bluuebunny/crossref_metadata_2025 huggingface dataset:
Aortic Coarctation Associated with Distal Aortic Arch Hypoplasia in Neonates Can Be Effectively Repaired through Left Thoracotomy
Authors: Provost Bastien , Fournier Emmanuelle , Hascoët Sebastien , Le Bret Emmanuel , Roussin Régine , Zoghbi Joy , Belli Emre
Published: December 2023

Objectives. Aortic coarctation in neonates remains a clinical challenge. Low weight, arch hypoplasia and ductal dependence have been identified as risk factors for recurrent coarctation. We hypothesized that a tailored surgical technique may prevent recurrence. Methods. Retrospective evaluation of neonates treated for coarctation through thoracotomy was done. No primary percutaneous procedure was performed and repairs through sternotomy were excluded. Aortic hypoplasia was defined as a ratio arch diameter (mm)/patient’s weight (kg) < 1. Extended end-to-end anastomosis (EEEA), subclavian flap (Waldhausen) and Amato aortoplasty were performed. Mortality and recurrent obstruction requiring re-intervention were assessed. Results. Records of 340 consecutive patients (2003–2019) were analyzed. Preoperative median age and weight were, respectively, 10 days (1–30) and 3080 grams (1400–5180). Arch hypoplasia was documented in 31 patients (9.1%). Prostaglandin was infused in 220 (65.3%). Critical preoperative status was documented in 35 (10.8%). EEEA repair was performed in 273 (80.3%), Waldhausen was performed in 42 (12.4%), and Amato was performed in 25 (7.4%). The last two were more likely to be performed in the presence of arch hypoplasia (

p

 < 0.0001). Hospital mortality occurred in 2 patients (0.6%). Thirty-six procedures (31 percutaneous/5 surgical) were performed for recurrent arch obstruction in 33 patients. Three late deaths occurred. Low-weight, hypoplastic arch, and ductal dependency did not influence the outcome. All survivors were free from residual coarctation at a mean follow-up of 3.6 ± 3.4 years postoperatively. Conclusions. Surgical repair remains the procedure of choice for neonatal coarctation. A tailored approach using alternative techniques seemed to offer comparable results even in presence of associated risk factors.
Surgical treatment of spontaneous intracranial hemorrhage in patients with cancer
Authors: Telles João Paulo Mota , Yamaki Vitor Nagai , Paiva Wellingson , Teixeira Manoel Jacobsen , Neville Iuri
Published: December 2023

Introduction: Intracranial hemorrhage (ICH) is the most common cerebrovascular event in patients with cancer. We sought to evaluate the outcomes of surgical treatment for ICH and to determine possible pre-operative outcome predictors.

Methods: We retrospectively reviewed surgical procedures for the treatment of ICH in patients with cancer. Analyses included clinical, laboratory, and radiological characteristics. Primary endpoints were survival and mortality in index hospitalization.

Results: Ninety-four emergency neurosurgeries were performed for ICH in 88 different patients with cancer over ten years. 51 patients had chronic subdural hematomas (CSDH: 54.3%), 35 with intraparenchymal hemorrhage (37.2%), 6 with acute subdural hematoma (ASDH: 6.4%), and only 2 with epidural hemorrhages (2.1%). Median patient follow-up was 63 days (IQR=482.2). 71 patients (75.5%) died at follow-up, with a median survival of 33 days. Overall 30-day mortality was 38.3% and reached 27.5% in patients with CSDH. Lower survival was associated to higher absolute leucocyte count (HR 1.06; 95%CI 1.04-1.09), higher aPTT ratio (HR 3.02; 95% CI 1.01-9.08), higher serum CRP (HR 1.01; 95%CI 1.01-1.01), and unresponsive pupils (each unresponsive pupil - HR 2.65; 95%CI 1.50-4.68). Lower absolute platelet count was associated with a modest increase in survival rates (every 1000 platelets - HR 0.99; 95%CI 0.97-0.99).

Conclusion: Outcomes following surgical treatment of ICH in patients with cancer impose significant morbidity and mortality. Altered pupillary reflexes, coagulopathies, and increased inflammatory response were predictors of mortality for any type of ICH. CSDH was the most common type of ICH and had higher mortality rates than non-oncologic patients.
Technology usage as a vehicle for information and approximation with society
Authors: Rosa Juliana da Costa , Furman Gabriela Fernanda , Mendes Juliana Monteiro , Nascimento Paulo Henrique Oliveira do , Aragão Natan de Araujo , Akkam Ramon Guimarães , Maya Maria Cristina Araújo
Published: December 2023

Introduction: Confronting the COVID-19 pandemic involves actions in the scope of information, especially in combating false content disseminated by social media. In this sense, medical students, including those belonging to a Trauma and Emergency Academic League, have mobilized to create a media campaign in order to disseminate information about SARS-CoV-2’s aspects to the population. The objective of this work was to report the contribution of the league members to the campaign developed to disseminate reliable scientific content based on simple and objective language about COVID-19. Methodology: A campaign was organized by second to the sixth-year medical students, members of 15 university academic leagues, with the aim to use social media as an information tool for health educational practice. Results: The students from the Trauma and Emergency Academic League made a total of 6 posts on Instagram, using the league’s and the campaign’s accounts. Those posts obtained a total of 1983 views and had the purposed of reaching the general population. The information provided was about self-medication and its risks or benefits, preventive measures against COVID-19 and how to make and use homemade masks. Among the public that accessed the campaign’s profile on Instagram, 70% were women and 80% were between 18 and 34 years old. Discussion: With the reported activities, league students described acquiring knowledge about COVID-19, in addition to teamwork experience and contribution to the fight against the pandemic through the materials production and its dissemination to the population. It allowed innovation in learning and in the access to knowledge, as the pandemic imposed new health-related educational challenges. However, it is noticed that there is a limitation in the posts scope, as they have mostly reached a specific age group. Conclusion: The proper internet usage is essential to combat misleading information in the pandemic context. Therefore, the online dissemination of reliable information with the intent to reach a larger audience indicates academic commitment, especially to social responsibility.
Barriers to enrollment in pulmonary rehabilitation in a private hospital in Brazil: a physician survey study
Authors: Gushken Fernanda , Degani-Costa Luiza Helena , Colognes Thaíz Carolina Pimentel , Rodrigues Maíra Thomazini , Zanetti Mayra , Bonamigo Filho José Luiz , Matos Luciana Diniz Nagem Janot De
Published: December 2023

Introduction: Pulmonary rehabilitation (PR) plays a key role in the management of chronic lung diseases, but it remains largely underused worldwide. The aim of this study was to assess clinicians’ knowledge about PR and to identify the barriers they encounter when referring patients with medical insurance to PR in a private hospital in Brazil. Methodology: This was a survey-based cross-sectional study conducted in 2019 at a reference hospital in São Paulo, Brazil. Eligible participants were physicians registered with the following specialties: Internal Medicine, Geriatrics, Cardiology, Pulmonology or Thoracic Surgery. Results: We collected 72 responses. While 99% of participants recognized COPD as a potential indication for PR, interstitial lung disease, bronchiectasis and pulmonary hypertension were less often recognized (75%). Most participants (67%) incorrectly associated PR with lung function improvement, while 28% of cardiologists and 35% of internists/geriatricians failed to recognize benefits on mood disorders. Notably, 18% of participants recommended PR only to patients on supplemental oxygen and 14% prescribed only home physiotherapy, patterns more commonly seen among non-respiratory physicians. The 3 most perceived barriers to referral and adherence were health insurance coverage (79%), transportation to the PR center (63%) and lack of social support (29%). Conclusions: Financial, logistic and social constraints pose challenges to PR enrollment even for patients with premium healthcare insurance plans. Moreover, physician knowledge gaps may be an additional barrier to PR referral and uptake. Providing continued medical education, incorporating automatic reminders in electronic medical records and using telerehabilitation tools may improve PR referral, adherence and ultimately patient care.
Outcomes of surgical and endovascular treatments for fusiform intracranial aneurysms: systematic review and individual participant data meta-analysis
Authors: Telles João Paulo Mota , Solla Davi Jorge Fontoura , Yamaki Vitor Nagai , Teixeira Manoel Jacobsen , Figueiredo Eberval Gadelha
Published: December 2023

Introduction: We propose a systematic review and meta-analysis of individual participant data with propensity-score adjustment to compare the functional and angiographic outcomes between surgical and endovascular approaches to FIA. Methods: We conducted a systematic review based on the PRISMA-IPD guidelines for articles published on the treatment of FIA with individual patient-level detailing. The primary studied outcome was morbidity, and secondary outcomes were angiographic results, recanalization, and retreatment.Results: Individual data were available for 296 patients in 29 studies. Out of 73 surgical cases, the commonest option was bypassing, combined with clipping, trapping, or excision (N=38, 52.1%). Out of 223 endovascular cases, stenting was the primary choice (N=127, 56.9%). Post-procedure morbidity inflicted 75 patients (25%), of which 22 had been submitted to open procedures (30.1%), and 53 had been treated endovascularly (23.8%). Crude models studied the relationship between surgical treatment and morbidity overall and within each location, and there were no significant associations (Figure 2, all P > 0.05). A final multivariable model was fitted, including the covariates rupture status, initial mRS, size, and age (Figure 3). Each additional score in the initial mRS was associated with an odds ratio of 1.79 of post-procedure morbidity (95% CI 1.24 – 2.6). No differences were detected between surgical and endovascular (OR 0.95, 95% CI 0.18-5.11). Conclusion: Comparing surgical and endovascular procedures, no differences were observed on post-procedure morbidity regardless of aneurysm location. A smaller percentage of unfavorable angiographic outcomes was reported after open procedures, but larger studies are necessary to evaluate those associations.
Perfil epidemiológico dos pacientes amputados acompanhados em um grande centro referência em reabilitação de Pernambuco
Authors: Lima Vicente Júlio Barbosa de , Gomes Ewertom Cordeiro , Rolim Filho Epitácio Leite , Malheiros Júnior Henrique José Alves , Almeida Thiago Danilo Rodrigues de , Bahé Ana Patrícia Montebello , Rocha Silvana Cristina de Melo
Published: December 2023

A amputação de um membro se reveste de maior dramaticidade e limitações sensório-motoras em pacientes jovens, assim como, na população adulta ou idosa com comorbidades. Objetivo: Traçar o perfil demográfico e epidemiológico dos pacientes atendidos em um grande centro de referência em reabilitação em Pernambuco. Métodos: Realizou-se um estudo de corte transversal com revisão de prontuários ativos. Os resultados foram tratados pelo Microsoft Excel® e o programa utilizado para os cálculos estatísticos foi o IBM® SPSS® na versão 23. Resultados: Observou-se idade média de 48,36 anos, gênero masculino (76,6%), casados (47,7%), ensino fundamental (64,8%) e oriundos de todas as regiões do estado. Quanto à amputação, sem predileção por lado, mais frequente nos membros inferiores transfemoral (55,1%), cotos de comprimento variável e causas vasculares e traumáticas mais frequentes. No exame físico, cotos em condições de reabilitação, utilização de aditamento comunitário ou domiciliar na primeira consulta e sem uso prévio de prótese. Em 83,6% dos casos, os pacientes usavam sua prótese mais de 7h/dia e 58,6% possuíam marcha independente na comunidade, com durabilidade da prótese em até 36 meses (75,8%). Conclusão: A amputação ocorre em idade jovem, sendo os homens mais acometidos, as doenças vasculares e acidentes envolvendo veículos motorizados são as principais causas, as cirurgias ocorrem mais nas diáfises ósseas. O tempo de terapias foi efetivo. Fazem-se necessárias políticas públicas que agilizem o acesso do paciente a centros especializados e desses aos centros de reabilitação e para melhoria dos materiais e componentes que compõem as próteses oferecidas pelo SUS.
Handgrip fatigue test using dynamic contractions in typical children
Authors: Martins Emanuela Juvenal , Franco Camila Scarpino Barboza , Zaparoli Lara , Ravanelli Leticia Sanches , Camargo Maira Verardino de , Mattiello-Sverzut Ana Cláudia
Published: December 2023

Objective: To verify the development of fatigue and sex-influence on the handgrip during dynamic contractions in typical children. Methods: Cross-section study. Fifty-eight children, distributed into two groups according to sex (30 boys), aged 8 to 12 years, of both sexes, performed successive dynamic contractions with a bulb dynamometer until they reached maximum perceived effort. The values from the first, the last contractions of the fatigue test, and the measure after 30-s of the last contraction (recovery contraction) were recorded and compared using the linear regression model with mixed effects. T-Student test was used to compare the perceived effort scores and time-to-fatigue between groups. Results: The handgrip values significantly decreased, and perceived effort scores significantly increased in the final measure in relation to the initial measure of the fatigue test. After the fatigue handgrip test, 30-sec of recovery was insufficient to restore the baseline handgrip values. There were no differences between the female and male groups for all variables. Conclusion: The handgrip fatigue test using dynamic contractions showed it efficiently induces motor and perceived fatigue in children, without differences between sexes.
Aplicabilidade da Classificação Internacional de Funcionalidade e Incapacidade e Saúde em unidades de emergência e cuidados intensivos: uma revisão sistemática
Authors: Dias Gabriel Henrique Pontes , Silva Marcos Antonio da , Martins Gabriela de Sousa
Published: December 2023

A Classificação Internacional de Funcionalidade e Incapacidade e Saúde (CIF), surgiu para proporcionar uma linguagem estruturada e padronizada para descrever os diferentes estados relacionados à saúde dos indivíduos. Objetivo: Realizar uma revisão da literatura nacional e internacional acerca da aplicabilidade e uso da CIF no ambiente de emergência e cuidados intensivos. Método: Trata-se de uma revisão sistemática, realizada nas bases de dados PUBMED, LILACS e MEDLINE, com artigos publicados nos últimos 10 anos (período de 2011 a 2021), que utilizaram a CIF, Core sets ou conceitos da CIF como medida de desfecho em ambiente de cuidados agudos: emergências e Unidade de Terapia Intensiva (UTI), em indivíduos adultos. Resultados: Foram identificados 11.373 estudos dos quais foram selecionados 14 estudos. Ao todo a amostra foi de 5.046 indivíduos, sendo 406 profissionais da saúde e 4.640 pacientes em diferentes condições de saúde. A maioria dos estudos (50%) foram realizados exclusivamente em UTI. Foi observado que 11 estudos utilizaram versões curtas e resumidas da CIF em Core sets e 5 deles contemplaram todos os 4 domínios da CIF (função e estrutura do corpo, atividade e participação e fatores ambientais). Conclusão: Devido a sua extensão e complexidade, o uso da CIF na emergência e cuidados intensivos tem sido adaptada e aplicada em versões curtas. Os core sets da CIF se mostraram uma ferramenta útil, aplicável em diferentes perfis de paciente críticos e permitiu fornecer informações de funcionalidade e incapacidade durante a internação e para a tomada de decisão das metas de reabilitação.
Associação de estimulação por ondas de choque a toxina botulínica e baclofeno durante a reabilitação de paciente com lesão medular e trauma cranioencefálico: relato de caso
Authors: Ferreira Valeska Beatrice , Shinzato Gilson Tanaka , Ribeiro Fernando de Quadros , Yoshioka Leandro Heidy , Casseb Tatiane Assone , Imamura Marta , Battistella Linamara Rizzo
Published: December 2023

Recentemente, a terapia por ondas de choque extracorpóreas (TOCE) mostraram-se ser uma promissora tecnologia não invasiva para neuromodulação e recuperação funcional devido a melhora em brotamento neuronal, neuroproteção, controle de neuroplasticidade e reorganização neuronal, além de atuar em fatores de neurogênese. Objetivo: Descrever um caso que usa TOCE como um adjuvante na reabilitação de trauma medular. Relato de caso: LPS, 25 anos, estudante de medicina, sofreu uma queda de altura indeterminada com fratura de C5 e lesão medular associada a trauma cranioencefálico. Na fase aguda, ele se recuperou adequadamente, tendo sido submetido a descompressão e fixação de coluna e hospitalizado por 5 meses devido a disautonomias e infecções urinárias. Após esse período, ele iniciou um programa de reabilitação intensiva para tetraplegia espástica com classificação inicial segundo o ASIA (American Spinal Injury Association) nível C5 motor e C6 sensório. O tratamento incluiu 10 sessões de TOCE, realizadas com Duolith SD1 (Storz Medical, Suíça) com uma densidade de energia de 0,25mJ/mm², 5 cm e 3 cm de profundidade de foco, 2000 pulsos aplicados na linha média de coluna níveis C5 a T1 e 2000 pulsos a 5 cm de profundidade aplicados em região plantar bilateral. Bloqueio com toxina botulínica e fenol foram realizados com resposta parcial apesar da dose otimizada de baclofeno.
Um glossário dos Estudos de Gênero no Brasil: bastidores de um trabalho terminográfico
Authors: Waquil Marina Leivas
Published: December 2023

Este trabalho apresenta a elaboração de “Um glossário dos Estudos de Gênero no Brasil”, um produto terminográfico feito com base na compreensão de que os termos são unidades das línguas gerais que adquirem caráter especializado de acordo com seu uso em contextos especializados. Portanto, utilizou-se a abordagem metodológica da Linguística de Corpus para a compilação de um corpus de estudo, bem como para a identificação das unidades terminológicas. O corpus, composto por artigos científicos de dois dos mais importantes periódicos da área no Brasil, a Revista de Estudos Feministas e a Cadernos Pagu, foi processado e analisado com a ferramenta Antconc. Além dos 218 termos elencados como entradas, organizados a partir de termos-base, o glossário apresenta contextos explicativos e/ou associativos, notas variadas e um sistema de sistema de cruzamento de informações que conecta os termos do campo.
Da vita monachorum a vita religiosa: a concepção de vida religiosa e a criação da Congregação Beneditina Portuguesa analisadas por meio de uma tradução da Regra de São Bento de 1586
Authors: Alves Jefferson dos Santos
Published: December 2023

Na tradução portuguesa da Regra de São Bento publicada em 1586, há o emprego das palavras “religioso” e “religião”, que não estão presentes no texto latino (religiosus e religio). O presente artigo apresenta uma análise do emprego dessas palavras, mostrando que se trata de uma estratégia adotada pelo tradutor que inseriu conceitos consolidados no século XIII em um texto produzido no sexto século, sem prejudicar seu sentido. Nessa análise há um estudo sobre as acepções do termo “religião” e “vida religiosa”, além da contextualização da tradução com a criação da Congregação Beneditina Portuguesa.
La note américaine
Authors: Leurquin Eric Claude
Published: December 2023

1921 Les guerres indiennes sont loin. Leurs survivants ont, pour la plupart, été parqués dans des réserves où ils végètent, misérables, abandonnés à leur sort.Une exception à cette règle : le peuple osage. Il s'est vu attribuer un territoire minéral aux confins de l'Oklahoma. Or ces rochers recouvrent le plus grand gisement de pétrole des États-Unis. Les Osages sont millionnaires, roulent en voitures de luxe, envoient leurs enfants dans les plus prestigieuses universités et se font servir par des domestiques blancs. Le monde à l'envers. Un jour, deux membres de la tribu disparaissent. Un corps est retrouvé, une balle dans la tête. Puis une femme meurt empoisonnée. Et une autre. Plus tard, une maison explose. Trois morts. Qui commet ces assassinats ? Qui a intérêt à terroriser les riches Osages ? Les premières enquêtes, locales, sont bâclées, elles piétinent. C'est pourquoi, après une nouvelle série noire, ce dossier brûlant est confié au BOI (Bureau of Investigation, qui deviendra le FBI en 1935). À sa tête, un très jeune homme. Son nom est Hoover, Edgar J. Hoover. Il veut deux choses. 
La première: faire toute la lumière sur cette sombre affaire, et il s'en donne les moyens, enquêteurs hors pair, méthodes rigoureuses de police scientifique, mise en fiche de la moindre information. La seconde : le pouvoir. Surtout le pouvoir. Et ce premier coup d'éclat va le lui offrir sur un plateau.
Heavy metal baselines in cyprinidae of the Han River: a decade-long study on bioaccumulation trends and species-specific sensitivities
Authors: Jung Hye-Ryeong , Lee Je-Seung , Ahn Mijin , Cha Yeong-Seop , Han Ihn-Sup
Published: December 2023

Despite numerous urban pollution sources, research on aquatic species bioaccumulation in the Han River is scarce. In this longitudinal study, we assessed baseline heavy metal (HM) concentrations in Cyprinidae, a major freshwater fish family in the Han River. Specifically, were evaluated copper (Cu), total mercury (THg), cadmium (Cd), lead (Pb), and chromium (Cr) levels in the muscle of common carp, crucian carp, and barbel steed. Common carp had the highest HM accumulation, with baseline concentrations of Cu, THg, Cd, Pb, and Cr at 0.877, 0.060, 0.003, 0.032, and 0.178 mg/kg, respectively. Larger fish exhibited greater bioaccumulation, with THg levels significantly correlated with fish length (correlation coefficients: 0.57 (p < 0.05)–0.74 (p < 0.001)). Notably, Cr accumulated more extensively in fish muscle than Pb, and the metal selectivity index (MSI) of THg in barbel steed was 2–3 times higher than in other fish species. The baseline concentrations determined in this study can serve as identifiers of the initial point of abnormal HM bioaccumulation in fish and provide foundational data for future long- or short-term fish monitoring.
Competing-risks analysis for evaluating the prognosis of patients with microinvasive cutaneous squamous cell carcinoma based on the SEER database
Authors: Zheng Suzheng , Xie Shuping , Yu Hai , Duan Xi , He Yong , Ho Chichien , Wan Yang , Hang Tie , Chen Wenhui , Lyu Jun , Deng Liehua
Published: December 2023

Background

Utilizing the traditional Cox regression model to identify the factors affecting the risk of mortality due to microinvasive cutaneous squamous cell carcinoma (micSCC) may produce skewed results. Since cause-specific mortality can guide clinical decision-making, this study employed the Fine-Gray model based on the Surveillance, Epidemiology, and End Results (SEER) database to identify significant predictive variables for the risk of micSCC-related mortality.

Methods

This study used the information of patients with micSCC who were listed in the SEER database during 2000–2015. Cox regression and Fine-Gray models were utilized for the multivariable analysis, and Gray’s test and the cumulative incidence function were used for the univariable analyses.

Results

There were 100 patients who died from other reasons and 38 who died from micSCC among the 1259 qualified patients with micSCC. Most were female, white, married, had localized metastasis, etc. According to the univariable Gray’s test (P < 0.05), the cumulative incidence rate for events of interest was strongly associated with age, sex, marital status, American Joint Committee on Cancer staging, radiation status, summary stage, chemotherapy status, surgery status, and tumor size. Multivariable Cox regression analysis and multivariable competing-risks analysis indicated that age, tumor size, and income were independent risk variables for the prognosis of patients with micSCC. In both age and tumor size variables, the competing-risks model showed a slight decrease in the hazard ratio and a slight narrowing of the 95% confidence interval compared with the Cox regression model. However, this pattern is not evident in the income variable.

Conclusions

This study established a Fine-Gray model for identifying the independent risk factors that influence the risk of mortality among patients with micSCC. This study uncovers that, in the context of competing risks, age, tumor size, and income serve as independent risk factors influencing the risk of mortality due to micSCC among patients. Our findings have the potential to provide more accurate risk assessments for patient outcomes and contribute to the development of individualized treatment plans.
Exploring extracellular matrix and prostaglandin pathway alterations across varying resection margin distances of right-sided colonic adenocarcinoma
Authors: Suwatthanarak Tharathorn , Tanjak Pariyada , Suwatthanarak Thanawat , Acharayothin Onchira , Thanormjit Kullanist , Chaiboonchoe Amphun , Tawantanakorn Thikhamporn , Phalanusitthepha Chainarong , Trakarnsanga Atthaphorn , Methasate Asada , Pithukpakorn Manop , Okamoto Ryuichi , Chinswangwatanakul Vitoon
Published: December 2023

Background

Surgical resection followed by indicated adjuvant therapy offers potential curative treatment in colonic adenocarcinoma. Beyond the well-established seed and soil theory of colon cancer progression, the 'normal-appearing' tissues near the tumor are not genuinely normal and remain as remnants in patients following surgery. Our objective was to elucidate the alteration of gene expression and pathways across various distances of resection margins in right-sided colonic adenocarcinoma.

Methods

Twenty-seven fresh samples of primary cancer and 56 matched non-tumor tissues adjacent to the tumor (NAT) were collected from patients with resectable right-sided colon cancer. NAT were systematically obtained at varying distances (1, 5, and 10 cm) on both proximal and distal sides. Comprehensive gene expression analysis was performed using 770-gene PanCancer Progression Panel, delineating distinctive pathways and functional predictions for each region.

Results

Distinctive gene signatures and pathways exhibited by normal-appearing tissues were discovered at varying distances from cancer. Notably, SFRP2, PTGDS, COL1A1, IL1B, THBS2, PTGIS, COL1A2, NPR1, and BGN were upregulated, while ENPEP, MMP1, and NRCAM were downregulated significantly in 1-cm tissue compared to farther distances. Substantial alterations in the extracellular matrix (ECM) and prostaglandin/thromboxane synthesis were significantly evident at the 1-cm distance. Functional analysis indicated enhanced cell viability and survival, alongside reduced cellular death and apoptosis.

Conclusions

Different distances exerted a significant impact on gene alteration within the normal-looking mucosa surrounding primary cancer, influenced by various mechanisms. These findings may highlight potential therapeutic targets related to the ECM and prostaglandin/thromboxane pathways for treatment strategies.
SINE-derived satellites in scaled reptiles
Authors: Vassetzky Nikita S. , Kosushkin Sergei A. , Ryskov Alexey P.
Published: December 2023

Background

The genomes of many eukaryotes contain DNA repeats in the form of both tandem and interspersed elements with distinct structure, evolutionary histories, and mechanisms of emergence and amplification. Although there is considerable knowledge regarding their diversity, there is little evidence directly linking these two types.

Results

Different tandem repeats derived from portions of short interspersed elements (SINEs) belonging to different families were identified in 56 genomes of squamate reptiles. All loci of SINE-derived satellites (sSats) were thoroughly analyzed. Snake sSats exhibited high similarity in both structure and copy number, while other taxa may have highly diverse (geckos), rare (Darevskia lizards), or missing sSats (agamid lizards). Similar to most satellites associated with heterochromatin, sSats are likely linked to subtelomeric chromosomal regions.

Conclusions

Discovered tandem repeats derived from SINEs exhibit satellite-like properties, although they have not amplified to the same degree as typical satellites. The autonomous emergence of distinct sSats from diverse SINE families in numerous squamate species suggests a nonrandom process of satellite genesis originating from repetitive SINEs.
Risk of positive screening for anorexia nervosa, bulimia nervosa and night eating syndrome and associated risk factors in medical fellows in Northeastern Mexico: a multicenter study
Authors: Ortiz-Lopez Cynthia Isabel , Romero-Ibarguengoitia Maria Elena , Cobos-Aguilar Hector
Published: December 2023

Background

Eating disorders and food ingestion (EDs) are serious mental illnesses with a higher prevalence in young adults, with difficult diagnoses that cause serious morbidity and mortality problems. There is not much information about the risk of positive screening for EDs, specifically, anorexia nervosa (AN) and bulimia nervosa (BN) and night eating syndrome (NES) in undergraduate medical interns (UMI) and medical residents (MR) in Mexico.

Aim

To determine the risk of AN, BN and NES and to determine the risk factors of such conditions such as age, body mass index (BMI) and gender of MR and UMI with AN/BN and NES at four private hospitals in northeastern Mexico.

Methods

A cross-sectional, descriptive, non-randomized survey in MR and UMI in four hospitals in Northeastern Mexico was conducted using an electronic questionnaire that included: informed consent signature, SCOFF questionnaire for AN and BN screening, NES questionnaire. Also, a survey on general sociodemographic data of each participant was included. Chi-square test and a logistic regression model were computed for analyses.

Results

The population included a total of 129 MR and UMI. It was observed that 48.8% were positive for AN or BN and 32.6% were positive for the NES. There was no difference between age, sex, BMI, or medical specialty (if they were MR); however, MR from the first year had a higher risk of AN or BN (OR 23.7, 95% CI 1.181–475.266).

Conclusions

There was a higher risk of positive screening for AN or BN and NES in UMI and MR in our population. In the case of MR, those in first year have a higher risk of AN and BN. Timely diagnosis and treatment are mandatory in this population.
Management of treatment-resistant depression with esketamine nasal spray: clinical questions for daily practice in Gulf Cooperation Council countries
Authors: Ahmed Nahida Nayaz , Albishi Faisal , Khan Suhail A. , Alsayegh Ammar , Stip Emmanuel , Makhoul Samer
Published: December 2023

Background

There is a high unmet need among patients with treatment-resistant depression (TRD) as treatment with standard therapies is associated with low response and remission rates and high rates of relapse. Esketamine nasal spray, an N-methyl-D-aspartate receptor antagonist, is a novel, fast-acting treatment option for TRD. This article addresses common questions in Gulf Cooperation Council (GCC) countries regarding esketamine nasal spray by discussing the latest clinical evidence and by providing expert opinions.

Methods

Six expert psychiatrists from the GCC region with clinical experience in TRD reviewed and critically appraised published evidence on esketamine nasal spray for TRD and considered clinical guidelines, expert opinions and consensus statements. Consensus views were reached on clinical questions pertinent to implementing esketamine nasal spray for TRD in the GCC region.

Results

Clinical questions on patient identification, selection of serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors, treatment duration, management of adverse events and clinical requirements for the safe administration of esketamine nasal spray were addressed.

Conclusions

Esketamine nasal spray represents a new treatment paradigm for TRD. This article provides clinical guidance based on the latest evidence and clinical experience to help mental health practitioners implement esketamine nasal spray into everyday clinical practice.
Cancer Risk Factors in Southern Brazil: Report of a Comprehensive, Matched Case-Control Study
Authors: Giacomazzi Juliana , Ziegelmann Patricia Klarmann , da Costa Samanta , Bittar Camila Matzenbacher , Obst Fernando Mariano , Rosset Clévia , Macedo Gabriel S. , Bock Hugo , Canal Thais , Paese Mari Ines , Benvenuti Jean Lucas , Buj Maria Carolina , Ashton-Prolla Patricia , Goldim José Roberto , Pozza Roberta
Published: December 2023

PURPOSE

To evaluate cancer risk factors among cancer cases and controls from Southern Brazil, to analyze a multigene hereditary panel testing (MGPT, 26 genes) for breast cancer (BC) and colorectal cancer (CCR) cases diagnosed age younger than 50 years and to characterize them for hereditary cancer syndrome (HCS) phenotypes.

METHODS

A case-control (matched by age group and sex) study was conducted on regional cancer. Data on exposure factors and first-/second-degree family history of cancer (1/2FHC) were collected. The MGPT was performed using Illumina next-generation sequencing technology.

RESULTS

A total of 1,007 cases and 1,007 controls were included. The most frequent cancers were BC (n = 311), CCR (n = 147), prostate (n = 132), and lung cancers (n = 89). It was independently associated with cancer, 1/2FHC, tobacco consumption (TC), pesticide exposure (PE), solvent/glue exposure, and BMI <24. BC was associated with 1/2FHC, TC, and hormone replacement therapy use; CCR with 1/2FHC, TC, and BMI <24; prostate cancer with 1/2FHC, TC, and alcohol consumption; and lung cancer with 1/2FHC, TC, PE, and BMI <24. MGPT identified pathogenic/likely pathogenic mutations in 24 (32%) women with BC and in three (18%) women and four (24%) men diagnosed with CCR at under 50 years. Among the tested patients under 50 years with diagnosed BC and CCR, 98.6% and 97% present criteria for HCS, respectively.

CONCLUSION

This study confirmed the association of several factors associated with BC, CCR, prostate, and lung cancers and reinforced the importance of evaluating FHC and genetic testing, especially for patients under 50 years with diagnosed BC or CCR. A better understanding of population-specific cancer risk factors builds on sustainable data for developing prevention strategies. These efforts increase the commitment to early detection and surveillance.
Epidemiological and Clinical Characteristics of Young Patients With Breast Cancer in Brazil: A Retrospective Study
Authors: Correa Daniela B. , Araújo Guilhermino C. , Alvarenga Bruno H. , Rodrigues Angélica N.
Published: December 2023

PURPOSE

Understanding the epidemiological profile of young patients with breast cancer (BC) is crucial for devising effective control strategies. However, data on Brazilian patients with BC, particularly concerning the association with pathogenic germline mutations, are limited. This retrospective cross-sectional study seeks to shed light on the epidemiological and genetic profiles of young patients with BC in Brazil, with a specific focus on the correlation between germline mutations and clinical outcomes.

METHODS

We analyzed medical records from two institutions in Minas Gerais, Brazil, focusing on young patients with BC diagnosed from January 2012 to December 2020. The collected variables included sociodemographic profile, tumor characteristics, mutational status, follow-up duration, and time from diagnosis to death.

RESULTS

The findings highlight high rates of genetic mutations, more aggressive tumor characteristics, and the necessity for more radical surgical interventions in patients with mutations.

CONCLUSION

In general, young patients with BC in Brazil present an unfavorable prognosis, emphasizing the need for early diagnosis and personalized treatment strategies.
RNA-Based Homologous Recombination Deficiency Signature Detects Homologous Recombination Deficiency-RNA+ Patients With and Without Homologous Recombination Repair Gene Pathogenic Alterations in Men With Prostate Cancer
Authors: Brown Landon C. , Zhu Jason , Mauer Elizabeth , Thiede Stephanie N. , Macera Lisa , Stein Michelle M. , Taxter Timothy , Raghavan Derek , Burgess Earle F.
Published: December 2023

PURPOSE

Homologous recombination deficiency (HRD) is a well-described phenotype of some prostate cancers; however, current biomarkers for HRD are imperfect and rely on detection of single gene alterations in the homologous recombination repair (HRR) pathway, which may not capture the complexity of HRD biology. RNA signature–based methods of HRD identification present a potentially dynamic assessment of the HRD phenotype; however, its relationship with HRR gene alterations is not well characterized in prostate cancer.

METHODS

A HRD assay on the basis of an RNA signature associated with biallelic BRCA1/2 loss was applied to a retrospective cohort study of 985 men with prostate cancer analyzed on the Tempus xT platform. HRD status was defined by a binary threshold on a continuous scale.

RESULTS

In this cohort, of the 126 (13%) patients found to be HRD+ by RNA signature (HRD-RNA+), 100 (79%) had no coexisting HRR gene alteration. Among samples with biallelic BRCA1/2 loss, 78% (7/9) were classified as HRD-RNA+, while 8% (2/25) of samples with BRCA1/2 monoallelic loss were HRD-RNA+. Biallelic and monoallelic ATM loss exhibited HRD-RNA+ at a lower prevalence: 6.7% (1/15) and 7.1% (1/14), respectively, compared with HRD-RNA+ prevalence among samples without any HRR gene loss (13%; 100/782). HRD-RNA+ was associated with a significantly higher prevalence of TP53 and AR gene alterations relative to HRD-RNA– after correction for multiple comparisons, 59% versus 39% ( q = 0.003) and 23% versus 12% ( q = 0.024), respectively.

CONCLUSION

Use of an RNA-based HRD signature significantly expands the fraction of patients with prostate cancer who may derive benefit from poly (ADP-ribose) polymerase inhibitors (PARPis) compared with using HRR gene mutations alone. Further studies are needed to evaluate functional HRD significance and inform future usage as a predictive biomarker for PARPi selection.
Η σχέση της ανακοπής του άρθρου 632 με την ανακοπή του άρθρου 933
Authors: Νάκης Νικόλαος
Published: December 2023

Αντικείμενο της παρούσας μελέτης είναι η σχέση της ανακοπής του αρθρ. 632 με την ανακοπή του αρθρ. 933 και πιο συγκεκριμένα τα δικονομικά ζητήματα που προκύπτουν στη (συχνότερη) περίπτωση της σωρευτικής αλλά και σε εκείνη της διαδοχικής άσκησής τους. Ειδικότερα, γίνεται παράθεση της ιστορικής καταγωγής της κάθε ανακοπής, του αντικειμένου της δίκης του κάθε ενδίκου βοηθήματος, αναλύονται τα ζητήματα των οψιγενών ισχυρισμών και της τήρησης της αρχής της προδικασίας και λαμβάνει χώρα σύγκριση της παρεχόμενης ένδικης προστασίας από κάθε ένδικο βοήθημα και ανάλυση του εννόμου συμφέροντος του οφειλέτη για την άσκηση αμφοτέρων είτε σωρευτικά είτε διαδοχικά και τούτο διότι η μεν ανακοπή του αρθρ. 632 προσφέρει δραστικότερη προστασία καθώς ακυρώνει τον εκτελεστό τίτλο ενώ η ανακοπή του αρθρ. 933 είναι ευρύτερη χρονικά διότι ακυρώνει τις μετά από την έκδοση του εκτελεστού τίτλου διενεργηθείσες πράξεις αναγκαστικής εκτέλεσης. Ακολούθως, η μελέτη εξετάζει τη δυνατότητα του οφειλέτη για τη σωρευτική άσκηση της ανακοπής του αρθρ. 933 με το δικόγραφο της ανακοπής του αρθρ. 632 όταν το τελευταίο υπάγεται στην καθ’υλην αρμοδιότητα του Πολυμελούς Πρωτοδικείου, τη σώρευση λόγω συνάφειας της ανακοπής του αρθρ. 933 που στρέφεται κατά των επόμενων πράξεων αναγκαστικής εκτέλεσης στο κατά τόπο αρμόδιο δικαστήριο της ανακοπής του αρθρ. 632, δικονομικά ζητήματα από τη διαφορετική προθεσμία άσκησης κάθε ενδίκου βοηθήματος, τη εφαρμογή ή μη της παραχρήμα απόδειξης στην περίπτωση της σωρευτικής άσκησης, τους ισχυρισμούς που δύναται να προβληθούν με τα δικόγραφα αυτά και τους πρόσθετους λόγους των δύο ανακοπών, την υποχρέωση ή μη της τήρησης της αρχής του ανευ επικουρίας δικάζεσθαι στη διαδοχική άσκηση των δύο ενδίκων βοηθημάτων, ειδικότερους λόγους των δύο ανακοπών, όπως το βέβαιο και το εκκαθαρισμένο της απαίτησης, την ένσταση συμψηφισμού, την ένσταση παραγραφής και την ένσταση του αρθρ. 281 ΑΚ, το ζήτημα της εκκρεμοδικίας μεταξύ των δύο ανακοπών, το δικονομικό φαινόμενο του δεδικασμένου από την τελεσίδικη απόφαση από την κάθε ανακοπή αλλά και από τη διαταγή πληρωμής, της εκτελεστότητας της πρωτοβάθμιας διαπλαστικής απόφασης, της σιωπηρής αποδοχής της απορριπτικής απόφασης επί της ανακοπής του αρθρ. 632 σε σχέση με το δικαίωμα άσκησης της ανακοπής του αρθρ. 933 και τέλος τα ζητήματα που ανακύπτουν από την άσκηση των ενδίκων μέσων, όπως της ανακοπής ερημοδικίας, της έφεσης, της αναίρεσης και της αίτησης αναψηλάφησης στην περίπτωση πάντα της σωρευτικής και της διαδοχικής άσκησής τους.
Τεχνικές επεξεργασίας και ανάλυσης ηλεκτροεγκεφαλικών σημάτων για την αξιολόγηση της γνωστικής απόκρισης του ανθρώπινου εγκεφάλου
Authors: Γιαννόπουλος Αναστάσιος
Published: December 2023

Η παρούσα διδακτορική διατριβή συντέθηκε με βάση μια σειρά από τεχνικές και πειραματικές ενότητες, στοχευμένες κυρίως στην παρουσίαση και την εφαρμογή προηγμένων μεθόδων επεξεργασίας εγκεφαλικών σημάτων σε ποικίλα κλινικά πειράματα. Καθ’ όλη την έκταση της παρούσας διατριβής, ο κεντρικός στόχος ήταν η ανάπτυξη μιας ολοκληρωμένης και αυτοματοποιημένης ακολουθίας βημάτων προς την (μερική) αποκρυπτογράφηση του πολυπλοκότερου συστήματος που συναντάται στην φύση: τον ανθρώπινο εγκέφαλο. Κυρίαρχος σκοπός των τεχνικών που παρουσιάστηκαν ήταν η κατάδειξη της συνέργειας μεταξύ Μηχανικής, Στατιστικής και Νευροεπιστημών προς την εξαγωγή συμπερασμάτων σχετικά με την γνωστική απόκριση του ανθρώπινου εγκεφάλου. Αξίζει να σημειωθεί ότι, η διαδικασία που εφαρμόστηκε σε καθένα από τα κεφάλαια που αφορούσαν συγκεκριμένα πειράματα είναι γενικού σκοπού, συνεπώς δύναται να επαναχρησιμοποιηθεί σε πληθώρα κλινικών ή μη εγκεφαλικών μελετών. Σαφώς, τροποποιήσεις των μεθόδων ανάλυσης είναι πιθανό να απαιτηθούν, ανάλογα με τις εκάστοτε τεχνικές ή θεωρητικές αλλαγές που απορρέουν από το εκάστοτε πείραμα. Στο πρώτο κεφάλαιο, παρουσιάστηκαν οι βασικές τεχνικές καταγραφής των εγκεφαλικών σημάτων, επισημαίνοντας τα κύρια χαρακτηριστικά και τα πλεονεκτήματα της τεχνικής του Ηλεκτροεγκεφαλογραφήματος (ΗΕΓ). Στο δεύτερο κεφάλαιο, δόθηκε μια τυποποιημένη αλληλουχία βημάτων προς τον μετριασμό του θορύβου στα σήματα ΗΕΓ, καθώς και των συνήθων τεχνικών επεξεργασίας. Το τρίτο κεφάλαιο παρουσιάζει όλες εκείνες τις στατιστικές τεχνικές που απαιτούνται για την επικύρωση των αποτελεσμάτων και της εξαγωγή συμπερασμάτων στις μελέτες ΗΕΓ. Στο τέταρτο κεφάλαιο μελετήθηκαν τα προκλητά δυναμικά κατά την εγκεφαλική δραστηριότητα της αυτοπροβολής στο παρελθόν ή στο μέλλον, με στόχο να διαλευκανθεί το αν η παρελθοντική και η μελλοντική σκέψη μοιράζονται κοινούς ή όχι εγκεφαλικούς πόρους. Στο πέμπτο κεφάλαιο, με τη χρήση του πειράματος PPI/PPF, παρουσιάστηκαν τρεις διαφορετικές μελέτες σχετικά με το αισθητικοκινητικό σύστημα. Το τελευταίο εμπλέκεται σε κάθε διεργασία που περιλαμβάνει την εκδήλωση μια μορφής αιφνιδιασμού-κίνησης και αισθητηριακών ερεθισμάτων. Εν συνεχεία, εξετάσαμε τους νευρικούς συσχετισμούς της BDD, διερευνώντας τις ηλεκτροφυσιολογικές αποκρίσεις σε ακουστικά ερεθίσματα PPI και PPF. Χρησιμοποιώντας όμοιο πείραμα, μελετήσαμε τις αποκρίσεις αιφνιδιασμού σε παιδιά και εφήβους. Τέλος, στο έκτο κεφάλαιο, διερευνήσαμε την ευαισθησία των ασθενών με BDD σε οπτικά ψευδαισθητικά φαινόμενα και τα αντίστοιχα μοτίβα συνδεσιμότητας του εγκεφάλου τους, ενώ έπαιρναν αποφάσεις σχετικά με τα αντίστοιχα οπτικά ερεθίσματα.
Διερεύνηση μη ασφαλών πρακτικών που ακολουθεί το νοσηλευτικό προσωπικό κατά τη χρήση πληροφοριακών συστημάτων των νοσοκομείων
Authors: Μαγδαληνού Ανδριάνα
Published: December 2023

Εισαγωγή: Οι μη ασφαλείς πρακτικές που ακολουθεί το νοσηλευτικό προσωπικό μπορεί να θέσουν τα ΠΣ και τα προσωπικά δεδομένα των ασθενών σε κίνδυνο. Σκοπός της έρευνας είναι η διερεύνηση των μη ασφαλών πρακτικών που ακολουθεί το νοσηλευτικό προσωπικό κατά τη χρήση πληροφοριακών συστημάτων των νοσοκομείων και η εκπαίδευση των νοσηλευτών στην ασφαλή χρήση του διαδικτύου. Μεθοδολογία: Αξιοποιήθηκε δείγμα 277 νοσηλευτών στους οποίους διανεμήθηκε το εργαλείο HAIS-Q. Το λογισμικό IBMSPSS 25.0χρησίμευσε για την ανάλυση. Ακολούθησε η ανάλυση των κοινωνικών δικτύων με τη χρήση UCINET 6/NetDraw. Τέλος, αναπτύχθηκε μια εκπαιδευτική παρέμβαση για την ασφαλή χρήση του Διαδικτύου η οποία αξιολογήθηκε από έξι ειδικούς με τη μέθοδο DELPHI. Τα αποτελέσματα της παρέμβασης σε 124 νοσηλευτές προέκυψαν από τη μεθοδολογία Double Pre Test Design και η ανάλυση ολοκληρώθηκε με τη χρήση του PSPP 1.6.2. Αποτελέσματα: Η γνώση, η στάση και οι πρακτικές σχετίζονται ισχυρά. Οι νοσηλευτές εμπιστεύονται τους προϊσταμένους τους και το τμήμα πληροφορικής για ζητήματα ασφάλειας και παρουσίασαν ουδέτερη έως καλή γνώση, στάση, πρακτικές, και ευαισθητοποίηση. Ο τομέας της διαχείρισης του διαδικτύου αποτελεί ένα νευραλγικό ζήτημα. Η εκπαιδευτική παρέμβαση κρίθηκε ως αποδεκτή και βελτίωσε τις απαντήσεις των νοσηλευτών σε θέματα ασφαλούς χρήσης του Διαδικτύου. Συμπεράσματα: Επιμέρους πτυχές στις πρακτικές των νοσηλευτών μπορούν να βελτιωθούν μέσω της αποτελεσματικής εκπαιδευτικής παρέμβασης που αναπτύχθηκε και η οποία μπορεί να πραγματοποιείται από το τμήμα πληροφορικής σε συνεργασία με τους προϊστάμενους των τμημάτων τους οποίους εμπιστεύονται οι νοσηλευτές.
Ιστορική θεώρηση των σχέσεων γηγενών και προσφύγων στη Δυτική Μακεδονία
Authors: Πολατίδης Κλεάνθης
Published: December 2023

Μετά τη Μικρασιατική Καταστροφή και τη Σύμβαση Ανταλλαγής των Πληθυσμών συντελέστηκαν οι μεγαλύτερες μεταναστευτικές ροές από την ίδρυση του ελληνικού κράτους. Οι μουσουλμάνοι αναχώρησαν για την Ανατολή και στη θέση τους ήρθαν περίπου 1.500.000 πρόσφυγες. Η εγκατάστασή τους, κυρίως, στα γόνιμα εδάφη της Δυτικής Μακεδονίας δημιούργησε μια νέα πραγματικότητα. Πέρα από τις δυσκολίες διαβίωσης τόσο των προσφύγων όσο και των φτωχών γηγενών που ζούσαν στην περιοχή, έπρεπε να συνυπάρξουν άνθρωποι διαφορετικής κουλτούρας και νοοτροπίας. Το ελληνικό κράτος επιχείρησε να ρυθμίσει τις σχέσεις ανάμεσά τους με πλείστους τρόπους, όχι όμως πάντοτε επιτυχημένα. Οι νομοθετικές ρυθμίσεις που αφορούσαν την ενσωμάτωση όλων στην ελληνική επικράτεια, ιδιαίτερα μέσω της εκπαιδευτικής πολιτικής που ακολουθήθηκε, διαμόρφωσαν ένα εκρηκτικό κλίμα. Η διαμόρφωση αυτής της κατάστασης έγινε αντικείμενο εκμετάλλευσης από τοπικούς πολιτευτές, αλλά και εκδότες των εφημερίδων της Δυτικής Μακεδονίας, οι οποίοι μέσα από αυτές τις σχέσεις αναδείχθηκαν και προσωπικά. Κορωνίδα των τριβών και των εντάσεων ανάμεσα σε γηγενείς και πρόσφυγες υπήρξε το ζήτημα της νομής της γης, όπως εφαρμόστηκε από τις ελληνικές κυβερνήσεις, αλλά και το αμφιλεγόμενο ζήτημα των «ανώμαλων δικαιοπραξιών», που αφορούσε τα ιδιωτικά συμφωνητικά παραχώρησης της γης των μουσουλμάνων στους γηγενείς των Νέων Χωρών. Η διατριβή αυτή παρακολουθεί τις πολυπρισματικές σχέσεις των γηγενών με τους πρόσφυγες στη Δυτική Μακεδονία κατά την περίοδο 1923-1936. Μέσα από πλήθος τεκμηρίων του τοπικού Τύπου, από τη δράση των πολιτευτών της εξεταζόμενης περιόδου, τις συνεδριάσεις της ελληνικής Βουλής, απόρρητα τηλεγραφήματα και επιστολές με τοπικούς παράγοντες και σωζόμενες προφορικές μαρτυρίες των πρωταγωνιστών εκείνης της περιόδου αναλύεται η διαμόρφωση των σχέσεών τους. Η έρευνα καταλήγει στο συμπέρασμα ότι, όσο διαρκούσε η αβεβαιότητα για την κατοχή της γης και δεν παραχωρούνταν οριστικοί τίτλοι ιδιοκτησίας, οι σχέσεις προσφύγων και γηγενών εξακολουθούσαν να δοκιμάζονται σε όλα τα επίπεδα. Η κρατική πολιτική λειτουργούσε στην πράξη ως «λερναία ύδρα», διευρύνοντας συνεχώς το χάσμα προσφύγων και των γηγενών.