Non-homogenous Group Research Articles

The surprises in optical coherence tomography (OCT) findings in patients presenting with in-stent restenosis: the road less travelled

Abstract Funding Acknowledgements Type of funding sources: None. Background Morphological features of neointimal tissue play a pivotal role in the pathophysiology of In-Stent Restenosis (ISR) after percutaneous coronary intervention, hence understanding these features and patterns is crucial. Purpose The present study was designed to qualitatively and quantitatively assess neointimal characteristics of lesions using OCT in patients presenting with ISR. Methods This was a single-center, prospective, observational study performed between 1st August 2020 and 30th December 2021 at a tertiary-care center in India. Patients diagnosed with stable angina and acute coronary syndrome with post-procedural angiographically documented restenosis (>50%) were included. Qualitative and quantitative assessment of neointimal hyperplasia patterns was performed using OCT. Results A total of 34 patients with ISR were studied. Neointimal hyperplasia was classified as (i) homogenous group (n=18) and (ii) non-homogenous group (n=16). As many as 14 (77.8%) diabetics belonged to the homogenous group. Predominant plaque characteristics such as neoatherosclerosis, cholesterol crystals, and calcium were documented in 14 (77.8%), 12 (66.7%), and 11 (61.1%) patients in the homogenous group and in 10 (62.5%), 10 (62.5%), and 9 (56.2%) patients in the non-homogenous group, respectively. Unexpanded stent struts were identified in 11 (61.1%) and 11 (68.8%) patients in the homogenous and non-homogenous groups, respectively. Mean strut thickness was 93.73 ± 31.03 µm and 83.54 ± 18.0 µm, ISR was 72.50 ± 15.93% and 65.37 ± 21.69%, the neointimal thickness was 588.06 ± 167.82 mm and 666.25 ± 218.05 mm, and neointimal hyperplasia was 54.54 ± 11.23% and 59.26 ± 8.86% in the homogenous and non-homogenous groups, respectively. Conclusion Neoatherosclerosis and stent underexpansion was predominantly observed in our study, which was in contrast to most of the existing literature [1,2,3], and only diabetes was found to be significantly associated with homogenous neointimal hyperplasia, irrespective of the generation of the stent.

R. Chris Davis. Hungarian Religion, Romanian Blood: A Minority’s Struggle for National Belonging, 1920–1945.

R. Chris Davis. <i>Hungarian Religion, Romanian Blood: A Minority’s Struggle for National Belonging, 1920–1945</i>.

PET/CT diagnostic value in suspicion of palatine tonsils’ lymphoma recurrence

&lt;b&gt;Introduction:&lt;/b&gt; Diffuse large B-cell lymphoma (DLBCL) is a non-homogenous group of neoplasms of the lymphatic system in terms of morphology, genetics, and clinical aspects. The follow-up of patients treated for lymphoma includes the following examinations: clinical, laboratory, and imaging. According to the recommendation of the National Comprehensive Cancer Network (NCCN) from 2020, the observation of patients with DLBCL is mostly based on the PET/CT examination with &lt;sup&gt;18&lt;/sup&gt;F-FDG, especially when suspecting the extranodal lymphoma recurrence. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; The aim of the study was to define the predictive value of the PET/CT examination in the evaluation of the recurrence of DLBCL in the palatine tonsils. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Material and methods:&lt;/b&gt; The analysis of the medical documentation of patients treated in our Department was performed. Research material included patients with suspicion of local recurrence of DLBCL in the palatine tonsils. Thirty-three patients were included in the study: 22 women and 11 men. The age range was 23–73 years with a mean of 53 years. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; The confirmation of the local recurrence of DLBCL in the histological examination was obtained in 11 patients – 7 women and 4 men aged 58–73 years (μ= 65.4). SUV&lt;sub&gt;max&lt;/sub&gt; in the palatine tonsil in those patients ranged: for the right tonsil 3.6–9.5 (μ=6.0), and for the left tonsil 3.8–9.5 (μ = 6.1). The second group of the patients did not present any local recurrence of DLBCL in the palatine tonsils. The histological diagnosis was chronic tonsillitis. The age of those patients ranged from 23 up to 73 years (μ = 43.1 years). SUV&lt;sub&gt;max&lt;/sub&gt; ranged: for the right palatine tonsil 2.8-27.7 (μ = 8.62), for the left palatine tonsil 3.8–27.4 (μ = 8.60). The sensitivity of PET/CT in the recurrence assessment in our study was 100%, while the specificity was 33.3%. The additional predictive value was 0.33.

B-mode and Doppler ultrasound features of mammary neoplasms and their comparison with normal mammary glands in dogs

Canine mammary neoplasms are naturally occurring non-homogenous group of tumours with many resemblances to human breast cancer. In female dogs mammary tumours are of great clinical relevance due to the high prevalence and mortality rate, which varies according to the histopathological classification and clinical stage. The aim of the study was to compare the ultrasonographic features of the normal mammary gland with benign and malignant mammary neoplasms in dogs, through assessed by B-mode and Doppler mode ultrasonography. Ultrasonographic examination of seven normal mammary glands along with six benign and 12 malignant mammary neoplasms were performed. Among the parameters evaluated by B-Mode ultrasonography, significant differences were found (p &lt; 0.01) in the tumour margin and invasiveness of neoplasms, where malignant tumours were invasive with uncircumscribed margin. Significant difference was also found in the presence of posterior acoustic enhancement (p&lt;0.05) between benign and malignant mammary neoplasms. Elevated peak systolic velocity of blood flow within the tumour vessels in malignant mammary neoplasm was the only feature assessed with Doppler mode having significant difference.

Women in Adébáyọ̀ Fálétí’s Poetry

Women have been victims of gender ideology which, according to Hussein (2005), is a systemic set of cultural beliefs through which a society constructs and wields its gender relations and practices. Gender ideology contains legends, narratives and myths about what it means to be a man or a woman and suggests how each should behave in a society (Olabode, 2009). Women are a non-homogenous group as their status and roles in the society are determined by a complexity of factors such as being a daughter, sister, and wife; a cultic member; and the economic and political positions they hold in the market place and in local governance (Ilesanmi, 2013). Sub-ethnic variations were also reported in customs and practices such as a marriage and family life, pre-natal and post-natal practices and others. Men in various sub-ethnic (Yorùba) groups are given privileges in matters relating to power and control ́ in domestic and public spheres. Since culture is not static but rather dynamic, therefore contemporary writers are now advocating for portrayal that will extol women’s virtues, thereby bringing to the fore the indispensable roles women play in society. In order to redeem and recreate an enhanced status for women, studies about women abound in literary studies, with little attention given to issues of women in Adébayó ̀ Fa ̩ ́letí ’s poetry. Thus, using the feminist approach ex ́ - amines how women are portrayed in Fálétí’s poetry so as to establish his view about the womenfolk.

Obesity and Energy Substrate Transporters in Ovarian Cancer-Review.

Ovarian cancer is the seventh most common cancer in women. It is characterized by a high mortality rate because of its aggressiveness and advanced stage at the time of diagnosis. It is a nonhomogenous group of neoplasms and, of which the molecular basics are still being investigated. Nowadays, the golden standard in the treatment is debulking cytoreductive surgery combined with platinum-based chemotherapy. We have presented the interactions and the resulting perspectives between fatty acid transporters, glucose transporters and ovarian cancer cells. Studies have shown the association between a lipid-rich environment and cancer progression, which suggests the use of correspondent transporter inhibitors as promising chemotherapeutic agents. This review summarizes preclinical and clinical studies highlighting the role of fatty acid transport proteins and glucose transporters in development, growth, metastasizing and its potential use in targeted therapies of ovarian cancer.

Indigenous Peoples Experiences with Aging

&#x0D; &#x0D; &#x0D; Indigenous Peoples in Canada are a non-homogenous group consisting of First Nations, Metis, and Inuit Peoples representing the original settlers of a given land or a geographical area (Parrott, 2018). Based on geographical location, there are unique names used to describe a given subset or group of Indigenous Peoples around the world. Despite their proximity, they originate from different nations, tribes, and communities and remain distinct in their spoken language, history, and way of life. Although there has been a notable growth in the literature on Indigenous Peoples, relatively little is published about their understanding of healthy aging. Similarly, there is a dearth of literature about the specific needs and wishes of Indigenous Peoples in Canada to facilitate a healthy aging process.&#x0D; &#x0D; &#x0D;

Variations in elderly peoples’ visits to the emergency departments in Iceland: A five-year population study

IntroductionElderly people visiting emergency departments (ED) are a non-homogenous group. Gender and other socio-demographic variations in emergency care might be present. However, gender-specific ED-data is scarce. MethodsWe retrieved retrospective data on all ED-visits, by 67years and older from 2008 to 2012, and calculated incidence of visits applying population registries. The relationship of age-categories, marital status, health and residence with outcomes were analyzed descriptively by Chi-square tests. Regression models were built to analyze gender-specific variations. ResultsOf the total ED-visits, 20% were from the elderly population (n=66,141), at a mean 3.1 visits per individual. Men (n=30.269) had higher incidence of visits in all age-categories. They were mostly married (69%) and women widowed (43%), although the incidence of partnered visitors underrepresented population-data while widowed and single living overrepresented. Women had more often co-morbidities, their most common causes of visits were musculoskeletal (20%) and men circulatory causes (14%). Men were more likely to be admitted (OR: 1.23; 95% CI 1.16–1.30) and had more unplanned ED-revisits (HR: 1.20; 95% CI 1.06–1.35) within 30 days. DiscussionElderly men visiting the ED were more often married than women. Gender differences were found in causes of visits and outcomes. In clinical practice, gender may be considered when identifying risk and planning adequate care related elderly ED-visits.

Does position of the patient adversely affect successful intubation whilst wearing CBRN-PPE?

Introduction Following a CBRN incident attending medical personnel will be required to instigate life saving airway interventions whilst wearing CBRN-PPE. CBRN-PPE is known to adversely affect fine motor skill but little is known about whether the position of the patient compounds this problem. Methods Seventy-five clinicians were recruited and performed intubation and insertion of a LMA in to a manikin whilst wearing CBRN-PPE. Both skills were completed twice with the manikin positioned on a bench and once on the floor. Following completion of the study 25 participants (a minimum of 2 participants from each professional group) were interviewed to ascertain their experiences. The recruitment of a non-homogenous group allowed for subgroup analysis with regards the potential impact of professional background on skill performance. Results 9.33% first attempts at intubation at waist height ended in failure but this reduced to 4% on the second attempt. This improvement was reversed with the manikin on the floor where the failure rate was 26.67%. Intubation on the floor took significantly longer to perform, being 45.9 s slower than the first attempt at intubation in the optimal position [95% CI (30.7 s, 61.1 s); p < 0.001] and 62.4 s longer than the second [95% CI (48.4 s, 76.3 s); p < 0.001]. LMA insertion was successful at all attempts, regardless of the manikins position. LMA placement on the floor was no slower than the second attempt at waist height ( p = 0.231) and faster than the first attempt at waist height (by 4.8 s [95% CI (3.4 s, 6.1 s); p < 0.001]). Anaesthetists were consistently the fastest at performing all airway skills regardless of the position of the manikin but previous exposure to wearing CBRN-PPE had no statistically significant impact on skill performance. All 25 clinicians interviewed had difficulty in viewing the larynx with the manikin positioned on the floor regardless of being an experienced ‘on floor’ intubator with the movement of the CBRN-PPE hood being the principle reason. This is in contrast to only three participants noting issues with vision whilst standing-up. Conclusion the position of the patient is likely to be an independent factor when choosing to either intubate or insert a LMA whilst wearing the current NHS CBRN-PPE.

Does wearing CBRN-PPE adversely affect the ability for clinicians to accurately, safely, and speedily draw up drugs?

Objective. Following a Chemical, Biological, Radiation, or Nuclear (CBRN) incident, the attending rescuers will be required to administer drugs while wearing the CBRN Personal Protective Equipment (CBRN-PPE). Little is known regarding the impact of the CBRN-PPE on the ability to speedily, safely, and accurately draw up drugs for subsequent administration. Design. A randomized control trial examining the ability of rescuers to draw up drugs from four different drug presentations (a Minijet prefilled syringe, an Aurum prefilled syringe, and glass and plastic ampoules with needle and syringe) was undertaken with participants wearing and not wearing the National Health Service (NHS) CBRN-PPE. Each participant underwent the procedure once in “normal clothes” and twice while wearing the CBRN-PPE. The speed and accuracy of each participant were measured as well as the participant's perceived risk of suit damage associated with the four different drug presentations. Participants. The participants constituted a non-homogenous group of emergency nurses, nurse lecturers, paramedic lecturers, and student paramedics. A total of 81 participants were recruited; one participant withdrew due to claustrophobia. All participants had used all four drug preparations prior to being enrolled into the study. Results. Wearing the CBRN-PPE had a negative effect on drawing up drugs in the first attempt while wearing the CBRN-PPE, typically taking 63.8% longer time than without (95% confidence interval: 55.3–72.9%). Improvements were noted on second attempts. The choice of drug presentation had an effect on the time taken to draw up the drugs, with Aurum being overall the fastest and glass ampoules the slowest (p-values < 0.001). All participants rated the prefilled syringes as the easiest and the safest to use, and the glass ampoules with needles and syringes as the most difficult to use and the ones most likely to puncture the CBRN-PPE. During the drawing-up process, varying amounts of “drug” were lost, although in two-thirds of the attempts all 10 mL was drawn up. The lowest volume was lost from the prefilled syringes and the maximum volume of fluid was lost from the glass ampoules. Conclusions. The NHS CBRN-PPE has a negative effect on the drawing up of drugs especially from glass ampoules. Glass ampoules represent a poor choice of drug preparation when considering speed, safety, and accuracy of drawing up of drugs while wearing protective clothing.

Set‐up and statistical validation of a new scoring system for obstructed defaecation syndrome

There is no objective means to assess the obstructed defaecation syndrome (ODS), to allow evaluation of outcome or to compare the efficacy of treatment including surgery. The study aimed to validate a disease-specific index to quantify severity to allow assessment of the results of treatment in clinical trials, to permit comparison between them. Seventy-six patients with ODS and 30 healthy controls entered the study after proctologic and ano-rectal physiological investigation. Hirschsprung's disease and slow transit constipation were excluded. An eight-item questionnaire with four or five possible answers was administered by two independent researchers at two different times. The ODS score was the sum of all points with a maximum possible of 31 points. Agreement between the two operators was evaluated by the Kappa coefficient for each single item. The coefficient of repeatability (CR) was assessed by the Bland and Altman plot. The internal consistency was evaluated by the Crohnbach-alpha test. A cluster analysis was carried out on each clinical finding. The Mann-Whitney U-test was used to compare median ODS score between patients and controls. The ODS score of the two operators was normally distributed and strongly correlated (r = 0.89). The correlation coefficient between the score assigned to each item by two operators ranged from 0.79 to 0.98. The degree of agreement between the operators was good and the two methods were reproducible (CR = 3.13). There was a significant difference between the mean ODS score for patients and controls (t = 20.70, P < 0.001). The Crohnbach alpha value for internal reliability was +0.513. Cluster analysis showed a different profile between cluster 1 (a nonhomogenous group including rectocoele, intussusception or perineal descent), and cluster 2 (pelvic dysynergia). The ODS score offers a validated severity of disease index in grading the severity of disease and monitoring the efficacy of therapy.

2D-3D Ultrasound in the Diagnosis of Uterine Malformations

Uterine malformations form a non-homogenous group of pathologies with a variable impact on reproduction, often not strictly related to the apparent seriousness of pathology. It concerns about 1-5% of women. Among the many tecniques, invasive and not, useful to diagnosis, many authors believe that laparoscopy associated with hysteroscopy allows diagnosis in all cases. Many references confirm this opinion: hysteroscopy and laparoscopy are used in the classification of uterine anomalies. Magnetic resonance imaging, safe and little invasive, gives a diagnostic accuracy close to 100%. From 1997 to nowadays magnetic resonance has demonstrated its role in the imaging of female pelvis. Pellerito et al using magnetic resonance correctly diagnosed 24 of 24 anomalies (100% accuracy), compared to 11 of 12 anomalies (92%) using endovaginal sonography. Magnetic resonance imaging demonstrated 100% sensitivity and specificity compared to 67% sensitivity and 100% specificity of transvaginal sonography for unicornuate or bicornuate uteri (anomalies requiring surgery). For non-surgical uterine anomalies, both techniques had 100% sensitivity and specificity. Pellerito et al also noted that magnetic resonance imaging had the further advantage of detecting other incidental abnormalities, including a dermoid and submucosal leiomyoma, not found on transvaginal ultrasound (indeterminate and nonvisualized). A review by Troiano et al confirms that the need for diagnostical surgical intervention has largely been eclipsed with the advent of magnetic resonance imaging, which has become the imaging modality of choice for characterization of congenital mullerian anomalies. Ultrasound imaging, in its various techniques available, gives 92% or more of diagnostic accuracy, with some advantages, like lower costs, availability of equipments, non invasivity, repeatability, use at an early stage of pregnancy. The traditional 2D ultrasound gives a good visualization of the uterine outline and a good endometrial image as well. The main difficulty is obtaining especially in “non-ideal” patients, all the correct sections, which is absolutely necessary to identify malformations, especially the coronal section. These limits of the bidimensional scanning were noted from 1987 in a study by Nicolini et al. The authors founds that transabdominal 2D sonography failed to visualize the uterine cavity adequately in as many as 35% of patients although it adequately imaged the uterine fundus in 90% of patients. For reasons not been elucidated, patients with uterine malformations often have preterm birth. Transvaginal ultrasound examination is an accurate test for the prediction of preterm birth. A study by Airoldi et al, examined specifically preterm birth in this population, evaluating 64 pregnancies : there were 28 with a bicornuate uterus, 13 with a septate uterus, 11 with a uterine didelphys, and 12 with a unicornuate uterus. They were followed prospectively. In women with uterine anomalies, if transvaginal scan shows a short cervical length , exists a 13fold risk for preterm birth. Unicornuate uterus had the highest rate of cervical shortening and preterm delivery (level of Evidence: II-2) (Figs 1 to 3). Sonohysterography provides further information on the endometrial cavity. In a study by Sergeant et al, 14 patients with a history of repeated spontaneous abortion or infertility, after the hysterosalpingography were examined by hysterosonography. The uterine septum were diagnosed by hysterosonography in all 14 patients (100%). A recent study that evaluates the role of saline infusion sonohysterography in the investigation of uterine abnormalities and malformations in Donald School Journal of Ultr Obstetrics and Gynecology, July-Sept. 2007;1(3):77-79

Surgical treatment of stage III non-small cell lung cancer

The resectability of NSCLC is determined by its stage. The surgical treatment in stage I and II NSCLC remains a golden standard. Stage IIIA NSCLC constitutes a non-homogenous group, and many patients are potentially non-resectable. The patients in stage IIIA NSCLC also constitute a non-homogenous group. The patients in stage T3N1 usually undergo surgical resection, but many patients with N2 disease are disqualified from surgical treatment due to the negative prognostic factors. The negative prognostic factors comprise: (1) metastases to upper paratracheal (no 2), anterior paratracheal (no 3), and subcarinal (no 7) lymph nodes; (2) metastases to multiple mediastinal lymph nodes; (3) occurrence of the so called ‘bulky disease’; (4) capsular lymph node invasion. The occurrence of one of these negative prognostic factors disqualifies the patient with N2 disease from radical surgical treatment. In more advanced cases, i.e. stage IIIB, and stage IV NSCLC, patients are rarely operated. It regards the patients in stage T4 N1, and in M1 disease with a single metastasis (mainly to CNS) accompanied by the stage I, or II, of the primary focus. In these cases N2 disease always constitutes the contraindication to the surgical treatment. Multidisciplinary approach in the treatment of NSCLC is supposed to improve the results of the treatment of NSCLC.

The significance of staphylococcal α toxin and leucocidin

A method for the simple demonstration of leucocidin specific for human blood cells was elaborated, by means of differential staining of killed and living leucocytes. The titre of specific leucocidin was determined in 476 strains, and the titre of alpha-toxin in 542 strains, all of different origin. In the case of alpha-toxin there is no difference in the titre in strains of different origin. In the case of specific leucocidin, strains isolated from a pathological process form far more leucoeidin than strains isolated from healthy subjects. There is a statistically significant correlation between the titre of the leucocidin and the degree of severity of the desease evoked by the strains in question. The characteristics of the strains isolated from healthy subjects show that this is a non-homogenous group, which contains both banal carriers of only slightly pathogenic staphylococci and also carriers of strains with the same properties as those isolated from infections. These results demonstrate the possibility of diagnosing particularly virulent and dangerous strains of staphylococci according to the production of leucocidin. When preparing a toxoid and staphylococcal serum for therapeutic purposes, the strains and also the methods should be selected not only according the titration of alpha-toxin but also according to the production of specific leucocidin.