Higher Severity Research Articles

Silicon, biological seed treatment and cutting reduce the intensity of leaf spot diseases affecting Lolium multiflorum

AbstractItalian ryegrass is a major pasture crop cultivated mainly for feeding cattle in southern Brazil. The choice of crop is based on nutritional quality and the shortage of pastures that occur during the winter in the southernmost part of Brazil. In this region, the production of biomass and seeds are threatened by diseases, in particular fungal diseases that affect the foliage. In this study we identified and monitored the natural occurrence of a complex of leaf spotting diseases and evaluated the effects of combined management practices to reduce the intensity of foliar diseases: seed treatment with Trichoderma atroviride, soil amendment with silicon and cutting frequency (none, one or two cuts). Three diseases were present in a two‐season experiment: grey leaf spot (Pyricularia oryzae), brown leaf spot (Bipolaris sorokiniana) and parrot's eye leaf spot (Cercospora sp.). Grey leaf spot had the highest severity, regardless of treatment, during the first season, and was the only disease present in the following season. Grey leaf spot dominated, and plants receiving only one cut were more prone to P. oryzae infection. The treatments with silicon or T. atroviride reduced the relative disease by 40% to 80%, in relation to untreated and uncut regimes. This study showed the main leaf spot diseases associated with L. multiflorum. Moreover, it demonstrates for the first time in the region the effectiveness of reducing leaf spot via the application of silicon in the soil, inoculation of seeds with T. atroviride and managing the cutting regime.

Pre-existing brain damage and association between severity and prior cognitive impairment in ischemic stroke patients

BackgroundWe evaluated whether pre-existing brain damage may explain greater severity in cognitively-impaired patients with ischemic stroke (IS). MethodsIS patients were retrieved from the population-based registry of Dijon, France. Pre-existing damage (leukoaraiosis, old vascular brain lesions, cortical and central brain atrophy) was assessed on initial CT-scan. Association between prestroke cognitive status defined as no impairment, mild cognitive impairment (MCI), or dementia, and clinical severity at IS onset assessed with the NIHSS score was evaluated using ordinal regression analysis. Mediation analysis was performed to assess pre-existing brain lesions as mediators of the relationship between cognitive status and severity. ResultsAmong the 916 included patients (mean age 76.8 ± 15.0 years, 54.3% women), those with pre-existing MCI (n = 115, median NIHSS [IQR]: 6 [2-15]) or dementia (n = 147, median NIHSS: 6 [3-15]) had a greater severity than patients without (n = 654, median NIHSS: 3 [1-9]) in univariate analysis (OR=1.69; 95% CI: 1.18-2.42, p = 0.004, and OR=2.06; 95% CI: 1.49-2.84, p < 0.001, respectively). Old cortical lesion (OR=1.53, p = 0.002), central atrophy (OR=1.41, p = 0.005), cortical atrophy (OR=1.90, p < 0.001) and moderate (OR=1.41, p = 0.005) or severe (OR=1.84, p = 0.002) leukoaraiosis were also associated with greater severity. After adjustments, pre-existing MCI (OR=1.52; 95% CI: 1.03-2.26, p = 0.037) or dementia (OR=1.94; 95% CI: 1.32-2.86, p = 0.001) remained associated with higher severity at IS onset, independently of confounding factors including imaging variables. Association between cognitive impairment and severity was not mediated by pre-existing visible brain damages. ConclusionImpaired brain ischemic tolerance in IS patients with prior cognitive impairment could involve other mechanisms than pre-existing visible brain damage.

Paediatric post-concussive symptoms: symptom clusters and clinical phenotypes

ObjectiveTo assess the co-occurrence and clustering of post-concussive symptoms in children, and to identify distinct patient phenotypes based on symptom type and severity.MethodsWe performed a secondary analysis of the prospective,...

Science, Medicine, and the Anesthesiologist

Science, Medicine, and the Anesthesiologist

Analysing foodborne illness outbreak severity in the USA, 2009–19

BackgroundIn the USA, one in six Americans have had a foodborne illness, resulting in approximately US$17·6 billion (2018) of losses annually attributed to medical costs, productivity losses, and economic burden due to death. Previous research has characterised these burdens with use of various methods, including disability-adjusted life-years (DALYs), medical care costs, and revenue losses of food retailers. However, these indices assess only the socioeconomic burdens of outbreaks without providing an index to compare the health-related severity of outbreaks regarding geographical spread of transmission, outbreak duration, and the morbidity and mortality of case outcomes. MethodsIn this study, we proposed a data-driven index for evaluating outbreak severity using the publicly available US Centers for Disease Control and Prevention's National Outbreak Reporting System (NORS) database from Jan 1, 2009, to Dec 31, 2019. We identified 67 metrics related to the geographical extent (eg, counties or states where individuals with a foodborne illness resided and were exposed), case severity (eg, primary cases, hospital admissions, emergency room visits, and deaths), duration (eg, days of illness and days of exposure events), and their ratios. We selected 11 metrics to create the index on the basis of completeness and distributional characteristics of these metrics. We generated index scores by normalising natural log-transformed values on a 0–1 scale and averaging all metrics per outbreak. Scores ranged from 0 (lowest severity) to 1 (highest severity). FindingsNORS reported 9407 outbreaks in our 11-year study period. We found that bacterial outbreaks associated with the genera Streptococcus, Listeria, and Salmonella had the highest median severity scores, whereas Bacillus, Staphylococcus, and Clostridium had the lowest scores. Among protozoa, Cryptosporidium and Cyclospora had the lowest median scores, whereas Giardia and Toxoplasma had the highest scores. Hepatitis had the highest median score for virus-associated outbreaks, whereas Norovirus, which had the most outbreaks reported in our study period (n=3088), had the lowest score. InterpretationOur index illustrates the usefulness of publicly reported surveillance data in establishing a data-driven approach for monitoring the severity of foodborne outbreaks regarding their spread, duration, and morbidity and mortality. Differences in outbreak severity by pathogen inform how to best allocate resources for monitoring, tracking, and preventing foodborne disease outbreaks. Being data driven, our index emphasises the importance of improved data quality, integrity, and completeness of surveillance records. Future research should strive to validate this index by use of longitudinal cohort studies. FundingUS Department of Defense, National Institute of Food and Agriculture.

Opportunities for Antibiotic Stewardship Interventions in a Pediatric Hospital

Abstract Objective This study's objective was to assess an antibiotic stewardship intervention, compare pediatric antibiotic usage in a non-university hospital (Children's Hospital Traunstein [TS]) with a university hospital (Dr. von Hauner Children's Hospital, Ludwig Maximilians University Munich [MUC]), and assess adherence to national guidelines. Methods Antibiotic usage pre- and post-antibiotic stewardship (ABS) intervention was compared, and antibiotic prescriptions over 4 months were prospectively recorded. ABS intervention consisted of weekly teaching sessions, antibiotic pocket cards, and rounds with pediatric infectious disease staff. Medical records were reviewed to describe antibiotic consumption, antibiotic dosages and length of use, and adherence to national guidelines. Pediatric antibiotic usage was compared between hospitals and patient groups. Results After the ABS intervention, the use of second-generation cephalosporins decreased, while penicillin with β-lactamase inhibitors (BLI) increased. Survey of antibiotic prescriptions over the 4 months study period in the non-university hospital showed a high administration rate of second-generation cephalosporins and extended-spectrum penicillins in the non-intensive care units (ICU) wards (48.53 and 38.93 days of therapy [DoT]/1,000 patient days [PD], respectively) and a high rate of third-generation cephalosporins in the ICU ward (110.33 DoT/1,000PD). A high prescriptions rate was seen in the neonatal intensive care unit (NICU) wards (DoT/ length of therapy [LoT] ratio of 2.185). Reserve group antibiotics were only given in the ICU. Adherence to national guidelines was highest in the NICU and pediatric ICU wards. Striking was the relatively high rate of incorrect usage of second-generation cephalosporins. Comparing the pediatric wards of the non-university hospital (TS) and the university hospital (MUC), the prescription ratio was 11.1% (TS) versus 30.6% (MUC), and DoT/1,000PD 198.9 (TS) versus 483.6 (MUC), p = 0.02. ABS intervention changed the choice of described antibiotics, but not the overall frequency. Conclusion Adherence to national guidelines was highest in fields with standardized therapy recommendations, like in the NICU. In MUC, antibiotics, in particular restricted ones, were prescribed more frequently, probably due to higher severity of illness.These data indicate that the usage of antibiotics and adherence to national guidelines show a wide variety, but ABS interventions were effective in changing prescription behavior.

Generalized ordered logit analysis on the injury severity of traffic crashes by older drivers: the case of South Korea

ABSTRACT With a case of South Korea, this study attempts to analyze how the severity of traffic crashes for which older drivers are at fault is associated with road/environmental/seasonal/weather conditions, driver’s attributes, and crash/violation types. It analyzes the ordinal variable of injury severity by specifying conventionally used ordered logit and its statistical alternatives, multinomial logit, generalized ordered logit, partial proportional odds models. Based on the assumptions and fits of the models, this study finds that relative to the poor, but conventional ordered logit model, the best-fit generalized ordered logit model reports more accurate results in terms of the coefficient significance, direction, and magnitude. Among its major findings, although the severity decreases by year (conventional model), it does not apply to the minor injury level (alternative). The higher severity in the picnic season (conventional) is also limited to the level of minor injury or less. The times of the day at which the severity is higher (4–6) and lower (8–21) (conventional) are specific to fatal and serious injuries, respectively (alternative). Several variables have double-edged effects. Single-vehicle crashes do not always result in higher severity. They also reduce it to the lowest report-only level. Likewise, age and alcohol use change the severity to the most severe fatal level as well as to the most minor report-only level. These results are compared with the accumulated findings of crash frequency studies and interpreted in relation to older drivers’ high cautiousness and low physical/cognitive ability.

Fear of clowns: An investigation into the prevalence of coulrophobia in an international sample

Although clowns have traditionally been portrayed as figures of fun in popular culture, more recent representations have been of fear-inducing characters such as “Pennywise” from the book and movie “IT”. However, it is not known whether these representations reflect fear of clowns within the general population, and there is a lack of data on the extent of this phenomenon. This study investigated the prevalence of clown fear in an international population, and the severity of this fear in those who reported it. The Fear of Clowns Questionnaire (FCQ), was designed for this purpose. Psychometric data indicated high levels of reliability for our new scale, with a Cronbach's alpha of 0.980, and a split-half reliability coefficient of 0.973. Demographic factors associated with clown fear were also explored; gender, age and country of birth. An opportunist sample of 987 participants were surveyed, consisting of 790 females and 197 males, aged between 18 and 77 years (M = 29.79; SD = 11.08). Of these, 272 (27.6%) reported a fear of clowns, whilst 50 (5.1%) rated this fear as extreme. A higher prevalence of clown fear was found for females compared to males (29.6 vs. 19.3%) and with a higher severity according to the FCQ. Age was negatively correlated with clown fear, and participants from the Asian continent exhibited the highest frequency of clown fear. We conclude that fear of clowns is common in the general population, although extreme fear has a similar incidence to that of other specific phobias.

Dysphagia, Fear of Choking and Preventive Measures in Patients with Huntington\u2019s Disease: The Perspectives of Patients and Caregivers in Long-Term Care

ObjectivesTo explore the prevalence of dysphagia and fear of choking in patients with Huntington’s disease (HD) as well as preventive measures, both those applied and those not included in managing dysphagia. Also, to investigate related problems encountered by their formal and informal caregivers.DesignA multi-center observational cross-sectional studySetting and Participants158 HD patients, recruited from six Dutch nursing homes specialized in HD, and their formal and informal caregiversMeasurementsPatients were assessed by means of questionnaires enquiring about dysphagia, fear of choking and measures to manage dysphagia. Also, questionnaires were administered about awareness of dysphagia symptoms, cognition and anxiety. Because we expected individuals with greater care dependency to have a higher severity of dysphagia, we distinguished between a care-independent and a care-dependent group of HD patients.ResultsIn the total group, 90.5% of HD patients had one or more dysphagia symptoms. The prevalence of FoC in HD patients and the formal and informal caregivers’ fears about choking in HD patients was 45.7%, 19.0% and 59.5%, respectively, for care-independent patients and 58.7%, 50.1% and 77.5% for care-dependent patients. The score on the Huntington’s Disease Dysphagia Scale was a predictor for fear of FoC in care-independent patients. Speech-language therapy, supervision during eating and drinking and adaptation of food and drink consistency were the most frequently applied measures to manage dysphagia, a combination was used in most HD patients.ConclusionsIn HD patients, the prevalence of dysphagia is high and fear of choking is common among both patients and caregivers. A more severe degree of dysphagia is a predictor of FoC in care-independent HD patients. A combination of measures was used to manage dysphagia in most HD patients.

Abstract WMP64: Multimodal Bayesian Modeling Of Stroke Severity

Introduction: Understanding the relations between lesions and outcomes is a particularly promising avenue to support tailored stroke care. We here employed a novel Bayesian framework integrating lesion location and functional lesion connectivity, i.e., lesion network mapping data, aiming to augment the prediction of stroke severity and the interpretability of lesion-symptom associations in a multi-center cohort of acute ischemic stroke (AIS) patients. Methods: Analyses relied on 1,077 AIS patients of the MRI-GENIE study [age: 64.2(14.7), 38%women]. NIHSS-based stroke severity was modeled via Bayesian linear regression. Structural location and functional connectivity information was represented by ten unique patterns each. We compared the out-of-sample predictive performances of structural vs. structural-functional models in Bayesian model comparisons. In ancillary analyses, we extracted functional connectivity pattern relevant for stroke severity and repeated analyses after stratifying for lesion size (50% of patients with larger lesions). Models were generally adjusted for age, sex, comorbidities and total DWI lesion volume. Results: Model comparison indicated a benefit of the combined structural-functional stroke severity prediction model compared to the structural one (model weights: 82% vs. 18%). This benefit of the combined model became even more apparent in case of patients with large lesions (97% vs. 3%). Positive lesion connectivity to the bilateral ventral attention (VA) and somatomotor networks, as well as temporal default mode network (DMN) predicted higher severity, while positive connectivity to more medial parts of the DMN and the visual network predicted lower severity. Additionally, negative lesion connectivity to the bilateral DMN, somatomotor, dorsal attention, and control networks predicted higher, and negative connectivity to the right control and bilateral VA networks predicted lower severity. Conclusions: Model comparisons indicated a benefit of integrating structural and functional information for the prediction of stroke severity, especially in case of larger lesions. Lesion connectivity data can enhance our understanding of why specific lesion locations can lead to symptoms post-stroke.

Abstract TMP81: The Relationship Between Carotid Stenosis And Silent Cerebrovascular Disease

Introduction: Patients with carotid stenosis may have silent cerebrovascular disease due to chronic hypoperfusion and atheroembolism. If so, progression of silent disease may be preventable through revascularization. We aim to evaluate the association between carotid stenosis/occlusion and cerebral small vessel disease (SVD) burden ipsilateral to the cervical carotid stenosis. Methods: Patients age ≥40 years with carotid stenosis or occlusion on carotid ultrasound who underwent MRI brain and intracranial angiogram with gradable SVD on MRI from 2011-2015 were included. Severity of carotid stenosis was defined using NASCET criteria as 50-69% (moderate), 70-99% (high-grade), or occluded. WMH volume was quantified using an automated artificial intelligence algorithm applied to axial T2 FLAIR images. Images were also scored for presence of chronic lacune, cerebral microbleeds (CMB), and silent infarcts using STRIVE criteria. Differences in WMD volume between hemispheres ipsilateral and contralateral to the carotid stenosis were calculated, and prevalence of SVD and silent infarct were compared across severities of carotid stenosis. Results: Of the 183 patients, mean age was 71±10 years and 38% were female. Moderate and severe stenosis was present in 36% and 46.5%, respectively, and 18% had carotid occlusion. Mean WMH volume was 7271±522mm 3 . Patients with carotid stenosis had greater WMH volume ipsilateral to the side of carotid stenosis than the contralateral side (mean difference 224±206mm 3 ), and higher severity of stenosis was associated with greater hemispheric difference in WMH volume (moderate vs high; 164±274mm 3 vs 743±309 mm 3 , p=0.009). Silent infarcts were more prevalent in high-grade carotid stenosis than moderate grade (moderate vs high, 10.8% vs 36.5%; p=0.002). There were no differences in either lacunae or CMBs across severities. Conclusions: Greater than one third of patients with high-grade carotid stenosis had ipsilateral silent brain infarction, and the volume of WMH was greater on the side of carotid stenosis. Future analyses should consider the potential yield of screening for carotid atherosclerosis in patients with varying degrees of hemispheric WMH asymmetry.

Usefulness of Dermoscopy in Localized Scleroderma (LoS, Morphea) Diagnosis and Assessment-Monocentric Cross-Sectional Study.

Morphea, also known as localized scleroderma (LoS), is a chronic autoimmune disease of the connective tissue. The clinical picture of LoS distinguishes between active and inactive lesions. Sometimes the clinical findings are challenging to identify, and therefore, the need for additional methods is emphasized. Our study aimed to demonstrate the characteristic dermoscopic features in morphea skin lesions, focusing on demonstrating features in active and inactive lesions. In our patients (n = 31) with histopathologically proven LoS, we performed clinical evaluation of lesions (n = 162): active/inactive and according to both disease activity (modified localized scleroderma severity index, mLoSSI) and damage (localized scleroderma skin damage index, LoSDI) parameters. In addition, we took into account compression locations to determine whether skin trauma, a known etiopathogenetic factor in LoS, affects the dermoscopic pattern of the lesions. We performed a dermoscopy of the lesions, categorizing the images according to the severity within the observed field. We showed that within the active lesions (clinically and with high mLoSSI), white clouds and linear branching vessels had the highest severity. These features decreased within the observed field in inactive lesions and with high LoSDI. Brownish structureless areas were most intense in inactive lesions with high LoSDI. Erythematous areas, linear branching vessels, dotted vessels, and crystalline structures were statistically significant for pressure locations. We have shown dermoscopy is a valuable tool to assess the activity or inactivity of lesions, which translates into appropriate therapeutic decisions and the possibility of monitoring the patient during and after therapy for possible relapse.

Factor structure of borderline personality disorder and response to Systems Training for Emotional Predictability and Problem Solving

Differential response to the Systems Training for Emotional Predictability and Problem Solving (STEPPS) program was compared in subgroups identified through latent class analysis (LCA). STEPPS is an evidence-based group treatment program for patients with borderline personality disorder (BPD). A reanalysis of data was conducted using data from a 20-week randomized controlled trial and 1-year follow-up. Subjects (n = 164) with DSM-IV BPD were assessed for comorbid Axis I and II disorders and selected clinical variables. Severity was assessed using the Zanarini Rating Scale for BPD (ZAN-BPD) and the Borderline Evaluation of Severity Over Time (BEST). Three- and four-class models were identified with the four-class model having the better fit. The latter included a high severity (HS) class (26%), an affective instability/substance abuse (AISA) class (16%), an empty/dissociation/identity disturbance (EDID) class (27%), and a low severity (LS) class (30%). High impulsiveness predicted membership in the HS class. Improvement was determined using a linear mixed-effects model. Those most likely to benefit were those in the HS group characterized by high symptom severity, Axis I and II comorbidity, problem relationships, abandonment fears, and intense anger. This work should help further efforts to match patients with treatments based on sociodemographic, diagnostic, and other illness characteristics.

Trauma outcomes in nonfatal road traffic accidents: a Portuguese medico-legal approach

The objective of this study was to compare the outcomes of nonfatal road traffic accidents by the victims’ age group and sex. We used the Portuguese medico-legal rules for personal injury assessment, in the scope of the Civil Law in that country, which includes a three-dimensional methodology. This was a retrospective study including 667 victims of road traffic accidents aged 3–94 years old. Their final medico-legal reports all used the Portuguese methodology for personal injury assessment. Outcomes were analysed by the victims’ age group (children, working-age adults, and older people) and sex. Road traffic accidents were generally serious (ISS mean 9.5), with higher severity in children and older people. The most frequent body sequelae were musculoskeletal (64.8%), which were associated with functional and situational outcomes. Temporary damage resulted in an average length of impairment of daily life of 199.6 days, 171.7 days to return to work, and an average degree of quantum doloris (non-economic damage related to physical and psychological harm) of 3.7/7. The average permanent damage was 7.3/100 points for Permanent Functional Deficit, 0.43/3 for Permanent Professional Repercussion, 2/7 for Permanent Aesthetic Damage, 3.9/7 for Permanent Repercussion on Sexual Activity and 3.2/7 for Permanent Repercussion on Sport and Leisure Activities. Overall, 19% of people became permanently dependent (10.6% needed third-party assistance). The medico-legal methodology used, considering victims’ real-life situation, allows a comprehensive assessment. There were several significant differences among the three age groups but none between sexes. These differences and the impact of the more severe cases justify further detailed medico-legal studies in these specific situations on children, older people, and severely injured victims. Key points: This was a retrospective study of accident mechanisms and injury outcomes in Portugal, and considered the outcomes in the victims’ real-life situation. Lesions from road traffic accidents were generally serious, with higher severity among children and older people. The most frequent sequels were musculoskeletal, and associated with functional and situational outcomes. Both temporary and permanent outcomes had repercussions for the victims. There were significant differences between children, working-age adults and older people, but none between sexes.

P125 Ankylosing spondylitis can influence the outcome of inflammatory bowel disease

Abstract Background Both inflammatory bowel disease (IBD) and ankylosing spondylitis (AS) are inflammatory diseases but there was little previous study that demonstrate the IBD severity and outcome in IBD patients with concomitant AS. Methods Patients’ records were collected from 3 tertiary hospitals (Seoul national university hospital, Seoul national university Bundang hospital, and Seoul metropolitan government Seoul national university Boramae medical center) from October 2004 to June 2021. Patients with IBD and concomitant AS (IBD-AS group) were identified and propensity score matching (PSM) was applied to match the IBD-AS group and IBD patients without AS (only IBD group). Results After PSM, significantly more patients in IBD-AS group had colectomies (p = .017) or were prescribed biologics (p &amp;lt; .001), immunosuppressive agents (p = .021), and steroid (p = .017) than in only IBD group. The number of patients treated with biologics (p &amp;lt; .001) or immunosuppressive agents (p = .032) were significantly greater in UC-AS group than in only UC group. There was no significant difference in outcomes between only CD group and CD-AS group. In logistic regression analyses, identified that concomitant AS was a significant factor associated with biologics treatment in patients with IBD. Kaplan-Meier analyses demonstrated that there was a significant difference in the probability of starting biologics treatment between IBD patients with and without concomitant AS (p = 0.002). In UC patients, the probability of starting biologics was also significantly different according to concomitance of AS (p &amp;lt; 0.001). Concomitant AS was a risk factor for predicting biologics treatment in patients with UC in Cox regression analysis after adjustment UC (adjusted hazard ratio, 6.296; confidence interval, 2.243 to 17.668; p &amp;lt; 0.001) Conclusion Patients with IBD-AS group were more likely to have a higher severity than in only IBD group. The current study result can help IBD specialists understand and treat patients with IBD and concomitant AS better.

P265 Open approach for ileocolic resection in Crohn’s disease in the era of minimally invasive surgery: indications and perioperative outcomes in a referral centre

Abstract Background Minimally invasive surgery (MIS) is the first-line approach for ileocolic resection in patients with Crohn’s disease (CD) and it is safe and feasible even in complex cases. However, an open approach is still required, but indications to open ileocolic resection for CD are not well described. Methods All consecutive adult patients with CD who underwent elective ileocolic resection in the Departments of Colon and Rectal Surgery at Mayo Clinic Rochester, Minnesota and Jacksonville, Florida between September 2014 and March 2021 were included and divided into “open” and “MIS” groups. Open approach was defined as upfront laparotomy, MIS included laparoscopic and robotic approaches, and conversion was defined as incision made earlier than planned. Indications to open approach were retrospectively reviewed by two authors, and any incongruity was resolved. Analogous indications were also assessed in the MIS group, as appropriate. Indications, baseline, perioperative characteristics, and short-term postoperative outcomes were compared between open and MIS. Results Among 319 ileocolic resections for CD, 45 (14.1%) were open and 274 (85.9%) MIS. Indications for open approach were severe disease, adhesions at previous surgery, history of abdominal sepsis, multifocal and extensive disease, abdominal wall involvement, concomitant open procedures, small bowel dilatation, and anaesthesiologic contraindications (Table 1). In addition, two or more of the above indications were present in 40 patients (89%) in the open group, while only in 6 patients (2%) in the MIS group (p&amp;lt;0.001). Compared to MIS patients, patients undergoing open ileocolic resection were older, with longer CD duration, more previous surgery and preoperative intra-abdominal abscess drainage (Table 2). Nine patients were converted in the MIS group (3.3%). Intraoperatively, open group had more adhesiolysis ≥45 min, more intraoperative complications, more blood loss, more primary stoma, less anastomosis, and longer operative time (Table 3). Postoperatively, they had more overall postoperative complications, ileus, surgical site infections, dehydration, vascular thromboembolism, higher severity by Clavien-Dindo classification, and longer length of stay (Table 4). Conclusion Overall rate of open approach ileocolic resection for CD was 14 % during a 7-years period in a referral centre. Open approach was the only operation performed in cases of abdominal wall involvement, concomitant open procedures, and anaesthesiologic contraindication. In addition, the presence of at least two indications,predicting high technical complexity, may be considered as a no-go for the MIS approach in ileocolic resections for CD.

Intensity of Basal Stem Rot Disease by Ganoderma in Oil Palm Plantations on Peatlands and Minerals

Basal stem rot caused by Ganoderma boninense is the main disease of oil palm plantations. The disease decreases yield, causes plant death, shortens economic life, and accelerates replanting. The purpose of this study is to compare the development of this disease in third-generation oil palm plantations in peat soil and mineral soils. Observations were made to verify secondary census data for 4 years on affected (endemic) rotten stems. Observations were made on each of the 3 blocks for peat soil and mineral soil with palm oil planting year 2011-2012. The results showed that stem base rot develops faster with a higher severity in peat soil than yellow-red podsolic soil. The availability of organic matter in both soil and oil palm plant residues becomes an important source of nutrients for pathogenic fungi in completing the cycle of disease in plantations.

Playing-Related Musculoskeletal Disorders, Risk Factors, and Treatment Efficacy in a Large Sample of Oboists.

ObjectivesDuring their lifetimes, a majority of musicians experience playing-related musculoskeletal disorders (PRMD). PRMD prevalence is tied to instrument choice, yet most studies examine heterogeneous groups of musicians, leaving some high-risk groups such as oboists understudied. This paper aims to (1) ascertain the prevalence and nature of PRMDs in oboists, (2) determine relevant risk factors, and (3) evaluate the efficacy of treatment methods in preventing and remedying injuries in oboe players.MethodsA 10-question online questionnaire on PRMDs and their treatments was completed by 223 oboists. PRMDs were compared across gender, weekly playing hours, career level, age, and years of playing experience.ResultsOf all respondents, 74.9% (167/223) reported having had at least one PRMD in their lifetime. A majority of these injuries (61.9% of all respondents) were of moderate to extreme severity (5 or higher on a scale of 1 to 10). Females (mean = 5.88) reported significantly more severe injuries than males. No significant effects of career level (i.e., professional vs. student vs. amateur), age, or years of playing experience were observed. We found significant non-linear relationships between weekly playing hours and PRMD prevalence and severity. Injuries were most commonly on the right side of the body, with the right thumb, wrist, hand, and forearm being most affected in frequency and severity. Of those injuries for which recovery information was provided, only 26.1% of injuries were “completely recovered.” The perceived effectiveness of a few treatments (physical therapy, rest, stretching, occupational therapy, massage) tended to be ranked more highly than others.ConclusionThe oboists in this study experienced high rates of PRMD, particularly in the right upper extremities. Females and those playing 7-9 and 16-18 h per week reported a significantly higher severity of injuries than other groups.

Spatial and Temporal Variation of Droughts in the Mongolian Plateau during 1959–2018 Based on the Gridded Self-Calibrating Palmer Drought Severity Index

Drought monitoring is challenging, but it is required for improving agricultural production, protecting the ecological environment, and reducing economic losses in drought-prone regions such as the Mongolian Plateau (MP). This study is a systematic analysis of the spatiotemporal changes in the characteristics of drought events (drought duration, severity, intensity, frequency, peak, and starting season) at the sub-regional scale between 1959 and 2018 based on the run theory and using the gridded self-calibrating Palmer Drought Severity Index (scPDSI) dataset. Principal component analysis and Varimax rotation and the Mann–Kendall trend and Sen’s slope were used for the sub-regional division and drought trend analysis, respectively. In addition, wavelet analysis was employed to analyze drought periodicity and determine the influence of large-scale climate indices on regional drought variation. The study results indicate clear differences in the spatial patterns of drought characteristics in the MP. The northern part suffered from droughts with longer duration and higher severity, whereas more drought events with shorter duration and less severity occurred in the southern part. Most of the MP experienced a relatively wet trend in 1996–2018 compared to the period of 1959–1995. The frequency of spring drought events showed an increasing trend in 1996–2018, unlike in 1959–1995. Some drought events simultaneously affected two or several sub-regions. The wavelet analysis results indicated that the drought periodicity in the MP was 10–64 months. The Arctic Oscillation (Pacific Decadal Oscillation) was significantly correlated with drought in the southern (northern) part.

Evaluation of the antitumour activity of local intraperitoneal hyperthermia in a model of advanced high-grade ovarian carcinoma in rats

In our study we carried out an exploratory assessment of the antitumor activity of hyperthermic intraperitoneal perfusion (Hipep) with 0.9 % sodium chloride solution and compared it with the effect of a single normothermic intraperitoneal (i.p.) Administration of cisplatin in the maximum tolerated dose (mtd). Thirty-six mature female Wistar rats with transplanted i.p. Syngeneic ovarian carcinoma were randomized into three groups: control group (2 ml of 0.9 % sodium chloride i.p. At room temperature, n=12); cisplatin group (cisplatin 4 mg/kg i.p. At room temperature, n=12); Hipep group (open i.p. Perfusion with 0.9 % sodium chloride solution at a temperature of 40,5–41,5 °c for 45 minutes, n=12). The primary endpoint was the overall survival (os) of the animals in each of the three groups. The total peritoneal cancer index (pci), weight and degree of ascites haemorrhagia were assessed at autopsy. The median os in the control group, Hipep, and cisplatin was 19, 39, and 40 days, respectively (log-rank test р&lt;0.0001). In comparison to the control group, the differences were statistically significant for both cisplatin (HR=0.22; 95 % ci: 0.08–0.62; log-rank test р&lt;0.0001) and Hipep (HR=0.32; 95 % ci 0.13–0.82; log-rank test р=0.0013). There were no differences in os between the cisplatin and Hipep groups (log-rank test р=0.4853). The Hipep procedure was associated with a significant decrease in total pci, a tendency towards a decrease in the ascites weight and a higher severity of haemorrhagia. In terms of os, local hyperthermia, provided by Hipep without a cytostatic drug, was comparable with single normothermic i.p. Administration of cisplatin in mtd and exceeded the effects of the latter in relation to the development of peritoneal carcinomatosis.