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Simple Summary: The Korean raccoon dog (Nyctereutes procyonoides koreensis) is an important species in Korea. However, there has been little research about its joint anatomy. In this study, we investigated the anatomy of the limb joints of the Korean raccoon dog using joint orientation angles, a method frequently used in humans, dogs, and cats. The findings of this study should be helpful not only for individual therapies, such as fracture repair, but also for comparative anatomy. Furthermore, this study is the first to measure joint orientation angles in wild animals such as the Korean raccoon dog, making it a useful reference for measurements in other wild canids. Studies are being conducted on the anatomical structures of various wild animals. Despite the ecological importance of the Korean raccoon dog (Nyctereutes procyonoides koreensis), limited research has been conducted on its anatomical structure. This study is the first to establish a reference range for joint orientation angles in the limbs of the Korean raccoon dog. Joint orientation angles are an unexplored concept not only in Korean raccoon dogs but also in other wildlife. However, they are important in the examination of the skeletal anatomy of humans and companion animals, such as dogs and cats. Because this type of measurement is still emerging in wildlife research, we applied the methodology used in the domestic dog (Canis lupus familiaris). Angles were measured between the mechanical or anatomical axis and the joint orientation lines in the thoracic and pelvic limbs of Korean raccoon dogs. No significant differences were observed between the sexes or between the left and right sides. These findings are consistent with those observed in domestic dogs. Based on this study, a reference range of joint orientation angles could be established for Korean raccoon dogs. [ABSTRACT FROM AUTHOR]

The heterogeneity of ovarian cancer (OC) has made developing effective treatments difficult. Nowadays, hormone therapy plays a growing role in the treatment of OC; however, hormone modulators have had only limited success so far. To provide a more rigorous foundation for hormonal therapy for different OC subtypes, the current study used a series of bioinformatics approaches to analyse the expression profiles of genes encoding membrane progesterone (PGRMC1, progestins and the adipoQ receptor [PAQR] family), and androgen (zinc transporter member 9 [ZIP9], OXER1) receptors. Our work investigated also their prognostic value in the context of OC. We found differences in expression of ZIP9 and OXER1 between different OC subtypes, as well as between patient tumour and normal tissues. Expression of mRNA encoding PAQR7 and PAQR8 in a panel of OC cell lines was below the qPCR detection limit and was downregulated in tumour tissue samples, whereas high expression of PGRMC1 and PAQR4 mRNA was observed in rare subtypes of OC cell lines. In addition, chemical inhibition of PGRMC1 reduced the viability of rare OCs represented by COV434 cells. In conclusion, PGRMC1 and PAQR4 are promising targets for anticancer therapy, particularly for rare subtypes of OC. These findings may reflect differences in the observed responses of various OC subtypes to hormone therapy.

Background: This study aimed to assess the role and effect of neoadjuvant targeted therapy (TT) versus targeted combined with chemotherapy (TC) for resectable EGFR-mutant non--small cell lung cancer (NSCLC). Methods: Between March 2021 and June 2023, 20 patients with stage IA3-IIIB NSCLC were enrolled in the study. Eleven patients received EGFR-TKIs in the TT group, while nine patients received EGFR-TKIs and two cycles of cisplatin-based doublet chemotherapy (TC group). We compare the differences between the two groups through the following variables, including age, sex, surgical approach, postoperative complications, neoadjuvant therapy adverse events, complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), objective response rate (ORR), major pathologic response (MPR), and pathologic complete response (pCR). Results: Patients were predominantly female (75%) and never-smokers (95%). The average age was 59.2 years (range 46-79 years). Fifty-five percent harbored an exon 19 EGFR mutation and 45% an exon 21 mutation. The average targeted drug dosing time was 2.91 ± 1.7 (range 1-6) months in the TT group and 3.56 ± 3.54 (range 1-12) months in the TC group (P=0.598). The most common side effects were rash and diarrhea. No grade 5 events with neoadjuvant therapy were observed. The rate of R0 resection was 100% in all patients. Among the 11 patients in the TT group, 6 achieved a PR and 5 had SD, resulting in an ORR of 54.5%. Among the 9 patients in the TC group, 6 had PR and the remaining 3 had SD, resulting in an ORR of 66.6%. one patient (11.1%) in the TC group achieved pCR, while no patients in the TT group achieved pCR (P = 0.142). Two patients (18.2%) in the TT group reached MPR, and 2 patients (22.2%) in the TC group reached MPR (P = 0.257). The overall clinical downstage rate is 60%. Only 9 (45%) cases of yield clinical TNM (ycTNM) were consistent with yield pathologic TNM (ypTNM). Conclusion: Results from this retrospective controlled research indicate that the neoadjuvant TT group is likely to be more effective outcomes and has safer profile in patients with EGFR-positive NSCLC than the neoadjuvant TC group. However, our results need to be validated in a multicenter, large sample prospective study. [ABSTRACT FROM AUTHOR]

Recently, the internet has created a global community by connecting millions of individuals, devices, and organizations. Unfortunately, internet connectivity is still not available to many people around the world. To provide everyone with internet access, network infrastructures must be expanded, and internet connection costs must be reduced, particularly in developing regions. Therefore, Wireless Community Networks (WCNs) have emerged as a crucial alternative for individuals who lack direct access to internet services provided by traditional internet service providers. This research paper aims to investigate the routing protocols that have been widely employed in WCNs over the past decade. Specifically, it focuses on evaluating the strengths and limitations of these protocols to assess their effectiveness and reliability in establishing optimal routing paths for end-to-end message delivery across the network. A set of recommendations and future directions are proposed to facilitate further research into unresolved challenges related to WCN routing protocols. [ABSTRACT FROM AUTHOR]

Abstract Background Pulmonary large-cell neuroendocrine carcinoma (pLCNEC) represents a rare malignancy characterized by its aggressive behavior and a notably high recurrence rate. Remarkably, there is currently no established standard treatment protocol for this condition. Case description In this report, we present an intriguing case of pLCNEC diagnosed at clinical-stage IIB. This case involves a 64-year-old man with a smoking history spanning four decades. In our approach, we initiated a course of neoadjuvant chemotherapy in combination with pembrolizumab, administered for two cycles prior to surgical resection. This innovative treatment strategy resulted in a significant pathological response, culminating in a major pathological remission (MPR). As of the time of composing this report, the patient has been diligently monitored for 39 months post-surgery, exhibiting no indications of recurrence, and has demonstrated exceptional tolerance to the entire treatment regimen. Conclusions We have first reported a clinically successful case of neoadjuvant combination chemotherapy with pembrolizumab in the treatment of pLCNEC. This case offers promising clinical insights and suggests that this therapeutic approach could be a viable option for managing pLCNEC.

The Multi-Point Relay (MPR) is one of the core technologies for Optimizing Link State Routing (OLSR) protocols, offering significant advantages in reducing network overhead, enhancing throughput, maintaining network scalability, and adaptability. However, due to the restriction that only MPR nodes can forward control messages in the network, the current evaluation criteria for selecting MPR nodes are relatively limited, making it challenging to flexibly choose MPR nodes based on current link states in dynamic networks. Therefore, the selection of MPR nodes is crucial in dynamic networks. To address issues such as unstable links, poor transmission accuracy, and lack of real-time performance caused by mobility in dynamic networks, we propose a comprehensive evaluation algorithm of MPR based on link-state awareness. This algorithm defines five state evaluation parameters from the perspectives of node mobility and load. Subsequently, we use the entropy weight method to determine weight coefficients and employing the method of Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) for comprehensive evaluation to select MPR nodes. Finally, the Comprehensive Evaluation based on Link-state awareness of OLSR (CEL-OLSR) protocol is proposed, and simulated experiments are conducted using NS-3. The results indicate that, compared to PM-OLSR, ML-OLSR, LD-OLSR, and OLSR, CEL-OLSR significantly improves network performance in terms of packet delivery rate, average end-to-end delay, network throughput, and control overhead. [ABSTRACT FROM AUTHOR]

In this article, the adoption of a legitimate language by the Mongolian People’s Republic following the language reform of the 1930s, which involved the switch to the Latin script, is considered. The language policy pursued by the MPR in the early 20th century is investigated from the perspective of the legitimate language theory. By that period, the traditional Mongolian script had become outdated and needed to be reformed. Furthermore, the illiteracy rate among Mongolian people was very high, and the old Mongolian script was difficult to study. Another reason is that the language turned into the main tool for promoting the new cultural and ideological values of the USSR. Thus, the shift of Mongolia to the writing system based on the Latin alphabet was a political phenomenon and played a key role in broadcasting the cultural policy of the new state. In the early years of the MPR, the Latin-based writing solved several problems at once: it promoted literacy among Mongolian people, gave greater publicity to the policy of the Mongolian People’s Revolutionary Party and the new culture, and became a platform to bring together Mongolia and the USSR. To substantiate the importance of the Latin graphics as the official state script, Pierre Bourdieu’s “Language and Symbolic Power” is analyzed, in which the author discusses the origin of the legitimate language and script, as well as their role in the process of nation building. Here, the documents in both Russian and Mongolian are also examined. The obtained results demonstrate that, despite various difficulties, the Latin script was adopted for a quite short period of time as legitimate in the MPR, which had a great influence on the development of the socialist culture and the Mongolian national identity.

Studies are being conducted on the anatomical structures of various wild animals. Despite the ecological importance of the Korean raccoon dog (Nyctereutes procyonoides koreensis), limited research has been conducted on its anatomical structure. This study is the first to establish a reference range for joint orientation angles in the limbs of the Korean raccoon dog. Joint orientation angles are an unexplored concept not only in Korean raccoon dogs but also in other wildlife. However, they are important in the examination of the skeletal anatomy of humans and companion animals, such as dogs and cats. Because this type of measurement is still emerging in wildlife research, we applied the methodology used in the domestic dog (Canis lupus familiaris). Angles were measured between the mechanical or anatomical axis and the joint orientation lines in the thoracic and pelvic limbs of Korean raccoon dogs. No significant differences were observed between the sexes or between the left and right sides. These findings are consistent with those observed in domestic dogs. Based on this study, a reference range of joint orientation angles could be established for Korean raccoon dogs.

Abstract Background The extra-pleural space is challenging to view radiologically and is commonly overlooked. Therefore, it is important to have a comprehensive understanding of its anatomy in order to correctly classify lesions as either pleural or extra-pleural so as to choose the most appropriate treatment. CT with multi-planar reformatting allows the assessment of pathological conditions involving the extra-pleural space. The aim of this cross-sectional study was to assess the role of CT in the detection and evaluation of the extra-pleural space lesions and to classify them according to their CT appearance in order to reach a proper diagnosis and successful management plan. Results This study was conducted on 131 patients who underwent CT scan of the chest for different chest complaints, and the detected extra-pleural space abnormalities were classified according to their CT appearance into three major groups which are fatty expansion and soft tissue stranding group that included 59 cases (45%), abnormal attenuation group that included 13 cases (10%), and soft tissue expansion group that included 59 cases (45%). Out of the 59 cases with increased fatty expansion and soft tissue stranding, 73% were of inflammatory cause (either pulmonary or pleural), 17% were of neoplastic cause, and 3 cases were caused by systemic conditions. The abnormal extra-pleural space attenuation group was classified into air-containing and blood-containing groups, and both were mainly caused by trauma. Soft tissue infiltration of extra-pleural space was classified into neoplastic (85%) and non-neoplastic (15%) lesions, while most of the non-neoplastic pathologies were caused by severe inflammatory processes. The axial images were mostly sufficient to detect extra-pleural space lesions. Conclusions CT has a crucial role in the assessment of extra-pleural space and the different lesions involving it. Those lesions can be classified according to their CT appearance in order to reach a proper diagnosis and as a result aid in better management of these pathologies.

Hongyan Xu, Wenjing Wang, Junlei Yin, Chengcun Song, Lin Li, Zhi Sun Department of Chemotherapy, Weihai Municipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, People’s Republic of ChinaCorrespondence: Hongyan Xu, Department of Chemotherapy, Weihai Municipal Hospital, No. 248, Tongyi Road, Huancui District, Weihai, Shangdong, 264200, People’s Republic of China, Tel +860631-5287510, Email xuhongyan19701212@163.comAim: To investigate the efficacy and safety of preoperative neoadjuvant therapy (PD-1 inhibitor plus nab-PTX and nedaplatin) for resectable stage III lung squamous cell carcinoma (SCC) patients.Methods: Patients with locally advanced lung SCC (stage IIIA, IIIB) who received PD-1 inhibitor combined with nab-PTX and NED between February 2019 and June 2021 in Weihai Municipal Hospital were included and underwent surgical treatment 4 weeks after 2– 4 cycles neoadjuvant therapy. The rate of resection R0, the effective rate, the complete pathological remission rate (pCR) and the rate of major pathological remission (MPR) were observed.Results: A total of 14 initially unresectable male patients with lung SCC were included and received neoadjuvant treatment after evaluation. Nine out of 14 patients (64.3%) experienced treatment-related adverse events (TRAE), among which 8 (57.1%) experienced grade (G) I–II TRAEs including nausea, vomiting, fatigue, constipation, elevated ALT and AST, hyperthyroidism, hypothyroidism, rash, granulocytopenia, and thrombocytopenia, and 1 (7.1%) experienced grade III–V TRAEs (G), including granulocytopenia and atelectasis. Thirteen patients (92.86%) achieved RECIST-assessed partial remission (PR), while 1 patient (7.14%) achieved stable disease (SD) on imaging assessment after neoadjuvant treatment and continued to be progression-free for 26 months. Of the 11 patients who underwent resection, all were alive and recurrence/progression-free. MPR and pCR were observed in 2 (18.18%) and 9 (81.82%), respectively. IHC results exhibited that all NSCLC patients exhibited positive PD-L1 expression (9/14, TPS ≥ 50% or greater; 5/14, 1% < TPS < 50%). Two were negative for ALK, EGFR, and ros-1, and the rest were not examined for driver oncogene mutation.Conclusion: The neoadjuvant therapy of the PD-1 inhibitor combined with nab-PTX and NED demonstrated remarkable therapeutic efficacy and good safety on stage III lung SCC without increasing the risk of TRAE, mortality and surgery-related complications, or impede surgery feasibility.Keywords: lung squamous cell lung cancer, neoadjuvant therapy, immunotherapy, complete pathological remission, pCR, major pathological remission, MPR

The Multi-Point Relay (MPR) is one of the core technologies for Optimizing Link State Routing (OLSR) protocols, offering significant advantages in reducing network overhead, enhancing throughput, maintaining network scalability, and adaptability. However, due to the restriction that only MPR nodes can forward control messages in the network, the current evaluation criteria for selecting MPR nodes are relatively limited, making it challenging to flexibly choose MPR nodes based on current link states in dynamic networks. Therefore, the selection of MPR nodes is crucial in dynamic networks. To address issues such as unstable links, poor transmission accuracy, and lack of real-time performance caused by mobility in dynamic networks, we propose a comprehensive evaluation algorithm of MPR based on link-state awareness. This algorithm defines five state evaluation parameters from the perspectives of node mobility and load. Subsequently, we use the entropy weight method to determine weight coefficients and employing the method of Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) for comprehensive evaluation to select MPR nodes. Finally, the Comprehensive Evaluation based on Link-state awareness of OLSR (CEL-OLSR) protocol is proposed, and simulated experiments are conducted using NS-3. The results indicate that, compared to PM-OLSR, ML-OLSR, LD-OLSR, and OLSR, CEL-OLSR significantly improves network performance in terms of packet delivery rate, average end-to-end delay, network throughput, and control overhead.

Copyright of Turkish Journal of Trauma & Emergency Surgery / Ulusal Travma ve Acil Cerrahi Dergisi is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The extra-pleural space is challenging to view radiologically and is commonly overlooked. Therefore, it is important to have a comprehensive understanding of its anatomy in order to correctly classify lesions as either pleural or extra-pleural so as to choose the most appropriate treatment. CT with multi-planar reformatting allows the assessment of pathological conditions involving the extra-pleural space. The aim of this cross-sectional study was to assess the role of CT in the detection and evaluation of the extra-pleural space lesions and to classify them according to their CT appearance in order to reach a proper diagnosis and successful management plan. Results: This study was conducted on 131 patients who underwent CT scan of the chest for different chest complaints, and the detected extra-pleural space abnormalities were classified according to their CT appearance into three major groups which are fatty expansion and soft tissue stranding group that included 59 cases (45%), abnormal attenuation group that included 13 cases (10%), and soft tissue expansion group that included 59 cases (45%). Out of the 59 cases with increased fatty expansion and soft tissue stranding, 73% were of inflammatory cause (either pulmonary or pleural), 17% were of neoplastic cause, and 3 cases were caused by systemic conditions. The abnormal extra-pleural space attenuation group was classified into air-containing and blood-containing groups, and both were mainly caused by trauma. Soft tissue infiltration of extra-pleural space was classified into neoplastic (85%) and non-neoplastic (15%) lesions, while most of the non-neoplastic pathologies were caused by severe inflammatory processes. The axial images were mostly sufficient to detect extra-pleural space lesions. Conclusions: CT has a crucial role in the assessment of extra-pleural space and the different lesions involving it. Those lesions can be classified according to their CT appearance in order to reach a proper diagnosis and as a result aid in better management of these pathologies. [ABSTRACT FROM AUTHOR]

Improving the rate of growth of real Gross Domestic Product (RGDP) has continued to be the most important policy of many countries, especially, the developing ones. Given the importance of ensuring economic growth in reducing poverty and ensuring improved welfare, it is imperative to identify its various determinants. Studies have identified the various determinants of economic growth, however, sustained economic growth continues to be a misery in Nigeria. This present study aims to determine the impact of monetary policy on economic growth in Nigeria. The study examined monetary policy on economic growth in Nigeria. In doing this, the study employed a time series data between the periods of 1990-2020. The methodology used involved examining the stationary nature of the data using Augmented Dickey-Fuller test and an ARDL bond test for examining the presence of long run relationship among the variables of the study. The short run regression conducted using ARDL regression method showed that monetary policy is an important determinant of economic growth in Nigeria. The two indicators of monetary policy used (Monetary Policy Rate, MPR and Money Growth Rate, M2) exert a significant impact on economic growth in Nigeria. Based on the findings, this study concludes that monetary policy significantly affects economic growth in Nigeria. It is recommended that policy makers in Nigeria should improve the monetary policy in such a way to increase the economic growth in Nigeria. [ABSTRACT FROM AUTHOR]

Positive feedback on gonadotropin release requires not only estrogen but also progesterone to activate neural circuits. In rodents, ovarian estradiol (E2) stimulates progesterone synthesis in hypothalamic astrocytes (neuroP), needed for the luteinizing hormone (LH) surge. Kisspeptin (kiss) neurons are the principal stimulators of gonadotropin-releasing hormone neurons, and disruption of kiss signaling abrogates the LH surge. Similarly, blocking steroid synthesis in the hypothalamus or deleting classical progesterone receptor (PGR) selectively in kiss neurons prevents the LH surge. These results suggest a synergistic action of E2 and progesterone in kiss neurons to affect gonadotropin release. The mHypoA51, immortalized kiss-expressing neuronal cell line derived from adult female mice, is a tractable model for examining integration of steroid signaling underlying estrogen positive feedback. Here, we report that kiss neurons in vitro integrate E2 and progesterone signaling to increase levels of kiss translation and release. mHypoA51 neurons expressed nonclassical membrane progesterone receptors (mPRα and mPRβ) and E2-inducible PGR, required for progesterone-augmentation of E2-induced kiss expression. With astrocyte-conditioned media or in mHypoA51-astrocyte co-culture, neuroP augmented stimulatory effects of E2 on kiss protein. Progesterone activation of classical, membrane-localized PGR led to activation of MAPK and Src kinases. Importantly, progesterone or Src activation induced release of kiss from E2-primed mHypoA51 neurons. Consistent with previous studies, the present results provide compelling evidence that the interaction of E2 and progesterone stimulates kiss expression and release. Further, these results demonstrate a mechanism though which peripheral E2 may prime kiss neurons to respond to neuroP, mediating estrogen positive feedback.

Abdullah A Mobarki,1 Gasim Dobie,1 Muhammad Saboor,1,2 Aymen M Madkhali,1 Mohammad S Akhter,1 Ali Hakamy,3 Adel Humran,4 Yousof Hamali,5 Denise E Jackson,6 Hassan A Hamali1 1Department of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 2Medical Research Center, Jazan University, Gizan, Saudi Arabia; 3Department of Respiratory Therapy, Faculty of Applied Medical Sciences, Jazan University, Gizan, Saudi Arabia; 4Respiratory Care Department, King Fahad Central Hospital, Gizan, Saudi Arabia; 5Radiodiagnostics and Medical Imaging Department, Prince Sultan Medical City, Riyadh, Saudi Arabia; 6Thrombosis and Vascular Diseases Laboratory, School of Health and Biomedical Sciences, Royal Melbourne Institute of Technology (RMIT) University, Bundoora, VIC, AustraliaCorrespondence: Hassan A HamaliDepartment of Medical Laboratory Technology, Faculty of Applied Medical Sciences, Jazan University, P.O. Box 1906, Gizan, 45142, Saudi ArabiaTel +966581155585Email hhamali@jazanu.edu.saObjective: The aims of the current study were to evaluate the importance of MPR and NLR as prognostic markers in ICU-admitted COVID-19 patients and to investigate the impact of COVID-19 on hematological and coagulation parameters in patients from Jazan region of Saudi Arabia.Methods: This retrospective study was conducted between October 2020 and January 2021 at King Fahad Central Hospital, Jazan region. Medical files, which included the results of complete blood count (CBC), calculated mean platelet volume to platelet count ratio (MPR) and neutrophils-to-lymphocytes ratio (NLR) parameters, coagulation profile and D-dimer test, of 96 (64 male and 32 female) COVID-19-infected patients admitted to the intensive care unit were reviewed. Associations between the test results and COVID-19 infection outcomes (discharged [DC] or passed away [PA]) were measured.Results: The results of the current study demonstrate overall significant differences in CBC parameters between PA group as compared to DC group (P < 0.05). The PA group had a significantly elevated MPR (10.15± 12.16 vs 4.04± 1.5; P < 0.01) and NLR (18.29± 19.82 vs 7.35± 9.68; P < 0.01) as compared to the DC group, suggesting an association between these parameters and mortality. Odds ratios analysis also showed that adjustment for demographic variables and comorbidities did not weaken the observed association.Conclusion: Elevated MPR and NLR are associated with poor prognosis in COVID-19 patients and could be useful as therapy management indicators.Keywords: COVID-19, NLR, MPR, ICU, CBC, mortality

Komplikasi hipertensi pada organ tubuh menyebabkan angka kematian yang tinggi. Hipertensi membutuhkan terapi obat jangka panjang sehingga pasien harus patuh menjalani pengobatan. Salah satu jenis kepatuhan dalam pengobatan hipertensi adalah kepatuhan pengambilan ulang obat dari fasilitas pelayanan kesehatan sehingga pasien senantiasa memiliki ketersediaan obat untuk diminum. Tujuan penelitian ini adalah untuk melihat kepatuhan pengambilan ulang obat anti hipertensi pasien hipertensi rujuk balik di Apotek Appo Farma Banjarmasin. Penelitian menggunakan desain observasional. Pengumpulan data dilakukan secara retrospektif. Data dikumpulkan dari resep pasien rujuk balik di Apotek Appo Farma Banjarmasin pada periode bulan Mei-Juni 2022. Sebanyak 123 sampel digunakan pada penelitian ini. Metode pengambilan sampel menggunakan teknik simple random sampling. Data kepatuhan pengambilan obat ulang dianalisis dengan metode Medication Possession Ratio (MPR). Parameter hasil perhitungan MPR dibagi menjadi kategori patuh apabila ? 80% dan tidak patuh apabila kurang dari 80%. Data hasil penelitian ditampilkan secara deskriptif. Hasil penelitian menunjukkan bahwa pada pengukuran kepatuhan pengambilan obat ulang dengan periode 3 bulan dan 6 bulan sama-sama didominasi oleh sampel dengan kategori patuh mengambil obat ulang dengan jumlah 103 sampel (83,74%). Berdasarkan data tersebut dapat disimpulkan bahwa sampel pasien hipertensi pada penelitian ini belum semuanya patuh dalam mengambil ulang obat anti hipertensinya.

Hydrologic modeling in Nigeria is plagued by non-existent or paucity of hydro-metrological/morphological records, which has detrimental impacts on sustainable water resource management and agricultural production. Nowadays, freely accessible remotely sensed products are used as inputs in hydrologic modeling, especially in regions with deficient observed records. Therefore, it is appropriate to utilize the fine-resolution spatial coverage offered by these products in a parameter regionalization method that supports sub-grid variability. This study assessed the transferability of optimized model parameters from a gauged to an ungauged basin using the mesoscale Hydrologic Model (mHM)—Multiscale Parameter Regionalization (MPR) technique. The ability of the fifth generation European Centre for Medium-Range Weather Forecasts Reanalysis product (ERA5), Climate Hazards Group InfraRed Precipitation with Station data (CHIRPS), Global Precipitation Climatology Centre (GPCC), and Multi-Source Weighted-Ensemble Precipitation (MSWEP) gridded rainfall products to simulate observed discharge in three basins was first assessed. Thereafter, the CHIRPS rainfall product was used in three multi-basin mHM setups. Optimized model parameters were then transferred to independent basins, and the reproduction of observed discharges was assessed. Kling–Gupta Efficiency (KGE) scores showed improvements when mHM runs were performed using optimized parameters in comparison to using default parameters for discharge simulations. Optimized mHM runs performed reasonably (KGE > 0.4) for all basins and rainfall products. However, only one basin showed a satisfactory KGE value (KGE = 0.54) when optimized parameters were transferred to an ungauged basin. This study underscores the utility of the mHM-MPR tool for parameter transferability during discharge simulation in data-scarce regions. [ABSTRACT FROM AUTHOR]

Adherence is a particular concern in treating hypertension, and non-adherence to antihypertensive drugs might cause uncontrolled hypertension. This study aimed to measure retrospectively the medication adherence of hypertensive patients with monotherapy treatment in a community health center (Puskesmas) in Bandung city, Indonesia. The retrospective patient data from 2011 to 2015 were obtained from an electronic prescription database. The patient data of those diagnosed with hypertension, >18 years old, and who received mono-antihypertensive therapy within a 12-month period were included in this study. To assess medication adherence, the medication possession ratio (MPR) was applied. Out of 780 patients, 93.6% of patients showed poor adherence, about 5.8% showed intermediate adherence, and 0.6% of patients had high adherence. Males and females showed different levels of adherence (p<0.05). Efforts should be focused on obtaining optimum clinical benefits and strengthening the effectiveness of health systems in Indonesia. [ABSTRACT FROM AUTHOR]

The People's Consultative Assembly (MPR) is a representative institution which is one of the highest state institutions in the Indonesian constitutional system. MPR Decrees are MPR Decrees to determine the exercise of MPR powers, namely to determine policies on State Policy Guidelines (GBHN). The MPR decree is one of the types of laws and regulations in force in Indonesia. The existence of the MPR Decree in the hierarchy of laws and regulations in force in Indonesia almost always experiences dynamics and ambivalence. Whether it is due to changes in the Indonesian constitutional system, as well as the development of knowledge and knowledge regarding the legislation itself. This raises several problems, both physiologically, juridically and theoretically. The purpose of this study was to determine the legal implications of the existence of MPR decrees in the hierarchy of laws and regulations in Indonesia. This research is a normative juridical research with a statutory approach, a historical approach, a conceptual approach, and a philosophical approach. The legal materials used are primary, secondary, and tertiary law materials with perspective analysis techniques with deductive-inductive reasoning. The results showed that the re-entry of the MPR Decree in Law no. 12 of 2011 as a type of Legislation and its hierarchy is placed after the 1945 Constitution as regulated in MPR Decree No. III/MPR/2000, making the implications of the MPR Decree very large and significant. MPR decrees have again become a source of formal and material law.

Kyung Rae Ko,1 Sangcheol Lee,2 Seo Yoon Oh,3 Ki-duk Kim,4 Sin Hyung Park,4,* Soonchul Lee2,* 1Department of Orthopaedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; 2Department of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, Seongnam-si, Gyeonggi-do, Republic of Korea; 3University of California, Berkeley, CA 94720, USA; 4Department of Orthopaedic Surgery, Bucheon Hospital, Soonchunhyang University School of Medicine, Bucheon-si, Gyeonggi-do, Republic of Korea*These authors contributed equally to this workCorrespondence: Soonchul LeeDepartment of Orthopaedic Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, Republic of KoreaTel +82 31-780-5289Fax +82 31-708-3578Email Lsceline78@gmail.comSin Hyung ParkDepartment of Orthopaedic Surgery, Bucheon Hospital, Soonchunhyang University School of Medicine, 170 Jomaru-Ro, Bucheon-si, Gyeonggi-do, Republic of KoreaTel +82 32-621-5114Fax +82 32-708-3578Email Sh0803@schmc.ac.krBackground: Factors determining bisphosphonate compliance are not fully understood. We examined fluctuations in oral bisphosphonate dosing intervals to gauge therapeutic compliance in patients with osteoporosis.Materials and Methods: Hospital data accruing between 2010 and 2017 were accessed to retrospectively study patients ≥ 50 years old (N=1873), each prescribed bisphosphonate at initial diagnosis of osteoporosis. The medication possession ratio (MPR), calculated as total days supplied divided by length of follow-up, served to measure therapeutic compliance. We compared MPRs of various prescription patterns (daily, weekly, monthly, and switch [ie, ≥ 1 change in pattern] groups). We also analyzed the impact of age, sex, fracture history, surgical history, and comorbidities. Multiple regression analysis was ultimately performed, using MPR as a dependent variable.Results: In our cohort (mean follow-up=5.7± 2.4 years), once weekly dosing was the most common prescription pattern (1223/1873, 65.3%), as opposed to monthly (366/1873, 19.5%) or daily (164/1873, 8.8%) dosing. A total of 120 patients (6.4%) comprising the switch group changed dosing patterns during the study period. MPR was significantly higher in the switch group (32.8± 22.7) than in the other three groups (daily, 21.9± 25.9; weekly, 22.7± 27.3; monthly, 23.2± 27.7). In multiple regression analysis, younger age (P< 0.001), female sex (P=0.004), and switching of prescription pattern (decrease or increase frequency) were factors significantly associated with higher MPR, signaling better compliance.Conclusion: Better bisphosphonate compliance was associated with physician-modified dosing patterns. We therefore recommend adjustments of prescription intervals in poorly compliant patients requiring long-term treatment.Keywords: bisphosphonate, compliance, medication possession ratio, MPR

Wacana reformulasi GBHN dan pengembalian kewenangan MPR untuk membuat ketetapan, kembali menguat pasca-Kongres V PDI-P (2019). Kongres tersebut menghasilkan 23 rekomendasi yang berisi sikap dan kebijakan partai serta usulan untuk pemerintahan Jokowi-Ma'ruf 2019-2024. Kajian ini bertujuan memetakan proses politik wacana reformulasi GBHN dan Posisi MPR pasca-amandemen UUD 1945. Hasil kajian ini menemukan fakta sebagai market leader dalam penataan sistem ketatanegaraan dengan memperkuat MPR dan menetapkan haluan negara, PDI-P kurang piawai mengelola situasi politik. PDI-P yang memperjuangkan agenda terbatas dalam amandemen, harus menenggang agenda lain. Saat ini kuasa ada di pimpinan PDI-P dan presiden, selain itu juga bergantung pada respon pemilik saham besar lain atas republik ini, yakni para ketua umum partai yang punya wakil di DPR/MPR.

Abstract Background Gastric cancer is regarded as the fifth most frequent tumor globally but the third most common fatal illness. As early as possible, we diagnose cancer stomach especially at early stages, the higher the rate of life. Nevertheless, most cases are diagnosed at late cases where surgery is not of the same benefit at early stages because of clinically indefinite symptoms. The prospective study goal is to estimate the role of MDCT in diagnosis and staging of cancer stomach. Results In our study, it was found that there was a high relationship between pathological and CT staging by using MPR. CT with MPR was specific and accurate in diagnosis of all stages of gastric cancer with specificity ranged between 93 and 97% and accuracy ranged between 90 and 92.5%. However, it showed lowest sensitivity in diagnosis of stage 1 of gastric cancer. On the other hand, it showed highest sensitivity (90%) in diagnosis of stage IV as well as we found that MPR and VR of MDCT are much more accurate (92.5%) than multi-detector computed tomography axial images (80%) in the diagnosis of all stages of gastric cancer with the difference between the two sequences was significant (P = 0.009). Conclusion Our results demonstrate that preoperative MDCT with contrast filling technique for abdomen and pelvis evaluates the local disease process of gastric cancer as well as the potential areas of spread. This information is vital in choosing between palliative or radical surgery. MPR and VR help in the assessment of tumor extension and considered as a highly representative prognostic value. Making it the imaging modality of choice in diagnosis and staging of gastric cancers.

The 1945 Constitution as the constitution of the Indonesian state which adopts a distribution of power system accompanied by a mechanism of checks and balances between state institutions based on popular sovereignty. In this case, as the People's Consultative Assembly and the Constitutional Court which have the authority related to the 1945 Constitution directly. Then it contains the research distinction that is the actual inherence of the authority of the People's Consultative Assembly and the Constitutional Court institutions as the guardians of the constitution through a technical review of checks and balances. Therefore, to scientifically strengthen this legal research, a juridical-normative, philosophical and conceptual-critical approach is used. On that basis, it is considered that between the People's Consultative Assembly and the Constitutional Court have actual significance of the checks and balances mechanism on their institutional authority as the guardian of the constitution. Therefore, it has implications for strengthening the institutional authority of the said state institution and realizing the order of legal civilization and democracy in the 1945 Constitution as the state constitution which is the central point of the administration of the Indonesian state as a democratic law state.

Background: This study aimed to assess the role and effect of neoadjuvant targeted therapy (TT) versus targeted combined with chemotherapy (TC) for resectable EGFR-mutant non-small cell lung cancer (NSCLC)., Methods: Between March 2021 and June 2023, 20 patients with stage IA3-IIIB NSCLC were enrolled in the study. Eleven patients received EGFR-TKIs in the TT group, while nine patients received EGFR-TKIs and two cycles of cisplatin-based doublet chemotherapy (TC group). We compare the differences between the two groups through the following variables, including age, sex, surgical approach, postoperative complications, neoadjuvant therapy adverse events, complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), objective response rate (ORR), major pathologic response (MPR), and pathologic complete response (pCR)., Results: Patients were predominantly female (75%) and never-smokers (95%). The average age was 59.2 years (range 46-79 years). Fifty-five percent harbored an exon 19 EGFR mutation and 45% an exon 21 mutation. The average targeted drug dosing time was 2.91 ± 1.7 (range 1-6) months in the TT group and 3.56 ± 3.54 (range 1-12) months in the TC group (P=0.598). The most common side effects were rash and diarrhea. No grade 5 events with neoadjuvant therapy were observed. The rate of R0 resection was 100% in all patients. Among the 11 patients in the TT group, 6 achieved a PR and 5 had SD, resulting in an ORR of 54.5%. Among the 9 patients in the TC group, 6 had PR and the remaining 3 had SD, resulting in an ORR of 66.6%. one patient (11.1%) in the TC group achieved pCR, while no patients in the TT group achieved pCR (P = 0.142). Two patients (18.2%) in the TT group reached MPR, and 2 patients (22.2%) in the TC group reached MPR (P = 0.257). The overall clinical downstage rate is 60%. Only 9 (45%) cases of yield clinical TNM (ycTNM) were consistent with yield pathologic TNM (ypTNM)., Conclusion: Results from this retrospective controlled research indicate that the neoadjuvant TT group is likely to be more effective outcomes and has safer profile in patients with EGFR-positive NSCLC than the neoadjuvant TC group. However, our results need to be validated in a multicenter, large sample prospective study., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer DC declared a shared affiliation with the authors to the handling editor at the time of review., (Copyright © 2024 Shao, Liu, Li, Chen, Liu, Li and Guo.)

Background: Pharmacy administrative claims data remain an accessible and efficient source to measure medication adherence for frequently hospitalized patient populations that are systematically excluded from the landmark drug trials. Published pharmacotherapy studies use medication possession ratio (MPR) and proportion of days covered (PDC) to calculate medication adherence and usually fail to incorporate hospitalization and prescription overlap/gap from claims data. To make the cacophony of adherence measures clearer, this study created a refined hospital-adjusted algorithm to capture pharmacotherapy adherence among patients with end-stage renal disease (ESRD). Methods: The United States Renal Data System (USRDS) registry of ESRD was used to determine prescription-filling patterns of those receiving new prescriptions for oral P2Y12 inhibitors (P2Y12-I) between 2011 and 2015. P2Y12-I-naïve patients were followed until death, kidney transplantation, discontinuing medications, or loss to follow-up. After flagging/censoring key variables, the algorithm adjusted for hospital length of stay (LOS) and medication overlap. Hospital-adjusted medication adherence (HA-PDC) was calculated and compared with traditional MPR and PDC methods. Analyses were performed with SAS software. Results: Hospitalization occurred for 78% of the cohort (N = 46 514). The median LOS was 12 (interquartile range [IQR] = 2-34) days. MPR and PDC were 61% (IQR = 29%-94%) and 59% (IQR = 31%-93%), respectively. After applying adjustments for overlapping coverage days and hospital stays independently, HA-PDC adherence values changed in 41% and 52.7% of the cohort, respectively. When adjustments for overlap and hospital stay were made concurrently, HA-PDC adherence values changed in 68% of the cohort by 5.8% (HA-PDC median = 0.68, IQR = 0.31-0.93). HA-PDC declined over time (3M-6M-9M-12M). Nearly 48% of the cohort had a ≥30 days refill gap in the first 3 months, and this increased over time (P <.0001). Conclusions: Refill gaps should be investigated carefully to capture accurate pharmacotherapy adherence. HA-PDC measures increased adherence substantially when adjustments for hospital stay and medication refill overlaps are made. Furthermore, if hospitalizations were ignored for medications that are included in Medicare quality measures, such as Medicare STAR program, the apparent reduction in adherence might be associated with lower quality and health plan reimbursement. [ABSTRACT FROM AUTHOR]

Cystic fibrosis (CF) is a genetic and multisystemic disease that requires a high therapeutic demand for its control. The aim of this study was to assess therapeutic adherence (TA) to different treatments to study possible clinical consequences and clinical factors influencing adherence. This is an ambispective observational study of 57 patients aged over 18 years with a diagnosis of CF. The assessment of TA was calculated using the Medication Possession Ratio (MPR) index. These data were related to exacerbations and the rate of decline in FEV1 percentage. Compliance was good for all CFTR modulators, azithromycin, aztreonam, and tobramycin in solution for inhalation. The patients with the best compliance were older; they had exacerbations and the greatest deterioration in lung function during this period. The three variables with the highest importance for the compliance of the generated Random Forest (RF) models were age, FEV1%, and use of Ivacaftor/Tezacaftor. This is one of the few studies to assess adherence to CFTR modulators and symptomatic treatment longitudinally. CF patient therapy is expensive, and the assessment of variables with the highest importance for a high MPR, helped by new Machine learning tools, can contribute to defining new efficient TA strategies with higher benefits.

Abstract Objective Recurrent spontaneous abortion (RSA) is a condition which is defined as three consecutive pregnancy losses prior to 20 weeks from the last menstrual period. Progesterone is a steroid hormone that has an essential role in the implantation and maintenance of pregnancy. The progesterone signaling is performed by nuclear progesterone receptors (NPRs) and membrane progesterone receptors (mPR). The aim of this study was to analyze gene expression of mPR-α, mPR-β and NPR in the endometrium of patients with a history of RSA compared to normal fertile women. Results In this study, endometrial samples were obtained from 10 women with a history of RSA and 10 fertile women during days 10–14 of menstrual cycle. Relative expression of mPR-α, mPR-β and NPR genes were studied by a quantitative real time polymerase chain reaction (qRT-PCR) and compared between the two groups. The mean relative expression of mPR-β gene was significantly lower in the case group compared to the fertile women (p

Esther du Pon,1,2 Siham El Azzati,1 Ad van Dooren,1 Nanne Kleefstra,3,4 Eibert Heerdink,1,5 Sandra van Dulmen6–8 1Research Group Process Innovations in Pharmaceutical Care, Utrecht University of Applied Sciences, Utrecht, the Netherlands; 2Diabetes Centre, Isala Clinics, Zwolle, the Netherlands; 3Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; 4Medical Research Group, Langerhans, Ommen, the Netherlands; 5Department of Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; 6NIVEL (Netherlands Institute for Health Services Research), Department of Communication in Healthcare, Utrecht, the Netherlands; 7Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Primary and Community care, Nijmegen, the Netherlands; 8Faculty of Health and Social Sciences, University of Southeast Norway, Drammen, Norway Purpose: The present study aims to investigate the effect of the group-based Proactive Interdisciplinary Self-Management (PRISMA) training program on medication adherence in patients with type 2 diabetes (T2DM) treated in primary care.Patients and methods: The current study is a two-arm, parallel group, randomized, open label trial (1:1) of 6-month duration with a 6-month extension period in which both groups received the intervention (wait-list control). People 18 years old or older who were diagnosed with T2DM were included. The intervention consisted of two group meetings about T2DM guided by care providers. The control group received usual care only (visits at the general practice). The primary outcome was adherence based on pharmacy refill data and was measured using medication possession ratio (MPR). The secondary outcomes were the number of drug holidays and self-reported adherence, measured by the 5-item Medication Adherence Rating Scale (MARS-5).Results: Of the total sample (n=108), 66.6% were male. The mean age was 69.3 years (SD=9.1). In the 6-month period, patients were more adherent in the intervention group (n=56) (median MPR =100.0 [51.1–100.0]) than in the control group (n=52) (median MPR =97.7 [54.1–100.0]) (U=1,042, z=-2.783, P=0.005). The intervention group had less drug holidays than the control group (relative risk 0.55, 95% CI, 0.37–0.80). The sum scores of the MARS did not differ between the intervention group (median =23.98, SD=0.91) and the control group (median =24.00, SD=1.54).Conclusion: The PRISMA program resulted in a small improvement in MPR and fewer drug holidays, while no improvement has been found in self-reported adherence. However, health care providers and policy makers could take into account that adherence might be influenced by PRISMA. Keywords: MPR, refill data, drug holidays, MARS, group education

Hydrologic modeling in Nigeria is plagued by non-existent or paucity of hydro-metrological/morphological records, which has detrimental impacts on sustainable water resource management and agricultural production. Nowadays, freely accessible remotely sensed products are used as inputs in hydrologic modeling, especially in regions with deficient observed records. Therefore, it is appropriate to utilize the fine-resolution spatial coverage offered by these products in a parameter regionalization method that supports sub-grid variability. This study assessed the transferability of optimized model parameters from a gauged to an ungauged basin using the mesoscale Hydrologic Model (mHM)—Multiscale Parameter Regionalization (MPR) technique. The ability of the fifth generation European Centre for Medium-Range Weather Forecasts Reanalysis product (ERA5), Climate Hazards Group InfraRed Precipitation with Station data (CHIRPS), Global Precipitation Climatology Centre (GPCC), and Multi-Source Weighted-Ensemble Precipitation (MSWEP) gridded rainfall products to simulate observed discharge in three basins was first assessed. Thereafter, the CHIRPS rainfall product was used in three multi-basin mHM setups. Optimized model parameters were then transferred to independent basins, and the reproduction of observed discharges was assessed. Kling–Gupta Efficiency (KGE) scores showed improvements when mHM runs were performed using optimized parameters in comparison to using default parameters for discharge simulations. Optimized mHM runs performed reasonably (KGE > 0.4) for all basins and rainfall products. However, only one basin showed a satisfactory KGE value (KGE = 0.54) when optimized parameters were transferred to an ungauged basin. This study underscores the utility of the mHM-MPR tool for parameter transferability during discharge simulation in data-scarce regions.

Canakinumab is a human IgGκ monoclonal antibody, with high affinity and specificity for IL-1β. The Canakinumab Anti-Inflammatory Thrombosis Outcome Study (CANTOS) trial, evaluating canakinumab for cardiovascular disease, provided the first signal of the potential of IL-1β inhibition on lung cancer incidence reduction. Here, we describe the rationale and design for CANOPY-N, a randomized Phase II trial evaluating IL-1β inhibition with or without immune checkpoint inhibition as neoadjuvant treatment in patients with non-small-cell lung cancer. Patients with stage IB to IIIA non-small-cell lung cancer eligible for complete resection will receive canakinumab or pembrolizumab as monotherapy, or in combination. The primary end point is major pathological response by central review; secondary end points include overall response rate, major pathological response (local review), surgical feasibility rate and pharmacokinetics. Clinical trial registration: NCT03968419 (ClinicalTrials.gov). [ABSTRACT FROM AUTHOR]

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The position of the People’s Consultative Assembly of the Republic of Indonesia (MPR) as the high state institution fundamentally changed after the amendments to the 1945 Constitution. Previously the MPR was the highest governing body in Indonesia. Nowadays the position and the authority of the MPR in the Indonesian constitutional structure is no longer the highest state institution then is equal to other high state institutions. It is a consequence of the presidential system of government, where the position of all high state institutions is balanced and the principle of “checks and balances” between branches of government is implemented. This paper is a normative legal research examining the amendments to the 1945 Constitution, especially the provisions governing the authority of the MPR as contained in article 3 of the Basic Law. Despite all the changes, the MPR is still being the highest legislative branch in the Indonesian political system. This is because the MPR still has the authority to amend the Constitution.

Myometrium tissue shows the expression of non-genomic membrane progesterone (P4) receptors, such as progesterone receptor membrane components (PGRMC) 1 and 2 and membrane progestin receptors (mPR) alpha (mPRα), beta (mPRβ), and gamma (mPRγ). Their variable expression in the bovine uterus during the estrous cycle and early pregnancy suggests that ovarian steroids and luteotropic and/or luteolytic factors may regulate the expression of these receptors in the myometrium. Therefore, this study aimed to examine the effect of P4, estradiol (E2), P4 with E2, prostaglandins (PG) E2 and F2α, oxytocin (OT), and tumor necrosis factor α (TNFα) on the gene expression of PGRMC1, PGRMC2, serpine-1 mRNA-binding protein (SERBP1), and mPRα, mPRβ, and mPRγ in bovine myometrial cells from days 6 to 10 and 11 to 16 of the estrous cycle. The PGE2 concentration and mRNA expression were determined by EIA and real-time PCR, respectively. The data indicated that P4 and E2 can affect the mRNA expression of all studied receptors and SERPB1. However, PGE2, OT, and TNFα could only modulate the expression of PGRMC1, PGRMC2, and SERPB1, respectively. Steroids/factors changed the expression of PGRMC and mPR genes depending on the dose, the stage of the estrous cycle, and the types of receptors. This suggests that the local hormonal milieu may influence the activity of these receptors and P4 action in myometrial cells during the estrous cycle.

Abstract Background Internal hernia is a rare cause of intestinal obstruction, and sigmoid mesocolon hernia is an extremely rare form of this condition. Among sigmoid mesocolon hernias, intramesosigmoid hernia is the least frequent subtype. We described a case of intramesosigmoid hernia through the orifice on the right leaf of the mesosigmoid with an incarcerated ileum of 6 cm in length without strangulation. This case was diagnosed by multidetector computed tomography with multiplanar reconstruction images and treated without resection of the small intestine in a 52-year-old man with characteristic diagnostic images. Case presentation A 52-year-old man suffering periumbilical cramping pain with sudden onset that had persisted for 1 week without recovery was referred to Fukui Katsuyama General Hospital. Multidetector computed tomography revealed small bowel obstruction, and an incarcerated short intestinal loop was revealed by sagittal slices of the multiplanar reconstruction images of the routine study of the left side of the pelvic space. Sagittal multiplanar reconstruction images also showed narrow belt-shaped fluid retention contacting the tip of the incarcerated short loop toward the cranial direction localized in the mesosigmoid. These findings indicated that the fluid and the herniated small bowel were wrapped together in the mesosigmoid, which was characteristic of intramesosigmoid hernia. The patient underwent laparotomy operation 2 days after admission. The ileum, which was approximately 75 cm proximal to the ileocecal junction and herniated into the mesosigmoid through the right leaf, was released without resection. The orifice located in the central part of the right leaf was oval shaped and measured less than 2 cm in diameter. The left leaf of the mesosigmoid was intact. The orifice of the right lobe was closed by suture. The patient showed an uneventful recovery. Conclusion We report an extremely rare case of incarcerated intramesosigmoid hernia that was diagnosed by multidetector computed tomography with multiplanar reconstruction images. The finding of narrow belt-shaped fluid retention contacting the tip of the incarcerated short intestinal loop is characteristic of intramesosigmoid hernia and will be useful for conclusively differentiating this disease from transmesosigmoid hernia. Although intramesosigmoid hernia is a rare cause of internal hernia, multidetector computed tomography and multiplanar reconstruction images can provide the characteristic findings and proved useful for the precise preoperative diagnosis and treatment of intramesosigmoid hernia.

The People's Consultative Assembly (MPR) is a representative institution which is one of the highest state institutions in the Indonesian constitutional system. MPR Decrees are MPR Decrees to determine the exercise of MPR powers, namely to determine policies on State Policy Guidelines (GBHN). The MPR decree is one of the types of laws and regulations in force in Indonesia. The existence of the MPR Decree in the hierarchy of laws and regulations in force in Indonesia almost always experiences dynamics and ambivalence. Whether it is due to changes in the Indonesian constitutional system, as well as the development of knowledge and knowledge regarding the legislation itself. This raises several problems, both physiologically, juridical and theoretically. The purpose of this study was to determine the legal implications of the existence of MPR decrees in the hierarchy of laws and regulations in Indonesia. This research is a normative juridical research with a statutory approach, a historical approach, a conceptual approach, and a philosophical approach. The legal materials used are primary, secondary, and tertiary law materials with perspective analysis techniques with deductive-inductive reasoning. The results showed that the re-entry of the MPR Decree in Law no.12 of 2011 as a type of Legislation and its hierarchy is placed after the 1945 Constitution as regulated in MPR Decree No. III/MPR/2000, making the implications of the MPR Decree very large and significant. MPR decrees have again become a source of formal and material law. [ABSTRACT FROM AUTHOR]

Background: Gastric cancer is regarded as the fifth most frequent tumor globally but the third most common fatal illness. As early as possible, we diagnose cancer stomach especially at early stages, the higher the rate of life. Nevertheless, most cases are diagnosed at late cases where surgery is not of the same benefit at early stages because of clinically indefinite symptoms. The prospective study goal is to estimate the role of MDCT in diagnosis and staging of cancer stomach. Results: In our study, it was found that there was a high relationship between pathological and CT staging by using MPR. CT with MPR was specific and accurate in diagnosis of all stages of gastric cancer with specificity ranged between 93 and 97% and accuracy ranged between 90 and 92.5%. However, it showed lowest sensitivity in diagnosis of stage 1 of gastric cancer. On the other hand, it showed highest sensitivity (90%) in diagnosis of stage IV as well as we found that MPR and VR of MDCT are much more accurate (92.5%) than multi-detector computed tomography axial images (80%) in the diagnosis of all stages of gastric cancer with the difference between the two sequences was significant (P = 0.009). Conclusion: Our results demonstrate that preoperative MDCT with contrast filling technique for abdomen and pelvis evaluates the local disease process of gastric cancer as well as the potential areas of spread. This information is vital in choosing between palliative or radical surgery. MPR and VR help in the assessment of tumor extension and considered as a highly representative prognostic value. Making it the imaging modality of choice in diagnosis and staging of gastric cancers. [ABSTRACT FROM AUTHOR]

Cancer is one of the most common causes of death worldwide, and its development is a result of the complex interaction of genetic factors, environmental cues, and aging. Hormone-sensitive cancers depend on the action of one or more hormones for their development and progression. Sex steroids and corticosteroids can regulate different physiological functions, including metabolism, growth, and proliferation, through their interaction with specific nuclear receptors, that can transcriptionally regulate target genes via their genomic actions. Therefore, interference with hormones’ activities, e.g., deregulation of their production and downstream pathways or the exposition to exogenous hormone-active substances such as endocrine-disrupting chemicals (EDCs), can affect the regulation of their correlated pathways and trigger the neoplastic transformation. Although nuclear receptors account for most hormone-related biologic effects and their slow genomic responses are well-studied, less-known membrane receptors are emerging for their ability to mediate steroid hormones effects through the activation of rapid non-genomic responses also involved in the development of hormone-sensitive cancers. This review aims to collect pre-clinical and clinical data on these extranuclear receptors not only to draw attention to their emerging role in cancer development and progression but also to highlight their dual role as tumor microenvironment players and potential candidate drug targets.

Christian M Sperber, Suren R Samarasinghe, Grace P Lomax Patient Connect Limited, Guildford, UK Background: The Medication Possession Ratio (MPR) is a ubiquitous and central measurement for adherence in the health care industry. However, attempts to standardize its calculation have failed, possibly due to the opacity of a single, static MPR, incapability of directly lending itself to a variety of studies, and challenges of comparing the value across studies. This work shows that the MPR strictly depends on the length of the time interval over which it is measured as well as on the dominant dispense quantity for short time intervals. Furthermore, removing a proportion of the patient cohort based on the number of acquisitions may also have a severe impact on the MPR. Therefore, it is suggested that the MPR is represented as a trend over a range of time intervals. To this end, an upper and lower bound of the MPR trend is developed with an upper bound acknowledging patients who change their treatment and the lower bound acknowledging patients who discontinue their treatment.Purpose: Introducing a representation of the MPR value as a trend rather than a static number by developing a quantitative description of an upper and lower bound of the MPR trend, while shedding light on the impacts on prefiltering the patient cohort.Patients and methods: Anonymized patient-level data was utilized as an example for a suggested calculation of an upper and lower bound of the MPR.Results: Representation of the MPR for a predefined time interval precludes a reliable MPR assessment. A quantitative approach is suggested to generate an upper and lower trend of the MPR while emphasizing the impact on removing patients with a limited number of acquisitions.Conclusion: An upper and lower trend makes the MPR more transparent and allows a better comparison across different studies. Removing patients with a limited number of acquisitions should be avoided. Keywords: MPR, adherence, pharmacy claims, quantitative calculation, compliance, administrative claims data

Purpose: The present study aims to investigate the effect of the group-based Proactive Interdisciplinary Self-Management (PRISMA) training program on medication adherence in patients with type 2 diabetes (T2DM) treated in primary care. Patients and methods: The current study is a two-arm, parallel group, randomized, open label trial (1:1) of 6-month duration with a 6-month extension period in which both groups received the intervention (wait-list control). People 18 years old or older who were diagnosed with T2DM were included. The intervention consisted of two group meetings about T2DM guided by care providers. The control group received usual care only (visits at the general practice). The primary outcome was adherence based on pharmacy refill data and was measured using medication possession ratio (MPR). The secondary outcomes were the number of drug holidays and self-reported adherence, measured by the 5-item Medication Adherence Rating Scale (MARS-5). Results: Of the total sample (n=108), 66.6% were male. The mean age was 69.3 years (SD=9.1). In the 6-month period, patients were more adherent in the intervention group (n=56) (median MPR =100.0 [51.1–100.0]) than in the control group (n=52) (median MPR =97.7 [54.1–100.0]) (U=1,042, z=-2.783, P=0.005). The intervention group had less drug holidays than the control group (relative risk 0.55, 95% CI, 0.37–0.80). The sum scores of the MARS did not differ between the intervention group (median =23.98, SD=0.91) and the control group (median =24.00, SD=1.54). Conclusion: The PRISMA program resulted in a small improvement in MPR and fewer drug holidays, while no improvement has been found in self-reported adherence. However, health care providers and policy makers could take into account that adherence might be influenced by PRISMA. [ABSTRACT FROM AUTHOR]

Background With increasing anti-PD-1 therapy use in patients with melanoma and other tumor types, there is interest in developing early on-treatment biomarkers that correlate with long-term patient outcome. An understanding of the pathologic features of immune-mediated tumor regression is key in this endeavor. Materials and methods Histologic features of immune-related pathologic response (irPR) following anti-PD-1 therapy were identified on hematoxylin and eosin (H&E)-stained slides in a discovery cohort of pre- and on-treatment specimens from n  = 16 patients with advanced melanoma. These features were used to generate an irPR score [from 0 = no irPR features to 3 = major pathologic response on biopsy (MPRbx, ≤10% residual viable tumor)]. This scoring system was then tested for an association with objective response by RECIST1.1 and overall survival in a prospectively collected validation cohort of pre- and on-treatment biopsies (n  = 51 on-treatment at 4-week timepoint) from melanoma patients enrolled on the nivolumab monotherapy arm of CA209-038 (NCT01621490). Results Specimens from responders in the discovery cohort had features of immune-activation (moderate–high TIL densities, plasma cells) and wound-healing/tissue repair (neovascularization, proliferative fibrosis) compared to nonresponders, (P  ≤ 0.021, for each feature). In the validation cohort, increasing irPR score associated with objective response (P  = 0.009) and MPRbx associated with increased overall survival (n  = 51; HR 0.13; 95%CI, 0.054–0.31, P  = 0.015). Neither tumoral necrosis nor pretreatment histologic features were associated with response. Eight of 16 (50%) of patients with stable disease showed irPR features, two of which were MPRbx, indicating a disconnect between pathologic and radiographic features at the 4-week on-therapy timepoint for some patients. Conclusions Features of immune-mediated tumor regression on routine H&E-stained biopsy slides from patients with advanced melanoma correlate with objective response to anti-PD-1 and overall survival. An on-therapy biopsy may be particularly clinically useful for informing treatment decisions in patients with radiographic stable disease. This approach is inexpensive, straightforward, and widely available. [ABSTRACT FROM AUTHOR]

This research lies within the scope of environmental research for seeking solutions for the optimizations of energy in the electrical supply network ADE- Adrar (Algérienne des Eaux d’Adrar/Algeria). Indeed, the principal aiming of this research is the integration of renewable resources (energy independence and sustainable development) that it pushes us to consider from now on the energy problem not only according to the economic point of view, but also according to an ecological point of view (reduction of CO2 emission). This with us encouraged to develop our systems of energy on the basis of distributed generation on a large scale including/understanding renewable energy and the high-output energetic solutions.

The Contributions of Islamic Order to Deliberative Democracy in Indonesia. Many references indicate the dynamic development of democracy with various definitions and classifications. The founding fathers did not want liberal democracy. Therefore, the consultative democracy was selected as outlined in the formulation of the fourth principle of Pancasila. This decision was considered special because there has been a contribution of Islamic thought. This article describes the principles of Islam in the deliberation that carry deliberative democracy including the meaning and purpose of deliberation, the agency that deliberation, and decision making. Those principles are reflected in the formulation of the fourth principle, the existence of the people’s Consultative Assembly, the membership of the Assembly in 1945 before amendments, and decision making method.DOI: 10.15408/ajis.v16i2.4446

Thirty-eight naphtha samples were used to develop a chemometric method to predict bromine number. All samples were characterized by Fourier transform near infrared spectroscopy (FT-NIR), and their spectra were correlated by similarity using principal component analysis (PCA). The models for bromine number determination (BN) were established by Partial Least Squares regression (PLS) and Multiple Polynomial Regression (MPR). PCA allowed classifying the samples into the light and heavy, determining the most significant spectral variables. These variables are located in the regions between 4000-4800 and 5200-6350cm-1. The results determined by combining FT-NIR spectroscopy and chemometrics were very close to those obtained by standardized methods. This approach may be an alternative for analysis of BN, which requires sample turnarounds lower than five minutes and lower cost compared to traditional methods.