Search results for: multiple group analysis

Authors: Afaf Alharbi, Qianni Zhang

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The identification of malignant tissue in histopathological slides holds significant importance in both clinical settings and pathology research. This paper introduces a methodology aimed at automatically categorizing cancerous tissue through the utilization of a multiple-instance learning framework. This framework is specifically developed to acquire knowledge of the Bernoulli distribution of the bag label probability by employing neural networks. Furthermore, we put forward a neural network based permutation-invariant aggregation operator, equivalent to attention mechanisms, which is applied to the multi-instance learning network. Through empirical evaluation of an openly available colon cancer histopathology dataset, we provide evidence that our approach surpasses various conventional deep learning methods.

Keywords: attention multiple instance learning, MIL and transfer learning, histopathological slides, cancer tissue classification

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Authors: Moiseenko F. V., Volkov N. M., Zhabina A. S., Stepanova E. O., Kirillov A. V., Myslik A. V., Artemieva E. V., Agranov I. R., Oganesyan A. P., Egorenkov V. V., Abduloeva N. H., Aleksakhina S. Yu., Ivantsov A. O., Kuligina E. S., Imyanitov E. N., Moiseyenko V. M.

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Analysis of ctDNA in patients with NSCLC is an emerging biomarker. Multiple research efforts of quantitative or at least qualitative analysis before and during the first periods of treatment with TKI showed the prognostic value of ctDNA clearance. Still, these important results are not incorporated in clinical standards. We evaluated the role of ctDNA in EGFR-mutated NSCLC receiving first-line TKI. Firstly, we analyzed sequential plasma samples from 30 patients that were collected before intake of the first tablet (at baseline) and at 6, 12, 24, 36, and 48 hours after the “starting point.” EGFR-M+ allele was measured by ddPCR. Afterward, we included sequential qualitative analysis of ctDNA with cobas® EGFR Mutation Test v2 from 99 NSCLC patients before the first dose, after 2 and 4 months of treatment, and on progression. Early response analysis showed the decline of EGFR-M+ level in plasma within the first 48 hours of treatment in 11 subjects. All these patients showed objective tumor response. 10 patients showed either elevation of EGFR-M+ plasma concentration (n = 5) or stable content of circulating EGFR-M+ after the start of the therapy (n = 5); only 3 of these patients achieved an objective response (p = 0.026) when compared to the former group). The rapid decline of plasma EGFR-M+ DNA concentration also predicted for longer PFS (13.7 vs. 11.4 months, p = 0.030). Long-term ctDNA monitoring showed clinically significant heterogeneity of EGFR-mutated NSCLC treated with 1st line TKIs in terms of progression-free and overall survival. Patients without detectable ctDNA at baseline (N = 32) possess the best prognosis on the duration of treatment (PFS: 24.07 [16.8-31.3] and OS: 56.2 [21.8-90.7] months). Those who achieve clearance after two months of TKI (N = 42) have indistinguishably good PFS (19.0 [13.7 – 24.2]). Individuals who retain ctDNA after 2 months (N = 25) have the worst prognosis (PFS: 10.3 [7.0 – 13.5], p = 0.000). 9/25 patients did not develop ctDNA clearance at 4 months with no statistical difference in PFS from those without clearance at 2 months. Prognostic heterogeneity of EGFR-mutated NSCLC should be taken into consideration in planning further clinical trials and optimizing the outcomes of patients.

Keywords: NSCLC, EGFR, targeted therapy, ctDNA, prognosis

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Authors: James Jin, Weisi Xia, Runzhe Gao, Alain Vandal, Darren Svirkis, Andrew Hill

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Background: Post-haemorrhoidectomy pain is concerned by patients/clinicians. Minimizing the postoperation pain is highly interested clinically. Combinations of topical cream targeting three hypothesised post-haemorrhoidectomy pain mechanisms were developed and their effectiveness were evaluated. Specifically, a multi-centred double-blinded randomized clinical trial (RCT) was conducted in adults undergoing excisional haemorrhoidectomy. The primary analysis was conveyed on the data collected to evaluate the effectiveness of the combinations of topical cream targeting three hypothesized pain mechanisms after the operations. Methods: 192 patients were randomly allocated to 4 arms (each arm has 48 patients), and each arm was provided with pain cream 10% metronidazole (M), M and 2% diltiazem (MD), M with 4% lidocaine (ML), or MDL, respectively. Patients were instructed to apply topical treatments three times a day for 7 days, and record outcomes for 14 days after the operations. The primary outcome was VAS pain on day 4. Covariates and models were selected in the blind review stage. Multiple imputations were applied for the missingness. LMER, GLMER models together with natural splines were applied. Sandwich estimators and Wald statistics were used. P-values < 0.05 were considered as significant. Conclusions: The addition of topical lidocaine or diltiazem to metronidazole does not add any benefit. ML had significantly better pain and recovery scores than combination MDL. Multimodal topical analgesia with ML after haemorrhoidectomy could be considered for further evaluation. Further trials considering only 3 arms (M, ML, MD) might be worth exploring.

Keywords: RCT, primary analysis, multiple imputation, pain scores, haemorrhoidectomy, analgesia, lmer

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Authors: A. Noll, J. Roth, M. Scholz

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The importance of written language in a democratic society is non-controversial. Students with physical, learning, cognitive or developmental disabilities often have difficulties in understanding information which is presented in written language only. These students suffer from obstacles in diverse domains. In order to reduce such barriers in educational as well as in out-of-school areas, access to written information must be facilitated. Readability can be enhanced by linguistic simplifications like the application of easy-to-read language. Easy-to-read language shall help people with disabilities to participate socially and politically in society. The authors state, for example, that only short simple words should be used, whereas the occurrence of complex sentences should be avoided. So far, these guidelines were not empirically proved. Another way to reduce reading barriers is the use of visual support, for example, symbols. A symbol conveys, in contrast to a photo, a single idea or concept. Little empirical data about the use of symbols to foster the readability of texts exist. Nevertheless, a positive influence can be assumed, e.g., because of the multimedia principle. It indicates that people learn better from words and pictures than from words alone. A qualitative Interview and Eye-Tracking-Study, which was conducted by the authors, gives cause for the assumption that besides the illustration of single words, the visualization of complete sentences may be helpful. Thus, the effect of photos, which illustrate the content of complete sentences, is also investigated in this study. This leads us to the main research question which was focused on: Does the use of easy-to-read language and/or enriching text with symbols or photos facilitate pupils’ comprehension of learning tasks? The sample consisted of students with learning difficulties (N = 144) and students without SEN (N = 159). The students worked on the tasks, which dealt with introducing fractions, individually. While experimental group 1 received a linguistically simplified version of the tasks, experimental group 2 worked with a variation which was linguistically simplified and furthermore, the keywords of the tasks were visualized by symbols. Experimental group 3 worked on exercises which were simplified by easy-to-read-language and the content of the whole sentences was illustrated by photos. Experimental group 4 received a not simplified version. The participants’ reading ability and their IQ was elevated beforehand to build four comparable groups. There is a significant effect of the different setting on the students’ results F(3,140) = 2,932; p = 0,036*. A post-hoc-analyses with multiple comparisons shows that this significance results from the difference between experimental group 3 and 4. The students in the group easy-to-read language plus photos worked on the exercises significantly more successfully than the students who worked in the group with no simplifications. Further results which refer, among others, to the influence of the students reading ability will be presented at the ICERI 2018.

Keywords: inclusive education, mathematics education, easy-to-read language, photos, symbols, special educational needs

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Authors: Zülfiye Bıkmaz, Aytolan Yıldırım

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This study was planned as a descriptive regressive study in order to determine the relationship between the competency levels of working nurses, the levels of competency expected by nursing students, the critical thinking disposition of nurses, their perceived autonomy levels, and certain socio demographic characteristics. It is also a methodological study with regard to the intercultural adaptation of the Nursing Competence Scale (NCS) in both working and student samples. The sample of the study group of nurses at a university hospital for at least 6 months working properly and consists of 443 people filled out questionnaires. The student group, consisting of 543 individuals from the 4 public university nursing 3rd and 4th grade students. Data collection tools consisted of a questionnaire prepared in order to define the socio demographic, economic, and personal characteristics of the participants, the ‘Nursing Competency Scale’, the ‘Autonomy Subscale of the Sociotropy – Autonomy Scale’, and the ‘California Critical Thinking Disposition Inventory’. In data evaluation, descriptive statistics, nonparametric tests, Rasch analysis and correlation and regression tests were used. The language validity of the ‘NCS’ was performed by translation and back translation, and the context validity of the scale was performed with expert views. The scale, which was formed into its final structure, was applied in a pilot application from a group consisting of graduate and student nurses. The time constancy of the test was obtained by analysis testing retesting method. In order to reduce the time problems with the two half reliability method was used. The Cronbach Alfa coefficient of the scale was found to be 0.980 for the nurse group and 0.986 for the student group. Statistically meaningful relationships between competence and critical thinking and variables such as age, gender, marital status, family structure, having had critical thinking training, education level, class of the students, service worked in, employment style and position, and employment duration were found. Statistically meaningful relationships between autonomy and certain variables of the student group such as year, employment status, decision making style regarding self, total duration of employment, employment style, and education status were found. As a result, it was determined that the NCS which was adapted interculturally was a valid and reliable measurement tool and was found to be associated with autonomy and critical thinking.

Keywords: nurse, nursing student, competence, autonomy, critical thinking, Rasch analysis

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Authors: Nkereke Essien

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The study seeks to analyze tone in the Educated Nigerian accent of English (ENAE) using the three tones: Low (L), High (H) and Low-High (LH). The aim is to find out whether there are any differences or similarities in the performance of the experimental group and the control. To achieve this, twenty educated Nigerian speakers of English who are educated in the language were selected by a Stratified Random Sampling (SRS) technique from two federal universities in Nigeria. They were given a passage to read and their intonation patterns were compared with that of a native speaker (control). The data were analyzed using Pierrehumbert’s (1980) intonation system of analysis. Three different approaches were employed in the analysis of the intonation Phrase (IP) as used by Pierrehumbert: perceptual, statistical and acoustic. We first analyzed our data from the passage and utterances using Willcoxon Matched Pairs Signs Ranks Test to establish the differences between the performance of the experimental group and the control. Then, the one-way Analysis of variance (ANOVA) statistical and Tukey-Krammar Post Hoc Tests were used to test for any significant difference in the performances of the twenty subjects. The acoustic data were presented to corroborate both the perceptual and statistical findings. Finally, the tonal patterns of the selected subjects in the three categories - A, B, C, were compared with those of the control. Our findings revealed that the tonal pattern of the Educated Nigerian Accent of English (ENAE) is significantly different from the tonal pattern of the Standard British Accent of English (SBAE) as represented by the control. A high preference for unidirectional tones, especially, the high tones was observed in the performance of the experimental group. Also, high tones do not necessarily correspond to stressed syllables and low tones to unstressed syllables.

Keywords: accent, intonation phrase (IP), tonal patterns, tone

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Authors: Reynante E. Autida, Maria Ana T. Quimbo

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The chemistry education curriculum provides an excellent avenue where students learn the principles and concepts in chemistry and at the same time, as a central science, better understand related fields. However, the teaching approach used by teachers affects student learning. Cased-based teaching (CBT) is one of the various forms of inductive method. The teacher starts with specifics then proceeds to the general principles. The students’ role in inductive learning shifts from being passive in the traditional approach to being active in learning. In this paper, the effects of Small-Group Case-Based Teaching (SGCBT) on college chemistry students’ achievement, critical thinking, and attitude toward chemistry including the relationships between each of these variables were determined. A quasi-experimental counterbalanced design with pre-post control group was used to determine the effects of SGCBT on Engineering students of four intact classes (two treatment groups and two control groups) in one of the State Universities in Mindanao. The independent variables are the type of teaching approach (SGCBT versus pure lecture-discussion teaching or PLDT) while the dependent variables are chemistry achievement (exam scores) and scores in critical thinking and chemistry attitude. Both Analysis of Covariance (ANCOVA) and t-tests (within and between groups and gain scores) were used to compare the effects of SGCBT versus PLDT on students’ chemistry achievement, critical thinking, and attitude toward chemistry, while Pearson product-moment correlation coefficients were calculated to determine the relationships between each of the variables. Results show that the use of SGCBT fosters positive attitude toward chemistry and provides some indications as well on improved chemistry achievement of students compared with PLDT. Meanwhile, the effects of PLDT and SGCBT on critical thinking are comparable. Furthermore, correlational analysis and focus group interviews indicate that the use of SGCBT not only supports development of positive attitude towards chemistry but also improves chemistry achievement of students. Implications are provided in view of the recent findings on SGCBT and topics for further research are presented as well.

Keywords: case-based teaching, small-group learning, chemistry cases, chemistry achievement, critical thinking, chemistry attitude

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Authors: Siwimol Phoomniyom, Pathom Karaipoom, Rossaphorn Kittyaowaman

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Background: C. trachomatis is the most common bacterial sexually transmitted infections. Although infection with C. trachomatis can be treated with antibiotic, it is frequently asymptomatic, especially in extragenital sites. Hence, if screening tests are not performed, undetected and untreated is a crucial problem for C. trachomatis infection, especially in Thailand, which is less well studied. We sought to assess the prevalence of C. trachomatis infection in multiple anatomical sites among patients attending Bangrak STIs Center. Methods: We examined laboratory results of all patients at baseline visit from 3 January 2018 to 27 December 2019. These results were tested by a validated in-house real time PCR specify for the cryptic plasmid gene of C. trachomatis. The prevalence of C. trachomatis was analyzed by anatomical sites, sexes, and ages. Urogenital samples were obtained from urethral swab of men and cervical swab of women. The median ages of the patients were 32 years (range 13-89 years). Chi-square test by IBM SPSS statistic version 20 was used to assess difference in the distribution of variables between groups. Results: Among 3,789 patients, the prevalence for C. trachomatis infection was the highest in rectal (16.1%), followed by urogenital (11.2%) and pharyngeal (3.5%) sites. Rectal and urogenital infection in men was higher than in women, with the highest prevalence of 16.6% in rectal site. Both rectal and urogenital sites also showed statistically significant differences between sexes (P<0.001). Meanwhile, pharyngeal C. trachomatis infection rate was higher in women than men. Interestingly, the chlamydia prevalence was the highest in age 13-19 years of all three sites (18.5%, urogenital; 17.7%, rectal; 6.5%, pharyngeal), with statistically significant difference between age groups (P<0.001). Total of 45 C. trachomatis infections, 20.0%, 51.1%, and 6.7% were isolated from urogenital, rectal, and pharyngeal sites. In total, 75.6%, 26.7%, and 80.0% of chlamydia infections would have been missed, if only urogenital, rectal, or pharyngeal screening was performed. Conclusions: The highest source of C. trachomatis infection was the rectal site. While, the highest prevalence in men was at rectal site, that in women was at urogenital site. The highest chlamydia prevalence was found in adolescent age group, indicating that the pediatric population was a high-risk group. This finding also elucidated that a high proportion of C. trachomatis infection would be missed, if only single anatomical site screening was performed, especially in extragenital sites. Hence, extragenital screening is also required for the extensive C. trachomatis detection.

Keywords: chlamydia trachomatis, anatomical sites, sexes, ages

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Authors: Keith T. S. Tung, Frederick K. Ho, Rosa S. Wong, Camilla K. M. Lo, Wilfred H. S. Wong, C. B. Chow, Patrick Ip

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Objectives: Underage drinking is an important public health problem both locally and globally. Conventional prevention/intervention relies on unidirectional knowledge transfer such as mail leaflets or health talks which showed mixed results in changing the target behaviour. Previously, we conducted a school internet-based intervention which was found to be effective in reducing alcohol use among adolescents, yet the underlying mechanisms have not been properly investigated. This study, therefore, examined the mechanisms that explain how the intervention produced a change in alcohol drinking behaviours among Chinese adolescent as observed in our previous clustered randomised controlled trial (RCT) study. Methods: This is a cluster randomised controlled trial with parallel group design. Participating schools were randomised to the Internet intervention or the conventional health education group (control) with a 1:1 allocation ratio. Secondary 1–3 students of the participating schools were enrolled in this study. The Internet intervention was a web-based quiz game competition, in which participating students would answer 1,000 alcohol-related multiple-choice quiz questions. Conventional health education group received a promotional package on equivalent alcohol-related knowledge. The participants’ alcohol-related attitude, knowledge, and perceived behavioural control were self-reported before the intervention (baseline) and one month and three months after the intervention. Results: Our RCT results showed that participants in the Internet group were less likely to drink (risk ratio [RR] 0.79, p < 0.01) as well as in lesser amount (β -0.06, p < 0.05) compared to those in the control group at both post-intervention follow-ups. Within the intervention group, regression analyses showed that high quiz scorer had greater improvement in alcohol-related knowledge (β 0.28, p < 0.01) and attitude (β -0.26, p < 0.01) at 1 month after intervention, which in turn increased their perceived behavioural control against alcohol use (β 0.10 and -0.26, both p < 0.01). Attitude, compared to knowledge, was found to be a stronger contributor to the intervention effect on perceived behavioural control. Conclusions: Our internet-based intervention has demonstrated effectiveness in reducing the risk of underage drinking when compared with conventional health education. Our study results further showed an attitude to be a more important factor than knowledge in changing health-related behaviour. This has an important implication for future prevention/intervention on an underage drinking problem.

Keywords: adolescents, internet-based intervention, randomized controlled trial, underage drinking

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Authors: Radha Tomar, Satish K. Jain, Manish Panchal, P. S. Rathore

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In the presented work, inset fed microstrip patch antenna (IFMPA) based two port MIMO Antenna system has been proposed, which is suitable for wireless local area network (WLAN) applications. IFMPA has been designed, optimized for 2.4 GHz and applied for MIMO formation. The optimized parameters of the proposed IFMPA have been used for fabrication of antenna and two port MIMO in a laboratory. Fabrication of the designed MIMO antenna has been done and tested experimentally for performance parameters like Envelope Correlation Coefficient (ECC), Mean Effective Gain (MEG), Directive Gain (DG), Channel Capacity Loss (CCL), Multiplexing Efficiency (ME) etc and results are compared with simulated parameters extracted with simulated S parameters to validate the results. The simulated and experimentally measured plots and numerical values of these MIMO performance parameters resembles very much with each other. This shows the success of MIMO antenna design methodology.

Keywords: multiple-input and multiple-output, wireless local area network, vector network analyzer, envelope correlation coefficient

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Authors: Eileen K. Africa, Karel J. van Deventer

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Neuro-typical children develop the motor skills necessary to play, do schoolwork and interact with others. However, this is not observed in children who have learning or behavioural problems. Children with Autism Spectrum Disorder (ASD) are often referred to as clumsy because their body parts do not work well together in a sequence. Physical Activity (PA) has shown to be beneficial to the general population, therefore, providing children with ASD opportunities to take part in PA programmes, could prove to be beneficial in many ways and should be investigated. The purpose of this study was to design a specialised group intervention programme, to attempt to improve gross motor skills of selected children diagnosed with ASD between the ages of eight and 13 years. A government school for ASD learners was recruited to take part in this study, and a sample of convenience (N=7) was selected. Children in the experimental group (n=4) participated in a 12-week group intervention programme twice per week, while the control group continued with their normal daily routine. The Movement Assessment Battery for Children-Second Edition (MABC-2), was administered pre- and post-test to determine the children’s gross motor proficiency and to determine if the group intervention programme had an effect on the gross motor skills of the experimental group. Statistically significant improvements were observed in total motor skill proficiency (p < 0.05), of the experimental group. These results demonstrate the importance of gross motor skills interventions for children diagnosed with ASD. Future research should include more participants to ensure that the results can be generalised.

Keywords: autism spectrum disorder, children, gross motor skills, group intervention programme

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Authors: Ping Xu, Gregory T. Golm, Guanghan (Frank) Liu

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In the presence of competing events, traditional survival analysis may not be appropriate and can result in biased estimates, as it assumes independence between competing events and the event of interest. Instead, competing risk analysis should be considered to correctly estimate the survival probability of the event of interest and the hazard ratio between treatment groups. The COVID-19 pandemic has provided a potential source of competing risks in clinical trials, as participants in trials may experienceCOVID-related competing events before the occurrence of the event of interest, for instance, death due to COVID-19, which can affect the incidence rate of the event of interest. We have performed simulation studies to compare multiple competing risk analysis models, including the cumulative incidence function, the sub-distribution hazard function, and the cause-specific hazard function, to the traditional survival analysis model under various scenarios. We also provide a general recommendation on conducting competing risk analysis in randomized clinical trials during the era of the COVID-19 pandemic based on the extensive simulation results.

Keywords: competing risk, survival analysis, simulations, randomized clinical trial, COVID-19 pandemic

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Authors: Alaa Jawad Hassan, Saad Marza Al-Aaraji, Fadil Abbas Hamad

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The current study was designed to assess some immunological parameters and pedigree analysis for atopic dermatitis patients, as the study included 64 patients (37 males and 27 females) and 24 healthy individuals (12 males and 12 females) with no history of the AD. The cases of this study were divided into two age groups; the first is infant and children (1-10 years), while the second is adolescent and adults (11- 60 years). The number of cases was 51 and 13 in each age group respectively. Sera samples from confirmed AD patients and healthy control were analysed by mean of ELISA for assessment the concentrations of IL-1β, IL-2, IL-4 and IgE. The study showed that a significant increase (P < 0.05) in IL-1β, IL-4 and IgE levels in the patients compared with the control group in both age groups and gender, while there was no significant difference (P < 0.05) in the concentration of IL-2. The study of pedigree analysis shows the genetic tendency in the frequency of disease depending on the genetic history of family, where more patients returning to families in which both parents or one of them infected with AD, whereas the patients were no parents infected with AD they are suffering from asthma and the disease recurs in their uncles.

Keywords: atopic dermatitis, cytokines, IgE, molecular biology

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Authors: Nail Nazarov, Vladimir Zobov, Alexandra Vyshtakalyuk, Vyacheslav Semenov, Irina Galyametdinova, Vladimir Reznik

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There have been studied effects of xymedon and six new pyrimidine derivatives, that are close and distant analogs of xymedon, on rats' working capacity in the test 'swimming to failure'. It has been shown that a single administration of the studied compounds did not have a statistically significant effect in the test. In the conditions of multiple intraperitoneal administration of the studied pyrimidine derivatives, the compound L-ascorbate, 1-(2-hydroxyethyl)-4.6-dimethyl-1.2-dihydropyrimidine-2-one had the lowest toxicity and the most pronounced actoprotective effect. Introduction in the dose of 20 mg/kg caused a statistically significant increase 440 % in the duration of swimming of rats on the 14th day of the experiment compared with the control group. Multiple administration of the compound in the conditions of physical load did not affect leucopoiesis but stimulates erythropoiesis resulting in an increase in the number of erythrocytes and a hemoglobin level. The substance introduction under mixed exhausting loads prevented such changes of blood biochemical parameters as reduction of glucose, increased of urea and lactic acid levels, what indicates improvement in the animals' tolerability of loads and an anti-catabolic effect of the compound. Absence of hepato and cardiotoxic effects of the substance has been shown. This work was performed with the financial support of Russian Science Foundation (grant № 14-50-00014).

Keywords: actoprotectors, physical working capacity, pyrimidine derivatives, xymedon

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Authors: Gospodinka Prakova, Pavlina Gidikova, Gergana Sandeva, Kamelia Haracherova, Emil Slavov

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Neopterin was demonstrated to be a sensitive marker of cell-mediated immune reactions which plays a key role in the interaction of monocyte / macrophage activation. The purpose of this work was to investigate changes in serum neopterin in workers exposed to different composition of mineral dust. Material and Methods: Serum neopterin was studied in 193 exposed workers, divided into three groups, depending on the mineral dust and content of the quartz in the respirable fraction. The I-st group-coal dust containing less than 2% free crystalline silica (n=44), II-nd group-coal dust containing over 2% free crystalline silica (n=94) and the III-rd group-mixed dust with corundum and carborundum (n=55). The control group was composed of 21 individuals without exposure to dust. Serum neopterin was investigated by Elisa method in ng/ml according to the instructions of the manufacturer. Results and Discussion: It was found significantly higher level of serum neopterin in exposed workers of mineral dust (2,10 ± 0,62 ng / ml), compared with that of the control group (1,10 ± 0,85 ng/ml; p < 0,05). Neopterin levels in workers exposed to coal dust (1,87 ± 0,42 ng / ml-I-st and 3,32 ± 0,77 ng / ml-II-nd group) were significantly higher compared with those exposed to a mixed dust (1,31±0,68 mg / ml-third) and control group (p < 0,05). No significant difference in serum neopterin when exposed to a mixed dust composed of corundum and carborundum (III-rd) and a control group. Conclusion: The results of this study indicate activates a cell-mediated immune response when exposed to a mineral dust. The level of that activation depends mainly on the composition of the dust and is significantly highest in workers exposed to coal dust.

Keywords: mineral dust, neopterin, occupational exposure, respirable crystalline silica

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Authors: Pavlina Capkova, Josef Srovnal, Vera Becvarova, Marie Trkova, Zuzana Capkova, Andrea Stefekova, Vaclava Curtisova, Alena Santava, Sarka Vejvalkova, Katerina Adamova, Radek Vodicka

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ASDs are heterogeneous and complex developmental diseases with a significant genetic background. Recurrent CNVs are known to be a frequent cause of ASD. These CNVs can have, however, a variable expressivity which results in a spectrum of phenotypes from asymptomatic to ID/DD/ASD. ASD is associated with ID in ~75% individuals. Various platforms are used to detect pathogenic mutations in the genome of these patients. The performed study is focused on a determination of the frequency of pathogenic mutations in a group of ASD patients and a group of ID/DD patients using various strategies along with a comparison of their detection rate. The possible role of the origin of these mutations in aetiology of ASD was assessed. The study included 35 individuals with ASD and 68 individuals with ID/DD (64 males and 39 females in total), who underwent rigorous genetic, neurological and psychological examinations. Screening for pathogenic mutations involved karyotyping, screening for FMR1 mutations and for metabolic disorders, a targeted MLPA test with probe mixes Telomeres 3 and 5, Microdeletion 1 and 2, Autism 1, MRX and a chromosomal microarray analysis (CMA) (Illumina or Affymetrix). Chromosomal aberrations were revealed in 7 (1 in the ASD group) individuals by karyotyping. FMR1 mutations were discovered in 3 (1 in the ASD group) individuals. The detection rate of pathogenic mutations in ASD patients with a normal karyotype was 15.15% by MLPA and CMA. The frequencies of the pathogenic mutations were 25.0% by MLPA and 35.0% by CMA in ID/DD patients with a normal karyotype. CNVs inherited from asymptomatic parents were more abundant than de novo changes in ASD patients (11.43% vs. 5.71%) in contrast to the ID/DD group where de novo mutations prevailed over inherited ones (26.47% vs. 16.18%). ASD patients shared more frequently their mutations with their fathers than patients from ID/DD group (8.57% vs. 1.47%). Maternally inherited mutations predominated in the ID/DD group in comparison with the ASD group (14.7% vs. 2.86 %). CNVs of an unknown significance were found in 10 patients by CMA and in 3 patients by MLPA. Although the detection rate is the highest when using CMA, recurrent CNVs can be easily detected by MLPA. CMA proved to be more efficient in the ID/DD group where a larger spectrum of rare pathogenic CNVs was revealed. This study determined that maternally inherited highly penetrant mutations and de novo mutations more often resulted in ID/DD without ASD in patients. The paternally inherited mutations could be, however, a source of the greater variability in the genome of the ASD patients and contribute to the polygenic character of the inheritance of ASD. As the number of the subjects in the group is limited, a larger cohort is needed to confirm this conclusion. Inherited CNVs have a role in aetiology of ASD possibly in combination with additional genetic factors - the mutations elsewhere in the genome. The identification of these interactions constitutes a challenge for the future. Supported by MH CZ – DRO (FNOl, 00098892), IGA UP LF_2016_010, TACR TE02000058 and NPU LO1304.

Keywords: autistic spectrum disorders, copy number variant, chromosomal microarray, intellectual disability, karyotyping, MLPA, multiplex ligation-dependent probe amplification

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Authors: Sukwoong Kang

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Background: The application of light-emitting diode (LED)-dependent photobiomodulation (PBM) in promoting post-tendon injury healing has been recently reported. Despite the establishment of a theoretical basis for ligament restoration through PBM, the lack of any empirical evidence deems this therapeutic strategy contentious. Therefore, the aim of this study was to investigate the potency of LED-based PBM in facilitating tendon healing in a murine model. Methods: Migration kinetics were analyzed at two specific wavelengths: 630 and 880 nm. The Achilles tendon in the hind limbs of Balb/c mice was severed via Achilles tendon transection. Subsequently, the mice were randomized into LED non-irradiation and LED irradiation groups. Mice with intact tendons were employed as healthy controls. The wounds were LED-irradiated for 20 min daily for two days. Histological properties, tendon healing mediators, and inflammatory mediators were screened on day 14. Results: The roundness of the nuclei and fiber structure, indicating the degree of infiltrated inflammatory cells and severity of fiber fragmentation, respectively, were considerably lower in the LED irradiation group than in the LED non-irradiation group. Immunohistochemical analysis depicted an increase in tenocytes (SCX+ cells) and a recovery of wounds with reduced fibrosis (lower collagen 3 and TGF-β1) in the LED irradiation group during healing; conversely, the LED non-irradiation group exhibited tissue fibrosis. The ratio of M2 macrophages to total macrophages was higher in the LED irradiation group than in the injured group. Conclusion: LED-based PBM in the Achilles tendon rupture murine model effectuated a rapid restoration of histological and immunochemical outcomes. The aforementioned findings suggest that LED-based PBM presents remarkable potential as an adjunct therapeutic for tendon healing and warrants further research to standardize various parameters to advance and establish it as a reliable treatment regime.

Keywords: photobiomodulation, light-emitting diode, tendon, regeneration

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Authors: Mayurachat Kanyamee, Srisuda Rassameepong, Narunest Chulakarn

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This experimental pretest-posttest control group design aimed to examine the effects of a family-based intervention on increasing fruit and vegetable intake and reduce fat and sugar intake and nutritional status among school-age children. Children were randomized to experimental 68 children and control 68 children. The experimental group received the intervention based on Social Cognitive Theory. The control group received the school’s usual educational program regarding healthy eating behavior. Data were collected via three questionnaires including: demographic characteristics; fruit and vegetable intake; and fat and sugar intake at baseline, sixteen weeks after baseline. Analysis of the data included the use of descriptive statistic and independent t-test. Results revealed the significant differences between the experimental and control group, regarding: fruit and vegetable intake, fat and sugar intake and nutritional status at sixteenth week after baseline. The findings suggest a family-based intervention, based on SCT, appears to be effective to improve eating behavior, and nutritional status of school -age children. So, the intervention can be applied to improve eating behavior among other groups of children.

Keywords: family-based intervention, children, unhealthy food, food safety

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Authors: Sajadian Akram, Tavasoli F.

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Breast cancer is the second most common cancer in the world and certainly the most frequent cancer mostly among women. This study was aimed to compare the effectiveness of individual counseling and group narrative therapy on female patients' life expectancy afflicted by breast cancer. The present study is a pre-test-post-test clinical trial. Fifty-five patients with breast cancer were randomly selected in the follow-up period and after their active medical treatment completion. Then, they were randomly divided into two groups: individual counseling and group counseling. Herth hope index (HHI) was used to measure the patients' hope level. Data were analyzed using t-test and SPSS software. hope rate was statistically significant in both groups receiving individual and group narrative therapy in the post-test compared to the pre-test (P <00000). Moreover, the comparative evaluation of hope in both groups (individual & group counseling) in the post-test showed that group narrative counseling is more effective than individual narrative counseling (P <00000). Conclusion: Narrative therapy promotes hope in breast cancer patients effectively. Due to the nature of breast cancer and its psychological effects in the post-treatment period, providing narrative group therapy can improve life quality. Patients' life quality changes in tandem with changes in hope.

Keywords: hope, narrative therapy, counseling, breast cancer

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Authors: Essam Amerian

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The aim of this study was to investigate the effects of improving waist-to-hip ratio (WHR) and visceral fat components on the health of shift workers in an offshore petrochemical company. A total of 100 male shift workers participated in the study, with an average age of 40.5 years and an average BMI of 28.2 kg/m². The study employed a randomized controlled trial design, with participants assigned to either an intervention group or a control group. The intervention group received a 12-week program that included dietary counseling, physical activity recommendations, and stress management techniques. The control group received no intervention. The outcomes measured were changes in WHR, visceral fat components, blood pressure, and lipid profile. The results showed that the intervention group had a statistically significant improvement in WHR (p<0.001) and visceral fat components (p<0.001) compared to the control group. Furthermore, there were statistically significant improvements in systolic blood pressure (p=0.015) and total cholesterol (p=0.034) in the intervention group compared to the control group. These findings suggest that implementing a 12-week program that includes dietary counseling, physical activity recommendations, and stress management techniques can effectively improve WHR, visceral fat components, and cardiovascular health among shift workers in an offshore petrochemical company.

Keywords: body composition, waist-hip-ratio, visceral fat, shift worker, work efficiency

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Authors: Balkibekova Venera Serikpaevna

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Background: Autism Spectrum Disorder (ASD) poses significant challenges in both diagnosis and treatment. Existing therapeutic interventions often target specific symptoms, necessitating the exploration of alternative approaches. This study investigates the RITM (Rhythm Integration Tapping Music) developed by Balkibekova, aiming to create imitation, social engagement and a wide range of emotions through brain development. Methods: A randomized controlled trial was conducted with 100 participants diagnosed with ASD, aged 1 to 4 years. Participants were randomly assigned to either the RITM therapy group or a control group receiving standard care. The RITM therapy, rooted in tapping rhythm to music such as: marche on the drums, waltz on bells, lullaby on musical triangle, dancing on tambourine, polka on wooden spoons. Therapy sessions were conducted over a 3 year period, with assessments at baseline, midpoint, and post-intervention. Results: Preliminary analyses reveal promising outcomes in the RITM therapy group. Participants demonstrated significant improvements in social interactions, speech understanding, birth of speech, and adaptive behaviors compared to the control group. Careful examination of subgroup analyses provides insights into the differential effectiveness of the RITM approach across various ASD profiles. Conclusions: The findings suggest that RITM therapy, as developed by Balkibekova, holds promise as intervention for ASD. The integrative nature of the approach, addressing multiple domains simultaneously, may contribute to its efficacy. Further research is warranted to validate these preliminary results and explore the long-term impact of RITM therapy on individuals with ASD. This abstract presents a snapshot of the research, emphasizing the significance, methodology, key findings, and implications of the RITM therapy method for consideration in an autism conference.

Keywords: RITM therapy, tapping rhythm, autism, mirror neurons, bright emotions, social interactions, communications

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Authors: Ashagrie Getnet Flattie

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Line-of-sight (LOS) information, data rates, good quality, and flexible network service are limited by the fact that, for the duration of any given connection, they experience severe variation in signal strength due to fading and path loss. Wireless system faces major challenges in achieving wide coverage and capacity without affecting the system performance and to access data everywhere, all the time. In this paper, the cell coverage and edge rate of different Multiple-input multiple-output (MIMO) schemes in 20 MHz Long Term Evolution (LTE) system under Unmanned Air Vehicles (UAV) platform are investigated. After some background on the enormous potential of UAV, MIMO, and LTE in wireless links, the paper highlights the presented system model which attempts to realize the various benefits of MIMO being incorporated into UAV platform. The performances of the three MIMO LTE schemes are compared with the performance of 4x4 MIMO LTE in UAV scheme carried out to evaluate the improvement in cell radius, BER, and data throughput of the system in different morphology. The results show that significant performance gains such as bit error rate (BER), data rate, and coverage can be achieved by using the presented scenario.

Keywords: LTE, MIMO, path loss, UAV

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Authors: Danni Cheng

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Purpose:Surgicallyinclusive treatment(SIT)isthemajor treatment fororopharyngealsquamouscellcarcinoma (OPSCC) in Eastern countries, while nonsurgical treatments(NSTs) are the priority treatment in Western countries. The preferred treatmentsforOPSCC patients remaindebated. Methods:Atotalof 153 consecutive OPSCC casesdiagnosed between 2009 and 2019inWCH, and 15,400 OPSCC cases from SEER database (2000-2017) were obtained. Clinical characteristics, treatments, and survival outcomes were retrospectively collected. We conductedKaplan-Meier curves univariate and multivariate analysis to compare the prognosis of OPSCC patients in WCH, SEER Asian, and SEER all ethnic population by different treatment modalities,HPVstatus, ages, and TNM stages. Results: The 5-year overall survival rate was 59% in WCH, 64% in the SEER all ethnic and 67% in SEER Asian group. In both univariate and multivariate analysis, SIT was observed as a consistent benefit factor for OPSCC patients in all three populations when classified by genders, tumor stages, and HPV status. Patients who underwent SIT had significantly better survival outcomes than those who received NSTsin WCH, SEER Asian, and SEER all ethnic groups. HPV positive status was the beneficial factor of OPSCC patients in all three groups. Besides, male patients had worse survival outcomes in both WCH and SEER Asian group, whereas male patients had better outcomes in the SEER all ethnic group. Conclusion: In contrast to nowadaysNSTs are the first-line therapiesfor OPSCC, our ten-year real-world data and SEER data indicated that OPSCC patients who underwent SIT had better prognosis than NSTs.

Keywords: OPSCC, survival outcome, SEER, treatment modalities

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Authors: S. El Ballal, H. El Sabbagh, M. Abd El Gaber, A. Eisa, A. Al Gamal

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Cadmium is one of the most harmful heavy metals able to induce severe injury. In this study, sixty four male Sprague Dawley rats weighing (70-80 gm) were used. Rats were divided into 4 groups each group of 16 rats. Group A: served as control and received commercial ration and distilled water Group B: cadmium chloride was administered orally in water at dose of 300 ppm cadmium (560 mg/L as CdCl2). Group C: Animals received cadmium in drinking water in addition to administration of N-acetylcysteine (NAC) orally at a dose of 150 mg/kg body weight, equivalent to 1500 ppm in food. Group D: Animals received cadmium in drinking water in addition to administration of alpha lipoic acid (ALA) orally at a dose of 150 mg/kg body weight, equivalent to 1500 ppm in food. The experiment was continued for 2 months. Collection of blood and tissue samples was performed at 2, 4, 6, 8 weeks. Blood sample were collected for serum biochemical analysis including malondialdehyde (MDA), total antioxidants, aspartate aminotransferase (AST), alanine aminotransferase (ALT), total protein, albumin, urea and uric acid. Tissue specimens were collected for histopathological examination including liver, kidney, brain and testis. Histopathological examination revealed that cadmium choloride induces pathological alterations which increased in severity with time. The use of NAC and ALA can ameliorate toxic effect of CdCl2. The results showed significant decrease MDA and significant increase total antioxidants in group C and D compared to group B, Liver enzymes include AST and ALT showed significant decrease. Regarding to results of total protein and albumin, they revealed significant increase. Urea and uric acid showed significant decrease. From our study we conclude that NAC and ALA have protective effect against cadmium toxicity.

Keywords: ALA, cadmium, histopathology, NAC

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Authors: Hasmik V. Zanginyan, Gayane S. Ghazaryan, Laura M. Hovsepyan

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Experimental autoimmune encephalomyelitis (EAE) is an inflammatory demyelinating disease of the central nervous system that is induced in laboratory animals by developing an immune response against myelin epitopes. The typical clinical course is ascending palsy, which correlates with inflammation and tissue damage in the thoracolumbar spinal cord, although the optic nerves and brain (especially the subpial white matter and brainstem) are also often affected. With multiple sclerosis, there is a violation of lipid metabolism in myelin. When membrane lipids (glycosphingolipids, phospholipids) are disturbed, metabolites not only play a structural role in membranes but are also sources of secondary mediators that transmit multiple cellular signals. The purpose of this study was to investigate the effect of ganglioside as a therapeutic agent in experimental multiple sclerosis. The biological activity of a ganglioside-containing medicinal preparation (Cronassial) was evaluated in an experimental model of multiple sclerosis in laboratory animals. An experimental model of multiple sclerosis in rats was obtained by immunization with myelin basic protein (MBP), as well as homogenization of the spinal cord or brain. EAE was induced by administering a mixture of an encephalitogenic mixture (EGM) with Complete Freund’s Adjuvant. Mitochondrial fraction was isolated in a medium containing 0,25 M saccharose and 0, 01 M tris buffer, pH - 7,4, by a method of differential centrifugation on a K-24 centrifuge. Glutathione peroxidase activity was assessed by reduction reactions of hydrogen peroxide (H₂O₂) and lipid hydroperoxides (ROOH) in the presence of GSH. LPO activity was assessed by the amount of malondialdehyde (MDA) in the total homogenate and mitochondrial fraction of the spinal cord and brain of control and experimental autoimmune encephalomyelitis rats. MDA was assessed by a reaction with Thiobarbituric acid. For statistical data analysis on PNP, SPSS (Statistical Package for Social Science) package was used. The nature of the distribution of the obtained data was determined by the Kolmogorov-Smirnov criterion. The comparative analysis was performed using a nonparametric Mann-Whitney test. The differences were statistically significant when р ≤ 0,05 or р ≤ 0,01. Correlational analysis was conducted using a nonparametric Spearman test. In the work, refrigeratory centrifuge, spectrophotometer LKB Biochrom ULTROSPECII (Sweden), pH-meter PL-600 mrc (Israel), guanosine, and ATP (Sigma). The study of the process of lipid peroxidation in the total homogenate of the brain and spinal cord in experimental animals revealed an increase in the content of malonic dialdehyde. When applied, Cronassial observed normalization of lipid peroxidation processes. Reactive oxygen species, causing lipid peroxidation processes, can be toxic both for neurons and for oligodendrocytes that form myelin, causing a violation of their lipid composition. The high content of lipids in the brain and the uniqueness of their structure determines the nature of the development of LPO processes. The lipid layer of cellular and intracellular membranes performs two main functions -barrier and matrix (structural). Damage to the barrier leads to dysregulation of intracellular processes and severe disorders of cellular functions.

Keywords: experimental autoimmune encephalomyelitis, multiple sclerosis, neuroinflammation, therapy

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Authors: J. Chow

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In laboratory settings, this study measured and reported the effects of undergraduate students watching animated videos on learning microeconomics as compared with the effectiveness of reading written texts. The study described an experiment on learning microeconomics in higher education using two different types of learning materials. It reported the effectiveness on microeconomics learning of watching animated videos and reading written texts. Undergraduate students in the university were randomly assigned to either a ‘video group’ or a ‘text group’ in the experiment. Previously-validated multiple-choice questions on fundamental concepts of microeconomics were administered. Both groups showed improvement between the pre-test and post-test. The experience of learning using text and video materials was also assessed. After controlling the student characteristics variables, the analyses showed that both types of materials showed comparable level of perceived learning experience. The effect size and statistical significance of these results supported the hypothesis that animated video is an effective alternative to text materials as a learning tool for students. The findings suggest that such animated videos may support teaching microeconomics in higher education.

Keywords: animated videos for education, laboratory experiment, microeconomics education, undergraduate economics education

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Authors: Erwin Geroleo, Higinio Mappala

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Introduction Overt Hepatic Encephalopathy (OHE) is the most dreaded outcome of liver cirrhosis. Aside from the triggering factors which are already known to precipitate OHE, there is growing evidence that an altered gut microbiota profile (dysbiosis) can also trigger OHE. MHE is the mildest form of hepatic encephalopathy(HE), affecting about one-third of patients with cirrhosis, and close 80% of patients with cirrhosis and manifests as abnormalities in central nervous system function. Since these symptoms are subclinical most patients are not being treated to prevent OHE. The gut microbiota have been evaluated by several studies as a therapeutic option for MHE, especially in decreasing the levels of ammonia, thus preventing progression to OHE Objectives This study aims to evaluate the efficacy of probiotics in terms of reduction of ammonia levels in patient with minimal hepatic encephalopathies and to determine if Probiotics has role in the prevention of progression to overt hepatic encephalopathy in adult patients with minimal hepatic encephalopathy (MHE) Methods and Analysis The literature search strategy was restricted to human studies in adults subjects from 2004 to 2022. The Jadad Score Calculation was utilized in the assessment of the final studies included in this study. Eight (8) studies were included. Cochrane’s Revman Web, the Fixed Effects model and the Ztest were all used in the overall analysis of the outcomes. A p value of less than 0.0005 was statistically significant. Results. These results show that Probiotics significantly lowers the level of Ammonia in Cirrhotic patients with OHE. It also shows that the use of Probiotics significantly prevents the progression of MHE to OHE. The overall risk of bias graph indicates low risk of publication bias among the studies included in the meta-analysis. Main findings This research found that plasma ammonia concentration was lower among participants treated with probiotics (p<0.00001).) Ammonia level of the probiotics group is lower by 13.96 μmol/ on the average. Overall risk of developing overt hepatic encephalopathy in the probiotics group is shown to be decreased by 15% as compared to the placebo group Conclusion The analysis showed that compared with placebo, probiotics can decrease serum ammonia, may improve MHE and may prevent OHE.

Keywords: minimal hepatic encephalopathy, probiotics, liver cirrhosis, overt hepatic encephalopathy

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Authors: Jayanti De

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Users of any urban road infrastructure may be classified into various categories. The current paper intends to see whether the opinions on different environmental and transportation criteria vary significantly among different types of road users or not. The paper addresses this issue by using a unique survey data that has been collected from Kolkata, a highly populated city in India. Multiple criteria should be taken into account while planning on infrastructure development programs. Given limited resources, a welfare maximizing government typically resorts to public opinion by designing surveys for prioritization of one project over another. Designing such surveys can be challenging and costly. Deciding upon whom to include in a survey and how to represent each group of consumers/road-users depend crucially on how opinion for different criteria vary across consumer groups. A unique dataset has been collected from various parts of Kolkata to statistically test (using Kolmogorov-Smirnov test) whether assigning of weights to rank the transportation criteria like congestion, air pollution, noise pollution, and morning/evening delay vary significantly across the various groups of users of such infrastructure. The different consumer/user groups in the dataset include pedestrian, private car owner, para-transit (taxi /auto rickshaw) user, public transport (bus) user and freight transporter among others. Very little evidence has been found that ranking of different criteria among these groups vary significantly. This also supports the hypothesis that road- users/consumers form their opinion by using their long-run rather than immediate experience. As a policy prescription, this implies that under-representation or over-representation of a specific consumer group in a survey may not necessarily distort the overall opinion, since opinions across different consumer groups are highly correlated as evident from this particular case study.

Keywords: multi criteria analysis, project-prioritization, road- users, survey designing

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Authors: Safak Baykal

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The purpose of this study is analyzing the relationship between self leadership and social capital of people with using Social Network Analysis. In this study, two aspects of social capital will be focused: bonding, homophilous social capital (BoSC) which implies better, strong, dense or closed network ties, and bridging, heterophilous social capital (BrSC) which implies weak ties, bridging the structural holes. The other concept of the study is Trust (Tr), namely interpersonal trust, willingness to ascribe good intentions to and have confidence in the words and actions of other people. In this study, the sample group, 61 people, was selected from a private firm from the defense industry. The relation between BoSC/BrSC and Tr is shown by using Social Network Analysis (SNA) and statistical analysis with Likert type-questionnaire. The results of the analysis show the Cronbach’s alpha value is 0.73 and social capital values (BoSC/BrSC) is highly correlated with Tr values of the people.

Keywords: bonding social capital, bridging social capital, trust, social network analysis (SNA)

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Authors: Fedili Benamar, Belloulou Mohamed Lamine, Ouahes Hassane, Ghattas Samir

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Introduction: Perioperative blood loss is a frequent cause of complications in total hip replacement (THR). The present prospective study assessed the efficacy of tranexamic acid (Exacyl(®)) in reducing blood loss in primary THR. Hypothesis: Tranexamic acid reduces blood loss in THR. Material and method: -This is a prospective randomized study on the effectiveness of Exacyl (tranexamic acid) in total hip replacement surgery performed on a standardized technique between 2019 and September 2022. -It involved 154 patients, of which 84 received a single injection of Exacyl (group 1) at a dosage of 10 mg/kg over 20 minutes during the perioperative period. -All patients received postoperative thromboprophylaxis with enoxaparin 0.4 ml subcutaneously. -All patients were admitted to the post-interventional intensive care unit for a duration of 24 hours for monitoring and pain management as per the service protocol. Results: 154 patients, of which 84 received a single injection of Exacyl (group 1) and 70 patients patients who did not receive Exacyl perioperatively : (Group 2 ) The average age is 57 +/- 15 years The distribution by gender was nearly equal with 56% male and 44% female; "The distribution according to the ASA score was as follows: 20.2% ASA1, 82.3% ASA2, and 17.5% ASA3. "There was a significant difference in the average volume of intraoperative and postoperative bleeding during the 48 hours." The average bleeding volume for group 1 (received Exacyl) was 614 ml +/- 228, while the average bleeding volume for group 2 was 729 +/- 300, with a chi-square test of 6.35 and a p-value < 0.01, which is highly significant. The ANOVA test showed an F-statistic of 7.11 and a p-value of 0.008. A Bartlett test revealed a chi-square of 6.35 and a p-value < 0.01." "In Group 1 (patients who received Exacyl), 73% had bleeding less than 750 ml (Group A), and 26% had bleeding exceeding 750 ml (Group B). In Group 2 (patients who did not receive Exacyl perioperatively), 52% had bleeding less than 750 ml (Group A), and 47% had bleeding exceeding 750 ml (Group B). "Thus, the use of Exacyl reduced perioperative bleeding and specifically decreased the risk of severe bleeding exceeding 750 ml by 43% with a relative risk (RR) of 1.37 and a p-value < 0.01. The transfusion rate was 1.19% in the population of Group 1 (Exacyl), whereas it was 10% in the population of Group 2 (no Exacyl). It can be stated that the use of Exacyl resulted in a reduction in perioperative blood transfusion with an RR of 0.1 and a p-value of 0.02. Conclusions: The use of Exacyl significantly reduced perioperative bleeding in this type of surgery.

Keywords: acid tranexamic, blood loss, anesthesia, total hip replacement, surgery

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