bluuebunny/crossref_metadata_2025 huggingface dataset:
Botox for Unremitting Chronic Migraine: Assessment of Muscle Function and Strength, Efficacy and Safety after More Than 10 Years of Continuous Treatment
Authors: Boudreau Guy P , Laquerre Mathew , Demers Catherine
Published: January 2023

Objectives: Our objectives were 3-fold: Assess the impact of the injection paradigms on muscle function and strength, assess the efficacy and safety over 10 years of repeated treatments every 3 months, identify risk factors maintaining chronicity in this unremitting migraine population. Method: One hundred patients were injected with a Botox dilution ratio of 1:1 with a sterile 0.9 % saline solution, 50 patients with a 100u vial of Botox in one, 1cc tuberculin syringe, and 50 patients with a 200u vial of Botox in two-1cc tuberculin syringe during 10 years. Results: The strength of the paracervical and first portion of the trapezius muscle was altered in 6% (100u) and 18% (155u) of subjects. The strength of the second portion of the trapezius muscle was altered in 2% (100u) and 10% (155u) of subjects. Muscle function of the paracervical and first portion of the trapezius muscles was altered in 34% (100u) and 28% (155) of subjects. For the second portion of the trapezius, muscle 58% (100u) and 52% (155) of subjects. The efficacy of Botox was constantly maintained during the 10 years of treatment. 72% (100u), and 74% (155u) of subjects had less than 7migraine days /month (77% improvement). Early onset of migraine, comorbid emotional burden and chronic neck pain, should be considered as risk factors for the unremitting condition. Conclusion: Muscle strength, and function alteration did not have an impact on esthetics of the face and on normal daily muscle function in both cohorts. In both cohorts, more than 70% of patients had more than 75% improvement in monthly migraine days. Depth of the toxin injection, diffusion and presence of adipose tissue (lean versus obese patients) may be responsible for muscle strength and function alteration.
Life-Threatening Amniotic Fluid Emboli Requiring Massive Blood Transfusion and Veno-Arterial Extracorporeal Membrane Oxygenation Therapy: Case Report and Review of the Literature
Authors: Sara Dichtwald , Ahmed Khashan , Avraham Meyer , M Gorfil Dan , Nisim Ifrach , Idan Drori
Published: January 2023

Background: Amniotic fluid embolism (AFE) is a rare and disastrous condition that occurs during labor or soon after delivery. Its course is abrupt and rapidly progressive and may result in cardiorespiratory collapse, profound hemorrhage and multi organ failure. Mortality and morbidity are high, with many survivors suffering major neurologic sequelae. Disseminated intravascular coagulation (DIC), severe coagulopathy and hemorrhage may pose a risk for extracorporeal membrane oxygenation (ECMO) therapy due to the need of full anticoagulation treatment. Case Report: A 41 year old healthy parturient who developed fulminant AFE during cesarean delivery, accompanied by cardiac arrest, severe acute respiratory distress syndrome and DIC with profound obstetric hemorrhage. She was placed on veno-arterial ECMO as a rescue therapy and required more than 850 blood products. She had concomitant septic shock with E-coli bacteremia due to chroioamnionitis. Despite prolonged and complicated ICU course, including recurrent hemorrhage, multiple surgeries and sepsis, she survived to hospital discharge without neurologic sequelae. Conclusion: ECMO therapy may be considered as a rescue therapy in AFE cases, refractory to standard cardiorespiratory support, despite the increased risk for hemorrhage under full anticoagulation therapy. Interdisciplinary coordination is mandatory for a good outcome.
Risk Factors of Infection of Human Papillomavirus (HPV) in the Lekoumou and Niari Departments (Congo Brazzaville)
Authors: FS Ngatali Christian , AF Bolenga Liboko , Y Mabiala , RA Doukaga Moussavou , D Moukassa , JB Nkoua Mbon
Published: January 2023

Objective: To determine the prevalence of risk factors of infection of human papillomavirus (HPV) in women in Lekoumou and Niari departments. Patients and Methods: We conducted a descriptive and cross-sectional study over a period of 7 months from January to July 2019 in the Lekoumou department. 100 women whose ages ranged from 16 to 73 years old. The variables studied were as follows: age, marital status, level of education, age of first intercourse, number of sexual partners, parity, The bivariate analysis was done between age, number of level of instruction, parity, age of first sexual intercourse and number of sexual Partners. The statistical analysis and the data processing were carried out by the Excel 2016 software and the graphpad prism version 5 software. The statistical test used was the chi-square test. Results: During this study we collected 100 women. The mean age of the patients was 34.6 ± 11.9 with ranges ranging from 16 to 73 years. The most represented age groups were 20-29 years old (31%) and 30-39 years old (29%). The highest level of education was college level in 53% of cases followed by primary level in 25% of cases. Almost ¾ of our study population were married women (74%), single people made up only 22% of the study population. The mean age at first intercourse was 16.4 ± 2.3 with extremes ranging from 12 to 25 years. Almost all of the women (97%) had had their first sexual intercourse before the age of 20. The average number of sexual partners was 5.3 ± 3.2 with extremes ranging from 1 to 15 partners, 53% of women had at least 5 sexual partners. The mean number of deliveries (parity) was 3.6 ± 2.4 with extremes ranging from 0 to 12 deliveries. 36% of our study population had between 4 and 7 deliveries. Bivariate analysis found a statistically significant difference between age and number of sexual partners, between age of first intercourse and level of education, but also between age and number of children. Conclusion: Cervical cancer is a public health problem. Apart from HPV infection, several cofactors have shown an associative link for its occurrence. It can be in our context mainly the number of children, parity and the number of sexual partners and the age at first intercourse.
Bone Scintigraphy Metastatic Patterns in Patient with Prostate Cancer at Ocean Road Cancer Institute
Authors: RS Iramu , HM Makungu , LS Lulu
Published: January 2023

Objectives: Prostate cancer is the second most common malignancy in the world next to lung cancer and it is the leading cause of morbidity and mortality among men. The most common metastatic site in prostate cancer is the bone. This study is aiming at finding the pattern and frequency of bone metastasis among prostate cancer patients at Ocean Road Cancer Institute, Tanzania. Methods: This was a cross section retrospective hospital based descriptive study involving 139 patients with prostate cancer who were seen from June 2014 to June 2016 whose bone scan were reviewed. Results: Bone metastases were found in 77 patients (55.4%) The prevalence was higher in the age group between 60 and 79 (56.3%) however there was no statistical significance between age and occurrence of bone metastasis. Patient who had high PSA level and Gleason score had more occurrence of skeletal metastasis. Spine was the most common site for bone metastasis constituting 72 patients (51.8%) of all the patients followed by ribs metastasis (31.7%), Also it was shown that of the spine metastasis, lumbar spine was more frequent affected (48.2%) followed by thoracic and cervical spine (41.0% and 27.3% respectively) Conclusion: The prevalence of skeletal metastasis in patients with Prostate cancer at Ocean Road Cancer Institute was high (55.4%). The prevalence was higher in patients with PSA level more than 20 and those with Gleason score of more than 7. Spine was the commonest site for metastasis and of the spine, metastasis lumbar spine metastasis was most frequent site. Recommendations: It is recommended that bone scan should be done as baseline in patients with prostate cancer particularly those with PSA level more than 20ng/ml and Gleason score of more than seven.
Anticancer and Antioxidant Effects of Bioactive Extracts from Monk Fruit (Siraitia grosvenori) with Potential Clinical Implications
Authors: Konno Sensuke , Elyaguov Jason , Dixon Ashley , Choudhury Muhammad
Published: January 2023

Background: To find the better option for cancer treatment and prevention, we have been working on the bioactive extracts of monk fruit, mogrosides, with potential anticancer and antioxidant activities. As oxidative stress (OXS), generation of reactive oxygen species, is believed to play a significant role in carcinogenesis, certain antioxidants may help prevent the development of cancer. Accordingly, we investigated if such mogroside-based products would have such biological activities in vitro. Materials and Methods: Anticancer effect of four selected products, LS, LME, and LLE, and MOG, was tested on five different cancer cells, including bladder, prostate, breast, lung, and liver. Cancer cells were treated with these products for 72 h and cell viability was determined by MTT assay. The anticancer mechanism was also explored, focusing on cell cycle and apoptosis. For antioxidant study, whether any products would protect normal kidney cells from hydrogen peroxide (H2 O2 )-induced OXS was examined. Cell viability and severity of OXS were determined by MTT assay and lipid peroxidation (LPO) assay, respectively. Results: Although any concentrations (0-500 μg/ml) of LS and LME had little effects, LLE (≥2 μg/ml) and MOG (≥1.5 mg/ml) showed a significant cell viability reduction in all five cancer cells. LLE and MOG, not LS and LME, concurrently led to a G1 cell cycle arrest and ultimately apoptosis. Additionally, LLE and MOG also protected normal cells from H2 O2 -induced OXS, and LPO assay further revealed a significant reduction in the severity of OXS with them. Conclusions: In this study, two of four monk fruit products tested, LLE and MOG, demonstrated their anticancer and antioxidant activities. They may stop/reduce cancer cell growth/viability, while they may also protect normal cells from OXS that can lead to the cancer development. Therefore, these two monk fruit products may have clinical implications in the cancer prevention/treatment.
Hypoglycemia and Dementia: Is Alzheimer's Disease a Consequence of Sugar Deficiency?
Authors: Gelbard Amos
Published: January 2023

This next essay will bring proof of reductions in cerebral glucose metabolism found in AD patients, possibly indicating that AD stems from Glucose insufficiency. It would later counter this assumption by showing the extremely high prevalence of AD among diabetics, and then, solve the mystery by proving that what's causing the dementia among diabetics is actually avoiding sugar according to doctor's orders. It will prove it by showing an unbreakable link between hypoglycemic (hypo, not hyper) events in diabetics and the risk of developing Alzheimer's disease. It's therefore will prove that AD in fact stems from lack of glucose consumption over the years and would suggest glucose as a possible treatment to AD patients.
The Impact of COVID-19 Pandemia during the First Lockdown Period on Gestational Diabetes Mellitus: A Retrospective Single Centre Evaluation
Authors: Burlina Silvia , Dalfrà Maria Grazia , Visentin Silvia , Annunziata Lapolla Silvia Pastrolin
Published: January 2023

Data on the impact of COVID-19 on diagnosis, management and outcomes of women with GDM are few. Our aim was to evaluate the possible impact of lockdown on GDM diagnosis and follow-up. We retrospectively analyzed the GDM diagnostic modalities, the clinical-metabolic characteristics and the maternal and fetal outcomes in 48 GDM women followed during the lockdown (March-May 2020) and to compare the results with the 61 GDM women followed in the same period in 2019. We found no significant differences between the two groups in terms of diagnosis, clinical-metabolic characteristics and maternal and fetal outcomes. Therefore, we found that lockdown did not affect negatively maternal and fetal outcomes of GDM patients followed in this period.
YAPILAŞMA TEORİSİ ÇERÇEVESİNDEN KULLANICILARIN KİŞİSEL İZLERİ İÇİN ŞEFFAF BİR DİJİTAL AĞ MODELİ ÖNERİSİ
Authors: ARISOY GEDİK Cansu
Published: January 2023

İnternet kullanıcıları sürekli olarak kişisel verilerini dijital sosyal ağlarda paylaşmaktadır. Onların her tıklamasını takip eden şirketler ise kullanıcıların kişisel verilerini tüketerek onlar hakkında önemli bilgiler elde etmekte ve bireylerin kişisel ihtiyaçlarına göre uyarlanmış tavsiyeler sunmaktadır. Şirketlerin ürün ve hizmetlerine ilişkin yaydıkları enformasyonu tüketen internet kullanıcıları arkalarında kişisel izlerini bırakmaya devam etmektedir. Böylelikle bu izleri takip eden şirketler de kullanıcıların enformasyonunu tüketmiş olmaktadır. Kişisel izlerin takibi sonucunda daha çok ürün ve hizmet satışı gerçekleşmektedir. Bu bağlamda dijital sosyal ağların internet kullanıcıları ve tüketicilere sağladığı olanaklara karşı kullanıcıların dijital izlerinin ticari amaçlarla tüketiliyor olması ve böylece bireylerin ticari nesnelere dönüştürülmesi bu çalışmanın sorunsalını oluşturmaktadır. Failin aktif potansiyelini vurgulayan kuramcı Anthony Giddens’ın yapılaşma teorisi ile inşa edilen çalışmanın amacı enformasyon toplumlarında tüketicilerin dijital sosyal ağlarda dolaşımını daha güvenli kılmak için şeffaf nitelik taşıyan bir iletişim modeline kaynak sağlamaktır. Çalışmada katılımcılara yöneltilen yarı-yapılandırılmış görüşme soruları derlenerek çalışmanın bulgularına ulaşılmıştır. Çalışmada aynı zamanda ikincil veriler kullanılmış, daha önce yayınlanmış olan bilimsel metinler taranarak araştırma kapsamında yeniden değerlendirilmiştir. Kişisel izlerin takibini ele alan küresel ve ulusal düzenlemelerin altında yatan esas hedeflere ulaşmak için, yasal çerçevelerin daha tutarlı ve duyarlı bir şekilde uygulanmasına ihtiyaç duyulduğu sonucuna ulaşılmıştır. Ayrıca çalışma Giddens’ın vurguladığı, bireysel eylem alabilen ve toplumu dönüştürme gücüne sahip olan failler haline gelebilmek için dijital okuryazarlık bilincini artırmak gerektiğini ortaya koymaktadır.
Pengelolaan Pendidikan Dasar Dikaitkan dengan Mobilitas Sosial
Authors: Lutfillah Maya Muizatil , Marini Arita , Nafiah Maratun
Published: January 2023

The educational system as a social media needs to change shortly as the society changes or vice versa. The changes in education should bring about improvement in the social life. The history have proved the linkages and close relationship between education on the one hand and the other social circumstances. From this, people can learn that social life in one period is determined by the education system that applied. Conversely, social educational system is strongly influenced by the style and circumstances that shape society. It looks that the relation between education system and the condition of a society which supports that system is a dilemma that tends to be static, because they both affect each other. This is because, on the one hand, education creates driving forces for progress and on the other hand, the community is a decisive force of civilization and knowledge and gives patterns and determine their own course of development and progress.
Implementasi Aliran Progresivisme dalam Pembelajaran Menurut Filsafat Pendidikan dan Perkembangan Kurikulum di Indonesia
Authors: Rahma An Nisa , Rohmah Hafidhotur , Bakar M. Yunus Abu
Published: January 2023

The Implementation of Progressivism in learning according to the philosophy of Education and curriculum development in Indonesia aims to make readers understand the implementation of Progressivism and examples of its curriculum which are explained in detail in the Education curriculum in Indonesia. The method used in this article is a qualitative method using a library research approach. In this stage, the researcher tries to select data (books) that are related to the flow of progressivism and its characters. The results of this study indicate that the flow of progressivism is a school of educational philosophy that supports the changes and progress of education in accordance with the changing times. This flow was influenced by William James, John Dewey, and Hans Vaihinger. The goal of the flow of progressivism is to produce students who can think practically, and can solve problems effectively in an increasingly developing and advanced environment by using their experiences. Educators only act as motivators, give directions or mentors of students. Progressivism flow uses non-authoritarian learning and indoctrination. The curriculum used is flexible, free, open and does not indoctrinate students. Indonesia is one of the countries that is developing its curriculum so that it is not left behind and can compete with international education.
Clinical Supervision Management in PAI Learning at SMP Maarif 1 Kebumen
Authors: Chamidi Raisa Ruchama Silmi , Chamidi Agus Salim
Published: January 2023

Efforts to develop Islamic Religious Education (PAI) learning in schools/madrasas can actually utilize the clinical supervision model. However, in general, school/madrasah principals are reluctant to carry out clinical supervision for various reasons, and subject teachers are not brave enough to propose it. This paper aims to get a brief overview of clinical supervision management in PAI learning. The research was conducted briefly at SMP Maarif 1 Kebumen. The method used is field research, with data collection techniques through interviews, observation, and documentation, and the results are in the form of qualitative descriptive narratives, and the principal is the key informant from which other informants are then developed through the snowball sampling model. The results of his research are that clinical supervision at SMP Maarif 1 Kebumen is managed using the POAC management model, namely (a)planning is carried out at the beginning of the semester which is prepared by the principal and held a meeting with the deputy heads, and then socialized to teachers through the beginning of the semester meeting, (b)organizing using the delegation model, (c)delegating of further clinical supervision from the school principal to the vice principal in the curriculum field assisted by a number of senior teachers, (d)actuating as implementation of clinical supervision is carried out starting from checking the quality of lesson plans in samples related to materials, learning resources, and learning methods, inviting teachers whose lesson plans need improvement, and carrying out clinical processes and improving the quality of lesson plans, (e)controlling is carried out through closed meetings between school principals and the deputy head of curriculum and a number of senior teachers. Furthermore, supervision of PAI learning itself is directly carried out by the school principal. Controls, evaluations and repairs are completed by discussion and friendly chat but it works. The Javanese cultural approach has a positive impact on the implementation of clinical supervision. The end of clinical supervision activities is imputing data of the supervision score into the system.
MANAJEMEN RISIKO REPUTASI PERGURUAN TINGGI DAN WORLD UNIVERSITY RANKINGS
Authors: Dominicus Savio Priyarsono
Published: January 2023

AbstractThe first critical step required in university reputation risk management is defining the meaning and formulating the method for measurement of reputation. This step can be facilitated by considering approaches utilized by world university ranking systems combined with relevant Ministerial policies and strategic planning of the university. Based on IPB University’s empirical experience in conducting reputation risk management, it can be concluded that reputation risk management is a type of strategic risk management that requires inter-functional integration so intensive that it needs involvement of the top management of the university.
Keywords: risk management, university rankings, university reputation.
AbstrakLangkah kritikal pertama yang diperlukan dalam manajemen risiko reputasi perguruan tinggi adalah perumusan makna dan penetapan metode pengukuran reputasi. Langkah ini dapat dipermudah dengan mempertimbangkan pendekatan-pendekatan yang digunakan dalam sistem- sistem pemeringkatan perguruan tinggi dunia yang dikombinasikan dengan kebijakan - kebijakan Kementerian yang relevan serta berbagai rencana strategis perguruan tinggi yang bersangkutan. Berdasarkan pengalaman empirik manajemen risiko reputasi yang diselenggarakan oleh IPB University, dapat disimpulkan bahwa manajemen risiko ini tergolong ke dalam manajemen risiko strategis yang memerlukan integrasi antarfungsi dalam organisasi sedemikian intensif sehingga memerlukan keterlibatan dari pucuk pimpinan perguruan tinggi.
Kata kunci: manajemen risiko, pemeringkatan perguruan tinggi, reputasi perguruan tinggi.
PENERAPAN MODEL MANAJEMEN RISIKO TEKNOLOGI DIGITAL DI LEMBAGA PERBANKAN BERKACA PADA CETAK BIRU TRANSFORMASI DIGITAL PERBANKAN INDONESIA
Authors: Ngamal Yohanes , Maximus Ali Perajaka
Published: January 2023

Abstrak:Artikel ini membahas mengenai tren pemanfaatan teknologi digital di industri perbankan yang terjadi di dunia secara khusus di Indonesia. Studi ini menemukan bahwa pemanfaatan teknologi digital (digitalisasi) telah membuat ekosistem keuangan global berubah dengan cepat. Hal ini tejadi karena demand (kebutuhan) masyarakat untuk mendapat jasa layanan akan digital terus bertambah. Hal ini membuka peluang bagi industri perbankan untuk meningkatkan jumlah nasabahnya dan meningkatkan keuntungannya. Namun, pada sisi lain terdapat sejumlah saluran di mana lembaga perbankan berpotensi mengalami potensi kerugian karena kejahatan siber akan terus meningkat.
Oleh karena itu penulis menyarankan supaya lembaga perbankan terus berupaya menemukan kembali fungsi manajemen risiko mereka, terutama melalui pengembangan manajemen risiko digital, untuk melindungi diri mereka sendiri, pelanggan mereka, dan tempat mereka di pasar. Di Indonesia, sesungguhnya Otoritas Jasa Keuangan (OJK) telah membuat cetak biru dan peta jalan (road map) yang membantu industri perbankan menerapkan digitalisasi dan mengembangkan manajemen risiko digital secara tepat sasar dan berdaya guna.
Kata kunci: bank, teknologi digital, digitalisasi, cetak biru transformasi digital, OJK. manajemen risiko digital
ASURANSI SEBAGAI PENGALIHAN, DAN PENGURANG RISIKO KEBIJAKAN PEMERINTAH DI SEKTOR PERTANIAN DI INDONESIA
Authors: Yohanes Ngamal, S.E., M.Si,
Published: January 2023

Abstraksi

Risiko utama dari lingkaran persoalan di sektor pertanian adalah keterbatasan dana yang dimiliki pemerintah Sementara pemerintah membutuhkan dana yang cukup besar untuk menggenjot pertumbuhan sektor pertanian. Untuk itu pemerintah harus mencari cara mengatasi persoalan tersebut. Salah satunya dengan melibat asuransi sebagai alat kebijakan dalam bidang pertanian. Program asuransi pertanian sangat penting karena dapat memberikan perlindungan serta rasa aman bagi para petani sehingga mendorong produktifitas petani dalam menghasil produk pertanian. Selain itu, asuransi pertanian merupakan sebuah cara menciptakan keberlanjutan pertanian melalui perlindungan dari berbagai risiko jika terjadi gagal panen bagi para petani sehingga menciptakan kemandirian pangan, produktifitas, sejahtera sehingga mampu memberi kontribusi bagi tercapainya pembangunan. Untuk itu studi ini bertujuan untuk memahami seberapa banyaknya risiko yang mengitari sektor pertanian dan dan bagaimana asuransi dapat digunkan sebagai pengalih dan mengurangi risiko disektor pertanian. Sebab kita sadari betul bahwa pembangunan pertanian yang sukses akan dapat menekan jumlah kemiskinan dan meningkatkan penyerapan tenaga kerja.
Kata kunci: pertanian, asuransi
MANAJEMEN RISIKO BERBASIS KEY PERFORMANCE INDICATOR PADA CREDIT UNION
Authors: Agustin Simatupang  , Afif Rahman  , Jesman Hasibuan  , Juniman Telaumbanua  , Agnes Hutabarat  , Gad Edison  , Yolanda Yunifer Pateh  , M. L. Denny Tewu
Published: January 2023

ABSTRAK
Penggunaan Balanced Scorecard sangat membantu perusahaan untuk memberikan pandangan mengenai kinerja sebuah perusahaan. Penelitian ini bertujuan untuk mengidentifikasi sifat dan karakteristik risiko yang dihadapi oleh koperasi credit union agar dapat menetukan keputusan apa yang akan diambil oleh koperasi credit union, penelitian ini menggunakan metode penelitian yang digunakan untuk penelitian ini adalah dengan menetapkan probabilitas munculnya risiko dan menilai peluang terjadinya risiko dikalikan dengan dampak nya terhadap koperasi credit union. Sasaran utama penelitian ini adalah Balance Score Card koperasi credit union dan alat ukur yang digunakan untuk menentukan efektivitas perusahaan adalah Key Performance Indikator (KPI). Hasil penelitian ini menunjukan bahwa Mitigasi risiko yang dilakukan credit union dikatakan efektif karena dapat menurunkan risk of level secara signifikan tetapi mitigasi akan lebih efisien apabila dilakukan secara bertahap karena biaya mitigasi yang sangat besar dapat mempengaruhi cash flow koperasi Credit Union. Implementasi mitigasi risiko harus langsung di respon secara cepat dan positif oleh koperasi kredit union karena dapat mempengaruhi citra koperasi credit union itu sendiri.
Kata kunci: Credit Union, Management Risiko, Key Performance Indikator.
Mineral Water Vincentka and its Influence on Mucosal Ulcers
Authors: BUDINSKAYA K , NÁDENÍČEK J , STRAČINA T , HENDRYCH M , PÍREK O , BARTÁKOVÁ A , ŠUDÁKOVÁ M , SVÍZELA V , NOVÁKOVÁ Z , NOVÁKOVÁ M , BABULA P
Published: January 2023

Gastropathy is one of the most common diseases of the human gastrointestinal tract. Apart from its consequences in the stomach, it is also manifested in other parts of the digestive tract, particularly in the duodenum. The aim of this pilot study was to verify on animal model the empirically observed alleviation of gastropathy symptoms in patients who underwent a drinking treatment of Vincentka natural mineral water during their spa treatment. Sixteen male Wistar rats were included in the study. The animals were randomly divided into two groups: experimental group (E; n=8) and control group (C; n=8). The experimental protocol consisted of three phases: (1) handling phase (7 days); (2) mineral water (E)/tap water (C) administration (7 days); (3) acute gastritis induction (1 day). Twenty-four hours after the induction of acute gastritis, the animals were sacrificed. The collected tissues (stomach and duodenum) and blood were examined by standard histological microscopy, and by immunohistochemical and biochemical methods. Histopathological analysis revealed significantly reduced damage to the gastric mucosa in the experimental group. Significantly different values of blood plasma antioxidant capacity, oxidative stress parameters and blood plasma biochemical parameters were also found. Based on these results, we conclude that the mineral water Vincentka has a positive impact on development and symptoms of acute gastric ulcers.
Lymphoepithelial Cysts of the Pancreas: CT and MRI Features
Authors: Tirkes Temel , Patel Aashish , Cramer Harvey , Evrimler Sehnaz , DeWitt John M. , Al-Haddad Mohammad
Published: January 2023

Objective: Describe CT and MRI features of the lymphoepithelial cyst (LEC) of the pancreas.

Methods: The authors identified 13 cases of LEC by searching their institutional electronic medical archives from 2004 to 2020. All of the patients had CT scans and six patients had both a CT and MRI. The final diagnosis was established either by fine-needle aspiration with cytopathology (n=6) or surgical resection (n=7).

Results: The mean diameter of the cysts was 36 mm (range: 6–93 mm). Almost all of the cysts were exophytic (92%) and solitary (85%), favouring the tail (54%) or body (38%) of the pancreas. LECs were either oval (62%) or round (39%) and had well-defined contours. All LECs showed T2 hyperintensity and T1 hypointensity; however, the signal was heterogeneous. Diffusion-weighted imaging showed restricted diffusion in all cases. On CT, LECs commonly showed complex fluid density (>15 HU) with no visible septation, enhancement or calcification.

Conclusion: LECs have a distinguishing feature on MRI, which is restricted diffusion on diffusion-weighted imaging. This is presumably secondary to the presence of keratin, which can be a helpful feature differentiating LECs from other pancreatic cystic neoplasms. Besides this, LECs predominantly appear as solitary and exophytic lesions, with complex fluid density on CT and heterogeneous hypointense T1 and heterogenous hyperintense T2 signal on MRI.
Artificial Intelligence in Patients with Congenital Heart Disease: Where Do We Stand?
Authors: Oudkerk Poo Marinka D. , Kauw Dirkjan , Bleijendaal Hidde , Mulder Barbara J.M. , Pinto Yigal , Bouma Berto J. , Winter Michiel M.
Published: January 2023

Life expectancy of patients with congenital heart disease (CHD) has increased in recent decades; however, late complications remain frequent and difficult to predict. Progress in data science has spurred the development of decision support systems and could aid physicians in predicting clinical deterioration and in the management of CHD patients. Newly developed artificial intelligence (AI) algorithms have shown performances comparable to humans in clinical diagnostics using statistical and computational algorithms and are expected to partly surpass human intelligence in the near future. Although much research on AI has been performed in patients with acquired heart disease, little data is available with respect to research on AI in patients with CHD. Learning algorithms in patients with CHD have shown to be promising in the interpretation of ECG, cardiac imaging, and the prediction of surgical outcome. However, current learning algorithms are not accurate enough to be implemented into daily clinical practice. Data on AI possibilities remain scarce in patients with CHD, and studies on large data sets are warranted to increase sensitivity, specificity, accuracy, and clinical relevance of these algorithms.
Neutrophilic Dermatoses Revisited
Authors: Rosmaninho Aristóteles , Carvalho Sandrina , Lobo Inês
Published: January 2023

The neutrophilic dermatoses (ND) comprise a group of heterogeneous disorders characterised by inflammatory skin lesions that histologically show an intense inflammatory infiltrate composed primarily by neutrophils, with no evidence of infection. Although there are distinct clinical differences in the classical lesions of these disorders, many patients have overlapping features. In this mini-review we describe the clinical aspects of the main NDs, including: Sweet’s syndrome, neutrophilic dermatosis of the dorsal hands, pyoderma gangrenosum, erythema elevatum diutinum, subcorneal pustular dermatosis, neutrophilic eccrine hidradenitis, rheumatoid neutrophilic dermatitis, neutrophilic panniculitis, and aseptic abscesses, their association with underlying diseases, differential diagnosis, treatment options, and prognosis.
Implications of Elevated Postprandial Glucose and Nutritional Approaches for Postprandial Glucose Management with a Focus on Whey Proteins
Authors: Taylor Jennifer
Published: January 2023

This symposium took place at the 58th Annual Meeting of the European Association for the Study of Diabetes (EASD) in Stockholm, Sweden. The first speaker was John L. Sievenpiper, who discussed the pathophysiology of postprandial hyperglycaemia and how it may impact the risk of cardiovascular disease (CVD), peripheral vascular disease, insulin resistance, and other comorbidities in patients with Type 2 diabetes (T2D). Sievenpiper then reviewed various pharmacological interventions that target postprandial glucose (PPG) and insulin levels, including incretin therapies and α-glucosidase inhibitors, such as acarbose. Data presented showed that a low glycaemic index (GI) diet can improve glycaemic control and reduce cardiometabolic risk factors in patients with Type 1 diabetes (T1D) and T2D. Sievenpiper then presented data on novel non-pharmacological approaches that target PPG, including mulberry leaf (Morus alba L) extract (MLE), which has α-glucosidase inhibitor activity, reducing PPG and insulin responses to sucrose. The second speaker, Bo Ahrén, presented data on the effects of whey protein (WP) and branched-chain amino acids (BCAA) on PPG management and as a potential intervention for postprandial hyperglycaemia. They also discussed the mechanisms underlying the effects of WP, and highlighted data presented at the 2022 58th Annual EASD meeting by Johansen and colleagues on a novel micelle microgel technology. WP microgels (WPM) deliver highly concentrated and lower calorie doses of WP, with the potential to be developed clinically as therapeutics for T2D. The symposium concluded with a question and answer session between panel members and the audience. Ian J. Neeland was the meeting moderator.
Exercise: A Powerful Tool to Manage Type 2 Diabetes in the Ageing Population
Authors: Zanuso Silvano
Published: January 2023

The aim of this paper is to highlight the evidence on the interrelationships between exercise and Type 2 diabetes mellitus (T2DM) in the ageing population. The evidence addressed in the specific literature is presented in three domains: aerobic exercise, resistance exercise, and combined aerobic and resistance exercise. The effects of aerobic exercise are well established, but in the ageing population resistance training could be considered a superior intervention to help glycaemic control; the effects of resistance training on insulin sensitivity are attributable to an increase in muscle mass. Thus, although with resistance training body weight does not change much, the main effect of resistance training on body composition of the elderly should be a shift from fat to muscle mass, and the maintenance of a large muscle mass may reduce obesity related risk factors. Fewer studies have investigated the effects of combined resistance and aerobic training, but from the available evidences it would appear that combined exercise training seems to offer additional benefits if compared with aerobic training alone and resistance training alone.
Adhesion Molecules as a Therapeutic Target in IBD
Authors: Leal Raquel F. , Salas Azucena
Published: January 2023

Recruitment of circulating leukocytes to areas of inflammation is a key process in the pathophysiology of inflammatory bowel diseases, including ulcerative colitis (UC). This is a finely regulated multistep process in which specialised adhesion and signalling molecules mediate a series of sequential steps. Following activation, integrins expressed on the surface of leukocytes become the key mediators of firm adhesion and emigration through interaction with immunoglobulin superfamily molecules expressed on the vascular endothelium. The anti α4 antibody natalizumab has shown efficacy in inducing and maintaining response and remission in patients with moderate and severe Crohn’s disease. However, a major safety setback involving the onset of progressive multifocal leukoencephalopathy (PML) in 1/1000 treated cases led to limitations on its clinical use and application in UC. The more selective anti α4β7 antibody vedolizumab has proven efficacious for inducing clinical and endoscopic remission in UC. Selective expression of the α4β7 receptor MAdCAM-1, which occurs predominantly in the intestine, may avoid the risk of those central nervous system infectious complications associated with the nonselective blockade of all α4 integrins. Moreover, treatment with anti-MAdCAM-1 or anti-α7 antibody (etrolizumab) showed promising results for inducing remission in UC. In conclusion, the development of safe and effective drugs that target these molecular components of the inflammatory response may yield novel, improved therapies for inflammatory bowel disease (IBD) that address as yet unmet needs.
Holistic Patient Care in Primary Biliary Cholangitis: Managing Both the Disease and the Symptoms
Authors: Roberts Eleanor
Published: January 2023

In the progressive, immune-mediated liver disease primary biliary cholangitis (PBC), the intrahepatic bile ducts are gradually destroyed over several years. The primary biochemical means to diagnose PBC, and assess progression and treatment response, is serum alkaline phosphatase (ALP). Further diagnostic criteria depend on antimitochondrial antibody (AMA) and specific antinuclear antibody status, and histological confirmation in some patients. First-line therapy for PBC is ursodeoxycholic acid (UDCA), which has been shown to improve biochemical indices of PBC and slow disease progression. However, major quality of life (QoL)-impacting symptoms of PBC, including pruritus and fatigue, are demonstrated to be independent of disease severity. There is evidence confirming that these symptoms negatively impact a number of aspects, including emotional status, ability to work, and social life, for some patients. In a symposium as part of the European Association for the Study of the Liver (EASL) International Liver Congress™ (ILC) 2022, Gideon Hirschfield, Toronto Centre for Liver Disease, University of Toronto, Ontario, Canada; Ana Lleo, Humanitas University and Humanitas Clinical and Research Centre, Milan, Italy; and David Jones, Newcastle University and Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK, discussed the holistic treatment of patients with PBC and whether goals of such should be more or equally dependent on biochemical status or impact on QoL. This discussion was expanded on in a session moderated by Jessica K. Dyson, Newcastle University and Newcastle-upon-Tyne Hospitals NHS Foundation Trust, UK.
Cost-Effective Interventions in The Control of Chronic Hepatitis B (CHB) Infection
Authors: Toy Mehlika
Published: January 2023

The hepatitis B virus (HBV) causes infection in the liver that can lead to cirrhosis, liver cancer, and premature death. The disease is not widely recognised as a serious public health problem, and as a result, inadequate resources are being allocated to hepatitis B prevention and control. Vaccination against HBV has been a great success and has resulted in a reduction in the rate of chronic infection; however, the vaccine is of no help for those already infected. The big challenge is how to deliver effective and affordable care to those who are carriers and who are eligible for treatment, and affordable diagnostics to detect those who are not yet aware of their infection, to prevent the spread to susceptible individuals. This review intends to give the reader a brief overview of the types of control strategies that have been examined in recent cost-effectiveness studies on the control of chronic hepatitis B.
Hepatic-Based Inborn Errors of Metabolism
Authors: Lund Tormod
Published: January 2023

Inborn errors of metabolism (IEMs) are a vast, diverse, and heterogeneous set of genetic disorders. Hepatic-based IEMs are a significant cause of morbidity and mortality, and represent a common indication for liver transplantation (LTx) in the paediatric population. This review focuses on four of the most common hepatic-based IEMs where Tx, either as whole organ liver or as isolated hepatocytes, may be an option: familial amyloid polyneuropathy, Wilson’s disease, alpha-1 antitrypsin deficiency, and phenylketonuria.
The Woest Study: Is Now Time to Update the Recommendations Regarding the Antithrombotic Therapy in Patients with Indication for Oral Anticoagulation Undergoing Coronary Stent Implantation?
Authors: Rubboli Andrea
Published: January 2023

Triple therapy (TT) of warfarin, aspirin, and clopidogrel is currently recommended as the antithrombotic therapy for patients with an indication for oral anticoagulation (OAC) undergoing percutaneous coronary intervention (PCI) with stent implantation (PCI). While appearing to be the most effective regimen in preventing the combined incidence of stroke, death, myocardial infarction, re-revascularisation, and stent thrombosis, TT is however associated with an increased incidence of bleeding. In the recent ‘What is the Optimal antiplatElet and anticoagulant therapy in patients with oral anticoagulation and coronary StenTing’ (WOEST) study, dual therapy (DT) with warfarin and clopidogrel has been shown to be significantly safer than TT on the occurrence of total bleeding, with no decrease in efficacy, as the combined incidence of stroke, death, myocardial infarction, re-revascularisation, and stent thrombosis was also significantly lower. Owing to the limited effect of DT on the occurrence of clinically major bleeding, as well as to the large undersizing of the WOEST study for a reliable evaluation of the effect on adverse cardiac events, and especially stent thrombosis, the results of the WOEST study should not yet prompt the substitution of TT for DT as the antithrombotic regimen for patients with an indication for OAC who are submitted to PCI.
Coronary Chronic Total Occlusions in the Setting of Acute Myocardial Infarction
Authors: Claessen Bimmer , Hoebers Loes , Henriques José
Published: January 2023

Approximately 10-15% of ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) are found to have a chronic total occlusion (CTO) in a non-infarct related artery (IRA). The presence of a coronary CTO in a non-IRA in STEMI patients is associated with increased mortality and above average deterioration of left ventricular function. A number of mechanisms may be responsible for this worsened prognosis, including impaired healing at the infarct border zone, decreased protection against future cardiovascular events, and potentially increased risk of arrhythmias. This review article aims to provide an overview of published data on the prognostic effect of CTOs in a non-IRA in the setting of primary PCI for acute STEMI. Additionally, observational data on staged PCI of CTOs after primary PCI, and future studies on additional CTO PCI after primary PCI, will be reviewed.
Stent Delivery Shaft Fracture Case Report: A Fractured Relationship
Authors: Brandon Lisa , Kerr Brian , Armstrong Richard , Cosgrave John
Published: January 2023

Percutaneous coronary intervention has been a major interventional medical development of our times, being a life-saving procedure in the setting of acute coronary syndrome, and providing significant improvements in quality of life for patients with chronic coronary syndromes.

Complications of coronary intervention have continued to downtrend, facilitated by improvements in stent and wire technology, the aggressive use of antiplatelets, and the regular use of invasive anatomical and physiological assessments.

The authors present the case of a challenging and rare procedural complication, that of stent delivery shaft fracture requiring emergency snare extraction.
Cardiovascular Remodelling In Chronic Kidney Disease
Authors: Rebić Damir , Rašić Senija
Published: January 2023

Left ventricular (LV) structure and function abnormalities are frequent in patients with chronic uraemia; these disorders increase the risk of cardiovascular (CV) and overall morbidity and mortality in the predialysed population, during dialysis treatment, and in renal transplant recipients. Since the first description of the association between chronic kidney disease (CKD) and heart disease, many epidemiological studies have confirmed and extended this finding. The risk of cardiovascular disease (CVD) is notably increased in patients with CKD. When adjusted for traditional CV risk factors, impaired kidney function increases the risk of CVD 2 to 4-fold. CVD is frequently underdiagnosed and undertreated in patients with CKD. This review will attempt to summarise current knowledge of the prevalence and pathophysiological mechanisms of LV disease in chronic uraemia, and to discuss useful medical strategies in this population.
The Use of Vaptans in Hyponatraemia
Authors: Giuliani Corinna , Peri Alessandro
Published: January 2023

Hyponatraemia is the most common electrolyte disorder in clinical practice. It is associated with increased morbidity, mortality, and length of hospital stay, and therefore represents a clinical, economic, and social burden for healthcare costs and caregivers. Acute and severe hyponatraemia is associated with severe neurological alterations that may lead to cerebral oedema and death. Even mild chronic hyponatraemia has been associated with neurological and extraneurological disorders, such as gait disturbances, attention deficit, increased risk of bone loss, falls, and fractures. These aspects appear relevant particularly in the elderly. Furthermore, an overly rapid correction of hyponatraemia may cause osmotic demyelination, thus making it necessary to define safe treatment strategies. In the last few years, the availability of new drugs, i.e. the vasopressin receptor antagonists or vaptans, has improved the therapeutic choices for the treatment of hyponatraemia. This review summarises the main aspects regarding the use of these drugs, in particular tolvaptan and conivaptan, which are the only vaptans currently available in clinical practice.
Management of Patients with High-Grade Glioma
Authors: Yuksel Simge , Kolb Anna , Solaroglu Ihsan , Watts Colin
Published: January 2023

The scientific basis for the surgical management of patients with glioma is rapidly evolving. The infiltrative nature of these cancers precludes a surgical cure, but despite this, cytoreductive surgery remains central to high-quality patient’s care. In addition to tissue sampling for accurate histopathological diagnosis and molecular genetic characterisation, clinical benefit from decompression of space-occupying lesions and microsurgical cytoreduction has been reported in patients with different grades of glioma. By integrating advanced surgical techniques with molecular genetic characterisation of the disease and targeted radiotherapy and chemotherapy, it is possible to construct a programme of personalised surgical therapy throughout the patient’s journey. The goal of therapeutic packages tailored to each patient is to optimise patient safety and clinical outcome, and must be delivered in a multidisciplinary setting. Here we review the current concepts that underlie surgical management of patients with high-grade glioma.
Women and Lung Cancer: Literature Assumptions and News from Recent Publications
Authors: Vavalà Tiziana , Novello Silvia
Published: January 2023

For a long period of time, lung cancer (LC) was considered as a malignancy affecting only males, but epidemiological data have shown a dramatic increase of the incidence of this disease among women, and the gender gap has been narrowing steadily since the 1980s, mainly as a consequence of the huge spread of tobacco consumption during the past 70 years. In 2013, the percentage of current cigarette smokers among adults aged 18 and over in the US was 19.9% for men and 15.2% for women (selected estimates based on data from the January-June 2013 National Health Interview Survey), reflecting the earlier and more marked decline in the prevalence of tobacco use in men. Nowadays, cigarette smoking accounts for >90% of LCs in men and 75-85% of LCs in women in the US and Europe, but 20% of women with LCs have never smoked. Many studies describe differences between males and females in the clinical presentation and biology of LC, suggesting that the disease should be considered a specific entity in women, where adenocarcinoma is the most common histological subtype, and prognosis and response to treatment appear to be different. In line with these findings, hormonal receptors have been isolated in LC tissues: the interaction of oestrogen receptors with growth-factor-receptor signalling is an emerging area of investigation and – considering the potential impact of hormonal factors – lung carcinogenesis appears distinctive in women. Despite these considerations, no ‘gender driven’ diagnostic or therapeutic approaches are available nowadays. Improving knowledge of LC in women will allow identification of specific genetic alterations or hormonal profiles which could be targeted by therapy in order to stimulate research progress towards personalised sex-based investigations.