An animal experimental study on pubourethral ligament restoration with platelet rich plasma for the treatment of stress urinary incontinence.

Introduction: Minimally invasive methods for injured ligament and tendon restoration have been developed and gained popularity in recent years. Injury and relaxation of the pubourethral ligament (PUL) can lead to stress urinary incontinence (SUI). The aim of this study was to investigate the impact of injecting platelet rich plasma (PRP) into the PUL following its surgical transection resulting in SUI, confirmed by leak point pressure (LPP) measurements pre- and post-intervention in an experimental animal model. Material and methods: Twenty female adult Sprague-Dawley rats were assigned in 2 groups: 1) treatment group with transection of the PUL and application of PRP at the time of transection and at one month follow-up and 2) a control group, with transection of the PUL only. Leak point pressures (LPPs) were measured prior to transection, immediately following the transection and at 1 and 2 months in both groups. Results: The median LPPs for the control group were: LPP - preT: 35.6 (29.8-44.8) cmH2O, LPP - postT: 14.6 (5.8-19.0) cmH2O, LPP - 1 month: 27.3 (19.2-33.8) cmH2O, LPP - 2 months: 29.0 (27.0-34.0) cmH2O, whereas for the PRP group were: LPP-preT: 40.5 (33.2-46.3) cmH2O, LPP - postT: 15.7 (3.0-24.0) cmH2O, LPP - 1month: 31.6 (24.8-37.4) cmH2O, LPP - 2 months: 36.8 (32.5-45.4) cmH2O. PRP injections on transected PULs significantly increased LPPs at one month follow-up [31.6 cmH2O vs. 27.3 cmH2O, p = .043]. This effect was confirmed at two months [36.8 cmH2O vs. 29.0 cmH2O, p <.001]. Conclusions: Injection of PRP into transected PULs significantly improved LPPs at one and two months' follow-up. However, further experimental and clinical research is needed to evaluate the safety and efficacy of this treatment, in clinical practice

Banks’ internalization effect and equilibrium

This paper extends the standard New Keynesian model to allow for the presence of large banks, when the cost channel of monetary policy matters. It is shown that once the presence of large banks is taken into account the severity of the firms’ credit constraints, the aggressiveness of the central bank in stabilizing inflation and the degree of loan setting centralization jointly affect the steady state output. Moreover, it turns out that the indeterminacy region is not only shrunk due to the presence of a finite number of large banks but also dependent – among others - on the way in which the central bank and the macroprudential authority systematically behave

Η διαμόρφωση των κοινωνικών αλληλεπιδράσεων στο χώρο υπό το πρίσμα της φορμαλιστικής θεώρησης του Georg Simmel

Σκοπός της εργασίας είναι η ανάδειξη της σημασίας των χωρικών προϋποθέσεων του εγκοινωνισμού, υπό την ιδιάζουσα οπτική του Georg Simmel, καθώς και η αποσαφήνιση ορισμένων κρίσιμων σημείων του έργου του. Ειδικότερα, διερευνάται η μεθοδολογία του σε σχέση με την θεωρητική του παραγωγή και εξετάζονται τα συνηθέστερα επικριτικά σχόλια, που αφορούν στην φορμαλιστική θεώρηση, στην ανιστορικότητα, στην ψυχολογίζουσα ερμηνεία και στον σχετικισμό. Μέσα από την μελέτη του έργου του για την μητρόπολη, τον ξένο, την φιλοσοφία του χρήματος, την γέφυρα και την πόρτα και την τραγωδία της κουλτούρας, επιχειρείται η προσέγγιση της έννοιας της ελευθερίας του νεωτερικού υποκειμένου που αναζητεί την ολότητα μέσα από το θραύσμα, με την διαλεκτική εγγύτητας-απόστασης, μορφής-περιεχομένου, εσωτερικού- εξωτερικού, υποκειμενικής και αντικειμενικής κουλτούρας. Η διάσωση της αυτονομίας σε ένα περιβάλλον αδιάκοπων αλληλεπιδράσεων και καταιγιστικών ερεθισμάτων είναι το πρωταρχικώς ζητούμενο για τον Georg Simmel και η κυριότερη πηγή αγωνίας που τον οδήγησε στην αέναη περιπλάνηση, ανάγοντάς τον σε ιμπρεσιονιστή της κοινωνικής θεωρίας. Προτείνεται επαναπροσδιορισμός της ερμηνείας και εκ νέου ανάγνωση του έργου του προκειμένου να αναδειχθεί προσηκόντως η ρηξικέλευθη συμβολή του στην μελέτη της νεωτερικότητας, η οποία αμφισβητήθηκε λόγω παρερμηνειών που πηγάζουν από την ιδιομορφία της μεθοδολογίας του.The aim of the work is to highlight the importance of the spatial conditions of sociation, from the unique perspective of Georg Simmel, as well as to clarify some critical points in his work. In particular, methodology is examined in relation to theoretical production and the most common critical assessments are investigated, including formalistic approach, ahistorical method, psychological interpretation and relativism. Through the study of his work on the metropolis, the foreigner, the philosophy of money, the bridge and the door and the tragedy of culture, an attempt is made to approach the concept of freedom of the modern subject who seeks wholeness through the fragment, with the dialectic of proximity-distance, form-content, internal-external, subjective and objective culture. Preserving autonomy in an environment of continuous interactions and constellation of stimuli is of primary importance for Georg Simmel and the main source of anxiety that led him to perpetual wandering, making him an impressionist of social theory. It is proposed to redefine the interpretation and re-read his work in order to properly highlight his groundbreaking contribution to the study of modernity, which was questioned due to misinterpretations stemming from the peculiarity of his methodology

Implementation and reporting of causal mediation analysis in 2015: a systematic review in epidemiological studies

BACKGROUND: Causal mediation analysis is often used to understand the impact of variables along the causal pathway of an occurrence relation. How well studies apply and report the elements of causal mediation analysis remains unknown. METHODS: We systematically reviewed epidemiological studies published in 2015 that employed causal mediation analysis to estimate direct and indirect effects of observed associations between an exposure on an outcome. We identified potential epidemiological studies through conducting a citation search within Web of Science and a keyword search within PubMed. Two reviewers independently screened studies for eligibility. For eligible studies, one reviewer performed data extraction, and a senior epidemiologist confirmed the extracted information. Empirical application and methodological details of the technique were extracted and summarized. RESULTS: Thirteen studies were eligible for data extraction. While the majority of studies reported and identified the effects of measures, most studies lacked sufficient details on the extent to which identifiability assumptions were satisfied. Although most studies addressed issues of unmeasured confounders either from empirical approaches or sensitivity analyses, the majority did not examine the potential bias arising from the measurement error of the mediator. Some studies allowed for exposure-mediator interaction and only a few presented results from models both with and without interactions. Power calculations were scarce. CONCLUSIONS: Reporting of causal mediation analysis is varied and suboptimal. Given that the application of causal mediation analysis will likely continue to increase, developing standards of reporting of causal mediation analysis in epidemiological research would be prudent

An online innovation platform to promote collaboration and sustainability in short food supply chains

A sustainable Short Food Supply Chain (SFSC) requires collaboration among all actors, which nowadays is facilitated by information and communication technologies (ICT). However, not all SFSC stakeholders network with others in this way, and it is not clear what will draw them to ICT interaction. A simple, user-friendly website, the SMARTCHAIN Innovation Platform, evolving since March 2019, may facilitate interaction and cooperation among SFSC stakeholders. This article presents the Platform's development and evaluates its efficacy and impact by analysing data from Google Analytics (GA) and other sources. Primary Platform features promote communication and information sharing: these are the 1) Innovation Hubs in 9 European countries, 2) Inventories including 150 SFSC innovations and 50 SFSC initiatives, 3) Resources databases of Publications and Weblinks, and 4) Training section. GA showed that visitors to the Platform increased slowly in the 16 months since its start, and the number of page views increased with the amount of time on the Platform. The most visited page of the Platform was the information-providing Innovation Inventory. Most Platform users were in partner countries of the SMARTCHAIN project, but not all Innovation Hubs had high numbers of users. Most users arrived at the Platform by direct link, but LinkedIn was the most important originating social network. Taken together, these data suggest growth potential for an easy-to-use website that provides useful and up-to-date information but little inclination for SFSC stakeholders to use an online Platform for communication

Survivors of an Acute Coronary Syndrome with Lower Patient Activation Are More Likely to Experience Declines in Health-Related Quality of Life

Background: Patient activation comprises the knowledge, skills, and confidence for self-care, and may lead to better health outcomes. Objectives: We examined the relationship between patient activation and changes in health-related quality of life (HRQOL) following hospitalization for an acute coronary syndrome (ACS). Methods: We studied patients from 6 medical centers in central Massachusetts and Georgia who had been hospitalized for an ACS between 2011 and 2013. At 1 month after hospital discharge, patients completed the 6-item Patient Activation Measure and were categorized into 4 levels of activation. Multinomial logistic regression analyses compared activation level with clinically meaningful changes (≥ 3.0 points generic, ≥10.0 points disease-specific) in generic physical (SF-36 PCS), generic mental (SF-36 MCS), and disease-specific (Seattle Angina Questionnaire, SAQ) HRQOL from 1 to 3 and 1 to 6 months after hospitalization, adjusting for potential sociodemographic and clinical confounders. Results: Patients (n=1,042) were on average 62 years old, 34% female, and 87% non-Hispanic white. Overall, 10% were in the lowest level of activation. Patients with the lowest activation had 1.95 (95% CI: 1.05, 3.62) and 2.18 (95% CI: 1.17, 4.05) times the odds of experiencing clinically significant declines in MCS and SAQ QOL scores, respectively, between 1 and 6 months than the most activated patients. Patient activation level was not associated with meaningful changes in PCS scores. Conclusions: Hospital survivors of an ACS with lower activation may be more likely to experience declines in mental and disease-specific HRQOL than more activated patients, identifying a group at risk of poor outcomes

Tumour invasiveness, the local and systemic environment and the basis of staging systems in colorectal cancer

background: The present study aimed to examine the relationship between tumour invasiveness (T stage), the local and systemic environment and cancer-specific survival (CSS) of patients with primary operable colorectal cancer. methods: The tumour microenvironment was examined using measures of the inflammatory infiltrate (Klintrup-Makinen (KM) grade and Immunoscore), tumour stroma percentage (TSP) and tumour budding. The systemic inflammatory environment was examined using modified Glasgow Prognostic Score (mGPS) and neutrophil:lymphocyte ratio (NLR). A 5-year CSS was examined. results: A total of 331 patients were included. Increasing T stage was associated with colonic primary, N stage, poor differentiation, margin involvement and venous invasion (P&lt;0.05). T stage was significantly associated with KM grade (P=0.001), Immunoscore (P=0.016), TSP (P=0.006), tumour budding (P&lt;0.001), and elevated mGPS and NLR (both P&lt;0.05). In patients with T3 cancer, N stage stratified survival from 88 to 64%, whereas Immunoscore and budding stratified survival from 100 to 70% and from 91 to 56%, respectively. The Glasgow Microenvironment Score, a score based on KM grade and TSP, stratified survival from 93 to 58%. conclusions: Although associated with increasing T stage, local and systemic tumour environment characteristics, and in particular Immunoscore, budding, TSP and mGPS, are stage-independent determinants of survival and may be utilised in the staging of patients with primary operable colorectal cancer

Clarithromycin Enhances the Antibacterial Activity and Wound Healing Capacity in Type 2 Diabetes Mellitus by Increasing LL-37 Load on Neutrophil Extracellular Traps

Background: Type 2 diabetes mellitus (T2D) is characterized by susceptibility to bacterial infections and impaired wound healing. Neutrophil extracellular traps (NETs) and the cathelicidin antimicrobial peptide LL-37 have been implicated both in defense against bacterial infections and in wound healing process. Recently, it was shown that macrolide antibiotic clarithromycin induces the release of LL-37-bearing NETs. In T2D there has not been identified any link between NETs and LL-37 and the effect of clarithromycin in neutrophils/NETs is unknown yet.Methods: Peripheral blood neutrophils were obtained from treatment-naive hyperglycemic T2D patients (naive), normoglycemic T2D patients under antidiabetic treatment (well-controlled) and healthy donors (controls). NET release and NET proteins were studied. Co-culture systems of NET structures with E. coli NCTC 9001 and primary skin fibroblasts were deployed to examine the in vitro antibacterial and fibrotic NET properties, respectively. The effect of clarithromycin was also investigated. Analysis was performed using immunofluorescence confocal microscopy, myeloperoxidase-DNA complex and LL-37 ELISA, immunoblotting and qRT-PCR.Results: NETs were characterized by the presence of LL-37, however they lacked antibacterial activity, in both groups of T2D patients. Clarithromycin significantly increased the externalization of LL-37 on NETs generated from well-controlled T2D neutrophils, thus restoring NET antibacterial capacity and promoting the wound healing process via fibroblast activation and differentiation.Conclusion: This study suggests that clarithromycin may add further advantage to well-controlled T2D patients, by enhancing their antibacterial defense and improving wound healing capacity of fibroblasts, through upregulation of LL-37 on NET structures

What causes increasing and unnecessary use of radiological investigations? a survey of radiologists' perceptions

<p>Abstract</p> <p>Background</p> <p>Growth in use and overuse of diagnostic imaging significantly impacts the quality and costs of health care services. What are the modifiable factors for increasing and unnecessary use of radiological services? Various factors have been indentified, but little is known about their relative impact. Radiologists hold key positions for providing such knowledge. Therefore the purpose of this study was to obtain radiologists' perspective on the causes of increasing and unnecessary use of radiological investigations.</p> <p>Methods</p> <p>In a mailed questionnaire radiologist members of the Norwegian Medical Association were asked to rate potential causes of increased investigation volume (fifteen items) and unnecessary investigations (six items), using five-point-scales. Responses were analysed by using summary statistics and Factor Analysis. Associations between variables were determined using Students' t-test, Spearman rank correlation and Chi-Square tests.</p> <p>Results</p> <p>The response rate was 70% (374/537). The highest rated causes of increasing use of radiological investigations were: a) new radiological technology, b) peoples' demands, c) clinicians' intolerance for uncertainty, d) expanded clinical indications, and e) availability. 'Over-investigation' and 'insufficient referral information' were reported the most frequent causes of unnecessary investigations. Correlations between causes of increasing and unnecessary radiology use were identified.</p> <p>Conclusion</p> <p>In order to manage the growth in radiological imaging and curtail inappropriate investigations, the study findings point to measures that influence the supply and demand of services, specifically to support the decision-making process of physicians.</p