Search results for: invasive lobular carcinoma

Authors: I. Wiemann, N. Weiß, E. Schlücker, M. Wensing

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A very promising alternative to compression or cryogenics is the chemical storage of hydrogen by liquid organic hydrogen carriers (LOHC). These carriers enable high energy density and allow, at the same time, efficient and safe storage under ambient conditions without leakage losses. Another benefit of this storage medium is the possibility of transporting it using already available infrastructure for the transport of fossil fuels. Efficient use of LOHC is related to precise process control, which requires a number of sensors in order to measure all relevant process parameters, for example, to measure the level of hydrogen loading of the carrier. The degree of loading is relevant for the energy content of the storage carrier and simultaneously represents the modification in the chemical structure of the carrier molecules. This variation can be detected in different physical properties like permittivity, viscosity, or density. E.g., each degree of loading corresponds to different viscosity values. Conventional measurements currently use invasive viscosity measurements or near-line measurements to obtain quantitative information. This study investigates permittivity changes resulting from changes in hydrogenation degree (chemical structure) and temperature. Based on calibration measurements, the degree of loading and temperature of LOHC can thus be determined by comparatively simple permittivity measurements in a cavity resonator. Subsequently, viscosity and density can be calculated. An experimental setup with a heating device and flow test bench was designed. By varying temperature in the range of 293,15 K -393,15 K and flow velocity up to 140 mm/s, corresponding changes in the resonation frequency were determined in the hundredths of the GHz range. This approach allows inline process monitoring of hydrogenation of the liquid organic hydrogen carrier (LOHC).

Keywords: hydrogen loading, LOHC, measurement, permittivity, viscosity

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Authors: Jiri Kysucan, Dusan Klos, Katherine Vomackova, Pavel Koranda, Martin Lovecek, Cestmir Neoral, Roman Havlik

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Aim: The prognosis of patients with pancreatic cancer is poor. The median of survival after establishing diagnosis is 3-11 months without surgical treatment, 13-20 months with surgical treatment depending on the disease stage, 5-year survival is less than 5%. Radical surgical resection remains the only hope of curing the disease. Early diagnosis with valid establishment of tumor resectability is, therefore, the most important aim for patients with pancreatic cancer. The aim of the work is to evaluate the contribution and define the role of 18F-FDG PET/CT in preoperative staging. Material and Methods: In 195 patients (103 males, 92 females, median age 66,7 years, 32-88 years) with a suspect pancreatic lesion, as part of the standard preoperative staging, in addition to standard examination methods (ultrasonography, contrast spiral CT, endoscopic ultrasonography, endoscopic ultrasonographic biopsy), a hybrid 18F-FDG PET/CT was performed. All PET/CT findings were subsequently compared with standard staging (CT, EUS, EUS FNA), with peroperative findings and definitive histology in the operated patients as reference standards. Interpretation defined the extent of the tumor according to TNM classification. Limitations of resectability were local advancement (T4) and presence of distant metastases (M1). Results: PET/CT was performed in a total of 195 patients with a suspect pancreatic lesion. In 153 patients, pancreatic carcinoma was confirmed and of these patients, 72 were not indicated for radical surgical procedure due to local inoperability or generalization of the disease. The sensitivity of PET/CT in detecting the primary lesion was 92.2%, specificity was 90.5%. A false negative finding in 12 patients, a false positive finding was seen in 4 cases, positive predictive value (PPV) 97.2%, negative predictive value (NPV) 76,0%. In evaluating regional lymph nodes, sensitivity was 51.9%, specificity 58.3%, PPV 58,3%, NPV 51.9%. In detecting distant metastases, PET/CT reached a sensitivity of 82.8%, specificity was 97.8%, PPV 96.9%, NPV 87.0%. PET/CT found distant metastases in 12 patients, which were not detected by standard methods. In 15 patients (15.6%) with potentially radically resectable findings, the procedure was contraindicated based on PET/CT findings and the treatment strategy was changed. Conclusion: PET/CT is a highly sensitive and specific method useful in preoperative staging of pancreatic cancer. It improves the selection of patients for radical surgical procedures, who can benefit from it and decreases the number of incorrectly indicated operations.

Keywords: cancer, PET/CT, staging, surgery

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Authors: Sergey Kholodkevich, Tatiana Kuznetsova

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The objective assessment of ecological state of water ecosystems is impossible without the use of biological methods of the environmental monitoring capable in the integrated look to reveal negative for biota changes of quality of water as habitats. Considerable interest for the development of such methods of environmental quality control represents biomarker approach. Measuring systems, by means of which register cardiac activity characteristics, received the name of bioelectronic. Bioelectronic systems are information and measuring systems in which animals (namely, benthic invertebrates) are directly included in structure of primary converters, being an integral part of electronic system of registration of these or those physiological or behavioural biomarkers. As physiological biomarkers various characteristics of cardiac activity of selected invertebrates have been used in bioelectronic system.lChanges in cardiac activity are considered as integrative measures of the physiological condition of organisms, which reflect the state of the environment of their dwelling. Greatest successes in the development of tools of biological methods and technologies of an assessment of surface water quality in real time. Essential advantage of bioindication of water quality by such tool is a possibility of an integrated assessment of biological effects of pollution on biota and also the expressness of such method and used approaches. In the report the practical experience of authors in biomonitoring and bioindication of an ecological condition of sea, brackish- and freshwater areas is discussed. Authors note that the method of non-invasive cardiac activity monitoring of selected invertebrates can be used not only for the advancement of biomonitoring, but also is useful in decision of general problems of comparative physiology of the invertebrates.

Keywords: benthic invertebrates, physiological state, heart rate monitoring, water quality assessment

Procedia PDF Downloads 701

Authors: Lubena Achmad, Herman Kristanto, Julian Dewantiningrum

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Background: The Bishop score is a standard method used to predict the success of induction. This examination tends to be subjective with high inter and intraobserver variability, so it was presumed to have a low predictive value in terms of the outcome of labor induction. Cervical length measurement using transvaginal ultrasound is considered to be more objective to assess the cervical length. Meanwhile, this examination is not a complicated procedure and less invasive than vaginal touché. Objective: To compare transvaginal ultrasound and Bishop score in predicting successful induction. Methods: This study was a prospective cohort study. One hundred and twenty women with singleton pregnancies undergoing induction of labor at 37 – 42 weeks and met inclusion and exclusion criteria were enrolled in this study. Cervical assessment by both transvaginal ultrasound and Bishop score were conducted prior induction. The success of labor induction was defined as an ability to achieve active phase ≤ 12 hours after induction. To figure out the best cut-off point of cervical length and Bishop score, receiver operating characteristic (ROC) curves were plotted. Logistic regression analysis was used to determine which factors best-predicted induction success. Results: This study showed significant differences in terms of age, premature rupture of the membrane, the Bishop score, cervical length and funneling as significant predictors of successful induction. Using ROC curves found that the best cut-off point for prediction of successful induction was 25.45 mm for cervical length and 3 for Bishop score. Logistic regression was performed and showed only premature rupture of membranes and cervical length ≤ 25.45 that significantly predicted the success of labor induction. By excluding premature rupture of the membrane as the indication of induction, cervical length less than 25.3 mm was a better predictor of successful induction. Conclusion: Compared to Bishop score, cervical length using transvaginal ultrasound was a better predictor of successful induction.

Keywords: Bishop Score, cervical length, induction, successful induction, transvaginal sonography

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Authors: Fadwa Chtioui

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Vital Pulp Therapy (VPT) is nowadays challenging the deep-rooted dogma of root canal treatment, being the only therapeutic option for permanent teeth diagnosed with irreversible pulpitis or carious pulp exposure. Histologic and clinical research has shown that compromised dental pulp can be treated without the full removal or excavation of all healthy pulp, and the outcome of the partial or full pulpotomy followed by a Tricalcium-Silicate-based dressing seems to show promising results in maintaining pulp vitality and preserving affected teeth in the long term. By reviewing recent advances in the techniques of VPT and their clinical effectiveness and safety in permanent teeth with irreversible Pulpitis, this work provides a new understanding of pulp pathophysiology and defense mechanisms and will reform dental practitioners' decision-making in treating irreversible pulpits from root canal therapy to vital pulp therapy by taking advantage of the biological effects of Tricalcium Silicate materials. Biography of presenting author: Fadwa Chitoui graduated from the school of Dental Medicine of Monastir, Tunisia, in 2015. After getting her DDS degree with honors, she earned her Postgraduate master's Degree in Endodontics and Restorative Dentistry from her Faculty. Since 2021, she has Started her own private and specialized practice based in the capital Tunis. She enjoys the sphere of associative life, worked with national and international associations, and got engaged in scientific dental research, whereby she tailored her passion for her field of specialty towards broadening her knowledge and ambitions, holding conferences and workshops nationally and internationally and publishing scientific articles in several journals.

Keywords: irreversible pulpitis, permanenet teeth, vital pulp therapy, pulpotomy

Procedia PDF Downloads 54

Authors: Farhan Nayyar, A. Batool

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The red palm weevil (RPW), being the most invasive insect pest of palm family, is considered as the most dangerous pest around the globe. As three out of four life stages of weevils are concealed inside the host plants, leaving only the adult stage for controlling it. The use of sex pheromone (Ferrugineol) for the management of red palm weevil is considered as the most rewarding technique of IPM. The current studies were conducted to find the relative potential of four different treatments including Sex pheromone, sex pheromone + date fruit + sugarcane pieces, sex pheromone + ethyl acetate and sex pheromone + jaggary water applied on the attraction behavior of weevils. The treatments were applied randomly at two different locations of Dera Ismail Khan, Khyber Pakhtunkhwa, Pakistan including Germ Plasm Unit (GPU) and fruit nursery farm having date palm plants of different ages of four varieties of date palm. The treatments were applied for three consecutive months, including February, March, and April 2022. The pheromone traps were installed at the height of two feet under shade on the western side of date palm plants. The results revealed that among the treatments, T4 consisting of Jaggary water and sex pheromone was found as the most effective treatment and attracted the maximum number of 127 weevils followed by T3 consisting of ethyl acetate and sex pheromone, attracting 53 weevils. In contrast to this, T2 consisting of sex pheromone and date fruit was found as the least effective treatment in attracting red palm weevil and attracted only 15 adult weevils. Among the two selected locations, the population of red palm weevil was found comparatively higher at GPU compared to the nursery farm, Dera Ismail Khan. In conclusion, T4 may be used for the effective and safer management of red palm weevil.

Keywords: red palm weevil, integrated management, sex pheromones, Jaggary water

Procedia PDF Downloads 81

Authors: Eric Sitorus, Septian Prahastudhi, Turgod Nainggolan, Erwin Riyanto

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Mining by block or panel caving is a mining method that takes advantage of fractures within an ore body, coupled with gravity, to extract material from a predetermined column of ore. The caving column is weakened from beneath through the use of undercutting, after which the ore breaks up and is extracted from below in a continuous cycle. The nature of this method induces cyclical stresses on the pillars of excavations as stress is built up and released over time, which has a detrimental effect on both the installed ground support and the rock mass itself. Ground support capacity, especially on the production where excavation void ratio is highest, is subjected to heavy loading. Strain above threshold of the elongation of support capacity can yield resulting in damage to excavations. Geotechnical engineers must evaluate not only the remnant capacity of ground support systems but also investigate depth of rock mass yield within pillars, backs and floors. Ground Penetrating Radar (GPR) is a geophysical method that has the ability to evaluate rock mass damage using electromagnetic waves. This paper illustrates a case study from the Grasberg mining complex where non-invasive information on the depth of damage and condition of the remaining rock mass was required. GPR with 100 MHz antenna resolution was used to obtain images of the subsurface to determine rehabilitation requirements prior to recommencing production activities. The GPR surveys were used to calibrate the reflection coefficient response of varying rock mass conditions to known Rock Quality Designation (RQD) parameters observed at the mine. The calibrated GPR survey allowed site engineers to map subsurface conditions and plan rehabilitation accordingly.

Keywords: block caving, ground penetrating radar, reflectivity, RQD

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Authors: Ramanen Sugunesegran, Michael L. Williams

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Over the past two decades surgical approaches for mitral valve (MV) disease have evolved with the advent of minimally invasive techniques. Robotic mitral valve repair (RMVr) safety and efficacy has been well documented, however, mid- to long-term data are limited. The aim of this review was to provide a comprehensive analysis of the available mid- to long-term term data for RMVr. Electronic searches of five databases were performed to identify all relevant studies reporting minimum 5-year data on RMVr. Pre-defined primary outcomes of interest were overall survival, freedom from MV reoperation and freedom from moderate or worse mitral regurgitation (MR) at 5-years or more post-RMVr. A meta-analysis of proportions or means was performed, utilizing a random effects model, to present the data. Kaplan-Meier curves were aggregated using reconstructed individual patient data. Nine studies totaling 3,300 patients undergoing RMVr were identified. Rates of overall survival at 1-, 5- and 10-years were 99.2%, 97.4% and 92.3%, respectively. Freedom from MV reoperation at 8-years post RMVr was 95.0%. Freedom from moderate or worse MR at 7-years was 86.0%. Rates of early post-operative complications were low with only 0.2% all-cause mortality and 1.0% cerebrovascular accident. Reoperation for bleeding was low at 2.2% and successful RMVr was 99.8%. Mean intensive care unit and hospital stay were 22.4 hours and 5.2 days, respectively. RMVr is a safe procedure with low rates of early mortality and other complications. It can be performed with low complication rates in high volume, experienced centers. Evaluation of available mid-term data post-RMVr suggests favorable rates of overall survival, freedom from MV reoperation and freedom from moderate or worse MR recurrence.

Keywords: mitral valve disease, mitral valve repair, robotic cardiac surgery, robotic mitral valve repair

Procedia PDF Downloads 68

Authors: Agata Krawczyk-Ozog, Mateusz K. Holda, Mateusz Koziej, Danuta Sorysz, Zbigniew Siudak, Wieslawa Klimek-Piotrowska, Dariusz Dudek

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Introduction: Rapid development of the surgical and less-invasive percutaneous mitral valve repair procedures greatly increase the interest of the mitral valve anatomy. The aim of this study was to characterize morphological variability of the mitral valve leaflets and to provide the size of their particular parts. Materials and Methods: In the study, we included 200 autopsied human hearts from Caucasian individuals (25% females) with mean age 47.5 (±17.9) without any valvular diseases. The morphology of the mitral valve was evaluated. The intercommissural and aorto-mural diameters of the mitral annulus were measured. All leaflets and their scallops were identified. The base and the height of the posteromedial commissure (PM-C), anterolateral commissure (AL-C), anterior leaflet (AL) and posterior leaflet (PL) with their scallops were measured. Results: The intercommissural diameter was 28.0±4.8 mm, the aorto-mural diameter 19.7±4.8 mm, circumference of the mitral annulus 89.9±12.6 mm and the area of the mitral valve 485.4±171.4 mm2. Classical mitral valves (AL+AL-C+PL(P1,P2,P3)+PM-C) were found in 141 (70.5%) specimens. In classical type, the mean AL base and height were 30.8±4.9 mm and 20.6±4.2 mm, while mean PL base and height 45.1±8.2 mm 12.9±2.8 mm respectively. The mean ratio of the AL base to PL base was 0.7±0.2. Variations in PL were found in 55 (27.5%) and in AL in 5 (2.5%) hearts. The most common variations were: valve with one accessory scallop (AcS) between P3 and PM-C (7%); AcS between P1 and AL-C (4%); connections of P2 and P3 scallops (4%); connections of P1 and P2 scallops (3%); AcS in AL (2.5%). All AcS were smaller than the main PL scallops. The mean intertrigonal distance was 21.9±3.8 mm. Conclusions: In all cases, the mitral valve is built by two main leaflets with possible variants in secondary to leaflets scallops (29.5%). The variations are largely associated with PL and are mostly related to the presence of AcS. Anatomically the AL is not divided into scallops, and it occupies 34.5% of the mitral annulus circumference. Understanding the anatomy of the mitral valve leaflets helps to planning and performing mitral valve repair procedures.

Keywords: accessory scallop, commissure, connected scallops, human heart, mitral leaflets, mitral valve

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Authors: Daniela E. Marin, Cornelia Braicu, Gina C. Pistol, Roxana Cojocneanu-Petric, Ioana Berindan Neagoe, Mihail A. Gras, Ionelia Taranu

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Aristolochic acid (AA) is a carcinogenic, mutagenic, and nephrotoxic compound commonly found in the Aristolochiaceae family of plants. AA is frequently associated with urothelial carcinoma of the upper urinary tract in human and animals and is considered as being responsible for Balkan Endemic Nephropathy. The pig provides a good animal model because the porcine urological system is very similar to that of humans, both in aspects of physiology and anatomy. MicroRNA (miRNA) are small non-coding RNAs that have an impact on a wide range of biological processes by regulating gene expression at post-transcriptional level. The objective of this study was to analyze the miRNA profiling in the kidneys of AA intoxicated swine. For this purpose, ten TOPIGS-40 crossbred weaned piglets, 4-week-old, male and females with an initial average body weight of 9.83 ± 0.5 kg were studied for 28 days. They were given ad libitum access to water and feed and randomly allotted to one of the following groups: control group (C) or aristolochic acid group (AA). They were fed a maize-soybean-meal-based diet contaminated or not with 0.25mgAA/kg. To profile miRNA in the kidneys of pigs, microarrays and bioinformatics approaches were applied to analyze the miRNA in the kidney of control and AA intoxicated pigs. After normalization, our results have shown that a total of 5 known miRNAs and 4 novel miRNAs had different profiling in the kidney of intoxicated animals versus control ones. Expression of miR-32-5p, miR-497-5p, miR-423-3p, miR-218-5p, miR-128-3p were up-regulated by 0.25mgAA/kg feed, while the expression of miR-9793-5p, miR-9835-3p, miR-9840-3p, miR-4334-5p was down-regulated. The microRNA profiling in kidney of intoxicated animals was associated with modified expression of target genes as: RICTOR, LASP1, SFRP2, DKK2, BMI1, RAF1, IGF1R, MAP2K1, WEE1, HDGF, BCL2, EIF4E etc, involved in cell division cycle, apoptosis, cell differentiation and cell migration, cell signaling, cancer etc. In conclusion, this study provides new data concerning the microRNA profiling in kidney after aristolochic acid intoxications with important implications for human and animal health.

Keywords: aristolochic acid, kidney, microRNA, swine

Procedia PDF Downloads 265

Authors: Sahar Rakhshan, Simonetta Geninatti Crich, Diego Alberti, Rachele Stefania

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The combination of imaging and therapeutic agents in the same smart nanoparticle is a promising option to perform a minimally invasive imaging guided therapy. In this study, Low density lipoproteins (LDL), one of the most attractive biodegradable and biocompatible nanoparticles, were used for the simultaneous delivery of Paclitaxel (PTX), a hydrophobic antitumour drug and an amphiphilic contrast agent, Gd-AAZTA-C17, in B16-F10 melanoma cell line. These cells overexpress LDL receptors, as assessed by Flow cytometry analysis. PTX and Gd-AAZTA-C17 loaded LDLs (LDL-PTX-Gd) have been prepared, characterized and their stability was assessed under 72 h incubation at 37 ◦C and compared to LDL loaded with Gd-AAZTA-C17 (LDL-Gd) and LDL-PTX. The cytotoxic effect of LDL-PTX-Gd was evaluated by MTT assay. The anti-tumour drug loaded into LDLs showed a significantly higher toxicity on B16-F10 cells with respect to the commercially available formulation Paclitaxel Kabi (PTX Kabi) used in clinical applications. It was possible to demonstrate a high uptake of LDL-Gd in B16-F10 cells. As a consequence of the high cell uptake, melanoma cells showed significantly high cytotoxic effect when incubated in the presence of PTX (LDL-PTX-Gd). Furthermore, B16-F10 have been used to perform Magnetic Resonance Imaging. By the analysis of the image signal intensity, it was possible to extrapolate the amount of internalized PTX indirectly by the decrease of relaxation times caused by Gd, proportional to its concentration. Finally, the treatment with PTX loaded LDL on B16-F10 tumour bearing mice resulted in a marked reduction of tumour growth compared to the administration of PTX Kabi alone. In conclusion, LDLs are selectively taken-up by tumour cells and can be successfully exploited for the selective delivery of Paclitaxel and imaging agents.

Keywords: low density lipoprotein, melanoma cell lines, MRI, paclitaxel, personalized medicine application, theragnostic System

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Authors: Hitesh Gupta, Surender Dabas

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TORS is increasingly gaining widespread use and has been explored as minimally invasive surgery for the treatment of supraglottic cancer (SGC). Being a central critical role of Supraglottis in deglutition, swallowing outcomes post TORS remain a most important factor. Available published studies show inconsistent swallowing outcomes and are deficient in standardized outcome measures, description of swallowing recovery and rehabilitation. So, the objective of this study is to find out swallowing outcomes in SGC patients after TORS provided with early dysphagia management using standardized measures. Prospectively 16 patients were recruited in the study who underwent TORS for primary tumor of Supraglottis, involving one or more sub-sites or invading to sites other than Supraglottis at the BLK Super Specialty Hospital, New Delhi from March 2019 to June 2020. All patients were evaluated for dysphagia with subsequent swallowing rehabilitation on post operative day 3 in the hospital or at the time of discharge, whichever was earlier. Functional oral intake scale (FOIS) and penetration-aspiration score (PAS) were used as outcome measures to quantify swallowing recovery at one month and six month post operatively. Post TORS, patients achieved functional swallow in less than one month, where resection was limited to Supraglottis, while the recovery was delayed in patients with extended resection to tongue base or hypopharynx. Overall, out of Total 16 cases including all supraglottis sub-catagories, 13 (81%) could remove their NG tube (FOIS ≥5 and PAS=1 ) within 6 months. In which 8 cases(62%) achieved functional swallow in less than one month. Swallowing outcomes post TORS supraglottic laryngectomy are favorable if provided with early dysphagia management (or swallowing rehabilitation).

Keywords: dysphagia, supraglottic cancer, swallowing, TORS

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Authors: Marisa Chrysochoou, James Mahoney, Kay Wille

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Pyrrhotite is an iron-sulfide mineral which releases sulfuric acid when exposed to water and oxygen. The presence of this mineral in concrete foundations across Connecticut and Massachusetts in the US is causing in some cases premature failure. This has resulted in a devastating crisis for all parties affected by this type of failure which can take up to 15-25 years before internal damage becomes visible on the surface. This study shares laboratory results aimed to investigate the fundamental mechanisms of pyrrhotite reaction and to further the understanding of its deterioration kinetics within concrete. This includes the following analyses: total sulfur, wavelength dispersive X-ray fluorescence, expansion, reaction rate combined with ion-chromatography, as well as damage evolution using electro-chemical acceleration. This information is coupled to a statistical analysis of over 150 analyzed concrete foundations. Those samples were obtained and process using a developed and validated sampling method that is minimally invasive to the foundation in use, provides representative samples of the concrete matrix across the entire foundation, and is time and cost-efficient. The processed samples were then analyzed using a developed modular testing method based on total sulfur and wavelength dispersive X-ray fluorescence analysis to quantify the amount of pyrrhotite. As part of the statistical analysis the results were grouped into the following three categories: no damage observed and no pyrrhotite detected, no damage observed and pyrrhotite detected and damaged observed and pyrrhotite detected. As expected, a strong correlation between amount of pyrrhotite, age of the concrete and damage is observed. Information from the laboratory investigation and from the statistical analysis of field samples will aid in forming a scientific basis to support the decision process towards sustainable financial and administrative solutions by state and local stakeholders.

Keywords: concrete, pyrrhotite, risk of failure, statistical analysis

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Authors: Balaji Devanathan, Gokul G., Abilash S., Abhishek Yadav, Sudhir K. Gupta

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Background: As an alternative to the traditional autopsy, a virtual autopsy is carried out using scanning and imaging technologies, mainly post-mortem computed tomography (PMCT). This facility aims to supplement traditional autopsy results and reduce or eliminate internal dissection in subsequent autopsies. For emotional and religious reasons, the deceased's relatives have historically disapproved such interior dissection. The non-invasive, objective, and preservative PMCT is what friends and family would rather have than a traditional autopsy. Additionally, it aids in the examination of the technologies and the benefits and drawbacks of each, demonstrating the significance of contemporary imaging in the field of forensic medicine. Results: One hundred falls resulting in fatalities was analysed by the writers. Before the autopsy, each case underwent a PMCT examination using a 16-slice Multi-Slice CT spiral scanner. By using specialised software, MPR and VR reconstructions were carried out following the capture of the raw images. The accurate detection of fractures in the skull, face bones, clavicle, scapula, and vertebra was better observed in comparison to a routine autopsy. The interpretation of pneumothorax, Pneumoperitoneum, pneumocephalus, and hemosiuns are much enhanced by PMCT than traditional autopsy. Conclusion. It is useful to visualise the skeletal damage in fall from height cases using a virtual autopsy based on PMCT. So, the ideal tool in traumatising patients is a virtual autopsy based on PMCT scans. When assessing trauma victims, PMCT should be viewed as an additional helpful tool to traditional autopsy. This is because it can identify additional bone fractures in body parts that are challenging to examine during autopsy, such as posterior regions, which helps the pathologist reconstruct the victim's life and determine the cause of death.

Keywords: PMCT, fall from height, autopsy, fracture

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Authors: Marc Sebastián-Romagosa, Woosang Cho, Rupert Ortner, Christy Li, Christoph Guger

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Neurorehabilitation based on Brain-Computer Interfaces (BCIs) shows important rehabilitation effects for patients after stroke. Previous studies have shown improvements for patients that are in a chronic stage and/or have severe hemiparesis and are particularly challenging for conventional rehabilitation techniques. For this publication, seven stroke patients in the chronic phase with hemiparesis in the lower extremity were recruited. All of them participated in 25 BCI sessions about 3 times a week. The BCI system was based on the Motor Imagery (MI) of the paretic ankle dorsiflexion and healthy wrist dorsiflexion with Functional Electrical Stimulation (FES) and avatar feedback. Assessments were conducted to assess the changes in motor improvement before, after and during the rehabilitation training. Our primary measures used for the assessment were the 10-meters walking test (10MWT), Range of Motion (ROM) of the ankle dorsiflexion and Timed Up and Go (TUG). Results show a significant increase in the gait speed in the primary measure 10MWT fast velocity of 0.18 m/s IQR = [0.12 to 0.2], P = 0.016. The speed in the TUG was also significantly increased by 0.1 m/s IQR = [0.09 to 0.11], P = 0.031. The active ROM assessment increased 4.65º, and IQR = [ 1.67 - 7.4], after rehabilitation training, P = 0.029. These functional improvements persisted at least one month after the end of the therapy. These outcomes show the feasibility of this BCI approach for chronic stroke patients and further support the growing consensus that these types of tools might develop into a new paradigm for rehabilitation tools for stroke patients. However, the results are from only seven chronic stroke patients, so the authors believe that this approach should be further validated in broader randomized controlled studies involving more patients. MI and FES-based non-invasive BCIs are showing improvement in the gait rehabilitation of patients in the chronic stage after stroke. This could have an impact on the rehabilitation techniques used for these patients, especially when they are severely impaired and their mobility is limited.

Keywords: neuroscience, brain computer interfaces, rehabilitat, stroke

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Authors: Abera Hailu Degaga, Emana Getu Degaga

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Spodoptera frugiperda is an invasive insect pest that infests and feeds various crops, particularly affecting maize yields. However, nature has its own way of maintaining balance, and in this case, natural enemies play a crucial role in regulating the population of S. frugiperda. Locally available and easily prepared botanical sources, bio-pesticides, are also important. The objectives of the study were to investigate the natural enemies of S. frugiperda in the Gurage zone and to compare Neem aqueous extracts against its larvae in central Ethiopia. S. frugiperda larvae and egg masses were collected randomly from smallholder maize farms infested with pests between June and August 2023. Our findings revealed the existence of diverse types of parasitoids, predators, and entomopathogenic fungi associated with S. frugiperda. Notably, we documented three species of parasitoids, namely Exorista xanthaspis and Tachina spp. (Diptera: Tachinidae) and Charops annulipes (Hymenoptera: Ichneumonidae). All three species of parasitoids were recorded from Ethiopia for the first time. The overall parasitism rate was 5.3%, with individual rates ranging from 1.3 to 4%. Additionally, we identified ten species of predator insects from four different orders, including Hemiptera, Dermaptera, Coleoptera, and Mantodea, in the maize farms infested with S. frugiperda. Aqueous extract of Neem seed and leaf powder and green leaf exhibited similar mortality rates of S. frugiperda larvae at 72 hours even though there was a significant difference at 24 and 48 hours of the test. For effective management of S. frugiperda further research is necessary to fully exploit the potential of these natural enemies and additionally to use botanical source pesticides like Azadirachta indica.

Keywords: bio-pesticide, natural enemy, parasitoids, predators, Tachinid flies

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Authors: A. Dean, M. Pitcher, L. Storer, K. Shanahan, I. Rio, B. Mann

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Purpose: Breast cancer survivors are at risk of specific physical and psycho-social issues, such as arm swelling, fatigue, and depression. Firstly, we investigate symptoms reported by Australia breast cancer survivors upon completion of definitive treatment. Secondly, we evaluate the appropriateness and effectiveness of a multi-centre pilot program nurse-led clinic to identify these issues and make timely referrals to available services. Methods: Patients post-definitive treatment (excluding ongoing hormonal therapy) for early breast cancer or ductal carcinoma in situ were invited to participate. An hour long appointment with a breast care nurse (BCN) was scheduled. In preparation, patients completed validated quality-of-life surveys (FACT-B, Menopause Rating Scale, Distress Thermometer). During the appointment, issues identified in the surveys were addressed and referrals to appropriate services arranged. Results: 183 of 274 (67%) eligible patients attended a nurse-led clinic. Mean age 56.8 years (range 29-87 years), 181/183 women, 105/183 post-menopausal. 96 (55%) participants reported significant level of distress; 31 (18%) participants reported extreme distress or depression. Distress stemmed from a lack of energy (56/175); poor quality of sleep (50/176); inability to work or participate in household activities (35/172) and problems with sex life (28/89). 166 referrals were offered; 94% of patients accepted the referrals. 65% responded to a follow-up survey: the majority of women either strongly agreed or agreed that the BCN was overwhelmingly supportive, helpful in making referrals, and compassionate towards them. 39% reported making lifestyle changes as a result of the BCN. Conclusion: Breast cancer survivors experience a unique set of challenges, including low mood, difficulty sleeping, problems with sex life and fear of disease recurrence. The nurse-led clinic model is an appropriate and effective method to ensure physical and psycho-social issues are identified and managed in a timely manner. This model empowers breast cancer survivors with information about their diagnosis and available services.

Keywords: early breast cancer, survivorship, breast care nursing, oncology nursing and cancer care

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Authors: V. Veeraprathap, G. S. Harish, G. Narendra Kumar

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Uncontrolled growth of abnormal cells in the lung in the form of tumor can be either benign (non-cancerous) or malignant (cancerous). Patients with Lung Cancer (LC) have an average of five years life span expectancy provided diagnosis, detection and prediction, which reduces many treatment options to risk of invasive surgery increasing survival rate. Computed Tomography (CT), Positron Emission Tomography (PET), and Magnetic Resonance Imaging (MRI) for earlier detection of cancer are common. Gaussian filter along with median filter used for smoothing and noise removal, Histogram Equalization (HE) for image enhancement gives the best results without inviting further opinions. Lung cavities are extracted and the background portion other than two lung cavities is completely removed with right and left lungs segmented separately. Region properties measurements area, perimeter, diameter, centroid and eccentricity measured for the tumor segmented image, while texture is characterized by Gray-Level Co-occurrence Matrix (GLCM) functions, feature extraction provides Region of Interest (ROI) given as input to classifier. Two levels of classifications, K-Nearest Neighbor (KNN) is used for determining patient condition as normal or abnormal, while Artificial Neural Networks (ANN) is used for identifying the cancer stage is employed. Discrete Wavelet Transform (DWT) algorithm is used for the main feature extraction leading to best efficiency. The developed technology finds encouraging results for real time information and on line detection for future research.

Keywords: artificial neural networks, ANN, discrete wavelet transform, DWT, gray-level co-occurrence matrix, GLCM, k-nearest neighbor, KNN, region of interest, ROI

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Authors: Geliashvili T. M., Tyulyandina A. S., Valiev A. K., Kononets P. V., Kharatishvili T. K., Salkov A. G., Pronin A. I., Gadzhieva E. H., Parnas A. V., Ilyakov V. S.

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Aim/Introduction: Metastasis (Mts) to the sternum, while extremely rare in differentiated thyroid cancer (DTC) (1), requires a personalized, multidisciplinary treatment approach. In aggressively growing Mts to the sternum, which rapidly become unresectable, a comprehensive therapeutic and diagnostic approach is particularly important. Materials and methods: We present a clinical case of solitary Mts to the sternum as first manifestation of a papillary thyroid microcarcinoma in a 55-year-old man. Results: 18F-FDG PET/CT after thyroidectomy confirmed the solitary Mts to the sternum with extremely high FDG uptake (SUVmax=71,1), which predicted its radioiodine-refractory (RIR). Due to close attachment to the mediastinum and rapid growth, Mts was considered unresectable. During the next three months, the patient received targeted therapy with the tyrosine kinase inhibitor (TKI) Lenvatinib 24 mg per day. 1st course of radioiodine therapy (RIT) 6 GBq was also performed, the results of which confirmed the RIR of the tumor process. As a result of systemic therapy (targeted therapy combined with RIT and suppressive hormone therapy with L-thyroxine), there was a significant biochemical response (decrease of serum thyroglobulin level from 50,000 ng/ml to 550 ng/ml) and a partial response with decrease of tumor size (from 80x69x123 mm to 65x50x112 mm) and decrease of FDG accumulation (SUVmax from 71.1 to 63). All of this made possible to perform surgical treatment of Mts - sternal extirpation with its replacement by an individual titanium implant. At the control examination, the stimulated thyroglobulin level was only 134 ng/ml, and PET/CT revealed postoperative areas of 18F-FDG metabolism in the removed sternal Mts. Also, 18F-FDG PET/CT in the early (metabolic) stage revealed two new bone Mts (in the area of L3 SUVmax=17,32 and right iliac bone SUVmax=13,73), which, as well as the removed sternal Mts, appeared to be RIRs at the 2nd course of RIT 6 GBq. Subsequently, on 02.2022, external beam radiation therapy (EBRT) was performed on the newly identified oligometastatic bone foci. At present, the patient is under dynamic monitoring and in the process of suppressive hormone therapy with L-thyroxine. Conclusion: Thus, only due to the early prescription of targeted TKI therapy was it possible to perform surgical resection of Mts to the sternum, thereby improve the patient's quality of life and preserve the possibility of radical treatment in case of oligometastatic disease progression.

Keywords: differentiated thyroid cancer, metastasis to the sternum, radioiodine therapy, radioiodine-refractory cancer, targeted therapy, lenvatinib

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Authors: Ya-Ching Fu, An-Kuo Chou, Boon-Fatt Tan, Chi-Nien Chen, Wen-Chien Yang, Pou-Leng Cheong

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Blind oro-/naso-pharyngeal suction and feeding tube placement are very common practices in neonatal intensive care unit. Though esophageal perforation is a rare complication of these instrumentations, its prevalence is highest in extremely premature neonates. Due to its association with significant morbidity (including respiratory deterioration, pneumothorax, and sepsis) and even mortality, it is an important issue to prevent this iatrogenic complication in the field of premature care. We demonstrate an esophageal perforation in an extreme-low-birth-weight neonate after oro-gastric tube placement. This female baby weighing 680 grams was delivered by caesarean section at 25 weeks of gestational age. She initially received oro-tracheal intubation with mechanical ventilation which was smoothly weaned to non-invasive positive-pressure ventilation at 7-day-old. However, after insertion of a 5-French oro-gastric tube, the baby’s condition suddenly worsened with apnea requiring mechanical ventilation. Her chest radiogram showed the oro-gastric tube in right pleural space, and thus another oro-gastric tube was replaced, and its position was radiographically confirmed. The malpositioned tube was then removed. The baby received 2-week course of intravenous antibiotics for her esophageal perforation. Feeding was then reintroduced and increased to full feeds in a smooth course. She was discharged at 107-day-old. Esophageal perforation in newborn is very rare. Sudden respiratory deterioration in a neonate after naso-/oro-gastric tube placement should alarm us to consider esophageal perforation, and further radiological investigation is required for the diagnosis. Tube materials, patient condition, and age are major risk factors of esophageal perforation. The use of softer tube material, such as silicone, in extreme premature baby might prevent this fetal complication.

Keywords: esophageal perforation, preterm, newborn, feeding tube

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Authors: Krishna Dahiya

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Introduction: Labour pain has been described as the most severe pain experienced by women in their lives. Pain management in labour is one of the most important challenges faced by the obstetrician. The opioids are the primary treatment for patients with moderate and severe pain but these drugs are not always tolerated and are associated with dose-dependent side effects. Nonsteroidal anti-inflammatory drugs, too, are associated with variable adverse effects. Considering these factors, our study compared the efficacy and side effect of intravenous tramadol and paracetamol. Objective: To evaluate the efficacy and adverse effects of an intravenous infusion of 1000 mg of paracetamol as compared with an intravenous injection of 50mg of tramadol for intrapartum analgesia. Methods: In a randomized prospective study at Pt. BDS PGIMS, 200 women in active labor were allocated to received either paracetamol (n=100) or tramadol (n=100). The primary outcome was the efficacy of the drug to supply adequate analgesia as measured by a change in the visual analog scale (VAS) pain intensity score at various times after drug administration. The secondary outcomes included the need for additional rescue analgesia and the presence of adverse maternal or fetal events. Results: The mean age of cases were 25.55 ± 3.849 years and 25.60 ± 3.655 years respectively As recorded by the VAS score, there was significant pain reduction at 30 minutes, and at 1 and 2 hours in both groups (P<0.01). In comparison, between group I and II, a significantly higher rate of nausea and vomiting in tramadol group (14% vs 8%; P < 0.03) patients. Similarly, drowsiness (0% vs 11%; P<0.01), dry mouth (0% vs 8%; P<0.04) and dizziness (0% vs 9%; P<0.02) was also significant in group II. Conclusion: Due to difficulty in administering epidural analgesia to all parturients, administration of paracetamol and tramadol infusion for analgesia is simple and less invasive alternative. In the present study, both paracetamol and tramadol were equally effective for labour analgesia but paracetamol has emerged as safe alternative as compared to tramadol due to a low incidence of side effects.

Keywords: paracetamol, tramadol, labor, analgesia

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Authors: Maria Bercea, Monica Diana Olteanu

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Investigation of polymer systems able to change inside of the body into networks represent an attractive approach, especially when there is a minimally invasive and patient friendly administration. Pharmaceutical formulations based on Pluronic F127 [poly (oxyethylene) (PEO) blocks (70%) and poly(oxypropylene) (PPO) blocks (30%)] present an excellent potential as drug delivery systems. The use of Pluronic F127 alone as gel-forming solution is limited by some characteristics, such as poor mechanical properties, short residence time, high permeability, etc. Investigation of the interactions between the natural and synthetic polymers and surfactants in solution is a subject of great interest from both scientific and practical point of view. As for example, formulations based on Pluronics and chitosan could be used to obtain dual phase transition hydrogels responsive to temperature and pH changes. In this study, different materials were prepared by using poly(vinyl alcohol), chitosan solutions mixed with aqueous solutions of Pluronic F127. The rheological properties of different formulations were investigated in temperature sweep experiments as well as at a constant temperature of 37oC for exploring in-situ gel formation in the human body conditions. In addition, some viscometric investigations were carried out in order to understand the interactions which determine the complex behaviour of these systems. Correlation between the thermodynamic and rheological parameters and phase separation phenomena observed for the investigated systems allowed the dissemination the constitutive response of polymeric materials at different external stimuli, such as temperature and pH. The rheological investigation demonstrated that the viscoelastic moduli of the hydrogels can be tuned depending on concentration of different components as well as pH and temperature conditions and cumulative contributions can be obtained.

Keywords: hydrogel, polymer mixture, stimuli responsive, biomedical applications

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Authors: Tarek K. Jalouta, Jolietta R. Holliman, Kathryn R. Burke, Kathleen M. Bewley-Thomas

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Background: Chronic hepatitis C virus (HCV) infection is one of the leading causes of liver cirrhosis and hepatocellular carcinoma. In the United States, HCV screening awareness, treatment, and linkage to care are under continues ascending progress. However, still millions of people are asymptomatically infected and undiagnosed yet. Through this community mission, we sought to identify the best and the newest strategies to identify those infected people to educate them, link them to care and cure them. Methods: We have identified patients that did not have a prior HCV screening in our Electronic medical record (EMR) including all our different hospital locations (South Suburban Chicago, Northern, Western and Central Indiana). Providing education to all Primary care/Gastroenterology/Infectious diseases providers and staff in the clinic to increase awareness of the HCV screening. Health-related quality of life, chronic clinical complications, and demographics data were collected for each patient. All outcomes of HCV antibody-reactive and HCV RNA–positive results were identified and statistically analyzed. Results: From July 2016 to July 2018 we screened 35,720 individuals of birth cohort in our different Franciscan’s health medical centers. Of the screened population, 986 (2.7%) individuals were HCV AB-reactive. Of those, 319 (1%) patients were HCV RNA-positive, and 264 patients were counseled and linked to providers. 34 patients initiated anti-HCV therapy with successful treatment. Conclusions: Our HCV screening augmentation project considered the largest screening program in the Midwest. Augmenting the HCV screening process through creating a Best Practice Alert (BPA) in the EMR (Epic Sys.) and point of care testing could be helpful. Although continued work is required, our team is working on increase screening through adding HCV test to CBC-Panels in Emergency Department settings, phone calls to all birth cohort individuals through Robo-Calling System aimed to reach 75,000 individuals by 2019. However, a better linkage to care and referral monitoring system to all HCV RNA positive patients is still needed, and access to therapy, especially for uninsured patients, is challenging.

Keywords: chronic hepatitis C, chronic hepatitis C treatment, chronic hepatitis C screening, chronic hepatitis C prevention, liver cancer

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Authors: Nino Tsamalaidze

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Cold plasma is an ionized neutral gas with a temperature of 30-40 degrees, but the impact of HP includes not only gas, but also active molecules, charged particles, heat and UV radiation of low power The main goal of the technology we describe is to launch the natural function of skin regeneration and improve the metabolism inside, which leads to a huge effect of rejuvenation. In particular: eliminate fine mimic wrinkles; get rid of wrinkles around the mouth (purse-string wrinkles); reduce the overhang of the upper eyelid; eliminate bags under the eyes; provide a lifting effect on the oval of the face; reduce stretch marks; shrink pores; even out the skin, reduce the appearance of acne, scars; remove pigmentation. A clear indication of the major findings of the study is based on the current patients practice. The method is to use combination of cold plasma and liquid threats. The advantage of cold plasma is undoubtedly its efficiency, the result of its implementation can be compared with the result of a surgical facelift, despite the fact that the procedure is non-invasive and the risks are minimized. Another advantage is that the technique can be applied on the most sensitive skin of the face - these are the eyelids and the space around the eyes. Cold plasma is one of the few techniques that eliminates bags under the eyes and overhanging eyelids, while not violating the integrity of the tissues. In addition to rejuvenation and lifting effect, among the benefits of cold plasma is also getting rid of scars, kuperoze, stretch marks and other skin defects, plasma allows to get rid of acne, seborrhea, skin fungus and even heals ulcers. The cold plasma method makes it possible to achieve a result similar to blepharoplasty. Carried out on the skin of the eyelids, the procedure allows non-surgical correction of the eyelid line in 3-4 sessions. One of the undoubted advantages of this method is a short rehabilitation and rapid healing of the skin.

Keywords: wrinkles, telangiectasia, pigmentation, pore closing

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Authors: Iva Blazkova, Amitava Moulick, Vedran Milosavljevic, Pavel Kopel, Marketa Vaculovicova, Vojtech Adam, Rene Kizek

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Doxorubicin is one of the most commonly used and the most effective chemotherapeutic drugs. This antracycline drug isolated from the bacteria Streptomyces peuceticus var. caesius is sold under the trade name Adriamycin (hydroxydaunomycin, hydroxydaunorubicin). Doxorubicin is used in single therapy to treat hematological malignancies (blood cancers, leukaemia, lymphoma), many types of carcinoma (solid tumors) and soft tissue sarcomas. It has many serious side effects like nausea and vomiting, hair lost, myelosupression, oral mucositis, skin reactions and redness, but the most serious one is the cardiotoxicity. Because of the risk of heart attack and congestive heart failure, the total dose administered to patients has to be accurately monitored. With the aim to lower the side effects and to targeted delivery of doxorubicin into the tumor tissue, the different nanoparticles are studied. The drug can be bound on a surface of nanoparticle, encapsulated in the inner cavity, or incorporated into the structure of nanoparticle. Among others, carbon nanoparticles (graphene, carbon nanotubes, fullerenes) are highly studied. Besides the number of inorganic nanoparticles, a great potential exhibit also organic ones mainly lipid-based and polymeric nanoparticle. The aim of this work was to perform a toxicity study of free doxorubicin compared to doxorubicin conjugated with various nanotransporters. The effect of liposomes, fullerenes, graphene, and carbon nanotubes on the toxicity was analyzed. As a first step, the binding efficacy of between doxorubicin and the nanotransporter was determined. The highest efficacy was detected in case of liposomes (85% of applied drug was encapsulated) followed by graphene, carbon nanotubes and fullerenes. For the toxicological studies, the chicken embryos incubated under controlled conditions (37.5 °C, 45% rH, rotation every 2 hours) were used. In 7th developmental day of chicken embryos doxorubicin or doxorubicin-nanotransporter complex was applied on the chorioallantoic membrane of the eggs and the viability was analyzed every day till the 17th developmental day. Then the embryos were extracted from the shell and the distribution of doxorubicin in the body was analyzed by measurement of organs extracts using laser induce fluorescence detection. The chicken embryo mortality caused by free doxorubicin (30%) was significantly lowered by using the conjugation with nanomaterials. The highest accumulation of doxorubicin and doxorubicin nanotransporter complexes was observed in the liver tissue

Keywords: doxorubicin, chicken embryos, nanotransporters, toxicity

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Authors: Beatriz Lafuente Alcázar, Yash Wani, Amit J. Nimunkar

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Cardiovascular Diseases (CVDs) are the leading cause of death globally, and around 80% of sudden cardiac deaths are due to arrhythmias or irregular heartbeats. The majority of these pathologies are revealed by either short-term or long-term alterations in the electrocardiogram (ECG) morphology. The ECG is the main diagnostic tool in cardiology. It is a non-invasive, pain free procedure that measures the heart’s electrical activity and that allows the detecting of abnormal rhythms and underlying conditions. A cardiologist can diagnose a wide range of pathologies based on ECG’s form alterations, but the human interpretation is subjective and it is contingent to error. Moreover, ECG records can be quite prolonged in time, which can further complicate visual diagnosis, and deeply retard disease detection. In this context, deep learning methods have risen as a promising strategy to extract relevant features and eliminate individual subjectivity in ECG analysis. They facilitate the computation of large sets of data and can provide early and precise diagnoses. Therefore, the cardiology field is one of the areas that can most benefit from the implementation of deep learning algorithms. In the present study, a deep learning algorithm is trained following a novel approach, using a combination of different databases as the training set. The goal of the algorithm is to achieve the detection of R-peaks in ECG signals. Its performance is further evaluated in ECG signals with different origins and features to test the model’s ability to generalize its outcomes. Performance of the model for detection of R-peaks for clean and noisy ECGs is presented. The model is able to detect R-peaks in the presence of various types of noise, and when presented with data, it has not been trained. It is expected that this approach will increase the effectiveness and capacity of cardiologists to detect divergences in the normal cardiac activity of their patients.

Keywords: arrhythmia, deep learning, electrocardiogram, machine learning, R-peaks

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Authors: Sally Ibrahim, Mohamed Hedia, Mohamed Taqi, Mohamed Derbala, Karima Mahmoud, Youssef Ahmed, Sayed Ismail, Mohamed El-Belely

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The identification and quantification of serum microRNA (miRNA) from mares with endometritis might serve as useful and implementable clinical biomarkers for the early diagnosis of endometiritis. Aims of the current study were (I) to study the expression pattern of eca-miR-155, eca-miR-223, eca-miR-17, eca-miR-200a, and eca-miR-205, and (II) to determine the levels of interleukin 6 (IL-6), prostaglandins (PGF₂α and PGE₂), in the serum of Arabian mares with healthy and abnormal uterine status (endometritis). This study was conducted on 80 Arabian mares (4-14 years old). Mares were divided into 48 sub-fertile mares suspected of endometritis and 32 fertile at stud farms. The criteria for mares to be enrolled in the endometritis group were that they had been bred three or more times unsuccessfully in the breeding season or had a history of more than one year of reproductive failure. In addition, two or more of the following criteria on a checklist were present: abnormal clinical findings, transrectal ultrasonographic uterine examination showed abnormal fluid in the uterus (echogenic or ≥2 cm in diameter), positive endometrial cytology; and bacterial and/or fungal growth. Serum samples were collected for measuring IL-6, PGF₂α, and PGE₂ concentrations, as well as serum miRNA isolation and quantitative real-time PCR. Serum concentrations of IL-6, PGE₂, and PGF₂α were higher (P ≤ 0.001) in mares with endometritis compared to the control healthy ones. The expression profile of eca-miR-155, eca-miR-223, eca-miR-17, eca-miR-200a, and eca-miR-205 increased (P≤0.001) in mares with endometritis compared to the control ones. To the best of our knowledge, this is the first study that revealed that serum miRNA and serum inflammatory mediators (IL-6, PGE₂, and PGF₂α) could be used as non-invasive gold standard biomarkers, and therefore might be served as an important additional diagnostic tool for endometritis in Arabian mares. Moreover, estimation of the serum concentrations of serum miRNA, IL-6, PGE₂, and PGF₂α is a promising recommended tool during the breeding soundness examination in mares.

Keywords: Arabian Mares, endometritis, inflammatory mediators, serum miRNA

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Authors: U.-B. Schaer, M. Wehr, R. Hodler

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Background: Most nursing students require more training time for necessary nursing skills than defined by nursing schools curriculum to acquire basic nursing skills. Given skills training lessons are too brief to enable effective student learning, meaning in-depth skills practice and repetition various learning steps. This increases stress levels and the pressure to succeed for a nursing student with slower learning capabilities. Another possible consequence is that nursing students are less prepared in the required skills for future clinical practice. Intervention: The Bern College of Higher Education of Nursing, Switzerland, started the independent peer practice learning program in 2012. A concept was developed which defines specific aims and content as well as student’s rights and obligations. Students enlist beforehand and order the required materials. They organize themselves and train in small groups in allocated training location in the area of Learning Training and Transfer (LTT). During the peer practice, skills and knowledge can be repeatedly trained and reflected in the peer groups without the presence of a tutor. All invasive skills are practiced only on teaching dummies. This allows students to use all their potential. The students may access learning materials as literature and their own student notes. This allows nursing students to practice their skills and to deepen their knowledge on corresponding with their own learning rate. Results: Peer group discussions during the independent peer practice learning support the students in gaining certainty and confidence in their knowledge and skills. This may improve patient safety in future daily care practice. Descriptive statics show that the number of students who take advantage of the independent peer practice learning increased continuously (2012-2018). It has to be mentioned that in 2012, solely students of the first semester attended the independent peer practice learning program, while in 2018 over one-third of the participating students were in their fifth semester and final study year. It is clearly visible that the demand for independent peer practice learning is increasing. This has to be considered in the development of future teaching curricula.

Keywords: learning program, nursing students, peer learning, skill training

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Authors: Ashwin Belle, Bryce Benson, Mark Salamango, Fadi Islim, Rodney Daniels, Kevin Ward

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A reliable, real-time, and non-invasive system that can identify patients at risk for hemodynamic instability is needed to aid clinicians in their efforts to anticipate patient deterioration and initiate early interventions. The purpose of this pilot study was to explore the clinical capabilities of a real-time analytic from a single lead of an electrocardiograph to correctly distinguish between rapid response team (RRT) activations due to hemodynamic (H-RRT) and non-hemodynamic (NH-RRT) causes, as well as predict H-RRT cases with actionable lead times. The study consisted of a single center, retrospective cohort of 21 patients with RRT activations from step-down and telemetry units. Through electronic health record review and blinded to the analytic’s output, each patient was categorized by clinicians into H-RRT and NH-RRT cases. The analytic output and the categorization were compared. The prediction lead time prior to the RRT call was calculated. The analytic correctly distinguished between H-RRT and NH-RRT cases with 100% accuracy, demonstrating 100% positive and negative predictive values, and 100% sensitivity and specificity. In H-RRT cases, the analytic detected hemodynamic deterioration with a median lead time of 9.5 hours prior to the RRT call (range 14 minutes to 52 hours). The study demonstrates that an electrocardiogram (ECG) based analytic has the potential for providing clinical decision and monitoring support for caregivers to identify at risk patients within a clinically relevant timeframe allowing for increased vigilance and early interventional support to reduce the chances of continued patient deterioration.

Keywords: critical care, early warning systems, emergency medicine, heart rate variability, hemodynamic instability, rapid response team

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Authors: Christine Ysabelle G. Roman, Pauline Torres

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Background: Hypertrophic cardiomyopathy is a disease of marked heterogeneity. It is a genetically determined heart disease characterized by significant myocardium hypertrophy that results in diastolic dysfunction, left ventricular outflow tract obstruction, and an increased risk of arrhythmias. The primary treatment in patients with such conditions is negative inotropic drugs, such as beta-blockers, calcium channel antagonists, and disopyramide. However, for those who remain symptomatic and need septal reduction therapy, surgical septal myectomy or alcohol septal ablation are options. Case Summary: A 19 – year old female presented in the authors’ institution with easy fatigability. The consult was done a year prior, and 2D echocardiography was requested which showed concentric left ventricular hypertrophy, asymmetrically hypertrophied interventricular septum (IVS) with the largest diameter of 3.3cm & subaortic dynamic obstruction with a maximum gradient of 47 mmHg. A repeat echo a year later showed asymmetric septal hypertrophy (IVS measuring at 3cm) with the systolic anterior motion of anterior mitral valve leaflet and left ventricular outflow tract obstruction (peak gradient of 50mmHg). The patient then underwent alcohol septal ablation and was discharged stable after four days of admission. Conclusion: Hypertrophic obstructive cardiomyopathy, a cardiovascular genetic disease, results in various patterns of left ventricular hypertrophy and abnormality of mitral valve apparatus. The patient is managed medically initially. However, despite optimal drug therapy and significant left ventricular outflow tract obstruction, significant heart failure symptoms or syncope require invasive treatment.

Keywords: hypertrophic obstructive cardiomyopathy, left ventricular outflow tract obstruction, alcohol septal ablation, alcohol

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