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Hypertonic saline has been used for the treatment of hyponatremia for nearly a century. There is now general consensus that hypertonic saline should be used in patients with hyponatremia associated with moderate or severe symptoms to prevent neurological complications. However, much less agreement exists among experts regarding other aspects of its use. Should hypertonic saline be administered as a bolus injection or continuous infusion? What is the appropriate dose? Is a central venous line necessary? Should desmopressin be used concomitantly and for how long? This article considers these important questions, briefly explores the historical origins of hypertonic saline use for hyponatremia, and reviews recent evidence behind its indications, dosing, administration modality and route, combined use with desmopressin to prevent rapid correction of serum sodium, and other considerations such as the need and degree for fluid restriction. The authors conclude by offering some practical recommendations for the use of hypertonic saline.

Metal nanoparticles have been used as antibacterial agents widely, and the combined use of enzymes and metal nanoparticles promotes antibacterial activity, achieving a synergistic effect. Additionally, enzymes decrease the amounts of metals and increase biocompatibility, thereby reducing toxicity of metals. However, the efficiency of enzymes is hindered when coupled with metals, which causes deactivation in the function of enzymes. How can a balance be struck between metals and enzymes? Although the antibacterial mechanism of metal nanoparticles is relatively clear, how enzyme–metal nanocomposites work against bacteria is not conclusive. Here, we describe several examples on the synthesis of enzyme–metal nanocomposites via co-immobilization or in situ reduction and summarize how enzyme–metal nanocomposites combat microorganisms.

The combined use of coal bottom ash (CBA) and ground CBA (GCBA) as partial replacement of fine natural aggregate (FNA) and Portland cement, respectively, was investigated for the production of concrete mixtures. Five concrete mixtures incorporating GCBA at 20 wt% replacement of binder and CBA at 0, 25, 50, 75 and 100 wt% replacement of FNA were produced and tested for strength, microstructural characteristics and carbonation resistance. A base concrete mixture made of conventional concrete was also produced as a reference concrete mixture. Test results showed that the combined use of GCBA and CBA in concrete mixtures results in enhancement of the microstructure, carbonation resistance and compressive strength of the resulting concrete mixtures. Scanning electron microscopy and X-ray diffraction analyses pointed at the occurrence of pozzolanic reaction and pore-filling effect of GCBA and CBA in the resulting concrete mixtures. It was observed that 25 wt% replacement of FNA with CBA is an optimum dosage considering its effects on the later age strength and durability characteristics of the resulting concrete mixtures.

This study is aimed at improving the seismic stability of bridge abutments. To study the effects of the combined use of a block of expanded polystyrene (EPS) and geogrid, a series of 1 g shaking table tests were conducted on a reduced-scale model of a cantilever-type bridge abutment and its backfill soil. The experiment results indicated that the base sliding and tilting of the wall can be further reduced by partly replacing the backfill soil with blocks of EPS, in combination with the use of the middle-height geogrid. Moreover, the relative settlement of the backfill soil at the interface with the wall could be reduced by the combined use of EPS and geogrid. Furthermore, the resultant normal force and rotational moment acting on the wall from the backfill soil during excitation also became small for the reinforced wall with both EPS and geogrid.

Background: Sepsis is considered to be a systemic inflammatory response due to infection, resulting in organ dysfunction. Timely targeted interventions can reduce mortality and improve prognosis. Therefore, it is important to identify potential sepsis in time. Inflammation plays a crucial role in the process of sepsis. We combined inflammatory markers to develop and validate a nomogram model and a simple risk scoring model for predicting sepsis in critically ill patients. Furthermore, comparing the prediction performance of the two models.Methods: The medical records of adult patients admitted to our intensive care unit (ICU) from August 2017 to December 2020 were analyzed. The finally included patients were randomly divided into training cohort (70%) and validation cohort (30%). A nomogram model for sepsis was developed through multivariate logistic regression analysis in the training cohort. The continuous variables included in nomogram model were transformed into dichotomous variables. Then a multivariable logistic regression analysis was performed based on these dichotomous variables and the odds ratio (OR) for each variable was used to construct a simple risk scoring model for predicting sepsis. The receiver operating characteristic curves (ROC) were constructed and the area under the curve (AUC) was calculated to evaluate the discrimination performance of the two models. Results: According to our inclusion and exclusion criteria, 2074 patients were included in study. Finally, white blood cell (WBC), C-reactive protein (CRP), interleukin-6 (IL-6), procalcitonin (PCT) and neutrophil-to-lymphocyte ratio (NLR) were included in our models. The AUC of the nomogram model was 0.854 (95%CI: 0.835-0.872). The AUC of the simple risk scoring model was 0.842 (95%CI: 0.822-0.861). When the cut-off value was 7.5 points, the sensitivity was 77.03% and the specificity was 75.75%. The prediction performance of the two models on sepsis is comparable (p=0.1298) and better than that of Sequential Organ Failure Assessment (SOFA) scores (AUC=0.759).Conclusions: This study combining five commonly available inflammatory markers (WBC, CRP, IL-6, PCT and NLR) developed a nomogram model and a simple risk scoring model to predict sepsis in critically ill patients. Although the prediction performance of the two models is comparable, the simple risk scoring model may be simpler and more practical for clinicians to identify potential sepsis in critically ill patients at an early stage and make treatment strategies.

У статті наведено результати експериментального дослідження взаємного потенціювання протимікробної активності антисептика декаметоксин і антибіотиків при поєднаному застосуванні. Встановлено посилення протимікробної ефективності антибіотиків цефалоспоринової, карбапенемової, аміноглікозидної, фторхінолонової, поліміксинової груп у присутності декаметоксину щодо неферментуючих грамнегативних бактерій та інших мікроорганізмів. Показано можливість досягнення бактерицидного ефекту щодо плівкових форм бактерій при поєднаному впливі антибіотиків і антисептиків.

Soil Cd pollution is a threat to the global ecological environment. Electrokinetic remediation (EKR) generally uses strong electric fields to obtain high removal efficiency, which leads to a series of side reactions and high energy consumption. EKR using low-voltage gradients showed weak migration of Cd and low remediation efficiency. Herein, to develop an effective enhanced EKR technology using low voltage gradient (0.2 V·cm−1), array adsorption zone and polarity exchange were applied simultaneously. Five experiments were conducted to determine the effect of polarity exchange, array adsorption zone and their combination on Cd removal when EKR was carried out at 0.2 V·cm−1. Results showed that the combined use of the array adsorption zone and polarity exchange achieved optimal remediation and average Cd removal efficiency was 83%. Moreover, the reciprocating motion of Cd caused by polarity exchange is no longer a side effect. In the wheat cultivation experiment, the Cd concentration of wheat root, stem and leaf decreased by 86%, 93% and 95% after Cd was removed by EKR coupled with array adsorption zone and polarity exchange. The 30-day energy consumption is 7.72 kWh·m−3, which is far lower than that of other enhancement methods. The present work proposes an effective EKR technology working at low voltage for Cd-contaminated soil.

Purpose We evaluated the diagnostic performance of the texture features of dynamic contrast-enhanced (DCE) MRI for breast cancer diagnosis in which the discriminator was optimized, so that the specificity was maximized via the restriction of the negative predictive value (NPV) to greater than 98%. Methods Histologically proven benign and malignant mass lesions of DCE MRI were enrolled retrospectively. Training and testing sets consist of 166 masses (49 benign, 117 malignant) and 50 masses (15 benign, 35 malignant), respectively. Lesions were classified via MRI review by a radiologist into 4 shape types: smooth (S-type, 34 masses in training set and 8 masses in testing set), irregular without rim-enhancement (I-type, 60 in training and 14 in testing), irregular with rim-enhancement (R-type, 56 in training and 22 in testing), and spicula (16 in training and 6 in testing). Spicula were immediately classified as malignant. For the remaining masses, 298 texture features were calculated using a parametric map of DCE MRI in 3D mass regions. Masses were classified into malignant or benign using two thresholds on a feature pair. On the training set, several feature pairs and their thresholds were selected and optimized for each mass shape type to maximize specificity with the restriction of NPV > 98%. NPV and specificity were computed using the testing set by comparison with histopathologic results and averaged on the selected feature pairs. Results In the training set, 27, 12, and 15 texture feature pairs are selected for S-type, I-type, and R-type masses, respectively, and thresholds are determined. In the testing set, average NPV and specificity using the selected texture features were 99.0% and 45.2%, respectively, compared to the NPV (85.7%) and specificity (40.0%) in visually assessed MRI category-based diagnosis. Conclusion We, therefore, suggest that the NPV of our texture-based features method described performs similarly to or greater than the NPV of the MRI category-based diagnosis.

The combined use of deuterium and tritium to determine travel time distributions (TTDs) in streams is an important development in catchment hydrology (Rodriguez et al, 2021). This comment takes issue with Rodriguez et al.'s general rejection of the truncation hypothesis, i.e. that the almost exclusive use of stable isotopes has truncated our vision of streamflow TTDs and caused us to miss the long tails of old water often shown by tritium. We discuss reasons why this hypothesis may not hold for the catchment described by Rodriguez et al. (2021), but could still apply to a large proportion of all catchments. We also discuss more generally future applications of tritium in northern and southern hemisphere catchments.

PetroChina’s Karamay heavy oil reservoirs mostly comprise Jurassic deposits of braided fluvial facies that have a low porosity, extremely high bitumen viscosity, and strong heterogeneities within the reservoir. Steam-assisted gravity drainage (SAGD) dilation start-up has been proven to be an efficient reservoir geomechanical stimulation method as it shortens the steam circulation time, reduces steam usage, and increases the oil production rates. This method worked well on relatively good-quality oil sand reservoirs. However, for reservoirs with heterogeneous reservoir properties along the SAGD well, field well production data indicated the presence of non-uniform steam chambers in post-dilation SAGD wells. Enhanced dilation methods, such as vertical well assisted SAGD dilation (VW-SAGD-Dilation) are have been used, and field pilot tests have yielded promising results. This reservoir stimulation process utilizes one or more vertical wells beside the SAGD well to initiate the formation of dilation zones that connect to the dilation zone formed during the conventional SAGD dilation start-up. Compared with the normal SAGD dilation start-up, this composite dilation process creates a uniform dilation zone along the SAGD well, thus improving the thermal conformance and well productivity. The vertical well and SAGD well are connected by this composite dilation zone, which enables the combined use of the SAGD process and cyclic steam stimulation process. This paper presents our understanding and numerical case studies of this enhanced dilation strategy. The well production data from the post-dilation wells were positive (uniform steam chamber growth and higher oil rate), which highlights the promising potential of using geomechanical dilation as a reservoir stimulation method to create a large stimulated reservoir volume in heterogeneous super-heavy oil reservoirs.

Relevance. The consumption of caffeine-containing food in the modern world must necessarily be safe for humans, including should not affect the hereditary material of the body. Objective: to determine the possible effect of caffeine at the cytogenetic level by the micronucleus method on erythrocytes. Materials and Methods. The objects for the study were non-linear mice, which were divided into 6 groups - one control group and 5 experimental groups. The first experimental group and the second in the experiment received caffeine in doses of 40 mg/kg and 100 mg/kg.The control group received saline. Caffeine was administered orally. The mutagen (dioxidine) was injected intraperitoneally. On the 5th day of the experimental study, we performed blood sampling for cytogenetic analysis. Results and Discussion. Our study of the caffeine preparation made it possible to determine the following patterns. Firstly, when administered within 5 days, caffeine at a dose of 40 and 100 mg/kg did not cause an increase in the number of micronuclei in erythrocytes in mice. Secondly, the combined use of caffeine (both at a dose of 40mg/kgand at a dose of 100 mg / kg) and dioxidine significantly increased the level of micronuclei in comparison with the control group. Thirdly, caffeine at a dose of 40mg/kgdid not increase the mutagenic activity of dioxidine, but a dose of caffeine of 100mg/kgwhen combined with a mutagen led to a significant increase in the level of cytogenetic damage. Conclusion. According to our data, caffeine in the experimental study was not a mutagen, but at a dose of 100 mg/kg it represented a comutagenic effect.

Objective The diagnosis of any dental pathology can vary from being simple to challenging. While the use of cone beam computed tomography (CBCT) is well established, magnetic resonance imaging (MRI) remains a proof of concept. This systematic review aims to compare the diagnostic ability of MRI with CBCT in diagnosing periapical pathosis. Materials and Methods This systematic search was performed using the electronic databases of MEDLINE, Cochrane Library, Google Scholar, and Science Direct to identify relevant articles from 2010 to 2020. The search terms used were magnetic resonance imaging, cone beam computed tomography, diagnosis, and periapical diseases. Result In total, 3218 potentially relevant abstracts and titles were identified. After removing duplicates, 1288 articles were reviewed for titles and abstracts, and 29 articles were selected for full-text reading. From those, 19 articles were finally selected that included original research studies, case reports, and case series and were included for systematic review. Most of the studies included in this review suggested that the combined use of CBCT and MRI is needed for a better and more precise diagnosis of complex periapical pathoses. The main advantage of MRI is its ability to image soft tissues usingnonionizing radiation, and the main disadvantage in the case of CBCT is overdiagnosis of the lesion. Conclusion MRI has various advantages over CBCT with similar diagnostic utility. When diagnosing periapical pathogens, both MRI and CBCT are needed for an accurate diagnosis.

Recently, structural elucidation of natural products has undergone a revolution. The combined use of different modern spectroscopic methods has allowed obtaining a complete structural assignment of natural products using small amounts of sample. However, despite the extraordinary ongoing advances in spectroscopy, the mischaracterization of natural products has been and remains a recurrent problem, especially when the substance presents several stereogenic centers. The misinterpretation of NMR data has resulted in frequent reports addressing structural reassignment. In this context, a great effort has been devoted to developing quantum chemical calculations that simulate NMR parameters accurately, allowing to achieve a more precise spectral interpretation. In this work, we employed a protocol for theoretical calculations of 1 H NMR chemical shifts and coupling constants using DFT, followed by the application of the DP4+ method to revisit the structure of Heliannuol L, a member of the Heliannuol class, isolated from Helianthus annuus. Our results indicate that the originally proposed structure of Heliannuol L needs a stereochemical reassignment, placing the hydroxyl bonded to C10 in the opposite side of the methyl and hydroxyl groups bonded to C7 and C8, respectively.

Background. The article is devoted to the problem of causal relationships between the effects of social risk factors in the form of excessive consumption of psychoactive substances on medical risk factors, the consequences of which are the formation and spread of addictive health disorders. The purpose of the study: Observation and processing of causal relationships between social and medical risk factors in the formation of addictive health disorders using the example of the Dniepropetrivsk region through a correlation analysis from the perspective of forensic pharmacy. Materials and methods. When conducting the study, we used the current legislative, regulatory and instructive documents, Internet resources. We applied documentary, forensic, statistical, correlation, comparative and graphical methods of analysis. Results. The article presents the results of forensic and pharmaceutical research, substantiates their relevance, formulates a goal, develops a design, and describes materials and research methods. The establishment of causal relationships between social and medical risk factors in the formation of addictive disorders was carried out on the example of the Dniepropetrivsk region, which is most typical for the Dnieper region of Ukraine, through a correlation analysis during 2014-2018. The collection, analysis and processing of peremptory data was carried out taking into account five indicators of social risk factors: circulation of a psychoactive substances of the 1st level of ethanol strength (beer); circulation of a psychoactive substances of the 2nd level of ethanol strength (liquors); circulation of a psychoactive substance of the 3rd level of ethanol strength (vodka); consumer price index; circulation of the joint use of psychoactive substances (in particular, alcoholic beverages + tobacco). The collection, analysis and processing of data on indicators of medical risk factors was carried out taking into account of four factors: the number of newly reported cases of addictive health disorders; the number of cases of diseases of the nervous system; the number of cases of addictive health disorders due to the use of a psychoactive substance of alcohol; the number of cases of addictive health disorders due to the combined use of psychoactive substances. According to the results of the study, found that indicators of social risk factors for the circulation of psychoactive substances of the 3rd level of ethanol strength (vodka) causally affect the indicators of medical risk factors, resulting in an increase in the number of cases of diseases of the nervous system. The structure of the normalized t-criterion of social and medical risk factors in the formation of addictive health disorders is determined. Conclusions. Established that the formation of addictive health disorders is caused by social risk factors (excessive and uncontrolled use of psychoactive substances in the form of alcoholic beverages of various strength levels or the combined use of psychoactive substances of various classification and legal groups, for example, alcoholic beverages + tobacco). Social risk factors affect medical risk factors, resulting in an increase in the number of newly reported cases of addictive health disorders and the number of cases of diseases of the nervous system. The data obtained are the basis for planning further forensic pharmaceutical research in this direction and focus the attention of state authorities on the need to develop socially-oriented preventive measures aimed at improving the circulation of alcoholic beverages of the 1st, 2nd and 3rd strength levels (beer, liquors, vodka), immoderate consumption of which leads to the formation of addictive health disorders.

The formation technology and performance characteristics of coatings based on aqueous dispersions are largely determined by the properties of the initial film-forming materials, which should ensure uniform thin-layer distribution on the substrate surface and the formation of coatings with the required technological complex of properties. Among them, due to their functional properties and relatively low cost, the most widespread are water-dispersion polymer coatings based on acrylic film-formers. In this paper, mathematical models of the structural and rheological dependences of heat-insulating acrylic aqueous dispersions are considered depending on the combined content of hydrophilic-hydrophobic fillers. To describe these dependencies, it is advisable to use equations of the second degree. According to the mathematical theory of experiment, the second-order orthogonal central compositional design makes it possible to predict the behavior of the response function. Carrying out an experiment in accordance with this plan makes it possible to establish the analytical dependence of the response function on the corresponding factors in the form of a polynomial equation of the second degree. The main response functions were: conditionally static yield stress, viscosity at the minimum rate of onset of fracture (initial effective viscosity), viscosity of the “destroyed” structure according to the Newtonian nature of the flow, activation energy of viscous flow at minimum, average and maximum shear rates. On the basis of the established dependences, the optimal ratios of hydrophobized aerosil and aluminosilicate microspheres were selected, the combined use of which makes it possible to reduce shear stresses to create a homogeneous aqueous acrylic dispersion, to predict the activation energy at various technological stages of preparation and application of heat-insulating coatings. The established results made it possible to create a hydrophilic-hydrophobic aqueous acrylic dispersion, which, without the use of surfactants, makes it possible to simplify the production technology of heat-insulating water-dispersion coatings, namely, to exclude the stage of pretreatment of fillers, to reduce the rotation speed of the frame mixer, and also to increase the kinetic stability of the finished dispersion.

Native mass spectrometry (nMS) is evolving into a workhorse for structural biology. The plethora of online and offline preparation, separation, and purification methods as well as numerous ionization techniques combined with powerful new hybrid ion mobility and mass spectrometry systems has established the great potential of nMS as a workhorse for structural biology. Fundamental to the progression of nMS has been the development of novel activation methods for dissociating proteins and protein complexes to deduce primary, secondary, tertiary, and quaternary structure through the combined use of multiple MS/MS technologies. This review highlights the key features and advantages of surface collisions (surface-induced dissociation, SID) for probing the connectivity of subunits within protein and nucleoprotein complexes and, in particular, for solving protein structure in conjunction with complementary techniques such as cryo-EM and computational modeling. A focus on several case studies wherein SID provided connectivity maps that were otherwise inaccessible by ‘gold standard’ structural biology techniques, or that agreed with solved crystal or cryo-EM structures, highlights the significant role SID, and more generally nMS, will play in structural elucidation of biological assemblies in the future as the technology becomes more widely adopted.

Objective: To explore the combined use of quantitative and qualitative methods with a longitudinal perspective in the field of obesity diet and physical activity. Method: A systematic scoping review following PRISMA guidelines. The databases searched were Web of Science, PubMed, and ASSIA. Results: 1592 records were returned from the searches. In total, nine studies met the inclusion criteria and were included in the review. Authors of included studies mixed quantitative and qualitative methods to obtain a deeper understanding of their study subjects, but few documents use longitudinal data. Authors value the combination of methods and try to integrate the results in their conclusions. Conclusions: Total integration is rarely achieved in the analysis. The origin of this divergence can be found in the lack of theoretical guidance in these articles, but also in the difficulty of working in multidisciplinary teams in the field of obesity. Resumen: Objetivo: Explorar el uso combinado de métodos cuantitativos y cualitativos con una perspectiva longitudinal en el campo de la obesidad y la actividad física. Método: Se ha realizado una revisión sistemática de las bases de datos Web of Science, PubMed y ASSIA siguiendo las pautas de PRISMA. Resultados: Solo nueve estudios fueron seleccionados de los 1592 que cumplieron los criterios de inclusión. Los autores combinan métodos cuantitativos y cualitativos, y afirman hacerlo para obtener una comprensión más profunda de sus sujetos de estudio, pero pocos utilizan datos longitudinales. Se valora la combinación de métodos y se intenta integrar los resultados en las conclusiones. Conclusiones: La integración total de métodos cuantitativos, cualitativos y longitudinales es excepcional y rara vez se logra en el análisis de los resultados. El origen de esta divergencia se puede encontrar en la falta de orientación teórica de estos artículos, pero también en la dificultad de trabajar en equipos multidisciplinarios en el campo de la obesidad.

Objetivo. Avaliar o uso combinado de marcadores sorológicos e análise espacial para ampliar a sensibilidade da vigilância epidemiológica da hanseníase. Método. Este estudo transversal foi realizado com vizinhos de casos de hanseníase e familiares e vizinhos de escolares com sorologia positiva anti-glicolipídeo fenólico I (PGL-I) em Diamantina, Minas Gerais, Brasil. Definiram-se como vizinhos as pessoas que residiam em um raio de até 100 metros de escolares e de casos de hanseníase. Para a coleta de dados, foram realizados entrevista semiestruturada, exame dermatoneurológico e teste sorológico rápido ML Flow. Todos os endereços foram georreferenciados. Foram realizadas regressão multivariada e análise espacial, tendo a sororreatividade anti-PGL-I como variável dependente. Resultados. Foram estudadas 1 491 pessoas: 1 009 (67,7%) familiares e vizinhos dos escolares com sorologia positiva e 482 (32,3%) vizinhos dos casos de hanseníase. Do total, 421 (28,2%) apresentaram soropositividade anti-PGL-I. A chance de soropositividade foi maior entre familiares e vizinhos dos escolares soropositivos (P < 0,001), entre pessoas com renda familiar de 1 salário-mínimo (P < 0,001), entre os mais jovens (P < 0,001) e entre os que residiam em domicílios com um a cinco cômodos (P = 0,007). A taxa de soropositividade foi maior em área geográfica correspondente aos escolares soropositivos (P < 0,001), ou seja, houve divergência entre o foco de maior concentração de casos e o de maior soropositividade. Conclusões. O uso combinado de marcadores sorológicos e análise espacial possibilitou identificar fragilidades operacionais dos serviços e uma possível endemia oculta de hanseníase nos setores censitários urbanos do município. Atividades de rastreamento de contatos sociais e vizinhos, busca ativa, campanhas educativas, inquéritos escolares e análise do território facilitam o diagnóstico precoce da hanseníase.

Most patients with undifferentiated thyroid cancer have unresectable disease with a very high rate of airway compromise. Tracheostomy typically entails technical issues in these cases. In fact, it can be very difficult to expose or simply locate the trachea beneath the mass, and the extensive soft tissue involvement can force the surgeon to cut the tumor to place the tracheostomy tube. The combined use of rigid bronchoscopy and percutaneous tracheostomy techniques, applied in an open surgical procedure, can greatly simplify the procedure. Furthermore, by this method, the airways are quickly secured and the risk of intraoperative bleeding is reduced.

Background and study aims This study evaluated the technical aspects of colorectal endoscopic submucosal dissection (ESD) with the Clutch Cutter (CC) (Fujifilm Co., Tokyo, Japan), a scissor-type knife, and the S-O clip (SO) as a traction clip, and compared the safety and efficacy to ESD using a needle-type knife. Patients and methods This was a single-center retrospective study. In Study 1, we evaluated 125 ESD patients: 60 using the SO and CC (SO group) and 65 using the CC (CC group). In Study 2, we evaluated 185 ESD patients: the CC group (N = 65) and 120 using the Flush knife BT-S (Flush group) (Fujifilm Co., Tokyo, Japan). In both studies, the clinicopathological features and therapeutic outcomes were compared using a propensity score-matched analysis. Results In 36 pairs of matched patients in Study 1, the rates of en bloc resection, R0 resection, perforation, and postoperative bleeding (POB) were 97.2 %, 88.9 %, 2.8 %, and 0 %, respectively, for the SO group and 100 %, 91.7 %, 0 %, and 0 % for the CC group (not significant). The mean procedure time for the SO group among less-experienced endoscopists was significantly shorter than in the CC group (42 vs. 65 minutes, P = 0.036). In 49 pairs of matched patients in Study 2, the rates of en bloc resection, R0 resection, perforation, and POB were 100 %, 95.8 %, 0 %, and 0 %, respectively, for the CC group and 98.0 %, 95.8 %, 0 %, and 2.0 % for the Flush group (not significant). The mean procedure time in the CC group among less-experienced endoscopists was significantly shorter than in the Flush group (52 vs. 67 minutes, P = 0.038). Conclusions CC and the combined use of CC and SO reduced colorectal ESD procedure time among less-experienced endoscopists.

Background/aim While controversial, cytoreductive surgery (CRS) with heated intra-peritoneal chemotherapy (HIPEC) and early postoperative intra-peritoneal chemotherapy (EPIC) remains the mainstay of treatment for low grade appendiceal neoplasm with pseudomyxoma peritonei (PMP). Our study aimed to investigate the difference in survival when administering HIPEC alone vs. HIPEC + EPIC. Additionally, we examined whether the duration of EPIC affects survival. Patients and methods We compared the difference in survival in 238 patients who underwent CRS + HIPEC alone vs. CRS + HIPEC/EPIC combination for low grade appendiceal cancer. We also compared short course (1-2 days) vs. long course (3-5 days) of EPIC. Results HIPEC/EPIC combination group (n=179) showed a significantly better 5-year survival of 95% compared to 71% in HIPEC alone (n=59). There was no statistically significant difference in 5-year survival between short course (n=22) and long course of EPIC (n=157). Conclusion Combined use of HIPEC and EPIC improves 5-year survival in low-grade appendiceal neoplasm. Two days of EPIC are sufficient.

An ideal biomaterial for bone regeneration is a longstanding quest nowadays. This study aimed to evaluate the osteogenic potentiality of nano-bioactive glass enhanced biocement based silicate with or without hyaluronic acid seeded in rabbits’ tibial bone defects. For this, 24 male rabbits with two 5 mm defects (1 defect per tibia) were divided into three equal groups. Among the predefined three groups, for the rabbits of group 1(control) bone defects were left untreated while for the members of group 2 defects received nano-bioactive glass enhanced biocement based silicate cement, and group 3 defects received nano-bioactive glass cement mixed with hyaluronic acid. Animals of each group were divided equally for euthanization after 3 and 6 weeks. Bone specimens were processed and examined histologically with histomorphometrically analysis of new bone area percentage. The bone defects in group 3 showed significantly improved osseous healing histologically as compared to the group 1&2. The morphometric analysis also revealed a significant increase in the new bone area percentage in group 3 as compared to the group 1 and 2 (P < 0.05). The results of the present study can be concluded that bone defects could be treated with nano-bioactive glass and hyaluronic acid cement. Although, nano-bioactive glass alone was capable of bone regeneration the combination of both had significant regenerative capacity.

Smooth milk production is very important to meet the baby's nutritional and nutritional needs. One of the most effective methods to increase milk production and reduce mother's stress while breastfeeding is to combine the BASOKU method (breastcare, oxytocin massage and husband's support) and regulate diet. This method is by doing breast massage, oxytocin massage on the spine as an effort to release the hormone oxytocin which can stimulate more milk production, coupled with the husband's support in exclusive breastfeeding for his baby. Mother's diet regulation that can increase milk production.The aim of the study was to determine the effectiveness of the combination of the BASOKU method and diet on increasing breast milk production at PMB Santi Yosina, Syamtalira Bayu District, North Aceh Regency.This type of research is a quasi-experimental research with a two-group posttest only design. The stages of the research are: The first stage of this research is to explain to postpartum mothers and their families about the BASOKU method and the diet that will be applied to mothers. The second stage is monitoring the increase in infant weight gain in those who receive treatment and those who do not receive the BASOKU method and diet. The population of this study were all postpartum mothers who gave birth at PMB Santi Yosina. The sample in this study used purposive sampling as many as 17 people in the control group and 17 people in the treatment group. Data were analyzed using paired t-test.The study was conducted from April to September 2021. The results of the univariate analysis showed that most of the increase in breast milk production in postpartum mothers in the intervention group in the 140-200 gram category was 15 people (88.2%) while in the control group in the

Tracheal disruption is a previously unreported complication of nonhuman primate social trauma. Two cases were identified in rhesus macaques with subcutaneous emphysema. These cases resolved with medical management and demonstrate that the combined use of radiography and tracheoscopy allows rapid assessment and diagnosis of tracheal trauma in nonhuman primates.

Los Trastornos del Espectro Autista (TEA) son un grupo de alteraciones del neurodesarrollo que afectan la comunicación y el comportamiento. El Centro de Control de Enfermedades (CDC, siglas en inglés) señaló que la prevalencia de TEA en Estados Unidos, hacia el año 2016, era de 1 de cada 54 niños menores de 8 años. Los criterios de diagnóstico clínico se encuentran tanto en el Manual Diagnóstico y Estadístico de Trastornos Mentales 5ta edición (DSM – 5) como en la Clasificación Internacional de Enfermedades, 10ma edición (CIE-10). Las herramientas de ayuda diagnóstica más usadas y que poseen un alto grado de confiabilidad para el cribado del TEA son las entrevistas semiestructuradas y cuestionarios como la Lista de Verificación Modificada para el Autismo en niños pequeños (M-CHAT), la Entrevista para el Diagnóstico del Autismo – Revisada (ADI-R), y la Escala de Observación para el Diagnóstico del Autismo (ADOS). Entre las nuevas herramientas debe mencionarse el uso combinado de la Preferencia de Mirada y el M-CHAT-R (GP-M-CHAT/R). Por su parte, Telesalud es un servicio que utiliza herramientas como Tecnologías de Información y Comunicaciones (TIC), cuya viabilidad, accesibilidad y confiabilidad para el diagnóstico de trastornos del neurodesarrollo como TEA, se vienen estudiando con resultados satisfactorios en diversas partes del mundo.

Objective To assess the usefulness of combined diffusion kurtosis imaging (DKI) and dynamic contrast-enhanced MRI (DCE-MRI) in the differentiation of parotid gland tumors. Methods Seventy patients with 80 parotid gland tumors who underwent DKI and DCE-MRI were retrospectively enrolled and divided into four groups: pleomorphic adenomas (PAs), Warthin tumors (WTs), other benign tumors (OBTs), and malignant tumors (MTs). DCE-MRI and DKI quantitative parameters were measured. The Kruskal–Wallis H test and post hoc test with Bonferroni correction and ROC curve were used for statistical analysis. Results WTs demonstrated the highest Kep value (median 1.89, interquartile range [1.46–2.31] min−1) but lowest Ve value (0.20, [0.15–0.25]) compared with PAs (Kep, 0.34 [0.21–0.55] min−1; Ve, 0.36 [0.24–0.43]), OBTs (Kep, 1.22 [0.27–1.67] min−1; Ve, 0.28 [0.25–0.41]), and MTs (Kep, 0.71 [0.50–1.23] min−1; Ve, 0.35 [0.26–0.45]) (all p D value (1.10, [0.88–1.29] × 10−3 mm2/s) compared with PAs (1.81, [1.60–2.20] × 10−3 mm2/s) and OBTs (1.57, [1.32–1.89] × 10−3 mm2/s) (both p trans value (0.12, [0.07–0.18] min−1) compared with OBTs (0.28, [0.11–0.50] min−1) (p Kep and Ve, D, and Ktrans to distinguish WTs, MTs, and PAs sequentially were 1.06 min−1, 0.28, 1.46 × 10−3 mm2/s, and 0.21 min−1, respectively (accuracy, 89% [71/80], 91% [73/80], 78% [62/80], respectively). Conclusion The combined use of DKI and DCE-MRI may help differentiate parotid gland tumors. Key Points • The combined use of DKI and DCE-MRI could facilitate the understanding of the pathophysiological characteristics of parotid gland tumors. • A stepwise diagnostic diagram based on the combined use of DCE-MRI parameters and the diffusion coefficient is helpful for accurate preoperative diagnosis in parotid gland tumors and may further facilitate the clinical management of patients.

This study aimed to evaluate the impact of the risk minimisation measures issued by the European Medicines Agency in 2014 to restrict the combined use of renin-angiotensin system (RAS) agents in Denmark. Data from the Danish National Prescription Registry covering all medications dispensed during January 2008-December 2018 was used. The outcome was monthly prevalence of patients co-dispensed RAS-acting agents. Autoregressive integrated moving average interrupted time series regression was used to evaluate dispensing trends. The prevalence of patients co-dispensed RAS-acting agents decreased from 0.01.0003intervention trend was declining and further decreased with an additional -0.45 (950.66, -0.25) co-dispensing per million population after the intervention. Overall, the intervention had minimal impact on the combined use of RAS-acting agents. However, as the combined use of RAS-acting agents is low, further interventions to restrict the combined use of RAS-acting agents may not be required in Denmark at this point. This study aimed to evaluate the impact of the risk minimisation measures issued by the European Medicines Agency in 2014 to restrict the combined use of renin-angiotensin system (RAS) agents in Denmark. Data from the Danish National Prescription Registry covering all medications dispensed during January 2008-December 2018 was used. The outcome was monthly prevalence of patients co-dispensed RAS-acting agents. Autoregressive integrated moving average interrupted time series regression was used to evaluate dispensing trends. The prevalence of patients co-dispensed RAS-acting agents decreased from 0.01% to 0.0003%. Pre-intervention trend was declining and further decreased with an additional -0.45 (95% confidence interval -0.66, -0.25) co-dispensing per million population after the intervention. Overall, the intervention had minimal impact on the combined use of RAS-acting agents. However, as the combined use of RAS-acting agents is low, further interventions to restrict the combined use of RAS-acting agents may not be required in Denmark at this point.