PAI Group Research Articles

Social Competence of Islamic Education Cluster Teachers in Improving Learning Quality during the Covid-19 Pandemic

This research aims to find out the basic concept of PAI teacher expertise in improving the quality of learning in the Covid-19 era. This research is a qualitative descriptive study, which only describes the social competence of PAI group teachers in improving the quality of learning during the Covid-19 pandemic at Madrasah Aliyah NU Alqur'an Science Sumbang Banyumas and Madrasah Aliyah Negeri 1 Cilacap. The research results show that teachers really need a more mature preparation process regarding the implementation of teaching and learning activity schedules. In connection with the actualization of the social skills of PAI teachers, each teacher forms a communication network between the teacher and students, as well as between teachers and the students' guardians. Teachers' obstacles in the PAI group as an effort to improve the quality of learning in the Covid-19 era are seen from the perspective of students who lack understanding of the teaching material. Another obstacle is related to learning activities which are still mostly theory based so that there is still a lack of applying the material to everyday life. Thus, teachers must motivate students to always learn so that students' understanding of the material increases. As well as thinking about ensuring that learning does not run monotonously, leading to student boredom.

Adrenal insufficiency as part of X-linked adrenoleukodystrophy

X-linked adrenoleukodystrophy (X-ALD) is a severe neurodegenerative metabolic disease with a frequency 1:17,000 in newborn boys. Being a major part of X-ALD with an incidence of 70-80% of patients, adrenal insufficiency (AI) is alife-threatening condition without timely treatment. The possibility of developing AI during the whole disease duration and the absence of any predictive factor for AI joining shows the necessity of studying AI in X-ALD patients to optimize current diagnostic and treatment algorithms. To study diagnostic and therapeutic features of primary adrenal insufficiency due to X-ALD. A retrospective observational comparative study was conducted in 66 male patients, examined and treated in the Pediatric endocrinology department of Endocrinology Research Centre, Research Centre for Medical Genetics, Research and Clinical Institute for Pediatrics of the Pirogov Russian National Research Medical University Detached Structural Unit Russian Children's Clinical Hospital (Moscow, Russia) for 2014-2022. All of patients were diagnosedwith primary AI and a genetically confirmed X-ALD. The median age of X-ALD manifestation was 6.6 years [4.7; 11.1]. The earliest age of AI diagnosis was 1.5 years atthe preclinical stage and 1 year 8 months with clinical symptoms. The renin level was studied in 22.7% at the manifestation of AI (15/66 patients), mineralocorticoid deficiency was found in 7 patients. Family history was positive in 39.4% of patients (n=66), only in 15.1% (10/66 patients) of patients the disease was established at the preclinical stage. In 59.1% (n=66) thecerebral form of the disease (cALD) was established, in 16.6% - adrenomyeloneuropathy (AMN), and in 24.2% - isolated adrenal insufficiency (PAI). Age of AI establishment in the group of patients with AMN (15.6 years) significantly differs from the establishment of AI in patients with cALD (7.4 years, p=0.001) and PAI (5.6 years, p = 0.000). Mineralocorticoid therapy was prescribed simultaneously with glucocorticoid therapy in patients with cALD, in AMN and PAI patients it was added after 11and 7 months, respectively (the differences between AMN and PAI groups were insignificant). Combined hormonal therapy receive 41% of patients with cALD, 54.5% of patients with AMN and 60% of patients with PAI. It is necessary to examine all male patients with AI regardless of the manifestation age to exclude adrenoleukodystrophy, and it is also important to examine patients for the presence of AI regardless of X-ALD manifestation age. The assessment of renin level in the manifestation of AI is also needed toprescribe mineralcorticoid therapy timely. Studying family history is the main method to detect X-ALD at the preclinical stage.

KORELASI ANTARA PRESTASI BELAJAR PENDIDIKAN AGAMA ISLAM DENGAN PERILAKU KEAGAMAAN TERHADAP SISWA MADRASAH ALIYAH NEGERI (MAN) BANJARMASIN

After learning religious education taught in various schools, it is expected that students can obtain religious teachings properly and correctly with independent mastery. This could indicate that the learning achievement of Islamic religious education has a relationship with the religious behaviour of students. The type of research carried out in this case is field research with quantitative methods. The subjects of this study were students at several MANs throughout the city of Banjarmasin, namely MAN 1 Banjarmasin, MAN 2 Banjarmasin, and MAN 3 Banjarmasin, totaling 127 people. Data collection techniques were carried out by collecting documentation in the form of learning achievement data in the form of semester report cards on subjects namely, the Quran Hadith (QH), Islamic Cultural History (SKI), Fiqh, and Aqidah Akhlak (AA). Data on religious behaviour will be collected by giving a questionnaire consisting of 16 statements. The results show that the correlation between the learning achievements achieved by subjects in the PAI group and the religious behaviour of students at MAN throughout the city of Banjarmasin is very weak and tends to be uncorrelated, or there is no significant (non-significant) relationship between the variables of student achievement and religious behaviour. That is, it is not certain that students' excellent religious behaviour is the result or impact of their learning achievements, which are also very good in madrasas.

Systemic Effects of Perineural Glucocorticoids on Fasting Serum Glucose, Potassium, and White Blood Cell Count in Total Hip Arthroplasty.

Glucocorticoids are commonly used as regional anesthesia adjuvants to improve blockade quality and duration. There are limited data in the literature regarding the potential systemic effects and safety of perineural glucocorticoids. This study examines the effects of perineural glucocorticoids on serum glucose, potassium, and white blood cell count (WBC) in the immediate postoperative period after primary total hip arthroplasty (THA). A retrospective cohort study was carried out at a tertiary academic medical center utilizing electronic health records of 210 patients who underwent THA, for which patients received either a periarticular local anesthetic injection alone (PAI, N=132) or additional peripheral nerve blocks (PNB, N=78) containing 10 mg dexamethasone and 80 mg methylprednisolone acetate (PAI+PNB). The primary outcome was change in serum glucose from a preoperative baseline on postoperative days (POD) 1, 2, and 3. Secondary outcomes included changes in WBC and serum potassium. The change in serum glucose from baseline was found to be significantly higher in the PAI+PNB group compared to the PAI group on POD 1 (mean difference 19.87 mg/dL, 95% CI [12.42, 27.32]; P<0.001) and POD 2 (mean difference 17.5 mg/dL, 95% CI [9.66, 25.44], P<0.001). No significant difference was found on POD 3 (mean difference -8.18 mg/dL, 95% CI [-19.07, 2.70], P=0.14). Statistically significant but clinically insignificant differences were detected in serum potassium in the PAI+PNB group compared to the PAI group on POD1 (mean difference 0.16 mEq/L, 95% CI [0.02, 0.30], P=0.03) and WBC on POD 2 (mean difference 3.18 × 1000/mm3, 95% CI [2.14, 4.22], P<0.001). Patients who underwent THA and received PAI+PNB with glucocorticoid adjuvants demonstrated higher elevations in serum glucose for the first two PODs compared to patients who received PAI alone. These differences resolved by a third POD and are likely to be of no clinical significance.

P163 Is Peri-appendiceal Inflammation of Clinical Significance in Patients with Ulcerative Colitis?

Abstract Background Peri-appendiceal inflammation (PAI) is often found in patients with left-sided ulcerative colitis (UC) or proctitis. However, there is still no consensus on the clinical significance of PAI. This study aimed to identify the clinical significance of PAI in UC as a prognosis factor. Methods We retrospectively collected medical records and endoscopic results of patients with diagnosed left side UC or proctitis between January 2013 and December 2021. According to the presence of PAI, we divided the patients into PAI and non-PAI groups. Demographic features and clinical course of the two groups were collected and analyzed. Results A total of 107 patients (41 of left site UC, 56 of proctitis) were enrolled, of which 52 were in the PAI group and 55 were in the non-PAI group There was no difference in most of the demographic and clinical variables between the PAI and non-PAI groups. During the follow-up period of 51 months for the PAI group and 46 months for the non-PAI group, respectively, there was no difference in disease relapse rate (47.1% vs 49.1%, p=0.823), cumulative rate of disease relapse at 1, 3, and 5 years (10.7%, 26.2%, 34.8% vs 8.39%, 23.0%, 36.7%, p=0.823), rate of treatment escalation (59.6% vs 41.8%, p=0.066) and proximal disease extension (25% vs 25.5%, p=0.957) however, new occurrence of PAI during the follow-up period in the non-PAI group was associated with proximal disease extension (55.6% vs 19.6%, p=0.037) In this study, oral 5-aminosalicylate (ASA) was administered to most patients regardless of the extent of the disease. In patients with proctitis with PAI, oral 5-ASA did not affect relapse rate (37.1% vs 66.7%, p=0.550) and proximal disease extension rate (28.6% vs 33.3%, p=1.000). Conclusion PAI at diagnosis did not affect the course of the disease nor did oral 5-ASA in proctitis, however new occurrences of PAI during follow-up were associated with proximal disease extension.

Early Surgical Care of Anticoagulated Hip Fracture Patients Is Feasible-A Retrospective Chart Review of Hip Fracture Patients Treated with Hip Arthroplasty within 24 Hours.

Anticoagulative medication such as antiplatelet drugs (PAI, acetylsalicylic acid and direct platelet aggregation inhibitors), vitamin-K-antagonist Warfarin (VKA) or direct oral anticoagulants (DOAC) are common among hip fracture patients, and the perioperative management of these patients is a rising challenge in orthopaedic trauma. Our objective was to determine the effect of oral anticoagulation in patients receiving early endoprosthetic treatment within 24 h after their admission. For the period from 2016 to 2020, a retrospective chart review of 221 patients (mean age 83 ± 7 years; 161 women and 60 men) who were treated either with hemi- (n = 209) or total hip arthroplasty (n = 12) within 24 h after their admission was performed. We identified 68 patients who took PAI, 34 who took DOAC and 9 who took VKA medications. The primary outcome measures were the transfusion rate and the pre- and postoperative haemoglobin (Hb) difference. The secondary outcome measures were the in-patient mortality and the rate of postoperative haematomas that needed operative treatment. A logistic/ordinal regression was performed considering the related variables to prevent cofounding occurring. The mean time to surgery was significantly longer for the DOAC and VKA groups when they were compared to the controls (none 14.7 ± 7.0 h; PAI 12.9 ± 6.7 h; DOAC 18.6 ± 6.3 h; VKA 19.4 ± 5.5 h; p &lt; 0.05). There was no difference in the preoperative Hb level between the groups. Overall, 62 patients (28%) needed blood transfusions during the in-patient stay with an ASA classification (p = 0.022), but the type of anticoagulative medication was not a significant predictor in the logistic regression. Anticoagulation with DOAC and grouped surgery times were positive predictors for a higher Hb difference in the patients who did not undergo an intraoperative blood transfusion (n = 159). Postoperative haematomas only occurred in patients taking anticoagulative medication (four cases in PAI group, and three cases in DOAC group), but the logistic regression showed that the anticoagulative medication had no effect. The in-patient mortality was significantly influenced by a high ASA grade (p = 0.008), but not by the type of anticoagulative medication in patients who were treated within 24 h. We conclude that the early endoprosthetic treatment of the anticoagulated hip fracture patient is safe, and a delayed surgical treatment is no longer justifiable.

Impact of a Bayesian Individualization of Cyclosporine Dosage Regimen for Children Undergoing Allogeneic Hematopoietic Cell Transplantation: A Cost-Effectiveness Analysis.

Cyclosporine A (CsA) is the main drug used to prevent graft-versus-host disease in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). CsA therapeutic drug monitoring (TDM) has been performed for ages, with studies revealing clinical benefits, but failing to examine its economic impact. In this article, the main objective was to evaluate the economic impact of the CsA TDM strategy, based on a Bayesian approach, by assessing costs related to its clinical impact. Furthermore, TDM effectiveness was analyzed for pharmacokinetics and clinical outcomes. A cost-effective, nonrandomized, retrospective, single-center study compared 2 CsA monitoring and dose adaptation strategies in pediatric patients undergoing HSCT. From 2014 to 2016, CsA TDM was performed using a population pharmacokinetics model-coupled Bayesian approach by a pharmacist ["pharmacist-assisted individualization" (PAI)]. From 2017 to 2018, CsA TDM was performed by the clinician without a Bayesian approach (non-PAI group). HSCT costs were evaluated from the French National Insurance perspective. Economic and clinical outcomes were assessed by measuring incremental cost-effectiveness ratios. The study included 144 patients: 90 and 54 patients in PAI and non-PAI groups, respectively. Both groups were comparable for sociodemographic and clinical characteristics. The mean total cost per patient was significantly lower (P < 0.01) in the PAI group (€85,947) than in the non-PAI group (€100,435). Multivariate analysis revealed that TDM based on the Bayesian approach was a protective factor (odds ratio = 0.86) for severe acute graft-versus-host disease. We noted that pharmacist-based TDM was the dominant strategy. Bayesian method-based TDM allowed an increase in the percentage of target attainment at any period post-HSCT. CsA TDM with a Bayesian approach is a cost-effective procedure, and highlighted clinical benefits encourage the development of new TDM strategies for HSCT.

Comparison between periarticular injection and intraarticular infusion for pain control following total knee arthroplasty

Objectives: To compare periarticular infiltration and intraarticular continuous infusion methods in pain management following total knee arthroplasty (TKA). Methods: Patients who underwent TKA from May 2015 through September 2015 according to their postoperative pain protocol were compared. The patients who received bupivacaine by periarticular infiltration (PAI group) and intraarticular infusion (IAI group) were included in the study. Patients also received a treatment through intravenous patient-controlled analgesia (PCA) device. The frequency of patients’ bolus need and the tramadol dose used via PCA device, Visual Analogue Scale (VAS) scores and clinical evaluation as active knee flexion at the postoperative 3th day were obtained from the patient follow - up forms and records. Side effects related to narcotic analgesic medications were also obtained. Results: The study included 90 patients, of whom 46 were in the PAI group (median age, 65.5 years; females, 82.6%) and 44 were in the IAI group (median age: 65.5 years; females, 81.8%). The VAS pain scores assessed at various postoperative time points and tramadol consumption were usually lower in the IAI group than in the PAI group. No difference was determined between the groups regarding the 3th-day VAS scores in flexion and in terms of analgesia-associated side effects. Conclusions: Bupivacaine administration by IAI for postoperative pain management following TKA is associated with lower pain and lower tramadol consumption as compared with bupivacaine administration by PAI. The groups were comparable in terms of side effects. Accordingly, IAI seems to be an effective and safe analgesic technique for patients undergoing TKA.

Effects of a short-term increase in physical activity on arterial stiffness during hyperglycemia.

We examined the effects of increasing physical activity on arterial stiffness during hyperglycemia. Nineteen glucose-intolerant elderly participated in the study. We randomly assigned 10 participants to increase their daily activity in everyday life, regardless of the time or intensity, for 1 month (PAI group) (age, 74.6±1.3 years; mean±SE) and nine participants to maintain their level of activity (CON group) (age, 79.2±2.1 years; mean±SE). The 75-g oral glucose tolerance test was conducted in each participant in both groups before and after the start of the intervention to confirm glucose intolerance. Brachial-ankle pulse wave velocity and cardio-ankle vascular index significantly increased from baseline at 30, 60, and 90min after the 75-g glucose ingestion after the intervention in the CON group (p<0.05), but not in the PAI group. Heart-brachial pulse wave velocity did not change compared to baseline after the 75-g glucose ingestion in either group and did not change from baseline at 30, 60, and 90min after the 75-g glucose ingestion before and after the intervention in both groups. The present findings indicate that a short-term increase in physical activity suppresses the increase in arterial stiffness after glucose intake.

How effective is periarticular drug infiltration in providing pain relief following Total Knee Replacement as compared to epidural analgesia?

IntroductionThe aim of the study was to compare the efficacy of pericapsular injection of analgesic drugs (PAI) with epidural analgesia (EA), in providing post-operative pain relief and early functional improvement of following Total Knee Arthroplasty. Materials and methods50 patients were randomized to 2 arms of 25 patients each, receiving either pericapsular injection or epidural analgesia. The Visual Analogue Scale (VAS), functional outcomes and side effects related to the EA and PAI groups were assessed. ResultsThe PAI group had significantly better pain relief on the first post-operative day with a mean VAS on 3.6 as opposed to 7 in the epidural group(p = 0.006). Functional outcomes in the PAI group were significantly better in the early post-operative period with patients taking less time to achieve the same physiotherapy goals – straight leg raising, climb 14 steps and walking 50 m. Side effects like nausea, vomiting, pruritus and urinary retention were less with PAI. However, by the 5th postoperative day, functional independence and pain control were similar in both groups. ConclusionPericapsular injection of analgesic drugs in total knee arthroplasty provides better pain control and functional recovery than epidural analgesia in the early post-operative period, and can be the choice method for analgesia following total knee replacement.

Inhibitory Effect of Polypeptide from &lt;em&gt;Argopecten irradias&lt;/em&gt; on Mice with Transplanted H22 Hepatocarcinoma and Its Mechanism

The objective of this study was to investigate the inhibitory effect of Polypeptide from <em>Argopecten Irradias</em> (PAI) on mice with transplanted H₂₂ hepatocarcinoma. PAI was prepared by enzymatic hydrolysis and separation and the results of its structure identification indicated that it contained five polypeptide components with molecular weights of 700-1000 Da. Forty Kunming mice were randomly divided into H₂₂ hepatocarcinoma group and low, medium and high dose PAI groups. After ig administration of normal saline and different doses of PAI for 10 days, all mice were inoculated with H₂₂ hepatocarcinoma cell suspension to establish models. After continuous gavage for 10 days, the blood was collected from the eyeball and the mice were sacrificed for index detection. It was found that the tumor inhibiting rates of PAI in three dose groups were 28.16, 41.93 and 84.00%, respectively. Compared to H<em>22</em> hepatocarcinoma group, the mutant serum p53, survivin and MDA levels of mice in three PAI-dose groups were significantly reduced (<em>p</em><0.01), the IL-2 and SOD levels were significantly increased (<em>p</em><0.01). The results suggested that PAI had obvious inhibitory effect on mice with H₂₂ hepatocarcinoma cells.

How Do Demographic, Surgical, Patient, and Cultural Factors Affect Pain Control After Unicompartmental Knee Arthroplasty? A Multivariable Regression Analysis

BackgroundControlling pain after unicompartmental knee arthroplasty (UKA) is essential for improving patient satisfaction, minimizing complications, and early rehabilitation. There is little literature available evaluating the effect of both treatment and patient characteristics on in-hospital pain after UKA. The purpose of this study was to examine the effect of patient and treatment characteristics on in-hospital pain after UKA. This study also evaluated the role of analgesic cocktail (traditional periarticular injection cocktail “[PAI]” vs cocktail including liposomal bupivacaine “[LBUP]”). MethodsThe study sample included 442 consecutive UKA cases performed between December 2011 and August 2013. The primary outcome measures were the average Visual Analog Scale pain score and the percent of pain scores during hospitalization that were 0, that is, “no pain.” Multivariable regression analyses were implemented to investigate associations between patient demographics and analgesic group with the outcomes. For the analgesic groups, the ”PAI” group received injections of a cocktail including Marcaine, ketorolac, and morphine, the ”LBUP” group received injections of LBUP. ResultsPostoperative pain was higher in females (P < .001) and younger patients (P = .002). The patient group treated with LBUP injection technique had similar overall average Visual Analog Scale pain scores to patients in the PAI group (P = .729); however, there was also a significant improvement in pain scores over time (as the study progressed) for patients in the LBUP group relative to the PAI group (P = .003), potentially indicating better outcomes with more experience with the injection technique. When compared individually by day, the LBUP group had lower pain scores from day 1 to 3 (P < .024). ConclusionThe results showed that in patients undergoing UKA, postoperative pain was lower in males, older patients, patients with lower body mass index, and those treated with LBUP over the study period. Understanding these associations is necessary to effectively manage pain and encourage earlier ambulation and physiotherapy after UKA.

Primary vs secondary adrenal insufficiency: ACTH-stimulated aldosterone diagnostic cut-off values by tandem mass spectrometry.

To validate the diagnostic utility of Cortrosyn(™) stimulated aldosterone in the differentiation of primary (PAI) and secondary adrenal insufficiency (SAI) and to evaluate the effect of urine sodium levels and posture on test performance. Cross-sectional study. Healthy volunteers (HV; n = 46) and patients with PAI (n = 26) and SAI (n = 29) participated in the study. Testing included cortisol and aldosterone (by liquid-chromatography tandem mass spectrometry) measurements at baseline and 30 and 60 min after 250 μg Cortrosyn(™). Plasma corticotropin (ACTH), renin activity (PRA) and urine spot sodium as a proxy for 24-h urine sodium excretion were measured at baseline. The effect of a sitting or semifowlers posture was evaluated in healthy volunteers. A Cortrosyn(™)-stimulated aldosterone level of 5 ng/dl (0·14 nmol/l) had 88% sensitivity and positive predictive value and 89·7% specificity and negative predictive value for distinguishing PAI from SAI. Spot urine sodium levels showed a strong correlation with peak aldosterone levels (r = -0·55, P = 0·02, n = 18) in the SAI but not PAI or HV groups. Posture did not have a significant effect on results. Once diagnosed with adrenal insufficiency, a stimulated aldosterone value of 5 ng/dl (0·14 nmol/l) works well to differentiate PAI from SAI. However, clinicians should be aware of the possible effect of total body sodium as reflected by spot urine sodium levels on aldosterone results. A 24-h urine sodium measurement may be helpful in interpretation.

An observational study on adrenal insufficiency in a French tertiary centre: Real life versus theory

BackgroundPatients suffering from adrenal insufficiency, whether primary (PAI) or secondary (SAI) have an increased mortality risk and increased morbidity. There are no guidelines on hydrocortisone replacement therapy and little is known on patients’ management in current practice. We described patients’ profiles and treatment in a tertiary referral centre. MethodsData were collected retrospectively from medical charts. PAI and SAI patients were described and compared. ResultsTwo hundred and one patients (79 PAI+122 SAI) were included. They had a mean duration of disease of 11.2years. Main causes of PAI were autoimmune diseases (31%) and adrenalectomy (26%). SAI was caused primarily by pituitary tumors (61%) and irradiation (20%). Mean dose of daily hydrocortisone (HC) was 27.5 and 19.9mg/day in PAI and SAI patients respectively, with a majority of patients dividing the dose into 2 intakes (46.8 and 72.2% in PAI and SAI groups, respectively). SAI patients exhibited more cardiovascular risk factors than PAI patients. The HC daily dose was slightly higher in patients with dyslipidemia (in both PAI and SAI groups) and in those with high blood pressure (in the SAI group only). One third of patients were out of work, due to unemployment, sick leaves, or disability. ConclusionsThe management of AI is far from standardized, and individual tailorization is difficult with currently available means of treatment. Under- and overdose of hydrocortisone likely leads to complications, and altered quality of life reflected by a high rate of “out of work” patients.

The Chitranjan Ranawat Award: Periarticular Injections and Femoral &amp; Sciatic Blocks Provide Similar Pain Relief After TKA: A Randomized Clinical Trial

Two of the more common methods of pain management after TKA are peripheral nerve blocks and intraarticular/periarticular injections. However, we are not aware of any study directly comparing the commonly used combination of a continuous femoral block given with a single-shot sciatic block with that of a periarticular injection after TKA. This randomized clinical trial compared a combined femoral and sciatic nerve block with periarticular injection as part of a multimodal pain protocol after total knee arthroplasty with respect to (1) pain; (2) narcotic use; (3) quadriceps function and length of stay; and (4) peripheral nerve complications. One hundred sixty patients completed randomization into two treatment arms: (1) peripheral nerve blocks (PNB; n=79) with an indwelling femoral nerve catheter and a single shot sciatic block; or (2) periarticular injection (PAI; n=81) using ropivacaine, epinephrine, ketorolac, and morphine. All patients received standardized general anesthesia and oral medications. The primary outcome was postoperative pain, on a 0 to 10 scale, measured on the afternoon of postoperative day 1 (POD 1). Secondary outcomes were narcotic use, quadriceps function, length of stay, and peripheral nerve complications. Mean pain scores on the afternoon of POD 1 were not different between groups (PNB group: 2.9 [SD 2.4]; PAI group: 3.0 [SD 2.2]; 95% confidence interval, -0.8 to 0.6; p=0.76). Mean pain scores taken at three times points on POD 1 were also similar between groups. Hospital length of stay was shorter for the PAI group (2.44 days [SD 0.65] versus 2.84 days [SD 1.34] for the PNB group; p=0.02). Narcotic consumption was higher the day of surgery for the PAI group (PAI group: 11.7 mg morphine equivalents [SD 13.1]; PNB group: 4.6 mg [SD 9.1]; p<0.001), but thereafter, there was no difference. More patients in the PNB group had sequelae of peripheral nerve injury (mainly dysesthesia) at 6-week followup (nine [12%] versus one [1%]; p=0.009). Patients receiving periarticular injections had similar pain scores, shorter lengths of stay, less likelihood of peripheral nerve dysesthesia, but greater narcotic use on the day of surgery compared with patients receiving peripheral nerve blocks. Periarticular injections provide adequate pain relief, are simple to use, and avoid the potential complications associated with nerve blocks. Level I, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Radiographic follow-up of periapical status after endodontic treatment of teeth with and without apical periodontitis

The aim was to assess objectively the rate of changes in periapical status after endodontic treatment in relation to preoperative radiographic status (Periapical Index Score, PAI) and to tooth type. Radiographic data from a total of 1,410 teeth in seven prospective clinical studies was pooled. The periapical status was evaluated blindly using the PAI scoring system. The longest follow-up period was 4 years; intervals between controls varied from 3 months to 1 year. Teeth with preoperative PAI score 1 maintained excellent periapical health throughout. Teeth with preoperative PAI score 2 showed some impairment in health over the first 6 months, but improved to approach 95 % healthy teeth at 2 years of observation. Teeth with PAI 3-5 at the start showed significant improvement at 3 months; 27 % were considered healthy (PAI 1 or 2) increasing to 41 % after 1 year. Improvement of periapical status was slower in PAI groups 4 and 5 compared with PAI 3 during the first year. After 2 years, improvement continued similarly in all preoperative PAI 3-5 groups of teeth. Upper lateral incisors showed the poorest healing rate. Healing of pre-existing periapical lesions is most pronounced from 3 months to 2 years. Teeth with initially healthy periapical structures predictably maintain good periapical health. Maxillary teeth, especially lateral incisors, showed poorer healing rates than mandibular teeth. Radiographic healing rates may vary among tooth groups within the dentition. Periapically healthy teeth that are root filled may not need postoperative controls.

La competencia científica y su evaluación. Análisis de las pruebas estandarizadas de PISA

In this paper, we present the results of research conducted under the Project I + D (SEJ2007-66 967): Educational Evaluation of Second Order Learning, Learning how to Learn, International Project Analysis and Testing of Alternative Strategies funded by the Ministry of Education and Science and led by Prof. Dr. D. Angel I. Perez Gomez (PAI Group HUM-311: Educational Innovation and Evaluation in Andalusia), University of Malaga (Andalusia, Spain). We will focus on international assessment PISA (Programme for International Student Assessment) in the specific area of science, understood as 'scientific expertise'. The PISA program, led by the OECD (Organization for Economic Cooperation and Development), is based on analyzing the performance of students from standardized tests that are conducted every three years and are aimed at international assessment of competencies achieved by students of fifteen years. In a first level of discussion, we conducted an analysis of the PISA tests released for the area of science in the years 2000-2006, on the six matrix scientific capabilities (play, implementation, reflection, transfer, heuristic and argumentation), concluding These tests require scientific capabilities primarily low complexity (implementation and reflection), with little presence in the mere repetition in them. In a second level of discussion, we have conducted an assessment of the distance between the global concept of competition proposed in the report for the OECD DeSeCo and what really seems to assess the PISA program in light of the results of our analysis. According to our research, PISA looks atomizing the notion of competence, thereby moving away from the original holistic approach, to assess capabilities only, to be assessed individually, not actually seem to show the level of acquiring skills in school by students.

Norton and Ethel Allen among the Paipai

Although Norton Allen is known primarily in connection with the archaeology of the Hohokam, he and his wife, Ethel, also took an inter est in contemporary Native Americans (see Schwartzlose's biography of Allen in this issue). This article examines the Aliens' collection of objects made by the Paipai of Baja California, particularly the pottery, donated by Ethel Allen to the Arizona State Museum (ASM) in Tucson. The Paipai are a Yuman-speaking people who today live in and around the village of Santa Catarina, which is about eighty miles south southwest of Calexico/Mexicali. The village is associated with the former Dominican mission of Santa Catarina (or Santa Catalina) de los Yumas, established in 1797 and destroyed in 1840 by a native revolt (Meigs 1935). The Paipai are linguistically related to the Kiliwa just to the south of them, the Ipai and Tipai (Kamia/Kumeyaay) in southern California and northwestern Baja, the Cocopa on the Colorado River delta, and the Arizona Pai groups (the Hualapai, Havasupai, and Yavapai) (see maps in Luomala 1978:fig. 1 and Owen 1969:fig. 1). The people referred to today as Paipai are actually an amalgam of what were formerly two separate groups, one of which spoke Paipai, the other Kuad, another Yuman language (Wilken 1987:19). Anthropologist Roger Owen stated, It seems likely that Santa Catarina was originally a Kuatl settlement to which Paipai were brought by the missionaries. All of the remembered Kuatl rancher?as were around and to the north of

Leisure-Time Physical Activity And Cardiovascular Risk Factors In Adolescents

Associations between leisure-time physical activity and cardiovascular risk factors are generally weak in observational studies in adolescents. PURPOSE: To study associations between leisure-time physical activity and blood lipids, lipoproteins and blood pressure in 13-year-old boys and girls. METHODS: This study is a part of the large prospective randomized STRIP study (Special Turku Coronary Risk Factor Intervention Project) on-going in Turku, Finland. In infancy, the children (n=1062) were randomized to an intervention group with regular dietary and lifestyle counselling and to a control group. Leisure-time physical activity habits were assessed during a study visit at age 13 by a self-reported questionnaire. Leisure-time physical activity index (PAI; MET h/wk) was calculated by multiplying mean leisure-time exercise intensity, duration and frequency (n=544). According to PAI, the girls and boys were divided into 3 groups and the least and most active groups were compared: 1) Sedentary, mean PAI 3.2 MET h/wk for intervention girls (n=39) and 3.1 for control girls (n=48), 8.6 for intervention boys (n=46) and 8.0 for control boys (n=64), 2) Active, mean PAI 56.3 MET h/wk (n=27) and 53.2 (n=26) for girls, 58.0 (n=49) and 59.7 (n=41) for boys, respectively. Cardiovascular risk factors included total cholesterol, HDL, HDL/total cholesterol ratio, LDL, triglyceride, systolic and diastolic blood pressure. ANCOVA with BMI and pubertal status as covariates was used to test differences in cardiovascular risk factors between the PAI groups. RESULTS: In the dietary counselling groups, HDL was higher in physically active boys than in sedentary boys (mean 1.24 vs. 1.13 mmol/L, adjusted p=0.034). In the control groups, HDL and HDL/total cholesterol ratio were higher in physically active girls than in sedentary girls (mean 1.29 vs. 1.16 mmol/L, adjusted p=0.021 and 0.31 vs. 0.27, adjusted p=0.0076, respectively). No other differences between groups were found. CONCLUSION: Cross-sectional associations between leisure-time physical activity and cardiovascular risk factors are weak and inconsistent in 13-year-old adolescents. However, it remains to be seen if this longitudinal study is able to find possible relationships in the future.

Influence of the Alu-Repeat I/D Polymorphism in t-PA Gene Intron 8 on the Stimulated t-PA Release After Venous Occlusion

Tissue type plasminogen activator (t-PA) is released from endothelium in both a constitutive and regulated fashion. In healthy subjects, an association between net t-PA release rate and a few t-PA gene polymorphisms, including the Alu-repeat I/D polymorphism in intron 8, was described. The possible influence of the Alu-repeat polymorphism on t-PA release was evaluated after a venous occlusion test (VO) in 82 patients showing an impaired fibrinolytic capacity associated with different arterial disease or with previous venous thrombosis, and in 50 healthy controls. Euglobulin lysis time, t-PA antigen (t-PA:Ag) and activity, PAI-1 antigen and activity plasma levels were assayed before and 20 minutes after VO; the Alu-repeat I/D polymorphism was determined by PCR. Defective fibrinolysis was due to reduced t-PA release in 40 patients (t-PA group) and to PAI-1 excess in 42 patients (PAI group). No differences in both genotype distribution and allele frequencies were observed between patients and controls. The t-PA:Ag increase after VO (20/0-minute levels ratio adjusted for hematocrit) was considerably higher both in controls and in PAI group patients carrying the I allele than in the DD genotype carriers (II, ID, DD: 3.77+/-0.62, 3.43+/-0.44, 2.06+/-0.32 in controls, and 3.67+/-0.23, 2.80+/-0.50, 1.62+/-0.29 in PAI group, respectively). The difference was significant between the DD and both the ID and II genotypes in controls (p<0.05), and between the DD and II genotypes in PAI-1 group (p<0.05). A slight and nonsignificant trend of association between genotype and t-PA:Ag 20/0 ratio was seen in the t-PA group patients. In conclusion, these data suggest a possible genetic modulation of t-PA-regulated secretion.