bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing the effectiveness of extracorporeal shockwave therapy and myofascial release therapy in chronic pelvic pain syndrome: study protocol for a randomized controlled trial
Authors: Huang Ningqing , Qin Zhi , Sun Wudong , Bao Kaiming , Zha Jingxian , Zhang Peng , Feng Panpan , Zhao Xiaojun , Liu Mengqian , Shi Jinjun , Ma Ming
Published: October 2023

Background

Chronic prostatitis/chronic pelvic pain syndrome is a highly prevalent syndrome. Previous studies showed that extracorporeal shockwave therapy and myofascial release therapy could improve the quality of life in patients with chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS). Theoretically, combined therapy with extracorporeal shockwave therapy and myofascial release therapy will likely have significant advantages in treating CP/CPPS. We, therefore, present a protocol for conducting a well-designed randomized controlled trial to compare the efficacy and safety of each therapy.

Methods

The proposed study will be a three-group randomized control trial (RCT) design that includes 150 participants from Zhongda Hospital Affiliated to Southeast University, with equal allocation of participants to the three intervention groups. The study duration will be 8 weeks, which includes a 4-week treatment period and a 4-week follow-up period. The primary outcome will be the changes in surface electromyography (sEMG) assessment and National Institutes of Health-Chronic Prostatitis Symptom Index (NIH-CPSI). The secondary outcomes will include the changes in three-dimensional quantification, shear wave elastography (SWE), and sympathetic skin response (SSR) testing. Assessments will be conducted before the intervention (T0), before the 5th intervention (T1), immediately after the 8th intervention (T2), and the 4th week after the end of the 8th intervention (T3).

Discussion

This trial will compare the differences in efficacy between single extracorporeal shockwave therapy, single myofascial release therapy, and combined therapy to select the most appropriate treatment option for patients with CP/CPPS. The possible pathogenesis of CP/CPPS would also be analyzed by comparing the intercorrelation between each objective and subjective measurement (NIH-CPSI score, sEMG, SWE, SSR).

Trial registration

The name of the registry: Extracorporeal Shockwave and Myofascial Release Therapy in Chronic Pelvic Pain Syndrome.

Registration number: NCT05659199. Date of registration: December 2022.
Colonic medullary carcinoma: an exceedingly rare type of colorectal malignancy: a case report and review of the literature
Authors: Al-Ishaq Fajer , Al-Dhaheri Mahmood , Toffaha Ali , Awad Salwa , Rizvi Syed , AbuNada Mohamed , Kurer Mohamed
Published: October 2023

Background

Medullary carcinoma of the colon is a rare subtype of colorectal cancer that has a unique, and sometimes varied, clinical and histologic profile. It usually presents in adult patients older than 50 years. Here, we report a unique case of young male patient who initially presented with abdominal pain followed by a large bowel obstruction.

Case presentation

A 40-year-old SriLankan male presented with right-sided abdominal pain and on examination, there was a palpable right iliac fossa mass. Colonoscopy and a computed tomography scan revealed cecal mass. Later, while waiting for elective resection, the patient developed symptoms and signs of a large bowel obstruction. He underwent a laparoscopic right hemicolectomy with an uneventful postoperative course. The histopathologic evaluation of the resected specimens showed invasive carcinoma with syncytial growth pattern, foci of lymphoid host response, and dirty necrosis, in keeping with a medullary carcinoma pT4a pN2b. Unlike most reported medullary carcinoma cases, this patient was young and caudal-related homeobox transcription factor 2 positive.

Conclusion

We have reported another case of medullary carcinoma of the colon in a young patient with unique histologic characteristics. Reporting such cases helps in refine understanding of the histologic and genetic, as well as clinical, phenotypes of medullary carcinoma of the colon.
Do public health expenditures affect maternal and child health in Madagascar?
Authors: Razakamanana Marilys Victoire , Andrianatoandro Voahirana Tantely , Ramiandrisoa Tiarinisaina Olivier
Published: October 2023

Background

Previous studies have argued that the relationship between health expenditures and health outcomes is more significant among the poor than the non-poor. However, public spending alone does not improve health status. Quality of governance is considered not only as an important determinant of health outcomes but also of the efficiency of public expenditure on health. In low-income countries, barriers to quality service provision can be observed, which may explain the effects of health expenditures. Therefore, this paper aims to identify the relationship between health expenditures and maternal and child mortality in Madagascar and the potential bottlenecks in the flow of funds for maternal and child health.

Methods

Using panel data, fixed and random effect models for the 22 regions of Madagascar over the period 2010 to 2017 were used. Then bottlenecks related to the flow of funds for maternal and child health were identified.

Results

The results reveal that, on the one hand, funding for maternal health, mainly constituted by equipment endowments for health facilities, significantly contributes to the improvement of maternal health (-0.35; p-value = 0.00). On the other hand, child health financing, often realized through transfers of funds to the health system, does not affect children’s health (0.22; p-value = 0.88). The bottleneck analysis illustrates that the transferred funds can suffer from delay or misappropriation and only few parts reach beneficiaries.

Conclusions

Equipment endowments contributed more to health improvement and would be more effective than monetary financing.
Physiological effects of high-flow nasal cannula oxygen therapy after extubation: a randomized crossover study
Authors: Basoalto Roque , Damiani L. Felipe , Jalil Yorschua , Bachmann María Consuelo , Oviedo Vanessa , Alegría Leyla , Valenzuela Emilio Daniel , Rovegno Maximiliano , Ruiz-Rudolph Pablo , Cornejo Rodrigo , Retamal Jaime , Bugedo Guillermo , Thille Arnaud W. , Bruhn Alejandro
Published: October 2023

Background

Prophylactic high-flow nasal cannula (HFNC) oxygen therapy can decrease the risk of extubation failure. It is frequently used in the postextubation phase alone or in combination with noninvasive ventilation. However, its physiological effects in this setting have not been thoroughly investigated. The aim of this study was to determine comprehensively the effects of HFNC applied after extubation on respiratory effort, diaphragm activity, gas exchange, ventilation distribution, and cardiovascular biomarkers.

Methods

This was a prospective randomized crossover physiological study in critically ill patients comparing 1 h of HFNC versus 1 h of standard oxygen after extubation. The main inclusion criteria were mechanical ventilation for at least 48 h due to acute respiratory failure, and extubation after a successful spontaneous breathing trial (SBT). We measured respiratory effort through esophageal/transdiaphragmatic pressures, and diaphragm electrical activity (ΔEAdi). Lung volumes and ventilation distribution were estimated by electrical impedance tomography. Arterial and central venous blood gases were analyzed, as well as cardiac stress biomarkers.

Results

We enrolled 22 patients (age 59 ± 17 years; 9 women) who had been intubated for 8 ± 6 days before extubation. Respiratory effort was significantly lower with HFNC than with standard oxygen therapy, as evidenced by esophageal pressure swings (5.3 [4.2–7.1] vs. 7.2 [5.6–10.3] cmH2O; p < 0.001), pressure–time product (85 [67–140] vs. 156 [114–238] cmH2O*s/min; p < 0.001) and ΔEAdi (10 [7–13] vs. 14 [9–16] µV; p = 0.022). In addition, HFNC induced increases in end-expiratory lung volume and PaO2/FiO2 ratio, decreases in respiratory rate and ventilatory ratio, while no changes were observed in systemic hemodynamics, Troponin T, or in amino-terminal pro-B-type natriuretic peptide.

Conclusions

Prophylactic application of HFNC after extubation provides substantial respiratory support and unloads respiratory muscles.

Trial registration January 15, 2021. NCT04711759.
Effective infection prevention and control measures in long-term care facilities in non-outbreak and outbreak settings: a systematic literature review
Authors: Bloch Nando , Männer Jasmin , Gardiol Céline , Kohler Philipp , Kuhn Jacqueline , Münzer Thomas , Schlegel Matthias , Kuster Stefan P. , Flury Domenica
Published: October 2023

Background

Healthcare-associated infections in long-term care are associated with substantial morbidity and mortality. While infection prevention and control (IPC) guidelines are well-defined in the acute care setting, evidence of effectiveness for long-term care facilities (LTCF) is missing. We therefore performed a systematic literature review to examine the effect of IPC measures in the long-term care setting.

Methods

We systematically searched PubMed and Cochrane libraries for articles evaluating the effect of IPC measures in the LTCF setting since 2017, as earlier reviews on this topic covered the timeframe up to this date. Cross-referenced studies from identified articles and from mentioned earlier reviews were also evaluated. We included randomized-controlled trials, quasi-experimental, observational studies, and outbreak reports. The included studies were analyzed regarding study design, type of intervention, description of intervention, outcomes and quality. We distinguished between non-outbreak and outbreak settings.

Results

We included 74 studies, 34 (46%) in the non-outbreak setting and 40 (54%) in the outbreak setting. The most commonly studied interventions in the non-outbreak setting included the effect of hand hygiene (N = 10), oral hygiene (N = 6), antimicrobial stewardship (N = 4), vaccination of residents (N = 3), education (N = 2) as well as IPC bundles (N = 7). All but one study assessing hand hygiene interventions reported a reduction of infection rates. Further successful interventions were oral hygiene (N = 6) and vaccination of residents (N = 3). In outbreak settings, studies mostly focused on the effects of IPC bundles (N = 24) or mass testing (N = 11). In most of the studies evaluating an IPC bundle, containment of the outbreak was reported. Overall, only four articles (5.4%) were rated as high quality.

Conclusion

In the non-outbreak setting in LTCF, especially hand hygiene and oral hygiene have a beneficial effect on infection rates. In contrast, IPC bundles, as well as mass testing seem to be promising in an outbreak setting.
Active sediment transport along trench axis: insights from X-ray fluorescence core scanning and magnetic analysis of marine sediments in the southwestern Ryukyu Trench
Authors: Hsiung Kan-Hsi , Kanamatsu Toshiya , Ikehara Ken , Murayama Masafumi , Yamamoto Yuhji
Published: October 2023

The southwestern Ryukyu Trench is an ideal place for investigating sediment transport from the Taiwan mountain belt to the Ryukyu Trench floor. To study the characteristics of trench turbidites and sediment transport along the trench, we utilize two piston cores: KR1518-PC04/PL04 at the southwestern end of Ryukyu Trench and YK1501-PC14/PL14 in the trench floor. We also collect two push cores, YK1611-6K1467MG and 6K1467MR, from undisturbed seabed surface to observe lithology. Our analysis reveals that the lithology of the cores shows homogeneous gray mud layers intercalated with very-thin fine sand layers, which we interpret as hemipelagites intercalated with very-thin turbidites. We identify 60 turbidites (0.3–4.0 cm thick) from YK1501-PC14 and 36 turbidites (0.9–4.2 cm thick) from KR1518-PC04. Based on observation from YK1501-PC14, most turbidites, which were less than 1 cm in thickness, displayed planar and sharp bottom contacts. The turbidite thickness of YK1501-PC14 (6448 m water depth) is thinner than that of KR1518-PC04 (6147 m water depth) in general. Through X-ray fluorescence core scans (ITRAX), we distinguished trench turbidites by elemental patterns and accurately determined the depths of every very-thin turbidite. Most hemipelagites from YK1501-PC14 and KR1518-PC04 show similar ITRAX profiles, indicating a similar source of the sediments. ITRAX analysis also revealed five intervals in high-Ca mud in YK1501-PC14, suggesting another potential source from the Ryukyu forearc. Anisotropy of Magnetic Susceptibility (AMS) results show that both YK1501-PC14/PL14 and KR1518-PC04/PL04 exhibit an oblate fabric indicating a normal sedimentary condition. Magnetic signatures showed the presence of pyrrhotite, supporting evidence that Taiwan-sourced sediments can be transported up to ~ 250 km by turbidity currents and spread from the Taiwan Island to the Ryukyu Trench floor. This study improves our understanding of Ryukyu Trench turbidites and provides valuable insights into active sediment transport along the southwestern Ryukyu Trench.
A preclinical platform for assessing long-term drug efficacy exploiting mechanically tunable scaffolds colonized by a three-dimensional tumor microenvironment
Authors: De Vlieghere Elly , Van de Vijver Koen , Blondeel Eva , Carpentier Nathan , Ghobeira Rouba , Pauwels Jarne , Riemann Sebastian , Minsart Manon , Fieuws Charlotte , Mestach Johanna , Baeyens Ans , De Geyter Nathalie , Debbaut Charlotte , Denys Hannelore , Descamps Benedicte , Claes Kathleen , Vral Anne , Van Dorpe Jo , Gevaert Kris , De Geest Bruno G. , Ceelen Wim , Van Vlierberghe Sandra , De Wever Olivier
Published: October 2023

Background

Long-term drug evaluation heavily relies upon rodent models. Drug discovery methods to reduce animal models in oncology may include three-dimensional (3D) cellular systems that take into account tumor microenvironment (TME) cell types and biomechanical properties.

Methods

In this study we reconstructed a 3D tumor using an elastic polymer (acrylate-endcapped urethane-based poly(ethylene glycol) (AUPPEG)) with clinical relevant stiffness. Single cell suspensions from low-grade serous ovarian cancer (LGSOC) patient-derived early passage cultures of cancer cells and cancer-associated fibroblasts (CAF) embedded in a collagen gel were introduced to the AUPPEG scaffold. After self-organization in to a 3D tumor, this model was evaluated by a long-term (> 40 days) exposure to a drug combination of MEK and HSP90 inhibitors. The drug-response results from this long-term in vitro model are compared with drug responses in an orthotopic LGSOC xenograft mouse model.

Results

The in vitro 3D scaffold LGSOC model mimics the growth ratio and spatial organization of the LGSOC. The AUPPEG scaffold approach allows to test new targeted treatments and monitor long-term drug responses. The results correlate with those of the orthotopic LGSOC xenograft mouse model.

Conclusions

The mechanically-tunable scaffolds colonized by a three-dimensional LGSOC allow long-term drug evaluation and can be considered as a valid alternative to reduce, replace and refine animal models in drug discovery.

Graphical Abstract
A case report of bilateral lateral ventricle calcified pseudoneoplasm of the neuraxins
Authors: Qiao Xiaolong , Chen Yinan , Ji Ying , Niu Chaoshi , Cheng Chuandong
Published: October 2023

Background

Calcifying pseudoneoplasm of the neuraxis (CAPNON) is indeed a rare central nervous system lesion that can occur in central nervous system (CNS). Due to its infrequency and limited literature reports, it is challenging to diagnose and manage CAPNON.

Case presentation

In this intriguing study, we embarked on a quest to uncover the story of a 16-year-old girl who experienced bothersome headaches. Through advanced imaging techniques like computed tomography (CT) and magnetic resonance imaging (MRI), we glimpsed a delicate calcified growth within the lateral ventricles’ posterior horn. Motivated by our unwavering commitment to solving mysteries, we embarked on a surgical journey that not only freed the young patient from her ailment but also shed light on the true nature of her puzzling adversary—a remarkable CAPNON.

Conclusions

For patients with CAPNON who have multiple or non-respectable lesions, the primary goal is to alleviate symptoms. After alleviating the symptoms with partial resection, close monitoring of any residual lesions is essential. If there is no evidence for disease progression, a strategy of continued close observation is appropriate.
Monitoring spatiotemporal changes of urban surface water based on satellite imagery and Google Earth Engine platform in Dhaka City from 1990 to 2021
Authors: Hossain Md. Jakir , Mahmud Md. Munir , Islam Sheikh Tawhidul
Published: October 2023

Background

This study focuses on Dhaka City and its impact on urban surface water. Cities, ecosystems, and agriculture need surface water. It is crucial for water resource planning and environmental preservation. The primary aim is to study how urbanization has affected surface water in Dhaka City over 30 years using satellite imagery.

Methods

The study analyzed three decades of urban surface water shifts using Landsat 5 TM and Landsat 8 OLI/TIRS satellite imagery and Google Earth Engine (GEE) with JavaScript code for water ratio index detection. To investigate water level changes, field observation surveys and secondary data analysis were conducted. This integrated methodology simplified surface water data extraction and analysis, making remote sensing easier and allowing cloud-based satellite data processing.

Results

The study demonstrates that the amount of surface water in cities is going down, from 36.23 km2 in 1990 to 5.83 km2 in 2021, which is an enormous decrease. This means that about 20 square kilometers, or 45 percent of the water's surface, have been lost in the last 30 years. The main reasons for the drop are unplanned expansion of cities, accelerated real estate development, and more trade and economic activities in the study area.

Conclusions

The GEE algorithms provide useful insights into surface water's maximum and minimum extent, enabling appropriate planning and management. These findings aid Dhaka City's water resource management and environmental protection.
Efficient genome editing in grapevine using CRISPR/LbCas12a system
Authors: Ren Chong , Gathunga Elias Kirabi , Li Xue , Li Huayang , Kong Junhua , Dai Zhanwu , Liang Zhenchang
Published: October 2023

Clustered regularly interspaced short palindromic repeats (CRISPR) /Cas12a system, also known as CRISPR/Cpf1, has been successfully harnessed for genome engineering in many plants, but not in grapevine yet. Here we developed and demonstrated the efficacy of CRISPR/Cas12a from Lachnospiraceae bacterium ND2006 (LbCas12a) in inducing targeted mutagenesis by targeting the tonoplastic monosaccharide transporter1 (TMT1) and dihydroflavonol-4-reductase 1 (DFR1) genes in 41B cells. Knockout of DFR1 gene altered flavonoid accumulation in dfr1 mutant cells. Heat treatment (34℃) improved the editing efficiencies of CRISPR/LbCas12a system, and the editing efficiencies of TMT1-crRNA1 and TMT1-crRNA2 increased from 35.3% to 44.6% and 29.9% to 37.3% after heat treatment, respectively. Moreover, the sequences of crRNAs were found to be predominant factor affecting editing efficiencies irrespective of the positions within the crRNA array designed for multiplex genome editing. In addition, genome editing with truncated crRNAs (trucrRNAs) showed that trucrRNAs with 20 nt guide sequences were as effective as original crRNAs with 24 nt guides in generating targeted mutagenesis, whereas trucrRNAs with shorter regions of target complementarity ≤ 18 nt in length may not induce detectable mutations in 41B cells. All these results provide evidence for further applications of CRISPR/LbCas12a system in grapevine as a powerful tool for genome engineering.

Graphical Abstract
Diabetic Neuropathies
Authors: Elafros Melissa A. , Callaghan Brian C.
Published: October 2023

OBJECTIVE

This article provides an up-to-date review of the diagnosis and management of the most common neuropathies that occur in patients with diabetes.

LATEST DEVELOPMENTS

The prevalence of diabetes continues to grow worldwide and, as a result, the burden of diabetic neuropathies is also increasing. Most diabetic neuropathies are caused by hyperglycemic effects on small and large fiber nerves, and glycemic control in individuals with type 1 diabetes reduces neuropathy prevalence. However, among people with type 2 diabetes, additional factors, particularly metabolic syndrome components, play a role and should be addressed. Although length-dependent distal symmetric polyneuropathy is the most common form of neuropathy, autonomic syndromes, particularly cardiovascular autonomic neuropathy, are associated with increased mortality, whereas lumbosacral radiculoplexus neuropathy and treatment-induced neuropathy cause substantial morbidity. Recent evidence-based guidelines have updated the recommended treatment options to manage pain associated with distal symmetric polyneuropathy of diabetes.

ESSENTIAL POINTS

Identifying and appropriately diagnosing the neuropathies of diabetes is key to preventing progression. Until better disease-modifying therapies are identified, management remains focused on diabetes and metabolic risk factor control and pain management.
Amyotrophic Lateral Sclerosis and Other Motor Neuron Diseases
Authors: Izenberg Aaron
Published: October 2023

Objective

This article reviews the clinical spectrum of amyotrophic lateral sclerosis (ALS), its variant presentations, and the approach to diagnosis and management. This review includes a detailed discussion of current and emerging disease-modifying therapies and the management of respiratory and bulbar manifestations of disease. An updated review of ALS genetics and pathophysiology is also provided. This article also touches on several other important motor neuron diseases.

Latest Developments

A new set of simplified diagnostic criteria may help identify patients at earlier stages of the disease. A coformulation of sodium phenylbutyrate and tauroursodeoxycholic acid has been shown to have a significant benefit on disease progression and survival, leading to approval by regulatory authorities in the United States and Canada. An oral formulation of edaravone and an antisense oligonucleotide to a SOD1 gene variation (tofersen) have also recently been approved by the US Food and Drug Administration (FDA). Phase 3 trials of intrathecal mesenchymal stem cells failed to meet primary end points for efficacy. Updated American Academy of Neurology quality measures for the care of patients with ALS were published in 2023.

Essential Points

There has been continued progress in ALS genetics, diagnosis, and disease-modifying therapies. However, we still lack a definitive biomarker or a treatment that can halt the progression or reverse the course of disease. The evolving understanding of the genetic and pathophysiologic underpinnings of disease offers promise for more effective and clinically meaningful treatments in the future.
Recovery of Shoulder, Elbow, and Forearm Movement After Nerve Reconstruction for Neonatal Brachial Plexus Palsy
Authors: Muhlestein Whitney E. , Chang Kate W.-C. , Justice Denise , Nelson Virginia S. , Brown Susan H. , Saadeh Yamaan S. , Smith Brandon W.
Published: October 2023

BACKGROUND AND OBJECTIVES:

There is a relative dearth of published data with respect to recovery of upper extremity movement after nerve reconstruction for neonatal brachial plexus palsy (NBPP). This study aimed to demonstrate long-term recovery of active range of motion (AROM) at the shoulder, elbow, and forearm after nerve reconstruction for NBPP and to compare that with patients managed nonoperatively.

METHODS:

We interrogated a prospectively collected database of all patients evaluated for NBPP at a single institution from 2005 to 2020. AROM measurements for shoulder, elbow, and forearm movements were collected at every visit up to 5 years of follow-up and normalized between 0 and 1. We used generalized estimated equations to predict AROM for each movement within local age windows over 5 years and compared the operative and nonoperative cohorts at each age interval.

RESULTS:

In total, >13 000 collected datapoints representing 425 conservatively and 99 operatively managed children were included for analysis. At 5 years, absolute recovery of AROM after nerve reconstruction was ∼50% for shoulder abduction and forward flexion, ∼65% for shoulder external rotation, and ∼75% for elbow flexion and forearm supination, with ∼20% loss of elbow extension AROM. Despite more limited AROM on presentation for the operative cohort, at 5 years, there was no significant difference between the groups in AROM for shoulder external rotation, elbow extension, or forearm supination, and, in Narakas grade 1–2 injury, shoulder abduction and forward flexion.

CONCLUSION:

We demonstrate recovery of upper extremity AROM after nerve surgery for NBPP. Despite more severe presenting injury, operative patients had similar recovery of AROM when compared with nonoperative patients for shoulder external rotation, elbow extension, forearm supination, and, for Narakas grade 1–2 injury, shoulder abduction and forward flexion.
Management for iatrogenic femoral pseudoaneurysms by embolisation of the aneurysmal neck from the contralateral femoral artery: A report of five cases
Authors: Kato Kenichi , Suzuki Tomohiro , Hamano Makoto , Mukaida Eisuke , Kawashima Kazuya , Yoshioka Kunihiro
Published: October 2023

Femoral pseudoaneurysms are typically associated with femoral arterial catheterisation. Treating iatrogenic morbidity requires curing the disease, without causing any additional complications. Occlusion of the aneurysmal neck is ideal to seal post-catheterised pseudoaneurysms along with maintaining the femoral arterial flow. However, few reports have suggested neck embolisation for post-catheterised pseudoaneurysms. We describe five cases of iatrogenic femoral pseudoaneurysms in patients successfully treated with embolisation through the aneurysmal neck. This technique may be an alternative therapeutic option in managing femoral pseudoaneurysms.
Ετεροτοπία και διαπολιτισμικότητα
Authors: Μάμμου Ανίλα
Published: October 2023

Η παρούσα διδακτορική διατριβή αποσκοπεί στη διερεύνηση των κρατικών ελληνικών μειονοτικών σχολείων της Αλβανίας ως χώρους ετεροτοπίας και διαπολιτισμικότητας. Συγκεκριμένα, επιδιώκεται η διερεύνηση του ρόλου των ελληνικών μειονοτικών σχολείων ως ενδιάμεσων χώρων ετεροτοπίας στο πλαίσιο του αλβανικού εκπαιδευτικού συστήματος και της Ελληνικής Εθνικής Μειονότητας, καθώς και του υφιστάμενου εκπαιδευτικού σχεδιασμού (εκπαιδευτικά προγράμματα, πρακτικές και επαγγελματικά χαρακτηριστικά Ελλήνων εκπαιδευτικών). Η συμπληρωματική ή περιθωριακή εφαρμογή της ελληνικής μειονοτικής εκπαίδευσης ερευνήθηκε ποιοτικά, μέσω της ενδελεχούς βιβλιογραφικής ανασκόπησης, της μελέτης αρχειακού υλικού και της διεξαγωγής τριάντα εξ αποστάσεως και δια ζώσης ημιδομημένων συνεντεύξεων. Μέσα από τη θεματική ανάλυση των ερευνητικών δεδομένων και τη χρήση των δύο πρώτων ερευνητικών εργαλείων, προκύπτει πως τα ελληνικά μειονοτικά σχολεία αποτελούν ισχυρούς χώρους ετεροτοπίας, στους οποίους εκδηλώνονται αποκλίσεις από την αλβανική κοινωνία, εκπαιδευτικές λειτουργικές αλλαγές, ασυμβίβαστες κοινωνικές θέσεις, αδύναμες σχέσεις με Ελλάδα και Αλβανία, έντονη διατήρηση ελληνικών πολιτισμικών στοιχείων και κλειστά κυρίως εκπαιδευτικά συστήματα. Μέσα σε αυτό το πλαίσιο, ο υφιστάμενος παιδαγωγικός σχεδιασμός της μειονοτικής εκπαίδευσης και ο τρόπος λειτουργίας της δεν καθιστά τα ελληνικά μειονοτικά σχολεία ισχυρούς ενδιάμεσους διαπολιτισμικούς χώρους και χώρους πολυπολιτισμικής ανταλλαγής. Η υιοθέτηση ορισμένων διαπολιτισμικών πρακτικών έρχονται σε αντίθεση με μεθοριακές καταστάσεις και τάσεις εθνοκεντρισμού, με αποτέλεσμα να εφαρμόζεται περισσότερο ένας επιφανειακός πολυπολιτισμός.
Exposure and absorption estimation of low and radio frequency electromagnetic fields in human tissues
Authors: Τυράκης Χαρίλαος
Published: October 2023

Τα ηλεκτρομαγνητικά πεδία (EMF) είναι μεταξύ των κορυφαίων ζητημάτων που απασχολούν το κοινό. Η μη ιονίζουσα ακτινοβολία EMF αποτελεί ουσιαστικό τομέα έρευνας καθώς οι ασύρματες τεχνολογίες εξελίσσονται συνεχώς. Η διείσδυση των κινητών επικοινωνιών είναι μεγάλη, με έναν σημαντικό αριθμό εφαρμογών και υπηρεσιών. Ο σκοπός αυτής της διδακτορικής διατριβής ήταν μέτρηση (και στη συνέχεια την αξιολόγηση) τόσο των επιπέδων ακτινοβολίας χαμηλής συχνότητας (LF) όσο και των επιπέδων ραδιοσυχνοτήτων (μέχρι 3000 MHz) σε περιοχές ευαίσθητων χρήσεων γης στην Ελλάδα. Το έργο αυτό αποτέλεσε σημαντικό μέρος του Εθνικού ερευνητικού προγράμματος EMF (EDBM34) με τη συμμετοχή του Εργαστηρίου Ιατρικής Φυσικής του Πανεπιστημίου Θεσσαλίας (Ιατρική Σχολή). Χίλια (1000) σημεία επιλέχθηκαν για το τμήμα RF, ενώ επιλέχθηκαν 247 για το τμήμα LF. Αξιολογήσαμε την ανθρώπινη ασφάλεια συγκρίνοντας τις τιμές έκθεσης με τα πιο πρόσφατα, ενημερωμένα όρια ασφαλείας του ICNIRP που εκδόθηκαν το 2020 καθώς και τα εγκεκριμένα ελληνικά όρια, τα οποία είναι αυστηρότερα από τις κατευθυντήριες γραμμές του ICNIRP. Και στα δύο έργα χρησιμοποιήθηκαν αναλυτές φάσματος παρέχοντας λεπτομερείς πληροφορίες σχετικά με τις εκπομπές που υπάρχουν στο περιβάλλον. Κατά την τρέχουσα Ph.D. διατριβή, τα δίκτυα 5G άρχισαν να αναπτύσσονται στην Ελλάδα στα 700 MHz, 2100 MHz και 3500 MHz (C-band). Η μελέτη μας στο 5G βασίστηκε σε μερικές ενδεικτικές μετρήσεις. Επιπλέον, εξετάσαμε τις πιο σημαντικές διεθνείς έρευνες 5G, διερευνώντας την πιθανή αύξηση της ανθρώπινης έκθεσης που προκαλείται από τις τεχνολογίες 5G, συμπεριλαμβανομένης της εξέλιξης του Διαδικτύου των Πραγμάτων (IoT). Με βάση όλα τα πειραματικά και θεωρητικά δεδομένα, η διατριβή κατέληξε σε συμπεράσματα σχετικά με την ανθρώπινη ασφάλεια στην περιοχή του φάσματος LF και RF, λαμβάνοντας υπόψη την προυπάρχουσα τεχνολογία καθώς και τις νέες ασύρματες τεχνολογίες που αναμένεται να παρουσιάσουν ευρεία χρήση στην Ελλάδα τα επόμενα χρόνια. Η τρέχουσα κατάσταση γνώσης, που προέρχεται από αυτό το Ph.D., υποστηρίζει ότι οι νέες ασύρματες τεχνολογίες δεν αναμένεται να αλλάξουν σημαντικά το ηλεκτρομαγνητικό υπόβαθρο σε οικιακά και εξωτερικά περιβάλλοντα. Όλα τα αποτελέσματα των μετρήσεων ήταν πολύ κάτω από τα αυστηρότερα ελληνικά όρια ασφαλείας για όλες τις ζώνες φάσματος που ερευνήθηκαν. Η ανασκόπηση της επιστημονικής βιβλιογραφίας ήταν επίσης μέρος της τρέχουσας διατριβής, συμπεριλαμβανομένων των ενημερωμένων κατευθυντήριων γραμμών για την ασφάλεια από το ICNIRP (2020). Τα επόμενα χρόνια, η επαναξιολόγηση των επιπέδων έκθεσης σε ραδιοσυχνότητες, στις τοποθεσίες που έχουν ήδη μετρηθεί, θα παρέχει στην επιστημονική κοινότητα πιο λεπτομερείς πληροφορίες για το περιβάλλον ραδιοσυχνοτήτων λόγω των εκπομπών 5G (θα εγκατασταθούν περισσότερες κεραίες 5G, περισσότεροι συνδρομητές θα χρησιμοποιούν αυτές τις υπηρεσίες ). Η εστίαση θα πρέπει επίσης να δοθεί στο νέο φάσμα που θα χρησιμοποιηθεί για το 5G, πάνω από 24 GHz, γνωστό ως ακτινοβολία κυμάτων χιλιοστών (mmWave).
Πολιτική οικονομία των πραγματικών συναλλαγματικών ισοτιμιών
Authors: Πουλάκης Αθανάσιος
Published: October 2023

Τα συμβατικά υποδείγματα αποτυγχάνουν να προβλέψουν τη μακροχρόνια συμπεριφορά των πραγματικών συναλλαγματικών ισοτιμιών και να ερμηνεύσουν τη δυναμική του διεθνούς εμπορίου. Αυτή τους η εμπειρική αδυναμία προκύπτει από τρεις αλληλοσυνδεόμενες, προβληματικές θεωρητικές υποθέσεις που υιοθετούν: την ισοδυναμία των αγοραστικών δυνάμεων, την ισοτιμία των επιτοκίων και τη θεωρία του συγκριτικού πλεονεκτήματος. Υπό αυτό το πρίσμα, η παρούσα διατριβή προτείνει μια εναλλακτική προσέγγιση προσδιορισμού και πρόβλεψης των πραγματικών συναλλαγματικών ισοτιμιών, η οποία θεμελιώνεται στην κλασική παράδοση της πολιτικής οικονομίας και δανείζεται βασικές της προτάσεις. Σύμφωνα με την εν λόγω προσέγγιση, ο κλασικός ανταγωνισμός αποτελεί τον μηχανισμό που διαμορφώνει τους κανόνες που διέπουν το εγχώριο και διεθνές εμπόριο, η εργασιακή θεωρία της αξίας είναι το εργαλείο μέσω του οποίου οι κανόνες αυτοί υλοποιούνται και η αρχή του απόλυτου πλεονεκτήματος είναι το αποτέλεσμα όλης αυτής της διαδικασίας. Για την εμπειρική τεκμηρίωση αυτών των προτάσεων διενεργούνται τρεις εμπειρικές έρευνες. Στην πρώτη εξετάζεται η αρχή της ισοδυναμίας των αγοραστικών δυνάμεων για 163 χώρες, οι οποίες ομαδοποιούνται ανάλογα με το επίπεδο ανάπτυξής τους. Ειδικότερα, για την αξιολόγηση της θεωρίας της ισοτιμίας αγοραστικών δυνάμεων εφαρμόζουμε μια σειρά από γραμμικούς και μη γραμμικούς ελέγχους μοναδιαίας ρίζας τόσο σε χρονοσειρές όσο και σε δεδομένα πάνελ, προκειμένου να ελέγξουμε την στασιμότητα των πραγματικών συναλλαγματικών ισοτιμιών για τις υπό εξέταση οικονομίες. Στη δεύτερη εμπειρική έρευνα, διερευνάται η δυναμική σχέση μεταξύ των πραγματικών συναλλαγματικών ισοτιμιών και των μοναδιαίων κοστών εργασίας των εμπορεύσιμων προϊόντων για ένα γκρουπ 18 χωρών, που αποτελείται τόσο από αναπτυγμένες όσο και από αναπτυσσόμενες οικονομίες. Το τελευταίο πραγματοποιείται εφαρμόζοντας σύγχρονες μεθόδους οικονομετρικής ανάλυσης σε δεδομένα πάνελ, με τη βραχυχρόνια και μακροχρόνια δυναμική να εκτιμάται βάσει της μεθόδου cross-sectional autoregressive distributed lag (CS-ARDL). Στην τρίτη εμπειρική έρευνα, με τη χρήση προχωρημένων οικονομετρικών μεθόδων, διαπιστώνεται ότι οι σχετικές εργασιακές αξίες αποτελούν τον βασικό ρυθμιστικό παράγοντα της μακροχρόνιας συμπεριφοράς των σταθμισμένων πραγματικών συναλλαγματικών ισοτιμιών ανάμεσα στην Κίνα και τις ΗΠΑ. Τα ευρήματα μας από τις δύο τελευταίες εμπειρικές έρευνες, επιβεβαιώνουν την ύπαρξη βραχυχρόνιων και μακροχρόνιων επιδράσεων από τα πραγματικά μοναδιαία κόστη εργασίας στην πραγματική συναλλαγματική ισοτιμία. Η διαπίστωση αυτή θέτει υπό αμφισβήτηση τις κυρίαρχες προσεγγίσεις προσδιορισμού των συναλλαγματικών ισοτιμιών και τις αντιλήψεις γύρω από τη χάραξη πολιτικών διεθνούς εμπορίου. Έτσι, προκύπτουν νέοι δίαυλοι άσκησης αποτελεσματικής συναλλαγματικής πολιτικής.
Η ανάκληση παράνομων κρατικών ενισχύσεων
Authors: Μουστακάτου Επιστήμη-Μαρία
Published: October 2023

Η παρούσα μελέτη πραγματεύεται ζητήματα που σχετίζονται με την αμφίδρομη σχέση επιρροής μεταξύ της ενωσιακής νομοθεσίας και νομολογίας και του εθνικού διοικητικού δικαίου των κρατών μελών κατά την άμεση και έμμεση εκτέλεση του ενωσιακού δικαίου στο πλαίσιο της διαδικασίας ανάκλησης παράνομων ευμενών διοικητικών πράξεων, στις περιπτώσεις που χορηγούνται παράνομες κρατικές ενισχύσεις ή ανακαλούνται από το κράτος μέλος αχρεωστήτως καταβληθείσες από την Ένωση ενισχύσεις. Αρχικά, αναλύεται η καθοριστική σημασία που έχουν, ελλείψει ενωσιακών ρυθμίσεων για την ανάκληση παράνομων ευμενών ενωσιακών πράξεων, οι διαμορφωθείσες, από τη νομολογία του Δικαστηρίου της Ευρωπαϊκής Ένωσης, αρχές της ασφάλειας δικαίου και της προστασίας της δικαιολογημένης εμπιστοσύνης στην άμεση εκτέλεση του ενωσιακού δικαίου. Ακολούθως, ερευνάται η σημασία που έχουν οι εν λόγω αρχές στην έμμεση εκτέλεση του ενωσιακού δικαίου, στην περίπτωση δηλαδή που οι ενισχύσεις χορηγήθηκαν χωρίς νόμιμη αιτία από την Ευρωπαϊκή Ένωση βάσει ενωσιακών διατάξεων. Περαιτέρω, η παρούσα μελέτη ασχολείται με τις περιπτώσεις της ανάκλησης παράνομων κρατικών ενισχύσεων, ενισχύσεων δηλαδή που χορηγούνται από κρατικά μέσα βάσει εθνικών διατάξεων σε σύγκρουση όμως με τις ενωσιακές διατάξεις χορήγησης ενισχύσεων των άρθρων 107 και 108 της ΣυνθήκηςΛΕΕ. Στο πλαίσιο αυτό αναπτύσσονται ζητήματα σχετικά με τη σπουδαιότητα των προαναφερομένων αρχών, με την ανακλητική εξουσία της διοίκησης σύμφωνα με το ελληνικό δίκαιο καθώς και με τη δυνατότητα εφαρμογής του γερμανικού δικαίου. Τέλος, ακολουθεί μία κριτική αποτίμηση και παρατίθενται τα συμπεράσματα της έρευνας.
Case Report: Whole lung lavage therapy for pulmonary alveolar proteinosis: a double-edged sword
Authors: Guediri Nouha , Moussa Chirine , Ben Jemia Emna , Rouis Houda , Kwas Hamida , Khouaja Ibtihel , Ghedira Habib , Maalej Sonia
Published: October 2023

Pulmonary alveolar proteinosis (PAP) is an uncommon disease characterized by the excessive accumulation of lipoprotein material in the alveoli. No uniform treatment existed. However, whole lung lavage (WLL) remains the main treatment.

We report the case of a 33-year-old non-smoking man, with no reported history of medical problems, who complained of dyspnea on exertion and cough for over 5 years. A CT scan revealed diffuse pulmonary interstitial infiltrates. Bronchoalveolar lavage was milky. WLL was planned, and the procedure was repeated 70 times and a total of 3,5 liters of saline serum was instilled and 2,8 liters of milky liquid was removed. The operation procedure was interrupted because of acute pulmonary edema. The patient was transferred to the intensive care unit for acute respiratory distress syndrome. He received 3 days of noninvasive ventilation and regression of supplemental oxygen.  Faced with the seriousness of the complication it was decided not to perform a third wash and to monitor the patient functionally and radiologically. Currently, after one year of the lung wash the patient is stable functionally and radiologically. We presented a rare complication of a WLL in a patient with PAP. Physicians should evaluate the patient carefully before suggesting WLL, which is an invasive procedure requiring general anesthesia for a pathology that may evolve spontaneously favorably.
Case Report: Idiopathic avascular necrosis of the femoral head following pregnancy
Authors: Suryadevara Manasa , Mishra Gaurav , Parihar P.H. , Shelar Dr. Sheetal , Nagendra Vadlamudi
Published: October 2023

Background: Hip pain during pregnancy is very common, but avascular necrosis (AVN) represents a very rare entity. Osteonecrosis of the head of the femur during the pregnancy, or shortly after the pregnancy, is a rare clinical problem. Little is known about pregnancy as an etiological factor for AVN of the femoral head.

Case: In this case report, a documented case of femoral head osteonecrosis, a rare complication after pregnancy is presented. The patient presented with complaints of pain in the left hip that gradually worsened and led to restriction of movement. The patient was advised an X-ray, which showed a fracture of neck of the left femur, and an MRI following the X-ray revealed features of AVN of the hip. The patient was later taken for total hip arthroplasty, which was uneventful. On follow-up, the patient had relief from her symptoms and had no complications. Alcoholism, steroid use, systemic lupus erythematosus, organ transplantation (particularly following kidney or bone marrow transplantation), dyslipidemia (particularly hypertriglyceridemia), Gaucher disease, decompression sickness, and drepanocytosis are known risk factors for osteonecrosis. We can list pro-coagulation abnormalities, chemotherapy, and HIV among the less established factors. Here, we present a case of a patient with postpartum AVN of the femoral head that suffered AVN of the left hip in the post-partum period, her symptom of hip pain was neglected as a benign cause initially, which led to aggressive treatment (total hip arthroplasty) at a young age.

Conclusions: Having high suspicion of the diagnosis of AVN and a low threshold for magnetic resonance imaging (MRI) imaging in a pregnant woman with hip pain is a requirement to avoid complications. This case highlights the need for high suspicion of osteonecrosis as a cause of hip pain in the post-partum period.
Case Report: Bell’s palsy: a neurological manifestation of COVID-19 infection
Authors: Abdelrahman Amro , Bitar Amira , Babiker Isra , Elgak Fawaz , Elgassim Mohamed
Published: October 2023

Background Coronavirus (COVID-19) is the causative agent of the most recent pandemic that hit the globe and has been the cause of a vast range of symptoms, including neurological symptoms. Bell’s palsy is an acute peripheral facial paralysis commonly associated with viral infections. Case presentation This case report describes a patient with incidental COVID-19 infection that led to acute unilateral peripheral facial paralysis, Bell’s palsy. Our patient is a 35-year-old male with no known comorbidities who was presenting with upper respiratory tract infection symptoms and was found to be positive for COVID-19. Soon after the onset of symptoms, he also developed right-sided facial weakness in association with his symptoms. A thorough examination revealed a peripheral neurological lesion. The diagnosis of Bell’s palsy secondary to COVID-19 virus infection was through the exclusion of other possible causes. Conclusions This case report suggests a potential link between Bell’s palsy and COVID-19, highlighting the importance of a comprehensive understanding of the neurological manifestations of COVID-19. Further research is essential to determine the significance of neuropathies in COVID-19 and enhance treatment strategies.
Metastasis to the stomach: a systematic review
Authors: Ibrahimli Arturan , Aliyev Altay , Majidli Aykhan , Kahraman Aysegul , Galandarova Aysuna , Khalilzade Emil , Mammadli Heydar , Huseynli Kamran , Assaf Karam , Kilinc Cagatay , Muradov Nijat , Alisan Omer F. , Abdullayev Sabir , Sahin Yeliz I. , Samadov Elgun
Published: October 2023

Background: This study reviews the literature on gastric metastases (GM) in terms of diagnosis, treatment, and outcomes. The goal of this study was to provide clinicians with a reliable and beneficial source to understand gastric metastases arising from various primary tumors and to present the growing literature in an easily accessible form.

Methods: Articles published in English language from implementation of MEDLINE and Cochrane databases until May 2022 were considered for the systematic review. Articles other than English language, letters to the editor, posters, and clinical images were excluded. Hematogenous and lymphogenic metastases were included whereas direct tumoral invasion and seeding were excluded. Articles and abstracts were analyzed and last selection was done after cross-referencing and by use of defined eligibility criteria.

Results: In total 1,521 publications were identified and 170 articles were finally included totaling 186 patients with GM. The median age of patients was 62 years. Gynecologic cancer was the most common cancer type causing GM (67 patients), followed by lung cancer (33 patients), renal cancer (20 patients), and melanoma (19 patients). One of the main treatment methods performed for metastasis was resection surgery (n=62), sometimes combined with chemotherapy (ChT) or immunotherapy. ChT was the other most used treatment method (n=78). Also, immunotherapy was amongst the most preferred treatment options after surgery and ChT (n=10).

Conclusions: As 172 case reports were screened in the systematic review from different journals, heterogeneity was inevitable. Some articles missed important information such as complete follow-up or clinical information. Moreover, since all of the included articles were case reports quality assessment could not be performed. Among 172 case reports reviewed, resection surgery was performed the most and was sometimes combined with ChT and immunotherapy. Further research about what type of treatment has the best outcomes for patients with gastric metastases is needed.
The effect of manual therapy on diaphragm function in adults with asthma: Protocol for a randomized controlled trial
Authors: Tsimouris Dimitrios , Grammatopoulou Eirini , Papandreou Maria , Gioftsos George , Koumantakis George
Published: October 2023

Background: Diaphragm dysfunction is prevalent among individuals with asthma due to lung hyperinflation and hyperventilation in asthma paroxysm. This study was designed to evaluate the effect of the manual diaphragm release technique (MDRT) on diaphragm function in individuals with asthma. Methods: Adults with diagnosed stable asthma (n = 24), will be recruited from the General Hospital of Kifissia “Agioi Anargyroi” in Athens, Greece. The volunteers who meet the inclusion criteria will be randomly allocated to two groups: (a) the experimental group (n = 12) that will receive 12 sessions of MDRT in conjunction with breathing retraining exercises (BRE), and (b) the control group (n = 12) that will receive 12 sessions of BRE. Measurements will occur at three time points: before the initiation of treatment sessions (week 0), followed by 12 treatment sessions (week 6), and three months from the beginning of the trial (week 12). The main outcomes will be the diaphragm excursion (ultrasonography) and chest expansion (inch tape), with secondary outcomes the maximal respiratory pressures (digital pressure manometer), dysfunctional breathing (Nijmegen questionnaire), asthma control (ACT), dyspnea (Borg scale) and quality of life (SF-12v2). Discussion: The proposed protocol is the first to examine the effectiveness of MRDT on diaphragm’s function in individuals with asthma. Manual Therapy (MT) is a low-cost alternative and supplementary therapy to standard treatment procedures that might improve the biomechanics of respiration in pulmonary rehabilitation. Trial Registration: Registered on Clinical Trials.gov (ID: NCT05709054) Protocol version: 29/09/2023
Practical tips for teaching the undifferentiated medical student in the emergency department
Authors: Winger Allan D. , Papanagnou Dimitrios
Published: October 2023

Emergency medicine clerkships have become more prevalent in the third year of medical school, a time when students are immersed in the core clinical training of their undergraduate medical education. There is little guidance for clinician educators, however, on how to effectively scaffold learning for third-year medical students when rotating in the emergency department (ED) during core clerkships. The authors sought to provide best practices in teaching to leverage the rich learning environment of the ED – regardless of their specialty selections. Based on an extensive review of the literature spanning on-shift teaching, feedback, clinical medicine, and bedside teaching, the following twelve tips are offered to guide the instruction of the undifferentiated third-year medical student in the ED.
Pediatric standardized residency training faculty’s perceptions of medical education research: a questionnaire survey
Authors: Yu Mu-Xue , Jiang Xiao-Yun , Li Xiao-Yu , Yue Zhi-Hui , Mo Ying , Liu Wang-Kai , Gu Yu-Fen
Published: October 2023

Background Rigorous medical education research (MER) conducted by faculty in pediatric standardized residency training (SRT) can contribute to the promotion of child health care. This study aimed to assess the perceptions of pediatric SRT faculty regarding MER in Guangdong Province, China. Methods In August 2022, an anonymous questionnaire survey was conducted during a medical education conference in Guangzhou, Guangdong. A total of 40 pediatric SRT clinical teachers from 10 teaching hospitals in Guangdong Province attended the pediatric session of the medical education conference and completed the questionnaire during the conference. The questionnaire covered various topics related to MER conducted in SRT, the challenges they encountered in MER, and their perceptions of grants on MER. Results Among the 40 teachers, 16 (40.00%) stated that they did not participate in any MER activities. The main challenges they encountered in conducting MER were the lack of training (72.50%), limited time (80.00%), and lack of grants funding (60.00%). Only 10 (25.00%) teachers were reported to have received grants for MER projects. Conclusions The findings highlight the importance of providing support and training to pediatric SRT faculty in Guangdong Province, China, to enhance their engagement in MER. Addressing these challenges can lead to significant improvements in child health care promotion through evidence-based educational practices.