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Aneurysms of the splenic artery are relatively rare, being found in patients with portal hypertension, multiparous, atherosclerosis, or in young people with various genetic diseases. In the uncomplicated forms, splenic artery aneurysms are often difficult to diagnose either because of the asymptomatic evolution, or because of the non-specific symptoms. In cases of trauma or large sizes, aneurysms can be complicated by rupture, which can cause hemoperitoneum with the risk of death if specific treatment is not initiated as soon as possible. Depending on the location of the splenic aneurysm, comorbidities, the patient's general condition or lifethreatening complications, laparotomy, laparoscopy, endovascular techniques or combined procedures can be performed. The case of a 33-year-old female patient who presented to the emergency room with abdominal pain, nausea, vomiting and later syncope is presented. The patient was referred to the radiology department, and computed tomography revealed a ruptured splenic artery aneurysm with hemoperitoneum. The splenic artery aneurysm and the spleen were excised by emergency surgery, with a favorable postoperative outcome. The young age of diagnosis and treatment probably implies a genetic component, so that she was referred for additional investigations after discharge.

In the present study we aimed to investigate the effects of therapy of combined endo -periodontal lesions in patients who underwent surgical treatment with debridement flap plus resorbable membrane placement (GTR) and debridement flap plus platelet enriched fibrin (A-PRF) on periodontal clinical and radiologic parameters. The study aims to investigate the specific effects on mandibular premolar teeth affected by combined endo-periodontal lesions. An important contribution has been made to the understanding of how these therapeutic procedures influence the course and outcome of endo periodontal lesions. To date, according to the information identified in the literature, this is the first study to evaluate these effects on mandibular premolar teeth with true endo periodontal combined lesions. This research has the potential to provide essential information on the optimal ways to treat this type of lesion. By evaluating and comparing the efficacy of two distinct therapeutic protocols, we aimed to identify the most effective and promising strategies for the management of these delicate clinical conditions. We opted for unit tooth selection to remove the risk of factors compromising the clarity of the results, such as furcation lesions at the level of pluri-radicular teeth or variations related to anatomo-physiological particularities in different areas of the maxilla.

Diabetes in children is a chronic condition that involves rigorous blood sugar management to prevent complications. The psychological stress associated with this disease can worsen the general condition and oral health of diabetic children, causing xerostomia, oral infections and gum disease. This study explores the effectiveness of stress management strategies, including relaxation techniques, psychological counseling, family support, and behavioral interventions such as cognitive behavioral therapy (CBT) and mindfulness. Research shows that these methods reduce anxiety, improve blood sugar control and adherence to treatment, thus contributing to better oral health and an improved overall quality of life. The integrated approach to psychological stress is essential in the holistic treatment of diabetic children, to prevent long-term complications and promote healthy living.

Abstract Background Maternally-inherited symbionts can induce pre-mating and/or post-mating reproductive isolation between sympatric host lineages, and speciation, by modifying host reproductive phenotypes. The large parasitoid wasp genus Cotesia (Braconidae) includes a diversity of cryptic species, each specialized in parasitizing one to few related Lepidoptera host species. Here, we characterized the infection status of an assemblage of 21 Cotesia species from 15 countries by several microbial symbionts, as a first step toward investigating whether symbionts may provide a barrier to gene flow between these parasitoid host lineages. Results The symbiotic microbes Arsenophonus, Cardinium, Microsporidium and Spiroplasma were not detected in the Cotesia wasps. However, the endosymbiotic bacterium Wolbachia was present in at least eight Cotesia species, and hence we concentrated on it upon screening additional DNA extracts and SRAs from NCBI. Some of the closely related Cotesia species carry similar Wolbachia strains, but most Wolbachia strains showed patterns of horizontal transfer between phylogenetically distant host lineages. Conclusions The lack of co-phylogenetic signal between Wolbachia and Cotesia suggests that the symbiont and hosts have not coevolved to an extent that would drive species divergence between the Cotesia host lineages. However, as the most common facultative symbiont of Cotesia species, Wolbachia may still function as a key-player in the biology of the parasitoid wasps. Its precise role in the evolution of this complex clade of cryptic species remains to be experimentally investigated.

Abstract Background Empathy is a key competency and is essential for doctor-patient relationships. Studies have proven a continuous reduction of empathy in medical students during their study period. The use of SPs is positively evaluated for competency acquisition and real patient communication training has positive effects on empathy empowerment. Therefore, the present study focusses on the impact of simulated patient (SP) vs real patient (RP) communication training on empathetic behaviour in undergraduate medical students. Methods The prospective evaluation took place during a 210-minute skills lab unit on medical communication for 3rd year medical students. Study participants were allocated in advance to one of three groups: one group trained with an SP (SP-group) and was informed about the fact that it was an SP; another group trained with an SP but assumed to encounter an RP (incognito patient group (IP-group)); the last group trained with an RP and was correctly informed about it (real patient group (RP-group). Self-assessed empathy was measured by using Jefferson Scale of Physician Empathy (JSPE) and Interpersonal Reactivity Index (IRI), as these are the most commonly used instruments for assessing empathy. Study participants were evaluated on empathetic behaviour by their group-associated patient using the Consultation and Relational Empathy (CARE) scale. Results 146 students participated. There was no significant difference in self-assessed empathy between groups for JSPE and IRI. External assessment via CARE showed a statistically significant difference between SP-group and IP-group , as well as between SP-group and RP-group. There was no significant difference between IP-group and RP-group. This means that students training with real patients (or who believed them to be real) did receive significantly lower performance ratings on their empathy. Conclusion The results demonstrate a significant lower external empathy rating for students who had trained with a real patient or if they were in the belief of having encountered a real patient; this may be due to inhibitions and a lack of routine. Therefore, we recommend implementing SPs in the early study period with the gradual integration of RPs in the student’s further course of study.

The globalised economic environment, exposed to financial, health, political and social turbulence, creates uncertainties and challenges in the business environment. Thus, companies are exposed to a portfolio of interrelated, diverse and complex risks, which requires a proactive approach to their management, but also a relationship based on transparency, consistency, credibility, with stakeholders. From this perspective, internal audit and corporate governance are the pillars of an attractive and sustainable business environment. The research has two components: the first component includes a review of the literature and regulations in the field; the second component includes a quantitative research on the degree of compliance of companies in the oil and gas industry, included in the BET - NG index, in terms of internal audit from a corporate governance perspective. The results of the research revealed a heterogeneous evolution of compliance of the companies analysed, but also their continued efforts to improve their corporate governance and compliance practices to ensure a transparent, credible, accountable and sustainable business environment. In relation to the governance model adopted by companies, the analysis revealed an increase in internal audit compliance for companies that have adopted the dual model. The research results add value on one hand to the literature and on the other hand to stakeholders in the oil and gas industry, the economic, social and regulatory environment in order to improve and strengthen corporate governance practices related to internal audit.

This paper presents the application of sodium aluminate, directly or after small adjustments in concentration and purity, in some other valuable intermediary products. Sodium aluminate is an intermediary product in Bayer technology applied by Alum SA Tulcea production of alumina and alumina products. Mainly, sodium aluminate is a carrier of aluminum hydroxide between important manufacturing stages in the Bayer process, bauxite processing, and aluminum hydroxide crystallization. After a short investigation of the uses of sodium aluminate, it was decided to choose and study the possibility of converting this secondary product into ecological material for the treatment of natural or industrial wastewater. Actually, on the market, products similar to sodium aluminate from Alum SA Tulcea provide treated waters with high purity and reasonable quality, excellent coagulation rates, rapid flotation, and sedimentation, and in addition, significant side effects, such as excellent removal of phosphorus and silica from treated water. Treatments do not require lime or hydroxide to control alkalinity, and chemical sludge remains at a minimum volume and mass. The test performed with sodium aluminate from Alum SA Tulcea was comparable with other tests with Al2(SO4)3 and FeCl3. The maximum removal yields of global organic load expressed by chemical oxygen demand (COD) and biochemical oxygen demand (BOD5), chromium (Cr VI), and total suspended solids (TSS) were: 83%COD, 71% BOD5, 99.7% Cr VI and 93% TSS.

This paper presents the remediation of polluted soils with chlorinated pesticides (HCH, DDX) by zerovalent iron technology (ZVI). We performed soil remediation tests with iron (two grinding sizes), three doses, with iron and acetic acid (two doses for each dose of iron and for each type of grinding iron size). In the study was applied 99 tests (samples). The diminishing of HCH and DDX concentrations in treated samples is more significant with the increasing of iron and acetic acid doses, for the same contact time: 99% HCH and 91% DDX for large iron particles and 95% HCH and 82% DDX for small iron particles.

Due to increasing workload and rising expectations for both undergraduate and speciality training in medicine, teaching in a clinical environment can be challenging. The “Train the Trainer” course, developed by CAL (Chirurgische Arbeitsgemeinschaft Lehre, Deutsche Gesellschaft für Chirurgie (DGCH)), aims to assist clinical teachers in their task. This study investigates the effect the course has on participants’ self-efficacy and teaching motivation.

Canker sores are a common condition among pregnant women, having a significant impact on oral and overall health. This article explores the causes, risks, and prevention strategies associated with mouth sores during pregnancy. Hormonal changes, weakening of the immune system, and stress are relevant factors in their occurrence. Risks include physical and emotional discomfort, as well as possible pregnancy complications. Proper oral hygiene, balanced nutrition, and stress reduction are essential strategies for preventing oral thrush. Treatment during pregnancy requires a gentle approach, and treatment options must be safe for the mother and baby. In conclusion, proper management of mouth sores during pregnancy is essential for the oral and general health of pregnant women and the fetus. The use of transdermal systems for administering crucial oils to pregnant women is an innovative and effective method of treatment of canker sores in pregnant women, offering multiple benefits and ensuring increased safety for mother and baby.

Oral rehabilitation of elderly hypertensive patients presents specific challenges, given the increased prevalence of systemic complications in this group. Hypertension can significantly influence dental management through drug interactions, oral side effects of antihypertensive therapies, and special needs during dental procedures. The complex and interdisciplinary approach to the management of oral rehabilitation of elderly hypertensive patients is essential to ensure safe and effective treatment. By implementing personalized assessment, intervention and education strategies, the quality of care provided to this group of patients can be significantly improved, optimizing treatment outcomes and improving their quality of life. This article reviews existing literature and explores the main risks and considerations for optimizing oral care in these patients.

IntroductionNovel strategies are needed to address barriers to COVID-19 vaccination among people experiencing homelessness (PEH), a population that faces increased COVID-19 risk. Although growing evidence suggests that financial incentives for vaccination are acceptable to PEH, their impact on uptake is unknown. This study aimed to assess whether offering $50 gift cards was associated with the uptake of the first doses of COVID-19 vaccine among PEH in Los Angeles County.MethodsVaccination clinics began on March 15, 2021; the financial incentive program was implemented from September 26, 2021 to April 30, 2022. Interrupted time-series analysis with quasi-Poisson regression was used to evaluate the level and slope change in the number of weekly first doses administered. Time-varying confounders included the weekly number of clinics and the weekly number of new cases. Demographic characteristics were compared for PEH vaccinated before and after the implementation of the incentive program using chi-square tests.ResultsOffering financial incentives was associated with the administration of 2.5 times (95% CI=1.8, 3.1) more first doses than would have been expected without the program. Level (-0.184, 95% CI= -1.166, -0.467) and slope change (0.042, 95% CI=0.031, 0.053) were observed. Individuals who were unsheltered, aged

As a result of the COVID-19 health epidemic, online life has exploded into our daily lives, forcing most of us to move previously seemingly irreplaceable "face-to-face" activities into "non-face-to-face" meetings and activities in many sectors. One of the biggest challenges has been in the field of education: This sector, compared to other sectors, was less digitized. Under these circumstances, the entire education process was transferred to online space overnight, which was/is a major challenge for everyone. Thus, a questionnaire survey was conducted among students from two universities in Hungary and Romania, the results of which are included in the present article. The aim of the research was to measure students' satisfaction and to examine the benefits of online education, for example, in terms of introducing hybrid education over the long term. Descriptive statistics as well as the Wilcoxon rank-sum test were used to analyze the database. The results showed that, from a practical point of view, there was no significant difference between the Hungarian and Romanian respondents who had a fundamentally positive view of digital education. In this respect, positive feedback can be seen as encouraging, especially for those individuals and social strata who may find online education much more attractive than traditional physical teaching. Online education could be an attractive, accessible, sustainable form of further education in the long run.

The robustness of computer vision models against adversarial attacks is a critical matter in machine learning that is often overlooked by researchers and developers. A contributing factor to this oversight is the complexity involved in assessing model robustness. This paper introduces RobustCheck, a Python package designed for evaluating the adversarial robustness of computer vision models. Utilizing black-box adversarial techniques, it allows for the assessment of model resilience without internal model access, reflecting real-world application constraints. RobustCheck is distinctive for its rapid integration into development workflows and its efficiency in robustness testing. The tool provides an essential resource for developers to enhance the security and reliability of computer vision systems.

Background:. There is a paucity of data evaluating femoral arterial access training, despite significant morbidity/mortality associated with incorrect femoral arterial access. The aim of this study was to develop and evaluate a novel 2-component simulation-based curriculum to address a lack of standardized access training and identify the most frequent errors in access. Methods:. The femoral arterial access curriculum was developed through a multi-disciplinary collaboration and utilized in-person simulation sessions in conjunction with online and in-person didactic training. Access errors and curriculum efficacy were assessed using mixed-methodology evaluation of video recordings of trainee arterial access pre- and postcurriculum. All recordings were reviewed and scored by 2 blinded, independent investigators. Results:. Twenty-six participants completed the curriculum with pre- and postcurriculum recordings. Sixteen participants (62%) were in their first year of residency training. Fifteen participants (58%) belonged to general surgery residency, 9 (35%) to emergency medicine, 1 to vascular surgery, and 1 to interventional radiology residency programs. The global rating for the overall ability to obtain femoral arterial access under ultrasound guidance (0 = fail, 4 = excellent) improved following the curriculum (0.87 ± 0.15, 2.79 ± 1.26, P < 0.0001). Fourteen participants (54%) were unable to independently complete the procedure before training, compared to only 2 participants (8%) following the curriculum. Procedural completion time decreased from 7.14 ± 4.26 to 3.81 ± 2.53 minutes (P < 0.001). Most frequent errors, determined through qualitative analysis, included difficulty using the ultrasound and unsafe maneuvers. Conclusions:. Before the curriculum, there were significant frequent errors in junior resident femoral arterial access with major patient safety concerns. A novel simulation-based femoral arterial access curriculum resulted in improved procedural skills across all metrics.

The memory-enhancing activity of Matricaria chamomilla hydroalcoholic extract (MCE) is already being investigated by behavioral and biochemical assays in scopolamine-induced amnesia rat models, while the effects of scopolamine (Sco) on cerebral glucose metabolism are examined as well. Nevertheless, the study of the metabolic profile determined by an enriched MCE has not been performed before. The present experiments compared metabolic quantification in characteristic cerebral regions and behavioral characteristics for normal, only diseased, diseased, and MCE- vs. Galantamine (Gal)-treated Wistar rats. A memory deficit was induced by four weeks of daily intraperitoneal Sco injection. Starting on the eighth day, the treatment was intraperitoneally administered 30 min after Sco injection for a period of three weeks. The memory assessment comprised three maze tests. Glucose metabolism was quantified after the 18F-FDG PET examination. The right amygdala, piriform, and entorhinal cortex showed the highest differential radiopharmaceutical uptake of the 50 regions analyzed. Rats treated with MCE show metabolic similarity with normal rats, while the Gal-treated group shows features closer to the diseased group. Behavioral assessments evidenced a less anxious status and a better locomotor activity manifested by the MCE-treated group compared to the Gal-treated group. These findings prove evident metabolic ameliorative qualities of MCE over Gal classic treatment, suggesting that the extract could be a potent neuropharmacological agent against amnesia.

Myopia is a current worldwide problem, due to a marked increase in its prevalence, all the more important in the age of monitors and working predominantly indoors. This impacts in particular on visual acuity and thus on quality of life, individual performance, with consequences for the labour market and economic implications for public health services. Consequently, much research is focused on modifying the factors that determine the onset and especially the progression of myopia, using various methods, such as the use of anticholinergic agents, the use of progressive lenses (aerial or contact), orthokeratology, refractive surgery techniques, each of which has varying degrees of effectiveness. The aim of this paper is to highlight the association between myopia progression and environmental and occupational factors, and to review currently available strategies for reducing myopia progression.

This review aims to evaluate efficacy and drug treatment options in cases of vaginal and vulvar candidiasis associated with diabetes. We conducted an exhaustive literature review, looking at relevant clinical trials, meta-analyses, and clinical experiences. Patients with candidiasis and diabetes mellitus were included in a clinical case study to assess their response to treatment. Antifungals such as fluconazole and clotrimazole have been effective in treating candidiasis, but success has been influenced by glucose control levels. Proper diabetes management, along with antifungal therapy, resulted in decreased recurrences. Treatment of candidiasis in a diabetic context requires an integrated approach, including antifungal therapy and adequate management of diabetes. Strict blood glucose control plays a crucial role in preventing recurrences and improving the quality of life of affected patients. Further studies are needed to better understand the complex interactions between diabetes and candidiasis, paving the way for the development of more personalized and effective treatment strategies.

During pregnancy, dental care is important for the overall health of the mother and unborn baby. However, it is essential to take into account certain aspects when planning dental treatments in a pregnant woman with cardio-vascular pathological implications. It is important to coordinate with your medical and dental team to ensure a safe and effective treatment plan. Pregnancy can bring additional challenges for patients with cardiovascular pathological implications during dental treatments. The medical team must know these aspects to ensure safe and effective dental treatment. Pregnancy itself can affect the cardiovascular system, and this aspect should be taken into account during dental treatments in pregnant women. It is also important to pay attention to medications and procedures used in dentistry to minimize the risk of cardiovascular complications during this delicate period. The dental management of a pregnant patient in the third trimester of pregnancy in the 7th month should be approached with caution and special attention to ensure the safety of both lives. In general, dental treatments are recommended during pregnancy to prevent dental complications that can affect the general health of the mother and fetus

The study presents an assessment of surgical and drug management of periodontal complications during pregnancy, with a focus on the impact of these interventions on pregnant women’s oral health and fetal development. Management dedicated to periodontal complications during pregnancy can help improve the oral health of pregnant women and reduce the risk of associated obstetric complications. These findings support the need to integrate periodontal treatment into prenatal care to improve both maternal and fetal health. Women with pre-existing periodontal disease may experience a worsening of their condition during pregnancy, with potential repercussions on overall health. Understanding the hormonal effects and risks associated with periodontal complications during pregnancy is essential to implement appropriate management strategies and ensure proper oral care during this delicate period. Preventive management and prompt treatment can significantly contribute to maintaining periodontal health and reducing risks to the mother and fetus. Vitamin complexes, especially vitamin C, are essential for the functioning of the immune system and contribute to the synthesis of collagen, a protein important for tissue health, including gums. Adequate levels of vitamin C can help heal gum tissues and reduce inflammation.

Background: Several adalimumab preparations are now available for patients with inflammatory bowel disease (IBD). Comparative satisfaction and tolerability are unknown. Objectives: This study investigated IBD patient satisfaction with approved adalimumab biosimilars and their originator. Design: In this cross-sectional study, we included 941 consecutive adalimumab-treated patients with IBD across 45 centres affiliated with the Groupe d’Etude Therapeutique des Affections Inflammatoires du tube Digestif who completed a satisfaction questionnaire comprising four items each rated by a 10-point scale. Methods: The differences in responses were performed using a one-way analysis of variance followed by Tukey’s honest significant difference test. Results: The most commonly used drugs at inclusion were Humira ® (436/941, 46.3%), Amgevita ® (177/941, 18.8%) and Hulio ® (105/941, 11.2%). The mean overall satisfaction rate with adalimumab was 8.5 (standard deviation 1.8). Overall satisfaction was significantly higher in patients treated with Humira (8.6 (1.5)), Hulio (8.6 (1.8)) or Amgevita (8.5 (1.4)) ( p