Abstract Painful defecation, the passage of hard stools, unpleasant or irregular bowel deviation/movements from regular rate, and/or the feeling of not enough elimination of stool are common symptoms ...of functional constipation. The goals in treating constipation are to produce soft, painless stools and to prevent the re-accumulation of feces. This study looked at how the telerehabilitation home program (TRP) affected the symptoms of FC and the children who were constipated in terms of their quality of life. A randomized controlled trial included 400 children aging 4–18 years with functional constipation distributed in two groups: control group consisted of 200 children receiving pharmaceutical treatment and the intervention group consisted of 200 children receiving the telerehabilitation home program in addition to pharmaceutical treatment. Both groups received the interventions for 6 months. The outcomes in terms of functional constipation symptoms and quality of life are measured and compared pre- and post-interventions. Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in the condition; there is a significant difference between the intervention and control group in all Rome criteria which assess symptoms of functional constipation except rush to the bath-room to poop which showed non-significant difference; there is also a significant difference between the intervention and control group in all domains of the SF-36 questionnaire which assess quality of life except the mental health domain which showed non-significant difference. Conclusion : Adding the telerehabilitation home program to pharmaceutical treatment of functional constipation in children results in prominent improvement in symptoms of functional constipation and quality of life. Trial registration : Our study was registered retrospectively with Clinicaltrials.gov under the identifier NCT06207721 on 5 January 2024. What Is Known: • Painful defecation, passage of hard stools, unpleasant or irregular bowel movements, feeling of incomplete stool elimination are common symptoms of functional constipation. • Goals in treating constipation include producing soft, painless stools and preventing re-accumulation of feces. What Is New: • Adding telerehabilitation home program to pharmaceutical treatment resulted in significant improvement in functional constipation symptoms and quality of life. • Significant differences between intervention group (200 children receiving telerehabilitation home program in addition to pharmaceutical treatment) and control group (200 children receiving pharmaceutical treatment) were observed in all Rome criteria except for rush to the bathroom to poop, and in all domains of SF36 questionnaire except for the mental health domain.
We explored the effects of B-cell directed therapy in subjects at risk of developing autoantibodypositive rheumatoid arthritis (RA), who never experienced inflammatory arthritis before, and explored ...biomarkers predictive of arthritis development.
Individuals positive for both anti-citrullinated peptide antibodies and rheumatoid factor but without arthritis were included in a randomised, double-blind, placebo-controlled study to receive a single infusion of 1000 mg rituximab or placebo.
Eighty-one individuals received treatment and were followed up for a mean of 29.0 (0-54) months, during which 30/81 (37%) individuals developed arthritis. The observed risk of developing arthritis in the placebo-treated group was 40%, which was decreased by 55% (HR 0.45, 95% CI 0.154 to 1.322) in the rituximab-treated group at 12 months. Rituximab treatment caused a delay in arthritis development of 12 months compared with placebo treatment at the point when 25% of the subjects had developed arthritis (p<0.0001). Erythrocyte sedimentation rate and the presence of anti-citrullinated α-enolase peptide 1 at baseline were significant predictors of arthritis development.
A single infusion of 1000 mg rituximab significantly delays the development of arthritis in subjects at risk of developing RA, providing evidence for the pathogenetic role of B cells in the earliest, prearthritis stage of autoantibody positive RA.
Introduction: Xanthomas are skin swellings that are caused by the accumulation of cholesterol and lipids in the body. They are associated with lipid disorders, such as familial hypercholesterolemia ...(FH). FH is a rare genetic disorder, which is characterized mainly by high levels of low density lipoprotein cholesterol. Case presentation: The authors report a case of an 11-year-old female who had multiple swellings all over the body with the largest measuring 7×4×3 cm in diameter. These lesions were gradually increasing in size since 4 years. She was being bullied by her school colleagues because of swellings appearance. Clinical examination revealed multiple yellowish masses on the patient’s elbows, knees, and buttocks which were painless, firm, and nontender. Laboratory tests revealed elevated levels of serum cholesterol (512 mg/dl) and low density lipoprotein cholesterol (469.2 mg/dl). Masses ultrasound showed similar echogenicity to upper and lower extremities subcutaneous fat. Incisional biopsy microscopic images revealed clusters of foam cells. These findings led to a diagnosis of Homozygous FH and she underwent surgery to remove the xanthomas on her elbows. Discussion: Xanthomas are small, yellowish skin swellings that form due to the presence of high lipids. As they are typically painless and small, this could lead to a late treatment or misdiagnosis. Drugs, lifestyle changes, and surgery represent treatment plan options. Conclusion: Xanthomas can be the first indication of an underlying hypercholesterolemia problem and this case report highlights the importance of early diagnosis of Homozygous FH by providing the suitable management for this case in its early stages which can prevent developing serious complication.
Abstract
Great interest is given in recent years to the small satellites as their main advantages are the low development cost and the reduced deployment time, which give attention to develop ...payloads that can be mounted on the platform of these satellite. the platform of small satellites imposes constraints on the sensor design to fit in the size, mass and power limitations, which leads to necessary trade-offs between the design parameters of the sensor. The selection of the operating frequency is dependent mainly on the mission requirements as each frequency band gives different information about the scene and has different penetration capabilities. However, the SAR sensors used on small satellites come with limitations, so other parameters should be considered during the design. After going through the SAR design process, a frequency analysis is presented at L, C and X bands, which is used to evaluate the effect on the size of the antenna (length and width) and the average power consumption that suit the constraints of small satellite.
InSAR image noise has a great effect on the efficiency of the phase unwrapping process and consequently the correct generation of the digital elevation model (DEM). However, phase unwrapping can be ...easier and more efficient by excellent interferometric phase image filtering which can be achieved by high noise reduction, perfect preservation of the image detail, and decreasing the number of residues. In this paper, a grey-scale soft morphological filter is optimized using the genetic algorithm and used to filter out the interferometric phase image noise. The filter parameters are optimized to achieve an optimum balance between the amount of noise reduction and the degree of preservation of the image detail. Simulated and real interferograms are employed to evaluate the performance of the optimized filter. The evaluation is based on both objective and subjective measures. The results demonstrate that the proposed filter achieves high noise reduction with perfect image detail preservation and very small number of residues. This outstanding performance guarantees efficient phase unwrapping and hence accurate DEM generation. The results show also that the filter outperforms other traditional filters used for denoising interferogram images.
In rheumatoid arthritis (RA) the cause for loss of tolerance and anti-citrullinated protein antibody (ACPA) production remains unidentified. Mouse studies showed that lymph node stromal cells (LNSCs) ...maintain peripheral tolerance through presentation of peripheral tissue antigens (PTAs). We hypothesize that dysregulation of peripheral tolerance mechanisms in human LNSCs might underlie pathogenesis of RA.
Lymph node (LN) needle biopsies were obtained from 24 RA patients, 23 individuals positive for RA-associated autoantibodies but without clinical disease (RA-risk individuals), and 14 seronegative healthy individuals. Ex vivo human LNs from non-RA individuals were used to directly analyze stromal cells. Molecules involved in antigen presentation and immune modulation were measured in LNSCs upon interferon γ (IFNγ) stimulation (
= 15).
Citrullinated targets of ACPAs were detected in human LN tissue and in cultured LNSCs. Human LNSCs express several PTAs, transcription factors autoimmune regulator (AIRE) and deformed epidermal autoregulatory factor 1 (DEAF1), and molecules involved in citrullination, antigen presentation, and immunomodulation. Overall, no clear differences between donor groups were observed with exception of a slightly lower induction of human leukocyte antigen-DR (HLA-DR) and programmed cell death 1 ligand (PD-L1) molecules in LNSCs from RA patients.
Human LNSCs have the machinery to regulate peripheral tolerance making them an attractive target to exploit in tolerance induction and maintenance.
I dentifying the environmental hazards of jack-up drilling rig, which is used as an exploratory drilling and offshore service platform, yet has been under intense discussion. Risk assessment along ...with determining the likelihood of an event occurrence and the severity of its consequences can be a useful tool for identifying the priorities and making satisfactory managerial decisions. In this study, the environmental risks attributed to jack-ups in the offshore area of Iran around the South Pars gas field were studied, and finally a new mathematical model for the environmental risk assessment in this area was presented. Due to qualitative nature of some indefinite factors, fuzzy logic was applied in this model. Moreover, the model design was tailored to the ecological and environmental conditions of South Pars gas field, and several sources of risk were aggregated for the final environmental risk assessment of jack-up drilling rig. The results indicated that the total risk calculated for jack-up in transportation was tolerable and limited management measures were required. However, for the jack-up operation risks, the site was found to be faced with “unacceptable risk” or requiring extensive management measures.
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