Academic literature on the topic 'Age 12-90'

Objectives The aim of this study was to determine the 10 th and90 th percentiles and medians of normal splenic lengths of Indone-sian children at Cipto Mangunkusumo Hospital by ultrasonogra-phy using a method introduced by Rosenberg et al .Methods The maximum splenic length was obtained in longitudi-nal coronal plane with the splenic hilum visualized. The age of thepatients were recorded. The medians and 10 th and 90 th percen-tiles for each age group were determined.Results Sixty-nine boys and 46 girls were examined at our institu-tion. The youngest subject was one month old and the oldest was15 years old. The 10 th percentile, median, and 90 th percentilesplenic length in the 1-3 months age group were 3.421 cm, 3.795cm, and 4.343 cm, respectively. In the 3-6 month age group thesemeasurements were 3.689 cm, 4.29 cm, and 5.094 cm, respec-tively; in the 6-12 month age group 4.016 cm, 4.72 cm, and 5.366cm, respectively; in the 1-2 years age group 4.558 cm, 5.04 cm,and 5.502 cm, respectively; in the 2-4 year age group 5.151 cm,6.225 cm, and 6.816 cm, respectively; in the 4-6 year age group5.774 cm, 6.415 cm, and 7.82 cm, respectively; in the 6-8 year agegroup 6.077 cm, 7.505 cm, and 8.228 cm, respectively; in the 8-10years age group 6.354 cm, 7.77 cm, and 8.602 cm, respectively;in the 10-12 years age group 6.354 cm, 7.77 cm, and 8.602 cm,respectively; and in the 12-15 year age group 7.934 cm, 9 cm, and9.919 cm, respectively. In all age groups, the 10 th percentiles,medians, and 90 th percentiles were smaller than those of Ameri-can children as reported by Rosenberg et al.Conclusion The normal splenic lengths of Indonesian childrenare smaller than those of American children as reported byRosenberg et al.

The objective of this study was to determine how weaning age, days on supplements, and lipid supplementation affected the growth and marbling deposition of steers. Steers from a single sire were early weaned (n = 24) at 150 ± 11 days of age or traditionally weaned (n = 24) at 210 ± 11 days of age. Steers were assigned to control (n = 12/weaning group) or an isocaloric, isonitrogenous rumen by-pass lipid (RBL, n = 12/weaning group) for either 45 (n = 6/treatment) or 90 (n=6/treatment) days then harvested. Steer body weight (BW) was recorded on days −14 and −7, then BW and blood samples were collected on days 0, 22, 45, 66, and 90. The right rib section of each animal was collected for proximate analysis. Longissimus dorsi from RBL steers had increased lipids compared with control steers (3.6 ± 0.2 vs. 2.4 ± 0.2% on a wet basis; p < 0.0001). Steers fed for 90 days had greater (p = 0.02) concentrations of Longissimus dorsi lipid (3.3 ± 0.2%) than those fed for 45 days (2.7 ± 0.2%). There was a weaning age by treatment by days on feed interaction for intramuscular adipocyte diameter (p = 0.02) in which early weaned RBL fed for 90 days steers had an increased adipocyte diameter compared to the early weaned control fed for 90 and early weaned fed for 45 days steers with all other treatment groups as intermediates. Supplementation of RBL increased concentrations of C18:2, C20:4, and total fatty acids on days 45 and 90 (p ≤ 0.05). Data show that RBL supplementation increased the marbling content of the Longissimus dorsi. Furthermore, a longer period of supplementation resulted in increased adipose diameter.

Background Recent studies revealed better outcomes among children with biliary atresia (BA) who underwent Kasai procedure at 60 to 90 days of age. Delayed Kasai procedure has a high risk of complications, including nutritional deficits which lead to malnutrition. Objective To determine the nutritional status of children with BA according to age at the time of Kasai procedure. Methods Using medical records, we conducted a retrospective study in children with BA based on magnetic resonance cholangiopancreatography (MRCP) or intraoperative cholangiography, who were admitted between 2015 to 2017 and underwent Kasai surgery at Dr. Sardjito General Hospital, Yogyakarta. Nutritional status was evaluated on the day before Kasai procedure, and classified into 4 groups of subjects based on age at the time the children underwent Kasai procedure (<60 days, 60-90 days, >90-120 days, and >120 days). Normal distribution data was analyzed with Saphiro-Wilk test and mean T-test was used to compare mean age at the time of Kasai procedure between groups of well-nourished and malnourished subjects. Results A total of 39 children with BA underwent Kasai procedure. Of 3 children who underwent Kasai procedure at <60 days of age, 2 were well-nourished and 1 was malnourished. Of the 12 children who underwent Kasai procedure at 60-90 days of age, 6 were well-nourished and 6 were malnourished. Of the 7 children who underwent Kasai procedure at >90-120 days of age, 4 were well-nourished and 3 were malnourished. Of 17 children who underwent Kasai procedure at >120 days of age, 5 were well-nourished and 12 were malnourished. The means of age at the time of Kasai procedure were higher in malnourished subject than well-nourished. Conclusion The highest prevalence of malnourishment is seen in children with biliary atresia who underwent Kasai procedure at >120 days of age.

In this review we collected data on the age at maturity (tm) and maximum reported age (tmax) for 235 stocks of Mediterranean marine fishes, belonging to 82 species, 37 families, 12 orders and 2 classes (Actinopterygii and Elasmobranchii). Among Actinopterygii (mean tm ± SD = 2.20 ± 1.43 y, n = 215), tm ranged from 0.3 y, for the common goby Pomatoschistus microps, to 12 y, for dusky grouper Epinephelus marginatus, while among Elasmobranchii (mean tm ± SD = 5.94 ± 2.47 y, n = 20), tm ranged between 2.7 y, for brown ray Raja miraletus, and 12 y for picked dogfish Squalus acanthias. Overall, the tmax ranged between 1 y, for transparent goby Aphia minuta, and 70 y, for wreckfish Polyprion americanus. The mean tmax of Actinopterygii (tmax ± SD = 10.14 ± 9.42 y) was lower than that of Elasmobranchii (tmax ± SD = 14.05 ± 8.47 y). The tm exhibited a strong positive linear relation with tmax for both Actinopterygii (logtm = 0.58 ´ logtmax – 0.25, r2 = 0.51, P < 0.001) and Elasmobranchii (logtm = 0.67 ´ logtmax – 0.006, r2 = 0.51, P = 0.007). The mean tm/tmax did not differ significantly with sex within Actinopterygii (ANOVA: F = 0.27, P = 0.60, n = 90; females: mean ± SD = 0.276 ± 0.143; males: mean ± SD = 0.265 ± 0.138) and Elasmobranchii (ANOVA: F = 1.44, P = 0.25, n = 10; females: mean ± SD = 0.499 ± 0.166; males: mean ± SD = 0.418 ± 0.133). Finally, the dimensionless ratio tm/tmax was significantly lower (ANOVA: F = 31.04, P < 0.001) for Actinopterygii (mean ± SD = 0.270 ± 0.135, n = 180) than for Elasmobranchii, (mean ± SD = 0.458 ± 0.152, n = 20), when stocks with combined sexes were excluded from the analysis.

This cross-sectional investigation evaluated the trend of psychological changes by ChunDoSunBup (CDSB) Qi-training using a self-report inventory of emotional distress, Symptom Check List-90-Revision (SCL-90-R). 41 normal healthy subjects (mean age = 20.98 ± 5.39) and 123 CDSB Qi-trainees (divided into three groups, Q1, Q2 and Q3) participated in this study. Group Q1 has received 1-4 months CDSB Qi-training (age 21.95 ± 7.82, n = 41); Q2 has 5-12 months Qi-training (age 20.0 ± 7.75, n = 41); and Q3 has more than 13 months Qi-training (age 22.68 ± 6.72, n = 41). Our results show that Qi-trainees over 13 months had significantly lower scores compared to controls. A significant negative correlation was found between the Qi-training period and all SCL-90-R subscales except phobic anxiety. These results suggest that CDSB Qi-training is effective in protection as well as reduction of psychological symptomatology.

On June 12, 2021, at the age of 90, a prominent Russian oceanographer, one of the founders of modern geophysical fluid dynamics, professor, Doctor of Physical and Mathematical Sciences Vladimir Moiseevich Kamenkovich passed away.

Background. Yttrium-90 (Y-90) can be an effective liver-directed therapy for patients with metastatic neuroendocrine tumors (NETs), but population-based data are limited. We characterized the use of Y-90 in NET patients and identified factors associated with response. Methods. We identified 49 patients with metastatic liver-dominant NETs across BC Cancer’s six regional centres who received Y-90 between June 2011 and January 2017 in British Columbia, Canada. Baseline characteristics, radiographic responses, and outcomes were summarized. Results. Of the 49 patients who received Y-90, the median age was 56 years (range 21–78), 49% were male, and 94% had an ECOG performance status of 0–1. The primary location of the NET included pancreas (31%), small bowel (41%), large bowel (6%), unknown (14%), and others (12%). 69% of these patients had liver metastases alone, and tumors were graded as G1 (61%), G2 (25%), G3 (2%), and unknown (12%). Prior therapies included surgery (63%), local ablative therapy (25%), somatostatin analogue (69%), and systemic therapy (35%). The median Y-90 dose was 2.2 GBq (range 0.8–3.6), as SIR-spheres (69%) or TheraSpheres (29%). Median time to Y-90 from diagnosis of metastases measured 1.54 years. 88% received segmental Y-90, with 1 (69%), 2 (29%), and 3 (2%) treatments. Y-90 resulted in partial response (53%), stable disease (33%), and progressive disease (12%). Y-90 was well-tolerated, with infrequent grade 3-4 biochemical toxicities (2%) and grade 3 abdominal pain (6%). Longer overall survival (OS) was associated with resection of primary tumor, well-differentiated histology, and low Ki-67. Median OS was 27.2 months (95% CI 8.0–46.5).Conclusions. In our population-based cohort, Y-90 was well-tolerated in patients with metastatic liver-dominant NETs. Prior surgical resection was an important predictor of OS.

The numerical density of GABA immunopositive and GABA immunonegative neurons was quantitatively determined in 0, 12, 30 and 90 day-old neocortical transplants, derived from E17 rat embryos and transplanted into adult hosts. It was found that the original, very high neuronal density in the fetal transplant declined steadily after transplantation to the somatosensory cortex of adult rat. The decline in numerical density of GABA-positive neurons, however, was disproportionately larger than that of GABA-negative nerve cells: At 90 days the proportion of GABA-positive cells was 2.3% (in contrast to the 11.8% in the adult host cortex). The density of GABA-negative neurons, on the other hand, remained slightly higher than comparable values in the control cortex. The decline in density Of GABA-positive neurons was continuous until the 90th post-transplantation day, while final, close to normal density values of GABA-negative nerve cells were already reached in 30 day-old grafts, with no significant change afterwards.

A serological prevalence survey was carried out in Luxembourg during 2000–2001 to determine the antibody status of the Luxembourg population against vaccine-preventable infections including varicella-zoster virus (VZV). ELISA tests performed on 2679 sera indicated that 96 (3·6%) of the study population were seronegative. Age-specific seroprevalence rose rapidly from approximately 70% at age 4 years to 90% at age 6 years to 95% at age 12 years. Significant heterogeneity of seroprevalence was observed between the six different primary schools. For age groups 0–5, 6–11 and 12+ years, we estimated an annual force of infection of 0·361 [95% confidence interval (CI) 0·31–0·415)], 0·204 (95% CI 0·12–0·29) and 0·05 (95% CI 0·024–0·082) respectively. Our results indicate that transmission of VZV is highest in children below the age of 6 years and that much lower levels of VZV transmission occur in secondary schools and throughout adulthood.

Expert treatment guidelines and consensus statements identified imaginal exposure therapy as a first-line treatment for posttraumatic stress disorder (PTSD) more than a decade ago. Subsequently, an Institute of Medicine report concluded that cognitive–behavioral therapy with exposure therapy is the only therapy with sufficient evidence to recommend it for PTSD. Imaginal exposure has been the most widely used exposure approach. It requires patients to recall and narrate their traumatic experience repeatedly, in progressively greater detail, both to facilitate the therapeutic processing of related emotions and to decondition the learning cycle of the disorder via a habituation–extinction process. Prolonged exposure, one of the best-evidenced forms of exposure therapy, incorporates psychoeducation, controlled breathing techniques, in vivo exposure, prolonged imaginal exposure to traumatic memories, and processing of traumatic material, typically for 9 to 12 therapy sessions of about 90 minutes each. However, avoidance of reminders of the trauma is a defining feature of PTSD, so it is not surprising that many patients are unwilling or unable to visualize effectively and recount traumatic events repeatedly. Some studies of imaginal exposure have reported 30% to 50% dropout rates before completion of treatment. Adding to the challenge, some patients have an aversion to “traditional” psychotherapy as well as to pharmacotherapy, and may find alternative approaches more appealing. Younger individuals in particular may be attracted to virtual reality-based therapies.

Bones are multifunctional passive organs of movement that supports soft tissue and directly attached muscles. They also protect internal organs and are a reserve of calcium, phosphorus and magnesium. Each bone is covered with periosteum, and the adjacent bone surfaces are covered by articular cartilage. Histologically, the bone is an organ composed of many different tissues. The main component is bone tissue (cortical and spongy) composed of a set of bone cells and intercellular substance (mineral and organic), it also contains fat, hematopoietic (bone marrow) and cartilaginous tissue. Bones are a tissue that even in adult life retains the ability to change shape and structure depending on changes in their mechanical and hormonal environment, as well as self-renewal and repair capabilities. This process is called bone turnover. The basic processes of bone turnover are: • bone modeling (incessantly changes in bone shape during individual growth) following resorption and tissue formation at various locations (e.g. bone marrow formation) to increase mass and skeletal morphology. This process occurs in the bones of growing individuals and stops after reaching puberty • bone remodeling (processes involve in maintaining bone tissue by resorbing and replacing old bone tissue with new tissue in the same place, e.g. repairing micro fractures). It is a process involving the removal and internal remodeling of existing bone and is responsible for maintaining tissue mass and architecture of mature bones. Bone turnover is regulated by two types of transformation: • osteoclastogenesis, i.e. formation of cells responsible for bone resorption • osteoblastogenesis, i.e. formation of cells responsible for bone formation (bone matrix synthesis and mineralization) Bone maturity can be defined as the completion of basic structural development and mineralization leading to maximum mass and optimal mechanical strength. The highest rate of increase in pig bone mass is observed in the first twelve weeks after birth. This period of growth is considered crucial for optimizing the growth of the skeleton of pigs, because the degree of bone mineralization in later life stages (adulthood) depends largely on the amount of bone minerals accumulated in the early stages of their growth. The development of the technique allows to determine the condition of the skeletal system (or individual bones) in living animals by methods used in human medicine, or after their slaughter. For in vivo determination of bone properties, Abstract 10 double energy X-ray absorptiometry or computed tomography scanning techniques are used. Both methods allow the quantification of mineral content and bone mineral density. The most important property from a practical point of view is the bone’s bending strength, which is directly determined by the maximum bending force. The most important factors affecting bone strength are: • age (growth period), • gender and the associated hormonal balance, • genotype and modification of genes responsible for bone growth • chemical composition of the body (protein and fat content, and the proportion between these components), • physical activity and related bone load, • nutritional factors: – protein intake influencing synthesis of organic matrix of bone, – content of minerals in the feed (CA, P, Zn, Ca/P, Mg, Mn, Na, Cl, K, Cu ratio) influencing synthesis of the inorganic matrix of bone, – mineral/protein ratio in the diet (Ca/protein, P/protein, Zn/protein) – feed energy concentration, – energy source (content of saturated fatty acids - SFA, content of polyun saturated fatty acids - PUFA, in particular ALA, EPA, DPA, DHA), – feed additives, in particular: enzymes (e.g. phytase releasing of minerals bounded in phytin complexes), probiotics and prebiotics (e.g. inulin improving the function of the digestive tract by increasing absorption of nutrients), – vitamin content that regulate metabolism and biochemical changes occurring in bone tissue (e.g. vitamin D3, B6, C and K). This study was based on the results of research experiments from available literature, and studies on growing pigs carried out at the Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences. The tests were performed in total on 300 pigs of Duroc, Pietrain, Puławska breeds, line 990 and hybrids (Great White × Duroc, Great White × Landrace), PIC pigs, slaughtered at different body weight during the growth period from 15 to 130 kg. Bones for biomechanical tests were collected after slaughter from each pig. Their length, mass and volume were determined. Based on these measurements, the specific weight (density, g/cm3) was calculated. Then each bone was cut in the middle of the shaft and the outer and inner diameters were measured both horizontally and vertically. Based on these measurements, the following indicators were calculated: • cortical thickness, • cortical surface, • cortical index. Abstract 11 Bone strength was tested by a three-point bending test. The obtained data enabled the determination of: • bending force (the magnitude of the maximum force at which disintegration and disruption of bone structure occurs), • strength (the amount of maximum force needed to break/crack of bone), • stiffness (quotient of the force acting on the bone and the amount of displacement occurring under the influence of this force). Investigation of changes in physical and biomechanical features of bones during growth was performed on pigs of the synthetic 990 line growing from 15 to 130 kg body weight. The animals were slaughtered successively at a body weight of 15, 30, 40, 50, 70, 90, 110 and 130 kg. After slaughter, the following bones were separated from the right half-carcass: humerus, 3rd and 4th metatarsal bone, femur, tibia and fibula as well as 3rd and 4th metatarsal bone. The features of bones were determined using methods described in the methodology. Describing bone growth with the Gompertz equation, it was found that the earliest slowdown of bone growth curve was observed for metacarpal and metatarsal bones. This means that these bones matured the most quickly. The established data also indicate that the rib is the slowest maturing bone. The femur, humerus, tibia and fibula were between the values of these features for the metatarsal, metacarpal and rib bones. The rate of increase in bone mass and length differed significantly between the examined bones, but in all cases it was lower (coefficient b <1) than the growth rate of the whole body of the animal. The fastest growth rate was estimated for the rib mass (coefficient b = 0.93). Among the long bones, the humerus (coefficient b = 0.81) was characterized by the fastest rate of weight gain, however femur the smallest (coefficient b = 0.71). The lowest rate of bone mass increase was observed in the foot bones, with the metacarpal bones having a slightly higher value of coefficient b than the metatarsal bones (0.67 vs 0.62). The third bone had a lower growth rate than the fourth bone, regardless of whether they were metatarsal or metacarpal. The value of the bending force increased as the animals grew. Regardless of the growth point tested, the highest values were observed for the humerus, tibia and femur, smaller for the metatarsal and metacarpal bone, and the lowest for the fibula and rib. The rate of change in the value of this indicator increased at a similar rate as the body weight changes of the animals in the case of the fibula and the fourth metacarpal bone (b value = 0.98), and more slowly in the case of the metatarsal bone, the third metacarpal bone, and the tibia bone (values of the b ratio 0.81–0.85), and the slowest femur, humerus and rib (value of b = 0.60–0.66). Bone stiffness increased as animals grew. Regardless of the growth point tested, the highest values were observed for the humerus, tibia and femur, smaller for the metatarsal and metacarpal bone, and the lowest for the fibula and rib. Abstract 12 The rate of change in the value of this indicator changed at a faster rate than the increase in weight of pigs in the case of metacarpal and metatarsal bones (coefficient b = 1.01–1.22), slightly slower in the case of fibula (coefficient b = 0.92), definitely slower in the case of the tibia (b = 0.73), ribs (b = 0.66), femur (b = 0.59) and humerus (b = 0.50). Bone strength increased as animals grew. Regardless of the growth point tested, bone strength was as follows femur > tibia > humerus > 4 metacarpal> 3 metacarpal> 3 metatarsal > 4 metatarsal > rib> fibula. The rate of increase in strength of all examined bones was greater than the rate of weight gain of pigs (value of the coefficient b = 2.04–3.26). As the animals grew, the bone density increased. However, the growth rate of this indicator for the majority of bones was slower than the rate of weight gain (the value of the coefficient b ranged from 0.37 – humerus to 0.84 – fibula). The exception was the rib, whose density increased at a similar pace increasing the body weight of animals (value of the coefficient b = 0.97). The study on the influence of the breed and the feeding intensity on bone characteristics (physical and biomechanical) was performed on pigs of the breeds Duroc, Pietrain, and synthetic 990 during a growth period of 15 to 70 kg body weight. Animals were fed ad libitum or dosed system. After slaughter at a body weight of 70 kg, three bones were taken from the right half-carcass: femur, three metatarsal, and three metacarpal and subjected to the determinations described in the methodology. The weight of bones of animals fed aa libitum was significantly lower than in pigs fed restrictively All bones of Duroc breed were significantly heavier and longer than Pietrain and 990 pig bones. The average values of bending force for the examined bones took the following order: III metatarsal bone (63.5 kg) <III metacarpal bone (77.9 kg) <femur (271.5 kg). The feeding system and breed of pigs had no significant effect on the value of this indicator. The average values of the bones strength took the following order: III metatarsal bone (92.6 kg) <III metacarpal (107.2 kg) <femur (353.1 kg). Feeding intensity and breed of animals had no significant effect on the value of this feature of the bones tested. The average bone density took the following order: femur (1.23 g/cm3) <III metatarsal bone (1.26 g/cm3) <III metacarpal bone (1.34 g / cm3). The density of bones of animals fed aa libitum was higher (P<0.01) than in animals fed with a dosing system. The density of examined bones within the breeds took the following order: Pietrain race> line 990> Duroc race. The differences between the “extreme” breeds were: 7.2% (III metatarsal bone), 8.3% (III metacarpal bone), 8.4% (femur). Abstract 13 The average bone stiffness took the following order: III metatarsal bone (35.1 kg/mm) <III metacarpus (41.5 kg/mm) <femur (60.5 kg/mm). This indicator did not differ between the groups of pigs fed at different intensity, except for the metacarpal bone, which was more stiffer in pigs fed aa libitum (P<0.05). The femur of animals fed ad libitum showed a tendency (P<0.09) to be more stiffer and a force of 4.5 kg required for its displacement by 1 mm. Breed differences in stiffness were found for the femur (P <0.05) and III metacarpal bone (P <0.05). For femur, the highest value of this indicator was found in Pietrain pigs (64.5 kg/mm), lower in pigs of 990 line (61.6 kg/mm) and the lowest in Duroc pigs (55.3 kg/mm). In turn, the 3rd metacarpal bone of Duroc and Pietrain pigs had similar stiffness (39.0 and 40.0 kg/mm respectively) and was smaller than that of line 990 pigs (45.4 kg/mm). The thickness of the cortical bone layer took the following order: III metatarsal bone (2.25 mm) <III metacarpal bone (2.41 mm) <femur (5.12 mm). The feeding system did not affect this indicator. Breed differences (P <0.05) for this trait were found only for the femur bone: Duroc (5.42 mm)> line 990 (5.13 mm)> Pietrain (4.81 mm). The cross sectional area of the examined bones was arranged in the following order: III metatarsal bone (84 mm2) <III metacarpal bone (90 mm2) <femur (286 mm2). The feeding system had no effect on the value of this bone trait, with the exception of the femur, which in animals fed the dosing system was 4.7% higher (P<0.05) than in pigs fed ad libitum. Breed differences (P<0.01) in the coross sectional area were found only in femur and III metatarsal bone. The value of this indicator was the highest in Duroc pigs, lower in 990 animals and the lowest in Pietrain pigs. The cortical index of individual bones was in the following order: III metatarsal bone (31.86) <III metacarpal bone (33.86) <femur (44.75). However, its value did not significantly depend on the intensity of feeding or the breed of pigs.

Anaemia is a very common problem in low- and middle-income countries (LMICs): 27% of the world’s population or 1.93 billion people are affected by anaemia (2013) and more than 90% of people with anaemia live in the developing world. Preschool children and women of reproductive age are particularly affected by anaemia and more 60% of anaemia is caused by iron deficiency. Causes of anaemia in LMICs—this is often multifactorial, with causes including (1) nutritional deficiencies—iron, folate, vitamin B₁₂; (2) chronic infection—including malaria, tuberculosis, AIDS; (3) blood loss—hookworm, schistosomiasis; (4) protein–energy malnutrition; (5) malabsorption—for example, tropical sprue; (6) hereditary—for example, thalassaemias, haemoglobin variants, glucose-6-phosphate dehydrogenase deficiency. A series of vicious cycles exist in LMICs—maternal anaemia due to iron or folate deficiency and chronic malaria is associated with the birth of underweight infants who frequently have low iron stores, may also be folate deplete, and are usually anaemic from about 6 months of age. Such infants are prone to infection, particularly gastrointestinal, and may be further depleted of iron or folate by inappropriately prolonged breastfeeding or weaning onto an inadequate diet. They are exposed to hookworm infection as soon as they start to crawl, malaria becomes an important problem after 6 months, and in many populations the increasingly common haemoglobinopathies are a further cause of anaemia after the first few months of life.

Megaloblastic anaemias are characterized by red blood cell macrocytosis. They arise because of inhibition of DNA synthesis in the bone marrow, usually due to deficiency of one or other of vitamin B₁₂ (cobalamin) or folate, but sometimes as a consequence of a drug or a congenital or acquired biochemical defect that disturbs vitamin B₁₂ or folate metabolism, or affects DNA synthesis independent of vitamin B₁₂ or folate. Acquired pernicious anaemia—antibodies in serum and gastric juice directed against parietal cells (85–90% of cases) and intrinsic factor (50%), and raised serum gastrin are associated with autoimmune gastritis and failure of absorption of vitamin B₁₂. Treatment and prevention of megaloblastic anaemia—vitamin B₁₂ deficiency—may be treated with intramuscular hydroxocobalamin (1-mg doses, six given in the first 2–3 weeks, then every 3 months). Oral therapy is practised by a minority and is unlikely to be useful in pernicious anaemia. Neurological complications are irreversible unless treated early. Folate deficiency—high-dose oral folic acid (5 mg daily) overcomes folate malabsorption, but this should not be given alone where vitamin B₁₂ deficiency coexists because neurological disease may be precipitated or exacerbated (although the haematological abnormalities improve). Where folate metabolism is disturbed by methotrexate, oral or parenteral folinic acid is given to restore DNA synthesis. Prevention—dietary folate fortification is an accepted and highly effective public health measure in many countries (none in Europe) for reducing the incidence of neural tube birth defects.

More than 25 million persons in the United States have at least one manifestation of atherosclerosis. Throughout the last 50 years, coronary arterial atherosclerosis has been the focus of basic and clinical investigation; however, the systemic nature of atherosclerosis must be acknowledged (Faxon et al., 2004). Stroke is the third leading cause of death and the principal cause of long-term disability in the United States. There are upward of 600,000 new or recurrent strokes annually. Black populations have a 40% higher stroke rate than white populations and experience a higher mortality. The clinical manifestations of aortic atherosclerosis include abdominal aortic aneurysm, aortic dissection, penetrating aortic ulcer, intramural hematoma, and peripheral atheroembolization. Thoracic aortic aneurysms also occur in patients with atherosclerotic risk factors, but are less common. The age-adjusted prevalence of peripheral arterial disease (PAD) is approximately 12% and may exceed 20% in persons greater than 70 years of age. An ankle–brachial index of less than or equal to 0.90 is 90% sensitive and 95% specific for PAD, identifying a patient population at risk for claudication, rest pain, skin ulceration, and critical leg ischemia, prompting amputation. A majority of patients with PAD have concomitant coronary artery disease (85%) and many have carotid artery disease (60%). Although the true prevalence of renal artery disease proceeding to clinical manifestations such as hypertension or renal insufficiency is unknown, autopsy series of patients with cerebrovascular disease and stroke have identified a high incidence of concomitant disease involving at least one renal artery. Vascular disease of the peripheral arterial circulation, most often caused by atherosclerosis and less commonly by vasculitis (or other nonatherosclerotic arteriopathies), is a chronic process that is responsible for progressive and, at times, incapacitating symptoms, disability, and limb loss. The arterial beds most frequently involved, in order of occurrence, are: . . . . • Femoropopliteal-tibial . . . . . . • Aortoiliac . . . . . . • Carotid and vertebral . . . . . . • Splanchnic and renal . . . . . . • Brachiocephalic . . .

Brain stem auditory evoked potentials (BAEPs) testing is a useful technique for the otoneurological assessment of patients with complaints of dizziness/imbalance, hearing loss, or tinnitus. The BAEP evaluation records neuroelectric potentials from cranial nerve (CN) VIII and the ascending brain stem pathways that are elicited as a response to brief auditory stimuli. BAEPs are performed in conjunction with audiology testing since conductive hearing losses as well as sensorineural disorders can affect BAEP waveform morphology and latencies. Overall sensitivity of BAEP is over 90% for patients with a CN VIII tumor, and the false-positive rate for patients having cochlear hearing loss is 12%. This chapter reviews BAEPs in the assessment of peripheral acoustic disordes and also discusses auditory neuropathy spectrum disorder and cochlear mocrophonic assessment as an additional electrophysiological method.

There have been issues identified regarding the education of children with hearing disorders. Those do not allow the development of communicative-linguistic competence and language, in addition to an efficient oral or written communication. This causes deficits in vocabulary, delay in morph syntactic structure. Education Technologies such as auditory training software have become an educational support for teachers and students. Software was developed to improve communication skills divided into modules with ascending degrees of difficulty they are presented in various environments and semantic fields. After about 4 months of effective use in an eight month period, applied to 45 preschool and elementary school students aged between 4 and 12 years, considering that 11 children present auditory handicap and the rest intellectual handicap, the results obtained were the following: The learning is globally 30% of the vocabulary contained in the application, 30 of 90 words. Word articulation is improved 50%, in attention span the period of attention increased from 3 to about 9 minutes.

There have been issues identified regarding the education of children with hearing disorders. Those do not allow the development of communicative-linguistic competence and language, in addition to an efficient oral or written communication. This causes deficits in vocabulary, delay in morph syntactic structure. Education technologies such as auditory training software have become an educational support for teachers and students. The software was developed to improve communication skills and divided into modules with ascending degrees of difficulty. They are presented in various environments and semantic fields. After about 4 months of effective use in an 8-month period, applied to 45 preschool and elementary school students aged between 4 and 12 years, considering that 11 children present auditory handicap and the rest intellectual handicap, the results obtained were the following: the learning is globally 30% of the vocabulary contained in the application, 30 of 90 words. Word articulation is improved 50%; in attention span, the period of attention increased from 3 to about 9 minutes.

ABSTRACT Background: Children who are first hospitalized may experience higher anxiety levels than children who have been hospitalized. The preliminary study in 2018 showed that when general surgery was to be done, as many as 90%school-age children were scared and nervous. It is important to provide play therapy to children who are going to undergo surgery. In addition to reading and seeing through photos, pop-up toy story books will also be offered to school-age children. This study aimed to examine the relationship between pop up toys as story play therapy on the level of anxiety on general anesthesia surgery among children around 6-12 years old. Subjects and Method: This was an experimental study with pre-post test with control group design. This study was conducted in Yogyakarta Province hospital. Study subjects were children around 6-12 years old and will performed general anesthesia surgery. The data were collected using questioner and in-depth interview. The data were analyzed using Mann-Whitney test. Results: There was a decrease number of children with moderate level of anxiety after the intervention group using pop up toys as story play therapy from 30 children (81.1%) to 6 children (16.2%). While in the control group, a total of 25 children had moderate level of anxiety (87.6%) before the theraphy, and after therapy a total of 2 children also had moderate level of anxiety (5.4%), and they were statistically significant. Conclusion: Playing pop up toys story therapy has an effect on the level of anxiety among children around 6-12 years old and will performed general anesthesia surgery. Keywords: pop up toys story therapy, anxiety level, general anesthesia, school age children Correspondence: Ni Ketut Mendri. School of Health Sciences, Yogyakarta. Email: mendriniketut@yahoo.com DOI: https://doi.org/10.26911/the7thicph.03.29

In hemophiliacs gross hematuria is often observed. The aim of this study is to evaluate renal functionand morphology in young hemophiliacs with at least one previous gross hematuria. Forty patients with hemophilia A or B were studied (age 8-49 yrs, mean 21.3). Neither renal nor urinary tract disease was referred. The following tests were performed: urinalysis, plasma creatinine and urea, glomerular filtration rate (GFR),effective renal plasma flow (ERPF),renal scans, isotopic renography and renal ecography. Urinalysis was normal in all but 6 pts. Plasma creatinine and urea were normal in all pts. GFR was reduced (< 90 ml/min) in 16 pts (mean 76.1±9.5),while it was normal (>90 ml/min) in the remaining 24 pts (mean 119.6±17.1). ERPF was < 350 ml/min in 11 pts (mean 290.3±51.7)and it was >350 ml/min in the remaining 24 pts (mean470.0±107.8). In 17 of these pts GFR has been measured a second time after 1-3 yrs. The second GFR decreased of more than 20% in 8 pts (mean decrease 35.3%)and increased of more than 20% in 3 pts (mean increase 52.9%). It was unchanged in the remaining 6 pts. In pts with lower GFR renal scans were abnormal in 5/12 cases, while in subjects with normal GFR renal scans resulted abnormal in only 4/22 cases. Isotopic renography demonstrated pathological findings in 5/9 pts with lower GFR,while in subjects with normal GFRthe abnormal renograms were 2/18. Renal ecography showed kidney abnormalities in 2/7 pts with low GFR while it was normal in 4/4 pts with normal GFR.The above results indicate that a relevant number ofyoung hemophiliacs with previous gross hematuria have a clinically significant impairment of renal function, and some abnormalities of renal morphology.

The efficacy of intravenous streptokinase on recanalization of the 'infarct vessel' and its effect on left ventricular function was assessed in two groups of patients. Group I consisted of 90 consecutive patients (age 32-75 years, mean 56 years) received 500,000 units of intravenous streptokinase (STK) over 30 minutes within 6 hours of onset of acute myocardial infarction (MI). Forty-eight patients had anterior MI and forty-two had inferior MI. The control group consisted of forty survivors of acute MI comparable in age and site of infarction. In Group I, ten patients were administered STK after baseline coronary angiogram demonstrated total occlusion of infarct related coronary artery. In these patients, serial coronary angiogram were done at intervals of 30 minutes after STK infusion upto a period of 3 hours. Recanalization was seen in all cases within 75-135 minutes (average 120 minutes). Seventy-nine of STK group and all of the control group underwent selective coronary arteriography and contrast left ventriculography within 48 to 72 hours of acute MI. Recanalization of infarct related artery was demonstrated in 72 out of 79 patients (91%) in STK group while 8 (20%) in control group had spontaneous recanalization. Left ventricular ejection fraction (LVEF) was higher in STK group (58%) as compared to control group (49%). Among patients with anterior MI, LVEF was significantly better in STK compared to control group (59% Vs. 44%, p > 0.01)while in inferior MI the difference was not significant (63% Vs. 59.4%, p > 0.05) in the two groups. Follow up study in 20 STK patients at 6 months revealed a decrease in residual stenosis from 75 ± 8% to 60 ± 6% and improvement in LVEF from 59 ± 8% to 68 ± 12% (p > 0.01). In conclusion, intravenous STK in acute MI results in high rate of infarct vessel patency and improved global left ventricular function during both early and late follow up period.

Washington State began legal cannabis retail sales in 2014. Legalization of adult use cannabis and retail sales may result in more cannabis products in homes and opportunities for accidental exposures among young children. Consumption of cannabis by young children can result in significant adverse health effects. This study examined details of cannabis exposure events involving children under age 12 that were reported to the Washington State Poison Center (WAPC) during January – December 2016. Redacted charts were obtained from the WAPC “Toxicall” database. 50 eligible events were identified. Structured data were used to describe child age and gender and to obtain information about the involved products, route of administration, exposure setting, and clinical effects. Additional information about the exposure event was available in case notes; qualitative methods were used to develop themes and categorize the cases. Most exposure events (62%) were for children ages 0-2, and 26% were for ages 3-5. None of the exposures were reported as intentional. Of those where the source of the product could be determined (N=29) either a parent (n=20, 69%) or grandparent (n=6, 21%) was the most common source. Nearly all (94%) exposures occurred at the patient’s home and involved a single substance (90%). Of those that noted the type (N=13), 85% indicated that the cannabis was obtained for medical purposes. Most exposures were by ingestion (86%), and edibles were the most often reported form (52% of 41 cases with product specified). Nearly all edibles were brownies, cookies, and candies (96%). Baked goods were reported to be both homemade and purchased. Three cases were exposures to cannabidiol (CBD) among children being treated for seizures by their parents: one was the result of a therapeutic error, one an adverse reaction, and one an unintentional exposure. A single child was reported as exposed through breastmilk. Of those with known medical outcomes (N=33), nearly all caused no or minor clinical effects (78%), and nearly all had symptoms for less than 24 hours, most commonly lethargy and drowsiness (50%), but five children were hospitalized for non-critical care and one child with a history of seizures, who was given CBD oil containing THC, required intensive care and intubation. Risk for accidental exposures to cannabis among young children may be increasing as legal cannabis markets become more common. Although most exposures do not cause long-lasting harms, some children can experience significant harm requiring medical intervention. Caregivers of young children are advised to safely store cannabis products in the home so that they are out of reach of children, and to use caution and consult with a healthcare provider about use of cannabis products for medical treatment of a child or adult use while breastfeeding. Clinicians may play a role by screening for household cannabis use among parents and other caregivers, and advising about safe home practices. Continued regulatory approaches to limit exposure, such as limits on THC potency and single-serving packaging designs, may also be useful.

Aim of the study: Thrombolysis is the treatment of choice in acute myocardial infarction (AMI). The delay between onset of symptoms and administration of thrombolytic drugs is critical for successful reperfusion and myocardial salvage. We studied the feasibility and safety of early prehospital thrombolytic treatment of AMI “at home”Methods: Eminase(R)(APSAC;BRL 26921 ) was used as thrombolytic agent: its long half-life allows administration as a single IV bolus. The study was performed in collaboration with a well organised group of GP's, extensively retrained in ECG and CPR for the purpose of this study. Whenever a GP made the tentative diagnosis of AMI of less than 2 hours, inclusion and exclusion criteria were reviewed using a check-list, and the mobile intervention team of the hospital (MITUZA), consisting of CCU physicians and emergency nurses, was activated. After rechecking all criteria, including a 12 lead ECG, brief medical history and physical examination, a single IV bolus of 30 U Eminase(R) was given, followed by transferral to the CCU. Follow-up included estimation of infarct-size and LV function using biochemical, ECG, radionuclide and angiographic methods.Results: Up till now, 15 male patients (age=57±9) have been treated using this protocol. Initial prehospital treatment consisted of Eminase(R) IV in 10 (reperfusion 9/10). Subsequent in-hospital treatment was streptokinase in 3 (reperfusion 2/3). In the 11 reperfused patients, PTCA was performed in 7 and CABG in 4. After onset of symptoms, the GP arrived after 55±24 min (15-90 min), Eminase(R) was administered after 95±28 min (75-130 min). The total calculated time gain (interval between treatment at home and admission in the CCU) was 42±15 min (20-75 min). There were no adverse events.Conclusion: This pilot study indicates that prehospital thrombolytic treatment of AMI is feasible and safe, resulting in a considerable time gain. Early reperfusion was obtained in 90%. Collaboration with a well organised and trained group of GP's, clearly defined inclusion and exclusion criteria and administration of the thrombolytic drug exclusively by experienced critical care physicians are mandatory.

To evaluate the risk of bleeding (B) related to intravenous (IV) thrombolysis (TL) in acute myocardial infarction (AMI), we retrospectively studied 110 patients (pts), age<70. All were treated within 6 hours of onset of pain by streptokinase (SK) : 1.5 M IU IV in 1 hour (n = 54) ; APSAC : 30 mg IV in 5 min (n = 16) ; rt-PA IV:.75 mg/kg in 90 min (n = 30), or rt-PA plus intracoronary (IC) SK (n = 10). Pre TL, heparin (H) was administered to all pts : a 5.000 IU bolus followed by continuous infusion . In 40, aspirin (ASA) : 250 or 500 mg IV, followed by 100 mg/day orally was associated with SK (n = 9), APSAC (n = 5) or rt-PA (n =26). At the end of TL, coronary angiography was performed in 73 pts followed by PTCA in 38.No fatal or neurological B occurred. Blood transfusion (BT) was required in 5 pts (4.5 %) : 4 on day 1 (2 hematomas at catheter site, 1 prolonged B at venous puncture site, and 1 hematemesis) and 1 on day 3 (pericardial haemorrhage needing surgery). Significant B, not requiring BT, occurred in 7 pts (6.3 %). B was often related to catheterization as 4 out 12 severe or significant B were located at the femoral puncture site. Minor ecchymo-sis and hematoma were not taken into account.Severe B only occurred in pts treated with SK either IV (3/ 54) or IC following rt-PA (2/10), but differences with other groups were not statistically significant. The responsability of associated H is difficult to assess since all pts were similarly anticoagulated. The frequency ofB was the same in pts with (3/40) as without ASA (9/70). Fibrinogen (F) (Clauss method) was undetectable at 1-4, 6, 12, 16 hours in respectively 75%, 67%, 45%, 5% of pts with SK, which was never the case with rt-PA. Intensity of defibrination was similar with APSAC or SK.In SK pts the mean duration of severe defibrination (F<.5g/1) was 13.3 t 5.5 hrs in pts without B and 10.3 ± 5.4 hrs in pts with B. It is conceivable, that severe defibrination may contribute to the risk of B, but no relationship was found between the intensity of defibrination or its duration and B.We conclude : 1) TL in AMI is relatively safe if contra-indications are respected 2) B is often located at the catheterization site

The radiological Inductively Coupled Plasma Mass Spectrometer (ICP-MS) is used to analyze the radioactive samples collected from different radioactive material processing operations at Savannah River Site (SRS). The expeditious processing of these samples is important for safe and reliable operations at SRS. As the radiological (RAD) ICP-MS machine ages, the experience shows that replacement parts and repairs are difficult to obtain on time for reliable operations after 5 years of service. A discrete event model using commercial software EXTEND was prepared to assess the impact on sample turn around times as the ICP-MS gets older. The model was prepared using the sample statistics from the previous 4 years. Machine utilization rates were calculated for the new machine, 5 year old machine, 10 year old machine, and a 12 year old machine. Computer simulations were run for these periods and the sample delay times calculated. The model was validated against the sample statistics collected from the previous 4 quarters. 90% confidence intervals were calculated for the 10th, 25th, 50th, and 90th quantiles of the samples. The simulation results show that if 50% of the samples are needed on time for efficient site operations, a 10 year old machine could take nearly 50 days longer to process these samples than a 5-year old machine.

Abstract The sediments of Bazhenov (BF) and Achimov (ACh) formations have been studied for more than 50 years, and to date, a large amount of core material obtained during drilling at the stage of exploration is stored in the core stores of Russian industrial companies. The rise in the cost of the complex of geological exploration and the emergence of new research methods enabled studies of the old/dry core from previously drilled exploration wells. BF and ACh reservoir rocks have low permeability and initially low water saturation, and therefore, during storage, rock samples could partially retain pore water. To study its composition and quantitative content, we used the previously proposed integrated approach with proven effectiveness in fresh low-permeability BF rocks. The studied materials include BF rock samples from 3 different fields stored for 2 years after sampling in the laboratory, and ACh rock samples from 12 fields, cored more than 10 years ago at the geologic exploration stage. The complex technique includes determining free and bound water contents by the evaporation method with isotopic analysis (δ18O and δD) of the released water. The modified water extraction method provides a range of pore water salinity, while the modified alcohol ammonium chloride method measures the cation exchange capacity (CEC). Auxilary methods include Rock-Eval pyrolysis to determine organic matter content, X-ray diffraction analysis (XRD) to assess the mineral composition of sediments. The verification of the results for the BF rock samples was carried out according to the data obtained for the new/fresh core, while for the ACh rock samples — according to the results of the direct chemical composition analysis of the formation water. Despite the low permeability, we found that the BF and ACh rock samples during storage lost almost all (up to 90%) free water due to evaporation. At the same time, salts from formation water remained in the pore space, which made it possible to estimate the range of its NaCl salinity: 1.84–14.7 g/L for ACh rock samples and 4.49–20.19 g/L for BF rock samples. The obtained values set the lower limit of the possible pore water salinity of the studied ACh and BF rock samples. Moreover, the results match those from direct salinity measurements in the ACh depth intervals and the results of fresh BF core laboratory studies. We showed that the old/dry BF and ACh core could be effectively used to assess the bound water content with subsequent determination of its genesis from isotopic composition data and CEC measurements. This opportunity relies on the high clay content in the studied BF and ACh rock samples. The obtained results show the fundamental capability of informative laboratory studies of BF and ACh rock samples from public and private core storage facilities and give new life to archived and old/dry core.

Background: In an era of explosive growth in biomedical evidence, improving systematic review (SR) search processes is increasingly critical. Text-mining tools (TMTs) are a potentially powerful resource to improve and streamline search strategy development. Two types of TMTs are especially of interest to searchers: word frequency (useful for identifying most used keyword terms, e.g., PubReminer) and clustering (visualizing common themes, e.g., Carrot2). Objectives: The objectives of this study were to compare the benefits and trade-offs of searches with and without the use of TMTs for evidence synthesis products in real world settings. Specific questions included: (1) Do TMTs decrease the time spent developing search strategies? (2) How do TMTs affect the sensitivity and yield of searches? (3) Do TMTs identify groups of records that can be safely excluded in the search evaluation step? (4) Does the complexity of a systematic review topic affect TMT performance? In addition to quantitative data, we collected librarians' comments on their experiences using TMTs to explore when and how these new tools may be useful in systematic review search¬¬ creation. Methods: In this prospective comparative study, we included seven SR projects, and classified them into simple or complex topics. The project librarian used conventional “usual practice” (UP) methods to create the MEDLINE search strategy, while a paired TMT librarian simultaneously and independently created a search strategy using a variety of TMTs. TMT librarians could choose one or more freely available TMTs per category from a pre-selected list in each of three categories: (1) keyword/phrase tools: AntConc, PubReMiner; (2) subject term tools: MeSH on Demand, PubReMiner, Yale MeSH Analyzer; and (3) strategy evaluation tools: Carrot2, VOSviewer. We collected results from both MEDLINE searches (with and without TMTs), coded every citation’s origin (UP or TMT respectively), deduplicated them, and then sent the citation library to the review team for screening. When the draft report was submitted, we used the final list of included citations to calculate the sensitivity, precision, and number-needed-to-read for each search (with and without TMTs). Separately, we tracked the time spent on various aspects of search creation by each librarian. Simple and complex topics were analyzed separately to provide insight into whether TMTs could be more useful for one type of topic or another. Results: Across all reviews, UP searches seemed to perform better than TMT, but because of the small sample size, none of these differences was statistically significant. UP searches were slightly more sensitive (92% [95% confidence intervals (CI) 85–99%]) than TMT searches (84.9% [95% CI 74.4–95.4%]). The mean number-needed-to-read was 83 (SD 34) for UP and 90 (SD 68) for TMT. Keyword and subject term development using TMTs generally took less time than those developed using UP alone. The average total time was 12 hours (SD 8) to create a complete search strategy by UP librarians, and 5 hours (SD 2) for the TMT librarians. TMTs neither affected search evaluation time nor improved identification of exclusion concepts (irrelevant records) that can be safely removed from the search set. Conclusion: Across all reviews but one, TMT searches were less sensitive than UP searches. For simple SR topics (i.e., single indication–single drug), TMT searches were slightly less sensitive, but reduced time spent in search design. For complex SR topics (e.g., multicomponent interventions), TMT searches were less sensitive than UP searches; nevertheless, in complex reviews, they identified unique eligible citations not found by the UP searches. TMT searches also reduced time spent in search strategy development. For all evidence synthesis types, TMT searches may be more efficient in reviews where comprehensiveness is not paramount, or as an adjunct to UP for evidence syntheses, because they can identify unique includable citations. If TMTs were easier to learn and use, their utility would be increased.