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OBJECTIVE To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy). DATA SOURCES MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles. METHODS OF STUDY SELECTION Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers. TABULATION, INTEGRATION, AND RESULTS Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption. CONCLUSION Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42021244487.

Respiratory Syncytial Virus (RSV) is a common seasonal respiratory virus and an important cause of illness among infants, but the burden of RSV disease is not well described among the older population. The objective of this study was to estimate the age-specific incidence of hospital admission among over 65s due to respiratory illnesses attributable to RSV in England to inform optimal vaccine and therapeutic interventions. We used linear multiple regression to examine the effect of changes in weekly counts of respiratory pathogens on the weekly counts of respiratory hospital admissions. The study population was all patients aged 65 years or over admitted to English hospitals between 2nd August 2010 and 30th July 2017. RSV was estimated to account for a seasonal annual average of 71 (95% CI 52-90) respiratory admissions per 100,000 in adults age 65-74 and 251 (95% CI 186-316) admissions per 100,000 adults age 75+. Pneumococcus was the pathogen responsible for highest annual average respiratory admission with 448 (95% CI 310-587) admissions per 100,000 adults age 65-74 and 1010 (95%CI 527-1493) admissions per 100,000 adults aged 75+. This study shows that RSV continues to exert a significant burden of disease among older adults in England. These findings will support development of policy for the use of RSV therapeutics and vaccines in this age group.

Finger injuries to the hand with extensive soft tissue defects might be challenging to treat. Typically, the first dorsal metacarpal artery (DMA) flap is used for reconstruction, whereas closure of the donor site is routinely performed with a split-thickness skin graft. The aim of the current study is to present a surgical technique that reports a modified incision, which allows elevation of the first DMA flap for the management of the soft tissue defects of the thumb without requiring a skin graft for coverage of the donor site. A 65-year-old man presented to the emergency department with a crush injury to the thumb. The patient had an extensive skin defect on the dorsal side of the thumb extending circumferentially to the ipsilateral thenar without tendon damages, whereas sensation of the finger was found intact. Surgical intervention was performed within six hours and involved DMA flap transfer through a modified skin incision, which allowed coverage of the donor defect in the index finger with a second DMA perforator flap. 3 months postoperatively, patient’s satisfaction, sensation and range of motion (ROM) of the fingers were assessed using The Michigan Hand Outcomes Questionnaire (MHQ) and the 2-point discrimination (2-PD) test. The patient regained active ROM of the thumb and index along with complete preservation of sensation, while the final cosmetic outcome was satisfactory. The application of this technique allows coverage of both trauma defect and donor site with a single skin incision, providing a successful clinical outcome.

This article provides a historical account of the emergence of crop ecology, a precursor of modern agroecology, in the twentieth century. It focuses on the transnational career of agronomist Ioanni...

To assess and compare all current computed tomography angiography (CTA) scoring systems for the diagnostic workup of brain death (BD) to digital subtraction angiography (DSA) and clinical tests. Fifty-two patients with a clinical suspicion of BD underwent CTA and subsequently DSA. The diagnostic performance of all current CTA scoring systems was compared to that of DSA, in all patients with a suspicion of BD. A comparison to clinical tests was made only in DSA-positive for BD patients (n = 49), since in DSA-negative BD patients (n = 3) clinical tests were not performed. Further subgroup analysis was performed in relation to skull defects (SDs) stratification. Statistical analysis was conducted by applying statistics-contingency tables, Cochran’s-Q test and McNemar’s test. The CTA -10, and -7- and all 4-point scoring systems, showed overall sensitivities of 81,6%, 87.8% and 95.9% respectively and 100% specificity, when compared to DSA. In patients with a clinical verification of BD, the CTA -10 and -7-point scoring systems were significantly inferior to clinical tests (p = 0.004 and p = 0.031), while the 4-point scoring systems showed no such difference (p = 0.5). All 4-point scoring systems showed 100% sensitivity in patients with a minor SD or no SD. In patients with a major SD, all CTA scoring systems (− 10, − 7- and all 4-point) were less sensitive (62.5%, 62.5% and 75% respectively). The presence of a major SD was associated with an 8 × relative risk for false negative results in all 4-point scoring systems. CTA showed excellent diagnostic performance in patients with a suspicion of BD. The 4-point CTA scoring systems are the most sensitive for the diagnosis of BD, although in patients with a major SD patient, the role of CTA is ambiguous.

The pseudoaneurysm of the radial artery is an infrequent complication mainly after iatrogenic procedures, with an increased incidence over the last years. The aim of the current study was to present a rare case of a radial artery pseudoaneurysm that projected through the skin after a single arterial puncture for blood-gas analysis. A 79-year-old man, with a history of atrial fibrillation and coronary heart disease on anticoagulants, was admitted to the cardiological intermediate care unit, with pulmonary oedema due to heart failure deregulation. On the next day, his left radial artery was punctured for blood-gas analysis. No other catheterization of the vessel was executed in the following days. Six days later a pulsatile, palpable mass on the skin surface, over the site of puncture, was recognized. Subsequently a Doppler ultrasound that was performed, confirmed the diagnosis of pseudoaneurysm. The pseudoaneurysm was surgically removed under general anesthesia. The patient was hospitalized for four days for trauma monitoring and intravenous antibiotics and afterwards he was discharged from the Hospital. Three months postoperatively, no sign of recurrence was observed. The pseudoaneurysm of the radial artery is an uncommon complication that might occur even after simple iatrogenic procedures, like after a direct arterial puncture for blood-gas analysis. Therefore, specialists should always be aware of this complication in similar cases.

Lung decortication for the treatment of chronic pleural empyema remains a technically challenging procedure that is associated with bleeding and air leak. The recent advent of pure argon plasma has provided thoracic surgeons with an electrically neutral energy source for dissection and coagulation of pulmonary tissue with minimal depth of necrosis. In this article, we describe the technique of lung decortication with argon plasma energy (PlasmaJet, Plasma Surgical, Roswell, GA, USA) for the treatment of chronic pleural empyema. With appropriate application, the PlasmaJet can facilitate the removal of fibrous cortex with satisfactory hemostasis and aerostasis. Argon plasma energy can potentially be a useful adjunct in lung decortication. Controlled trials are needed to determine its role in the surgical management of advanced pleural empyema.

Slipping rib syndrome (SRS) is an uncommon condition, typically affecting young adults and adolescents. The syndrome is mainly characterized by chronic, restrictive pain, caused by the impingement of the loose false rib tips to the adjacent intercostal nerves. The most commonly involved ribs are the 9th, 10th, and 11th ribs. There are several reports and case series reporting the efficacy of surgical interventions for the treatment of SRS. Costal cartilage excision, rib resection, and rib stabilization-plating procedure are successful surgical approaches for the management of slipping rib syndrome.

Post-traumatic headache (PTH), a common type of headache secondary to traumatic brain injury (TBI) or whiplash, carries a relevant burden on patients. PTH is still an undertreated condition because of limited pharmacological treatment options. Therefore, multimodal non-pharmacologic approaches, which account for comorbidities and biopsychosocial factors, are often used in PTH patients.After providing a brief overview of PTH, a systematic review was conducted, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendations on recently published (2015-2020) papers on non-pharmacological interventions for PTH. We also collected data on ongoing trials on this topic. Studies and results are reviewed and discussed.PTH is one of the most common complications of TBI and accounts for almost 4% of symptomatic headache disorders. The most common clinical presentations of PTH are migraine-like or tension type (TTH)-like headache, neck pain, cognitive complaints, and psychological/psychiatric symptoms. Growing evidence suggests that combined pharmacological and non-pharmacological interventions, encompassing noninvasive neuromodulation, physical therapy, cognitive-behavioral treatment, and education, may be the best approaches for PTH and related comorbidities. Acute/preemptive pharmacological treatments for PTH include drugs used for migraine and TTH. When PTH management is multidisciplinary, the patient benefits most.

Over 1 million Canadian children are estimated to have a mental health disorder, which are commonly treated with medications, such as second-generation antipsychotics (SGAs). Estimates suggest that SGA prescriptions to children are increasing in Canada. Although these medications are important and lifesaving components of psychiatric treatment, they are not without side effects. For some children, SGA treatment is associated with adverse metabolic complications including rapid weight gain, dyslipidemia, elevated blood pressure, and risk for type 2 diabetes. It is not clear why these complications develop, but it is assumed that SGAs stimulate appetite and food intake, and reduce resting energy expenditure leading to weight gain and that the metabolic complications occur secondary to the weight gain. Understanding the mechanisms underlying these complications is key to being able to identify children at risk and prevent and optimize treatment. In this narrative review, we provide an overview of the literature pertaining to the weight gain and metabolic complications in children treated with SGAs, highlighting the scope of the problem and the current limited research on how diet and physical activity can be used to prevent or lessen the severity of the metabolic complications and improve the long-term health trajectories of SGA-treated children.Novelty: Children are increasingly being treated with second-generation antipsychotics for mental health disorders. Dietary and physical activity assessments are not commonly considered in clinical settings. Randomized controlled trials of lifestyle interventions are needed to determine the effectiveness of mitigating the cardiometabolic complications in second-generation antipsychotic-treated children.

In recent years, the number of patients presenting to the emergency department with mental health complaints has been growing, alongside an increase in second-generation antipsychotic (SGAs) prescriptions for a variety of mental health conditions. Children treated with SGAs may have abnormalities, such as rapid weight gain and central adiposity, glucose intolerance, dyslipidemia, and hypertension; they may present to the pediatric emergency department with components of metabolic syndrome or type 2 diabetes, and a subsequent significant risk for cardiovascular complications later in life. Pediatric emergency department providers may serve as a safety net for patients to detect SGA-related metabolic complications, especially among vulnerable populations lacking access to primary care or psychiatric services.

Background Exfoliative and erosive cheilitis, may be a source of speech and chewing discomfort, but may also be an aesthetic issue for the patients affected. Such a clinical presentation may implicate a variety of inflammatory conditions, including atopic (eczematous) cheilitis. Topical and systemic agents, e.g. corticosteroids, have been used to treat inflammatory lip conditions. Topical tacrolimus has also been used in some inflammatory lip conditions. Material and Methods We performed a retrospective clinical analysis of atopic cheilitis patients. Results Between 2015 and 2020, we addressed 7 (seven) patients with atopic dermatitis affecting only lips and were diagnosed as atopic-eczematous cheilitis. They were treated with 0.03 per cent topical tacrolimus ointment and responded completely. Conclusions These cases represent an underreported atopy / eczema event;-few cases of atopic cheilitis without concomitant dermal lesions appear in the literature. We are also showing and discussing yet another application of tacrolimus in a local atopic form of inflammation affecting the lips. Key words:Atopy, cheilitis, tacrolimus.

To describe the clinical presentation, course of disease and health-care seeking behaviour of the first few hundred cases of coronavirus disease 2019 (COVID-19) in the United Kingdom of Great Britain and Northern Ireland.We implemented the World Health Organization's First Few X cases and contacts investigation protocol for COVID-19. Trained public health professionals collected information on 381 virologically confirmed COVID-19 cases from 31 January 2020 to 9 April 2020. We actively followed up cases to identify exposure to infection, symptoms and outcomes. We also collected limited data on 752 symptomatic people testing negative for COVID-19, as a control group for analyses of the sensitivity, specificity and predictive value of symptoms.Approximately half of the COVID-19 cases were imported (196 cases; 51.4%), of whom the majority had recent travel to Italy (140 cases; 71.4%). Of the 94 (24.7%) secondary cases, almost all reported close contact with a confirmed case (93 cases; 98.9%), many through household contact (37 cases; 39.8%). By age, a lower proportion of children had COVID-19. Most cases presented with cough, fever and fatigue. The sensitivity and specificity of symptoms varied by age, with nonlinear relationships with age. Although the proportion of COVID-19 cases with fever increased with age, for those with other respiratory infections the occurrence of fever decreased with age. The occurrence of shortness of breath also increased with age in a greater proportion of COVID-19 cases.The study has provided useful evidence for generating case definitions and has informed modelling studies of the likely burden of COVID-19.Décrire la manifestation clinique, l'évolution de la maladie et la propension à recourir aux services de santé des premières centaines de cas de maladie à coronavirus 2019 (COVID-19) au Royaume-Uni de Grande-Bretagne et d'Irlande du Nord.Nous avons appliqué leEnviron la moitié des cas de COVID-19 ont été importés (196 cas; 51,4%), la majorité s'étant récemment rendue en Italie (140 cas; 71,4%). Sur les 94 (24,7%) cas secondaires, presque tous ont signalé un contact rapproché avec un cas confirmé (93 cas; 98,9%), généralement au sein de leur foyer (37 cas; 39,8%). Au niveau de l'âge, la proportion d'enfants ayant contracté la COVID-19 était moindre. La plupart des cas avaient de la toux, de la fièvre et de la fatigue. La sensibilité et la spécificité des symptômes variaient en fonction de l'âge, présentant une relation non linéaire avec cet élément. Plus l'âge des cas de COVID-19 avançait, plus ils étaient susceptibles de développer de la fièvre, à l'exception de ceux touchés par d'autres infections respiratoires. Le risque d'essoufflement augmentait lui aussi avec l'âge chez une grande partie des cas de COVID-19.Cette étude a apporté un éclairage utile dans l'établissement d'une définition des cas. Elle a également fourni, pour diverses modélisations, des indications sur la charge que pourrait faire peser la COVID-19.Describir la presentación clínica, el curso de la enfermedad y el comportamiento de búsqueda de atención sanitaria de los primeros cientos de casos de la enfermedad del coronavirus de 2019 (COVID-19) en Reino Unido e Irlanda del Norte.Implementamos el protocolo de investigación de los primeros casos y contactos de la Organización Mundial de la Salud para la COVID-19. Profesionales expertos en el área de la salud pública recopilaron información sobre 381 casos virológicamente confirmados de COVID-19 entre el 31 de enero de 2020 y el 9 de abril de 2020. Realizamos un seguimiento activo de los casos para identificar la exposición a la infección, los síntomas y los resultados. También recogimos datos limitados sobre 752 personas sintomáticas que dieron negativo en los resultados de la COVID-19, como grupo de control para el análisis de la sensibilidad, la especificidad y el valor predictivo de los síntomas.Casi la mitad de los casos de COVID-19 fueron importados (196 casos; 51,4%), de los cuales la mayoría había hecho un viaje reciente a Italia (140 casos; 71,4%). De los 94 (24,7%) casos secundarios, casi todos informaron de un contacto cercano con un caso confirmado (93 casos; 98,9%), muchos de ellos a través del contacto con el hogar (37 casos; 39,8%). Por edad, una proporción menor de niños tenía COVID-19. La mayoría de los casos se presentaban con tos, fiebre y fatiga. La sensibilidad y especificidad de los síntomas variaba según la edad, con relaciones no lineales con la edad. Aunque la proporción de casos de COVID-19 con fiebre aumentaba con la edad, en el caso de los que tenían otras infecciones respiratorias la aparición de fiebre disminuía con la edad. La incidencia de la falta de aliento también aumentó con la edad en una mayor proporción de casos de COVID-19.El estudio ha aportado pruebas útiles para generar definiciones de casos y también ha servido de base a los estudios de modelización del probable coste de la COVID-19.الغرض وصف العرض السريري، ومسار المرض وسلوك البحث عن الرعاية الصحية لأول بضع مئات من حالات الإصابة بمرض فيروس كورونا 2019 (كوفيد 19) في المملكة المتحدة لبريطانيا العظمى وأيرلندا الشمالية. الطريقة قمنا بتنفيذ بروتوكول منظمة الصحة العالمية للتحقيق بخصوص الحالات الـ X القليلة الأولى للإصابة بكوفيد 19، والمخالطين لهم. وقام أخصائيو الصحة العامة المدربون بتجميع معلومات عن 381 حالة إصابة فيروسية مؤكدة بكوفيد 19 في الفترة من 31 يناير/كانون ثاني 2020 إلى 9 أبريل (نيسان) 2020. وتابعنا بدأب الحالات لتحديد التعرض للعدوى والأعراض والنتائج. كما قمنا بجمع بيانات محدودة عن 752 شخصاً يعانون من أعراض كوفيد 19، ولكن كانت نتيجة الاختبار سلبية، كمجموعة تحكم لتحليلات الحساسية، والنوعية، والقيمة التنبؤية للأعراض. النتائج تم استيراد نصف حالات الإصابة بكوفيد 19 تقريباً (196 حالة؛ 51.4%)، سافر معظمهم مؤخراً إلى إيطاليا (140 حالة؛ 71.4%). من بين 94 حالة ثانوية (24.7%)، أبلغت كل الحالات تقريباً عن مخالطة وثيقة مع حالة مؤكدة (93 حالة؛ 98.9%)، والعديد منها عن طريق الاتصال المنزلي (37 حالة؛ 39.8%). وبالنسبة للعمر، فقد أُصيبت نسبة أقل من الأطفال بكوفيد 19. وكانت معظم الحالات مصحوبة بسعال وحمى وإرهاق. تختلف حساسية ونوعية الأعراض تبعاً للعمر، مع علاقات غير خطية مع العمر. على الرغم من أن نسبة حالات الإصابة بكوفيد 19 المصحوبة بالحمى قد زادت مع تقدم العمر، إلا أنه بالنسبة للمصابين بأمراض الجهاز التنفسي، فإن الإصابة بالحمى انخفضت مع التقدم في العمر. كما زاد كذلك حدوث ضيق التنفس مع التقدم في العمر في نسبة أكبر من حالات الإصابة بكوفيد 19. الاستنتاج قدمت الدراسة أدلة مفيدة لوضع تعريفات الحالة، وأوضحت لدراسات النماذج العبء المحتمل لمرض كوفيد 19.旨在描述大不列颠及北爱尔兰联合王国最初数百个新型冠状病毒肺炎（新冠肺炎）病例的临床表现、病程及就医行为。.我们实施了世界卫生组织制定的少数最初新冠肺炎病例和接触者调查方案。经过培训的公共卫生专业人员收集了 2020 年 1 月 31 日至 2020 年 4 月 9 日期间通过病毒学方法确诊的 381 例新冠肺炎病例的相关信息。我们积极跟踪病例，以确定接触感染情况、症状和结果。我们还针对 752 名具有新冠肺炎症状但其检测结果为阴性的病例收集了有限的数据，并将其作为对照组，以分析症状的敏感性、特异性和预测价值。.约有一半的新冠肺炎病例属于境外输入病例（196 例；51.4%），且其中大多数病例近期曾前往意大利旅行（140 例；71.4%）。在 94 例 (24.7%) 二代病例中，几乎所有病例都报告称曾与确诊病例密切接触（93 例；98.9%），且许多病例是因家庭内部接触而导致感染（37 例；39.8%）。按年龄统计，患有新冠肺炎的儿童比例较低。大多数病例表现为咳嗽、发热和疲乏。症状的敏感性和特异性因年龄而异，并与年龄呈非线性关系。虽然其他呼吸道疾病感染病例的发热症状发生率随着年龄增长而降低，但新冠肺炎病例的发热症状发生比例却随年龄增长而增加。而且，大部分新冠肺炎病例的呼吸短促发生率也随年龄的增长而增加。.本研究为制定诊断标准提供了有用的证据，并为针对新冠肺炎潜在负担的模拟研究提供了素材。.Описать клинические признаки, течение болезни и обращение за медицинской помощью первых нескольких сотен случаев коронавирусного заболевания 2019 г. (COVID-19) в Соединенном Королевстве Великобритании и Северной Ирландии.Авторы внедрили протокол исследования первых случаев заболевания новой коронавирусной инфекцией 2019 г. (COVID-19) и контактов, разработанный Всемирной организацией здравоохранения. Квалифицированные специалисты в области общественного здравоохранения собрали информацию о 381 подтвержденном вирусологическим тестированием случае заболевания COVID-19 в период с 31 января по 9 апреля 2020 года. Авторы активно отслеживали данные случаи для определения контакта с инфекцией, изучения симптомов и исхода болезни. Были собраны ограниченные данные по 752 пациентам, имеющим клинические симптомы заболевания, но отрицательный результат теста на COVID-19, в качестве контрольной группы для анализа чувствительности, специфичности и прогностической ценности симптомов.Примерно половина случаев COVID-19 была завезена из-за границы (196 случаев; 51,4%), большинство из которых недавно путешествовали в Италию (140 случаев; 71,4%). Из 94 (24,7%) вторичных случаев заражения почти все сообщали о тесном контакте с лицами с подтвержденным случаями заболевания (93 случая; 98,9%), многие из которых проживали совместно с инфицированными (37 случаев; 39,8%). Вирус COVID-19 редко заражает детей. В большинстве случаев отмечались кашель, высокая температура и утомляемость. Чувствительность и специфичность симптомов варьировались в зависимости от возраста и находились в нелинейной зависимости от возраста. Несмотря на то что доля случаев COVID-19 с высокой температурой увеличивалась с возрастом, у людей с другими респираторными инфекциями частота наличия лихорадки с возрастом снижалась. Возникновение одышки также увеличивалось с возрастом для большинства случаев COVID-19.Исследование предоставило полезную информацию для определения случаев возникновения и послужило основой для модельных исследований вероятного бремени COVID-19.

Unilateral Sensorineural Hearing Loss (USNHL) or even Single Sided Deafness (SSD) were mistakenly believed in the past that they could not induce a notable negative effect on the average individual adult. Respectively, a child with USNHL could eventually develop typically and adequately with no particular challenges. Today, it is well established that both children and adults with USNHL and SSD experience difficulties locating sound sources than their normal peers attributable to the concomitant deprivation of data utilized for localization; interaural time differences along with interaural intensity differences, especially for high frequency sounds. Moreover, USNHL and SSD patients suffer from the absence of the binaural benefits that permit people with bilateral Normal Hearing (NH) to perform relatively well in challenging listening environments. These benefits encompass binaural summation that causes improved speech perception, and binaural release from masking that facilitates word recognition in noise. Rising treatment strategies, involving various type of amplification, Assistive Listening Devices (ALSs) and Cochlear Implantation, can greatly widen our overall approach regarding USNHL and / or SSD. Nevertheless, most recent evidence points out that both prompt and adequate intervention is crucial to promote optimal outcomes.

The administration of certain drugs is directly related to inner ear damage. Due to the potential of these elements and their usage, more extensive monitoring of adverse effects should be implemented. That is why, baseline evaluation for ototoxicity must be adequately extensive and should embrace conventional PTA thresholds, HFA, immittance measurements, speech audiometry in quiet and in noise, and assessment of OAEs. Health care specialists have reasonably quested other test modalities for ototoxic monitoring, in their effort to eliminate behavioral – subjective testing and even more establishing further improvements in test efficacy. To iterate, drug induced ototoxicities typically are initially presented as OHC dysfunction, and the exact correlation between present OAEs and functional OHCs is fairly well demonstrated. This study provides recent evidence regarding OAEs’ strategic advantages as a part of an ototoxicity monitoring program, as they can detect earlier ototoxic induced thresholds shifts, do not need patient’s own cooperation and are substantially easy to perform and quick. This fact is particularly crucial during present COVID-19 pandemic where ototoxic agents such as chloroquine and hydroxychloroquine are routinely administered in many patients who may be too sick and haggard to perform adequately enough in conventional PTA or similar, behavioral based exams.

Bone conduction involves sound transmission through bone oscillations of the skull or neighboring body areas, resulting in auditory perception. Its significance is not confined to differential diagnosis of hearing loss only. It represents a secondary auditory pathway supplementing air conduction process co instantaneously. Known bio-mechanical mechanisms involved in bone conduction in humans are analyzed and summarized in a most concise way including most recent updates that improve current clinical routine practice. Nevertheless, longstanding assumptions still need further research in order to establish a thorough bone and tissue conduction understanding.

Malignant pleural effusion is a severe and common complication in patients with primary or metastatic malignancies of the pleura. Although talc pleurodesis is widely used for managing malignant pleural effusions, there is still controversy in the literature regarding its superiority compared to other approaches. We conducted this meta-analysis to further investigate its efficacy compared to alternative interventions. We systematically reviewed the PubMed, Cochrane, and Scopus databases to identify studies that fulfilled our inclusion criteria. Study quality was evaluated using validated tools and the pooled Risk Ratio (RR) and confidence interval (CI) were calculated. We performed sensitivity analyses based on the meta-analysis method and type of study. Twenty-four studies were included in the current systematic review meta-analysis. Talc pleurodesis was associated with statistically significant higher successful pleurodesis rates when compared with all controls [RR (95% CI) 1.15 (1.00, 1.31); Pz = 0.04], only chemical controls [RR (95% CI) 1.26 (1.13, 1.40); Pz 1-month follow-up time point favored talc pleurodesis [RR (95% CI): 1.62 (1.15, 2.27); Pz = 0.005]. Finally, talc poudrage was associated with a statistically significant higher successful pleurodesis rate when compared with all controls. Sensitivity analyses verified the robustness of our results. Talc pleurodesis is an effective MPE management approach presenting borderline statistically significant superiority compared to control methods especially compared to bleomycin as well as when pleurodesis success is evaluated later than 1 month postoperatively.

Background Congenital long-QT syndrome represents the most common cardiac channelopathy and manifests as potentially lethal ventricular arrhythmias. Prevention strategies include beta-blockade pharmacotherapy, implantable cardioverter-defibrillators, and left cardiac sympathetic denervation, which can increase the threshold for ventricular fibrillation. Herein, we report our experience with video-assisted thoracoscopic left cardiac sympathetic denervation. Methods We performed a retrospective review of the electronic medical records of all patients with congenital long-QT syndrome who underwent video-assisted thoracoscopic left cardiac sympathetic denervation at our institution. Results From September 2009 to May 2016, 6 patients with a mean age of 30.5 years (range 20–47 years) underwent video-assisted thoracoscopic left cardiac sympathetic denervation for medically refractory long-QT syndrome. All patients had an uneventful recovery and were discharged 1–3 days after the operation. At a median follow-up of 14 months (range 12–60 months), 4 patients had no cardiac events while 2 experienced 1 episode of arrhythmic syncope and 1 episode of appropriate implantable cardioverter-defibrillator shock. Following surgery, the mean annual cardiac events in the study cohort decreased from 2.13 to 0.33 ( p = 0.004) and the mean corrected QT interval reduced from 560 ms to 491 ms ( p = 0.006). Conclusions Video-assisted thoracoscopic left cardiac sympathetic denervation is a safe and effective therapy in patients with congenital long-QT syndrome who continue to suffer from recurrent life-threatening arrhythmias or frequent implantable cardioverter-defibrillator discharges despite maximum tolerated doses of beta blockers.

Although Nuss procedure is performed with satisfactory results, there has been a controversy in the literature regarding the effect of a Nuss procedure on the spine. This review article aims to perform an updated overview of the literature about the effect of pectus excavatum correction at the spine and the management of patients with both pectus excavatum and scoliosis. Although acquired scoliosis has been rarely reported after a Nuss procedure, studies show that the Nuss procedure can have a beneficial effect in mild coexisting scoliosis especially when it is performed during the adolescence. The management of cases presented with both pectus excavatum and scoliosis depends on the severity of pre-operative scoliosis and demands detailed evaluation of the spine pre and postoperatively. In the rare condition of post-operative scoliosis following a Nuss procedure, the removal of the metallic bar and conservative measures may have satisfactory results on the spine.

This study aims to clarify some of the issues associated with the reliable measurement of muscle thickness on ultrasonographic images of the musculoskeletal system, namely the repeatability of measurements in different time frames, the effect of body side selection, and the effect of scan orientation. Ultrasound scans were performed on muscles associated with essential daily activities: geniohyoid, masseter, anterior arm muscles, rectus femoris, vastus intermedius, tibialis anterior, and gastrocnemius. Measurements of the muscle thickness were performed and repeated after 1, 6, and 24 h, on both dominant and nondominant side, using both transverse and longitudinal scans. Thirteen healthy volunteers (eight males and five females, mean age = 24 years, SD = 2.86, range = 19-29) were included. The intraclass correlation coefficient (ICC) was calculated between the baseline and the 1-, 6-, and 24-h interval, using a two-way mixed model of absolute agreement. The ICC ranged from 0.295 for the longitudinal scan of the left masseter muscle in the 6-h interval to 0.991 for the longitudinal scan of the nondominant anterior arm muscles in the 24-h interval. The results indicate that there is variable reliability of the measurements depending on the muscle, time frame, body side, and scan orientation. Consequently, the choice of these parameters can affect the validity of the measurements. Further investigation on a larger scale is required to establish the preferred parameters for each anatomical site.

Given that 5-25% of the adult population report child sexual abuse (CSA), most clinicians will care for victims. Data regarding CSA experiences among medical students are limited and the association of medical students' own history of CSA with relevant perceptions has not been previously examined. The aim of this study was to assess CSA perceptions and exposure of medical students, while exploring their associations. For this purpose, a link was created and made available on a site accessed solely by the Athens medical school undergraduates from February 20 to March 20 2019, comprising a 12-item questionnaire to assess the knowledge and past experience of CSA. This was based on a larger published questionnaire, which was translated and adapted. The questionnaire was then transcripted online, and after pilot testing, was disseminated using the Google documents® platform. Out of 261 responses, CSA was reported by 48 participants (18%), of which 39 were women. Thirty five reported contact CSA. Thirty seven victims (77%) reported previous disclosure of the event, but 18 of them were not protected post disclosure. CSA victims were less likely to agree with the perception that most perpetrators are mentally ill or disabled (p = 0.043), and more likely to strongly disagree with the statement that reputable families are protected from sexual abuse (p = 0.019). In agreement with existing data in general populations globally, about one in five medical students had exposure to CSA. In addition, a potential association of their own experiences with shaping perceptions regarding the identity of CSA perpetrators and affected families for medical students is highlighted.

Pelvic pain could be acute or chronic but rarely could be life threatening with various reasons such as pathological, physiological or functional. Clinical evaluation and management should be performed simultaneously, especially in emergencies that carry a high risk of mortality. Clinical evaluation and management should be performed simultaneously, especially in emergencies that carry a high risk of mortality. Although a detailed history, physical and gynecological examination, supplemented with imaging modalities can itself be diagnostic, the role of laparoscopy for diagnosis should not be overlooked. The common causes of pelvic pain with focus on a minimally invasive approach in this age group are as following: endometriosis, rupture of ovarian cyst, infection, ovarian torsion, pelvic vein syndrome, adhesions pain due to previous surgery and unsatisfactory treated infections.

4D flow MRI is a quantitative MRI technique that allows the comprehensive assessment of time-resolved hemodynamics and vascular anatomy over a 3-dimensional imaging volume. It effectively combines several advantages of invasive and non-invasive imaging modalities like ultrasound, angiography, and computed tomography in a single MRI acquisition and provides an unprecedented characterization of velocity fields acquired non-invasively in vivo. Functional and morphological imaging of the abdominal vasculature is especially challenging due to its complex and variable anatomy with a wide range of vessel calibers and flow velocities and the need for large volumetric coverage. Despite these challenges, 4D flow MRI is a promising diagnostic and prognostic tool as many pathologies in the abdomen are associated with changes of either hemodynamics or morphology of arteries, veins, or the portal venous system. In this review article, we will discuss technical aspects of the implementation of abdominal 4D flow MRI ranging from patient preparation and acquisition protocol over post-processing and quality control to final data analysis. In recent years, the range of applications for 4D flow in the abdomen has increased profoundly. Therefore, we will review potential clinical applications and address their clinical importance, relevant quantitative and qualitative parameters, and unmet challenges.

Long-wave multi-joule ultrashort laser pulses are predicted to confine highly uniform electromagnetic energy and field intensities while sustaining high density uniform plasmas within nonlinear Bessel zones under extreme driving conditions in contrast to near-IR sources. This opens up novel applications in laser wakefield generation, radiofrequency/microwave guiding, and lightning control.

Background Pericoronary fat attenuation index (FAI) on coronary computed tomography angiography (CCTA) imaging has been proposed as a sensitive marker of coronary vascular inflammation with prognostic value for major cardiovascular events. To date though there is no systematic review of the published literature and no meta-analyzed data of previously published results. Methods We performed a systematic review and meta-analysis according to the PRISMA guidelines. We systematically explored published literature in MEDLINE (Pubmed) before February 1, 2021 for studies assessing FAI in both diagnostic and prognostic clinical settings in patients with or without cardiovascular disease. The primary outcome was the mean difference in FAI attenuation between stable and unstable coronary plaques. The secondary outcome was the hazard ratio of high FAI values for future cardiovascular events. We calculated I2 to test heterogeneity. We used random effects modelling for the meta-analyses to assess the primary and secondary outcome. Results In total, 16 studies and 6,944 patients were included in this meta-analysis. FAI was significantly higher in unstable compared to stable plaques with a mean difference of 4.07 HU (95% CI: 1.10–7.89, I2=88%). Higher FAI values offered incremental prognostic value for major cardiovascular events (MACE) in studies with prospective follow-up (HR=3.29, 95% CI= 1.88–5.76, I2=75%). Conclusion FAI is a promising imaging biomarker that may be successfully be used for detection of coronary inflammation, discrimination between stable and unstable plaques and prognosis of future MACE. There is undeniable need of further studies to establish the utility of this biomarker in clinical practice in order to improve coronary plaque discrimination and cardiovascular risk prognostication. Funding Acknowledgement Type of funding sources: None.

Aims Post-operative systemic inflammatory reaction is part of the stress response caused by major thoracic surgery. Different anaesthetic agents used affect different immunological phenomena. This systematic review evaluates the impact of anaesthetic agents on the immunological profile and the associated clinical significance. Methods A systematic review of MEDLINE, EMBASE and Cohrane databases to explore how different anaesthetic agents affect post-operative inflammatory response. Results A total of nine studies were included in our analysis. Peri-operative use of dexmedetomidine, propofol, sevoflurane, isoflurane, ropivacaine, sufentanil, naloxone and clonidine were compared, based on their effect on the systemic release of inflammatory markers. Variance on the levels of the circulating inflammatory molecules such as interleukins, interferon-γ, tumor necrosis factor a and on the cellular response including natural killer, CD4 and CD8 T cells, were observed among different anaesthetic agents. Conclusions Inflammation improves immunity and regenerative cell recruitment, however excessive responses can lead to delayed wound healing, organ dysfunction and increased morbidity and mortality. There is still uncertainty regarding the role of immune changes on clinical outcomes of patients undergoing thoracic surgery, and more research is needed to explore other immunological effects related to anaesthetic agents.

ObjectiveΤo report outcomes of breakthrough COVID-19 in comparison with COVID-19 in unvaccinated patients with systemic rheumatic diseases (SRDs).MethodsPatients with SRD with COVID-19 (vaccinated and unvaccinated) were included by their rheumatologists in a registry operated by the Greek Rheumatology Society in a voluntarily basis. Type, date and doses of SARS-CoV-2 vaccines were recorded, and demographics, type of SRD, concurrent treatment, comorbidities and COVID-19 outcomes (hospitalisation, need for oxygen supplementation and death) were compared between vaccinated and unvaccinated patients.ResultsBetween 1 March 2020 and 31 August 2021, 195 patients with SRD with COVID-19 were included; 147 unvaccinated and 48 vaccinated with at least one dose of a SARS-CoV-2 vaccine (Pfizer n=38 or AstraZeneca n=10). Among vaccinated patients, 29 developed breakthrough COVID-19 >14 days after the second vaccine dose (fully vaccinated), while 19 between the first and ConclusionsVaccinated patients with SRD with breakthrough COVID-19 have better outcomes compared with unvaccinated counterparts with similar disease/treatment characteristics.

Lung carcinoma management secondary to chronic lymphocytic leukemia could be quite challenging. We report a case of a 60-year-old male with several co-morbidities, who presented with shortness of breath and persistent cough. A chest imaging showed a right pleural effusion and complete white-out of the right chest cavity. A computed tomography scan revealed consolidation of the right upper lobe with a 6-cm lesion in hilum with complete occlusion of right lobe bronchus. The patient underwent a video-assisted thoracoscopic surgery, drainage of pleural effusion and pleural and lung biopsy. Talc pleurodesis as well as a flexible bronchoscopy of the endobronchial lesion was performed. Histopathological examination showed a small B-cell lymphoma of the right pleura and an invasive non-small cell carcinoma of the right lung. Dual neoplasms are challenging in terms of diagnosing, and they usually require a multidisciplinary team for the right treatment strategy, including surgery and chemotherapy.

We present an update of the literature concerning long-term neuropsychological outcomes following surgery for refractory temporal lobe epilepsy (TLE). A thorough search was conducted through the PubMed and Medline electronic databases for studies investigating neuropsychological function in adult patients undergoing resective TLE surgery and followed for a mean/median > five years period. Two independent reviewers screened citations for eligibility and assessed relevant studies for the risk of bias. We found eleven studies fulfilling the above requirements. Cognitive function remained stable through long-term follow up despite immediate post-surgery decline; a negative relation between seizure control and memory impairment has emerged and a possible role of more selective surgery procedures is highlighted.

We report a case of a 64-year-old female who first presented with a transient ischemic attack in 2007 due to an innominate artery stenosis, which indicated an endovascular stent placement. In 2008, she presented with recurrence of symptoms and was diagnosed with in-stent restenosis alongside an unusual occurrence of retrograde migration into the ascending aortic arch. We performed an aorto-innominate bypass through a median sternotomy. The patient was discharged without any complications thereafter, and the graft has shown excellent patency. As of 2019, the patient remains well.

Despite the recent advances in treatment, antineutrophil cytoplasmic antibody (ANCA) associated vasculitides (AAV) are among the rheumatic diseases with the highest morbidity and mortality. These outcomes are affected by a variety of factors apart from the disease itself, and are driven by infections, cardiovascular disease and drug toxicity. Even after the induction of remission, patients and their treating physicians are challenged by frequent relapses, accrual of chronic damage and impaired quality of life. Given their rarity along with their heterogeneous disease spectrum, patient registries are of utmost need for the study of all aspects of AAV. Already established AAV registries have a significant contribution in the apprehension of these diseases outside the strict context of clinical trials, and are becoming increasingly important as new drugs and treatment strategies are about to be introduced in daily practice. We here describe the design of a contemporary, web-based and easy-to-use patient registry specifically for patients with AAV, including all the necessary domains suggested by international working groups. This project is anticipated to contribute in better understanding of AAV in our country, with a future prospect of contributing to and sharing data with other international registries.

Objective:To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants.Design:Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology.Setting:Telephone interview with babies’ mothers or fathers.Participants:Representative sample of infants who participated in the national neonatal screening programme (n 549 in 2017, n 586 in 2007).Results:We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and Conclusions:We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates – particularly rates of exclusive breast-feeding – remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding ‘culture’ and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

The complement system has been recently proposed to play an important role in the pathogenesis of ANCA-associated vasculitis (AAV). This study evaluated the value of serum and kidney deposited C3 in predicting renal outcomes in AAV. This was a retrospective study of 47 patients with AAV, who were categorized according to their serum C3 levels as hypo- or normo-complementemic and to those with positive or negative kidney biopsy immunofluorescence (IF) for C3. Baseline characteristics as well as progression to end-stage renal disease (ESRD) between the 2 groups were compared. In total, 23% (11/47) were hypo-complementemic; these patients were older (74 vs. 65 years, p = 0.013), had higher creatinine levels (4.9 vs. 2.2 mg/dL, p = 0.006), were more often hemodialysis dependent (64% vs. 19%, p = 0.009) and progressed more often to ESRD (55% vs. 11%, p = 0.01) compared to normo-complementemic patients (n = 36). On multivariate analysis, serum creatinine at diagnosis (HR = 16.8, 95%CI: 1.354–208.62, p = 0.028) and low serum C3 (HR = 2.492; 95% CI: 1.537–11.567; p = 0.044) were independent predictors for ESRD. Among 25 patients with an available kidney biopsy, 56% had C3 deposition by IF and displayed more often a mixed histological pattern (72% vs. 27%, p = 0.033), low serum C3 levels (42% vs. 18%, p < 0.001) and serious infections during follow-up (57% vs. 18%, p = 0.047) compared to those with negative (n = 11) IF staining. Almost one of four patients with AAV has low C3 levels at diagnosis which is associated with more severe renal disease and worse renal outcomes (ESRD). This should be taken into account in therapeutic and monitoring strategies.

Background/objective Blood pressure abnormalities may play an important role in macrovascular damage in type 1 diabetes. Little is known about blood pressure abnormalities and macrovascular damage in children with type 1 diabetes. Methods Children with type 1 diabetes (n = 57) for a short (3 months-2 years; n = 24) or long duration (≥5 years; n = 33) and a group of control children without diabetes (n = 29) completed 24-h ambulatory blood pressure monitoring (ABPM). Carotid intima media thickness (cIMT), a subclinical indicator of atherosclerosis, was assessed by carotid ultrasound. Results ABPM abnormalities were more prevalent (57% vs 24%, respectively), and daytime, nighttime and 24-h systolic, diastolic, and mean arterial blood pressure indices were higher in children with type 1 diabetes compared to control children. The odds estimate of an ABPM abnormality was 6.68 (95% confidence interval: 1.95, 22.9; P = .003) in children with type 1 diabetes compared to controls after adjusting for age, sex, and BMI standardized for age and sex (zBMI). An interaction between ABPM and zBMI on cIMT was observed. In children with type 1 diabetes and ABPM abnormalities, every 1 SD increase in zBMI was associated with a 0.030 mm increase in cIMT (95% confidence interval: 0.002, 0.041; P = .031). This was not observed in control children with ABPM abnormalities or in children with normal ABPM, regardless of type 1 diabetes status. Conclusions Children with type 1 diabetes have a high prevalence of ABPM abnormalities independent of disease duration and this is related to early indicators of cardiovascular damage.

Purpose As long as migration is recognized as a public health concern, policies exist to address migrants’ health, and provide comprehensive information on how public and private health care system operates, health rights and what their health care plan does or does not cover. Thereby, responding to patients’ expectations significantly affects overall satisfaction with health care services because this dimension is most strongly associated with patient satisfaction. The purpose of this paper is to constitute the first quantitative large-scale study (n=1,512) in Cyprus and Greece exploring the level of satisfaction among third-country nationals (TCN) in relation to their health care needs. Design/methodology/approach The questionnaire used in this study has been developed and measured (Cronbach α =0.7) in a similar study in Greece (Galanis et al., 2013) and it has been used by other studies too (Vozikis, 2015). Findings The authors can conclude that participants’ knowledge of the health system is not good as 70.2 percent that they do not have a good knowledge. The findings suggest that nearly one in two TCN faced problems in accessing clinics or communicating due to various factors. Practical implications The findings of this study provide the context for further exploration of different means to improve cultural awareness amongst health and social care professionals, including multicultural training of health and social service providers and medical pluralist approaches that may be closer to migrants’ cultural and health background. Overall, types of interventions to improve cultural competency included training/workshops/programs for health practitioners (e.g. doctors, nurses and community health workers), culturally specific/tailored education or programs for patients/clients, interpreter services, peer education, patient navigators and exchange programs (Truong, 2014). To the above, practices can also be added as multicultural education to all health professionals in order to develop enthusiasm and be able to acknowledge immigrants’ difficulties. Adding to the above recommendation, interdisciplinary education with allied health professionals (psychologists, social workers and nurses) may lead to a more holistic approach of this group’s needs, especially in the forthcoming health system where primary care will play a vital role. Social implications Access to the health system may lead to social inclusion of TCN in the local society and improve their quality of life. It is also important for TCN to feel that the current health system is aware of issues related to their social and cultural background; thus, it will make the health system and those who work look more friendly and approachable. Originality/value In an era of crisis and of great debate around a forthcoming National Health System, these findings indicate that healthcare providers in Cyprus will need to address several challenges in managing care for migrants. In order for that to happen, assessing patient satisfaction is thereby important in the process of quality evaluation, especially when dealing with population subgroups at higher risk of inequalities such as immigrants or ethnic minorities. Such studies help systems to develop by measuring their weaknesses and enhancing their strengths. Voicing clients/patients feedback is always helpful to minimize risks.

Funding Information: The authors are grateful to the Birmingham Surgical Trials Consortium at the University of Birmingham for the use of their servers for secure online data collection. Disclosure: The authors declare no conflict of interest.

Introduction\ud \ud Patients with cancer who develop small bowel obstruction are at high risk of malnutrition and morbidity following compromise of gastrointestinal tract continuity. This study aimed to characterise current management and outcomes following malignant small bowel obstruction.\ud \ud \ud \ud Methods\ud \ud A prospective, multicentre cohort study of patients with small bowel obstruction who presented to UK hospitals between 16th January and 13th March 2017. Patients who presented with small bowel obstruction due to primary tumours of the intestine (excluding left-sided colonic tumours) or disseminated intra-abdominal malignancy were included. Outcomes included 30-day mortality and in-hospital complications. Cox-proportional hazards models were used to generate adjusted effects estimates, which are presented as hazard ratios (HR) alongside the corresponding 95% confidence interval (95% CI). The threshold for statistical significance was set at the level of P ≤ 0.05 a-priori.\ud \ud \ud \ud Results\ud \ud 205 patients with malignant small bowel obstruction presented to emergency surgery services during the study period. Of these patients, 50 had obstruction due to right sided colon cancer, 143 due to disseminated intraabdominal malignancy, 10 had primary tumours of the small bowel and 2 patients had gastrointestinal stromal tumours. In total 100 out of 205 patients underwent a surgical intervention for obstruction. 30-day in-hospital mortality rate was 11.3% for those with primary tumours and 19.6% for those with disseminated malignancy. Severe risk of malnutrition was an independent predictor for poor mortality in this cohort (adjusted HR 16.18, 95% CI 1.86 to 140.84, p = 0.012). Patients with right-sided colon cancer had high rates of morbidity.\ud \ud \ud \ud Conclusions\ud \ud Mortality rates were high in patients with disseminated malignancy and in those with right sided colon cancer. Further research should identify optimal management strategy to reduce morbidity for these patient groups.

Highlights • Carcinoma of unknown primary clinical manifestations usually associated with head and neck region. • Painless cervical Lymphadenopathy is the most common symptom of the disease. • Laboratory tests usually do not identify the primary disease. • Limited data exists about management and the role of surgery in carcinoma of unknown primary if a single neck mass exists without evidence of lymph node implication., Introduction Carcinoma of unknown primary is a well-recognized clinical syndrome which accounts for the 3–5% of all the malignancies. Patients with carcinoma of unknown primary usually present with late stage disease without having identified the primary source of the tumour despite an extensive diagnostic work-up. Presentation of case A 60 years old male presented to the clinic complaining of a neck mass to the left lateral neck. Patient’s history was unremarkable without evidence of any malignant disease. Clinical and radiological examination revealed a cystic mass extending from the lower one third of the neck to the left clavicle causing periostal reaction. Mass biopsy and PET-CT was unspecific for the primary origin of the mass. However in the context of tumour immunohistochemistry, HPV status, neck location and basaloid cell differentiation, the tumour mass was considered as carcinoma of unknown primary with possible oropharyngeal primary location. The patient underwent surgical resection of the mass, left clavicle and the first rib. One year after the operation the patient is disease free. Discussion Although CUP usually presents with cervical lyphadenopathy, in our case there was no evidence of lymph node tissue infiltration in the neck region. Surgical resection of the mass showed that the location was extending within the cervical soft tissues and upper thorax. Taking into consideration the absence of lymphadenopathy this is an uncommon location of carcinoma of unknown primary in the neck. Conclusion This is an uncommon location of CUP with possible implications in survival and management.

State control over Greece’s agricultural institutions increased during Metaxas’s authoritarian regime (1936–41). Analysing such state control allows us to address, in the Greek context, two questions with regard to fascist agrarian regimes. First, considering the trajectory of agricultural policy before the emergence of these regimes, how much of what they did was new, and how much was not? Second, how did the cadres of agricultural specialists participate in, or at least accommodate, the new regimes? Our research shows that Metaxas received support from the agronomists who had been active in Greece under previous liberal administrations. Such support did not take the form of laudatory statements or ideology-driven activism. It was rather a discreet acceptance of the new circumstances, combined with defection from one’s previous political camp. Metaxas’s dictatorship inherited most traits that made it a fascist agricultural regime from previous liberal administrations.

Shared mobility can fundamentally change road transport and improve life quality. Car-sharing services have reached a high level of growth worldwide and members adopting them as an alternative transportation mode are constantly on the increase. The advent of highly automated vehicles could boost the adoption of car sharing as more inexpensive and convenient on-demand services could be achieved. In recent years, vehicle automation is facilitated and supported by the latest advances in information and communication technologies, forming the cornerstone of the new generation of In-Vehicle Intelligent Systems. The goal of this study is to introduce a novel in-vehicle cognitive framework that utilises (i) driver's/user's profile data and personal preferences, (ii) real-time information associated with the vehicle's driving environment, and (iii) previous knowledge and experience, in proposing adaptations of the vehicle's level of autonomy, in an automated manner, when a driver/user wishes to make a road journey within the automated vehicle sharing context. Knowledge is obtained through the exploitation of Bayesian networking principles. Indicative results on the performance of the proposed cognitive mechanism and the associated knowledge-based selection scheme are presented, mostly with regards to proactively identifying the optimum level of autonomy to be implemented.

Human assistive technology and computer-aided diagnosis is an emerging field in the area of medical imaging. Following the recent advances in this domain, a study for integrating machine learning techniques in musculoskeletal ultrasonography images was conducted. The goal of this attempt was to investigate how feature extraction techniques, that capture higher-level information, perform in identifying human characteristics. The potential success of these techniques could lead to significant improvement of the current assessment methods—as the gray-scale image analysis—for distinguishing healthy and pathologic conditions, that are heavily dependent on the image-acquisition system. The contribution of this work is threefold. First, a new privately held data set of 74 healthy patients was presented. This data set included musculoskeletal ultrasound images from four muscles of the human body, namely the biceps brachii, tibialis anterior, gastrocnemius medialis and rectus femoris, recorded in the transverse and longitudinal plane. Second, two classification tasks were performed, namely, gender and muscle-type recognition, to assess the performance of the proposed method for successfully identifying differences in the texture of the examined muscle sections. Third, a novel method used with great success in the computer vision domain was presented, allowing the extraction of a high-level feature representation, by encoding the distribution of locally invariant texture descriptors. On the muscle-type recognition our method achieved an 87.07% classification rate, and on the task of gender recognition it surpassed state-of-the-art textural representations, reported in the literature in almost all the examined muscle sections.

Current national estimates of respiratory syncytial virus (RSV)-associated hospital admissions are insufficiently detailed to determine optimal vaccination strategies for RSV. We employ novel methodology to estimate the burden of RSV-associated hospital admissions in infants in England, with detailed stratification by patient and clinical characteristics.We used linked, routinely collected laboratory and hospital data to identify laboratory-confirmed RSV-positive and RSV-negative respiratory hospital admissions in infants in England, then generate a predictive logistic regression model for RSV-associated admissions. We applied this model to all respiratory hospital admissions in infants in England, to estimate the national burden of RSV-associated admissions by calendar week, age in weeks and months, clinical risk group and birth month.We estimated an annual average of 20,359 (95% CI 19,236-22,028) RSV-associated admissions in infants in England from mid-2010 to mid-2012. These admissions accounted for 57,907 (95% CI 55,391-61,637) annual bed days. 55% of RSV-associated bed days and 45% of RSV-associated admissions were in infants3 months old. RSV-associated admissions peaked in infants aged 6 weeks, and those born September to November.We employed novel methodology using linked datasets to produce detailed estimates of RSV-associated admissions in infants. Our results provide essential baseline epidemiological data to inform future vaccine policy.

Background: To determine the patient outcomes of retrospectively collected data between surgical versus nonsurgical treatment of chronic subdural hematoma (CSDH) with Dexamethasone (DX). Methods: This was a retrospective study of 171 patients with chronic subdural hematoma between January 2012 and December 2016 and was derived into three groups: Group A: burr-hole craniostomy (BHC) with DX as an adjunct to surgery; Group B: BHC surgery without DX; and Group C: conservative treatment with DX monotherapy. Results: There were 120 males (70.1%) with mean age 76.4 ± 9.3 years (range 63 years, 33–96). In Group A [n = 24 (14.0%)], there were 20 males (80%) and the mean age was 75.5 ± 8.6 years. In Group B [n = 136 (80.1%)], there were 92 males (67.6%) with mean age 76.9 ± 11.3 years and in Group C [n = 10 (5.8%)], there were 8 males (80%) with mean age 70.0 ± 10.6 years.The incidence of recurrence in Group A was 1 case (4%) compared with Group B 10 cases (7.3%), and Group C 3 cases (30%) and there were a statistical significant difference between groups (P = 0.030). Conclusion: Patients with CSDHs have better outcome when treated with BHC and corticosteroids among other therapeutic options. Between BHC with DX and BHC without use of corticosteroids in surgical management of CSDHs, the combination therapy should be considered a first-choice. Keywords: Chronic subdural hematoma, Single burr hole, Corticosteroids monotherapy

Objectives The main aims of this study were to evaluate the Greek version of the diagnosis-related group reimbursement system (KEN-DRG) and to compare the KEN-DRG prices with the average actual cost of each group of study cases. Along with other aspects, the differences between the KEN-DRG average length of stay (ALOS) and the actual ALOS was evaluated in selected cases. Methods In the first part of this study, the top-down costing approach was selected in order to break down the total operating costs of the hospital, by hospital department. The aim of this stage was identification of the total operating costs and the average cost per patient day for each Internal Medicine Department of the ‘Hippokration’ General Hospital of Athens during the period 2014–2015. The final cost drivers were identified using the concept of cluster-related incidents in the hospital. In a subsequent stage, the 13 most frequent cancer KEN-DRG prices charged by Internal Medicine Departments were selected as a sample for further data analysis. Results With regard to the costing of the oncological KEN-DRG, the present study illustrates that a majority of the current reimbursement rates for oncological KEN-DRG codes are under-reimbursed, taking into account the actual costs of hospitalization for each group of cases. The results also reveal that the ALOS of the KEN-DRG does not reflect the actual ALOS in the sample of cases examined. In addition, under the scope of this study, two proposed models for the KEN-DRG price recalculation were developed, based on the average estimated cost of hospitalization for the sample incidents, which could improve the existing reimbursement system for Greek hospitals in the medium term. Conclusions The KEN-DRG payment system that was implemented in Greece for the first time in 2012 needs redesigning in terms of the true cost of hospital services and the actual cost of each patient’s treatment. With regard to the existing KEN-DRG reimbursement system, the current study suggested the use of a DRG price calculation model that consists of a relative weight factor and a base price, based on a real cost calculation process on an annual basis. Moreover, it should be stressed that the present study, as well as other related studies, make it possible to know the actual cost of hospitalization, and can contribute to the creation of a cost database over time at the level of hospitals or specific clinical departments.

Summary This paper presents the design, testing, and validation of a ultra‐wideband (UWB) wireless solution to replace wired intra‐spacecraft communications with wireless communications. The system...

Full-endoscopic transforaminal lumbar discectomy is based on a puncture technique using a guide needle to reach the target area of the foramen via a percutaneous posterolateral/lateral approach. It may correlate with specific approach-related complications, as exiting nerve root injury. We report the first case of pseudoaneurysm of the lumbar segmental artery secondary to a transforaminal full-endoscopic surgery in the treatment of a lumbar herniated disc. A 39-year-old man underwent left L4-L5 full-endoscopic transforaminal lumbar discectomy for a herniated disc. Three hours after surgery, he experienced acute progressive abdominal pain. An abdomen CT scan showed contrast extravasation in the left paraspinal compartment at L4 vertebral body level. The selective left lumbar angiogram revealed a pseudoaneurysm of a side branch of the left lumbar segmental artery, which was treated by endovascular coiling. The patient made a rapid postoperative recovery without further complications and was discharged 4 days later. This report identifies a rare complication of transforaminal full-endoscopic surgery in the treatment of a herniated lumbar disc. To our knowledge this is the first case of pseudoaneurysm formation of the lumbar artery following a full-endoscopic transforaminal lumbar discectomy.

Three-dimensional (3D) printing is gaining importance as a sustainable route for the fabrication of high-performance energy storage devices. It enables the streamlined manufacture of devices with programmable geometry at different length scales down to micron-sized dimensions. Miniaturized energy storage devices are fundamental components for on-chip technologies to enable energy autonomy. In this work, we demonstrate 3D printed microsupercapacitor electrodes from aqueous inks of pristine graphene without the need of high temperature processing and functional additives. With an intrinsic electrical conductivity of ∼1370 S m-1 and rationally designed architectures, the symmetric microsupercapacitors exhibit an exceptional areal capacitance of 1.57 F cm-2 at 2 mA cm-2 which is retained over 72% after repeated voltage holding tests. The areal power density (0.968 mW cm-2) and areal energy density (51.2 μWh cm-2) outperform the ones of previously reported carbon-based supercapacitors which have been either 3D or inkjet printed. Moreover, a current collector-free interdigitated microsupercapacitor combined with a gel electrolyte provides electrochemical performance approaching the one of devices with liquid-like ion transport properties. Our studies provide a sustainable and low-cost approach to fabricate efficient energy storage devices with programmable geometry.

Corporate Social Responsibility (CSR) becomes popular as big international firms gain more power than states and global issues engender concerns to people from all over the world. The pandemic of novel coronavirus is a current issue of global concern that threats humanity and global economy since the end of 2019. A lot of firms have announced urgent actions to support their employees and the local communities. The present study aims to examine whether the CSR activities of firms due to the pandemic could be categorized either as strategical or tactical CSR. The researcher recognizes the formation of a new kind of CSR called critical CSR as a hybrid between tactical and strategical CSR sharing characteristics from both. The examination of the case of Greece during the pandemic has provided a variety of examples of CSR activities from big Greek international firms that have been processed to support the validity of the reasoning. Finally, the paper delineates this new universal form of CSR born under the critical circumstances of the pandemic and the ensuing economic recession. That fact proves that this crisis could be transformed into a chance for corporations to realize their social role and improve their CSR footprint with the learnings of this pandemic by underlining possible advantages of these urgent CSR actions that could be incorporated into the usual CSR policy of the firms.