Search results for: treatment based on acceptance and commitment
Commenced in January 2007
Frequency: Monthly
Edition: International
Paper Count: 35429

Search results for: treatment based on acceptance and commitment

33929 Macroscopic Evaluation of the Effect of Low-Level Laser and Plasma Jet on Wound Healing in Rats

Authors: Zahra Tabarsi, Mehdi Marjani, Alireza Najafpour, Alborz Mirzade

Abstract:

The aim of this study was to evaluate and compare the macroscopic effect of low level laser and plasma jet for wound healing in rats. The study was performed on 40 old male white rats with an average weight of 250 g and an average age of the same age. After preparing the rats from Ibn Sina Research Institute, they were kept the same for one week under environmental conditions such as temperature, humidity and light, and nutrition such as the type of diet and the number of meals. Then, to start the research, rats were randomly divided into two groups (A): laser treatment of wounds, group (B): plasma wound treatment. All rats were inhibited 4 hours before each anesthesia under conditions of abstinence and up to 2 hours after drinking water. Rats were anesthetized by intraperitoneal injection of ketamine 10% and xylazine 2%.After scrubbing between two shoulders of each rat, a circular wound was created by sterile 5 mm biopsy puncture. Group A rats were treated with low level laser in three sessions and group B in three sessions with argon plasma. Based on the observed results, it seems that Low level laser radiation has more acceptable and appropriate effects than cold plasma on the healing of rat skin wounds.

Keywords: low-level laser, plasma jet, rat, wound healing

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33928 Numerical Prediction of Wall Eroded Area by Cavitation

Authors: Ridha Zgolli, Ahmed Belhaj, Maroua Ennouri

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This study presents a new method to predict cavitation area that may be eroded. It is based on the post-treatment of URANS simulations in cavitant flows. The most RANS calculations with incompressible consideration are based on cavitation model using mixture fluid with density (ρm) calculated as a function of liquid density (ρliq), vapour or gas density (ρvap) and vapour or gas volume fraction α (ρm = αρvap + (1-α) ρliq). The calculations are performed on hydrofoil geometries and compared with experimental works concerning flows characteristics (size of pocket, pressure, velocity). We present here the used cavitation model and the approach followed to evaluate the value of α fixing the shape of pocket around wall before collapsing.

Keywords: flows, CFD, cavitation, erosion

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33927 Building Secondary School Mathematics Teachers’ Effective Teaching Practices Through Professional Development with Lesson Study

Authors: Temesgen Yadeta, Abbi Lemma, Maina Faith, Adula Bekele Hunde

Abstract:

Effective teaching plays a central role in students’ success in school. The main purpose of the study was to understand how engaging in a lesson study could help to develop secondary school mathematics teachers’ effective teaching practices to support students’ learning better. The research was conducted in Jimma City and employed design-based research with qualitative and quantitative data collected from two secondary schools and 12 mathematics teachers. A purposive sampling technique was used to select participants. Interviews, observations, document analysis, and questionnaires were the main sources of data. Qualitative data were analyzed through coding, categorizing, and thematizing supported by Atlas-ti qualitative data analysis software. Quantitative data were analyzed using mean, standard deviations, medians, and a Wilcoxon-ranked signed test supported by statistical packages for social sciences software. The findings of the study revealed that engaging in lesson study built mathematics teachers’ effective teaching practices. School leaders’ positive attitudes and initiative towards the lesson study were found to be supportive. Teachers’ collaboration, commitment with determination, and active participation during the study periods were also found to be supportive. Shortage of time and teachers’ high teaching load had constrained teachers’ active engagement in lesson study during study periods. In conclusion, the lesson study provided a more practical link between teachers’ professional learning activities and actual classroom practices. Therefore, it would be crucial to integrate lesson study into the present school-based teachers’ pedagogical capacity-building program in the country. It would also be beneficial to extend the merits of lesson study to other school subjects and more schools in the country based on their specific school contexts to build teachers’ effective teaching practices.

Keywords: effective teaching practices, lesson study, mathematics teachers, professional development, secondary school

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33926 Developing a Smart Card Using Internet of Things-Uni-C

Authors: Enji E. Alzamzami, Kholod A. Almwallad, Rahaf J. Alwafi, Roaa H. Alansari, Shatha S. Alshehri, Aeshah A. Alsiyami

Abstract:

This paper demonstrates a system that helps solve the congestion problem at the entrance gates and limits the spread of viruses among people in crowded environments, such as COVID-19, using the IoT (Internet of Things). This system may assist in organizing the campus entry process efficiently by developing a smart card application supported by NFC (Near Field Communication) technology through which users' information could be sent to a reader to share it with the server and allow the server to perform its tasks and send a confirmation response for the request either by acceptance or rejection.

Keywords: COVID-19, IoT, NFC technology, smart card

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33925 The Effects of Source and Timing on the Acceptance of New Product Recommendation: A Lab Experiment

Authors: Yani Shi, Jiaqi Yan

Abstract:

A new product is important for companies to extend consumers and manifest competitiveness. New product often involves new features that consumers might not be familiar with while it may also have a competitive advantage to attract consumers compared to established products. However, although most online retailers employ recommendation agents (RA) to influence consumers’ product choice decision, recommended new products are not accepted and chosen as expected. We argue that it might also be caused by providing a new product recommendation in the wrong way at the wrong time. This study seeks to discuss how new product evaluations sourced from third parties could be employed in RAs as evidence of the superiority for the new product and how the new product recommendation could be provided to a consumer at the right time so that it can be accepted and finally chosen during the consumer’s decision-making process. A 2*2 controlled laboratory experiment was conducted to understand the selection of new product recommendation sources and recommendation timing. Human subjects were randomly assigned to one of the four treatments to minimize the effects of individual differences on the results. Participants were told to make purchase choices from our product categories. We find that a new product recommended right after a similar existing product and with the source of the expert review will be more likely to be accepted. Based on this study, both theoretical and practical contributions are provided regarding new product recommendation.

Keywords: new product recommendation, recommendation timing, recommendation source, recommendation agents

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33924 Development of a Model Based on Wavelets and Matrices for the Treatment of Weakly Singular Partial Integro-Differential Equations

Authors: Somveer Singh, Vineet Kumar Singh

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We present a new model based on viscoelasticity for the Non-Newtonian fluids.We use a matrix formulated algorithm to approximate solutions of a class of partial integro-differential equations with the given initial and boundary conditions. Some numerical results are presented to simplify application of operational matrix formulation and reduce the computational cost. Convergence analysis, error estimation and numerical stability of the method are also investigated. Finally, some test examples are given to demonstrate accuracy and efficiency of the proposed method.

Keywords: Legendre Wavelets, operational matrices, partial integro-differential equation, viscoelasticity

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33923 New Photosensitizers Encapsulated within Arene-Ruthenium Complexes Active in Photodynamic Therapy: Intracellular Signaling and Evaluation in Colorectal Cancer Models

Authors: Suzan Ghaddar, Aline Pinon, Manuel Gallardo-villagran, Mona Diab-assaf, Bruno Therrien, Bertrand Liagre

Abstract:

Colorectal cancer (CRC) is the third most common cancer and exhibits a consistently rising incidence worldwide. Despite notable advancements in CRC treatment, frequent occurrences of side effects and the development of therapy resistance persistently challenge current approaches. Eventually, innovations in focal therapies remain imperative to enhance the patient’s overall quality of life. Photodynamic therapy (PDT) emerges as a promising treatment modality, clinically used for the treatment of various cancer types. It relies on the use of photosensitive molecules called photosensitizers (PS), which are photoactivated after accumulation in cancer cells, to induce the production of reactive oxygen species (ROS) that cause cancer cell death. Among commonly used metal-based drugs in cancer therapy, ruthenium (Ru) possesses favorable attributes that demonstrate its selectivity towards cancer cells and render it suitable for anti-cancer drug design. In vitro studies using distinct arene-Ru complexes, encapsulating porphin PS, are conducted on human HCT116 and HT-29 colorectal cancer cell lines. These studies encompass the evaluation of the antiproliferative effect, ROS production, apoptosis, cell cycle progression, molecular localization, and protein expression. Preliminary results indicated that these complexes exert significant photocytotoxicity on the studied colorectal cancer cell lines, representing them as promising and potential candidates for anti- cancer agents.

Keywords: colorectal cancer, photodynamic therapy, photosensitizers, arene-ruthenium complexes, apoptosis

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33922 Valorisation of a Bioflocculant and Hydroxyapatites as Coagulation-Flocculation Adjuvants in Wastewater Treatment of the Steppe in the Wilaya of Saida

Authors: Fatima Zohra Choumane, Belkacem Benguella, Bouhana Maachou, Nacera Saadi

Abstract:

Pollution caused by wastewater is a serious problem in Algeria. This pollution has certainly harmful effects on the environment. In order to reduce the bad effects of these pollutants, many wastewater treatment processes, mainly physicochemical, are implemented. This study consists in using two flocculants; the first one is a biodegradable natural bioflocculant, i.e. Cactaceaeou ficus-indica cactus juice, and the second is the synthetic hydroxyapatite, in a physico-chemical process through coagulation-flocculation, using two coagulants, i.e. ferric chloride and aluminum sulfate, to treat wastewater collected at the entrance of the treatment plant, in the town of Saida. The influence of various experimental parameters, such as the amounts of coagulants and flocculants used, pH, turbidity, COD and BOD5, was investigated. The coagulation - flocculation jar tests of wastewater reveal that ferric chloride, containing a mass of 0.3 g – hydroxyapatite, treated for 1 hour through calcination, is the most effective adjuvant in clarifying the wastewater, with turbidity equal to 98.16 %. In the presence of the two bioflocculants, Cactaceae juice and aluminum sulphate, with a dose of 0.2 g, flocculation is good, with turbidity equal to 95.61 %. Examination of the key reaction parameters, following the flocculation tests of wastewater, shows that the degree of pollution decreases. This is confirmed by the COD and turbidity values obtained. Examination of these results suggests the use of these flocculants in wastewater treatment.

Keywords: wastewater, cactus ficus-indica, hydroxyapatite, coagulation - flocculation

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33921 Nanotechnology-Based Treatment of Liver Cancer

Authors: Lucian Mocan

Abstract:

We present method of Nanoparticle enhanced laser thermal ablation of HepG2 cells (Human hepatocellular liver carcinomacell line), using gold nanoparticles combuned with a specific growth factor and demonstrate its selective therapeutic efficacy usig ex vivo specimens. Ex vivo-perfused liver specimens were obtained from hepatocellular carcinoma patients similarly to the surgical technique of transplantation. Ab bound to GNPs was inoculated intra-arterially onto the resulting specimen and determined the specific delivery of the nano-bioconjugate into the malignant tissue by means of the capillary bed. The extent of necrosis was considerable following laser therapy and at the same time surrounding parenchyma was not seriously affected. The selective photothermal ablation of the malignant liver tissue was obtained after the selective accumulation of Ab bound to GNPs into tumor cells following ex-vivo intravascular perfusion. These unique results may represent a major step in liver cancer treatment using nanolocalized thermal ablation by laser heating.

Keywords: HepG2 cells, gold nanoparticles, nanoparticle functionalization, laser irradiation

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33920 Saving Energy at a Wastewater Treatment Plant through Electrical and Production Data Analysis

Authors: Adriano Araujo Carvalho, Arturo Alatrista Corrales

Abstract:

This paper intends to show how electrical energy consumption and production data analysis were used to find opportunities to save energy at Taboada wastewater treatment plant in Callao, Peru. In order to access the data, it was used independent data networks for both electrical and process instruments, which were taken to analyze under an ISO 50001 energy audit, which considered, thus, Energy Performance Indexes for each process and a step-by-step guide presented in this text. Due to the use of aforementioned methodology and data mining techniques applied on information gathered through electronic multimeters (conveniently placed on substation switchboards connected to a cloud network), it was possible to identify thoroughly the performance of each process and thus, evidence saving opportunities which were previously hidden before. The data analysis brought both costs and energy reduction, allowing the plant to save significant resources and to be certified under ISO 50001.

Keywords: energy and production data analysis, energy management, ISO 50001, wastewater treatment plant energy analysis

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33919 Can We Develop a Practical and Applicable Ethic in Veterinary Health Care with a Universal Application and without Dogma?

Authors: Theodorus Holtzhausen

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With a growing number of professionals in healthcare moving freely between countries and also in general a more mobile global workforce, awareness of cultural differences have become more urgent for health care workers to apply proper care. There is a slowly emerging trend in health care due to globalisation that may create a more uniform cultural base for administering healthcare, but it is still very vulnerable to being hijacked and misdirected by major commercial interests. Veterinary clinics and medical clinics promoting alternative remedies lacking evidence based support and simultaneously practicing medicine as a science have become more common. Such ‘holistic’ clinics see these remedies more as a belief system causing no harm with minimal impact but with added financial benefit to the facility. With the inarguable acceptance and realisation of the interconnection between evolutionary aspects of cognition, knowledge and culture as a global but vulnerable cognition-gaining process affecting us all, we can see the enormous responsibility we carry. Such a responsibility for creating global well-being calling for an universally applicable ethic. Such an ethic with the potential of having significant impact on our cognition gaining process.

Keywords: veterinary health care, ethics, wellbeing, veterinary clinics

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33918 Pediatric Drug Resistance Tuberculosis Pattern, Side Effect Profile and Treatment Outcome: North India Experience

Authors: Sarika Gupta, Harshika Khanna, Ajay K Verma, Surya Kant

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Background: Drug-resistant tuberculosis (DR-TB) is a growing health challenge to global TB control efforts. Pediatric DR-TB is one of the neglected infectious diseases. In our previously published report, we have notified an increased prevalence of DR-TB in the pediatric population at a tertiary health care centre in North India which was estimated as 17.4%, 15.1%, 18.4%, and 20.3% in (%) in the year 2018, 2019, 2020, and 2021. Limited evidence exists about a pattern of drug resistance, side effect profile and programmatic outcomes of Paediatric DR-TB treatment. Therefore, this study was done to find out the pattern of resistance, side effect profile and treatment outcome. Methodology: This was a prospective cohort study conducted at the nodal drug-resistant tuberculosis centre of a tertiary care hospital in North India from January 2021 to December 2022. Subjects included children aged between 0-18 years of age with a diagnosis of DR-TB, on the basis of GeneXpert (rifampicin [RIF] resistance detected), line probe assay and drug sensitivity testing (DST) of M. tuberculosis (MTB) grown on a culture of body fluids. Children were classified as monoresistant TB, polyresistant TB (resistance to more than 1 first-line anti-TB drug, other than both INH and RIF), MDR-TB, pre-XDR-TB and XDR-TB, as per the WHO classification. All the patients were prescribed DR TB treatment as per the standard guidelines, either shorter oral DR-TB regimen or a longer all-oral MDR/XDR-TB regimen (age below five years needed modification). All the patients were followed up for side effects of treatment once per month. The patient outcomes were categorized as good outcomes if they had completed treatment and cured or were improving during the course of treatment, while bad outcomes included death or not improving during the course of treatment. Results: Of the 50 pediatric patients included in the study, 34 were females (66.7%) and 16 were male (31.4%). Around 33 patients (64.7%) were suffering from pulmonary TB, while 17 (33.3%) were suffering from extrapulmonary TB. The proportions of monoresistant TB, polyresistant TB, MDR-TB, pre-XDR-TB and XDR-TB were 2.0%, 0%, 50.0%, 30.0% and 18.0%, respectively. Good outcome was reported in 40 patients (80.0%). The 10 bad outcomes were 7 deaths (14%) and 3 (6.0%) children who were not improving. Adverse events (single or multiple) were reported in all the patients, most of which were mild in nature. The most common adverse events were metallic taste 16(31.4%), rash and allergic reaction 15(29.4%), nausea and vomiting 13(26.0%), arthralgia 11 (21.6%) and alopecia 11 (21.6%). Serious adverse event of QTc prolongation was reported in 4 cases (7.8%), but neither arrhythmias nor symptomatic cardiac side effects occurred. Vestibular toxicity was reported in 2(3.9%), and psychotic symptoms in 4(7.8%). Hepatotoxicity, hypothyroidism, peripheral neuropathy, gynaecomastia, and amenorrhea were reported in 2 (4.0%), 4 (7.8%), 2 (3.9%), 1(2.0%), and 2 (3.9%) respectively. None of the drugs needed to be withdrawn due to uncontrolled adverse events. Conclusion: Paediatric DR TB treatment achieved favorable outcomes in a large proportion of children. DR TB treatment regimen drugs were overall well tolerated in this cohort.

Keywords: pediatric, drug-resistant, tuberculosis, adverse events, treatment

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33917 Flowering Response of a Red Pitaya Germplasm Collection to Lighting Addition

Authors: Dinh-Ha Tran, Chung-Ruey Yen, Yu-Kuang H. Chen

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A collection of thirty cultivars/clones of red pitaya was used to investigate flowering response to lighting supplementation in the winter season of 2013-2014 in southern Taiwan. The night-breaking treatment was conducted during the period of 10 Oct. 2013 to 5 Mar. 2014 with 4-continuous hours (22.00–02.00 hrs) of additional lighting daily using incandescent bulbs (100W). Among cultivars and clones tested, twenty-three genotypes, most belonging to the red-magenta flesh type, were found to have positive flowering response to the lighting treatment. The duration of night-breaking treatment for successful flowering initiation varied from 33 - 48 days. The lighting-sensitive genotypes bore 1-2 flowering flushes. Floral and fruiting stages took 21-26 and 46-59 days, respectively. Among sixteen fruiting genotypes, the highest fruit set rates were found in Damao 9, D4, D13, Chaozou large, Chaozhou 5, Small Nick and F22. Five cultivars and clones (Orejona, D4, Chaozhou large, Chaozhou 5, and Small Nick) produced fruits with an average weight of more than 300 g per fruit which was higher than those of the fruits formed in the summer of 2013. Fruits produced during off-season contain total soluble solids (TSS) from 17.5 to 20.7 oBrix, which was higher than those produced in-season.

Keywords: flowering response, long-day plant, night-breaking treatment, off-season production, pitaya

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33916 Effect of Foot Reflexology Treatment on Arterial Blood Gases among Mechanically Ventilated Patients

Authors: Maha Salah Abdullah Ismail, Manal S. Ismail, Amir M. Saleh

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Reflexology treatment is a method for enhancing body relaxation. It is a widely recognized as an alternative therapy, effective for many health conditions. This study aimed to evaluate the effect of reflexology treatment on arterial blood gases among mechanically ventilated patients. A quasi-experimental (pre and post-test) research design was used. Research hypothesis was mechanically ventilated patients who will receive the reflexology treatment will have improvement in their arterial blood gases than those who will not. The current study was carried out in different Intensive Care Units at the Cairo University Hospitals. A purposeful sample of 100 adults’ mechanically ventilated patients was recruited over a period of three months of data collection. The participants were divided into two equally matched groups; (1) The study group who has received the routine care, in addition, two reflexology sessions on the feet, (2) The control group who has received only the routine care. One tool was utilized to collect data pertinent to the study; mechanically ventilated patients' data sheet that consists of demographic and medical data. Result: Majority (58% of the study group and 82% of the control group) were males, with mean age of 50.9 years in both groups. Patients who received the reflexology treatment significantly increase in the oxygen saturation pre second session (t=5.15, p=.000), immediate post sessions (t=4.4, p=.000) and post two hours (t= 4.7, p= .000). The study group was more likely to have lower PaO2 (F=5.025, p=.015), PaCo2 (F=4.952, p=.025) and higher HCo3 (F=15.211, p=.000) than the control group. Conclusion: This study results support the positive effect of reflexology treatment in improving some arterial blood gases among mechanically ventilated patients’ with the conventional therapy as in the study group there was increase in the oxygen saturation. In differences between groups there decrease PaO2, PaCo2 and increase HCo3 in the study group. Recommendation: Nurses should be trained how to demonstrate the foot reflexology among mechanically ventilated patients.

Keywords: arterial blood gases, foot, mechanical ventilated patient, reflexology

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33915 Non Pharmacological Approach to IBS (Irritable Bowel Syndrome)

Authors: A. Aceranti, L. Moretti, S. Vernocchi, M. Colorato, P. Caristia

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Irritable bowel syndrome (IBS) is the association between abdominal pain, abdominal distension and intestinal dysfunction for recurring periods. About 10% of the world's population has IBS at any given time in their life, and about 200 people per 100,000 receive an initial diagnosis of IBS each year. Persistent pain is recognized as one of the most pervasive and challenging problems facing the medical community today. Persistent pain is considered more as a complex pathophysiological, diagnostic and therapeutic situation rather than as a persistent symptom. The low efficiency of conventional drug treatments has led many doctors to become interested in the non-drug alternative treatment of IBS, especially for more severe cases. Patients and providers are often dissatisfied with the available drug remedies and often seek complementary and alternative medicine (CAM), a unique and holistic approach to treatment that is not a typical component of conventional medicine. Osteopathic treatment may be of specific interest in patients with IBS. Osteopathy is a complementary health approach that emphasizes the role of the musculoskeletal system in health and promotes optimal function of the body's tissues using a variety of manual techniques to improve body function. Osteopathy has been defined as a patient-centered health discipline based on the principles of interrelation between body structure and function, the body's innate capacity for self-healing and the adoption of a whole person health approach. mainly by practicing manual processing. Studies reported that osteopathic manual treatment (OMT) reduced IBS symptoms, such as abdominal pain, constipation, diarrhea, and improved general well-being. The focus in the treatment of IBS with osteopathy has gone beyond simple spinal alignment, to directly address the abnormal physiology of the body using a series of direct and indirect techniques. The topic of this study was chosen for different reasons: due to the large number of people involved who suffer from this disorder and for the dysfunction itself, since nowadays there is still little clarity about the best type of treatment and, above all, to its origin. The visceral component in the osteopathic field is still a world to be discovered, although it is related to a large part of patient series, it has contents that affect numerous disciplines and this makes it an enigma yet to be solved. The study originated in the didactic practice where the curiosity of a topic is marked that, even today, no one is able to explain and, above all, cure definitively. The main purpose of this study is to try to create a good basis on the osteopathic discipline for subsequent studies that can be exhaustive in the best possible way, resolving some doubts about which treatment modality can be used with more relevance. The path was decided to structure it in such a way that 3 types of osteopathic treatment are used on 3 groups of people who will be selected after completing a questionnaire, which will deem them suitable for the study. They will, in fact, be divided into three groups where: - the first group was given a visceral osteopathic treatment. - The second group was given a manual osteopathic treatment of neurological stimulation. - The third group received a placebo treatment. At the end of the treatment, questionnaires will be re-proposed respectively one week after the session and one month after the treatment from which any data will be collected that will demonstrate the effectiveness or otherwise of the treatment received. The sample of 50 patients examined underwent an oral interview to evaluate the inclusion and exclusion criteria to participate in the study. Of the 50 patients questioned, 17 people who underwent different osteopathic techniques were eligible for the study. Comparing the data related to the first assessment of tenderness and frequency of symptoms with the data related to the first follow-up shows a significant improvement in the score assigned to the different questions, especially in the neurogenic and visceral groups. We are aware of the fact that it is a study performed on a small sample of patients, and this is a penalizing factor. We remain, however, convinced that having obtained good results in terms of subjective improvement in the quality of life of the subjects, it would be very interesting to re-propose the study on a larger sample and fill the gaps.

Keywords: IBS, osteopathy, colon, intestinal inflammation

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33914 Refractory T-Cell Prolymphocytic Leukemia with JAK3 Mutation: In Vitro and Clinical Synergy of Tofacitinib and Ruxolitinib

Authors: Mike Wei, Nebu Koshy, Koen van Besien, Giorgio Inghirami, Steven M. Horwitz

Abstract:

T-cell prolymphocytic leukemia (T-PLL) is a rare hematologic disease characterized by a T-cell phenotype, rapid progression, and poor prognosis with median survival of less than a year. Alemtuzumab-based chemotherapy has increased the rate of complete remissions but these are often short-lived, and allogeneic transplant is considered the only curative therapy. In recent studies, JAK3 activating mutations have been identified in T-cell cancers, with T-PLL having the highest rate of JAK3 mutations (30 – 42%). As such, T-PLL is a model disease for evaluating the utility of JAK3 inhibitors. We present a case of a 64-year-old man with relapsed-refractory T-PLL. He was initially treated with alemtuzumab and obtained complete response and was consolidated with matched unrelated donor stem cell transplant. His disease stayed in remission for approximately 1.5 years before relapse, which was then treated with a clinical trial of romidepsin-lenalidomide (partial responses then progression at 6 months) and later alemtuzumab. Due to complications of myelosuppression and CMV reactivation, his treatment was interrupted leading to disease progression. The doubling time of lymphocyte count was approximately 20 days and over a span of 60 days the lymphocyte count rose from 8 x 109/L to 68 x 109/L. Exon sequencing showed a JAK3 mutation. The patient consented to and was treated with FDA-approved tofacitinib (initially 5 mg BID, increased to 10 mg BID after 15 days of treatment). An initial decrease in lymphocyte count was followed by progression. In vitro treatment of the patient’s cells showed modest effects of tofacitinib and ruxolitinib as single agents, in the range of doxorubicin, but synergy between the agents. After 40 days of treatment with tofacitinib and with a lymphocyte count of 150 x 109/L, ruxolitinib (5mg BID) was added. Over the 60 days since dual inhibition was started, the lymphocyte count has stabilized. The patient has remained completely asymptomatic during treatment with tofacitinib and ruxolitinib. Neutrophil count has remained normal. Platelet count and hemoglobin have however declined from ~50 x109/L to ~30 x109/L and from 11 g/dL to 8.1 g/dL respectively, since the introduction of ruxolitinib. The stabilization in lymphocyte count confirms the clinical activity of JAK inhibitors in T-PLL as suggested by the presence of JAK3 mutations and by in-vitro assays. It also suggests clinical synergy between ruxolitinib and tofacitinib in this setting. Prospective studies of JAK inhibitors in PLL patients with formal dose-finding studies are needed.

Keywords: tofacitinib, ruxolitinib, T-cell prolymphocytic leukemia, JAK3

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33913 Review of Current Literature on Use of Prazosin for Treatment of Post-Traumatic Stress Disorder Related Sleep Disturbances in Child and Adolescent Population

Authors: Davit Khachatryan, Shuo Xiang

Abstract:

Numerous published studies on the use of prazosin in the treatment of PTSD-related sleep disturbances in adult population have resulted in updates to the recommendation for prazosin for nightmares that showed its strength of evidence elevated from C to B in the US Department of Veterans Affairs clinical practice guideline. In addition, the American Academy of Sleep Medicine clinical practice guideline gave prazosin a level-A recommendation for the treatment of PTSD-associated nightmares. The aim of this review is to summarize the available literature for prazosin use for nightmares and other sleep disturbances in children and adolescents with PTSD. Method: A comprehensive search for studies on prazosin use for sleep disturbances in child and adolescent population with PTSD has been performed. We looked at MEDLINE, EMBASE, PsycINFO, CINAHL, AMED, Scopus, Web of Science, and Cochrane CENTRAL databases. Results: Compared to adult population with similar psychopathology, the available literature in child and adolescent population is scarce. Despite increased interest in prazosin in the management of PTSD, only six studies investigating this medication in children and adolescents have been published. Conclusion: A large randomized control trial on this topic is needed for more definite evidence on the efficacy and safety of prazosin in the treatment of nightmares in children and adolescents with PTSD.

Keywords: guidelines, prazosin, PTSD, sleep disturbance

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33912 Enhancing Root Canal Therapy with MTA and Tetracycline-Loaded Nanochitosan: An Approach for Infected Root Canal Treatment in Dogs (in-vivo Animal Study)

Authors: Rania Hanafi Mahmoud Said, Rasha Mohamed Taha

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Background: A recent study has explored the potential of an approach to treating infected root canals using a combination of Mineral Trioxide Aggregate (MTA) and Tetracycline-loaded Nanochitosan. Material and methods: Forty dogs were included in the study, with infected periapical areas induced by leaving access openings in their teeth for four months. Bacteriological samples from the infected root canals were collected and managed anaerobically to identify and count the different microorganisms present. The most common microorganisms detected were Prevotella oris, Fusobacterium nucleatum, Streptococcus viridans, Enterococcus faecalis, Clostridium subterminale, Porphyromonas gingivalis, and Peptostreptococcus anaerobius. The dogs were divided into four groups based on the sealant used to treat the infected periapical areas: Group I: Negative control (no treatment) Group II: Positive control (MTA only) Group III: MTA + tetracycline Group IV: MTA + tetracycline loaded on nanochitosan Results: Periapical areas in Group IV showed significantly more bone healing than those in Groups I, II, and III. The newly formed bone was evaluated radiographically, histologically, and immunohistochemically using Osteopontin (OSP) antibodies. Data collected was statistically analysed using SPSS software at a 0.05 significance level. Conclusion: The study concluded that the combined use of Tetracycline-loaded Nanochitosan and MTA presents a promising approach for the treatment of infected root canals. The potent antimicrobial activity of Tetracycline-loaded Nanochitosan, along with the biocompatibility and desirable properties of MTA, may synergistically contribute to improved clinical outcomes in endodontic therapy. This study has important implications for the clinical management of infected root canals. The combination of Tetracycline-loaded Nanochitosan and MTA could provide a more effective and efficient means of treating these challenging cases. Further research is needed to confirm these findings in humans and to optimize the treatment protocol.

Keywords: mineral trioxide aggregate, tetracycline-loaded nanochitosan, periapical infection, osteopontine

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33911 School and Family Impairment Associated with Childhood Anxiety Disorders: Examining Differences in Parent and Child Report

Authors: Melissa K. Hord, Stephen P. Whiteside

Abstract:

Impairment in functioning is a requirement for diagnosing psychopathology, identifying individuals in need of treatment, and documenting improvement with treatment. Further, identifying different types of functional impairment can guide educators and treatment providers. However, most assessment tools focus on symptom severity and few measures assess impairment associated with childhood anxiety disorders. The child- and parent-report versions of the Child Sheehan Disability Scale (CSDS) are measures that may provide useful information regarding impairment. The purpose of the present study is to examine whether children diagnosed with different anxiety disorders have greater impairment in school or home functioning based on self or parent report. The sample consisted of 844 children ages 5 to 19 years of age (mean 13.43, 61% female, 90.9% Caucasian), including 281 children diagnosed with obsessive compulsive disorder (OCD), 200 with generalized anxiety disorder (GAD), 176 with social phobia, 83 with separation anxiety, 61 with anxiety not otherwise specified (NOS), 30 with panic disorder, and 13 with panic with agoraphobia. To assess whether children and parents reported greater impairment in school or home functioning, a multivariate analysis of variance was conducted. (The assumptions of independence and homogeneity of variance were checked and met). A significant difference was found, Pillai's trace = .143, F (4, 28) = 4.19, p < .001, partial eta squared = .04. Post hoc comparisons using the Tukey HSD test indicated that children report significantly greater impairment in school with panic disorder (M=5.18, SD=3.28), social phobia (M=4.95, SD=3.20), and OCD (M=4.62, SD=3.32) compared to other diagnoses; whereas parents endorse significantly greater school impairment when their child has a social phobia (M=5.70, SD=3.39) diagnosis. Interestingly, both children and parents reported greater impairment in family functioning for an OCD (child report M=5.37, SD=3.20; parent report M=5.59, SD=3.38) diagnosis compared to other anxiety diagnoses. (Additional findings for the anxiety disorders associated with less impairment will also be presented). The results of the current study have important implications for educators and treatment providers who are working with anxious children. First, understanding that differences exist in how children and parents view impairment related to childhood anxiety can help those working with these families to be more sensitive during interactions. Second, evidence suggests that difficulties in one environment do not necessarily translate to another environment, thus caregivers may benefit from careful explanation of observations obtained by educators. Third, results support the use of the CSDS measure by treatment providers to identify impairment across environments in order to more effectively target interventions.

Keywords: anxiety, childhood, impairment, school functioning

Procedia PDF Downloads 278
33910 Effect of Ethanol Concentration and Enzyme Pre-Treatment on Bioactive Compounds from Ginger Extract

Authors: S. Lekhavat, T. Kajsongkram, S. Sang-han

Abstract:

Dried ginger was extracted and investigated the effect of ethanol concentration and enzyme pre-treatment on its bioactive compounds in solvent extraction process. Sliced fresh gingers were dried by oven dryer at 70 °C for 24 hours and ground to powder using grinder which their size were controlled by passing through a 20-mesh sieve. In enzyme pre-treatment process, ginger powder was sprayed with 1 % (w/w) cellulase and then was incubated at 45 °C for 2 hours following by extraction process using ethanol at concentration of 0, 20, 40, 60 and 80 % (v/v), respectively. The ratio of ginger powder and ethanol are 1:9 and extracting conditions were controlled at 80 °C for 2 hours. Bioactive compounds extracted from ginger, either enzyme-treated or non enzyme-treated samples, such as total phenolic content (TPC), 6-Gingerol (6 G), 6-Shogaols (6 S) and antioxidant activity (IC50 using DPPH assay), were examined. Regardless of enzyme treatment, the results showed that 60 % ethanol provided the highest TPC (20.36 GAE mg /g. dried ginger), 6G (0.77%), 6S (0.036 %) and the lowest IC50 (625 μg/ml) compared to other ratios of ethanol. Considering the effect of enzyme on bioactive compounds and antioxidant activity, it was found that enzyme-treated sample has more 6G (0.17-0.77 %) and 6S (0.020-0.036 %) than non enzyme-treated samples (0.13-0.77 % 6G, 0.015-0.036 % 6S). However, the results showed that non enzyme-treated extracts provided higher TPC (6.76-20.36 GAE mg /g. dried ginger) and Lowest IC50 (625-1494 μg/ml ) than enzyme-treated extracts (TPC 5.36-17.50 GAE mg /g. dried ginger, IC50 793-2146 μg/ml).

Keywords: antioxidant activity, enzyme, extraction, ginger

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33909 Effects of Bulblet Induction Medium on Bulb Size and Weight of Endemic Fritillaria aurea Schoot after Treatment with Putrescine for Different Durations of Time

Authors: Suleyman Kizil, Khalid Mahmood Khavar

Abstract:

Fritillaria aurea Schott is an important horticultural crop with high economic potential for the ornamental plant industry and is endemic to the Central and South-Eastern Anatolian regions of Türkiye. This study reports an experiment conducted under in vitro conditions to improve the weight and diameter of the in vitro regenerated bulblets. The micro bulblets used in this study were obtained from callus induced on half-sliced bulblets cultured on MS medium containing 0.1 mg L⁻¹ NAA + 0.05 TDZ (R₁ medium) and 0.1 mg L⁻¹ NAA + 0.10 mg L⁻¹ TDZ (R₂ medium). Thereafter, the micro bulblets obtained from here were treated with 50 mg L⁻¹ putrescine, (tetramethylenediamine) for 3, 5, and 7 weeks. The putrescine treatment has a significant effect on the increase in diameter and weight of bulblets when compared to initial diameters, irrespective of the treatment periods and seed germination medium. When the duration of putrescine in weeks was compared, 7 weeks of treatments with putrescine were more conducive for induction in bulblet weight compared to 3 and 5 weeks treatment periods. Maximum seed weight of 0.52 grams was noted on 7 weeks of putrescine treated bulblets regenerated on 0.1 mg L⁻¹ TDZ. This strategy to increase bulb weight and diameter could be positively used to conserve and multiply this beautiful ornamental and endemic plant species.

Keywords: Fritillaria aurea, bulblet, diameter, weight, micropropagation, polyamine

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33908 Innovative Method for Treating Oil-Produced Water with Low Operating Cost

Authors: Maha Salman, Gada Al-Nuwaibit, Ahmed Al-Haji, Saleh Al-Haddad, Abbas Al-Mesri, Mansour Al-Rugeeb

Abstract:

The high salinity of oil-produced water and its complicated chemical composition, makes designing a suitable treatment system for oil-produced water is extremely difficult and costly. On the current study, a new innovative method was proposed to treat the complicated oil-produced water through a simple mixing with brine stream produced from waste water treatment plant. The proposal will investigate the scaling potential of oil-produce water, seawater and the selected brine water (BW) produced from Sulaibiya waste water treatment and reclamation plant (SWWTRP) before and after the mixing with oil-produced water, and will calculate the scaling potential of all expected precipitated salts using different conversion and different % of mixing to optimize the % of mixing between the oil-produced water and the selected stream. The result shows a great, feasible and economic solution to treat oil produced with a very low capital cost.

Keywords: brine water, oil-produced water, scaling potential, Sulaibiyah waste water and reclaminatin plant

Procedia PDF Downloads 447
33907 Effect of a Single Injection of hCG on Testosterone Concentration in Male Alpacas

Authors: A. ElZawam, D. McLean, A. Tibary

Abstract:

In alpaca, age at puberty is variable and the factors regulating the pattern of puberty and sexual maturation are a subject of controversy. Plasma testosterone level is often used as an indicator of sexual maturity. Our hypothesis is that hCG treatment will cause an increase in testosterone level that is correlated with animal age. The specific aim was to investigate the testicular tissue response to a single hCG injection by monitoring the serum testosterone concentration. Eighty four (n=84) males ranging in age from 6 to 60 months were used. Alpacas were grouped based on their ages into 15 groups. Each group had three to five male animals. Blood samples were collected from the jugular vein before treatment with hCG and 2 hours after intravenous administration of 3000 IU of hCG (Chorulon®). The serum was harvested and stored at -20ºC until the analysis. The effect of age on basal testosterone level and response to hCG treatment was evaluated by Analysis of Variance. As a result, basal serum testosterone concentrations were very low (<0.1ng/ml) until 9 months of age. Although basal serum testosterone concentrations increased steadily with age there was a significant variation amongst males within the same age group. Administration of 3000 IU of hCG, resulted in an average increase of 50% (P<0.05) in serum testosterone concentration after 2 hours. The percentage increase in serum testosterone in response to hCG stimulation varied from 51 to 81%. There was no correlation between the degree of response and age. However, the response to hCG injection presented two modes of increase depending on the age of animals. The first mode occurred at ages 9 to 14 months and the second mode was observed between 22 and 36 months. In conclusion, our results suggest that testicular growth and sensitivity to LH stimulation may be bimodal in the male alpaca with a rapid increase in growth and sensitivity between 9 and 14 months of age and a second phase of increased responsiveness after 21 months of ages.

Keywords: alpaca, testosterone, hCG, animal science

Procedia PDF Downloads 571
33906 Organic Matter Removal in Urban and Agroindustry Wastewater by Chemical Precipitation Process

Authors: Karina Santos Silvério, Fátima Carvalho, Maria Adelaide Almeida

Abstract:

The impacts caused by anthropogenic actions on the water environment have been one of the main challenges of modern society. Population growth, added to water scarcity and climate change, points to a need to increase the resilience of production systems to increase efficiency regarding the management of wastewater generated in the different processes. Based on this context, the study developed under the NETA project (New Strategies in Wastewater Treatment) aimed to evaluate the efficiency of the Chemical Precipitation Process (CPP), using the hydrated lime (Ca(OH )₂) as a reagent in wastewater from the agroindustry sector, namely swine wastewater, slaughterhouse and urban wastewater, in order to make the productive means 100% circular, causing a direct positive impact on the environment. The purpose of CPP is to innovate in the field of effluent treatment technologies, as it allows rapid application and is economically profitable. In summary, the study was divided into four main stages: 1) Application of the reagent in a single step, raising the pH to 12.5 2) Obtaining sludge and treated effluent. 3) Natural neutralization of the effluent through Carbonation using atmospheric CO₂. 4) Characterization and evaluation of the feasibility of the chemical precipitation technique in the treatment of different wastewaters through the technique of determining the chemical oxygen demand (COD) and other supporting physical-chemical parameters. The results showed an approximate average removal efficiency above 80% for all effluents, highlighting the swine effluent with 90% removal, followed by urban effluent with 88% and slaughterhouse with 81% on average. Significant improvement was also obtained with regard to color and odor removal after Carbonation to pH 8.00.

Keywords: agroindustry wastewater, urban wastewater, natural carbonatation, chemical precipitation technique

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33905 Human Metabolism of the Drug Candidate PBTZ169

Authors: Vadim Makarov, Stewart T.Cole

Abstract:

PBTZ169 is novel drug candidate with high efficacy in animals models, and its combination treatment of PBTZ169 with BDQ and pyrazinamide was shown to be more efficacious than the standard treatment for tuberculosis in a mouse model. The target of PBTZ169 is famous DprE1, an essential enzyme in cell wall biosynthesis. The crystal structure of the DprE1-PBTZ169 complex reveals formation of a semimercaptal adduct with Cys387 in the active site and explains the irreversible inactivation of the enzyme. Furthermore, this drug candidate demonstrated during preclinical research ‘drug like’ properties what made it an attractive drug candidate to treat tuberculosis in humans. During first clinical trials several cohorts of the healthy volunteers were treated by the single doses of PBTZ169 as well as two weeks repeated treatment was chosen for two maximal doses. As expected PBTZ169 was well tolerated, and no significant toxicity effects were observed during the trials. The study of the metabolism shown that human metabolism of PBTZ169 is very different from microbial or animals compound transformation. So main pathway of microbial, mice and less rats metabolism connected with reduction processes, but human metabolism mainly connected with oxidation processes. Due to this difference we observed several metabolites of PBTZ169 in humans with antitubercular activity, and now we can conclude that animal antituberculosis activity of PBTZ169 is a result not only activity of the drug itself, but it is a result of the sum activity of the drug and its metabolites. Direct antimicrobial plasma activity was studied, and such activity was observed for 24 hours after human treatment for some doses. This data gets high chance for good efficacy of PBTZ169 in human for treatment TB infection. Second phase of clinical trials was started summer of 2017 and continues to the present day. Available data will be presented.

Keywords: clinical trials, DprE1, PBTZ169, metabolism

Procedia PDF Downloads 167
33904 Experimental Investigation on Effect of Different Heat Treatments on Phase Transformation and Superelasticity of NiTi Alloy

Authors: Erfan Asghari Fesaghandis, Reza Ghaffari Adli, Abbas Kianvash, Hossein Aghajani, Homa Homaie

Abstract:

NiTi alloys possess magnificent superelastic, shape memory, high strength and biocompatible properties. For improving mechanical properties, foremost, superelasticity behavior, heat treatment process is carried out. In this paper, two different heat treatment methods were undertaken: (1) solid solution, and (2) aging. The effect of each treatment in a constant time is investigated. Five samples were prepared to study the structure and optimize mechanical properties under different time and temperature. For measuring the upper plateau stress, lower plateau stress and residual strain, tensile test is carried out. The samples were aged at two different temperatures to see difference between aging temperatures. The sample aged at 500 °C has a bigger crystallite size and lower amount of Ni which causes the mentioned sample to possess poor pseudo elasticity behaviour than the other aged sample. The sample aged at 460 °C has shown remarkable superelastic properties. The mentioned sample’s higher plateau is 580 MPa with the lowest residual strain (0.17%) while other samples have possessed higher residual strains. X-ray diffraction was used to investigate the produced phases.

Keywords: heat treatment, phase transformation, superelasticity, NiTi alloy

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33903 Risk Reassessment Using GIS Technologies for the Development of Emergency Response Management Plans for Water Treatment Systems

Authors: Han Gul Lee

Abstract:

When water treatments utilities are designed, an initial construction site risk assessment is conducted. This helps us to understand general safety risks that each utility needs to be complemented in the designing stage. Once it’s built, an additional risk reassessment process secures and supplements its disaster management and response plan. Because of its constantly changing surroundings with city renovation and developments, the degree of various risks that each facility has to face changes. Therefore, to improve the preparedness for spill incidents or disasters, emergency managers should run spill simulations with the available scientific technologies. This research used a two-dimensional flow routing model to simulate its spill disaster scenario based on its digital elevation model (DEM) collected with drone technologies. The results of the simulations can help emergency managers to supplement their response plan with concrete situational awareness in advance. Planning based on this simulation model minimizes its potential loss and damage when an incident like earthquakes man-made disaster happens, which could eventually be a threat in a public health context. This pilot research provides an additional paradigm to increase the preparedness to spill disasters. Acknowledgment: This work was supported by Korea Environmental Industry & Technology Institute (KEITI) through Environmental R&D Project on the Disaster Prevention of Environmental Facilities Program funded by Korea Ministry of Environment (MOE) (No.202002860001).

Keywords: risk assessment, disaster management, water treatment utilities, situational awareness, drone technologies

Procedia PDF Downloads 146
33902 Study of Treatment Plant of The City Chlef Study of Environmental Impact

Authors: Houmame Benbouali, Aboubakr Gribi

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The risks, in general, exist in any project, one can hardly carry out a project without taking risks. The hydraulic works are rather complex projects in their design, realization and exploitation and are often subjected at the multiple risks being able to influence with their good performance and can have a negative impact on their environment. The present study was carried out to quote the impacts caused by purification plant STEP Chlef on the environment, it aims has studied the environmental impacts during construction and when designing this STEP, it is divided into two parts: The first part results from a research task bibliographer which contain three chapters (- cleansing of water-worn- general information on water worn-proceed of purification of waste water). The second part is an experimental part which is divided into four chapters (detailed state initial description of the station of purification-evaluation of the impacts of the project analyzes measurements and recommendations).

Keywords: treatment plant, waste water, waste water treatment, Chlef

Procedia PDF Downloads 334
33901 Origin, Exposition, and Treatment of Economic Violence

Authors: Lucrezia Crescenzi-Lanna, Silvia Cataldi, Williams Contreras, Valerio Pieri

Abstract:

According to the European Commission, gender-based violence (GBV) is a violation of human rights and a form of discrimination against women in five areas: physical violence, sexual violence, psychological violence, mistreatment of women, and economic violence (henceforth EV). The TESORO project "Treatment, ExpoSition, and ORigin of economic viOlence: An innovation and internationalization project between Italy and Spain" focuses on this last dimension of gender-based violence, the least studied and the one that has received least media coverage. In Spain, 12% (2,350,684) of women over fifteen years of age have suffered economic violence from their partner or ex-partner during their lives. In Italy, another country participating in the project, many women who are welcomed in refuges and who report cases of psychological violence (79%) and/or physical violence (61%) are also victims of economic violence (34%), according to the D.i.Re. Thermometer: "Donne in Rete contro la Violenza", the association that brings together more than eighty refuges against violence in Italy. At the social level, this form of violence is incorporated into practices of inequality that manifest themselves in both the daily management of couples and families and the workplace and institutional settings. As for the mechanisms related to EV, the literature argues that it is a complex and multidimensional phenomenon that has socioeconomic and cultural roots. EV manifests itself through various strategies, which represent forms of power and control aimed at preventing women's financial independence. To analyse the issue of EV we use a multidisciplinary approach and a mixed design that includes: 1) a questionnaire administered to a stratified sample of more than a thousand Italian and Spanish citizens to study the cultural and socio-relational mechanisms and the origin of EV in family and couple contexts; and 2) interviews with those running refuges as part of the struggle against gender violence, to understand how mechanisms and educational activities in the field of economic violence are manifested in the respective region and are supportive of women. The decision to use this strategy responds to the need to combine an exploratory perspective with an explanatory one in order to understand some of the relevant concepts related to the complex phenomena of EV and the interventions dedicated to its prevention. The data will be finalized in June 2022 and presented at the ICWS conference. Among TESORO’s contributions, its collection of qualitative and quantitative data on EV in Italy and Spain stands out, deepening its origin, prevention, and treatment beyond its incidence, which has already been studied in the Macro-Survey on Violence against Women.

Keywords: gender-based violence, economic violence, economic harm, gender inequality, workplace and family contexts

Procedia PDF Downloads 95
33900 Treatment of Drug-Induced Oral Ulceration with Hyaluronic Acid Gel: A Case Report

Authors: Meltem Koray, Arda Ozgon, Duygu Ofluoglu, Mehmet Yaltirik

Abstract:

Oral ulcerations can be seen as a side effect of different drugs. These ulcers usually appear within a few weeks following drug treatment. In most of cases, these ulcers resist to conventional treatments, such as anesthetics, antiseptics, anti-inflammatory agents, cauterization, topical tetracycline and corticosteroid treatment. The diagnosis is usually difficult, especially in patients receiving multiple drug therapies. Hyaluronan or hyaluronic acid (HA) is a biomaterial that has been introduced as an alternative approach to enhance wound healing and also used for oral ulcer treatment. The aim of this report is to present the treatment of drug-induced oral ulceration on maxillary mucosa with HA gel. 60-year-old male patient was referred to Department of Oral and Maxillofacial Surgery complaining of oral ulcerations during few weeks. He had received chemotherapy and radiotherapy in 2014 with the diagnosis of nasopharyngeal carcinoma, and he has accompanying systemic diseases such as; cardiological, neurological diseases and gout. He is medicated with Escitalopram (Cipralex® 20mg), Quetiapine (Seroquel® 100mg), Mirtazapine (Zestat® 15mg), Acetylsalicylic acid (Coraspin® 100mg), Ramipril-hydrochlorothiazide (Delix® 2.5mg), Theophylline anhydrous (Teokap Sr® 200mg), Colchicine (Colchicum Dispert® 0.5mg), Spironolactone (Aldactone® 100mg), Levothyroxine sodium (Levotiron® 50mg). He had painful oral ulceration on the right side of maxillary mucosa. The diagnosis was 'drug-induced oral ulceration' and HA oral gel (Aftamed® Oral gel) was prescribed 3 times a day for 2 weeks. Complete healing was achieved within 3 weeks without any side effect and discomfort. We suggest that HA oral gel is a potentially useful local drug which can be an alternative for management of drug-induced oral ulcerations.

Keywords: drug-induced, hyaluronic acid, oral ulceration, maxillary mucosa

Procedia PDF Downloads 270