Search results for: oral and maxillofacial surgery

Authors: Raúl Jiménez Vilches

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Native (L1) speakers can mark prosodically one part of an utterance and make it more relevant as opposed to the rest of the constituents. Conversely, non-native (L2) speakers encounter problems when it comes to marking prosodically information structure in English. In fact, the L2 speaker’s choice for the prosodic realization of focus is not so clear and often obscures the intended pragmatic meaning and the communicative value in general. This paper reports some of the findings obtained in an L2 prosodic training course for Spanish learners of English within the context of public speaking. More specifically, it analyses the effects of the course experiment in relation to the non-native production of the tonic syllable to mark focus and compares it with the public speeches delivered by native English speakers. The whole experimental training was executed throughout eighteen input sessions (1,440 minutes total time) and all the sessions took place in the classroom. In particular, the first part of the course provided explicit instruction on the recognition and production of the tonic syllable and how the tonic syllable is used to express focus. The non-native and native oral presentations were acoustically analyzed using Praat software for speech analysis (7,356 words in total). The investigation adopted mixed and embedded methodologies. Quantitative information is needed when measuring acoustically the phonetic realization of focus. Qualitative data such as questionnaires, interviews, and observations were also used to interpret the quantitative data. The embedded experiment design was implemented through the analysis of the public speeches before and after the intervention. Results indicate that, even after the L2 prosodic training course, Spanish learners of English still show some major inconsistencies in marking focus effectively. Although there was occasional improvement regarding the choice for location and word classes, Spanish learners were, in general, far from achieving similar results to the ones obtained by the English native speakers in the two types of focus. The prosodic realization of focus seems to be one of the hardest areas of the English prosodic system to be mastered by Spanish learners. A funded research project is in the process of moving the present classroom-based experiment to an online environment (mobile app) and determining whether there is a more effective focus usage through CAPT (Computer-Assisted Pronunciation) tools.

Keywords: focus, prosody, public speaking, Spanish learners of English

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Authors: Mehrnoosh Abouzari, Shahrokh Sahraei

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Arrival of artificial intelligence or smart robots in the modern world put them in charge on pericise and at risk. So acting human activities with robots makes criminal or civil responsibilities for their acts or behavior. The practical usage of smart robots has entered them in to a unique situation when naturalization happens and smart robots are identifies as members of society. There would be some legal situation by adopting these new smart citizens. The first situation is about legal responsibility of robots. Recognizing the naturalization of robot involves some basic right , so humans have the rights of employment, property, housing, using energy and other human rights may be employed for robots. So how would be the practice of these rights in the society and if some problems happens with these rights, how would the civil responsibility and punishment? May we consider them as population and count on the social programs? The second episode is about the criminal responsibility of robots in important activity instead of human that is the aim of inventing robots with handling works in AI technology , but the problem arises when some accidents are happened by robots who are in charge of important activities like army, surgery, transporting, judgement and so on. Moreover, recognizing independent identification for robots in the legal world by register ID cards, naturalization and civilian rights makes and prepare the same rights and obligations of human. So, the civil responsibility is not avoidable and if the robot commit a crime it would have criminal responsibility and have to be punished. The basic component of criminal responsibility may changes in so situation. For example, if designation for criminal responsibility bounds to human by sane, maturity, voluntariness, it would be for robots by being intelligent, good programming, not being hacked and so on. So it is irrational to punish robots by prisoning , execution and other human punishments for body. We may determine to make digital punishments like changing or repairing programs, exchanging some parts of its body or wreck it down completely. Finally the responsibility of the smart robot creators, programmers, the boss in chief, the organization who employed robot, the government which permitted to use robot in important bases and activities , will be analyzing and investigating in their article.

Keywords: robot, artificial intelligence, personality, responsibility

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Authors: Mohammed S. Mohammed, Asmaa M. S. Mohammed

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Background: To achieve the quality of cancer care, the oncologic academic programs should be continuously developed with establishing new ones. We highlighted three disciplines, Clinical nutrition, medical biophysics and radiobiology and Psycho-oncology programs; without a doubt, the Egyptian National Cancer Institute, in ‎the accreditation era, will be establishing them ‎ due to their importance in improving the skills of cancer practitioners. Methods: The first suggested program in Clinical Nutrition that is dealing with the assessment of the patient's well-being before, during and after treatment to avoid the defects in the metabolism resulting from the cancer disease and its treatment by giving the supplements in the patient's diet. The second program is Medical Biophysics and Radiobiology, which there's no denying that it ‎is ‎provided ‎in Cairo University as a good program in the faculty of science but lacks the clinical ‎practice. Hence, it is probably better to establish this program in our institute to ‎improve the ‎practitioner skills and introduce a tailored radiation therapy regimen for every patient according to ‎their characteristic profile.‎ While patients are receiving their treatment, the risk of post-traumatic stress disorder arises, so the importance of the third program, Psycho-Oncology, is clearly obtained. This program is concerned with the psychological, social, behavioral, and ethical aspects of cancer. The area of multi-disciplinary interest has boundaries with the major specialties in oncology: the clinical disciplines (surgery, medicine, pediatrics, and radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. Results: It is a prospective academic plan which is compatible with the institutional vision and its strategic plan. Conclusion: In this context, evaluating and understanding the suggested academic programs has become a mandatory part of cancer care. And it is essential to be provided by the NCI.

Keywords: clinical nutrition, psycho-oncology, medical biophysics and radiobiology, medical education

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Authors: Agnieszka Rolinska, Marta Makara-Studzinska

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Introduction: In recent years, there has been an intensive development of research into the physiological relationships between the experienced stress and obesity. Moreover, strong chronic stress leads to the disorganization of a person’s activeness on various levels of functioning, including the behavioral and cognitive sphere (also in one’s diet). Aim: The present work addresses the following research questions: Is there a relationship between an increase in stress related to the disease and the need for the cyclicality of diabetologic education in gestational diabetes? Are there any differences in terms of the experienced stress during the last three months of pregnancy in women with gestational diabetes and in normal pregnancy between the patients with normal weight gains and those with abnormal weight gains? Are there any differences in terms of stress coping styles in women with gestational diabetes and in normal pregnancy between the patients with normal weight gains and those with abnormal weight gains? Method: The study involved pregnant women with gestational diabetes (treated with diet, without insulin therapy) and in normal pregnancy – 206 women in total. The following psychometric tools were employed: Perceived Stress Scale (PSS; Cohen, Kamarck, Mermelstein), Coping Inventory for Stressful Situations (CISS; Endler, Parker) and authors’ own questionnaire. Gestational diabetes mellitus was diagnosed on the basis of the results of fasting oral glucose tolerance test (75 g OGTT). Body weight measurements were confirmed in a diagnostic interview, taking into account medical data. Regularities in weight gains in pregnancy were determined according to the recommendations of the Polish Gynecological Society and American norms determined by the Institute of Medicine (IOM). Conclusions: An increase in stress related to the disease varies in patients with differing requirements for the cyclical nature of diabetologic education (i.e. education which is systematically repeated). There are no differences in terms of recently experienced stress and stress coping styles between women with gestational diabetes and those in normal pregnancy. There is a relationship between weight gains in pregnancy and the stress experienced in life as well as stress coping styles – both in pregnancy complicated by diabetes and in physiological pregnancy. In the discussion of the obtained results, the authors refer to scientific reports from English-language magazines of international range.

Keywords: diabetologic education, gestational diabetes, stress, weight gain in pregnancy

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Authors: Bheki R. Mngomezulu

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The present paper cogently and systematically traces the history of Umkhonto Wesizwe (MK) and identifies its important role in shaping South Africa’s post-apartheid foreign policy and international relations under black leadership. It provides the political and historical contexts within which we can interpret and better understand South Africa’s controversial ‘Quiet Diplomacy’ approach to Zimbabwe’s endemic political and economic crises, which have dragged for too long. On 16 December 1961, the African National Congress (ANC) officially launched the MK as its military wing. The main aim was to train liberation fighters outside South Africa who would return into the country to topple the apartheid regime. Subsequently, the ANC established links with various countries across Africa and the globe in order to solicit arms, financial resources and military training for its recruits into the MK. Drawing from archival research and empirical data obtained through oral interviews that were conducted with some of the former MK cadres, this paper demonstrates how the ANC forged relations with a number of countries that were like-minded in order to ensure that its dream of removing the apartheid government became a reality. The findings reveal that South Africa’s foreign policy posture and international relations after the demise of apartheid in 1994 built on these relations. As such, even former and current socialist countries that were frowned upon by the Western world became post-apartheid South Africa’s international partners. These include countries such as Cuba and China, among others. Even countries that were not recognized by the Western world as independent states received good reception in post-apartheid South Africa’s foreign policy agenda. One of these countries is Palestine. Within Africa, countries with questionable human rights records such as Nigeria and Zimbabwe were accommodated in South Africa’s foreign policy agenda after 1994. Drawing from this history, the paper concludes that it would be difficult to fully understand and appreciate South Africa’s foreign policy direction and international relations after 1994 without bringing the history and the politics of the MK into the equation. Therefore, the paper proposes that the utilitarian role of history should never be undermined in the analysis of a country’s foreign policy direction and international relations. Umkhonto Wesizwe and South Africa are used as examples to demonstrate how such a link could be drawn through archival and empirical evidence.

Keywords: African National Congress, apartheid, foreign policy, international relations

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Authors: Hsiu-Ling Hsu, En-Minh (John) Lan

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Pronunciation has received more and more language researchers’ and teachers’ attention because it is important for effective or even successful communication. How to consistently and correctly orally produce verbal morphology, such as English regular past tense inflection, has been a big challenge and troublesome for FL learners. The research aims to explore EFL (English as a foreign language) learners’ developmental trajectory of the inflectional morphology, that is, what mediating processes and strategies EFL learners use, to attain native-like prosodic structure of inflectional morphemes (e.g., –ed and –s suffixes) by comparing the differences among EFL learners at different English levels. This research adopted a self-repair analysis and Prosodic Transfer Hypothesis with three developmental stages as a theoretical framework. To answer the research questions, we conducted two experiments, grammatical tense test written production (Experiment 1) and read-aloud oral production (Experiment 2), and recruited 30 participants who were divided into three groups, low-, middle-, and advanced EFL learners. Experiment 1 was conducted to ensure that participants had learned the knowledge of forming the English regular past tense rules and Experiment 2 was carried out to compare the data across FL English learner groups at different English levels. The EFL learners’ self-repair data showed at least four interesting findings. First, low achievers were more sensitive to the plural suffix -s than the past tense suffix -ed. Middle achievers exhibited a greater responsiveness to the past tense suffix, while high achievers demonstrated equal sensitivity to both suffixes. Additionally, two strategies used by EFL English learners to produce verbs and nouns with inflectional morphemes were to delete internal syllable and to divide a four-syllable verb (e.g., ‘graduated’) into two prosodic structures (e.g., ‘gradu’ and ‘ated’ or ‘gradua’ and ‘ted’). Third, true vowel epenthesis was found only in the low EFL achievers. Moreover fortition (native-like sound) was observed in the low and middle EFL achievers. These findings and self-repair data disclosed mediating processes between the developmental stages and provided insight on how Taiwan EFL learners attained the adjunction prosodic structures of inflectional Morphemes in English.

Keywords: inflectional morphology, prosodic structure, developmental trajectory, strategies and mediating processes, English as a foreign language

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Authors: Guilherme Gomes, Jose Lebre de Freitas

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The rules of Civil Procedure that are defined in the Portuguese Civil Procedure Code of 2013 particularly their articles 552 to 626- represent the model that the legislator thought that would be more suitable for national civil litigation, from the moment the action is brought by the plaintiff to the moment when the sentence is issued. However, procedural legalism is no longer a reality in the Portuguese Civil Procedural Law. According to the article 547 of the code of 2013, the civil judge has a duty to adopt the procedure that better suits the circumstances of the case, whether or not it is the one defined by law. The main goal of our paper is to answer the question whether the formal adequation imposed by this article diminishes the importance of the Portuguese rules of Civil Procedure and their daily application by national civil judges. We will start by explaining the appearance of the abovementioned rules in the Civil Procedure Code of 2013. Then we will analyse, using specific examples that were obtained by the books we read, how the legal procedure defined in the abovementioned code does not suit the circumstances of some specific cases and is totally inefficient in some situations. After that, we will, by using the data obtained in the practical research that we are conducting in the Portuguese civil courts within the scope of our Ph.D. thesis (until now, we have been able to consult 150 civil lawsuits), verify whether and how judges and parties make the procedure more efficient and effective in the case sub judice. In the scope of our research, we have already reached some preliminary findings: 1) despite the fact that the legal procedure does not suit the circumstances of some civil lawsuits, there are only two situations of frequent use of formal adequation (the judge allowing the plaintiff to respond to the procedural exceptions deduced in the written defense and the exemption from prior hearing for the judges who never summon it), 2) the other aspects of procedural adequation (anticipation of the production of expert evidence, waiving of oral argument at the final hearing, written allegations, dismissal of the dispatch on the controversial facts and the examination of witnesses at the domicile of one of the lawyers) are still little used and 3) formal adequation tends to happen by initiative of the judge, as plaintiffs and defendants are afraid of celebrating procedural agreements in most situations. In short, we can say that, in the Portuguese legal order of the 21st century, the flexibility of the legal procedure, as it is defined in the law and applied by procedural subjects, does not affect the importance of the rules of Civil Procedure of the code of 2013.

Keywords: casuistic adequation, civil procedure code of 2013, procedural subjects, rules of civil procedure

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Authors: Policarpio Jr. Joves

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Physicians in most teaching hospitals are commonly promoted into managerial roles, yet their training is mostly in clinical and scientific skills but not in leadership competencies. When they shift into roles of physician leadership, the majority hold on to their primary identity of physicians. These conflicting roles affect their identity and eventually their work. The physician leaders also face additional challenges related to academics which include incorporation of new knowledge into the existing curriculum, use of technology in the delivery of teaching, the need to train medical students outside of hospital wards, etc. The study aims to explore how physician leaders in teaching hospitals of private medical schools enact their leadership roles and how they face the challenges as physician leaders. The study setting shall be teaching hospitals of three private medical schools situated in the National Capital Region, Philippines. A multiple case study design shall be adopted in this research. Physicians shall be eligible to participate in the study if they are practicing clinicians limited to the five major clinical specialty: Internal Medicine, Pediatrics, Family Medicine, Surgery, Obstetrics and Gynecology. They must be teaching in the College of Medicine prior to their appointments as physician leaders in both medical school and teaching hospital. Semi-structured face-to-face interviews shall be utilized as a means of data collection, with open-ended questions, enabling physician leaders to present narratives about their identity, role enactment, conflicts, reaction of colleagues, and the challenges encountered in their day-to-day work as physician leaders. Interviews shall be combined with observations and review of records to gain more insights into how the physician leaders are 'doing' management. Within-case analysis shall be done initially followed by a thematic analysis across the cases, referred to as cross–case analysis or cross-case synthesis.

Keywords: academic leaders, academic managers, physician leaders, physician managers

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Authors: Trenton Hubbard, Kenneth Soyemi, Emily Siffermann

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Introduction: According to the American Academy of Pediatrics (AAP) there are different weight-based recommendations for the treatment of Chlamydia trachomatis (CT) in patients who are being evaluated for sexual assault. Current AAP Red Book guidelines recommend that uncomplicated C. trachomatis anogenital infection in prepubertal patients weighing less than =<45 kg be treated with oral erythromycin 50 mg/kg/day QID for 14 days with no alternative therapies, and for patients whose weight => 45 kg are Azithromycin 1 gm PO once. Our study objective was to determine the efficacy of single-dose Azithromycin therapy for the treatment of Chlamydia trachomatis in patients weighing less than 50 kg who were evaluated for child sexual abuse in an urban setting. Methods: We conducted a retrospective chart review of historical medical records (paper and electronic) patients weighing less than 50 kg who were evaluated for child sexual abuse and subsequently treated for C. trachomatis infection with Azithromycin (20 mg/kg PO once up to a maximum 1 gm) and received a Test of Cure (TOC) from 2006-2016. Qualitative variables were expressed as percentages. Quantitative variables were expressed as mean values (+/- standard deviation [SD]) if they followed a normal distribution or as median values (interquartile range[IQR]) if they did not. Wilcoxson two-sample test was used to compare means of Azithromycin Dose, mg/kg, and TOC timing between treatment responders and non-responders. Results: We reviewed records of 34 patients, average age (SD) was 5.4 (2.0) years, 33 (97%) were treated for CT and 1(3%) for both GC and CT. 25 (74%) were females. Urine PCR was the most commonly used test at evaluation and as TOC with 13 (38%) patients completing both tests. The average (SD) dose of Azithromycin at treatment was 470 (136) mg and average (SD) mg/kg dose of 20 (1.9) mg/kg for all patients. Median (IQR) timing for TOC testing was 19 (14-26) days. Of the 33 with complete data 25 (74%) had a negative TOC. When compared with treatment non-responders (TOC failures), treatment responders received higher doses (average dose (SD) received 495 (139) vs 401(110), P 0.06)); similar average (SD) weight base dosing received (20.8(2.0) vs 19.7 (1.5), P 0.15)), and earlier average (SD)TOC test timing (18.8 (5.6) vs 32 (28.6) P 0.02)). Conclusion: Azithromycin dosing appears to be efficacious in the treatment of CT post sexual assault as majority of patients responded. Although treatment responders and non-responders received similar weight based doses, there is need for additional studies to understand variances and predictors of response.

Keywords: child sexual abuse, chlmaydia trachmotis infection, single-dose azithromycin, weight less than or equal to 45 kilograms

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Authors: Abdolamir Allameh, Seyyed Mortaza Haghgoo, Adnan Khosravi, Esmaeil Mortaz, Mihan Pourabdollah-Toutkaboni, Sharareh Seifi

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Non-Small Cell Lung Carcinoma (NSCLC) is associated with a number of gene mutations in epidermal growth factor receptor (EGFR). The prognostic significance of mutations in exons 19 and 21, together with serum levels of EGFR, amphiregulin (AR), and Transforming Growth Factor-alpha (TGF-α) are implicated in diagnosis and treatment. The aim of this study was to examine the relationship of EGFR mutations in selected exons with the expression of relevant ligands in sera samples of NSCLC patients. For this, a group of NSCLC patients (n=98) referred to the hospital for lung surgery with a mean age of 59±10.5 were enrolled (M/F: 75/23). Blood specimen was collected from each patient. Besides, formalin fixed paraffin embedded tissues were processed for DNA extraction. Gene mutations in exons 19 and 21 were detected by direct sequencing, following DNA amplification which was done by PCR (Polymerase Chain Reaction). Also, serum levels of EGFR, AR, and TGF-α were measured by ELISA. The results of our study show that EGFR mutations were present in 37% of Iranian NSCLC patients. The most frequently identified mutations were deletions in exon 19 (72.2%) and substitutions in exon 21 (27.8%). The most frequently identified alteration, which is considered as a rare mutation, was the E872K mutation in exon 21, which was found in 90% (9 out of 10) cases. EGFR mutation detected in exon 21 was significantly (P<0.05) correlated with the levels of its ligands, EGFR and TGF-α in serum samples. Furthermore, it was found that increased serum AR (>3pg/ml) and TGF-α (>10.5 pg/ml) were associated with shorter overall survival (P<0.05). The results clearly showed a close relationship between EGFR mutations and serum EGFR and serum TGF-α. Increased serum EGFR was associated with TGF-α and AR and linked to poor prognosis of NSCLC. These findings are implicated in clinical decision-making related to EGFR-Tyrosine kinase inhibitors (TKIs).

Keywords: lung cancer, Iranian patients, epidermal growth factor, mutation, prognosis

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Authors: Lucie Matricon, Anne Roubaud, Geert Haarlemmer, Christophe Geantet

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Introduction: This case discusses the management of two floor of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. Case Report: A 51 year-old male presented with right FOM erythroleukoplakia. Relevant medical history included alcoholic dependence syndrome and alcoholic liver disease. Relevant drug therapy encompassed acamprosate, folic acid, hydroxocobalamin and thiamine. The patient had a 55.5 pack-year smoking history and alcohol dependence from age 14, drinking 16 units/day. FOM incisional biopsy and histopathological analysis diagnosed Carcinoma in situ. Treatment involved wide local excision. Specimen analysis revealed two separate foci of pT1 moderately differentiated SCCs. Carcinoma staging scans revealed no pathological lymphadenopathy, no local invasion or metastasis. SCCs had been excised in completion with narrow margins. MDT discussion concluded that in view of the field changes it would be difficult to identify specific areas needing further excision, although techniques such as Lugol’s Iodine were considered. Further surgical resection, surgical neck management and sentinel lymph node biopsy was offered. The patient declined intervention, primary management involved close monitoring alongside alcohol and smoking cessation referral. Discussion: Narrow excisional margins can increase carcinoma recurrence risk. Biopsy failed to identify SCCs, despite sampling an area of clinical concern. For gross field change multiple incisional biopsies should be considered to increase chance of accurate diagnosis and appropriate treatment. Coupling of tobacco and alcohol has a synergistic effect, exponentially increasing the relative risk of oral carcinoma development. Tobacco and alcoholic control is fundamental in reducing treatment‑related side effects, recurrence risk, and second primary cancer development.

Keywords: microalgae, biofuels, hydrothermal liquefaction, biomass

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Authors: Felipa De Mello-Sampayo

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Background: The aim of this study is to undertake, from a patient perspective, an economic analysis of presurgical teledermatology, comparing it with a conventional referral system. Store-and-forward teledermatology allows surgical planning, saving both time and number of visits involving travel, thereby reducing patients’ out-of-pocket expenses, i.e., costs that patients incur when traveling to and from health providers for treatment, visits’ fees, and the opportunity cost of time spent in visits. Method: Patients’ out-of-pocket expenses-effectiveness of presurgical teledermatology were analyzed in the setting of a public hospital during two years. The mean delay in surgery was used to measure effectiveness. The teledermatology network covering the area served by the Hospital Garcia da Horta (HGO), Portugal, linked the primary care centers of 24 health districts with the hospital’s dermatology department. The patients’ opportunity cost of visits, travel costs, and visits’ fee of each presurgical modality (teledermatology and conventional referral), the cost ratio between the most and least expensive alternative, and the incremental cost-effectiveness ratio were calculated from initial primary care visit until surgical intervention. Two groups of patients: those with squamous cell carcinoma and those with basal cell carcinoma were distinguished in order to compare the effectiveness according to the dermatoses. Results: From a patient perspective, the conventional system was 2.15 times more expensive than presurgical teledermatology. Teledermatology had an incremental out-of-pocket expenses-effectiveness ratio of €1.22 per patient and per day of delay avoided. This saving was greater in patients with squamous cell carcinoma than in patients with basal cell carcinoma. Conclusion: From a patient economic perspective, teledermatology used for presurgical planning and preparation is the dominant strategy in terms of out-of-pocket expenses-effectiveness than the conventional referral system, especially for patients with severe dermatoses.

Keywords: economic analysis, out-of-pocket expenses, opportunity cost, teledermatology, waiting time

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Authors: Magdalena Korytowska, Gunnar Lengstrand, Cecilia Larsson Wexell

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Background: Breast cancer (BC) is the most common cancer among women worldwide, and cases are continuing to increase in Sweden. Bone is the most common metastatic site in breast cancer patients, where > 65-75% of women with advanced breast cancer develop bone metastases during their disease. To prevent the skeletal-related events of metastases (e.g., pathological fractures, bone loss, cancer-induced bone pain, and hypercalcemia bone), two different classes of antiresorptive medications (AR), bisphosphonate and denosumab are typically administered every 3 to 4 weeks. Since 2015, adjuvant bisphosphonate treatment has been used every six months for three to five years in postmenopausal women for the prevention of skeletal metastases and improved survival. Methods: A case-control study was conducted to test the hypotheses that patients treated with high-dose AR are at higher risk of developing MRONJ than breast cancer patients with adjuvant bisphosphonate treatment at a lower dose. Medical and odontological data was collected between 2015-2020. Assessment of oral health and dental care before and during oncological treatment took place at the specialist clinic for Orofacial medicine linked to the specific hospital. Results: In total, 220 patients were included, 101 patients in the high-dose group and 119 patients in the adjuvant BP-treatment group. MRONJ was diagnosed in 13 patients (14%) in the high-dose group. The mandible was affected in most of the cases (84.6%), with a mean duration of high-dose treatment of 19.7 months. In 46.2% of cases, no dental cause of MRONJ could be identified. Overall, estrogen receptor-positive (ER+) BC was the most representative type in 172 patients (78.2%). However, this was 83.9% in the high-dose cases group. The most used drug was denosumab. Twenty-five patients (26.9%) switched their medication from ZOL to denosumab during their oncological treatment. Patients with ER+ breast cancer were reported in 88 patients (87.8%) in the adjuvant group that was treated with ZOL. Conclusions: MRONJ was diagnosed only in the high-dose AR group. Dental assessment and care of patients in the adjuvant group should be considered, with a recommendation to potentially prolong ZOL treatment from 3 to 5 years, with concomitant use of hormonal therapy in patients diagnosed with ER+ breast cancer to prevent bone loss induced by oncological treatment. A new referral for dental assessment is very important in the case of bone metastases when treatment with high dose AR will be required since it is associated with a higher risk of MRONJ.

Keywords: antiresorptive therapy, breast cancer, dental care, MRONJ

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Authors: Yimei Huang, Harvey Lui, Jianhua Zhao, Zhenguo Wu, Haishan Zeng

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Conventional laser treatment of skin diseases and cosmetic surgery is based on the principle of one-photon absorption selective photothermolysis which relies strongly on the difference in the light absorption between the therapeutic target and its surrounding tissue. However, when the difference in one-photon absorption is not sufficient, collateral damage would occur due to indiscriminate and nonspecific tissue heating. To overcome this problem, we developed a spatially selective photothermolysis method based on multiphoton absorption in which the heat generation is restricted to the focal point of a tightly focused near-infrared femtosecond laser beam aligned with the target of interest. A multimodal optical microscope with co-registered reflectance confocal imaging (RCM), two-photon fluorescence imaging (TPF), and second harmonic generation imaging (SHG) capabilities was used to perform and monitor the spatially selective photothermolysis. Skin samples excised from the shaved backs of euthanized NODSCID mice were used in this study. Treatments were performed by focusing and scaning the laser beam in the dermis with a 50µm×50µm target area. Treatment power levels of 200 mW to 400 mW and modulated pulse trains of different duration and period were experimented. Different treatment parameters achieved different degrees of spatial confinement of tissue alterations as visualized by 3-D RCM/TPF/SHG imaging. At 200 mW power level, 0.1 s pulse train duration, 4.1 s pulse train period, the tissue damage was found to be restricted precisely to the 50µm×50µm×10µm volume, where the laser focus spot had scanned through. The overlying epidermis/dermis tissue and the underneath dermis tissue were intact although there was light passing through these regions.

Keywords: multiphoton absorption photothermolysis, reflectance confocal microscopy, second harmonic generation microscopy, spatially selective photothermolysis, two-photon fluorescence microscopy

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Authors: A. Barratt, M. H. Granat, S. Buttress, B. Roy

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Introduction: Physiotherapy is an essential part of the treatment of patients with shoulder problems. The focus of treatment is usually centred on addressing specific physiotherapy goals, ultimately resulting in the improvement in pain and function. This study investigates if computerised physiotherapy using gamification principles are as effective as standard physiotherapy. Methods: Physiotherapy exergames were created using a combination of commercially available hardware, the Microsoft Kinect, and bespoke software. The exergames used were validated by mapping physiotherapy goals of physiotherapy which included; strength, range of movement, control, speed, and activation of the kinetic chain. A multicenter, randomised prospective controlled trial investigated the use of exergames on patients with Shoulder Impingement Syndrome who had undergone Arthroscopic Subacromial Decompression surgery. The intervention group was provided with the automated sensor-based technology, allowing them to perform exergames and track their rehabilitation progress. The control group was treated with standard physiotherapy protocols. Outcomes from different domains were used to compare the groups. An important metric was the assessment of shoulder range of movement pre- and post-operatively. The range of movement data included abduction, forward flexion and external rotation which were measured by the software, pre-operatively, 6 weeks and 12 weeks post-operatively. Results: Both groups show significant improvement from pre-operative to 12 weeks in elevation in forward flexion and abduction planes. Results for abduction showed an improvement for the interventional group (p < 0.015) as well as the test group (p < 0.003). Forward flexion improvement was interventional group (p < 0.0201) with the control group (p < 0.004). There was however no significant difference between the groups at 12 weeks for abduction (p < 0.118067) , forward flexion (p < 0.189755) or external rotation (p < 0.346967). Conclusion: Exergames may be used as an alternative to standard physiotherapy regimes; however, further analysis is required focusing on patient engagement.

Keywords: shoulder, physiotherapy, exergames, gamification

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Authors: Malika Turganova, Aigul Abduldayeva

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Modern conditions require nursing innovations at the primary ambulatory stage in the health system of Kazakhstan. There is a growing need for nurses involved in before-doctor attendance for preventive interview with a female population about reproductive health. We conducted questionnaire survey of the population of Astana in 2015. Questionnaires were drawn up according to the criteria of sexual health of World Health Organization. 3593 respondents out of 8000 questionnaires agreed to answer the questions anonymously, mM=±2,1. The average age of women comprised 37,4±11,2, Ме=31,7 years of age. Analysis of awareness about marriage hygiene revealed that 72,7% of respondents did not receive information about marriage hygiene and 89,1% respondents consider it more advisable before marriage. 45,9% of respondents specified the internet as a source of information on marriage hygiene issues, 24,5% of respondents pointed out friends, and 21,5% specified doctor. Comparing female age groups under and after 40 years old we see that proportion of cases when parents provide information about marriage hygiene issues comprises 4.3% (χ2 =9.8, p<0.05). The most important factor of preservation of women reproductive health is handling a problem of unwanted pregnancy. The responsibility lies equally in men and women. Data analysis of contraceptive methods by ranking showed three most frequently used methods: contraception sheath – 29.3%, then coitus interruptus – 18.7% and hormonal preparations – 16.9%. The most important factor of women's reproductive health preservation is a solving of the problem of unwanted pregnancy, and in this respect, the responsibility lies equally in men and women. Analyzing obtained data on contraceptive methods by ranking three of the most frequently used methods are condoms – 29,3%, then coitus interruptus – 18,7% and hormonal preparations – 16,9%. Additional oral survey of the population showed a low level of informational support of female population by family physicians, health care professionals of educational organizations (schools, universities, and colleges) about hormonal contraceptive. Females of both age groups used to think that hormonal contraceptives cause collateral damage such as blastoma, cancer, increased body weight, varix dilatation of lower limbs. Satisfaction with the frequency of sexual relations of the respondents comprised 57,6%. At that, women under 40 years of age are the most satisfied women among age groups (χ2 =5,8, p<0,05).

Keywords: nurse, public health service of Kazakhstan, reproductive and sexual health, trust of population

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Authors: Robin Turner

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In the context of the strengthening conservative movements such as “Brexit” and the election of US President Donald Trump, the global political stage was shaken up by the election of Emmanuel Macron to the French presidency, defeating the far-right candidate Marine Le Pen. The election itself was a first for the Fifth Republic in which neither final candidate was from the traditional two major political parties: the left Parti Socialiste (PS) and the right Les Républicains (LR). Macron, who served as the Minister of Finance under his predecessor, founded the centrist liberal political party En Marche! in April 2016 before resigning from his post in August to launch his bid for the presidency. Between the time of the party’s creation to the first round of elections a year later, Emmanuel Macron and En Marche! had garnered enough support to make it to the run-off election, finishing far ahead of many seasoned national political figures. Now months into his presidency, the youngest President of the Republic shows no sign of losing fuel anytime soon. His unprecedented success raises a lot of questions with respect to international relations, economics, and the evolving relationship between the French government and its citizens. The effectiveness of Macron’s campaign, of course, relies on many factors, one of which is his manner of communicating his platform to French voters. Using data from oral discourse and primary material from Macron and En Marche! in sources such as party publications and Twitter, the study categorizes linguistic instruments – address, lexicon, tone, register, and syntax – to identify prevailing patterns of speech and communication. The linguistic analysis in this project is two-fold. In addition to these findings’ stand-alone value, these discourse patterns are contextualized by comparable discourse of other 2017 presidential candidates with high emphasis on that of Marine Le Pen. Secondly, to provide an alternative approach, the study contextualizes Macron’s discourse using those of two immediate predecessors representing the traditional stronghold political parties, François Hollande (PS) and Nicolas Sarkozy (LR). These comparative methods produce an analysis that gives insight to not only a contributing factor to Macron’s successful 2017 campaign but also provides insight into how Macron’s platform presents itself differently to previous presidential platforms. Furthermore, this study extends analysis to supply data that contributes to a wider analysis of the defeat of “traditional” French political parties by the “start-up” movement En Marche!.

Keywords: Emmanuel Macron, French, discourse analysis, political discourse

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Authors: Yasser Ahmed Mahmoud Ali Helal

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The use of CAD (Computer Aided Design) technology is ubiquitous in the architecture, engineering and construction (AEC) industry. This has led to its inclusion in the curriculum of architecture schools in Nigeria as an important part of the training module. This article examines the ethical issues involved in implementing CAD (Computer Aided Design) content into the architectural education curriculum. Using existing literature, this study begins with the benefits of integrating CAD into architectural education and the responsibilities of different stakeholders in the implementation process. It also examines issues related to the negative use of information technology and the perceived negative impact of CAD use on design creativity. Using a survey method, data from the architecture department of University was collected to serve as a case study on how the issues raised were being addressed. The article draws conclusions on what ensures successful ethical implementation. Millions of people around the world suffer from hepatitis C, one of the world's deadliest diseases. Interferon (IFN) is treatment options for patients with hepatitis C, but these treatments have their side effects. Our research focused on developing an oral small molecule drug that targets hepatitis C virus (HCV) proteins and has fewer side effects. Our current study aims to develop a drug based on a small molecule antiviral drug specific for the hepatitis C virus (HCV). Drug development using laboratory experiments is not only expensive, but also time-consuming to conduct these experiments. Instead, in this in silicon study, we used computational techniques to propose a specific antiviral drug for the protein domains of found in the hepatitis C virus. This study used homology modeling and abs initio modeling to generate the 3D structure of the proteins, then identifying pockets in the proteins. Acceptable lagans for pocket drugs have been developed using the de novo drug design method. Pocket geometry is taken into account when designing ligands. Among the various lagans generated, a new specific for each of the HCV protein domains has been proposed.

Keywords: drug design, anti-viral drug, in-silicon drug design, hepatitis C virus (HCV) CAD (Computer Aided Design), CAD education, education improvement, small-size contractor automatic pharmacy, PLC, control system, management system, communication

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Authors: Linda Jane Wells

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In 1914 Topsy Smith, a woman of the First Nations Arabana tribe arrived in Alice Springs with her seven children and a herd of goats. They had come in from the goldfields at Arltunga where they had been living, and Topsy’s husband, Welsh-born Bill Smith, had recently died. Sergeant Stott, the local policeman and sub-protector of Aborigines for the region, erected a tin shed for Topsy and the children to live in, which became known as the Bungalow for half-castes. Over the years that followed many more children of mixed descent were removed from their families and brought to live at the Bungalow until, a decade later, sixty children were growing up there, cared for predominantly by Topsy Smith; Ida Standley who was the first, white schoolteacher for the town; and Sergeant Stott. The story of the Bungalow is pivotal to the foundations of social relations in the town of Alice Springs and beyond. At the same time, it is little known, recognised or understood locally, let alone more broadly. This is typical of the dominant historic narratives that have emerged out of the Australian colonial project and led to ‘the Great Australian Silence.’ The term was coined by Australian anthropologist WEH Stanner in his 1968 Boyer Lectures, in reference to the omission of the Aboriginal experience from the dominant narratives of the nation’s history. In his lecture, he attributed this silence to something that may have begun as a simple forgetting of other possible views which turned, under habit and over time, into something like a cult of forgetfulness practised on a national scale. This doctoral project, underpinned by a methodology of practice-led research, engages a bricolage of methods including archival research, ethnography, and oral histories to research the bungalow and the context in which it operated. Techniques of fictocriticism, speculative biography, autoethnography, and archival poetics are then engaged to write the research outcomes into a post-colonial, multi-genre work of creative non-fiction that speaks into the silences in the archives. The overall intent of this doctoral work is to explore and demonstrate how techniques of creative non-fiction can be used to rewrite narratives of Australian colonial history that resonate beyond the academy, thus contributing to the bank of post-colonial stories and working towards a more just, honest and inclusive national ‘memory’ and identity.

Keywords: Australian history, collective memory, creative non-fiction, postcolonialism

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Authors: Ujunma Nnenna Egbuawa

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Rape or sexual assault is a hideous crime of violence done predominantly to women and occasionally to men. In institutions of higher learning, it’s mostly experienced within or outside the campus environment due to students who are from different backgrounds socially. These students also have been imbibed with conflicting ethical standards, thus act both morally and amoral with respect to their sexual urges. The most affected among these are the female students who live outside the campus environment that is suitable for any immoral activity. These female students that are victims of rape hardly would want to be identified and this has left them as habitual prey to the unsuspecting predators. The socio-cultural setting has also been a contributory factor to the psychological and physical damage these victims face throughout their time of study as female rape victims. This is an empirical study designed to elicit information from students of Federal Polytechnic Nekede Owerri Imo State Nigeria on whether they have been sexually assaulted or raped and how they handled it thereafter. This institution was used as a case study because the provost of this tertiary institution is a woman whose name is Dr( Mrs ) C.U Njoku who has made consented efforts to ensure these rape victims rise above the social stigma associated with it. This rector has also put in some measures to bring about a decline in cases of rape within and outside the campus environment. She also granted the researcher an oral interview on how she has been able to achieve these and the challenges she hitherto faced in the process. Three research questions and a hypothesis guided the study. Samples of 119 students were used and stratification was done for sex, age and the academic level of the students. 14 item questionnaires were used and data generated from the survey were analyzed using percentages. This workshop would engage the participants by investigating some courses that may help in declining the rate of rape cases within a campus. Also, necessary measures that would be taken to help in sensitizing the tertiary institutions in areas that can aid the healing procedures of these victims. The need also for guidance and counseling unit is also a necessity for the psychological survival of these rape victims. As a result, the participants would gain an increased awareness of the influence of rape and sexual assault on campus. There ought to be a paradigm shift in institutions of higher learning in policies, administrative decisions and introduction of courses that will uplift ethical standards in order to bring about a change both locally and globally.

Keywords: institutions, psychological, sexual assault, socio-cultural

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Authors: Pravina Gurjar, Bothiraja Pour, Vijay Kumbhar, Ganesh Dama

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Andrographolide (AG), a bioactive phytoconstituent, has a wider range of pharmacological action. However, due to the intestinal degradation, shows low oral bioavailability. The aim of the present work was to develop Floating In-situ gelling Gastro retentive System (FISGS) for AG in order to enhance its site specific absorption and minimize pH dependent hydrolysis in alkaline environment. Further to increase its therapeutic efficacy for peptic ulcer disease caused by H. pyroli. Gellan based floating in situ gelling system of AG were prepared by using sodium citrate and calcium carbonate. The 32 factorial designs was used to study the effect of gellan and calcium carbonate concentration (independent variables) on dependent variable such as viscosity, floating lag time and drug release. Developed system was evaluated for drug content, floating lag time, viscosity, and drug release studies. Drug content, viscosity, and floating lag time was found to be 81-99%, 67-117 Cps, and 3-5 sec, respectively. The obtained system showed good in vitro floating ability for more than 12 h using 0.1 N HCl as dissolution medium with initial burst release followed by the controlled zero order drug release up to 24 hrs. In vivo testing of FISGS of AG to rats demonstrated significant antiulcer activity that were evaluated by various parameters like pH, volume, total acidity, millimole equivalent of H+ ions/30 min, and protein content of gastric content. The densities of all the formulation batches were found to be near about 0.9 and floating duration above 12 hr. It was observed that with the increase in conc. of gellan there was increase in the viscosity of formulation but all formulations were in optimum range. The drug content of optimized batch was found to be 99.23. In histopathology study of stomach, the villi at the mucosal surface, the intercellular junction, the intestinal lumen were intact; no destruction of the epithelium, and submucosal gland in formulation treated and control group animals as compared to pure drug AG and standard ranitidine. Gellan-based in situ gastro retentive floating system could be advantageous in terms of increased bioavailability of AG to maintain an effective drug conc. in gastric fluid as well as in serum for longer period of time.

Keywords: andrographolide, floating drug delivery, in situ gelling system, gastroretentive system

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Authors: Rakan Hassan M. Alzahrani, Ziyad Alzahrani, Bader Bashrahil, Abdulrahman Elyasi, Abdullah a Ghaddaf, Rayan Alzahrani, Mohammed Alkathlan, Nawaf Alghamdi, Dakheelallah Almutairi

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Background: Corticosteroid irrigations, which regularly involve the off-label use of budesonide mixed with normal saline in high volume Sino-nasal irrigations, have been more commonly used in the management of post-operative chronic rhinosinusitis (CRS). Objective: This article attempted to measure the efficacy of post-operative budesonide nasal irrigation compared to normal saline-alone nasal irrigation in the management of chronic rhinosinusitis (CRS) through a systematic review and meta-analysis of randomized controlled trials (RCTs). Methods: The databases PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched by two independent authors. Only RCTs comparing budesonide irrigation to normal saline alone irrigation for CRS with or without polyposis after functional endoscopic sinus surgery (FESS) were eligible. A random effect analysis model of the reported CRS-related quality of life (QOL) measures and the objective endoscopic assessment scales of the disease was done. Results: Only 6 RCTs met the eligibility criteria, with a total number of participants of 356. Compared to normal saline irrigation, budesonide nasal irrigation showed statically significant improvements in both the CRS-related quality of life (QOL) and the endoscopic findings (MD= -4.22 confidence interval [CI]: -5.63, -2.82 [P < 0.00001]), (SMD= -0.50 confidence interval [CI]: -0.93, -0.06 [P < 0.03]) respectively. Conclusion: Both intervention arms showed improvements in CRS-related QOL and endoscopic findings in post-FESS chronic rhinosinusitis with or without polyposis. However, budesonide irrigation seems to have a slight edge over conventional normal saline irrigation with no reported serious side effects, including hypothalamic-pituitary-adrenal (HPA) axis suppression.

Keywords: Budesonide, chronic rhinosinusitis, corticosteroids, nasal irrigation, normal saline

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Authors: H. Jeries, N. Volkova, C. G. Iglesias, M. Najjar, M. Rosenblat, M. Aviram, T. Hayek

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Background: Synthetic forms of glucocorticoids (e.g., prednisone, prednisolone) are anti-inflammatory drugs which are widely used in clinical practice. The role of glucocorticoids (GCs) in cardiovascular diseases including atherosclerosis is highly controversial, and their impact on macrophage foam cell formation is still unknown. Our aim was to investigate the effects of prednisone or its active metabolite, prednisolone, on macrophage oxidative stress and lipid metabolism using in-vivo, ex-vivo and in-vitro systems. Methods: The in-vivo study included C57BL/6 mice which were intraperitoneally injected with prednisone or prednisolone (5mg/kg) for 4 weeks, followed by lipid metabolism analyses in the mice aorta, and in peritoneal macrophages (MPM). In the ex-vivo study, we analyzed the effect of serum samples obtained from 9 healthy volunteers before or after treatment with oral prednisone (20mg for 5 days), on J774A.1 macrophage atherogenicity. In-vitro studies were conducted using J774A.1 macrophages, human monocyte derived macrophages (HMDM) and fibroblasts. Cells were incubated with increasing concentrations (0-200 ng/ml) of prednisone or prednisolone, followed by determination of cellular oxidative status, triglyceride and cholesterol metabolism. Results: Prednisone or prednisolone treatment resulted in a significant reduction in triglycerides and mainly in cholesterol cellular accumulation in MPM or in J774A.1 macrophages incubated with human serum. Similar resulted were noted in HMDM or in J774A.1 macrophages which were directly incubated with the GCs. These effects were associated with GCs inhibitory effect on triglycerides and cholesterol biosynthesis rates, throughout downregulation of diacylglycerol acyltransferase1 (DGAT1) expression, and of the sterol regulatory element binding protein (SREBP2) and HMGCR expression, respectively. In parallel to prednisone or prednisolone induced reduction in macrophage triglyceride content, paraoxonase 2 (PON2) expression was significantly upregulated. GCs-induced reduction of cellular triglyceride and cholesterol mass was mediated by the GCs receptors on macrophages since the GCs receptor antagonist (RU 486) abolished these effects. In fibroblasts, unlike macrophages, prednisone or prednisolone showed no anti-atherogenic effects. Conclusions: Prednisone or prednisolone are anti-atherogenic since they protected macrophages from lipid accumulation and foam cell formation.

Keywords: atherosclerosis, cholesterol, foam cell, macrophage, prednisone, prednisolone, triglycerides

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Authors: Azizollah Arbabisarjou, Leila Safabakhsh, Mozhgan Jahantigh, Mahshid Nazemzadeh, Shahindokht Navabi

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Background: Health promotion is an essential strategy for reduction of health disparities. Health promotion includes all activities that encourage optimum physical, spiritual, and mental function. The aim of this study was to determine the impact of a Health Promotion Program (HPP) on behavior in terms of the dimensions of the Health Promoting Lifestyle Profile (HPLP) in patients after Coronary Artery Bypass Graft (CABG). Methods and Materials: In this clinical trial study, 80 patients who had undergone CABG surgery (2011-2012) were selected and randomly divided in two groups: Experimental and Control that investigated by (HPLP II). Then the experimental group was educated about diet, walking and stress management. The program process was followed up for 3months and after that all variables were investigated again. The overall score and the scores for the six dimensions of the HPLP (self-actualization, health responsibility, exercise, nutrition, interpersonal support and stress management) were measured in the pre- and post-test periods. Statistical analysis was performed using Student's t-test and paired t-test. Results: Results showed that Score of stress management (p=.036), diet (p=.002), Spiritual Growth (p=.001) and interrelationship (p=002) increase in experimental group after intervention .Average scores after 3 months in the control group had no significant changes; except responsibility for health (p < .05). Results of the study revealed that comparison the scores of the experimental group were significantly different from the control group in all lifestyle aspects except for spiritual growth. Conclusion: This study showed that Health promoting program on lifestyle and health promotion in patients who suffer from CAD could enhance patient's awareness of healthy behaviors and improves the quality of life.

Keywords: coronary artery bypass graft, health promotion, lifestyle, education

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Authors: D. Hammad, D. P. Tonge

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Rheumatoid arthritis (RA) is a disabling and common autoimmune disease during which the body's immune system attacks healthy tissues. This results in complicated and long-lasting actions being carried out by the immune system, which typically only occurs when the immune system encounters a foreign object. In the case of RA, the disease affects millions of people and causes joint inflammation, ultimately leading to the destruction of cartilage and bone. Interestingly, the disease mechanism still remains unclear. It is likely that RA occurs as a result of a complex interplay of genetic and environmental factors including an imbalance in the microorganism population inside our body. The human microbiome or microbiota is an extensive community of microorganisms in and on the bodies of animals, which comprises bacteria, fungi, viruses, and protozoa. Recently, the development of molecular techniques to characterize entire bacterial communities has renewed interest in the involvement of the microbiome in the development and progression of RA. We believe that an imbalance in some of the specific bacterial species in the gut, mouth and other sites may lead to atopobiosis; the translocation of these organisms into the blood, and that this may lead to changes in immune system status. The aim of this study was, therefore, to characterize the microbiome of RA serum samples in comparison to healthy control subjects using 16S rRNA gene amplification and sequencing. Serum samples were obtained from healthy control volunteers and from patients with RA both prior to, and following treatment. The bacterial community present in each sample was identified utilizing V4 region 16S rRNA amplification and sequencing. Bacterial identification, to the lowest taxonomic rank, was performed using a range of bioinformatics tools. Significantly, the proportions of the Lachnospiraceae, Ruminococcaceae, and Halmonadaceae families were significantly increased in the serum of RA patients compared with healthy control serum. Furthermore, the abundance of Bacteroides and Lachnospiraceae nk4a136_group, Lachnospiraceae_UGC-001, RuminococcaceaeUCG-014, Rumnococcus-1, and Shewanella was also raised in the serum of RA patients relative to healthy control serum. These data support the notion of a blood microbiome and reveal RA-associated changes that may have significant implications for biomarker development and may present much-needed opportunities for novel therapeutic development.

Keywords: blood microbiome, gut and oral bacteria, Rheumatoid arthritis, 16S rRNA gene sequencing

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Authors: Komal Vig

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Cardiovascular disease (CVD)-related deaths occur in 17.3 million people globally each year, accounting for 30% of all deaths worldwide, with a predicted annual incidence of deaths to reach 23.3 million globally by 2030. Autologous bypass grafts remain an important therapeutic option for the treatment of CVD, but the poor quality of the donor patient’s blood vessels, the invasiveness of the resection surgery, and postoperative movement restrictions create issues. The present study is aimed to improve the endothelialization of intimal surface of graft by using low temperature plasma (LTP) to increase the cell attachment and proliferation. Polytetrafluoroethylene (PTFE) was treated with LTP. Air was used as the feed-gas, and the pressure in the plasma chamber was kept at 800 mTorr. Scaffolds were also modified with gelatin and collagen by dipping method. Human umbilical vein endothelial cells (HUVEC) were plated on the developed scaffolds, and cell proliferation was determined by the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay and by microscopy. mRNA expressions levels of different cell markers were investigated using quantitative real-time PCR (qPCR). XPS confirmed the introduction of oxygenated functionalities from LTP. HUVEC cells showed 80% seeding efficiency on the scaffold. Microscopic and MTT assays indicated increase in cell viability in LTP treated scaffolds, especially when treated with gelatin or collagen, compared to untreated scaffolds. Gene expression studies shows enhanced expression of cell adhesion marker Integrin- α 5 gene after LTP treatment. LTP treated scaffolds exhibited better cell proliferation and viability compared to untreated scaffolds. Protein treatment of scaffold increased cell proliferation. Based on our initial results, more scaffolds alternatives will be developed and investigated for cell growth and vascularization studies. Acknowledgments: This work is supported by the NSF EPSCoR RII-Track-1 Cooperative Agreement OIA-2148653.

Keywords: LTP, HUVEC cells, vascular graft, endothelialization

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Authors: Abraham Finkelman

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Computerized Surgical Guides have been proven to be a predictable way to perform dental implants, with a relatively high accuracy in comparison to a treatment plan. When using the CSG Bone supported, it allows us to make the necessary changes of the hard tissue prior to the implant placement and after the implant placement. The CSG gives us an accurate position for the drilling, and during the implant placement it allows us to alter the vertical position of the implant altering the final position of the abutment and avoiding any risk of any damage to the adjacent anatomical structures. Any Changes required to the bone level can be done prior to the fixation of the CSG using a reduction guide, which incur extra surgical fees and the need of a second surgical guide. Any changes of the bone level after the implant placement are at the risk of damaging the implant neck surface. The technique consists of a universal system that allows us to remove the excess bone around the implant sockets prior to the implant placement which then enables us to place the implant in the vertical position with accuracy as planned with the CSG. The systems consist of a hollow pin of different sizes and diameters. Depending on the implant system that we are using. Length sizes are from 6mm-16mm and a diameter of 2.6mm-4.8mm. Upon the completion of the drilling, the pin is then inserted into the implant socket-using the insertion tool. Once the insertion tool has unscrewed the pin, we can continue with the bone reduction. The bone reduction can be done using conventional methods upon the removal of all the excess bone around the pin. The insertion tool is then screwed into the pin and the pin is then removed. We now, have the new bone level at the crest of the implant socket which is our mark for the vertical position of the implant. In some cases, when we are locating the implant very close to anatomical structures, any form of deviation to the vertical position of the implant during the surgery, can cause damage to such anatomical structures, creating irreversible damages such as paresthesia or dysesthesia of the mandibular nerve. If we are planning for immediate loading and we have done our temporary restauration in base of our computerized plan, deviation in the vertical position of the implant will affect the position of the abutment, affecting the accuracy of the temporary prosthesis, extending the working time till we adapt the prosthesis to the new position.

Keywords: bone reduction, computer aided navigation, dental implant placement, surgical guides

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Authors: Naum Simanovsky, Vladimir Goldman, Michael Zaidman

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Background: The optimal algorithm for the management of symptomatic tarsal coalition is still under discussion in pediatric literature. It's debatable what surgical steps are essential to achieve the best outcome. Method: The investigators retrospectively reviewed the records of twelve patients with symptomatic tarsal coalition that were treated operatively between 2017 and 2019. Only painful flat feet were operated. Two patients were excluded from the study due to lack of sufficient follow-up. Ten of eleven feet were treated with the combination of calcaneal lengthening osteotomy (CLO) and resection of coalition (RC). Only one foot was operated with CLO alone. In half of our patients, Achilles lengthening was performed. For two children, medial plication was added. Short leg cast was applied to all children for 6-8 weeks, and soft shoe insoles for medial arch support were prescribed after. Demographic, clinical, and radiographic records were reviewed. The outcome was evaluated using American Orthopedic Foot and Ankle Society (AOFAS) Ankle Hindfoot Score. Results: There were seven boys and three girls. The mean age at the time of surgery was 13.9 (range 12 to 17) years, and the mean follow-up was 18 (range 8 to 34) months. The early complications included one superficial wound infection and dehiscence. Late complication includes two children with residual forefoot supination. None of our patients required additional operations during the follow-up period. All feet achieved complete deformity correction or dramatic improvement. In the last follow-up, seven feet were painless, and four children had some mild pain after intensive activities. All feet achieved excellent and good scoring on AOFAS. Conclusions: Many patients with talocalcaneal coalition also have rigid or stiff, painful, flat feet. For these patients, the resection of coalition with concomitant CLO can be safely recommended.

Keywords: Tarsal coalition, calcaneal lengthening osteotomy., flat foot, coalition resection

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Authors: Ramin Zargarbashi, Hamid Rabie, Behnam Panjavi, Hooman Kamran, Seyedarad Mosalamiaghili, Zohre Erfani, Seyed Peyman Mirghaderi, Maryam Salimi

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Background: Posterior shoulder dislocation is one of the disabling complications of brachial plexus birth injury (BPBI), and various treatment options, including capsule and surrounding muscles release for open reduction, humeral derotational osteotomy, and tendon transfers, have been recommended to manage it. In the present study, we aimed to determine the clinical outcome of open reduction with soft tissue release, tendon transfer, and glenoid osteotomy inpatients with BPBI and posterior shoulder dislocation or subluxation. Methods: From 2018 to 2020, 33 patients that underwent open reduction, glenoid osteotomy, and tendon transfer were included. The glenohumeral deformity was classified according to the Waters radiographic classification. Functional assessment was performed using the Mallet grading system before and at least two years after the surgery. Results: The patients were monitored for 26.88± 5.47 months. Their average age was 27.5±14 months. Significant improvement was seen in the overall Mallet score (from 13.5 to 18.91 points) and its segments, including hand to mouth, hand to the neck, global abduction, global external rotation, abduction degree, and external rotation degree. Hand-to-back score and the presence of trumpet sign were significantly decreased in the post-operation phase (all p values<0.001). The above-mentioned variables significantly changed for both infantile and non-infantile dislocations. Conclusion: Our study demonstrated that open reduction along with glenoid osteotomy improves retroversion, and muscle strengthening with different muscle transfers is an effective technique for BPBI.

Keywords: birth injuries, nerve injury, brachial plexus birth palsy, Erb palsy, tendon transfer

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Authors: Ouassila Bekkal Brikci Benhabib, Zahia Boucherit Otmani, Kebir Boucherit, A. Seghir

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The establishment of intravenous catheters in hospitalized patient is an act common in many clinical situations. These therapeutic tools, from their insertion in the body, represent gateways including fungal germs prone. The latter can generate the growth of biofilms, which can be the cause of fungal infection. Faced with this problem, we conducted a study at the University Hospital of Tlemcen in the neurosurgery unit and aims to isolate and identify Candida yeasts from intravenous catheters. Then test their ability to form biofilms. Materials and methods: 256 patient hospitalized in surgery of the hospital in west Algeria were submitted to this study. All samples were taken from peripheral venous catheters implanted for 72 hours or more days. A total of 31 isolates of Candida species were isolated. MIC and SMIC are determined at 80% inhibition by the test XTT tetrazolium measured at 490 nm. The final concentrations of antifungal agent being between 0.03 and 16 mg / ml for amphotericin B and from 0.015 to 8 mg / mL caspofungin. Results: 31 Candida species isolates from catheters including 14 Candida albicans and 17 Candida non albicans . 21 strains of all the isolates were able to form biofilms. In their form of Planktonic cells, all isolates are 100% susceptible to antifungal agents tested. However, in their state of biofilms, more isolates have become tolerant to the tested antifungals. Conclusion: Candida yeasts isolated from intravascular catheters are considered an important virulence factor in the pathogenesis of infections. Their involvement in catheter-related infections can be disastrous for their potential to generate biofilms. They survive high concentrations of antifungal where treatment failure. Pending the development of a therapeutic approach antibiofilm related to catheters, their mastery is going through: -The risk of infection prevention based on the training and awareness of medical staff, -Strict hygiene and maximum asepsis, and -The choice of material limiting microbial colonization.

Keywords: candida, biofilm, hospital, infection, amphotericin B, caspofungin

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