Use of artificial intelligence in total mesorectal excision in rectal cancer surgery: State of the art and perspectives

BACKGROUND Colorectal cancer is a major public health problem,with 1.9 million new cases and 953000 deaths worldwide in 2020.Total mesorectal excision(TME)is the standard of care for the treatment of rectal cancer and is crucial to prevent local recurrence,but it is a technically challenging surgery.The use of artificial intelligence(AI)could help improve the performance and safety of TME surgery.AIM To review the literature on the use of AI and machine learning in rectal surgery and potential future developments.METHODS Online scientific databases were searched for articles on the use of AI in rectal cancer surgery between 2020 and 2023.RESULTS The literature search yielded 876 results,and only 13 studies were selected for review.The use of AI in rectal cancer surgery and specifically in TME is a rapidly evolving field.There are a number of different AI algorithms that have been developed for use in TME,including algorithms for instrument detection,anatomical structure identification,and image-guided navigation systems.CONCLUSION AI has the potential to revolutionize TME surgery by providing real-time surgical guidance,preventing complic-ations,and improving training.However,further research is needed to fully understand the benefits and risks of AI in TME surgery.

Peer pressure and academic stress among junior high school students:a cross-sectional study

Objective:The objective of the study was to explore the connection between peer pressure and academic stress among junior high school students.Methods:This descriptive correlational study was conducted to investigate the link between perceived peer pressure and academic stress.The study involved a total of 525 adolescents,aged 14-19 years,drawn from 6 public junior high schools(PJHS)in Padang,Indonesia,using purposive sampling.Academic stress and perceived peer pressure were assessed using the Educational Stress Scale for Adolescents(ESSA)and the Perceived Peer Pressure Scale(PPPS).Results:The findings indicated significant variations in stress levels among students in different grade levels(7th,8th,and 9th grades)(P<0.05),while there were no noteworthy differences in peer pressure across these grade levels(P>0.05).Additionally,there was a positive correlation observed between perceived peer pressure and academic stress(r=0.14,P<0.05).Furthermore,multiple regression analyses,incorporating demographic variables and perceived peer pressure as independent factors,yielded statistically significant results(adjusted R^(2)=0.082,F=4.33,P<0.001).Notably,peer pressure had a direct impact on academic stress among adolescents,with class level and parents’educational background mediating the relationship between academic stress and adolescent behavioral problems.Conclusions:These findings underscore the importance of addressing both external and internal factors at the individual,family,school,and societal levels to enhance adolescents’psychological resilience and mitigate problem behaviors.

Vocational Rehabilitation after Acquired Brain Injury: A Swedish Study of Benefits and Costs

Purpose: To examine the benefits from a vocational rehabilitation program for patients suffering from Acquired Brain Injury (ABI) in terms of quality of life, and overall health. In addition, to examine the direct societal costs of healthcare interventions related to vocational rehabilitation and indirect societal costs related to production loss. Method: Identified interventions in 45 patients with ABI who were discharged from a vocational rehabilitation program between 2010 and 2011 were documented, classified and translated into costs. Expenses associated with production loss were calculated by comparing sick leave production loss at first contact with the team, with sick leave production loss at discharge. Health related QoL and overall health, was measured at first contact and at discharge by using the EQ5D. Results: For vocational rehabilitation interventions, mean costs were €6303/individual/month. At first contact with the team, mean production loss was estimated to be €4409/individual/month compared;at discharge to be €2446. QoL ratings increased from first contact to discharge, although estimated health did not change. At discharge, significant correlations were found between QoL ratings and estimated health and the extent of production loss

Comparative Oral Absorption of Different Citicoline and Homotaurine Formulations: A Single-Dose, Two-Period Crossover Trial in the Dog

Background: Citicoline and homotaurine are compounds with a potent neuroprotective activity and they have been administered for many years in the treatment of numerous neurodegenerative and ophthalmological diseases, including glaucoma. Initially available only as liquid form, through parenteral route, nowadays citicoline can be administered also as tablet but no data on bioavailability of these different forms are available. In the present study, pharmacokinetics of citicoline in tablet versus vials, each at the therapeutic dose of 500 mg, in addition to 50 mg of homotaurine was investigated. Materials and methods: Ten mixed breed dogs received a single dose of 50 mg oral homotaurine and 500 mg citicoline in tablet and vials with the same dose were administered after a seven days wash-out period. Parameters assessed for citicoline metabolites (cytidine, uridine and choline) were AUC0&#8722;t, Cmax and Tmax. Results: Citicoline bioavailability appeared to be slightly higher for the tablet compared to the vial formulation. Cytidine is equivalent in absorption dynamics both for tablet and liquid form;uridine for tablet reaches its maximum and is reabsorbed more quickly while choline for the liquid form reaches the maximum first and is reabsorbed more quickly. Conclusions: Citicoline in tablet and liquid formulation have pharmacokinetic properties leading to a very similar bioavailability.

The research status of self-care agency assessment and intervention of enterostomy patients

Objective:To discuss the research status of self-care agency assessment and intervention of enterostomy patients at home and abroad,and to provide reference for medical staff to understand the defects and needs of self-care agency of enterostomy patients and implement effective intervention.Methods:By searching the literature comprehensively,the latest research progress of self-care agency assessment and intervention of enterostomy patients at home and abroad was summarized.Results:The self-care agency assessment tools for patients with enterostomy included Stoma Self-Care Scale(SSCS),Specific Self-Care for Ostomized Patients Questionnaire(CAESPO)and Self-Care Competence of the Person with an Intestinal Stoma:Nursing School of Porto(CAO-EI:ESEP).Interventions included extended care,educational intervention and multidisciplinary team nursing.Conclusion:The concept of renewal should be used to evaluate the self-care agency of enterostomy patients from various aspects.In the future,we should actively carry out standardized research on the content and time of extended nursing and educational intervention,promote the extensive and standardized implementation of multidisciplinary team nursing,and promote the comprehensive improvement of self-care agency of enterostomy patients.

AB073.Correlations between control of saccadic eye movements and performance in other cognitive tasks in younger adults,older adults and patients with Parkinson’s disease

Background:Cognitive control is defined as the ability to act flexibly in the environment by either behaving automatically or inhibiting said automatic behaviour and it can be measured using an interleaved pro/anti-saccade task.Decline in cognitive control has been attributed to normal aging and neurological illnesses such as Parkinson’s disease(PD)as well as decline in other cognitive abilities.This parallel might highlight the role played by cognitive control in information processing and working memory.However,little is known about the relationship between cognitive control and other cognitive processes such as visual memory,decision making,and visual search.We thus propose to correlate the incidence of impaired cognitive control with deficits in visual memory,decision making and visual search in three groups:younger adults,older adults and patients with idiopathic PD.Methods:Seventy-one participants,namely 34 adults(M=22.75,SD=3.8),22 older adults(M=67.4,SD=8.3),and 20 PD patients(M=65.59,SD=8.2)performed four tasks:interleaved pro/anti-saccade,visual memory,decision making,and serial and pop-out visual search.Results:Results show that within each group,anti-saccade error rate(ER)were significantly and negatively correlated with visual memory ER(ryounger=−0.378,P=0.036;rolder=−0.440,Polder=0.046;rPD=−0.609,P=0.016).On the other hand,correct decision-making reaction times(RT)were significantly correlated with anti-saccade ER,and RTs only in older adults(rER=0.529,P=0.014;rRT=0.512,P=0.018)and PD patients(rER=0.727,P=0.012;rRT=0.769,P=0.001).For visual search,PD patients showed a significant relationship between RTs for correct pro-saccades and pop-out(r=0.665,P=0.007),and serial(r=0.641,P=0.010)search RTs.Furthermore,there was a significant correlation between MoCA scores and anti-saccade RTs(r=−0.559,P=0.030)and ER(r=−0.562,P=0.029)in PD patients.Taken together,these results support the hypothesis of PD patients’reliance on bottom-up processes as top-down processes decline.For younger adults,there was a significant correlation between serial search performance and both anti-saccade ER(r=0.488,P=0.005),and correct pro-saccade ER(r=0.413,P=0.021).In older adults,this relationship was absent,but anti-saccade ER significantly correlated with pop-out search times(r=0.473,P=0.030).Conclusions:We found significant relationships between cognitive tasks and cognitive control as measured through the interleaved pro/anti-saccade task across and within participant groups,providing evidence of the appropriateness of the use of the interleaved pro/anti-saccade task as a measure of overall cognitive control.

A Qualitative Study of Individual and Organizational Learning through Physiotherapists’ Participation in a Research Project

The need for evidence-based practice has been recognized by physiotherapy organizations over the past decades. Earlier studies have documented facilitators and barriers that affect the use and implementation of evidence-based practice. Less is known about what kind of interventions might be useful to implement evidence-based practice. This study explores what physiotherapists learn through participation in a research project relevant to their professional development towards achieving a more evidence-based physiotherapy practice. To what extent this learning was transferred to colleagues for organizational learning is also examined. This study was set in Sweden, where health care is publicly funded. Patients do not need a referral from a physician to consult a physiotherapist. Eleven interviews were conducted with physiotherapists who had participated in a randomized, controlled, multicenter, physiotherapy intervention investigating neck-specific exercise for patients with whiplash disorder. Gadamer’s hermeneutics was used to analyze the data. The physiotherapists described a range of learning experiences from their project participation, including instrumental learning (the concrete application of knowledge to achieve changes in practice) and conceptual learning (changes in knowledge, understanding or attitudes). The research project enabled the physiotherapists to develop new treatment techniques for broader application and extend their competence in techniques already known (instrumental learning). The physiotherapists believed that project participation enhanced their overall competence as physiotherapists, increased their job motivation and strengthened their self-confidence and self-efficacy (conceptual learning). Physiotherapists’ participation in the research project yielded many individual learning experiences, fostered positive attitudes to research and was conducive to achieving a more research-informed physiotherapy practice. Participation was associated with a deeper understanding of the challenges involved in conducting research. The transfer from individual learning to the wider organization in terms of organizational learning was limited.

Undiagnosed obstructive sleep apnea in hypertensive outpatients in primary care—Associations with sleep complaints, depressive symptoms and global perceived health

Objective: 1) To describe the prevalence of undiagnosed obstructive sleep apnea (OSA) and depressive symptoms in hypertensive men and women below 65 years of age, and 2) to describe the association of OSA to subjective sleep complaints, depressive symptoms and global perceived health. Design: Cross-sectional design focusing on nursing care outcomes of obstructive sleep apnea. Setting: Four primary care health centres in Sweden. PATIENTS: 411 consecutive patients (52% women), mean age 57.9 years (SD 5.9 years), with diagnosed hypertension (BP > 140/90). Main Outcome Measures: Prevalence of OSA and depressive symptoms, and association of OSA to sleep complaints, depressive symptoms and global perceived health. RESULTS: Mild, moderate and severe OSA was seen among 29%, 16% and 14% of patients, respectively. Depressive symptoms were seen in 16% of the total group, with a higher prevalence among men, compared to women, 21% vs. 12%. No differences were found regarding blood pressure, estimated sleep need, sleep sufficiency index, insomnia symptoms, daytime sleepiness or depressive symptoms with respect to different degrees of OSA. Apnea-hypopnea index was significantly associated to perceived health after adjustment for gender and comorbidities, but when depressive symptoms and non-restorative sleep were added to the model, 33% of the variance in global perceived health was explained. Conclusion: OSA is highly prevalent among patients with hypertension in primary care and does together with sleep complaints and depressive symptoms have a negative impact on global perceived health. Hypertensive patients without subjective sleep complaints or depressive symptoms may still have OSA.

Gastroprotection induced by capsaicin in healthy human subjects

AIM： To evaluate the gastro-protective effect of capsaicin against the ethanol- and indomethacin （IND）-induced gastric mucosal damage in healthy human subjects. METHODS： The effects of small doses （1-8 μg/mL, 100 mL） of capsaicin on the gastric acid secretion basal acid output （BAO） and its electrolyte concentration, gastric transmucosal potential difference （GTPD）, ethanol- （5 mL 300 mL/L i.g.） and IND- （3×25 mg/d） induced gastric mucosal damage were tested in a randomized, prospective study of 84 healthy human subjects. The possible role of desensitization of capsaicin-sensitive afferents was tested by repeated exposures and during a prolonged treatment. RESULTS： Intragastric application of capsaicin decreased the BAO and enhanced “non-parietal” component, GTPD in a dose-dependent manner. The decrease of GTPD evoked by ethanol was inhibited by the capsaicin application, which was reproducible. Gastric microbleeding induced by IND was inhibited by co-administration with capsaicin, but was not influenced by two weeks pretreatment with a daily capsaicin dose of 3×400μg i.g. CONCLUSION： Capsaicin in low concentration range protects against gastric injuries induced by ethanol or IND, which is attributed to stimulation of the sensory nerve endings.

Depression and chronic heart failure in the elderly： an intriguing relationship

Chronic heart failure and depressive disorders have a high prevalence and incidence in the elderly. Several studies have shown how depression tends to exacerbate coexisting chronic heart failure and its clinical outcomes and vice versa, especially in the elderly. The negative synergism between chronic heart failure and depression in the elderly may be approached only taking into account the multifaceted pathophysiological characteristics underlying both these conditions, such as behavioural factors, neurohormonal activation, inflammatory mediators, hypercoagulability and vascular damage. Nevertheless, the pathophysiological link between these two conditions is not well established yet. Despite the high prevalence of depression in chronic heart failure elderly patients and its negative prognostic value, it is often unrecognized especially because of shared symptoms. So the screening of mood disorders, using reliable questionnaires, is recommended in elderly patients with chronic heart failure, even if cannot substitute a diagnostic interview by mental health professionals. In this setting, treatment of depression requires a multidisciplinary approach including： psychotherapy, antidepressants, exercise training and electroconvulsive therapy. Pharmacological therapy with selective serotonin reuptake inhibitors, despite conflicting results, improves quality of life but does not guarantee better outcomes. Exercise training is effective in improving quality of life and prognosis but at the same time cardiac rehabilitation services are vastly underutilized.

Role of monoclonal antibody drugs in the treatment of COVID-19

Currently clinicians all around the world are experiencing a pandemic caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).The clinical presentation of this pathology includes fever,dry cough,fatigue and acute respiratory distress syndrome that can lead to death infected patients.Current studies on coronavirus disease 2019(COVID-19)continue to highlight the urgent need for an effective therapy.Numerous therapeutic strategies have been used until now but,to date,there is no specific effective treatment for SARS-CoV-2 infection.Elevated inflammatory cytokines have been reported in patients with COVID-19.Evidence suggests that elevated cytokine levels,reflecting a hyperinflammatory response secondary to SARS-CoV-2 infection,are responsible for multi-organ damage in patients with COVID-19.For these reason,numerous randomized clinical trials are currently underway to explore the effectiveness of biopharmaceutical drugs,such as,interleukin-1 blockers,interleukin-6 inhibitors,Janus kinase inhibitors,in COVID-19.The aim of the present paper is to briefly summarize the pathogenetic rationale and the state of the art of therapeutic strategy blocking hyperinflammation.

Effectiveness of oral probiotics supplementation in the treatment of adult small chalazion

AIM:To define the possible beneficial impact of probiotics oral supplementation on patients affected by chalazion.METHODS:Prospective comparative pilot study on 20 adults suffering from chalazion randomly divided into two groups.The first group(n=10)received conservative treatment with lid hygiene,warm compression,and dexamethasone/tobramycin ointment for at least 20 d.The second group(n=10),in addition to the conservative treatment,received a mixture of probiotic microorganisms of Streptococcus thermophilus ST10(DSM 25246),Lactococcus lactis LLC02(DSM 29536)and Lactobacillus delbrueckii(DSM 16606)once a day up to 3 mo.Chalazia were classified according to their size into three groups:small(<2 mm),medium(≥2 to<4 mm),or large(≥4 mm).When conservative treatment with and without probiotics supplementation failed to resolve the lesion,invasive methods were used,intralesional steroid injection in medium size chalazion and surgical incision and curettage for the largest ones.RESULTS:Medical treatment with or without probiotics supplementation was effective only on the small size chalazia.There was a significant difference in the time taken for complete resolution of small size chalazia between the two groups in favor of the patients receiving probiotics(38.50±9.04 d vs 21.00±7.00 d,P=0.039).Medium and large size chalazia did not respond to medical treatment with or without probiotics supplementation over the follow-up period(3 mo).The treatment did not induce any complications in both groups and no recurrence of chalaziosis was recorded in both groups.CONCLUSION:The considerable difference in time taken for complete resolution of small chalazia between the two groups in favor of the experimental one confirms the presence of a gut-eye axis.

Support Systems Designed for Older Drivers to Achieve Safe and Comfortable Driving

Background: The number of older people is increasing. Many of them expect to maintain a rich social life and to continue driving at an older age. Objective: The present study investigates the mechanisms behind self-regulation and driving cessation in order to suggest development of support systems to prolong older drivers’ safe mobility. Method: Three focus groups were conducted with 19 older active drivers aged 65+ who were divided according to annual mileage driven. Results: A content analysis revealed broad self-regulatory behaviour as already reported in the literature, e.g., avoiding driving at rush hour and at night. The participants also reported difficulty in finding the way to their final destination and an increasing need to plan their travelling. Co-piloting was a behaviour applied by couples to cope with difficulties encountered in traffic. A large part of the discussion was focused on emerging feelings of stress, anxiety and fear when driving in recent years, a feeling induced by external factors e.g., other road users’ behaviour, traffic density or high speed. Apart from health problems, high levels of stress could explain driving cessation, especially for women. An increased feeling of safety and comfort could be achieved by an increased use of support systems specifically designed to respond to older drivers’ needs. Conclusion: Support systems for older drivers should increase comfort and decrease their stress levels. New systems, such as co-pilot function and more developed Global Positioning System (GPS) supporting of the entire travel from door to door, should be developed to respond to the market needs.

Life before Myocardial Infarction<br/>—A Qualitative Study of Middle-Aged Women

The health burden of myocardial infarction is rising for middle-aged women and they are underrepresented in research of cardiovascular diseases. The aim of this qualitative study was to explore how life had been for middle-aged women before they suffered a myocardial infarction (MI). Through a health care register, we identified all women (n = 46) under 65 years of age in a defined region in southeast Sweden who had suffered an MI the past 2 years and a strategic selection of n = 16 women from these was made. These selected women were interviewed and their narratives were interpreted by qualitative content analysis. The qualitative interviews generated five general themes: “Serious life events”, “Negative affectivity”, “Loneliness”, “Being a good girl” and “Lack of control”. The interviews revealed that many of these women had been exposed to extreme and repeated traumatic life events in their lives. Many had a cynical attitude towards others, felt lonely and experienced a lack of social support. Many of these women endeavored to “be a good girl”, which was a special psychosocial phenomenon found. This study uncovered that these women before they suffered an MI were affected by a variety of psychosocial factors. The study stresses the importance of psychosocial risk factors in the assessment of middle-aged women’s risk profile for MI. A general conclusion for clinical practice is that in the assessment of the individual risk for myocardial infarction for middle-aged women, potential psychosocial factors might also be considered.

Feasibility of a Fully Automated Multiple Session Alcohol Intervention to University Students,Using Different Modes of Electronic Delivery—The TOPHAT 1 Study

Background: In recent years more and more electronic health behaviour interventions have been developed in order to reach individuals with an unhealthy behaviour such as risky drinking. This is especially relevant in university students who are among those who most frequently are risky drinkers. This study explored the acceptability and feasibility, in an unselected group of university students, of a fully automated multiple session alcohol intervention offering different modes of delivery such as email, SMS and Android. Material and Methods: A total of 11,283 students at Link?ping University in Sweden were invited to perform a single session alcohol intervention and among those accepting this (4916 students) a total of 24.7% accepted to further participate in the extended multiple intervention lasting 3 - 6 weeks. The students could choose mode of delivery, total length of the intervention (between 3 - 6 weeks) and number of messages per week (3, 5, or 7 per week). A follow-up questionnaire was applied after the intervention to which 82.7% responded. Results: most students wanted to receive the messages by email with the shortest intervention length (3 weeks) and as few messages as possible per week (3 messages). However, no major difference was seen regarding satisfaction with the length and frequency of the intervention despite chosen length and frequency. Most students also expressed satisfaction with the content of the messages and would recommend the intervention to a fellow student in need of reducing drinking. Discussion and Conclusion: Based upon feedback from the students, a multiple push-based intervention appears to be feasible to offer students interested in additional support after a single session alcohol intervention. In a forthcoming study we will further explore the optimal mode of delivery and length of intervention and number of messages per week.

High concentration but low biological activity of hepatocyte growth factor in patients with chronic renal failure

Hepatocyte growth factor (HGF) is a renotropic, antifibrotic and regenerative factor with cytoprotective effects that is produced by mesenchymal cells and shows high affinity to components of extra cellular matrix, such as heparan sulphate proteoglycan (HS-PG), in healthy. Patients with chronic renal failure (CRF) suffer from a chronic inflammatory disorder. In order to assess the underlying mechanisms for development of CRF we aimed to assess the amounts and affinity of HGF in this patient group. Elisa, western blot and surface plasmon resonance (SPR) were used to study HGF in blood samples, as well as in isolated neutrophils, in CRF patients compared to healthy controls. Patients with CRF showed higher HGF levels in serum (P P < 0.0001), compared to healthy controls. Addition of protease inhibitors decreased the difference between patients with CRF compared to healthy individuals. HGF with potent regenerative function during injury lacks affinity to HSPG in patients with CRF that may depend on production of proteases from activated immune cells. This information might be used to highlight underlying mechanisms for chronicity and leading to new strategies for treatment of chronic injuries.

Eye Tracking during High Speed Navigation at Sea--Field Trial in Search of Navigational Gaze Behaviour

Purpose: Professional high speed sea navigational procedures are based on turn points, courses, dangers and steering cues in the environment. Since navigational aids have become less expensive and due to the fact that electronic sea charts can be integrated with both radar and transponder information, it may be assumed that traditional navigation by using paper based charts and radar will play a less significant role in the future, especially among less experienced navigators. Possible navigational differences between experienced and non-experienced boat drivers is thus of interest with regards to their use of navigational aids. It may be assumed that less experienced navigators rely too much on the information given by the electronic sea chart, despite the fact that it is based on GPS information that can be questioned, especially in littoral waters close to land. Method: This eye tracking study investigates gaze behaviour from 16 ex perienced and novice boat drivers during high speed navigation at sea. Results: The results show that the novice drivers look at objects that are close to themselves, like instrumentation, while the experienced look more at objects far away from the boat. This is in accordance with previous research on car drivers. Further, novice boat drivers used the electronic navigational aids to a larger extent than the experienced, especially during high speed conditions. The experienced drivers focused much of their attention on objects outside the boat. Conclusions: The findings verify that novice boat drivers tend to rely on electronic navigational aids. Experienced drivers presumably use the navigational aids to verify what they have observed in the surrounding environment and further use the paper based sea chart to a larger extent than the novice drivers.

Circulating inflammatory factors associated with worse long-term prognosis in colorectal cancer

AIM To investigate association of circulating inflammatory factors at the time of colorectal cancer(CRC) surgery with survival.METHODS Plasma levels from 174 CRC patients(69 females and 105 men), with median age 70 years(range 29-90), localized in the colon(n = 105) or rectum(n = 69), with stage Ⅰ(n = 24), stage Ⅱ(n = 54), stage Ⅲ(n = 67) and stage Ⅳ(n = 29) were measured using commercially available Bio-Plex Pro? Human Chemokine Panel 40-Plex, including 40 different chemokines, cytokines and interleukins. The prognostic association of each inflammatory factor was analysed as CRC-specific and total mortality.RESULTS Out of 174 patients, 66 died during the follow-up, 40 because of CRC specific mortality. High tertile levels of 8 factors were significantly associated with increased CRC-specific mortality, of which CCL1, CCL20, CCL24, CX3CL1, IL-4 and TNF-α remained significant in a multivariate Cox regression analysis. High tertile levels of 14 factors were associated with increased total mortality, of which CCL1, CCL15, CCL20, CX3CL1, CXCL13, IFN-γ, IL-2, IL-4 and IL-10 remained significant after adjustment for clinical covariates. For most of the inflammatory factors the association between higher tertile levels and an increased mortality in general appeared two years after surgery. High tertile levels of TNF-α and CCL24 were exclusively associated with CRC-specific mortality. The distribution of these factors were not associated with TNM stage with exception for CCL20.CONCLUSION High plasma levels of inflammatory factors are associated with increased risk of mortality among CRC patients and could be potential biomarkers for revealing prognosis.

Beyond the joint: Subclinical atherosclerosis in rheumatoid arthritis

Rheumatoid arthritis is a chronic autoimmune inflammatory disease associated with increased cardiovascular risk and higher mortality in respect to general population.Beyond joint disease,inflammation is the major determinant of accelerated atherosclerosis observed in rheumatoid arthritis.We review the relationship between inflammation,atherosclerosis and cardiovascular risk in rheumatoid arthritis,focusing on the assessment of subclinical atherosclerosis by functional and morphological methods.These tools include flow mediated dilatation,carotid intima-media thickness,ankle/brachial index,coronary calcium content,pulse wave analysis and serum biomarker of subclinical atherosclerosis.

Decomposition pattern and insect colonization in two cases of suicide by hanging

Hanging is one of the most common methods of suicide worldwide.Despite the high incidence,only a little knowledge about the pattern of cadaver colonization by insects on hanging corpse is available.Different types of hanging can alter the body decomposition process as well as the pattern and rate of insect colonization.Two case studies where the hanging occurred with a similar postmortem interval of 34 days are described.The two bodies showed different patterns of insect colonization and decomposition scored using the Total Body Score (TBS) and the TBS for hanging (TBShang).The first case was about the body of a 24-years-old male,with mummification of the unclothed upper anatomical parts.A TBS of 14 and a TBShang of 18 were assigned.The second body,belonging to a 1 S-years-old male,was found pre-skeletonized lying on the ground with the skull disarticulated.A TBS of 31 and a TBShang of 32 were assigned.Average temperatures of (21.5 ± 2.5) ℃ for the first body and (25.1 ± 2.7) ℃ for the second body were recorded in the 34 days preceding the bodies' discovery for a total of 731 and 853 Accumulated Degree Days (ADD) respectively.According to previous studies,the different decomposition patterns were related to temperatures of exposition and to the diversity of arthropod community found on the bodies because of the different types of hanging: totally suspended vs.in contact with the soil.The limited insect activity caused by hanging explains the delay in decomposition of hanging bodies in which mummification can take place,especially on the upper body parts.In vertical body position,the body fluids accumulated in the lower body parts accelerating the desiccation of soft tissues on the upper parts.The effect of gravity can also explain the decrease of internal maggot mass as larvae easily fall from the hanging body to the drip zones below where they are unable to recolonize the body if totally suspended.Furthermore,in a hanging body a greater surface is exposed to wind and sun with a quicker skin drying preventing the additional Diptera colonization.This paper shows the weaknesses of scoring scales and regression models developed to predict ADD when irregular decomposition and mummification have not taken into account.