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Background: Laparoscopic surgery has become the preferred management for paraesophageal hernias (PEH); however surgical management versus watchful waiting remains controversial in older patients. Methods: This retrospective study analyzed the outcomes of PEH repair in elderly patients surgically managed at The Ottawa Hospital over a 10-year period. Patients older than 60 years who underwent PEH repair were examined with respect to presentation, technique and associated complications. Results: Despite similar demographics, our study groups showed significantly different characteristics of surgical techniques. Most surgeries were performed laparoscopically; however, patients aged 70 years or older underwent more open and emergency surgeries than the younger group. Despite a 30-day postoperative complication rate of 45% and 13% in the older ([greater than or equal to] 70 yr) and younger (60-69 yr) groups, respectively, the rates during elective repair were similar. There were no deaths in the younger group, whereas the 30-day mortality rate was 5% in patients aged 70 years and older, including a 2-fold increase with emergency repair (4 v. 2 patients). Conclusion: Management of PEH in older adults remains controversial in relation to a surgical versus watchful waiting approach. We found that in patients aged 70 years and older who undergo surgical management of PEH experience more open and emergency procedures, which are associated with higher complication rates. However, in the elective setting older patients had increased laparoscopic repairs and comparable complication rates to younger patients. We found the greatest outcomes with early, elective laparoscopic repair, irrespective of age. Contexte : La chirurgie laparoscopique est devenue la modalité préférée pour les hernies paraoesophagiennes (HPO); par contre, chez les patients plus âgés, la prise en charge chirurgicale plutôt qu'une attente vigilante ne fait pas l'unanimité. Méthodes : Cette étude rétrospective a analysé les résultats des réparations d'HPO chez des patients âgés qui ont été opérés à l'Hôpital d'Ottawa sur une période de 10 ans. Les patients de plus de 60 ans soumis à une réparation d'HPO ont été analysés au plan des symptômes, des techniques chirurgicales et des complications associées. Résultats : Malgré des caractéristiques démographiques similaires, les groupes de notre étude se sont révélés très différents au plan des techniques chirurgicales. La plupart des chirurgies ont été effectuées par voie laparoscopique; par contre, les patients de 70 ans ou plus ont subi davantage de chirurgies ouvertes et de chirurgies d'urgence, comparativement au groupe plus jeune. Malgré un taux de complications postopératoires à 30 jours de 45% et de 13% chez les groupes âgés ([greater than or equal to] 70 ans) et plus jeunes (60-69 ans) respectivement, pour les interventions non urgentes les taux ont été similaires. On n'a signalé aucun décès dans le groupe plus jeune, tandis que le taux de mortalité à 30 jours a été de 5% chez les patients de 70 ans et plus, y compris une augmentation du double lors des interventions urgentes (4 c. 2 patients). Conclusion : Pour la prise en charge de l'HPO chez les adultes âgés, on ne s'entend pas sur la conduite à tenir entre l'approche chirurgicale et l'approche attentiste. Nous avons constaté que chez les patients de 70 ans et plus qui subissent une réparation chirurgicale d'HPO et il y a plus d'interventions ouvertes et d'urgence, qui sont associées à des taux de complications plus élevés. Toutefois, dans le contexte des chirurgies non urgentes, les patients âgés ont eu un plus grand nombre de réparations laparoscopiques et un taux de complications comparable à ceux des patients plus jeunes. Nous avons constaté que les résultats étaient plus favorables lors des réparations laparoscopiques précoces, non urgentes, indépendamment de l'âge., A paraesophageal hernia (PEH) refers to a subtype of hiatal hernia where a true hernia sac composed of peritoneum is formed. These are classified into 3 subtypes, types II, III [...]

This study investigated the effects of three kinds of gloss conditions that is traditional non-CALL marginal gloss, computer-based audio gloss, and computer-based extended audio gloss, on reading comprehension of Iranian EFL learners. To this end, three experimental and one control groups, each comprising 15 participants, took part in this study. In order to ensure that the participants were from the right proficiency level, KET (Key Language Test) was used to select upper-intermediate proficiency learners. Participants in each group read two passages under one of the three mentioned conditions, with no gloss offered for control group. They all completed one pretest, one reading session, and one post-test. The data were analyzed using t-tests and one-way ANOVA. Statistical analyses of the results revealed that extended audio gloss group, who were provided with the voice of a speaker to read the meaning of the target word, as well as one example sentence, significantly outperformed the other groups. The results of this study provide some insights for teachers and administrators to review their curricula, approaches, and educational tools, and to consider the possibility of incorporating CALL technology into their teaching.

Pranoprofen (PRA)-loaded nanostructured lipid carriers (NLC) have been dispersed into blank gels composed of 1% of Carbomer 940 (PRA-NLC-Car) and 3% of Sepigel® 305 (PRA-NLC-Sep) as a novel strategy to refine the biopharmaceutical profile of PRA, for dermal administration in the treatment of skin inflammation that may be caused by possible skin abrasion. This stratagem intends to improve the joining of PRA with the skin, improving its retention and anti-inflammatory effect. Gels were evaluated for various parameters such as pH, morphology, rheology, and swelling. In vitro drug release research and ex vivo permeation through the skin were carried out on Franz diffusion cells. Additionally, in vivo assays were carried out to evaluate the anti-inflammatory effect, and tolerance studies were performed in humans by evaluating the biomechanical properties. Results showed a rheological profile common of semi-solid pharmaceutical forms for dermal application, with sustained release up to 24 h. In vivo studies using PRA-NLC-Car and PRA-NLC-Sep in Mus musculus mice and hairless rats histologically demonstrated their efficacy in an inflammatory animal model study. No signs of skin irritation or modifications of the skin's biophysical properties were identified and the gels were well tolerated. The results obtained from this investigation concluded that the developed semi-solid formulations represent a fitting drug delivery carrier for PRA's transdermal delivery, enhancing its dermal retention and suggesting that they can be utilized as an interesting and effective topical treatment for local skin inflammation caused by a possible abrasion. [ABSTRACT FROM AUTHOR]

Introduction: To achieve successful root canal treatments on cardiovascular patients, endodontists must have enough knowledge of these diseases and related considerations. Hence, the aim of this study was to evaluate the knowledge, attitudes, and performance of Iranian endodontists regarding patients with cardiovascular disorders. Materials and Methods: This cross-sectional study involved 101 specialist endodontists (41 men and 60 women) from different geographical parts of Iran. A 29-item questionnaire was used to assess knowledge, attitudes, and performance in terms of managing patients with cardiovascular disorders in specialist endodontic practice. Responses were analyzed using Chi-square or Fisher's exact test with IBM SPSS version 22 software. Results: Knowledge was rated as favorable for 67.3% of respondents and as acceptable for the remaining 32.7%, while attitudes were rated as favorable for 40.6% and acceptable for 57.4%. Performance was graded as favorable for 75.2% and acceptable for the remaining 24.8. Conclusion: Overall the majority of Iranian Endodontists had a good level of knowledge regarding the management of patients with cardiovascular disorders. Furthermore, because of the high importance of this medical intervention and the high number of patients dealing with cardiovascular disorders, the majority of the responders were still interested in promoting their knowledge on this topic through participating in continual educational programs. [ABSTRACT FROM AUTHOR]

Background: Evidence-Based Reviews in Surgery (EBRS) is a program developed to teach critical appraisal skills to general surgeons and residents. The purpose of this study was to assess the use of EBRS by general surgery residents across Canada and to assess residents' opinions regarding EBRS and journal clubs. Methods: We surveyed postgraduate year 2-5 residents from 15 general surgery programs. Data are presented as percentages and means. Results: A total of 231 residents (58%, mean 56% per program, range 0%-100%) responded: 172 (75%) residents indicated that they know about EBRS and that it is used in their programs. More than 75% of residents who use EBRS agreed or strongly agreed that the EBRS clinical and methodological articles and reviews are relevant. Only 55 residents (24%) indicated that they used EBRS online. Most residents (198 [86%]) attend journal clubs. The most common format is a mandatory meeting held at a special time every month with faculty members with epidemiological and clinical expertise. Residents stated that EBRS articles were used exclusively (13%) or in conjunction with other articles (57%) in their journal clubs. Most respondents (176 of 193 [91%]) stated that journal clubs are very or somewhat valuable to their education. Conclusion: The EBRS program is widely used among general surgery residents across Canada. Although most residents who use EBRS rate it highly, a large proportion are unaware of EBRS online features. Thus, future efforts to increase awareness of EBRS online features and increase its accessibility are required. Contexte: Le programme de revues factuelles en chirurgie EBRS (Evidence-Based Reviews in Surgery) a ete mis au point pour enseigner aux chirurgiens et aux residents en chirurgie generale les competences necessaires pour faire des evaluations critiques. Le but de cette etude etait d'analyser l'utilisation des EBRS par les residents en chirurgie generale au Canada et de leur demander leur opinion au sujet des EBRS et des clubs de lecture. Methodes: Nous avons interroge des residents des annees 2 a 5 rattaches a 15 programmes de chirurgie generale. Les donnees sont presentees sous forme de pourcentages et de moyennes. Resultats: En tout, 231 residents (58 %, moyenne de 56 % par programme, intervalle 0 %-100 %) ont repondu: 172 residents (75 %) ont indique qu'ils connaissent les EBRS et que leur programme les utilise. Plus de 75 % des residents qui utilisent les EBRS se sont dit d'accord ou tout a fait d'accord avec l'enonce sur la pertinence des articles et revues cliniques et methodologiques des EBRS. Seulement 55 residents (24 %) ont dit utiliser les EBRS en ligne. La plupart des residents (198 [86 %]) participaient a des clubs de lecture. Leur utilisation la plus courante prend la forme d'une reunion obligatoire tenue a un moment particulier tous les mois avec les enseignants de la faculte ayant une expertise epidemiologique et clinique. Les residents ont indique que les EBRS etaient utilises seuls (13 %) ou avec d'autres articles (57 %) dans leurs clubs de lecture. La plupart des repondants (176 sur 193 [91 %]) ont affirme que leurs clubs de lecture sont tres ou assez utiles pour leur formation. Conclusion: Le programme EBRS est largement utilise par les residents en chirurgie generale au Canada. Meme si la plupart des residents qui utilisent les EBRS leur accordent une cote elevee, une forte proportion ignore l'existence des possibilites web des EBRS. Il faudra donc travailler a mieux faire connaitre les possibilites offertes par le programme EBRS sur le web et en faciliter l'acces., Evidence-Based Reviews in Surgery (EBRS) is a joint program of the Canadian Association of General Surgeons (CAGS) and the American College of Surgeons (ACS) and was developed to teach critical [...]

Background: Templating is a preoperative planning procedure that improves the efficiency of the surgical process and reduces postoperative complications of total hip arthroplasty (THA) by improving the precision of prediction of prosthetic implant size. This study aimed to evaluate the accuracy of the preoperative cup and stem size digital 2D templating of THA with mediCAD® software and find the factors that influence the accuracy, such as indication for surgery, patients' demographics, implant brand, and the assessors' grade of education. Methods: We retrospectively retrieved 420 patient template images of all patients who underwent THA between March 2018 and March 2021. Templating of all included images was processed using mediCAD® software a day before surgery by a newcomer physician to hip arthroplasty course (PGY-2 orthopedic resident or hip surgery fellow). Preoperative templating cup and stem sizes were compared with the actual inserted implant sizes. Result: After excluding ineligible patients, this study included 391 patients, 193 (49.4%) males and 198 (50.6%) females with a mean age of 43.3 ± 14.9. The average cup sizes predicted before and after surgery were 52.12 ± 14.28 and 52.21 ± 15.05 respectively, and the mean delta cup size (before and after surgery) was 2.79 ± 2.94. The delta stem size before and after surgery has a mean value of 1.53 ± 1.49. The acetabular cup components, measured within ± 0, ± 1, and ± 2 sizes, were 28.9%, 63.9%, 83.1% accurate, respectively. The femoral stem design component measured within ± 0, ± 1, and ± 2 sizes were 27.2%, 61.0%, 78.6% accurate, respectively. Wagner Cone® stem brand, DDH patients, and females showed significantly higher accuracy of stem size templating. Revision THA has the lowest accuracy in terms of cup size templating. The compression of accuracy rate between resident and fellow revealed no significant differences. Also, no significant difference was detected between the accuracy of templating performed in the first months with the second months of the arthroplasty course period. Conclusion: Our study showed that under mentioned condition, templating using mediCAD® has acceptable accuracy in predicting the sizes of femoral and acetabular components in THA patients. Digital software like mediCAD® remains favorable because of the short learning curve, user-friendly features, and low-cost maintenance, leading to level-up patient care and THA efficacy. Further studies are necessary for clarifying the role of the assessor's experience and expertise in THA preoperative templating. Level of evidence: Level III (retrospective observational study). [ABSTRACT FROM AUTHOR]

The efficiency ofTrichoderma harzianum(MIAU 145 C) in promoting kidney bean (cv. Goli) growth in different soil texture (sandy loam, loam and clay loam) and organic matter content (0.5 and 2% of leaf litter) was assessed in a factorial experiment in the absence ofMeloidogyne javanica. In another factorial experiment, the effect of soil texture, soil organic content and control measure (no control, 10 ml ofT. harzianumcontaining 106spore ml−1and 2 mg ai cadusafos kg−1soil) was determined on nematode-infected kidney bean’s growth, fungus controlling activity andM. javanicareproduction. Except for the shoot length, the fungus improved plant growth. Clay loam was not a proper soil type for the cultivation of kidney bean plants (even in the soil without nematode), but the plant grew better in sandy loam and loam soil. The presence of leaf litter in the soil enhanced plant growth, increased fungal efficiency and increased nematode reproduction. It seems thatT. harzianumcan activate the plant defence system in sandy loam soil.T. harzianumwas more effective in sandy loam or loam soil containing 2% organic matter (leaf litter) and reduced the reproduction factor of the nematode in the tested soil textures equally to the chemical nematicide treatment. [ABSTRACT FROM PUBLISHER]

Abstract: The automatic recognition of the modulation format of a detected signal, the intermediate step between signal detection and demodulation, is a major task of an intelligent receiver, with various civilian and military applications. Obviously, with no knowledge of the transmitted data and many unknown parameters at the receiver, such as the signal power, carrier frequency and phase offsets, timing information, etc., blind identification of the modulation is a difficult task. This becomes even more challenging in real world. In this paper I develop a novel algorithm using Two Threshold Sequential Algorithmic Scheme (TTSAS) algorithm and pattern recognition to identify the modulation types of the communication signals automatically. I have proposed and implemented a technique that casts modulation recognition into shape recognition. Constellation diagram is a traditional and powerful tool for design and evaluation of digital modulations. In this paper, modulation classification is performed using constellation of the received signal by fuzzy clustering and consequently hierarchical clustering algorithms are used for classification of Quadrature–Amplitude Modulation (QAM) and Phase Shift Keying (PSK) modulations and also modulated signal symbols constellation utilizing TTSAS clustering algorithm, and matching with standard templates, is used for classification of QAM modulation. TTSAS algorithm used here is implemented by the Hamming neural network. The simulation results show the capability of this method for modulation classification with high accuracy and appropriate convergence in the presence of noise. [Copyright &y& Elsevier]

Among the many factors important in children's development is sleep. Sleep disorders can impair children's sleep and lead to negative consequences. Obstructive sleep apnea (OSA), which involves blockage of the airway during sleep, can affect development and behaviour; thus, OSA in children should be diagnosed and treated at an early stage. One of the main causes of childhood OSA is enlargement of the tonsil tissues and, in most cases, their removal serves as an ultimate treatment of OSA. However, it remains unclear what proportion of children with enlarged tonsil tissue suffer from OSA. Dentists are becoming increasingly aware of the issue of OSA as they are sometimes involved in treatment of this condition using oral appliances. Moreover, as dentists often look into children's mouths, they can play an active role in identifying those with enlarged tonsils and referring them for sleep assessment. [ABSTRACT FROM AUTHOR]

Thoracic surgery is associated with significant rates of postoperative morbidity and postdischarge return to the hospital or emergency department (ED). This study aims to assess the impact of a novel integrated patient-centered, hospital-based multidisciplinary community program (Integrated Comprehensive Care [ICC]) on postdischarge outcomes in patients undergoing thoracic surgery compared to routine care. This was a retrospective cohort study of patients who underwent surgical resection for lung malignancies at a tertiary care center from 2010 to 2014. Patients were divided into 2 cohorts based on their enrollment in the ICC program (intervention cohort; 2012-2014) or routine postoperative care (control cohort; 2010-2012). Propensity score matching was performed to match the 2 cohorts. The impact of the ICC program on postoperative length of stay (LOS), rate of ED visits, readmissions, and mortality within the first 60 days was assessed. Of the 1288 patients included in this study, 658 (51.1%) were male patients with mean age of 64 years (standard deviation 14.1 years). After propensity score matching, 478 patients were enrolled in the ICC cohort and 592 were enrolled as controls. The ICC cohort had significantly shorter LOS (4 days, vs 5 days in controls, P =.001), lower rate of 60-day ED visits (9.8% vs 28.4% in controls, P <.001), and readmissions (6.9% vs 8.6% in controls, P <.001). The 60-day mortality was also significantly lower in the ICC cohort compared with the control group (0.6% vs 0.8% in controls, P <.001). The ICC program is associated with shorter LOS, fewer ED visits and readmissions after discharge, and ultimately may decrease postoperative mortality. The ICC program performs an inpatient assessment and arranges for the appropriate homecare services resulting in shorter length of stay, fewer emergency department visits, and readmissions. [Display omitted] [ABSTRACT FROM AUTHOR]

Objectives The value of intraoperative extracorporeal membrane oxygenation (ECMO) in lung transplantation remains controversial. In our department, ECMO has been used routinely for intraoperatively unstable patients for more than 15 years. Recently, we have extended its indication to a preemptive application in almost all cases. In addition, we prolong ECMO into the early postoperative period whenever graft function does not meet certain quality criteria or in patients with primary pulmonary hypertension. The objective of this study was to review the results of this strategy. Methods All standard bilateral lung transplantations performed between January 2010 and June 2016 were included in this single-center, retrospective analysis. Patients were divided into 3 groups: group I—no ECMO (n = 116), group II—intraoperative ECMO (n = 343), and group III—intraoperative and prolonged postoperative ECMO (n = 123). The impact of different ECMO strategies on primary graft function, short-term outcomes, and patient survival were analyzed. Results The use of intraoperative ECMO was associated with improved 1-, 3-, and 5-year survival compared with non-ECMO patients (91% vs 82%, 85% vs 76%, and 80% vs 74%; log-rank P = .041). This effect was still evident after propensity score matching of both cohorts. Despite the high number of complex patients in group III, outcome was excellent with higher survival rates than in the non-ECMO group at all time points. Conclusions Intraoperative ECMO results in superior survival when compared with transplantation without any extracorporeal support. The concept of prophylactic postoperative ECMO prolongation is associated with excellent outcomes in recipients with pulmonary hypertension and in patients with questionable graft function at the end of implantation. [ABSTRACT FROM AUTHOR]

Background: Esophageal cancer is associated with poor prognosis. Diagnosis is often delayed, resulting in presentation with advanced disease. We developed a clinical score to predict the risk of a malignant diagnosis in symptomatic patients prior to any diagnostic tests., Methods: We analyzed data from patients referred to a regional esophageal diagnostic assessment program between May 2013 and August 2016. Logistic regression was performed to identify predictors of malignancy based on patient characteristics and symptoms. Predicted probabilities were used to develop a score from 0 to 10 which was weighted according to beta coefficients for predictors in the model. Score accuracy was evaluated using a receiver operating characteristic (ROC) curve and internally validated using bootstrapping techniques. Patients were classified into low (0-2 points), medium (3-6 points), and high (7-10 points) risk groups based on their scores. Pathologic tissue diagnosis was used to assess the effectiveness of the developed score in predicting the risk of malignancy in each group., Results: Of 530 patients, 363 (68%) were diagnosed with malignancy. Factors predictive of malignancy included male sex, family history of cancer and esophageal cancer, fatigue, chest/throat/back pain, melena and weight loss. These factors were allocated 1-2 points each for a total of 10 points. Low-risk patients had 70% lower chance of malignancy (RR =0.28, 95% CI: 0.21-0.38), medium-risk had 50% higher chance of malignancy (RR =1.5, 95% CI: 1.26-1.77), and high-risk patients were 8 times more likely to be diagnosed with malignancy (RR =8.2, 95% CI: 2.60-25.86). The area under the ROC curve for malignancy was 0.82 (95% CI: 0.77-0.87)., Conclusions: A simple score using patient characteristics and symptoms reliably distinguished malignant from benign diagnoses in a population of patients with upper gastrointestinal symptoms. This score might be useful in expediting investigations, referrals and eventual diagnosis of malignancy., Competing Interests: Conflicts of Interest: YS serves as the unpaid editorial board member of Journal of Thoracic Disease from Aug 2019 to Jul 2021. The other authors have no conflicts of interest to declare., (2020 Journal of Thoracic Disease. All rights reserved.)

Among the many factors important in children"s development is sleep. Sleep disorders can impair children"s sleep and lead to negative consequences. Obstructive sleep apnea (OSA), which involves blockage of the airway during sleep, can affect development and behaviour; thus, OSA in children should be diagnosed and treated at an early stage. One of the main causes of childhood OSA is enlargement of the tonsil tissues and, in most cases, their removal serves as an ultimate treatment of OSA. However, it remains unclear what proportion of children with enlarged tonsil tissue suffer from OSA. Dentists are becoming increasingly aware of the issue of OSA as they are sometimes involved in treatment of this condition using oral appliances. Moreover, as dentists often look into children"s mouths, they can play an active role in identifying those with enlarged tonsils and referring them for sleep assessment.