Search results for: conventical treatment

Authors: Yaxian Chen, Yeonhee Park

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Driven by evolving FDA recommendations, modern clinical trials demand innovative designs that strike a balance between statistical rigor and ethical considerations. Covariate-adjusted response-adaptive (CARA) designs bridge this gap by utilizing patient attributes and responses to skew treatment allocation in favor of the treatment that is best for an individual patient’s profile. However, existing CARA designs for survival outcomes often hinge on specific parametric models, constraining their applicability in clinical practice. In this article, we address this limitation by introducing a CARA design for survival outcomes (CARAS) based on the Cox model and a variance estimator. This method addresses issues of model misspecification and enhances the flexibility of the design. We also propose a group sequential overlapweighted log-rank test to preserve type I error rate in the context of group sequential trials using extensive simulation studies to demonstrate the clinical benefit, statistical efficiency, and robustness to model misspecification of the proposed method compared to traditional randomized controlled trial designs and response-adaptive randomization designs.

Keywords: cox model, log-rank test, optimal allocation ratio, overlap weight, survival outcome

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Authors: Shih-Ping Liu, Cheng-Hsuan Chang, Yu-Chuen Huang, Shih-Yin Chen, Woei-Cherng Shyu

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Embryonic stem cells (ES) and induced pluripotnet stem cells (iPS) are both pluripotent stem cells. For mouse stem cells culture technology, leukemia inhibitory factor (LIF) was used to maintain the pluripotency of stem cells in vitro. However, LIF is an expensive reagent. The goal of this study was to find out a pure compound extracted from Chinese herbal medicine that could maintain stem cells pluripotency to replace LIF and improve the iPS generation efficiency. From 20 candidates traditional Chinese medicine we found that Cordycepsmilitaris triggered the up-regulation of stem cells activating genes (Oct4 and Sox2) expression levels in MEF cells. Cordycepin, a major active component of Cordycepsmilitaris, also could up-regulate Oct4 and Sox2 gene expression. Furthermore, we used ES and iPS cells and treated them with different concentrations of Cordycepin (replaced LIF in the culture medium) to test whether it was useful to maintain the pluripotency. The results showed higher expression levels of several stem cells markers in 10 μM Cordycepin-treated ES and iPS cells compared to controls that did not contain LIF, including alkaline phosphatase, SSEA1, and Nanog. Embryonic body formation and differentiation confirmed that 10 μM Cordycepin-containing medium was capable to maintain stem cells pluripotency after four times passages. For mechanism analysis, microarray analysis indicated extracellular matrix and Jak/Stat signaling pathway as the top two deregulated pathways. In ECM pathway, we determined that the integrin αVβ5 expression levels and phosphorylated Src levels increased after Cordycepin treatment. In addition, the phosphorylated Jak2 and phosphorylated Sat3 protein levels were increased after Cordycepin treatment and suppressed with the Jak2 inhibitor, AG490. The expression of cytokines associated with Jak2/Stat3 signaling pathway were also up-regulated by Q-PCR and ELISA assay. Lastly, we used Oct4-GFP MEF cells to test iPS generation efficiency following Cordycepin treatment. We observed that 10 Μm Cordycepin significantly increased the iPS generation efficiency in day 21. In conclusion, we demonstrated Cordycepin could maintain the pluripotency of stem cells through both of ECM and Jak2/Stat3 signaling pathway and improved iPS generation efficiency.

Keywords: cordycepin, iPS cells, Jak2/Stat3 signaling pathway, molecular biology

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Authors: Nik Azmah Nik Yusuff, Faridah Hassan Basri, Rosnidar Mansor

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The purpose of the study is to find out the effectiveness of using Graphic calculators (GC) with Calculator Based Laboratory 2 (CBL2) in teaching and learning of form four biology for these topics: Nutrition, Respiration and Dynamic Ecosystem. Sixty form four science stream students were the participants of this study. The participants were divided equally into the treatment and control groups. The treatment group used GC with CBL2 during experiments while the control group used the ordinary conventional laboratory apparatus without using GC with CBL2. Instruments in this study were a set of pre-test and post-test and a questionnaire. T-Test was used to compare the student’s biology achievement while a descriptive statistic was used to analyze the outcome of the questionnaire. The findings of this study indicated the use of GC with CBL2 in biology had significant positive effect. The highest mean was 4.43 for item stating the use of GC with CBL2 had saved collecting experiment result’s time. The second highest mean was 4.10 for item stating GC with CBL2 had saved drawing and labelling graphs. The outcome from the questionnaire also showed that GC with CBL2 were easy to use and save time. Thus, teachers should use GC with CBL2 in support of efforts by Malaysia Ministry of Education in encouraging technology-enhanced lessons.

Keywords: biology experiments, Calculator-Based Laboratory 2 (CBL2), graphic calculators, Malaysia Secondary School, teaching/learning

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Authors: Murray David Schane

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Though years of clinical encounters with patients with autism spectrum disorders and those with a schizoid personality the many defining diagnostic features shared between these conditions have been explored and current neurobiological differences have been reviewed; and, critical and different treatment strategies for each have been devised. The paper compares and contrasts the apparent similarities between autism spectrum disorders and the schizoid personality are found in these DSM descriptive categories: restricted range of social-emotional reciprocity; poor non-verbal communicative behavior in social interactions; difficulty developing and maintaining relationships; detachment from social relationships; lack of the desire for or enjoyment of close relationships; and preference for solitary activities. In this paper autism, fundamentally a communicative disorder, is revealed to present clinically as a pervasive aversive response to efforts to engage with or be engaged by others. Autists with the Asperger presentation typically have language but have difficulty understanding humor, irony, sarcasm, metaphoric speech, and even narratives about social relationships. They also tend to seek sameness, possibly to avoid problems of social interpretation. Repetitive behaviors engage many autists as a screen against ambient noise, social activity, and challenging interactions. Also in this paper, the schizoid personality is revealed as a pattern of social avoidance, self-sufficiency and apparent indifference to others as a complex psychological defense against a deep, long-abiding fear of appropriation and perverse manipulation. Neither genetic nor MRI studies have yet located the explanatory data that identifies the cause or the neurobiology of autism. Similarly, studies of the schizoid have yet to group that condition with those found in schizophrenia. Through presentations of clinical examples, the treatment of autists of the Asperger type is revealed to address the autist’s extreme social aversion which also precludes the experience of empathy. Autists will be revealed as forming social attachments but without the capacity to interact with mutual concern. Empathy will be shown be teachable and, as social avoidance relents, understanding of the meaning and signs of empathic needs that autists can recognize and acknowledge. Treatment of schizoids will be shown to revolve around joining empathically with the schizoid’s apprehensions about interpersonal, interactive proximity. Models of both autism and schizoid personality traits have yet to be replicated in animals, thereby eliminating the role of translational research in providing the kind of clues to behavioral patterns that can be related to genetic, epigenetic and neurobiological measures. But as these clinical examples will attest, treatment strategies have significant impact.

Keywords: autism spectrum, schizoid personality traits, neurobiological implications, critical diagnostic distinctions

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Authors: Buhari Samaila, Buhari Maidamma

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Background: The use of ionizing radiation in medical diagnostics and treatment is indispensable for accurate imaging and effective cancer therapies. However, radiation exposure carries inherent risks, necessitating strict protection measures to safeguard both patients and healthcare workers. This review critically examines the existing radiation protection measures in diagnostic radiology and radiotherapy, highlighting technological advancements, regulatory frameworks, and challenges. Objective: The objective of this review is to critically evaluate the effectiveness of current radiation protection measures in diagnostic and therapeutic radiology, focusing on minimizing patient and staff exposure to ionizing radiation while ensuring optimal clinical outcomes and propose future directions for improvement. Method: A comprehensive literature review was conducted, covering scientific studies, regulatory guidelines, and international standards on radiation protection in both diagnostic radiology and radiotherapy. Emphasis was placed on ALARA principles, dose optimization techniques, and protective measures for both patients and healthcare workers. Results: Radiation protection measures in diagnostic radiology include the use of shielding devices, minimizing exposure times, and employing advanced imaging technologies to reduce dose. In radiotherapy, accurate treatment planning and image-guided techniques enhance patient safety, while shielding and dose monitoring safeguard healthcare personnel. Challenges such as limited infrastructure in low-income settings and gaps in healthcare worker training persist, impacting the overall efficacy of protection strategies. Conclusion: While significant advancements have been made in radiation protection, challenges remain in optimizing safety, especially in resource-limited settings. Future efforts should focus on enhancing training, investing in advanced technologies, and strengthening regulatory compliance to ensure continuous improvement in radiation safety practices.

Keywords: radiation protection, diagnostic radiology, radiotherapy, ALARA, patient safety, healthcare worker safety

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Authors: Bayan Almofty, Yuto Yamaki, Tadamasa Terai, Sadahito Uto

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Myopathy (muscles disease) treatment are expected in the field of regenerative medicine and applied research of cultured muscle to bio actuator is performed in Biomedical Engineering as applied research of cultured muscle. This study is about cultured myoblast C2C12 from mouse skeletal muscle and a mechanism of cultured muscle contraction by electric stimulation is investigated. Grayanotoxins (GTXs) belong to neurotoxins known to enhance the permeability of cell membrane for Na ions. Grayanotoxins are extracted from a famous Pieris japonica and Ericaceae as a phytotoxin. We investigated the functional role of GTXs on muscle cells (C2C12) contraction and membrane potential. A change in membrane potential is measured using a micro glass tube electrode contraction of myotubes is induced by applying an external electrical stimulation. The contraction and membrane potential change induced by injection of current using the micro glass electrode are also measured. From the result, contraction and membrane potential of muscle cells was affected by GTXs treatment, suggesting that the diverse chemical structures of GTXs are responsible for contraction and membrane potential of muscle cells.

Keywords: skeletal muscle, C2C12, myoblast, myotubes, contraction, Grayanotoxins, membrane potential, neurotoxins, phytotoxin

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Authors: Maha Salah, Hanaa Hashem, Mahmoud M. Alsagheir, Mohammed Salah

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Acute respiratory distress syndrome (ARDS) represents a complex clinical syndrome and carries a high risk for mortality. The severity of the clinical course, the uncertainty of the outcome, and the reliance on the full spectrum of critical care resources for treatment mean that the entire health care team is challenged. Researchers and clinicians have investigated the nature of the pathological process and explored treatment options with the goal of improving outcome. Through this application of research to practice, we know that some previous strategies have been ineffective, and innovations in mechanical ventilation, sedation, nutrition, and pharmacological intervention remain important research initiatives. Developed Clinical pathway is multidisciplinary plans of best clinical practice for this specified groups of patients that aid in the coordination and delivery of high quality care. They are a documented sequence of clinical interventions that help a patient to move, progressively through a clinical experience to a desired outcome. Although there is a lot of heterogeneity in patients with ARDS, this suggested developed clinical pathway with alternatives was built depended on a lot of researches and evidence based medicine and nursing practices which may be helping these patients to improve outcomes, quality of life and decrease mortality.

Keywords: acute respiratory distress syndrome (ARDS), clinical pathway, clinical syndrome

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Authors: Fernanda Conforto de Oliveira

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The International Monetary Fund (IMF) has a central role in global financial governance as the world’s leading crisis lender. Its practice of conditional lending – conditioning loans on the implementation of economic policy adjustments – is the primary lever by which the institution interacts with and influences the policy choices of member countries and has been a key topic of interest to scholars and public opinion. However, empirical evidence about the economic and (geo)political determinants of IMF lending behavior remains inconclusive, and no model that explains IMF policies has been identified. This research moves beyond panel analysis to focus on financial negotiations for the first IMF programs in Argentina and Brazil in the early post-war period. It seeks to understand why negotiations achieved distinct objectives: Argentinean officials cooperated and complied with IMF policies, whereas their Brazilian counterparts hesitated. Using qualitative and automated text analysis, this paper analyses the hypothesis about whether a differential IMF treatment could help to explain these distinct outcomes. This paper contributes to historical studies on IMF-Latin America relations and the broader literature in international policy economy about IMF policies.

Keywords: international monetary fund, international history, financial history, Latin American economic history, natural language processing, sentiment analysis

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Authors: Rika Susanti, Eryati Darwin, Dedi Afandi, Yanwirasti, Syahruddin Said, Noverika Windasari, Zelly Dia Rofinda

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Introduction: Blunt head trauma is one of the leading causes of death associated with murders and other deaths involved in criminal acts. Creatine kinase (CKBB) levels have been used as a biomarker for blunt head trauma. Therefore, it is now used as an alternative to an autopsy. The aim of this study is to investigate CKBB levels in cerebrospinal fluid (CSF) and post-mortem serum in order to deduce the cause and time of death. Method: This investigation was conducted through post-test–only group design involving deaths caused by blunt head trauma, which was compared to deaths caused by ketamine poisoning. Results: There were eight treatment groups, each consisting of six adult rats (Rattus norvegicus) Sprague-Dawley strain. Examinations were done at 0 hours, 1 hour, 2 hours, and 3 hours post-mortem, which followed by brain tissue observation. Data were then analyzed statistically with a repeated-measures general linear model. Conclusion: There were increases in the level of CKBB in CSF and postmortem serum in both blunt head trauma and ketamine poisoning treatment groups. However, there were no significant differences between these two groups.

Keywords: blunt head trauma, CKBB, the cause of death, estimated time of death

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Authors: Feng-Tsai Weng, Rick Wang, Yan-Cong Liao

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Passivation is a kind of surface treatment for material to reinforce the corrosion resistance specially the stainless alloy. Passive film, is to getting more potential compared to their status before passivation. An oxidation film can be formed on the surface of stainless steel, which has a strong corrosion resistance ability after passivation treatment. In this research, a new passivation technology is proposed for a special stainless alloy which contains a 12-14% Chromium. This method includes the A-A-A (alkaline-acid-alkaline) process basically, which was developed by Carpenter that can neutralize trapped acid. Besides, a corrosion resistant coating layer was obtained by immersing the parts in a water bath of mineral oil at high temperature. Salt spray test ASTM B368 was conducted to investigated performance of corrosion resistant of the passivated stainless steel alloy parts. Results show much better corrosion resistant that followed a coating process after A-A-A Passivation process, than only using A-A-A process. The passivation time is with more than 380 hours of salt spray test ASTM B368, which is equal to 3000 hours of Salt spray test ASTM B117. Proposed passivation method of stainless steel can be completed in about 3 hours.

Keywords: passivation, alkaline-acid-alkaline, stainless steel, salt spray test

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Authors: Madhumita Sahu, S. S. Tiwary

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The Radiotherapy of Carcinoma Lung has always been difficult and a matter of great concern. The significant movement due to fractional motion caused due to non-rhythmic respiratory motion poses a great challenge for the treatment of Lung cancer using Ionizing Radiation. The present study compares the accuracy in the measurement of Target Volume using Slow-CT and 4DCT Imaging in SBRT for Lung Tumor. The experimental samples were extracted from patients with Lung Cancer who underwent SBRT. Slow-CT and 4DCT images were acquired under free breathing for each patient. PTV were delineated on Slow CT images. Similarly, ITV was also delineated on each of the 4DCT volumes. Volumetric and Statistical analysis were performed for each patient by measuring corresponding PTV and ITV volumes. The study showed (1) The Maximum Deviation observed between Slow-CT-based PTV and 4DCT imaging-based ITV is 248.58 cc. (2) The Minimum Deviation observed between Slow-CT-based PTV and 4DCT imaging-based ITV is 5.22 cc. (3) The Mean Deviation observed between Slow-CT-based PTV and 4DCT imaging-based ITV is 63.21 cc. The present study concludes that irradiated volume ITV with 4DCT is less as compared to the PTV with Slow-CT. A better and more precise treatment could be given more accurately with 4DCT Imaging by sparing 63.21 CC of mean body volume.

Keywords: CT imaging, 4DCT imaging, lung cancer, statistical analysis

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Authors: Nazedah Ain Ibrahim, Mohamed Mansor Manan

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Treatment of suspected early onset neonatal sepsis (EONS) in Neonatal Intensive Care Unit (NICU) is essential. However, information regarding EONS pathogens may vary between regions. Global perspectives showed Group B Streptococcal (GBS) as the most common causative pathogens, but the widespread use of intrapartum antibiotics has changed the pathogens pattern towards gram negative microorganisms, especially E. coli. Objective of this study is to describe the pathogens isolated, to assess current treatment and risk of EONS. Records of 899 neonates born in three General Hospitals between 2009 until 2012 were retrospectively reviewed. The inclusion criteria were neonates with blood culture taken prior to empiric antibiotics administration and within 72 hours of life. Of the study group, a total of 734 (82%) cases had documented blood culture that met the inclusion criteria. Proven EONS (as confirmed by positive blood culture) was found in 22 (3%) neonates. The majority was isolated with gram positive organisms, 17 (2.3%). In addition, other common gram positive organism isolated were Coagulase negative staphylococci (7) followed by Bacillus sp. (5) and Streptococcus pneumonia (2), and only one case isolated with GBS, Streptococcus spp. and Enterococcus sp. Meanwhile, only five cases of gram negative organisms [Stenotropomonas (xantho) maltophi (1), Haemophilus influenza (1), Spingomonas paucimobilis (1), Enterobacter gergoviae (1) and E. coli (1)] were isolated. A total of 286 (39%) cases were exposed to intrapartum antibiotics and of those, 157 (21.4%) were administered prior to delivery. All grams positive and most gram negative organisms showed sensitivity to the tested antibiotics. Only two rare gram negative organisms showed total resistant. Male, surfactant, caesarean delivery and prolonged rapture of membrane >18hours were a possible risk of proven EONS. Although proven EONS remains uncommon in Malaysia, nonetheless, the effect of intrapartum antibiotics still required continuous surveillance. However, by analyzing isolated pathogens it can be used as treatment guidance in managing suspected EONS.

Keywords: early onset neonatal sepsis, neonates, pathogens, gram positive, gram negative

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Authors: Sina Mahdavi

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Background and Objective: Multiple sclerosis (MS) is the most common inflammatory autoimmune disease of the central nervous system (CNS) that affects the myelination process in the CNS. Complex interactions of various "environmental or infectious" factors may act as triggers in autoimmunity and disease progression. The association between viral infections, especially the John Cunningham virus (JCV) and MS is one potential cause that is not well understood. This study aims to summarize the available data on JCV infection in MS disease progression. Materials and Methods: For this study, the keywords "Multiple sclerosis", " John Cunningham virus ", and "central nervous system" in the databases PubMed, Google Scholar, Sid, and MagIran between 2019 and 2022 were searched, and 12 articles were chosen, studied, and analyzed. Results: MS patients are candidates for natalizumab therapy, which inhibits lymphocyte migration and increases the risk of progressive multifocal leukoencephalopathy (PML), a rare lytic infection of glial cells caused by JCV. Oligodendrocytes may be the target of JCV infection in the central nervous system (CNS). Conclusion: There is a high expression of JCV during the natalizumab treatment period for MS patients, suggesting that the virus may play a role in the development of MS by inducing an inflammatory state. Therefore, it is necessary to evaluate anti-JCV antibody serum as an important risk factor for the development of PML before deciding on the treatment course for these patients.

Keywords: multiple sclerosis, John Cunningham virus, central nervous system, autoimmunity

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Authors: G. Kontochristopoulos, T. Spiliopoulos, V. Markantoni, E. Platsidaki, A. Kouris, E. Balamoti, C. Bokotas, G. Haidemenos

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Introduction: There is a high patient demand for periorbital rejuvenation since the facial area is often the first to show visible signs of aging. With advancing age, there are sometimes marked changes that occur in the skin, fat, muscle and bone of the periorbital region, resulting to wrinkles and skin laxity. These changes are among the easiest areas to correct using several minimally invasive techniques, which have become increasingly popular over the last decade. Lasers, radiofrequency, botulinum toxin, fat grafting and fillers are available treatments sometimes in combination to traditional blepharoplasty. This study attempts to show the benefits of a minimally invasive approach to periorbital wrinkles and skin laxity that combine microneedling and 10% trichloroacetic acid (TCA) peels. Method: Eleven female patients aged 34-72 enrolled in the study. They all gave informed consent after receiving detailed information regarding the treatment procedure. Exclusion criteria in the study were previous treatment for the same condition in the past six months, pregnancy, allergy or hypersensitivity to the components, infection, inflammation and photosensitivity on the affected region. All patients had diffuse periorbital wrinkles and mild to moderate upper or lower eyelid skin laxity. They were treated with Automatic Microneedle Therapy System-Handhold and topical application of 10% trichloroacetic acid solution to each periorbital area for five minutes. Needling at a 0,25 mm depth was performed in both latelar (x-y) directions. Subsequently, the peeling agent was applied to each periorbital area for five minutes. Patients were subjected to the above combination every two weeks for a series of four treatments. Subsequently they were followed up regularly every month for two months. The effect was photo-documented. A Physician's and a Patient's Global Assessment Scale was used to evaluate the efficacy of the treatment (0-25% indicated poor response, 25%-50% fair, 50%-75% good and 75%-100% excellent response). Safety was assessed by monitoring early and delayed adverse events. Results: At the end of the study, almost all patients demonstrated significant aesthetic improvement. Physicians assessed a fair and a good improvement in 9(81.8% of patients) and 2(18.1% of patients) participants respectively. Patients Global Assessment rated a fair and a good response in 6 (54.5%) and 5 (45.4%) participants respectively. The procedure was well tolerated and all patients were satisfied. Mild discomfort and transient erythema were quite common during or immediately after the procedure, however only temporary. During the monthly follow up, no complications or scars were observed. Conclusions: Microneedling is known as a simple, office–based collagen induction therapy. Low concentration TCA solution applied to the epidermis that has been more permeable by microneedling, can reach the dermis more effectively. In the present study, chemical peels with 10% TCA acted as an adjuvant to microneedling, as it causes controlled skin damage, promoting regeneration and rejuvenation of tissues. This combined therapy improved periorbital fine lines, wrinkles, and overall appearance of the skin. Thus it constitutes an alternative treatment of periorbital skin aging, with encouraging results and minor side-effects.

Keywords: chemical peels, microneedling, periorbital wrinkles, skin laxity

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Authors: Karen Koellner, Nanette Seago, Jennifer Jacobs, Helen Garnier

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Although studies of teacher professional development (PD) are prevalent, surprisingly most have only produced incremental shifts in teachers’ learning and their impact on students. There is a critical need to understand what teachers take up and use in their classroom practice after attending PD and why we often do not see greater changes in learning and practice. This paper is based on a mixed methods efficacy study of the Learning and Teaching Geometry (LTG) video-based mathematics professional development materials. The extent to which the materials produce a beneficial impact on teachers’ mathematics knowledge, classroom practices, and their students’ knowledge in the domain of geometry through a group-randomized experimental design are considered. Included is a close-up examination of a small group of teachers to better understand their interpretations of the workshops and their classroom uptake. The participants included 103 secondary mathematics teachers serving grades 6-12 from two US states in different regions. Randomization was conducted at the school level, with 23 schools and 49 teachers assigned to the treatment group and 18 schools and 54 teachers assigned to the comparison group. The case study examination included twelve treatment teachers. PD workshops for treatment teachers began in Summer 2016. Nine full days of professional development were offered to teachers, beginning with the one-week institute (Summer 2016) and four days of PD throughout the academic year. The same facilitator-led all of the workshops, after completing a facilitator preparation process that included a multi-faceted assessment of fidelity. The overall impact of the LTG PD program was assessed from multiple sources: two teacher content assessments, two PD embedded assessments, pre-post-post videotaped classroom observations, and student assessments. Additional data were collected from the case study teachers including additional videotaped classroom observations and interviews. Repeated measures ANOVA analyses were used to detect patterns of change in the treatment teachers’ content knowledge before and after completion of the LTG PD, relative to the comparison group. No significant effects were found across the two groups of teachers on the two teacher content assessments. Teachers were rated on the quality of their mathematics instruction captured in videotaped classroom observations using the Math in Common Observation Protocol. On average, teachers who attended the LTG PD intervention improved their ability to engage students in mathematical reasoning and to provide accurate, coherent, and well-justified mathematical content. In addition, the LTG PD intervention and instruction that engaged students in mathematical practices both positively and significantly predicted greater student knowledge gains. Teacher knowledge was not a significant predictor. Twelve treatment teachers self-selected to serve as case study teachers to provide additional videotapes in which they felt they were using something from the PD they learned and experienced. Project staff analyzed the videos, compared them to previous videos and interviewed the teachers regarding their uptake of the PD related to content knowledge, pedagogical knowledge and resources used. The full paper will include the case study of Ana to illustrate the factors involved in what teachers take up and use from participating in the LTG PD.

Keywords: geometry, mathematics professional development, pedagogical content knowledge, teacher learning

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Authors: Timmis W., Simms M., Thomas C.

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This case discusses the management of two floors of mouth (FOM) Squamous Cell Carcinomas (SCC) not identified upon initial biopsy. 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. 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: alcohol dependence, biopsy, oral carcinoma, tobacco

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Authors: Rafia S. Al-lamki, Jun Wang, Simon Pacey, Jordan Pober, John R. Bradley

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Tumor necrosis factor alpha (TNF), signaling through TNFR2, may act an autocrine growth factor for renal tubular epithelial cells. Clear cell renal carcinomas (ccRCC) contain cancer stem cells (CSCs) that give rise to progeny which form the bulk of the tumor. CSCs are rarely in cell cycle and, as non-proliferating cells, resist most chemotherapeutic agents. Thus, recurrence after chemotherapy may result from the survival of CSCs. Therapeutic targeting of both CSCs and the more differentiated bulk tumor populations may provide a more effective strategy for treatment of RCC. In this study, we hypothesized that TNFR2 signaling will induce CSCs in ccRCC to enter cell cycle so that treatment with ligands that engage TNFR2 will render CSCs susceptible to chemotherapy. To test this hypothesis, we have utilized wild-type TNF (wtTNF) or specific muteins selective for TNFR1 (R1TNF) or TNFR2 (R2TNF) to treat either short-term organ cultures of ccRCC and adjacent normal kidney (NK) tissue or cultures of CD133+ cells isolated from ccRCC and adjacent NK, hereafter referred to as stem cell-like cells (SCLCs). The effect of cyclophosphamide (CP), currently an effective anticancer agent, was tested on CD133+SCLCs from ccRCC and NK before and after R2TNF treatment. Responses to TNF were assessed by flow cytometry (FACS), immunofluorescence, and quantitative real-time PCR, TUNEL, and cell viability assays. Cytotoxic effect of CP was analyzed by Annexin V and propidium iodide staining with FACS. In addition, we assessed the effect of TNF on isolated SCLCs differentiation using a three-dimensional (3D) culture system. Clinical samples of ccRCC contain a greater number SCLCs compared to NK and the number of SCSC increases with higher tumor grade. Isolated SCLCs show expression of stemness markers (oct4, Nanog, Sox2, Lin28) but not differentiation markers (cytokeratin, CD31, CD45, and EpCAM). In ccRCC organ cultures, wtTNF and R2TNF increase CD133 and TNFR2 expression and promote cell cycle entry whereas wtTNF and R1TNF increase TNFR1 expression and promote cell death of SCLCs. Similar findings are observed in SCLCs isolated from NK but the effect was greater in SCLCs isolated from ccRCC. Application of CP distinctly triggered apoptotic and necrotic cell death in SLCSs pre-treatment with R2TNF as compared to CP treatment alone, with SCLCs from ccRCC more sensitive to CP compared to SLCS from NK. Furthermore, TNF promotes differentiation of SCLCs to an epithelial phenotype in 3D cultures, confirmed by cytokeratin expression and loss of stemness markers Nanog and Sox2. The differentiated cells show positive expression of TNF and TNFR2. These findings provide evidence that selective engagement of TNFR2 drive CSCs to cell proliferation/differentiation, and targeting of cycling cells with TNFR2 agonist in combination with anti-cancer agents may be a potential therapy for RCC.

Keywords: cancer stem cells, ccRCC, cell cycle, cell death, TNF, TNFR1, TNFR2, CD133

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Authors: Muhammad Tariq, Bushra Siddique, Muhammad Naeem, Asim Gulzar

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The chemical ecology of natural enemies can play a pivotal role in any Integrated Pest Management (IPM) program. Different chemical cues help to correspond in the diversity of associations between prey and host plant species. Coccinellaseptempunctata and Diaeretiellarapae have the abilities to explore several chemical cues released by plants under herbivore attack that may enhance their efficiency of foraging. In this study, the behavioral responses of Coccinellaseptempunctata and Diaeretiellarapae were examined under the application of two semiochemicals and a plant extract and their combinations using four-arm olfactometer. The bioassay was consists of a pairwise treatment comparison. Data pertaining to the preference of C. septempunctata and D. rapae after treatment application were recorded and analyzed statistically. The mean number of entries and time spent of Coccinellaseptempunctata and D. rapaewere greater in arms treated with E-β-Farnesene. However, the efficacy of E-β-Farnesene was enhanced when combined with β-pinene. Thus, the mean number of entries and time spent of C. septempunctata and D. rapaewere highest in arms treated with the combination of E-β-Farnesene x β-pinene as compared with other treatments. The current work has demonstrated that the insect-derived semiochemicals may enhance the efficacy of natural enemies when applied in combination.

Keywords: olfectometer, parasitoid, predator, preference

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Authors: J. Naalamle Amissah, Dorcas Osei‐Safo, C. M. Asare, Benjamin Missah‐Assihene, Eric. Y. Danquah, Ivan Addae‐Mensah

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Medicinal plants serve as a reservoir of active ingredients for the treatment of common ailments such as cancer, malaria and diabetes. With the recent wave of health consciousness and reliance on plant based medicines, the demand for medicinal plants has increased considerably. This surge in medicinal plant use has raised great concern amongst key players (herbalist, collectors, conservationist and researchers) along the value chain about the sustainability of the raw material. The over reliance on wild crafting as a means to obtain the raw material spells doom for several of Africa’s native medicinal plant species. In this study domestication protocols for the cultivation of Cryptolepis sanguinolenta (CS), a medicinal plant used in the treatment of malaria were developed. Initial surveys were conducted, using questionnaires comprising of open and close ended questions, to gather information that would inform the domestication and cultivation of the species. A field study was then conducted to determine the plant’s cropping cycle and the effect of staking and plant age on the active ingredient (cryptolepine) concentration in its roots. Results of the survey confirmed the demand for the raw material and threw more light on the harvesting methods and intensity of CS collection from the wild. Cryptolepine concentration was found to be highest (~1.84 mg/100 mg of root material) at 289 days after planting (DAP) which coincided with the peak of root dry weight (52.8 g), signifying the best time for root harvest. Staking was found to be important for seed production. The first 105 DAP were characterized by low yields of root dry weight (13.5 g), followed by a period of rapid growth in which the root dry weight increased almost linearly until 289 DAP. Although dry matter partitioned to the vines increased towards the end of the experimental period (60%), dry matter partitioned to the roots remained fairly constant (30%) throughout the experimental period. Cryptolepine was found to increase as the plant aged and the practice of staking CS promoted pod formation. A suitable cropping cycle for the cultivation of CS was also developed.

Keywords: domestication, staking, conservation, wild harvesting

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Authors: Lidia Lombardi

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Waste management in Europe and North America is evolving towards sustainable materials management, intended as a systemic approach to using and reusing materials more productively over their entire life cycles. Various waste management strategies are prioritized and ranked from the most to the least environmentally preferred, placing emphasis on reducing, reusing, and recycling as key to sustainable materials management. However, non-recyclable materials must also be appropriately addressed, and waste-to-energy (WtE) offers a solution to manage them, especially when a WtE plant is integrated within a complex system of waste and wastewater treatment plants and potential users of the output flows. To evaluate the environmental effects of such system integration, Life Cycle Assessment (LCA) is a helpful and powerful tool. LCA has been largely applied to the waste management sector, dating back to the late 1990s, producing a large number of theoretical studies and applications to the real world as support to waste management planning. However, LCA still has a fundamental role in helping the development of waste management systems supporting decisions. Thus, LCA was applied to evaluate the environmental performances of a Municipal Solid Waste (MSW) management system, with improved separate material collection and recycling and an integrated network of treatment plants including WtE, anaerobic digestion (AD) and also wastewater treatment plant (WWTP), for a reference study case area. The proposed system was compared to the actual situation, characterized by poor recycling, large landfilling and absence of WtE. The LCA results showed that the increased recycling significantly increases the environmental performances, but there is still room for improvement through the introduction of energy recovery (especially by WtE) and through its use within the system, for instance, by feeding the heat to the AD, to sludge recovery processes and supporting the water reuse practice. WtE offers a solution to manage non-recyclable MSW and allows saving important resources (such as landfill volumes and non-renewable energy), reducing the contribution to global warming, and providing an essential contribution to fulfill the goals of really sustainable waste management.

Keywords: anaerobic digestion, life cycle assessment, waste-to-energy, municipal solid waste

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Authors: M. Chafi, S. Akazdam, C. Asrir, L. Sebbahi, B. Gourich, N. Barka, M. Essahli

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Fixed bed adsorption has become a frequently used industrial application in wastewater treatment processes. Various low cost adsorbents have been studied for their applicability in treatment of different types of effluents. In this work, the intention of the study was to explore the efficacy and feasibility for azo dye, Acid Orange 7 (AO7) adsorption onto fixed bed column of NaOH Treated eggshell (TES). The effect of various parameters like flow rate, initial dye concentration, and bed height were exploited in this study. The studies confirmed that the breakthrough curves were dependent on flow rate, initial dye concentration solution of AO7 and bed depth. The Thomas, Yoon–Nelson, and Adams and Bohart models were analysed to evaluate the column adsorption performance. The adsorption capacity, rate constant and correlation coefficient associated to each model for column adsorption was calculated and mentioned. The column experimental data were fitted well with Thomas model with coefficients of correlation R2 ≥0.93 at different conditions but the Yoon–Nelson, BDST and Bohart–Adams model (R2=0.911), predicted poor performance of fixed-bed column. The (TES) was shown to be suitable adsorbent for adsorption of AO7 using fixed-bed adsorption column.

Keywords: adsorption models, acid orange 7, bed depth, breakthrough, dye adsorption, fixed-bed column, treated eggshell

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Authors: Sarra K. Ikhlef, Onita Basu

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Natural organic matter (NOM) removal efficiency using drinking water treatment biological filters can be highly influenced by backwashing conditions. Backwashing has the ability to remove the accumulated biomass and particles in order to regenerate the biological filters' removal capacity and prevent excessive headloss buildup. A lab scale system consisting of 3 biological filters was used in this study to examine the implications of different backwash strategies on biological filtration performance. The backwash procedures were evaluated based on their impacts on dissolved organic carbon (DOC) removals, biological filters’ biomass, backwash water volume usage, and particle removal. Results showed that under nutrient limited conditions, the simultaneous use of air and water under collapse pulsing conditions lead to a DOC removal of 22% which was significantly higher (p>0.05) than the 12% removal observed under water only backwash conditions. Employing a bed expansion of 20% under nutrient supplemented conditions compared to a 30% reference bed expansion while using the same amount of water volume lead to similar DOC removals. On the other hand, utilizing a higher bed expansion (40%) lead to significantly lower DOC removals (23%). Also, a backwash strategy that reduced the backwash water volume usage by about 20% resulted in similar DOC removals observed with the reference backwash. The backwash procedures investigated in this study showed no consistent impact on biological filters' biomass concentrations as measured by the phospholipids and the adenosine tri-phosphate (ATP) methods. Moreover, none of these two analyses showed a direct correlation with DOC removal. On the other hand, dissolved oxygen (DO) uptake showed a direct correlation with DOC removals. The addition of the extended terminal subfluidization wash (ETSW) demonstrated no apparent impact on DOC removals. ETSW also successfully eliminated the filter ripening sequence (FRS). As a result, the additional water usage resulting from implementing ETSW was compensated by water savings after restart. Results from this study provide insight to researchers and water treatment utilities on how to better optimize the backwashing procedure for the goal of optimizing the overall biological filtration process.

Keywords: biological filtration, backwashing, collapse pulsing, ETSW

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Authors: Atakan Efe Akpınar, Zeynep Demir

Abstract:

Seed priming technologies are frequently used nowadays to increase the germination potential and stress tolerance of seeds. These treatments might be beneficial for native species as well as crops. Different priming treatments can be used depending on the type of plant, the morphology, and the physiology of the seed. Moreover, these may be various physical, chemical, and/or biological treatments. Aiming to improve studies about seed priming, ideas need to be brought into this technological sector related to the agri-seed industry. This study addresses the question of whether seed priming with plant extracts can improve seed vigour and germination performance. By investigating the effects of plant extract priming on various vigour parameters, the research aims to provide insights into the potential benefits of this treatment method. Thus, seed priming was carried out using some plant extracts. Firstly, some plant extracts prepared from plant leaves, roots, or fruit parts were obtained for use in priming treatments. Then, seeds of Common zinnia (Zinnia elegans) were kept in solutions containing plant extracts at 20°C for 48 hours. Seeds without any treatment were evaluated as the control group. At the end of priming applications, seeds are dried superficially at 25°C. Seeds of Common zinnia (Zinnia elegans) were analyzed for vigour (normal germination rate, germination time, germination index etc.). In the future, seed priming applications can expand to multidisciplinary research combining with digital, bioinformatic and molecular tools.

Keywords: seed priming, plant extracts, germination, biology

Procedia PDF Downloads 74

Authors: M. Khaledi Pour, P. Akbartehrani, M. Amini, M. Khani, M. Mohajeri Tehrani, R. Radi, B. Shokri

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Diabetic Foot Ulcer (DFU) is one of the costly severe complications of diabetes. Neuropathy and Peripheral Arterial Disease (PAD) due to diabetes are significant causes of this complication. In 10 years the patients with DFUs are twice as likely to die as patients without DFUs. Cold Atmospheric Plasma (CAP) is a promising tool for medical purposes. CAP generate reactive species at room temperature and are effective in killing bacteria and fibroblast proliferation. These CAP-based tools produce NO, which has bactericidal and angiogenesis properties. It also showed promising effects in the DFUs surface reduction and the time to wound closure. In this paper, we evaluated the effect of the Argon Plasma Jet (APJ) on the healing process of the Wagner Grade 2 DFUs in a randomized clinical trial. The 20 kHz sinusoidal voltage frequency derives the APJ. Patients (n=20) were randomly double-blinded assigned into two groups. These groups receive the standard care (SC, n=10) and the standard care with APJ treatment (SC+APJ, n=10) for five sessions in four weeks. The results showed that the APJ treatment along standard care could reduce the wound surface by 20 percent more than the standard care. Also, It showed a more influential role in controlling wound infection.

Keywords: argon plasma jet, cold atmospheric plasma, diabetes, diabetic foot ulcer

Procedia PDF Downloads 201

Authors: Eun Jae Ko, In Young Sung, Eui Soo Joeng

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Cognitive impairment is commonly encountered problem in children with various clinical diseases, including Down syndrome, autism spectrum disorder, brain injury, and others. Cognitive impairment limits participation in education and society, and this further hinders development in cognition. However, young children with cognitive impairment tend not to respond well to traditional cognitive treatments, therefore alternative treatment choices are need. As a cognitive training program, touch screen technology can easily be applied to very young children by involving visual and auditory support. Injini was developed as tablet computer based cognitive rehabilitation program for young children or individuals with severe cognitive impairment, which targeted on cognitive ages of 18 to 36 months. The aim of this study was to evaluate the efficacy of a tablet computer based cognitive rehabilitation program (Injini) for children with cognitive impairment. 38 children between cognitive ages of 18 to 36 months confirmed by cognitive evaluations were recruited and randomly assigned to the intervention group (n=20) and the control group (n=18). The intervention group received tablet computer based cognitive rehabilitation program (Injini) for 30 minutes per session, twice a week, over a period of 12 weeks, in addition to the traditional rehabilitation program. The control group received traditional rehabilitation program only. Mental score of Bayley Scales of Infant Development II (BSID II), Pediatric Evaluation of Disability Inventory (PEDI), Laboratory Temperament Assessment Battery (Lab-TAB), Early Childhood Behavior Questionnaire (ECBQ), and Goal Attainment Scale (GAS) were evaluated before and after 12 weeks of therapeutic intervention. When comparing the baseline characteristics, there was no significant difference between the two groups in the measurements of cognitive function. After 12 weeks of treatment, both group showed improvements in all measurements. However, in comparison of improvements after treatment, the intervention group showed more improvements in the mental score of BSID II, social function domain of PEDI, observation domain of Lab-TAB, and GAS, as compared to the control group. Application of the tablet computer based cognitive rehabilitation program (Injini) would be beneficial for improvement of cognitive function in young children with cognitive impairment.

Keywords: cognitive therapy, computer-assisted therapy, early intervention, tablets

Procedia PDF Downloads 284

Authors: Nuri Balta, Ali Eryilmaz

Abstract:

High-quality teachers are the key to improve student learning. Without a professional development of the teachers, the improvement of student success is difficult and incomplete. This study offers an in-service training course model for professional development of teachers (PD) entitled "teachers teaching teachers" (TTT). The basic premise of the PD program, designed for this study, was primarily aimed to increase the subject matter knowledge of high school physics teachers. The TTT course (the three hour long workshops), organized for this study, lasted for seven weeks with seventeen teachers took part in the TTT program at different amounts. In this study, the effect of the TTT program on teachers’ knowledge improvement was searched through the modern physics unit (MPU). The participating teachers taught the unit to one of their grade ten classes earlier, and they taught another equivalent class two months later. They were observed in their classes both before and after TTT program. The teachers were divided into placebo and the treatment groups. The aim of Solomon four-group design is an attempt to eliminate the possible effect of pre-test. However, in this study the similar design was used to eliminate the effect of pre teaching. The placebo group teachers taught their both classes as regular and the treatment group teachers had TTT program between the two teachings. The class observation results showed that the TTT program increased teachers’ knowledge and skills in teaching MPU. Further, participating in the TTT program caused teachers to teach the MPU in accordance with the requirements of the curriculum. In order to see any change in participating teachers’ success, an achievement test was applied to them. A large effect size (dCohen=.93) was calculated for the effect of TTT program on treatment group teachers’ achievement. The results suggest that staff developers should consider including topics, attractive to teachers, in-service training programs (a) to help teachers’ practice teaching the new topics (b) to increase the participation rate. During the conduction of the TTT courses, it was observed that teachers could not end some discussions and explain some concepts. It is now clear that teachers need support, especially when discussing counterintuitive concepts such as modern physics concepts. For this reason it is recommended that content focused PD programs be conducted at the helm of a scholarly coach.

Keywords: high school physics, in-service training course, modern physics unit, teacher professional development

Procedia PDF Downloads 197

Authors: Majid Shahbazi

Abstract:

Subclavian artery stenosis (SAS) is a common vascular disease that can cause a range of symptoms, from arm fatigue and weakness to ischemic stroke. Revascularization procedures, such as percutaneous transluminal angioplasty and stenting, are widely used to treat SAS and improve blood flow to the affected arm. However, the optimal management of patients with SAS is still unclear, and further research is needed to evaluate the safety and efficacy of different treatment options. This study aims to investigate the characteristics of patients with SAS who underwent revascularization procedures in Latvia (Specifically RAKUS). The research part of this paper aims to describe and analyze the demographics, comorbidities, diagnostic methods, types of revascularization procedures, and antiaggregant therapy used. The goal of this study is to provide insights into the current clinical practice in Latvia and help future treatment decision-makers. To achieve this aim, a retrospective study of 76 patients with SAS who underwent revascularization procedures was performed. After statistical analysis of the data, the study provided insights into the characteristics and management of patients with SAS in Latvia, highlighting the most observed comorbidities in these patients, the preferred diagnostic methods, and the most performed procedures. These findings can inform clinical decision-making and may have implications for the management of patients with subclavian artery stenosis in Latvia.

Keywords: subclavian artery stenosis, revascularization, characteristics of patients, comorbidities, retrospective analysis

Procedia PDF Downloads 95

Authors: Calvince Okome Odeny

Abstract:

There is a current action to increase radiotherapy services in Kenya. The National government of Kenya, in collaboration with the county governments, has embarked on building radiotherapy centers in all 47 regions of the country. As these new centers are established in Kenya, it has to be ensured that minimum radiation safety standards are in place prior to operation. For full implementation of this, it is imperative that more Research and training for regulators are done on radiation protection, and safety and national regulatory infrastructure is geared towards ensuring radiation protection and safety in all aspects of the use of external radiotherapy practices. The present work aims at reviewing the level of protection and safety for patients and staff during external beam radiotherapy using Linac in Kenya and provides relevant guidance to improve protection and safety. A retrospective evaluation was done to verify whether those occupationally exposed workers and patients are adequately protected from the harmful effect of radiation exposure during the treatment procedures using Linac. The project was experimental Research, also including an analysis of resource documents obtained from the literature and international organizations. The critical findings of the work revealed that the key elements of protection of occupationally exposed workers and patients include a comprehensive quality Management system governing all planned activities from siting, safety, and design of the Facility, construction, acceptance testing, commissioning, operation, and decommissioning of the Facility; Government empowering the Regulatory Authority to license Medical Linear facilities and to enforce the applicable regulations to ensure adequate protection; A comprehensive Radiation Protection and Safety program must be established to ensure adequate safety and protection of workers and patients during treatment planning and treatment delivery of patients and categories of staff associated with the Facility must be well educated and trained to perform professionally with a commitment to sound safety culture. Relevant recommendations from the findings are shared with the Medical Linear Accelerator facilities and the regulatory authority to provide guidance and continuous improvement of protection and safety to improve regulatory oversight.

Keywords: oncology, radiotherapy, protection, staff

Procedia PDF Downloads 75

Authors: Srivilai Worametrachanon, Arunee Apichartsrangkoon, Jiranat Techarang, Boonrak Phanchaisri

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A human-digestive simulator consisted of four colon compartments, i.e., stomach, small intestine, proximal colon and distal colon used to harbor L. casei 01 plus either pasteurized ordinary-purple-rice drinks or germinated-purple-rice drinks. Accordingly, three treatment compositions had been set up and the effects of treatments on colon bacterial communities including their by-products were thoroughly examined. L. casei 01 plus purple-rice drinks gave rise to significantly high formation (P ≤ 0.05) of short-chain-fatty acids (SCFA) of which highest acetic acid was found followed by propionic and butyric acids, while the germinated-rice drink showed the greatest impact. Moreover, the effect was more pronounced upon prolonged fermentation. In addition, the influence of treatments on colon microbes was also demonstrated. Accordingly, desirable bacteria including colon Lactobacilli and Bifidobacteria were significantly increased (P ≤ 0.05) in both colons in comparison with the control and the effect was more prominent after adding purple-rice drink. On the other hand, undesirable Clostridia and coliforms were apparently diminished by the influence of treatment conditions, in which both compartments exhibited similar results.

Keywords: human-digestive simulator, Lactobacillus casei 01, Pasteurized-purple-rice drinks

Procedia PDF Downloads 222

Authors: Orawan Vichiansan, J. Kraipoj, K.Phandech, P. Sirasaporn

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Generally, frozen shoulder will improve over time, although it may take a long time up to year. The symptoms of frozen shoulder present by pain around shoulder and consequently limit range of motions. The effect of frozen shoulder leads to limit activities daily living life and high medical care cost. Physiotherapy is well known treatment for frozen shoulder but there was no data about the treatment of physiotherapy in frozen shoulder and length of follow up. Thus the aim of this study was to investigate physiotherapy program for frozen shoulder on range of motion and length of follow up. A retrospective study design was conducted. 469 medical records of patients with frozen shoulder were reviewed. These frozen shoulders were treated at physiotherapy unit, department of Rehabilitation last 3 years (January, 2014- December, 2016). The data consist of range of motions and length of follow up was recorded. The medical record of 183 males and 286 females with average aged 57.82±12.32 years were reviewed in this study. There was a statistically significant increase in shoulder flexion [mean difference 30.24 with 95%CI were [24.37-36.12], shoulder abduction [mean difference 34.93 with 95%CI were 27.8-42.0], shoulder internal rotation [mean difference 17.25 with 95%CI were 12.55-21.95] and shoulder external rotation [mean difference 17.71 with 95%CI were [13.07-22.36] respectively. In addition, the length of follow up averaged 84 days. In summary, the retrospective study show physiotherapy program likely to be benefit for patients with frozen shoulder in term of range of motion and short length of follow up.

Keywords: frozen shoulder, physiotherapy, range of motions, length of follow up

Procedia PDF Downloads 173