Significant Decrement Research Articles

Seasonal Changes in 25(OH)D Concentration in Young Soccer Players-Implication for Bone Resorption Markers and Physical Performance.

Searching for potential relations between changes in 25(OH)D concentration and in physical fitness is an interesting scientific topic. Thus, the main purpose of this study was to investigate the changes in serum concentrations of 25(OH)D in young football players in conjunction with indicators determining bone resorption and physical fitness. A total of 35 young soccer players were tested during the autumn competition period. Biochemical analysis of blood, aerobic capacity, running speed and power tests (Wingate test, squat jump, counter movement jump) were carried out at the beginning and at the end of the competition period. Significant decrements in concentration of 25(OH)D from 33.9 ± 5.87 to 23.7 ± 5.58 ng/mL were noted after the analyzed competition period. There were no significant changes in aerobic capacity along the competition period. Significant improvements were observed in 10 m sprint, 30 m sprint (p < 0.001), maximal power (p = 0.011) and total work capacity (p = 0.024). We found that the effect of changes in the players’ physical fitness does not occur in relation to 25 OH(D) concentration but occurs when these changes are analyzed as a function of the duration of the observation period. Changes in physical fitness of soccer players are determined by other factors then 25(OH)D concentration.

The effectiveness of propranolol, flunarizine, amitriptyline and botulinum toxin in vestibular migraine complaints and prophylaxis: a non-randomized controlled study

IntroductionVestibular migraine is the most common cause of spontaneous episodic vertigo in adult patients and the second most common cause of vertigo in patients of all ages. ObjectiveTo assess the effectiveness of oral medication type (propranolol, flunarizine, and amitriptyline) and botulinum toxin A application on vestibular symptoms, headache severity and attack frequency for vestibular migraine patients. MethodsSixty patients with vestibular migraine were enrolled. Thirty patients received botulinum toxin A treatment (B+ group) in addition to the oral medication, whereas 30 patients received only oral medication (B− group). Headache severity was evaluated with Migraine Disability Assessment Scale and vertigo severity was evaluated with Dizziness Handicap Inventory scale. Vestibular migraine attack frequencies in the last three months were also evaluated. ResultsThere was a statistically significant decrement in mean Dizziness Handicap Inventory scores, Migraine Disability Assessment Scale scores and vertigo attack frequencies after treatment for all patients, B+ and B− group patients (p<0.001 for all). The mean Migraine Disability Assessment Scale score gains (p<0.001) and vertigo attack frequency gains (p= 0.003) were significantly higher in the B+ patients than B− patients. ConclusionsBoth B+ and B− group patients exhibited significant improvement in vestibular migraine attack frequencies, Dizziness Handicap Inventory score and Migraine Disability Assessment Scale score values. However, botulinum toxin A application had a more pronounced effect for Migraine Disability Assessment Scale score gain and vestibular migraine attack frequency values, but not for Dizziness Handicap Inventory score gain values. Thus, botulinum toxin A application should be considered for vestibular migraine patients whose headache severity degrees are more profound. The oral medication type (propranolol, flunarizine or amitriptyline) did not differ in influencing the vestibular migraine attack frequency, Dizziness Handicap Inventory score gain and Migraine Disability Assessment Scale score gain values.

Electrophysiological and neurochemical evaluation of the adverse effects of REM sleep deprivation and epileptic seizures on rat's brain

AimThe current study aims to investigate the impact of paradoxical (REM) sleep deprivation and/or epileptic seizures on rat's cortical brain tissues. Main methodsAnimals were divided into four groups; control, epileptic, REM sleep deprived and epileptic subjected to REM sleep deprivation. Electrocorticogram (ECoG) signals were recorded and quantitatively analyzed for each group. Concentrations of amino acid neurotransmitters; proinflammatory cytokines; and oxidative stress parameters; and acetylcholinesterase activity were determined in the cortex of the animals in different groups. Key findingsResults showed significant variations in the spectral distribution of ECoG waves in the epilepsy model, 24- and 48-hours of REM sleep deprivation and their combined effects indicating a state of cortical hyperexcitability. Significant increases in NO and taurine and significant decrement in glutamine, GABA and glycine were determined. In REM sleep deprived rats significant elevation in glutamate, aspartate, glycine and taurine and a significant lowering in GABA were obtained. This was accompanied by significant reduction in AchE and IL-β. In the cortical tissue of epileptic rats deprived from REM sleep significant increases in lipid peroxidation, TNF-α, IL-1β, IL-6 and aspartate and a significant reduction in AchE were observed. SignificanceThe present data indicate that REM sleep deprivation induces an increase in lipid peroxidation and storming in proinflammatory cytokines in the cortex of rat model of epilepsy during SRS. These changes are associated with a decreased seizure threshold as inferred from the increase in alpha and Beta waves and a decrease in Delta waves of ECoG.

Predictors of outcomes of therapy-related acute myeloid leukemia after allogeneic hematopoietic stem cell transplantation

Background/ObjectiveExisting literature on allogeneic hematopoietic stem cell transplantation (allo-HSCT) in therapy-related acute myeloid leukemia (t-AML) is confounded by the inclusion of patients with secondary AML and t-MDS. We aim to report our 20-year experience of HSCT in t-AML. MethodsWe retrospectively reviewed patients with t-AML who underwent HSCT. Patients were analyzed for prior malignancy, therapy, time to diagnosis of t-AML, transplant details, relapse-free survival (RFS), overall survival (OS), and predictors of outcomes. ResultsIn total, 68 patients (59.9% female; median age, 56.5 years) underwent HSCT. Acute and chronic graft-versus-host disease (GVHD) occurred in 39 (57.4%) and 23 (33.8%) patients, respectively. Cumulative incidence of relapse, nonrelapse mortality, RFS, and OS at 2 years were 17.9%, 34.5%, 47.6%, and 49.3%, respectively. Significant predictors of reduced OS were presence of 11q23 rearrangement (hazard ratio [HR], 3.24), using induction regimens other than FLAG-Ida or 7 + 3 (HR, 3.65), haploidentical donors (HR, 3.48), Eastern Cooperative Oncology Group performance status 2 or higher (HR, 5.83), and using cyclosporine A–methotrexate as GVHD prophylaxis (HR, 2.41). A significant decrement in survival was seen with an increasing number of any of these prognostic factors. ConclusionOutcomes of t-AML are satisfactory after allo-HSCT. Patients with t-AML with good-risk karyotypes, good performance status, having HLA-matched donors, and receiving intensive induction regimens have better outcomes after HSCT.

Effect of Cell Phone-Emitted Electromagnetic Waves on Levels of Male Sex Hormones and Oxidative Stress Biomarkers in Humans

Cell phones emit Electromagnetic Waves (EMWs) that may have adverse effects on human health. The study aimed to investigate some possible health impacts associated with cell phone-derived EMWs on male sex hormones and oxidative stress biomarkers. One-hundred recruited male volunteers were classified into two equal groups; group 1 who used mobile phones less than one hour per day for less than five years and group 2 who used mobile phones more than one hour per day for more than five years which then subdivided into 3 groups according to the duration of usage in daily hours and annual usage. Sex hormones (testosterone, luteinizing hormone, follicle-stimulating hormone) as well as oxidative stress biomarkers (malondialdehyde and superoxide dismutase) were investigated. In comparison to group 1, group 2 showed a significant decrement in the blood levels of both testosterone and superoxide dismutase, which is accompanied by an increment in levels of luteinizing and follicle-stimulating hormones as well as malondialdehyde. Moreover, among group 2 subjects that used mobile for ˃3 h/day for ˃15 years showed highly significant differences than those who used mobile for shorter periods, meaning that duration of exposure to mobile has serious clinical significance. Findings from our study confirmed that long-term use of cell phones can cause alteration in male sex hormones as well as a redox imbalance characterized by increased lipid peroxidation and decreased antioxidant biomarkers.

Trend analysis of cardiovascular disease mortality, incidence, and mortality-to-incidence ratio: results from global burden of disease study 2017

BackgroundCardiovascular diseases (CVDs) are one of the global leading causes of concern due to the rising prevalence and consequence of mortality and disability with a heavy economic burden. The objective of the current study was to analyze the trend in CVD incidence, mortality, and mortality-to-incidence ratio (MIR) across the world over 28 years.MethodsThe age-standardized CVD mortality and incidence rates were retrieved from the Global Burden of Disease (GBD) Study 2017 for both genders and different world super regions with available data every year during the period 1990–2017. Additionally, the Human Development Index was sourced from the United Nations Development Programme (UNDP) database for all countries at the same time interval. The marginal modeling approach was implemented to evaluate the mean trend of CVD incidence, mortality, and MIR for 195 countries and separately for developing and developed countries and also clarify the relationship between the indices and Human Development Index (HDI) from 1990 to 2017.ResultsThe obtained estimates identified that the global mean trend of CVD incidence had an ascending trend until 1996 followed by a descending trend after this year. Nearly all of the countries experienced a significant declining mortality trend from 1990 to 2017. Likewise, the global mean MIR rate had a significant trivial decrement trend with a gentle slope of 0.004 over the time interval. As such, the reduction in incidence and mortality rates for developed countries was significantly faster than developing counterparts in the period 1990–2017 (p < 0.05). Nevertheless, the developing nations had a more rather shallow decrease in MIR compared to developed ones.ConclusionsGenerally, the findings of this study revealed that there was an overall downward trend in CVD incidence and mortality rates, while the survival rate of CVD patients was rather stable. These results send a satisfactory message that global effort for controlling the CVD burden was quite successful. Nonetheless, there is an urgent need for more efforts to improve the survival rate of patients and lower the burden of this disease in some areas with an increasing trend of either incidence or mortality.

Further Evidence for the Expansion of Adult Cochlear Implant Candidacy Criteria.

1) To complete a follow-up investigation of postoperative outcomes for adult cochlear implant (CI) recipients scoring ≥30% Consonant-Nucleus-Consonant (CNC) preoperatively, and 2) to describe the postoperative performance trajectory for this group of higher performing patients. Retrospective chart review. Tertiary referral center. One hundred four (105 ears) postlingually deafened adults who scored ≥30% CNC word recognition in the ear to be implanted preoperatively. One hundred four subjects underwent cochlear implantation. Pre- and postoperative CNC word scores and AzBio sentences in quiet and noise in the ear to be implanted as well as the bilateral-aided condition pre-CI and at 1, 3, 6, and 12 months post-CI. Statistically significant improvement was demonstrated for CNC and AzBio sentences in quiet and noise for the CI alone and bilateral listening conditions. Most improvement was demonstrated by 6-months postoperatively (p < 0.001) with the exception of AzBio sentences in noise demonstrating improvement within 3 months (p < 0.001). For patients with preop CNC scores up to 40% (n = 57), all recipients demonstrated either equivocal (n = 17) or statistically significant improvement (n = 40) for CNC word recognition in the CI-alone condition and none demonstrated a significant decrement in the bilateral condition. For patients with preop CNC scores >40% (n = 47, 48 ears), 89.3% (42 patients) demonstrated either equivocal (n = 24, 50%) or statistically significant improvement (n = 19, 39.6%) for CNC word recognition in the CI-only condition and none demonstrated a significant decrement in the bilateral condition. CI candidates with preoperative CNC word scores higher than conventional CI recipients derive statistically significant benefit from cochlear implantation for both the CI ear and best-aided condition. These data provide further support for the expansion of adult CI candidacy up to at least 40% CNC word recognition preoperatively with consideration given to further expansion possibly up to 60%.

A Three-Arm Parallel-group Exploratory Trial documents balance improvement without much evidence of white matter integrity changes in people with multiple sclerosis following two months ambulatory neuroproprioceptive "facilitation and inhibition" physical therapy.

Changes of white matter integrity in people with multiple sclerosis (MS) were documented following mainly motor/skill acquisitions physical therapy, while following neuroproprioceptive "facilitation, inhibition" (neurofacilitation) only by two pilot studies. Neurofacilitation has potential to induce white matter changes due to the possibility of interfering with the neuronal tactility threshold. However stronger evidence is missing. This study investigates whether neurofacilitation (three physical therapy types) induce white matter changes and if they relate to clinical improvement. The Three-Arm Parallel-group Exploratory Trial (NCT04355663). Each group underwent different kinds of two months ambulatory therapy (Motor Program Activating Therapy, Vojta's reflex locomotion and Functional Electric Stimulation in Posturally Corrected Position). MS people with moderate disability. At baseline and after the program, participants underwent magnetic resonance diffusion tensor imaging (DTI) and clinical assessment. Fractional anisotropy maps obtained from DTI were further analyzed using tract-based spatial statistic exploring the mean values in the whole statistic skeleton. Moreover, additional exploratory analysis in 48 regions of white matter was done. Ninety-two people were recruited. DTI data from 61 people were analyzed. The neurofacilitation (irrespective type of therapy) resulted in significant improvement on the Berg Balance Scale (P=0.0089), mainly driven by the Motor Program Activating Therapy. No statistically significant change in the whole statistic skeleton was observed (only a trend for decrement of fractional anisotropy after Vojta's reflex locomotion). Additional exploratory analysis confirmed significant decrement of fractional anisotropy in the right anterior corona radiata. Neurofacilitation improved balance without much evidence of white matter integrity changes in people with MS. The study results point to the importance of neuroproprioceptive "facilitation and inhibition" physical therapy in the management of balance in people with multiple sclerosis; and the potential to induce white matter changes due to the possibility of interfering with the neuronal tactility threshold.

Investigation of aging induced processes on thermo-kinetic and combustion characteristics of tungsten pyrotechnic delay composition

A degradation in performance parameters related to thermal decomposition and combustion behaviour of tungsten based pyrotechnic delay composition can occur when subjected to accelerated aging conditions in a controlled environment. The present study utilizes various methods to quantify the extent of degradation in thermo-kinetic and burning characteristics as well as to postulate a fundamental aging mechanism for traditional tungsten (W) pyrotechnic delay material, which has not been attempted in the past. The delay composition based on metallic fuel (W) and perchlorate oxidizer is subjected to aging at constant temperature of 71 °C and 95% relative humidity, for 2 and 12 weeks, respectively. Experiments including thermal analysis, combustion temperature profile and burning rate measurements are conducted together with numerical simulation of an actual pyrotechnic delay device. Moreover, the reaction mechanism, chemical kinetics, and combustion behaviour between pristine and aged cases are examined. Results illustrate that there exist two aging induced processes, which increases the presence of large agglomerated particles, high metal oxide content by thickening the outer oxide layer of metallic fuel, and more unreacted oxygen to instigate incomplete combustion in aged samples. This alters the reaction pathway of combustion process, lowers average thermal conductivity, and reduces diffusion of reactants in aged samples, thus causing significant decrement in the heat of reaction (31%), combustion zone temperature (10%), reactivity (12%), and burning rates (10%), such that the overall pyrotechnic delay device experiences misfiring during operation or a failure in accomplishing its actual intended task.

Pool Boiling Heat Transfer Augmentation in a Novel Aqueous Binary Mixture of Surfactants

Abstract This paper investigates the augmentation of heat transfer during pool boiling of a novel aqueous binary mixture of surfactants. The surfactants used were sodium dodecyl sulfate (SDS) (anionic), centrimonium bromide (CTAB) (cationic), and nicotine (nonionic). The aqueous binary mixtures SDS–CTAB, CTAB–nicotine, and SDS–nicotine were prepared on the volume percentage basis. A reduction in surface tension was attained by SDS–CTAB, CTAB–nicotine, and SDS–nicotine aqueous mixtures compared to its individual aqueous surfactant solutions at their optimum concentrations. The most significant surface tension result was obtained by the novel SDS–nicotine aqueous binary system at 25:75 volume percentages. The heat transfer augmentation was investigated by studying the single bubble dynamic in the aqueous SDS–nicotine mixture. The investigation was conducted at two values of heat fluxes to probe the effect of heat flux on bubble dynamics. A significant decrement in the bubble departure diameter and a substantial increment in the release frequency was observed for the SDS–nicotine aqueous mixture at both heat fluxes. The heat transfer coefficient was found to be increased by 36.32% and 58.67% compared to saturated water at low and high heat flux, respectively.

Adolescents with cancer on privacy: Fact-finding survey on the need for confidentiality and space.

Cancer diagnosis and related treatment can limit young patients' privacy. Their need for private physical and psychological spaces can be impeded by limited freedom, e.g., sharing hospital rooms with others and exposing their body to their parents and doctors. We conducted a survey among young patients of our center to investigate how their perception of privacy changed after being diagnosed with cancer and their need for hospital dedicated physical spaces and time for patients to enjoy their privacy. A questionnaire with 16 items was developed by the staff involving psychologists and physicians. The relevance of changes before and after the cancer diagnosis was assessed by calculating two scores indicating the situation before and after diagnosis for each answer, as well as a delta score. Between May and June 2020, the questionnaire was completed by 60 patients aged 16-24 years. The median delta scores describing the changes before and after diagnosis were -8 points for perception of privacy, indicating a significant decrement of the level of privacy perceived. A major issue was the constant presence of parents being perceived as intrusive. Concerning hospital dedicated physical spaces and time for patients to enjoy their privacy, respondents requested dedicated spaces (50% of patients) and opportunities to have private interviews with medical personnel (88%). Our study offers a snapshot of how young people with cancer perceive the impact of the disease and its treatment on their privacy with the restrictions imposed on their individual freedom. Patients' personal needs must be taken into consideration to adopt appropriate measures and better organize wards.

Decrement of secondary gamma radiation flux during lunar eclipse June 16, 2011

The lunar eclipse at Udaipur (27◦ 43’ 12.00” N, 75◦ 28’ 48.01” E), India was experimentally observed on June16, 2011 using ground based NaI (Tl) Scintillation detector. We interpret such decrement of secondary gamma radiation flux (SGRF) on the basis of obstruction effect produced by Earth and Moon during lunar eclipse on radiation. Objective: To observe secondary gamma radiation flux during lunar eclipse day on comparison to pre and post eclipse days. Methods: For this experimental study we used ground based NaI (Tl) Scintillation detector. The data files were stored in computer for thirty minutes duration from 1.00 AM to 2.00 AM (Indian Time) on pre-eclipse normal days June 14 and 15, 2011 as well as on post eclipse normal day June 17 and also on eclipse day June 16, 2011. Finding: The analyzed data reveal significant decrement of secondary gamma radiation flux (SGRF) on lunar eclipse day about 6% on comparison to pre and post lunar eclipse days. Novelty: In this experimental study first time we reported about 6% decrement of secondary gamma radiation flux on lunar eclipse day on comparison to pre and post lunar eclipse days. Keywords: Lunar eclipse; cosmic radiation; reflected solar radiation; secondary gamma radiation; obstruction effect by Earth and Moon

Comparison of Hematological and Biochemical Profile Changes in Pre- and Post-Chemotherapy Treatment of Cancer Patients Attended at Ayder Comprehensive Specialized Hospital, Mekelle, Northern Ethiopia 2019: A Retrospective Cohort Study.

PurposeThis study aims to compare hematological and biochemical profile changes in pre- and post-chemotherapy among cancer patients admitted at the Oncology Unit of Ayder Comprehensive Specialized Hospital (ACSH), Mekelle, Northern Ethiopia.Patients and MethodsA retrospective cohort study was conducted in 376 cancer patients admitted in the Oncology Unit at ACSH. Demographic data, hematological and biochemical profiles were collected from smart care and patient cards. The data were analyzed using SPSS version 20 statistical package. Descriptive statistics and paired sample students T-test statistical methods were used.ResultsFrom 376 study subjects, 228 (60.6%) were females. All the hematological profiles, except lymphocyte (LYM) (P > 0.05), showed significant decrement in post-chemotherapy compared to pre-chemotherapy; white blood cell (WBC) (P < 0.01), red blood cell (RBC) (P < 0.01), hemoglobin (Hb) (P<0.001), hematocrit (HCT) (P < 0.05), platelet (PLT) (P < 0.001) and neutrophil (NUT) (P < 0.05). The biochemical profiles showed that blood urea nitrogen and creatinine levels were non-significantly decreased, urea (P > 0.05) and creatinine (CR) (P > 0.05), in post-chemotherapy compared to pre-chemotherapy whereas alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels were non significantly increased, ALT (P > 0.05) and AST (P> 0. 05), in post-chemotherapy compared to pre-chemotherapy.ConclusionHematological profiles, except lymphocytes, were found significantly decreased whereas biochemical profiles, urea, and creatinine were decreased non-significantly, while AST and ALT showed non-significant increments in post-chemotherapy compared to pre-chemotherapy.

Utility Decrements Associated With Diabetes and Related Complications: Estimates From a Population-Based Study in Germany

ObjectivesHealth utility decrement estimates for diabetes and complications are needed for parametrization of simulation models that aim to assess the cost-utility of diabetes prevention and care strategies. This study estimates health utility decrements associated with diabetes and cardiovascular and microvascular complications from a population-based German study. MethodsData were obtained from the population based cross-sectional KORA (Cooperative Health Research in the Augsburg Region) health questionnaire 2016 and comprised n = 1072 individuals with type 2 diabetes and n = 7879 individuals without diabetes. Health utility was assessed through the EQ-5D-5L. We used linear regression models with interaction terms between type 2 diabetes and different cardiovascular and microvascular complications while adjusting for demographic and socio-economic factors and other comorbidities. ResultsType 2 diabetes (β = −0.028, standard error [SE] = 0.014), stroke (β = −0.070, SE = 0.010), cardiac arrhythmia (β = −0.031, SE = 0.006), heart failure (β = −0.073, SE = 0.009), coronary heart disease (β = −0.028, SE = 0.010), myocardial infarction (β = −0.020, SE = 0.011, estimates of main effect), and neuropathy (β = −0.067, SE = 0.020), diabetic foot (β = −0.042, SE = 0.030), nephropathy (β = −0.032, SE = 0.025), and blindness (β = −0.094, SE = 0.056, estimates of interaction terms) were negatively associated with health utility. The interaction term for diabetes x stroke (β = −0.052, SE = 0.021) showed that the utility decrement for stroke is significantly larger in people with type 2 diabetes than in people without diabetes. ConclusionsDiabetes, cardiovascular, and microvascular conditions are associated with significant health utility decrements. Utility decrements for some conditions differ between people with and without type 2 diabetes. These results are of high relevance for the parametrization of decision analytic simulation models and applied health economic evaluations in the field of prevention and management of type 2 diabetes in Germany.

Enhanced transport properties of graphene oxide based cement composite material

This study is aimed to evaluate the transport properties of a cement composite incorporated with graphene oxide (GO). GO is a 2-dimensional nano material, enriched with reactive oxygen functional groups which made it as a suitable reactive material with cementitious materials. The GO-cement composite was prepared by adding GO in four different proportions such as 0.01%, 0.02%, 0.03%, and 0.04% by weight of cement. In the durability aspect water absorption, water sorptivity, resistance to acid attack, mechanical properties, thermal analysis, chloride migration coefficient, and chloride penetration depth were examined experimentally for GO-cement composite specimens and compared with plane cement composite specimens. Experimental results indicated that 14.5%, 30%, and 40.47% degradation in water absorption capacity, chloride migration coefficient, and chloride penetration depth of cement composite specimens with 0.03% addition of graphene oxide than normal cement composite specimens at 28 days of curing. Additionally, significant decrement in the sorptivity coefficient of cement composite was also achieved at 0.03% of GO addition. Mechanical properties were enhanced by 77.70% in flexural strength at 0.03% of GO addition and 47.61% in compressive strength at 0.04% of GO addition in cement composite at 28 days of curing. SEM analysis of the test samples exhibited the pore filled structure of the cement composites with GO addition. In addition, all GO-cement composite specimens exhibited greater resistance to an acidic environment and negligible loss in strength and weight was observed than normal cement composite specimens at 28 days immersion in 2% and 5% concentrations of both H2SO4 and HCl acidic solutions. Thermal resistance was increased in the terms of compressive strength in all GO-cement composite mixes gradually by increasing the concentration of GO content from 0.01% to 0.04% by weight of cement. It can be concluded that an effective improvement in transport properties of cement composite was achieved by the incorporation of graphene oxide nano material.

POEM: clinical outcomes beyond 5 years.

The short-term success of peroral endoscopic myotomy (POEM) is well documented but the durability of the operation is questioned. The aim of this study was to evaluate the clinical outcomes of the POEM procedure for esophageal motility disorders in a large cohort in which all patients had at least 5years of follow-up. All patients from a single center who underwent a POEM between October 2010 and September 2014 were followed for long-term clinical outcomes. Postoperative Eckardt symptom scores of short term and ≥ 5years were collected through phone interview. Clinical success was defined as an Eckardt score < 3. Overall success was defined as Eckardt score < 3 and freedom from additional interventions. Of 138 patients, 100 patients were available for follow-up (mean age 56, 52% male). The indication for operation was achalasia in 94. The mean follow-up duration was 75months (range: 60-106months). Dysphagia was improved in 91% of patients. Long-term overall success was achieved in 79% of patients (80% of achalasia patients, 67% of DES patients). Preoperative mean Eckardt score was 6. At 6months, it was 1, and at 75months, it was 2 (p = 0.204). Five-year freedom from intervention was 96%. Overall, 7 patients had additional treatments: 1 balloon dilation (35mm), 4 laparoscopic Heller myotomy, and 2 redo POEM at a mean of 51months post-POEM. Ninety-three percent expressed complete satisfaction with POEM. A multitude of studies has shown the early benefits of POEM. Here, we show that nearly 80% of patients report clinical success with no significant decrement in symptom scores between their short- and long-term follow-up. Clearly POEM is an effective option for achalasia with durable long-term treatment efficacy.

The effect of periodontal treatment on depression, body image, self esteem and anxiety in individuals: A randomized controlled clinical trial

Aim: Depression is a multi-factorial disease characterized by a variety of symptoms. Individuals with psychiatric disorders areseem to be more prone to periodontitis. However, depression and periodontal disease can be considered bidirectional risk factors.Periodontal diseases can also be an effect on depression. The aim of this study is to determine the effect of non-surgical mechanicalperiodontal treatment on psychological state.Materials and Methods: Two randomized groups were established from depressed patients with non-treated periodontal diseases.Test (n = 92) and control group (n = 92). Clinical periodontal and psychological measures were administered at baseline and at 6weeks in the control and test group. Periodontal treatment was applied to the test group.Results: After 6 weeks (the end of the periodontal therapy) there was a significant decrement in the results of Beck DepressionInventory (p a = 0.038) and a significant increment in Body Cathexis Scale (p a < 0.001) results in the test group. However, the resultsof Rosenberg Self-Esteem Scale (p a = 0.820) and Beck Anxiety Inventory (p a = 0.071) is similar between test and control groups.Conclusion: Within the limits of present study, the results suggest that periodontal treatment might be useful to improve depressivepatients’ psychological conditions.

Robotic hepatectomy is a feasible minimally-invasive modality for experienced liver surgeons

Presenter: Benjamin Motz MD | Carolinas HealthCare System Background: Modern liver surgery has seen increasing success over the last several decades due to advances in perioperative anesthesia care and surgical technique. One such improvement has been the development of minimally-invasive approaches to hepatectomy, which is associated with lower surgical morbidity, shorter hospital length of stay (LOS) and patient-reported outcomes. Although laparoscopic liver resection continues to be associated with a steep learning curve, more recently, the development of robotic approaches has reduced the technical limitations of these complex procedures. Herein we present outcomes and learning curve experience following the development of a high-volume robotic liver surgery program at a major hepatobiliary surgery center. Methods: A retrospectively maintained registry of robotic hepatectomies performed at a single high-volume tertiary care center was queried for all procedures performed between September 1, 2012 when the robotic hepatobiliary program was started and September 30, 2020. All operations were performed by either of two surgeons with significant experience in hepatobiliary surgery: JBM and DV. DV began his robotic liver surgery practice in the midst of the study period. Patient charts were retrospectively reviewed and data was collected, including patient demographics, preoperative characteristics, intraoperative details, and postoperative outcomes. Once cases were identified, they were then divided into five epochs of equal size (n=53) based on date of surgery in order to identify trends in outcomes related to experience. Statistical comparisons were performed using ANOVA or χ2 test, as appropriate. All data collection and chart review was approved by the Institutional Review Board. Results: During the study period, 265 patients underwent robotic hepatectomy. 152 (57.4%) were female, and average age was 58 years. 101 (38.1%) were major hepatectomies involving ≥3 segments. Case volume has steadily increased over time, before decreasing slightly in 2020 (Figure 1). Intraoperative outcomes remained similar between the five epochs. Average EBL over the study period was 435mL for all hepatectomies, 555 mL for major hepatectomies, 301cc for minor hepatectomies, and there was no significant improvement or decrement over time (p=0.57). Average operative time was 196 minutes, and there was no significant difference in operative time between epochs (p=0.90). Postoperative outcomes also remained similar over time. Median hospital LOS was 3 days and has remained stable between the five epochs (p=0.91). Finally, 54 patients (20.4%) suffered a complication, with the majority being minor and only 12 major complications (Clavien-Dindo Grade ≥3). The highest Clavien-Dindo Complication Grade within 30 days of surgery was not significantly different between epochs (p=0.23). Conclusion: Robotic hepatectomy is a safe and feasible option for most liver resections, including complex major resections. Over the development period of a high-volume robotic liver surgery program, there were no significant changes in major intraoperative and postoperative outcomes over time, despite the fact that one of the surgeons was going through his learning curve during the study period. This supports the hypothesis that robotic techniques may reduce the learning curve for minimally-invasive liver surgery, opening minimally-invasive options for experienced hepatobiliary surgeons who typically perform open liver surgery.

Sit-to-Stand Power Across the Lifespan: A Cross-Sectional Analysis.

Lower-body power measured by a linear position transducer during the sit-to-stand (STS) movement declines with age and may be a predictor of physical disability in older adults. The purpose of this study was to establish normative data for STS power across the lifespan and to determine if differences exist between age cohorts, sexes, and age cohort-sex subgroups. Adults (N = 557) aged 18-89 were divided into five age cohorts and performed the STS connected to a linear position transducer, which calculated power and velocity during the movement. Significantly lower (p < .01) velocity was observed in a younger age cohort in females than males, whereas males saw a significant average power decrement (p < .01) in a younger age cohort than females. STS power norms give clinicians a metric predicting physical disability and may be of particular interest to males as their power production begins to decline at an earlier age.

Comparison of Clinical Efficacy and Urodynamic Changes Using Single-incision Slings (MiniArc® vs. Solyx™) for the Treatment of Female Stress Urinary Incontinence.

Objective:To compare the clinical efficacy and urodynamic parameter changes between the MiniArc and the Solyx sling for the treatment of female urodynamic stress incontinence (USI).Materials and Methods:One-hundred and thirty (MiniArc n = 79, BS-Solyx n = 51) patients were included in this study. Cough stress test (ST), pad test (PT), Incontinence Impact short form Questionnaire (IIQ-7), Urogenital Distress Inventory six-item questionnaire (UDI-6), Sexual Questionnaire-Short Form (PIS-Q), and urodynamic parametric changes were assessed to determine objective and subjective outcomes following the procedure. Objective cure was defined as negative ST and PT <2 g and subjective cure was defined as “No” to the answer of UDI-6 Question #3. Predictors of surgical failure were also determined.Results:All Solyx users, as opposed to 91.1% of MiniArc patients, obtained objective cure at postoperative 3 months (P = 0.042). No significant difference in subjective cure rates (93.7% vs. 90.2% at 3-months (P = 0.513); 89.9% vs. 80.4% at 1 year for Solyx and MiniArc patients, respectively (P = 0.126)) and improvement scores in UDI-6 and IIQ-7 were observed. The Solyx group incurred more de novo urgency (17.6% vs. 6.3% at 3 months (P = 0.042); 23.5% vs. 7.6% at 1 year (P = 0.01)). Both procedures yielded significant decrements in maximal urethral closure pressure (P < 0.001) and average flow rate (P = 0.015). The preoperative PT and sling type were strong predictors of surgical failure, where the Solyx tape reported lower odds (odds ratio = 0.174, P = 0.02) compared to the MiniArc sling.Conclusion:Single-incision mini-slings are safe and effective treatment for female USI. The Solyx SIS demonstrated superiority over the MiniArc in this study based on its higher objective cure rate and lower risk for surgical failure.