Liver Transplant Imaging prior to and during the COVID-19 Pandemic

Background. The suspension of the surgical activity, the burden of the infection in immunosuppressed patients, and the comorbidities underlying end-stage organ disease have impacted transplant programs significantly, even life-saving procedures, such as liver transplantation. Methods. A review of the literature was conducted to explore the challenges faced by transplant programs and the adopted strategies to overcome them, with a focus on indications for imaging in liver transplant candidates. Results. Liver transplantation relies on an appropriate imaging method for its success. During the Coronavirus Disease 2019 (COVID-19) pandemic, chest CT showed an additional value to detect early signs of SARS-CoV-2 infection and other screening modalities are less accurate than radiology. Conclusion. There is an emerging recognition of the chest CT value to recommend its use and help COVID-19 detection in patients. This examination appears highly sensitive for liver transplant candidates and recipients, who otherwise would have not undergone it, particularly when asymptomatic.

The timed up and go test in idiopathic normal pressure hydrocephalus: a Nationwide Study of 1300 patients

Background The aim of this study was to describe the outcome measure timed up and go (TUG) in a large, nationwide cohort of patients with idiopathic normal pressure hydrocephalus (iNPH) pre- and post-operatively. Furthermore, to compare the TUG test to the 10-m walk test (10MWT), the iNPH scale, the modified Rankin scale (mRS) and the Mini Mental State Examination (MMSE), which are commonly applied in clinical assessment of iNPH. Methods Patients with iNPH (n = 1300), registered in the Swedish Hydrocephalus Quality Registry (SHQR), were included. All data were retrieved from the SHQR except the 10MWT, which was collected from patient medical records. Clinical scales were examined pre- and 3 months post-operatively. Data were dichotomised by sex, age, and preoperative TUG time. Results Preoperative TUG values were 19.0 [14.0–26.0] s (median [IQR]) and 23 [18–30] steps. Post-operatively, significant improvements to 14.0 [11.0–20.0] s and 19 [15–25] steps were seen. TUG time and steps were higher in women compared to men (p < 0.001) but there was no sex difference in improvement rate. Worse preoperative TUG and younger age favoured improvement. TUG was highly correlated to the 10MWT, but correlations of post-operative changes were only low to moderate between all scales (r = 0.22–0.61). Conclusions This study establishes the distribution of TUG in iNPH patients and shows that the test captures important clinical features that improve after surgery independent of sex and in all age groups, confirming the clinical value of the TUG test. TUG performance is associated with performance on the 10MWT pre- and post-operatively. However, the weak correlations in post-operative change to the 10MWT and other established outcome measures indicate an additional value of TUG when assessing the effects of shunt surgery.

Urine Biomarkers Combined With Ultrasound for the Diagnosis of Obstruction in Pediatric Hydronephrosis

Introduction: To establish the efficacy of ultrasound (US) combined with urine biomarkers in differentiating patients who require surgical management from those who do not, avoiding invasive investigations.Materials and Methods: From February 2019 to February 2021, all pediatric patients who presented with hydronephrosis were selected for the study. All renal units (RU) were evaluated by US, and fresh frozen voided urine samples were collected at the time of inclusion. Hydronephrosis grade was evaluated by the Society for Fetal Urology (SFU) and an alternative grading system (AGS). Patients who had high-grade hydronephrosis on US were referred to renal scan (RS) or intervention, when there was an increase of dilatation in subsequent follow-up images. Fresh frozen urine from the control group with no history of renal diseases and no renal anomalies on US was collected. We compared differences of US parameters combined with urine biomarkers between surgically and non-surgically managed patients and between the groups of patients when they were stratified by different RS findings and analyzed whether urinary biomarkers give any additional value to US. Instead of the anterior–posterior diameter (APD), we used its ratio with mid-parenchymal thickness. The additional efficacy of biomarkers to US was calculated when the US component was derived to a cumulative APD/mid-parenchymal ratio.Results: Sixty-four patients with hydronephrosis were prospectively included in the study accounting for a total of 81 patient visits and 162 RUs evaluated. A control group of 26 patients was collected. The mean age at inclusion in the hydronephrosis group was 43.7(±45.5) months, and a mean age in a control group was 61.2(±41.3) months. The cumulative APD/mid-parenchymal ratio combined with urinary albumin, β2 microglobulin (β2-M), and urinary neutrophil gelatinase-associated lipocalcin may have a better performance in the prediction of surgical intervention than the cumulative APD/mid-parenchymal ratio alone (p = 0.1). The best performance to detect the increased tissue transit time and obstructive curve on RS was demonstrated by the β2-M creatinine ratio. An increased cumulative APD/mid-parenchymal ratio with biomarkers together had a fairly good sensitivity and specificity for detection of DRF &lt; 40%.Conclusions: According to our data, the APD/mid-parenchymal ratio alone has good efficacy in prediction of surgery and abnormal RS findings especially when combined with urine biomarkers.

Unraveling heterogeneity within ACPA-negative rheumatoid arthritis: the subgroup of patients with a strong clinical and serological response to initiation of DMARD treatment favor disease resolution

Background Rheumatoid arthritis (RA) is a heterogeneous disease, as evidenced by the differences in long-term outcomes. This applies especially to anti-citrullinated protein antibodies (ACPA)-negative RA, where a proportion achieves sustained DMARD-free remission (SDFR; sustained absence of synovitis after DMARD cessation). Differentiation of RA patients who will achieve SDFR can guide personalized treatment/tapering strategies. Although this subgroup remains scarcely discerned, previous research demonstrated that these RA patients are characterized by an early clinical response (DAS remission after 4 months) after DMARD start. We studied whether, in addition to this clinical response, a specific biomarker response can further distinguish the subgroup of RA patients most likely to achieve SDFR. Methods In 266 RA patients, levels of 12 biomarkers (SAA/CRP/MMP-1/MMP-3/resistin/leptin/IL-6/TNF-R1/YKL-40/EGF/VEGF/VCAM-1), in the first 2 years after diagnosis, were studied in relation to SDFR, stratified for ACPA status. Subsequently, biomarkers associated with SDFR development were combined with early DAS remission to study its additional value in defining subgroups. Since most biomarker levels are not routinely measured in clinical practice, we explored how this subgroup can be clinically recognized. Results ACPA-negative RA patients achieving SDFR were characterized by high baseline levels and stronger decline in MMP-1/MMP-3/SAA/CRP after DMARD-start, respectively 1.30×/1.44×/2.12×/2.24× stronger. This effect was absent in ACPA-positive RA. In ACPA-negative RA, a strong biomarker decline is associated with early DAS remission. The combination of both declines (clinical, biomarker) was present in a subgroup of ACPA-negative RA patients achieving SDFR. This subgroup can be clinically recognized by the combination of high baseline CRP levels (≥ 3 times ULN), and early DAS remission (DAS4 months < 1.6). This latter was replicated in independent ACPA-negative RA patients. Conclusions ACPA-negative RA patients with early DAS remission and a strong biomarker response (or baseline CRP levels ≥ 3× ULN) are most likely to achieve SDFR later on. This could guide personalized decisions on DMARD tapering/cessation in ACPA-negative RA.

Project-Oriented Game-Based Learning

In this chapter, the authors investigate the potential of project-oriented game-based learning in making students of educational institutes more engaged and gain a deep understanding of the curriculum content. The literature review presents the main definitions and benefits of project-oriented game-based learning, followed by its contribution to improving the performance of students' training. The results of the research are based on testing the main statements of project-oriented game-based learning empirically – if it really can provide additional value for learners in higher education. The empirical data have been collected based on Ukrainian case study and allow the authors to prove the influence of project-oriented game-based learning on increasing students' engagement, satisfaction, performance, and improving learning outcomes. The main idea of the teaching project was to take as an object of the research a character from a fairytale and analyze its managerial activities. The chapter also analyzes the e-learning instruments which can be used in remote teaching.

The Applicability of Process-Orientation to Software Development Projects

The progress in the digital single market (DSM) has been acknowledged as one of the 10 political priorities by the European Commission since 2015. It could contribute € 415 billion per year (GDP) to the economy of the 28 EU Member States and create hundreds of thousands of new jobs. Nowadays, the ICT sector and the European Digital Agenda have declared it as one of the seven pillars of the Europe 2020 strategy. In order to speed up the development of new information technology and its commercialisation, it is necessary to increase software quality aimed at accelerating and improving technology transfer, taking into account process quality management. The aim of this article is to give an overview of a new approach to producing an additional value of the software development projects to improve the technology transfer process.

Persepsi Mahasiswa Pendidikan Matematika FKIP Universitas Mataram Terhadap Pembelajaran Daring di Era Covid-19

This study aims to determine the perception of mathematics education students of FKIP Unram on the online learning process, abilities after online learning, and to describe related to online learning in the covid-19 era in mathematics education students of FKIP Unram in the 2020/2021 academic year. This research was carried out using descriptive qualitative research methods, for data collection a questionnaire was distributed via google form, with a sample of mathematics education students who were active and learning online in the 2020/2021 academic year. The instrument used in this study is a closed questionnaire, where respondents just choose the answers that are already available. The results showed that the perception of students of the Mathematics Education Study Program FKIP Unram towards the online learning process in the 2020/2021 academic year was categorized as good with a percentage of 79.13%. Meanwhile, students' perceptions of abilities after online learning are in good category with a percentage of 70.44%. Based on the results of the percentage scores for each indicator of the perception of the online learning process and the ability after online learning, there are several things that must be maintained and developed in online learning at the Unram Mathematics Education Study Program, namely 1). Lecturers always provide learning materials or materials. 2). The material provided by the lecturer is in the form of modules or textbooks. 3). The material presented online is in accordance with the lecture/RPS contract. 4). The online learning process is carried out using the Google Meet application. 5). Students find it easier to use the Google Meet application in the online learning process. 6). Students always do the assignments given by the lecturer. 7). Lecturers always check student attendance. 8). Lecturers give additional value to students who actively ask and answer in the online learning process. 9). Lecturers always provide opportunities for students to ask questions and discuss. 10). Lecturers respond to questions that arise during the online lecture process. 11). Lecturers provide feedback by asking students questions related to the material that has been studied.

Inside and outside perspectives on the relation of personal values and legal norm acceptances

Based on a representative survey on crime prevention, this paper studies how personal values are related to persons’ acceptance of legal norms (LNA). We here take a closer look at these relations than previous research. Offenses, in particular, are classified into three offense types (no victim (OT1), legal person as victim (OT2, real person as victim (OT3)), and the persons’ ratings are studied both as observed and as individually centered data. It is found that conservation-oriented persons give higher and less differentiated badness ratings for all offenses than persons striving for hedonism and stimulation. The correlational structure of basic personal values and norm acceptance ratings for 14 different offenses, when represented via multidimensional scaling, exhibits that conservation orientation becomes a better predictor of LNA of all offense types if it is augmented by an additional value, peace of mind. When looking at centered ratings (i.e., controlling for each person’s mean ratings), social values become the best predictors of OT2 offenses (tax evasion, benefits fraud, taking bribes). Statements on the impact of personal values on general norm acceptance should, therefore, be replaced with more differentiated relations on how particular values are related to peoples’ attitudes towards particular offenses.

Radiation-Induced Heart Disease

Cancer incidence and survivorship have had a rising tendency over the last two decades due to better treatment modalities. One of these is radiation therapy (RT), which is used in 20–55% of cancer patients, and its basic principle consists of inhibiting proliferation or inducing apoptosis of cancer cells. Classically, photon beam RT has been the mainstay therapy for these patients, but, in the last decade, proton beam has been introduced as a new option. This newer method focuses more on the tumor and affects less of the surrounding normal tissue, i.e., the heart. Radiation to the heart is a common complication of RT, especially in patients with lymphoma, breast, lung, and esophageal cancer. The pathophysiology is due to changes in the microvascular and macrovascular milieu that can promote accelerated atherosclerosis and/or induce fibrosis of the myocardium, pericardium, and valves. These complications occur days, weeks, or years after RT and the risk factors associated are high radiation doses (>30 Gy), concomitant chemotherapy (primarily anthracyclines), age, history of heart disease, and the presence of cardiovascular risk factors. The understanding of these mechanisms and risk factors by physicians can lead to a tailored assessment and monitorization of these patients with the objective of early detection or prevention of radiation-induced heart disease. Echocardiography is a noninvasive method which provides a comprehensive evaluation of the pericardium, valves, myocardium, and coronaries, making it the first imaging tool in most cases; however, other modalities, such as computed tomography, nuclear medicine, or cardiac magnetic resonance, can provide additional value.

Near-Infrared Fluorescence Imaging for the Intraoperative Detection of Endometriosis: A Pilot Study

Introduction: Endometriosis surgery is associated with a high risk of reoperation due to an insufficient recognition of endometriotic lesions. Our aim was to explore the role of near-infrared fluorescence (NIRF) imaging for the visualization and identification of endometriotic lesions next to conventional white light (WL) laparoscopy. Materials and methods: Fifteen women scheduled for diagnostic laparoscopy in whom peritoneal endometriosis was suspected were included. Peritoneal exploration was performed in WL, followed by NIRF imaging after ICG administration. Biopsies of all the suspected lesions were taken for histological examination. Subjective evaluations of the equipment and NIRF imaging were also performed. Results: Only 61% (44) of the biopsied lesions contained endometriosis. The positive predictive value (PPV) for the lesions found in WL was 64%. The PPV for the lesions found under NIRF was 69% and the PPV for the lesions found in both modes was 61%. The mean satisfaction of surgeons regarding the surgical procedure and equipment using both imaging modalities was 6.5 (p > 0.05) on a 10 item Likert scale and the mean satisfaction with the quality of the NIRF imaging was 7.4 (p > 0.05). Conclusion: In this study, the additional value of NIRF imaging, although feasible, was found to be limited for the intraoperative detection of endometriotic lesions.