatively cool ambient temperatures and a caloric deficit, mice will undergo daily torpor – a short-term regulated reduction in metabolic rate with a concomitant drop in body temperature. Mice can alternatively achieve metabolic savings by utilizing behavioral changes, such as seeking a warmer environment. However, there is a lack of knowledge about the behavioral interaction between torpor utilization and thermotaxis. That is, if a fasted mouse is faced with a choice between a warm environment not conducive for torpor, and a cool environment that will induce torpor, which scenario will the fasting mouse choose? Here, the temperature preferences of fasted mice were studied using a temperature gradient device that allows a mouse to freely move along a gradient of temperatures. C57BL/6 mice were implanted with temperature telemeters that recorded location, core temperature (Tb), and activity concurrently over a 23-h period in the thermal gradient. When the gradient was on, mice preferred the warm end of the gradient when fed (71 ± 4% of the time) and even more so when fasted (84 ± 2%). When the gradient was on, the fasted minimum Tb was significantly higher (34.4 ± 0.3 °C) than when the gradient was off (27.7 ± 1.6 °C). Further, fasted mice lost significantly more weight when the gradient was off despite maintenance of a metabolically favorable lower minimum Tb in this condition. These results indicate that fasted mice not only prefer warm ambient temperatures when given the choice, but that it is also the pathway with more favorable metabolic outcomes in a period of reduced caloric intake.The purpose of this study was to understand and discuss the relationships of the thermal environment, morphophysiological response, performance, and carcass traits of Brahman bulls from weaning at 18 months exposed to grazing conditions based on the physiological and evolutionary rationale behind the different proposals for the thermal adaptation of zebu cattle. Fifty-three uncastrated and clinically healthy bulls with birth and weaning weight of 34.0 ± 3.32 kg and 215.5 ± 44.75 kg, respectively, were evaluated. Fifteen canonical correlations were estimated, but only six were significant thermal environment × thermoregulatory responses (rc = 0.4635; P = 0.0413); thermal environment × performance (rc = 0.4338; P = 0.0218); thermoregulatory responses × performance (rc = 0.5119; P = 0.0071); hair coat characteristics × performance (rc = 0.4939; P = 0.0273); hormone × carcass traits (rc = 0.5408; P = 0.0698); and performance × carcass traits (rc = 0.9644; P less then 0.0001). Thermal environment, thermoregulatory responses and hair coat morphology influence of 18.81%, 21.49% and 24.40%, respectively, were found in the performance. We also concluded that (i) rectal temperature (RT) is a homoeothermic indicator; (ii) sweating rate (SR) is an important heat dissipation mechanism to explain the adaptation of zebu animals in the tropics and is related to weight at 550 days (W550); (iii) coat morphology, especially length (HL), diameter (HD) and hair density (ND) are related to animal performance; and (iv) hormonal profile, mainly T4, influences the carcass traits (yield, weight, subcutaneous fat and marble meat).The purpose of this study is to develop a comprehensive thermodynamic model of the human respiratory system and quantify the effects of inspiratory air temperature, relative humidity (RH), lung capacity and O2 fluctuation in metabolic reaction on the human respiratory system under three different physiological conditions, i.e. rest, moderate level of physical activity and extreme level of physical activity. Therefore, a second law-based analysis has carried out for the human respiratory system. It is observed that exergetic efficiency decreases by 21% and 16.5% during moderate and extreme level of activity respectively as compared to the physical condition of rest. The respiratory efficiency also increases with the increase in inspiratory air temperature and RH. For a given inspiratory air temperature, an increase in lung volume leads to a reduction in the efficiency. Increase in TV with a high airflow rate gives a higher magnitude of efficiency, such a situation appearing when a person’s lung compliance harmed due to diseases. The respiratory efficiency decreases up to 2% with the increase in O2 percentage. The efficiency of the respiratory system is in maximum during rest followed by an extreme and moderate level of activity. However, with the controlled supply of O2, the efficiency of the human respiratory performance increases with the decrease in O2 percentage. Due to partial oxidation of glucose at a reduced O2 level, exergy input from the metabolic reaction is less leading to increased exergetic efficiency.Motion Sickness is associated with a variety of symptoms, which differ in occurrence rate and intensity between individuals. In order to research the cause of car sickness and develop countermeasures, it is important to determine symptoms and their severity objectively. A tool for this purpose could be the assessment of physiological reactions due to motion sickness. This paper describes and discusses a methodology to identify changes in facial skin temperatures in a real-driving study. Common techniques had to be adjusted in order to meet the requirements given by the challenges of in-car-recording. The examined data was generated in a previous study, which was designed to research motion sickness in a driving environment. A pre-processing technique had to be developed to magnify features on the face and subsequently improve the tracking in thermal imagery. After the pre-processing, regions of interest (ROI) were manually marked and tracked in thermal images. The thereby assessed facial skin temperatures were compared to tympanic temperatures. Derived temperatures from the forehead as well as from the 20 hottest pixels within the face indicated a better tracking, while the nose tip was more affected by detection errors. The correlation of the three features with the tympanic temperature showed remarkable differences between a baseline measurement and the actual driving. Less than 10% of the data derived during the driving and up to 30% of the data during the baseline measurement correlated highly. It is concluded that detecting changes in facial skin temperature using thermal infrared imaging in a moving car is challenging and results are hardly comparable to tympanic temperatures. Future research should aim at the different influencing factors of skin and tympanic temperature, while enhancing tracking or detection of ROI could be achieved by reducing the passengers’ movements or choosing the target area more carefully.Safety instrumented systems often employ redundancy to enhance the ability to detect and respond to hazardous events. The use of redundancy increases the fault tolerance to single failure but remains vulnerable in case of dependent failures, including common cause failures and cascading failures. Reliability analysis of safety instrumented systems therefore involves the impact of dependent failures. The used approaches have primarily focused on common cause failures. In this paper, it is argued the need to consider the efforts of cascading failures that are caused by functional dependencies, hazardous events, and shared resources. A recursive aggregation-based approach is proposed for performance analyzing of K-out-of-N safety instrumented systems with consideration of cascading failures. General approximation formulas are developed for estimating the average probability of failures on demand of different configurations of safety instrumented systems. These formulas are compared with those for common cause failures. Then a case of fire water pump is studied to illustrate the effects of cascading failures on safety instrumented systems.This paper proposes new indices of cascaded multilevel inverters (MLIs) in order to compare the conventional topology with 10-existed new topologies. Reduction in the number of power switches is the main target of these new topologies. This aim is to reduce the total cost of designed inverters, though the mentioned aim is not enough to design new inverters. Thus, in this study, four comparative indices including sources power uniform distribution index (SPUDI), switches current uniform distribution index (SCUDI), switches loss uniform distribution index (SLUDI), and switches voltage uniform distribution index (SVUDI), are proposed. In addition, it is shown that in most of the new topologies, reducing the number of switches can lead to lowered values of the proposed indices, after which non-uniform power, current, loss, and voltage pattern are obtained. The results prove that mere emphasis on the number of switches, along with the exclusion of either of the proposed indices will cause significant problems, where cost reduction may be underachieved. Based on new indices, the advantages of conventional topology over new ones are presented in this study.Low frequency oscillation (LFO) is one of the major concerns for reliable operation of the power system. This LFO occurs due to the failure of the rotor to supply sufficient damping torque to compensate the imbalance between mechanical input and electrical output. Hence, in this paper, we adopt a third generation flexible AC transmission system (FACTS) device named generalized unified power flow controller (GUPFC) based damping controller in order to investigate its effect for mitigating LFO for an single machine infinite bus (SMIB) system. To find an effective damping controller-optimizer pair, we integrate proportional-integral (PI) or lead-lag as a controller and grey wolf optimizer (GWO), differential evolution (DE), particle swarm optimization (PSO), whale optimization algorithm (WOA), and chaotic whale optimization algorithm (CWOA) as an optimizer. Later, we investigate the performances for the above mentioned controller-optimizer pairs through time domain simulation, eigenvalue analysis, nyquist stability test, and quantitative analysis. Moreover, we carry out two non-parametric statistical tests named as one sample Kolmogorov-Smirnov (KS) test and paired sample t-test to identify statistical distribution as well as uniqueness of our optimization algorithms. Our analyses reveal that the GWO tuned lead-lag controller surpasses all other controller-optimizer combinations.

The relationship between adiponectin and type 2 diabetes mellitus (T2DM) is established; however the evidence on its role in high-density lipoprotein (HDL) functionality is still scant. The aim of this study was to assess the association of adiponectin with HDL functionality especially on the antioxidant capacity and HDL subfractions in individuals with T2DM.

This case-control study enrolled 356 individuals who were divided into two groups diabetics [T2DM (n = 188)] and non-diabetic [nT2DM (n = 168)]. The association of adiponectin level on HDL functionality parameters was done in function of the cut-off point for adiponectin [percentile p < 75 = 12.9 μg/mL versus p ≥ 75 = 12.9 μg/mL] and multiple adjustments applied in the logistic regression models.

Body mass index (BMI), waist circumference (WC) and body fat mass (FM) were higher in T2DM. The larger HDL particles (HDL

) were lower in T2DM group in comparison with nT2DM (28.20% versus 30.40%; p = 0.016). Individuals with T2DM and simultaneous highest adiponectin (p ≥ 75) had 2.25 OR (95% CI = 1.03-4.91) and 5.14 OR (95% CI = 2.37-11.15) to present higher HDL-C and HDL

concentrations. After adjustment for multiple confounders, high level of adiponectin was independently related with improvement of the HDL antioxidant capacity (OR = 2.78; 95% CI = 1.16-6.67).

High adiponectin level associates with a lesser negative impact of T2DM on HDL functionality by increase in APO AI, particles size, and cholesterol content. On the same token, higher adiponectin was associated with greater odds to have high antioxidant capacity.

High adiponectin level associates with a lesser negative impact of T2DM on HDL functionality by increase in APO AI, particles size, and cholesterol content. On the same token, higher adiponectin was associated with greater odds to have high antioxidant capacity.

In individuals at increased risk of infections, e.g., patients with type 2 diabetes, low MBL may have detrimental effects. We used the Mendelian randomization principle to examine whether genetically low MBL is a risk factor for developing infections in patients with type 2 diabetes.

Serum MBL (n = 7305) and MBL genotype (n = 3043) were determined in a nationwide cohort of patients with new type 2 diabetes and up to 8 years follow-up for hospital-treated infections and community-based antimicrobial prescriptions. The associations were examined in spline and Cox regression analyses.

1140 patients (16%) were hospitalized with an infection and 5077 patients (70%) redeemed an antimicrobial prescription. For low (≤100 μg/L) versus intermediate (101-1000 μg/L) serum MBL concentration, the adjusted hazard ratios (aHRs) were 1.13(95% confidence interval, 0.96-1.33) for any hospital-treated infections and 1.19(1.01-1.41) for bacterial infections. Low MBL expression genotype was not associated with risk of any hospital-treated infections except for diarrheal diseases (aHR 2.23[1.04-4.80]). Low MBL expression genotype, but not low serum MBL, was associated with increased risk for antimicrobial prescriptions (aHR 1.18[1.04-2.34] and antibacterial prescriptions 1.20[1.05-1.36]).

Low MBL is a weak causal risk factor for developing infections in patients with type 2 diabetes.

Low MBL is a weak causal risk factor for developing infections in patients with type 2 diabetes.

The aim of this study was to evaluate changes in both mechanism and diagnoses of injuries presenting to the orthopaedic department during this lockdown period, as well as to observe any changes in operative case-mix during this time.

A study period of twelve weeks following the introduction of the nationwide „lockdown period”, March 23

– June 14

, 2020 was identified and compared to the same time period in 2019 as a „baseline period”. A retrospective analysis of all emergency orthopaedic referrals and surgical procedures performed during these time frames was undertaken. All data was collected and screened using the 'eTrauma’ management platform (Open Medical, UK). The study included data from a five NHS Foundation Trusts within North West London. A total of 6695 referrals were included for analysis.

The total number of referrals received during the lockdown period fell by 35.3% (n=2631) compared to the same period in 2019 (n=4064). Falls remained proportionally the most common mechanism of injury acjuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.

In conclusion, the nationwide lockdown has led to a decrease in emergency orthopaedic referrals and procedure numbers. There has been a change in mechanism of injuries, with fewer sporting injuries, conversely, there has been an increase in the number of pushbike or scooter related injuries during the lockdown period. NOF fractures remained at similar levels to the previous year. There was a change in strategy for managing distal radius fractures with more fractures being treated non-operatively.

To explore the association between return to work (RTW) and mental health outcomes in Black men in Philadelphia recovering from serious traumatic injuries.

We analyzed data from 498 Black men aged ≥ 18 years living in Philadelphia who were admitted to a Level I trauma center for injury between January 2013 and June 2017. We used multivariable logistic regression to estimate the association between pre-injury occupation, RTW and depression or PTSD 3 months after hospitalization.

In adjusted analyses, men who had not RTW at follow-up had higher odds of poor mental health outcomes than men who had RTW (OR 2.7, 95% CI 1.8, 4.2). Additional significant factors included younger age, lack of or public health insurance and higher lifetime experiences of racism.

The mental health recovery trajectory of injured Black men living in Philadelphia is associated with RTW and other factors that can influence financial stability and economic resources.

Programmatic strategies that seek to optimize recovery after injury in Black men should include consideration of key structural factors such as employment, financial stability, and the impact of racism-related exposures.

Programmatic strategies that seek to optimize recovery after injury in Black men should include consideration of key structural factors such as employment, financial stability, and the impact of racism-related exposures.

Tibial shaft fractures are a commonly encountered challenge presented to orthopaedic trauma surgeons. Intramedullary nailing (IMN) is often the treatment of choice and whilst effective, complications of delayed and/or non-union can cause significant morbidity and necessitate additional operative procedures. The use of Poller screws during IMN are a recognised way of aiding fracture reduction, however the clinical benefits of this are debated. This study evaluated the outcome of tibial shaft fractures treated with IMN with or without the addition of Poller screws.

Retrospective cohort study of all patients undergoing IMN following tibial shaft fractures over a 5-year period. 154 operated tibial shaft fractures were identified, with patients divided into 3 groups – Group 1 IM nailing alone, Group 2 IMN+1 conventional Poller screw, or Group 3 IMN+2 Poller screws placed Epicentrically across the fracture site. Data collected included demographics, length of stay, fracture type, position and AO classification ition of Poller screws appear to be a safe and effective adjunct in the treatment of tibial shaft fractures via IMN. Further prospective randomised trials are needed to fully elucidate both the role and potential benefits of Poller screw augmentation in acute lower limb fracture management.Epstein Barr virus-associated smooth muscle tumors are an uncommon neoplasm that occurs in immunosuppressed patients of any age. Usually, it presents as multifocal tumors mainly in the spinal cord, epidural region, gastrointestinal tract and liver, upper respiratory tract and skin, the latest with few cases reported in the literature and related with human immunodeficiency virus infection and acquired immune deficiency syndrome. The authors present the first case of a Colombian adult patient with human immunodeficiency virus infection and multifocal Epstein Barr virus-associated smooth muscle tumors in the skin and epidural region, confirmed by histopathology, immunohistochemistry and in situ hybridization studies.

There are no guidelines to screen haemato-oncologic children when a tuberculosis (TB) outbreak is suspected.

After exposition to an adult with active TB, children exposed from a haemato-oncology unit were screened according to immunosuppression status and time of exposure. Until an evaluation after 8-12 weeks from last exposure, isoniazid was indicated to those with negative initial work-up.

After 210 interventions, we detected a case of pulmonary TB, and another with latent TB infection. Pulmonary findings and treatment approach were challenging in some patients.

The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.

The TB screening of oncologic children required a multidisciplinary approach, and clinicians managed challenging situations.Immunization is the most effective preventive strategy against varicella. While the Oka strain is commonly used for varicella vaccination worldwide, Korea widely uses the MAV/06 strain. A new live attenuated MAV/06 strain varicella vaccine (MG1111), which uses the new cell line Medical Research Council-5 for better viral propagation, was developed. MG1111 was approved by Korean health authorities. Here, we report the results of phase III, randomized, double-blind, multicenter study conducted in Korea and Thailand, which compared the immunogenicity and safety profiles of MG1111 versus the control vaccine, VarivaxTM. In total, 515 healthy children (12 month-12 years) were randomized 11 to receive either the MG1111 or control vaccine (MG1111 258, Control 257). The seroconversion rate (SCR) and geometric mean titer (GMT) were measured using the fluorescent antibody to membrane antigen (FAMA) test. The MG1111 group achieved a SCR of 97.9% (95% CI 95.2-99.3) after vaccination. The lower limit of 95% CI for SCR difference (MG1111-VarivaxTM) was -4.0%, which was higher than the specified non-inferiority margin of -10%. Further, the GMT of the MG1111 increased from 2.0 to 74.2 (95% CI 65.0-84.8) and the lower limits of the 95% CI for post-vaccination GMT ratios (MG1111/VarivaxTM) were 0.55 higher than the specified parameter of 0.5. Therefore, the MG1111 group was not statistically inferior to the control vaccine group in terms of SCR and GMT. Furthermore, the MG1111 and control vaccine groups were not significantly different in the percentage of participants showing adverse events-solicited, local, or systemic during 43-day period of observation and serious adverse events during 6 month of observation. The present results indicate that MG1111was not immunologically inferior to VarivaxTM, and safety profiles of MG1111 are similar to those of VarivaxTM.

There is evidence that the pneumococcal polysaccharide vaccine (PPV) may reduce cardiovascular disease. We aimed to evaluate the cost-effectiveness of PPV for primary prevention of acute coronary syndrome (ACS) in the elderly in Australia.

A Markov model was developed to investigate the costs, QALYs and ICERs of PPV administration in those aged ≥65years without a history of ACS from the perspective of Australian healthcare system, using elderly-specific clinical data and local costs from Australian Heart Foundation and Australian Institute of Health and Welfare databases. A ten-years horizon was used, and all costs and health outcomes were discounted at 5% annually. The impact of various assumptions was tested with sensitivity analyses.

In the base-case analysis, interventional strategy (100% PPV coverage) prevented an additional five incident ACS events among 1000 „healthy” elderly individuals compared with standard of care (50% PPV coverage) over 10years. 100% PPV was the dominant strategy, resulting in a QALY gain of 0.0075 and cost saving of AU$ 179 per person. The results were most sensitive to effectiveness of PPV at preventing ACS and reducing hospital bed-days, and cost of ACS admission, but in all sensitivity analyses 100% PPV remained the dominant strategy. Shortening the time horizon from ten to five years resulted in further cost saving.

PPV for the prevention of ACS in those aged ≥65 is a dominant intervention strategy, with cost saving and minor improvements in QALY. Healthcare providers should promote PPV administration for all eligible populations.

PPV for the prevention of ACS in those aged ≥65 is a dominant intervention strategy, with cost saving and minor improvements in QALY. Healthcare providers should promote PPV administration for all eligible populations.

Malnutrition is associated with poor prognosis in a wide range of chronic illnesses, however, the impact of malnutrition on long-term outcomes of patients at advanced stages of atherosclerosis, coronary chronic artery occlusion (CTO), is not known.

This study aims to investigate the relationship between malnutrition and adverse cardiovascular events in patients with CTO after percutaneous coronary intervention (PCI).

Baseline malnutrition risk was determined in 669 patients with CTO after PCI in this study. All patients were divided into 3 groups according to 3 categories of the geriatric nutritional risk index (GNRI) moderate to severe, GNRI of <92 (n=70); low, GNRI of 92-98 (n=197); and absence of risk, GNRI of ≥98 (n=402). The primary endpoint was all-cause mortality and the secondary endpoint was major adverse cardiovascular events (MACE).

Average age in this study was 65.32±9.97 years old. More than one-third of patients were at risk of malnutrition (moderate to severe 10.5%; low 29.4%; and abing risk prediction model significantly increased the predictive ability for cardiovascular events in CTO patients after PCI.

Malnutrition assessed by the GNRI score on admission was an independent predictor for adverse cardiovascular events in CTO patients after PCI. Addition of the GNRI score to the existing risk prediction model significantly increased the predictive ability for cardiovascular events in CTO patients after PCI.Full-thickness macular hole is a rare complication of macular telangiectasia type 2, and its treatment is still controversial. A patient with a full-thickness macular hole secondary to macular telangiectasia type 2 underwent vitreoretinal surgery with a plasma rich in growth factors membrane in the macular hole. At the sixth month of follow-up, anatomical and functional improvements were achieved, with no adverse effects. Plasma rich in growth factors is a new option, with advantages due to its biological properties that achieves good results in terms of safety and effectiveness in the surgical treatment of macular hole.A 54-year-old female patient with a history of acute myeloid leukaemia and receiving maintenance chemotherapy had a systemic relapse. She also had candidaemia caused by Candida tropicalis. Her blood cultures were negative after receiving antifungal treatment. Later, she had an ophthalmological assessment as part of the protocol, without ocular discomfort. In the fundoscopic examination, a whitish chorioretinal lesion was found in the left eye in relation to subretinal abscess, which correlated with retinal angiography and optical coherence tomography. The patient was treated with systemic antifungals with a favourable resolution of the lesion.Trochleitis is usually a transient and non-disabling inflammation of the trochlea of superior oblique. The case is presented of a difficult to manage bilateral trochleitis in a 29-year-old woman. After an exhaustive aetiological study with neuro-imaging tests, as well as an analysis of autoimmunity and infection, no underlying cause was found. Multiple injections of corticosteroids were required in both eyes, with a partial effect. Surgical intervention was finally decided in order to visually examine the trochlea, take biopsies, and inject methylprednisolone. These were effective in relieving the symptoms. This case is exceptional due to it involving both eyes and its severity, and represented a therapeutic challenge for the clinical team.

To perform pre-clinical testing using optical design tools to simulate the optical quality of a smart artificial iris platform encapsulated in a scleral contact lens. These tools allow us to generate aniridia eye models and evaluate different metrics of visual quality and retinal illumination based on the aperture of the artificial iris based on liquid crystals.

The OCT imaging technique was used to measure the geometry of the anterior segment in a patient with aniridia and, from these data, the eye model was generated with the Zemax optical design program and specific programs developed in Matlab. Ocular aberrations were calculated and the visual function of the anirida eye model was evaluated in three scenarios (i) without optical correction, (ii) with correction with a commercial scleral contact lens, and (iii) with correction with an optical lens. intelligent contact based on artificial iris.

Optical quality in patients with aniridia is limited by the magnitude of high-order aberrations. Conventionae concept of an intelligent artificial iris platform encapsulated in a scleral contact lens and its possible application in patients with aniridia. Furthermore, it allows us to anticipate possible visual results in clinical trials with healthy patients (after application of mydriatic agents) and in patients with aniridia. The results demonstrate a better visual quality and a decrease in retinal illumination.Intravascular papillary endotelial hyperplasia is a bening vascular lesion that rarely involves the periocular region, nevertheless, it should be considered in the differential diagnosis of a periorbital mass. It is histopatologically characterized by intravascular fibrous papillary fronds covered by endothelial cells. Histopathological differentiation from angiosarcoma can be challenging but is very important to avoid aggressive treatments. Complete surgical excision is frequently curative. Uncompleted excision can lead to recurrences. We describe the clinical and histological findings of intravascular papillary endotelial hyperplasia in the left lower lid of a 72-year-old woman who had a painless mass since 15 years ago, that caused hypertropia of her left eye. Histopathological examination revealed intralesional calcification, which is not an usual feature in this entity. The patient underwent complete surgical resection of the mass and there was no evidence of recurrence after 5 months of follow-up after surgery.

The effectiveness of technology-assisted interventions designed to ameliorate depressive symptoms and improve antidepressant medication adherence is hampered by diminished usage over time and poor integration with clinical care.

This manuscript presents patient perspectives on a texting and secure messaging intervention designed to engage providers and patients during a targeted transition period when patients were initiating a new antidepressant medication.

Development of the intervention was guided by feedback from a presentation and discussion with an engagement panel of local stakeholders, including patients, who meet quarterly with research investigators.

Semi-structured, qualitative, telephone interviews were conducted with 21 participants. Interviews were designed to identify the themes of self-determination and planned behavior in using the text messaging intervention. Qualitative analysis of participants’ experiences used inductive and deductive coding, as well as pile sorting.

The intervenstand provider buy-in, or lack thereof, in e-health interventions.

Compare failure modes and fracture origins using fractography on recovered clinically fractured parts of indirect resin composite endocrowns and overlay restorations on endodontically treated teeth (ETT).

Four endocrowns (3 molars, 1 premolar) and one overlay (molar) adhesively luted on ETT were recovered after fracturing during function. The time in service ranged between 4 and 48 months. The composite materials were (i) CAD/CAM LAVA Ultimate (N = 1), (ii) Premise Indirect (N = 2), and (iii) Colombus (N = 2). Fractography was performed by means of digital microscopy and SEM. Occlusal surfaces were checked for signs of fatigue degradation and contact wear. Cuspal plane angles were measured from profiles obtained from 3D digital microscope images with respect to the horizontal plane of the occlusal central crown groove.

All five cases showed a wedge-opening mode I fracture, splitting the crown and tooth in two parts through the crown’s central groove. Classic brittle fracture features (arrest lines, twist and wake hackle) were easily identified on the fracture surfaces. Multiple origins were located along the central groove in conjunction with the presence of fatigue cracks. Contact wear surfaces showed pitting and cracking. Cuspal plane angles were around 30-35°, except a 50° palatal cusp slope for the Lava Ultimate overlay.

Fractography on clinical fractures of resin composites was enlightening. Occlusal surface fatigue degradation from cyclic loading, mode I fracture from applied mastication forces on cuspal planes, and stress concentration within the crown’s central groove, indicate limitations of use of these materials for endocrowns in posterior teeth.

Fractography on clinical fractures of resin composites was enlightening. Occlusal surface fatigue degradation from cyclic loading, mode I fracture from applied mastication forces on cuspal planes, and stress concentration within the crown’s central groove, indicate limitations of use of these materials for endocrowns in posterior teeth.

Temporal lobe epilepsy is associated with tissue abnormalities of several gray and white matter structures that are reproduced in animal models. Few longitudinal studies have focused on the identification of structural differences during epileptogenesis. The diffusion tensor model is a useful tool for evaluating cell death, gliosis, and axonal plasticity in epileptic subjects. This study aimed to evaluate temporal tissue changes after experimental status epilepticus in an animal model of chronic temporal lobe epilepsy.

Systemic pilocarpine-induced status epilepticus in adult Sprague-Dawley rats. Animals were scanned using diffusion tensor imaging (DTI) at three time points prior to status epilepticus, and 24 and 64 days post-induction (early and late chronic, respectively). Fractional anisotropy, apparent diffusion coefficient, axial diffusivity (D

), and radial diffusivity (D

) were evaluated in white (fimbria, cingulum, corpus callosum, and internal capsule) and gray (dorsal hippocampus, dentate gyrus, and CA3) matter regions for the three time points. Histological assessment of neurodegeneration in Klüver-Barrera preparations from the same animals was performed.

Significantly reduced volume of dorsal hippocampus and fimbria of the epileptic animals was observed already at 24 days post-status epilepticus. Progressive changes of DTI parameters in both the white and gray matter structures of the experimental group were also observed. Stained sections confirmed such alterations.

Our study revealed time-dependent diffusion changes in gray and white matter structures after pilocarpine-induced status epilepticus. The characterization of these alterations over time may be potential imaging markers for epileptogenesis.

Our study revealed time-dependent diffusion changes in gray and white matter structures after pilocarpine-induced status epilepticus. The characterization of these alterations over time may be potential imaging markers for epileptogenesis.

This study aimed to evaluate national trends in utilization, resource use, and predictors of immediate breast reconstruction (IR) after mastectomy.

The 2005-2014 National Inpatient Sample database was used to identify adult women undergoing mastectomy. IR was defined as any reconstruction during the same inpatient stay. Multivariable regression models were utilized to identify factors associated with IR.

Of 729,340 patients undergoing mastectomy, 41.3% received IR. Rates of IR increased from 28.2% in 2005 to 58.2% in 2014 (NP-trend<0.001). Compared to mastectomy alone, IR was associated with increased length of stay (2.5 vs. 2.1 days, P<0.001) and hospitalization costs ($17,628 vs. $8,643, P<0.001), which increased over time (P<0.001). Predictors of IR included younger age, fewer comorbidities, White race, private insurance, top income quartile, teaching hospital designation, high mastectomy volume, and performance of bilateral mastectomy.

Mastectomy with IR is increasingly performed with resource utilization rising at a steady pace. Our study points to persistent sociodemographic and hospital level disparities associated with the under-utilization of IR. Efforts are needed to alleviate disparities in IR.

Mastectomy with IR is increasingly performed with resource utilization rising at a steady pace. Our study points to persistent sociodemographic and hospital level disparities associated with the under-utilization of IR. Efforts are needed to alleviate disparities in IR.

Hypoalbuminemia is a negative acute phase reactant which has been associated with inflammatory response and poor outcome in infectious diseases. The aim of this study was to analyze the value of hypoalbuminemia on admission as a predictor of mortality and adverse events in COVID-19 patients.

We analyzed retrospective data from a cohort of 609 consecutive patients, with confirmed diagnosis of COVID-19, discharged from hospital (deceased or alive). Demographic characteristics, previous comorbidities, symptoms and laboratory findings on admission were collected. Comorbidities were assessed by Charlson-Age Comorbidity Index.

Hypoalbuminemia on admission (<34g/L) was more frequent in nonsurvivors than survivors (65.6% vs. 38%, p<0.001) and was significantly associated with the development of sepsis, macrophage activation syndrome, acute heart failure, acute respiratory distress syndrome and acute kidney injury, regardless of Charlson-Age Comorbidity Index. Hypoalbuminemia was a predictor of mortality ium albumin determination on admission may help to identify patients with SARS-CoV-2 infection at high risk of developing potential life-threatening conditions and death.

The aims of this retrospective study were, first to evaluate the distance between the root apices of the upper first molars and the palatal plane (PP), and second to determine the validity (accuracy) of the use of cephalometric radiographs or panoramic X-rays compared to cone beam computed tomography (CBCT) in determining this distance.

The distance was calculated from the root apices of the first molars to PP, on the cephalometric radiographs of 204 subjects and then 57 measurements were compared to those obtained on panoramic X-rays and CBCT images, in order to find a statistically significant difference according to age, sex, side, vertical and sagittal skeletal patterns, and to determine if 2D radiographs are suitable for this task.

The distance increased significantly in subjects after 20 years of age and in hyperdivergent patients, but was not influenced by sex, side or anteroposterior position of the mandible. No statistical significance was found between the calculated measurements on cephalometric and CBCT radiographs, but both were different from those taken on panoramic X-rays.

Cephalometric radiographs are reliable in the assessment of the distance between the roots of the upper molars and the PP. In hyperdivergent and adult patients, posterior teeth have enough space between their roots and the upper limit of the hard palate to undergo intrusion mechanics using miniscrews, but care must be taken while planning and managing these movements in order to minimize the unwanted side effects.

Cephalometric radiographs are reliable in the assessment of the distance between the roots of the upper molars and the PP. In hyperdivergent and adult patients, posterior teeth have enough space between their roots and the upper limit of the hard palate to undergo intrusion mechanics using miniscrews, but care must be taken while planning and managing these movements in order to minimize the unwanted side effects.

Despite growing evidence that checkpoint inhibitor immunotherapy (IO) toxicity is associated with improved treatment response, the relationship between immune-related adverse events (irAEs) and overall survival (OS) among older adults [age ≥ 70 years (y)] remains unknown. The study goal was to determine differences in OS based on age and ≥ grade 3 (G3) irAEs.

This was a retrospective cohort study of 673 patients with advanced cancer. Patients who received ≥1 dose of IO at our institution from 2011 to 2018 were eligible. The primary outcome was OS from the start of first line of IO treatment, compared between four patient groups stratified by age and ≥ G3 irAEs with adjustment for patient characteristics using a Cox proportional hazards model.

Among all 673 patients, 35.4% were ≥ 70y, 39.8% had melanoma, and 45.6% received single-agent nivolumab. Incidence and types of ≥G3 irAEs did not differ by age. Median OS was significantly longer for all patients with ≥G3 irAEs (unadjusted 21.7 vs. 11.9 months, P =ased OS (HR 0.33, 95% CI 0.21-0.52, P less then 0.001). Younger patients, but not older adults, with high-grade irAEs experience strong survival benefit. This difference may be due to the toll of irAEs themselves or the effects of treatments for irAEs, such as corticosteroids. Factors impacting OS of older adults after irAEs must be determined and optimized.

Medication self-management is complicated for older people. Little is known about older persons’ considerations and decisions concerning medication therapy at home.

(s) To explore how older people living at home self-manage their medication and what considerations and decisions underpin their medication self-management behavior.

Semi-structured interviews with consenting participants (living at home, aged ≥65, ≥5 different prescription medications daily) were recorded and transcribed with supporting photographs. Content was analyzed with a directed approach and presented according to three phases of medication self-management (initiation, execution, and discontinuation).

Sixty people were interviewed. In the initiation phase, participants used different techniques to inform healthcare professionals and to fill and check prescriptions. Over-the-counter medication was seldom discussed, and potential interactions were unknown to the participants. Some participants decided to not start treatment after rean of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals.

Participants’ considerations and decisions led to the following problems in organizing medication intake, inadequate discussion of medication-related information with healthcare professionals, and incorrect and undesirable medication storage and disposal. There is a need for medication self-management observation, monitoring, and assistance by healthcare professionals.Corynebacterium kroppenstedtii is an immobile, non-sporulated, glucose-fermenting and lipophilic gram-positive rod of the skin microbiota. In recent years, numerous isolates of this species have been reported mainly in breast infections, such as abscesses and granulomatous mastitis. We present here four cases of C. kroppenstedtii infections isolated from breast aspiration samples in women. C. kroppenstedtii was identified by conventional methodology and mass spectrometry (MALDI-TOF MS). Using the epsilometric method, these isolates showed susceptibility to penicillin, ceftriaxone, minocycline, ciprofloxacin, and vancomycin, and variable susceptibility to clindamycin and trimethoprim sulfamethoxazole. Due to the association of C. kroppenstedtii with mammary infections, the identification at the species level of those corynebacteria isolated from this location is highly advisable in order to reach the final diagnosis and to test the antimicrobial susceptibility in order to apply the appropriate antibiotic treatment.Each of the 3 morphological subtypes of cholangiocarcinoma has a different set of imaging differentials. Emulators of mass-forming cholangiocarcinoma include other primary and secondary hepatic malignancies, benign tumors and tumor-like mimics such as abscess, hemangioma and confluent hepatic fibrosis. Benign inflammatory biliary strictures constitute the major differential of periductal-infiltrative type and intraductal calculi are the main consideration for intraductal-growth type. CT and MRI are the standard imaging tools for characterization of cholangiocarcinoma and differentiating it from close mimics. Here we will describe the various tumoral and non-tumoral mimics of cholangiocarcinoma and discuss specific imaging features useful in differentiation.No abstract available.At present, effective antibiotics and comprehensive symptomatic/supportive treatment as early as possible are mainly used for the treatment of severe pertussis in clinical practice. However, some children with severe pertussis have unsatisfactory response to commonly used drugs and treatment measures in the intensive care unit and thus have a high risk of death. Studies have shown that certain treatment measures given in the early stage, such as exchange transfusion, may help reduce deaths, but there is still a lack of uniform implementation norms. How to determine the treatment regimen for severe pertussis and improve treatment ability remains a difficult issue in clinical practice. This article reviews the advances in the treatment of severe pertussis, in order to provide a reference for clinical treatment and research.

To study the clinical application of the modified nutritional risk screening tool and nutrition assessment in pediatric patients in China, and to provide a theoretical basis for establishing a standardized nutritional management process for pediatric patients.

A retrospective analysis was performed for the nutritional risk screening and nutrition assessment data of 16 249 hospitalized children. According to the degree of nutritional risk, the children were divided into a high nutritional risk group with 588 children, a moderate nutritional risk group with 4 330 children, and a non-nutritional risk group with 11 331 children. Nutrition assessment results were compared between groups. The composition of nutritional risk screening scores and the impact of nutritional risk screening on the rate of nutrition support therapy were analyzed.

The incidence rate of nutritional risk was 30.27% (4 918/16 249), and the incidence rates of malnutrition and overnutrition were 27.37% (4 448/16 249) and 11.29% (1 834/16 249), respectively.