Long-term active problems in patients with cloacal exstrophy: a systematic review

BACKGROUND: Cloacal exstrophy (CE) is the most severe end of the Exstrophy-Epispadias Complex malformations spectrum. Improvements in postnatal management and well-established operative techniques have resulted in survival rates approaching 100%. This systematic review aims to define the prevalence of long-term active medical problems affecting CE patients after the first decade of life. METHODS: PubMed/Medline, Embase, Scopus, and ISI Web of Knowledge databases were used for the literature search. Original articles related to medical, surgical, and psychosocial long-term problems in CE patients >10 years of age were included in the study. Quality assessment of the articles was performed through the Newcastle-Ottawa Scale. Prevalence estimates and 95% CI were assessed for each outcome. RESULTS: Twelve studies were included. The most common long-term active problems identified were: urinary incontinence with a prevalence ranging from 9.1% to 85%; sexual function issues related to vaginal anomalies with a prevalence ranging from 8.3% to 71.3%, and uterine anomalies, with a prevalence from 14.3% to 71%; gender identity issues in 46, XY patients raised female had a prevalence from 11.1% to 66.7%. There is no documented history of paternity. Impairment of ambulatory capacity was recorded in 13.8% of patients. Only one paper studied psychological well-being, reporting significantly higher levels of depression among gender reassigned patients. CONCLUSIONS: Teenagers and adults born with CE have well defined long-term problems compared to the general population. Recognition and expert management are crucial to improve care and quality of life during and after the transition into adulthood

Οι αρμοδιότητες και ο ρόλος της Τοπικής Αυτοδιοίκησης στην αντιμετώπιση των κρίσεων. Μελέτη περίπτωσης: Η πυρκαγιά στο Μάτι της Ανατολικής Αττικής το 2018

Η Ελλάδα έχει μακρά εμπειρία επαναλαμβανόμενων δασικών πυρκαγιών, κυρίως κατά τη θερινή περίοδο, οι οποίες όταν εκδηλώνονται σε μικτές ζώνες δάσους και οικιστικής ανάπτυξης έχουν οδηγήσει σε απώλεια ανθρωπίνων ζωών Η πυρκαγιά που αποτέφρωσε μεγάλο μέρος της Ανατολικής Αττικής τον Ιούλιο του 2018 και είχε ως τραγικό απολογισμό 100 νεκρούς, οφείλεται κυρίως στις ακραίες συνθήκες που αναπτύχθηκαν, την γεωμορφολογία και την δόμηση της περιοχής, αλλά οι συνέπειες μπορεί να ήταν σημαντικά ηπιότερες αν είχε εφαρμοστεί καλύτερος συντονισμός, ο οποίος ήταν αδύνατος λόγω κατάτμησης και επικάλυψης αρμοδιοτήτων. Με δεδομένο ότι στο μέλλον, λόγω των συνεπειών της κλιματικής αλλαγής, η Ελλάδα αναμένεται να αντιμετωπίσει ανάλογα φαινόμενα και ότι σαν την Ανατολική Αττική υπάρχουν άλλες 100 τουλάχιστον ανάλογες περιοχές, η παρούσα εργασία εξετάζει τον ρόλο και τις αρμοδιότητες της τοπικής αυτοδιοίκησης στο θέμα της πολιτικής προστασίας και το κατά πόσο θα μπορούσε η Ελλάδα να εφαρμόσει την πρότυπη οργάνωση χωρών του εξωτερικού, όπως η Κοινοπολιτεία της Αυστραλίας, η οποία δίνει έμφαση στην σχεδίαση, πρόληψη και ενημέρωση των πολιτών σε τοπικό επίπεδο. Τέλος καταλήγει σε συγκεκριμένα συμπεράσματα όσον αφορά την πυρκαγιά στο Μάτι της Αττικής και σε προτάσεις για τον τρόπο με τον οποίο πρέπει να λειτουργήσει η πυρασφάλεια και η πολιτική προστασία στο μέλλον.Greece has a long experience of repeated wildfires, especially in the summer season, that in case of wildland urban interface may lead to human loss. The wildfire that incinerated a great part of Eastern Attica region on July 2018 and resulted to 100 deaths, was mainly due to extreme weather conditions, geomorphology and the urban planning of the territory, but consequences could have been milder with a better coordination, which was unattainable because of the division and overlapping of competences. Taking into account that due to climate change Greece is expected to have similar circumstances in the future, and there are more than 100 similar areas, present study also examines the role and the jurisdictions of local government on the issue of its as well as how may Greece implement foreign response plans, such as Australia’s that emphasizes in design, prevention and information of citizens at local level. Finally, it comes to spacidic conclusions concerning the wildfire at Mati of Attica and to suggestions about the way that firesafety and civil protection should react in the future

Microscopic Model of Charge Carrier Transfer in Complex Media

We present a microscopic model of a charge carrier transfer under an action of a constant electric field in a complex medium. Generalizing previous theoretical approaches, we model the dynamical environment hindering the carrier motion by dynamic percolation, i.e., as a medium comprising particles which move randomly on a simple cubic lattice, constrained by hard-core exclusion, and may spontaneously annihilate and re-appear at some prescribed rates. We determine analytically the density profiles of the "environment" particles, as seen from the stationary moving charge carrier, and calculate its terminal velocity as the function of the applied field and other system parameters. We realize that for sufficiently small external fields the force exerted on the carrier by the "environment" particles shows a viscous-like behavior and define an analog of the Stokes formula for such dynamic percolative environments. The corresponding friction coefficient is also derived.Comment: appearing in Chem. Phys. Special Issue on Molecular Charge Transfer in Condensed Media - from Physics and Chemistry to Biology and Nano-Engineering, edited by A.Kornyshev (Imperial College London), M.Newton (Brookhaven Natl Lab) and J.Ulstrup (Technical University of Denmark

(PVDF)2(PEO)2 miktoarm star copolymers: Synthesis and isothermal crystallization leading to exclusive β-phase formation

In this work, we study how chain topology can induce different polymorphic behaviors in poly(vinylidene fluoride) (PVDF)-based materials. A linear PVDF precursor with two azido groups at the junction point, (PVDFx-N3)2 and three 4-miktoarm star copolymers (PVDFx)2-b-(PEOy)2 with two poly(ethylene oxide) (PEO) and two PVDF arms were synthesized and employed in this study. The amphiphilic miktoarm copolymers were prepared by a combination of anionic ring-opening polymerization, iodine transfer radical polymerization (ITP), and copper-catalyzed azide-alkyne cycloaddition (CuAAC). They have practically similar overall molar mass but different compositions, ideal for performing bulk morphology and crystallization investigations. The isothermal overall crystallization kinetics of the PVDF and PEO arms of the 4-miktoarm star copolymers and representative PEO and PVDF precursors was determined by Differential Scanning Calorimetry (DSC). The results indicate that the star arms crystallized faster than the equivalent precursors as the kinetics are dominated by nucleation effects. The phases formed by the PVDF components in the materials examined were analyzed by studying their melting behavior by DSC, their superstructural morphology by Polarized Light Optical Microscopy (PLOM), and the phase structure by Fourier Transform Infrared Spectroscopy (FTIR). The linear PVDF and (PVDF29-N3)2, exhibited α, β and γ-phases (with a majority of β-phase formation) during melting after isothermal crystallization. The ratio of the different phases depends on the crystallization temperature. An analysis of the multiple melting behavior indicated that the sample forms both α and β-phases initially, and the α-phase partially transforms into the γ-phase during isothermal crystallization when the temperature of crystallization increases. We found a remarkable behavior for the 4-miktoarm star copolymers, as the PVDF arms only form the ferroelectric β-phase when all three materials were isothermally crystallized regardless of the crystallization temperature employed. The presence of the polymorphism in the PVDF was detected by DSC, PLOM, and FTIR. Hence, we have shown that tailoring chain topology in PVDF copolymers can lead to exclusive β-phase formation, a path that can be exploited for future piezoelectric applications.We acknowledge funding from MICINN through grant PID2020-113045GB-C21. We would also like to acknowledge the support of the Basque Government through grant IT1503-22. N. M. thankfully acknowledges his Ph.D. fellowship from the POLYMAT Basque Center for Macromolecular Design and Engineering. J. M. acknowledges partial financial support from the IBERDROLA Foundation. Y.P., G.P., A.P., V.R., and N.H. thankfully acknowledge the support of King Abdullah University of Science and Technology (KAUST)

Ibutilide for the Cardioversion of Paroxysmal Atrial Fibrillation during Radiofrequency Ablation of Supraventricular Tachycardias

Direct current electrical cardioversion (DC-ECV) is the preferred treatment for the termination of paroxysmal atrial fibrillation (AF) that occurs during radiofrequency ablation (RFA) of supraventricular tachycardias (SVT). Intravenous Ibutilide may be an alternative option in this setting. Thirty-four out of 386 patients who underwent SVT-RFA presented paroxysmal AF during the procedure and were randomized into receiving ibutilide or DC-ECV. Ibutilide infusion successfully cardioverted 16 out of 17 patients (94%) within 17.37 ± 7.87  min. DC-ECV was successful in all patients (100%) within 17.29 ± 3.04  min. Efficacy and total time to cardioversion did not differ between the study groups. No adverse events were observed. RFA was successfully performed in 16 patients (94%) in the ibutilide arm and in all patients (100%) in the DC-ECV arm, p = NS. In conclusion, ibutilide is a safe and effective alternative treatment for restoring sinus rhythm in cases of paroxysmal AF complicating SVT-RFA