Intraventricular Hemorrhage in Preterm Infants, Review Article

Intraventricular hemorrhage (IVH) or germinal matrix (GM) in other words, is a condition that can occur in premature births and can lead to long-term medical and developmental effects. While GM/IVH can happen in full-term infants, the hemorrhage in this group of infants is different from periventricular hemorrhage (PVH)/IVH in premature infants. Family members and caregivers of preterm infants and those at risk of preterm birth are confronted with two significant uncertainties concerning these newborns: Is the survival of this child likely? Will the child experience long-term sequelae, particularly developmental sequelae, if they survive? The significance of these questions lies in their potential to impact future medical decisions, including the level of intensity in the care provided. Infants born prematurely can suffer from various acquired lesions in the central nervous system (CNS), leading to long-term disability. These lesions include GM/IVH, periventricular white matter injury, hemorrhage, and diffuse injury to the developing brain. GM/IVH continues to be a major contributor to both illness and death in premature newborns.  GM/IVH is primarily diagnosed by brain imaging techniques, typically cranial ultrasonography, as depicted below. Screening and serial examinations are essential for diagnosing GM/IVH, as it can occur without any noticeable clinical indications

The mechanism of action of Spirulina as antidiabetic: a narrative review

Spirulina happens to be a special type of blue-green algae that originally emerged 3.5 billion years ago and was used as a source of nutrition. Spirulina gets its name from the filaments’ spiral or helical structure, but its true name is taxonomically Genus Arthrospira which encompasses several species. The most common species are S. fusiformis, S. maxima, and S. platensis. It is rich in various nutrients and chemical components including protein, carbohydrates, lipids, vitamins, minerals, pigments, chlorophyll, and enzymes. Spirulina’s active molecules and rich nutrients make it have several pharmacological activities and uses including antioxidant, anti-inflammatory, immunomodulatory, immune system booster, anticancer, antiviral activity, and neuroprotective properties. It is also utilized as a nutritional supplement and for weight loss. Moreover, several studies confirm that Spirulina improves insulin sensitivity and reduces blood glucose levels in rat models as well as diabetic patients. The reason behind this unique behavior could be credited to the presence of several active components in it, but the action’s fundamental mechanism is still a matter of debate. Several studies have suggested different mechanisms including anti-inflammatory activity, increased insulin sensitivity, inhibition of gluconeogenesis, antioxidant activity, modulating gut microbiota composition, improved glucose homeostasis, and insulin receptor activation. Therefore, it became clear that Spirulina is a mine of active substances used as a nutritional supplement and reduces blood glucose levels or used in conjunction with other treatments to tackle type 2 diabetes. Further exploration is required to fully explain its effects on human physiology and determine optimal dosages for treatment

Efficacy and safety-in analysis of short-course radiation followed by mFOLFOX-6 plus avelumab for locally advanced rectal adenocarcinoma

Background: Neoadjuvant chemotherapy and short-course radiotherapy followed by resection has been gaining recognition in the treatment of rectal cancer. Avelumab is a fully human immunoglobulin that binds Programmed Death-Ligand 1 (PD-L1) and prevents the suppression of the cytotoxic T cell immune response. This phase II trial evaluates the safety and pathologic response rate of short-course radiation followed by 6 cycles of mFOLFOX6 with avelumab in patients with locally advanced rectal cancer (LARC). Methods: This study is prospective single-arm, multicenter phase II trial adopting Simon's two-stage. Short-course radiation is given over 5 fractions to a total dose of 25 Gy. mFOLFOX6 plus avelumab (10 mg/kg) are given every 2 weeks for 6 cycles. Total mesorectal excision is performed 3-4 weeks after the last cycle of avelumab. Follow up after surgery is done every 3 months to a total of 36 months. Adverse event data collection is recorded at every visit. Results: 13 out of 44 patients with LARC were enrolled in the first stage of the study (30% from total sample size). All patients met the inclusion criteria and received the full short-course radiation course followed by 6 cycles of mFOLFOX6 plus avelumab. 12 out of the 13 patients completed TME while one patient had progression of disease and was dropped out of the study. The sample consisted of 9 (69%) males and 4 (31%) females with median age of 62 (33-73) years. The first interim analysis revealed that 3 (25%) patients achieved pathologic complete response (pCR) (tumor regression grade, TRG 0) out of 12. While 3 (25%) patients had near pCR with TRG 1. In total, 6 out of 12 patients (50%) had a major pathologic response. All patients were found to be MMR proficient. The protocol regimen was well tolerated with no serious adverse events of grade 4 reported. Conclusion: In patients with LARC, neoadjuvant radiation followed by mFOLFOX6 with avelumab is safe with a promising pathologic response rate. Trial Registration Number and Date of Registration ClinicalTrials.gov NCT03503630, April 20, 2018. https://clinicaltrials.gov/ct2/show/NCT03503630term=NCT03503630draw=2rank=1. © 2020 The Author(s)

Short-course radiation followed by mFOLFOX-6 plus avelumab for locally-advanced rectal adenocarcinoma

Background: Current standard practice for locally advanced rectal cancer (LARC) entails a multidisciplinary approach that includes preoperative chemoradiotherapy, followed by total mesorectal excision, and then adjuvant chemotherapy. The latter has been accompanied by low compliance rates and no survival benefit in phase III randomized trials, so the strategy of administering neoadjuvant, rather than adjuvant, chemotherapy has been adapted by many trials, with improvement in pathologic complete response. Induction chemotherapy with oxaliplatin has been shown to have increased efficacy in rectal cancer, while short-course radiation therapy with consolidation chemotherapy increased short-term overall survival rate and decreased toxicity levels, making it cheaper and more convenient than long-course radiation therapy. This led to recognition of total neoadjuvant therapy as a valid treatment approach in many guidelines despite limited available survival data. With the upregulation (PDL-1) expression in rectal tumors after radiotherapy and the increased use of in malignant melanoma, the novel approach of combining immunotherapy with chemotherapy after radiation may have a role in further increasing pCR and improving overall outcomes in rectal cancer. Methods: The study is an open label single arm multi- center phase II trial. Forty-four recruited LARC patients will receive 5Gy x 5fractions of SCRT, followed by 6 cycles of mFOLFOX-6 plus avelumab, before TME is performed. The hypothesis is that the addition of avelumab to mFOLFOX-6, administered following SCRT, will improve pCR and overall outcomes. The primary outcome measure is the proportion of patients who achieve a pCR, defined as no viable tumor cells on the excised specimen. Secondary objectives are to evaluate 3-year progression-free survival, tumor response to treatment (tumor regression grades 0 & 1), density of tumor-infiltrating lymphocytes, correlation of baseline Immunoscore with pCR rates and changes in PD-L1 expression. Discussion: Recent studies show an increase in PD-L1 expression and density of CD8+ TILs after CRT in rectal cancer patients, implying a potential role for combinatory strategies using PD-L1- and programmed-death- 1 inhibiting drugs. We aim through this study to evaluate pCR following SCRT, followed by mFOLFOX-6 with avelumab, and then TME procedure in patients with LARC. Trial registration: Trial Registration Number and Date of Registration: ClinicalTrials.gov NCT03503630, April 20, 2018. © 2020 The Author(s)

On T-Transformation of Probability Measures

The concept of the (T=(s,t))-transformation of probability measures, introduced for s>0 and t∈R, is examined in this work from the perspective of Cauchy–Stieltjes kernel (CSK) families and their related variance functions (VFs). We calculate the VF formula under the T-transformation of measures. Furthermore, the stability of the free Meixner family (FMF) of probability measures under the (T=(s,t))-transformation is significantly shown based on this formula. Additionally, the Wigner’s semicircle CSK family is given a novel characterization based on the (1,t)-transformation of probability measures

Generalized OWA operators for uncertain queuing modeling with application in healthcare

The weighted averaging operators are one of the popular methods for aggregating information. In recent years, ordered weighted averaging operators (OWA) have attained a great attention by researchers. These OWA operators due to their versatility are very useful to model many real world situations. Several extensions of OWA operators are presented in the literature which can handle a situation with uncertainty. Although many queuing models have been proposed in numerous healthcare studies, the inclusion of OWA operators is still rare. In this research study, we propose a novel method using the uncertain generalized ordered weighted average and illustrate its application to the uncertain queue modeling in a hospital emergency room; where incoming flux of patients and the required level of service for each patient is unknown and uncertain. The model with multilateral decision making process has been described which will provide several alternatives to decision makers to select the best alternative for their challenging situations. The proposed method has resulted an improved performance of the queuing system, increased customer satisfaction as well as a significant reduction in the operational cost. This study will enable decision makers to operate a flexible and cost-effective system in the event of uncertainty, uncontrollable and unpredicted situations

Equipping lecturers with student-centric and learner-focused methods in response to evolving learner needs in foreign language instruction

This research aimed to investigate the effectiveness of training for foreign language instructors in adopting student-centered and learner-centric approaches to address evolving learner needs in foreign language education. The study assessed how student-centered teaching models impact the performance of foreign language students. Employing a mixed-methods approach, data were gathered through questionnaires and interviews, involving a sample of 152 lecturers and teacher trainers selected purposively. Both qualitative and quantitative analyses were conducted. The findings underscored the significance of learner autonomy, technological integration, and educators\u27 willingness to adapt in enhancing effective foreign language education. The study emphasized the pivotal role of professional training in shaping the pedagogical landscape of foreign language education. Beyond equipping educators with learner-centric and student-centered methodologies, this training program empowered them to navigate the changing demands of language learners. Notably, the results aligned with the constructivist framework, highlighting its substantial influence in promoting active learning, autonomy, and collaboration in foreign language education. This research contributes to the growing body of evidence illustrating the essential role of professional development in fostering learner-centric and student-centered foreign language education, ultimately elevating the quality of language instruction and responsiveness to student requirements

The effectiveness of water jet flossing and interdental flossing for oral hygiene in orthodontic patients with fixed appliances: a randomized clinical trial

Abstract Background Orthodontic treatment presents challenges with plaque accumulation around brackets, archwires, and elastics, leading to retained plaque and gingival inflammation. Conventional toothbrushing may not be enough, requiring additional oral hygiene aids like interproximal brushes, dental flosses, and water flossers. Limited research exists on comparing water flossing and interdental flossing in orthodontic patients. Therefore, this study aims to assess their effectiveness in maintaining oral hygiene during active orthodontic treatment. Methods A single-blind, randomized, parallel clinical study recruited orthodontic patients with full-mouth brackets and archwires. Thirty participants were randomly assigned to either water jet flossing or interdental flossing groups. All participants were instructed to brush twice daily with a provided toothbrush and toothpaste and use the assigned intervention once daily at night. Clinical measures, including the Gingival Bleeding Index (BI), Plaque Index (PI), and Gingival Index (GI), were recorded at baseline and day 14. Descriptive statistics and statistical tests were performed using SPSS software. Results The water jet flossing group demonstrated a slightly higher, albeit non-significant, benefit in plaque removal (median difference of 6.79%%, P = 0.279) and bleeding reduction (median difference of 5.21%%, P = 0.172) compared to the interdental flossing group after two weeks. Both groups showed significant reductions in gingival bleeding index and plaque index from baseline to the 2-week follow-up. The interdental flossing group had median mean percentage differences of 16.13%% (plaque index) and 23.57% (gingival bleeding index), while the water jet flossing group had median percentage differences of 21.87% (plaque index) and 32.29% (gingival bleeding index). No significant changes in gingival index grades were observed in either group. Conclusion Both water jet flossing and interdental flossing were effective in reducing plaque accumulation and gingival bleeding among orthodontic patients. While no significant differences were found between the two methods, water jet flossing showed a potential advantage. Further research is needed to validate its effectiveness, assess long-term impact, and understand its benefits for orthodontic patients