Calcium Channel Blockers and Esophageal Sclerosis: Should We Expect Exacerbation of Interstitial Lung Disease?

Esophageal sclerosis is the most common visceral manifestation of systemic sclerosis, resulting in impaired esophageal clearance and retention of ingested food; in addition, co-existence of lung fibrosis with esophageal scleroderma is not uncommon. Both the progression of generalized connective tissue disorders and the damaging effect of chronic aspiration due to esophageal dysmotility appear to be involved in this procedure of interstitial fibrosis. Nifedipine is a widely prescribed calcium antagonist in a significant percentage of rheumatologic patients suffering from Raynaud syndrome, in order to inhibit peripheral vasospasm. Nevertheless, blocking calcium channels has proven to contribute to exacerbation of gastroesophageal reflux, which consequently can lead to chronic aspiration. We describe the case of severe exacerbation of interstitial lung disease in a 76-year-old female with esophageal sclerosis who was treated with oral nifedipine for Raynaud syndrome

Prognostic value of follicular fluid 25-OH vitamin D and glucose levels in the IVF outcome

Objectives: The aim of the present study was to measure serum and follicular fluid 25-OH vitamin D and glucose levels in women who underwent IVF-ET treatment and to further investigate whether the circulating 25-OH vitamin D and glucose levels correlate with IVF success. Methods: This prospective observational study included 101 consecutive women who underwent 101 IVF-ICSI ovarian stimulation cycles and were allocated to one of the three groups according to their follicular fluid 25-OH vitamin D concentrations. Group A (n = 31) with less than 20 ng/ml, group B (n = 49) with vitamin levels between 20.1 and 30 ng/ml and group C (n = 21) with more than 30 ng/ml vitamin concentration. Results: Follicular fluid vitamin levels significantly correlated with the quality of embryos in total (r = -0.27, p = 0.027), while the quality of embryos of group C were of lower quality as compared to those of groups A and B (p = 0.009). Follicular fluid glucose levels were lower in women of group C as compared to the respective levels of groups A and B (p = 0.003). Clinical pregnancy rate demonstrated in 14.5% in women of group C and 32.3% and 32.7% in groups A and B, respectively (p = 0.047). Conclusion: The data suggests that excess serum and follicular fluid vitamin levels in combination with decreased follicular fluid glucose levels have a detrimental impact on the IVF outcome

Prevalence of alexithymia and its association with anxiety and depression in a sample of Greek chronic obstructive pulmonary disease (COPD) outpatients

<p>Abstract</p> <p>Background</p> <p>Chronic obstructive pulmonary disease (COPD) is a major health problem, especially in adults over 40 years of age, and has a great social and economic impact. The psychological morbidity of COPD patients with regard to anxiety and depressive symptoms has been extensively studied in the past. However, few studies have investigated the prevalence of alexithymia in these patients, as well as its association with this comorbidity. Based on this fact, we studied the prevalence of alexithymia and its association with anxiety and depressive symptoms in COPD outpatients.</p> <p>Methods</p> <p>The present study included 167, randomly selected, outpatients diagnosed with COPD. Alexithymia, anxiety and depression were assessed using the Toronto Alexithymia Scale (TAS-20), Spielberger Trait Anxiety Inventory (STAI), and Beck Depression Inventory (BDI), respectively.</p> <p>Results</p> <p>The mean BDI score was 12.88 (SD: 7.7), mean STAI score 41.8 (SD: 11.0) and mean TAS-20 score 48.2 (SD: 11.5). No differences were observed between genders regarding age and alexithymia (t test <it>P </it>> 0.05), while female patients presented higher depression and trait anxiety scores than males (t test <it>P </it>< 0.05). Clinically significant levels of anxiety were present in 37.1% of men, and in 45.7% of women. The mean depression score was also higher than the corresponding mean score in the general population (one-sample t test <it>P </it>< 0.01), while 27.7% and 30.5% of the sample presented mild and moderate to severe depression, respectively. Finally, a strong correlation was observed between alexithymia, depression and anxiety.</p> <p>Conclusions</p> <p>This study confirms the high prevalence of anxiety and depression symptoms in Greek outpatients with COPD. The prevalence of alexithymia in COPD patients, contrary to what has been observed in patients with other chronic respiratory diseases, seem to be lower. However, we observed a strong association between alexithymia, depression and anxiety levels. This observation suggests that alexithymia should be taken into consideration when drafting specific psychotherapeutic interventions for these patients.</p

Discrimination, Reliability, Sensitivity, and Specificity of Robotic Surgical Proficiency Assessment With Global Evaluative Assessment of Robotic Skills and Binary Scoring Metrics: Results From a Randomized Controlled Trial

Objective: To compare binary metrics and Global Evaluative Assessment of Robotic Skills (GEARS) evaluations of training outcome assessments for reliability, sensitivity, and specificity. Background: GEARS–Likert-scale skills assessment are a widely accepted tool for robotic surgical training outcome evaluations. Proficiency-based progression (PBP) training is another methodology but uses binary performance metrics for evaluations. Methods: In a prospective, randomized, and blinded study, we compared conventional with PBP training for a robotic suturing, knot-tying anastomosis task. Thirty-six surgical residents from 16 Belgium residency programs were randomized. In the skills laboratory, the PBP group trained until they demonstrated a quantitatively defined proficiency benchmark. The conventional group were yoked to the same training time but without the proficiency requirement. The final trial was video recorded and assessed with binary metrics and GEARS by robotic surgeons blinded to individual, group, and residency program. Sensitivity and specificity of the two assessment methods were evaluated with area under the curve (AUC) and receiver operating characteristics (ROC) curves. Results: The PBP group made 42% fewer objectively assessed performance errors than the conventional group (P &lt; 0.001) and scored 15% better on the GEARS assessment (P = 0.033). The mean interrater reliability for binary metrics and GEARS was 0.87 and 0.38, respectively. Binary total error metrics AUC was 97% and for GEARS 85%. With a sensitivity threshold of 0.8, false positives rates were 3% and 25% for, respectively, the binary and GEARS assessments. Conclusions: Binary metrics for scoring a robotic VUA task demonstrated better psychometric properties than the GEARS assessment. </jats:sec

Multidisciplinary approach to synchronous prostate and rectal cancer: current experience and future challenges.

The management of synchronous prostate and rectal cancer is a challeging task for the general surgeons and urologists, due to the complex anatomy of the pelvis and the sequential significant effects on the patient's functional independency and quality of life. As both rectal and prostate cancers still remain leading causes of death in the male population, along with the increase of the average life expectancy, it is certain that synchronous prostate and rectal cancer will be a clinical scenario that the clinicians of the future will encounter more frequently. Our aim is to perform a comprehensive review on the management of this oncological entity, focusing on the significance of multidisciplinary approach which will enable the formation of an accurate strategy plan, having at all times the patient in the center of desicion-making

Radial artery as a graft for coronary artery bypass surgery in the era of transradial catheterization

Radial artery use as a bypass conduit is well established during the past decades, in terms of both patency and safety. On the other hand, transradial catheterization causes a series of structural and functional changes to the vessel itself. Impairment of nitric oxide-dependent vasodilation and notable decrease in radial artery diameter due to intima thickening and hyperplasia, especially during the first 3 months after its cannulation, constitute some of the most important alterations on the radial artery wall and its function after a transradial coronary catheterization procedure. Given the constantly increasing numbers of these transradial catheterization procedures, the authors of this article focus on the current knowledge regarding the potential use of the radial artery as a bypass conduit, after its catheterization, also considering several possible mechanisms on its subsequent structural and functional changes. Keywords: Radial artery, Transradial catheterization, Bypass condui

Life Cycle Assessment of Variable Rate Fertilizer Application in a Pear Orchard

Precision Agriculture (PA) is a crop site-specific management system that aims for sustainability, adopting agricultural practices more friendly to the environment, like the variable rate application (VRA) technique. Many studies have dealt with the effectiveness of VRA to reduce nitrogen (N) fertilizer, while achieving increased profit and productivity. However, only limited attention was given to VRA&rsquo;s environmental impact. In this study an International Organization for Standardization (ISO) based Life Cycle Assessment (LCA) performed to identify the environmental effects of N VRA on a small pear orchard, compared to the conventional uniform application. A Cradle to Gate system with a functional unit (FU) of 1 kg of pears was analyzed including high quality primary data of two productive years, including also the non-productive years, as well as all the emissions during pear growing and the supply chains of all inputs, projecting them to the lifespan of the orchard. A methodology was adopted, modelling individual years and averaging over the orchard&rsquo;s lifetime. Results showed that Climate change, Water scarcity, Fossil fuels and Particulate formation were the most contributing impact categories to the overall environmental impact of the pear orchard lifespan, where climate change and particulates were largely determined by CO2, N2O, and NH3 emissions to the air from fertilizer production and application, and as CO2 from tractor use. Concerning fertilization practice, when VRA was combined with a high yield year, this resulted in significantly reduced environmental impact. LCA evaluating an alternative fertilizer management system in a Greek pear orchard revealed the environmental impact reduction potential of that system

Understanding circular economy awareness and practices in manufacturing firms

© 2019, Emerald Publishing Limited. Purpose: Circular economy (CE) has evolved as a result of the growing environmental awareness, environmental legislation and the need for social responsibility. However, awareness levels of CE are not as high as expected and practices are further behind than they should be, with a significant lack of research around the subject in the literature. Therefore, the purpose of this paper is to examine the current state of awareness levels and the practices around CE in manufacturing firms. Moreover, the study aims to empirically validate one of the earlier proposed CE models. Design/methodology/approach: The study adopts a quantitative survey questionnaire based approach. More than 500 people from various manufacturing organisations were contacted directly over a 40-day long sampling process through the FAME database, personal contacts and LinkedIn. The survey resulted in 103 completed responses. Given the exploratory nature of the study, the data were mainly analysed using descriptive statistics. To validate the CE model, a correlation analysis was also conducted. Findings: The research findings show that with the growing emphasis on CE across the globe by governing bodies, firms are becoming more aware of CE practices. The analysis also shows some useful insights on the state of each of the pillars (economic benefits, environmental impact and resource scarcity) of CE. The findings also indicate that the environmental impact pillar of CE is at a more developed state than the other two pillars which are, mostly, in a research state. Research limitations/implications: The study provides manufacturing firms with a thorough understanding of the state of CE practices and importance of its successful implementation. The findings of the study advocates consideration of all three pillars of CE by managers as a guide to plan for an efficient strategy around CE implementation. Moreover, our study adds to existing efforts by the academic community to raise the awareness towards CE practice among all relevant stakeholders. The findings of this study are based on the responses from a limited 103 survey responses from manufacturing firms. Originality/value: This study adds to the very limited empirical literature on CE awareness and practices in manufacturing firms. This is also one of the first studies attempting to empirically validate an existing CE model