Corrected evaluation of the breech presentation outcome based on etiology of this presentation in congenitally malformed uterus.

Background: Breech presentation (BP) results from at random filling of the intrauterine cavity, with an equal probability for a BP or cephalic presentation (CP). Each fetus in BP has its "pair" in CP randomly assumed CP. Direct comparison of BP and CP makes bias to less expressed differences between these two groups. It is therefore necessary to subtract the number of fetuses/newborns from the CP set that are identical to the number of fetuses/newborns in the BP set, with identical characteristics, and add this group to the BP set before comparing them to the rest of the CP fetuses/newborns in the matching process. Methods: The procedure encompasses nine variables in pregnancies with a congenitally malformed uterus (CMU) identified at the Department of Obstetrics (1985-2014): gestational age, birth mass, birth length, head circumference, shoulders circumference, umbilical length, placental weight, newborn mass/newborn length ratio, and newborn mass/placental mass ratio. Firstly, the probability of BP was determined and its relation to gestational age, physical characteristics, and previous presentations. Then direct comparison as well as case-control matching of the CP and BP were performed. Case-control matching was based on either a single specific variable (M1) or all combined variables (M2). Findings: 462 deliveries were identified with CMU. In 81 cases of multiparity, a fetal presentation was found to be an independent event regardless of the previous presentation, gestational age, and newborn physical characteristics. In four types of CMU with 337 deliveries (Bicornuate, Didelphys, Unicornuate, Arcuate), 9 variables with 36 instances of comparison were observed. M1 in 10 instances and M2 in 6 instances showed a statistically significant lower value of breech/random presentation compared with CP. CP have lower value in 2 instances in M1 and 1 in M2. Statistically significant differences were absent without the matching process. Interpretations: The study confirms the maximum probability for the BP is 50%. The case-control matching procedure shows that it is able to detect the difference between the breech/random presentation and CP, while the classic method of direct comparison was unable to detect any differences. The outcome of the breech/random presentation in CMU should be evaluated with the described case-control matching procedure.

Waste tire carbon in synergetic interaction with spent gamma radioactive source for efficient radiocatalytic degradation of organic dye.

Enhanced degradation of organic dye was achieved using two different kinds of waste materials: waste tire granules and spent sealed radioactive sources. Waste tire granules were used as raw material for the production of waste tire char (WTC), which was further utilized as an adsorbent matrix for synergetic adsorption/irradiation degradation of organic dye. The spent radioactive sources were radiographic sealed sources that originate from the industry which generate the high energy radiation. Methylene Blue (MB) was used as an organic model compound. Synthesized WTC has turbostratic structure, irregular shaped particles and developed mesoporous surface. Complete degradation of 0.02 dm3 of 100 mg dm-3 MB solution, having WTC dose of 1.25 g dm-3, was achieved with delivered doze of only 60 Gy. The applied doses were 100 times smaller than those presented in the literature. Degradation pathway was determined: OH radicals that originate from radiolysis of water and from the surface of WTC played the crucial role in the radiocatalytic degradation of MB. Breakage of the aromatic ring of MB appeared by the scission of the double C‒S+Ë­C bond as a result of the attack of OH species on adsorbed and electronically reorganized MB molecule.

Intelligent Poly(N-Isopropylmethacrylamide) Hydrogels: Synthesis, Structure Characterization, Stimuli-Responsive Swelling Properties, and Their Radiation Decomposition.

Poly(N-isopropylmethacrylamide) (p(NiPMAm)) is one of the lesser known homopolymers that has significant potential for designing new "intelligent" materials. The aims of this work were the synthesis a series of cross-linked p(NiPMAm) hydrogels by the free radical polymerization method and the application of gamma-ray radiation for additional cross-linking. The synthesized p(NiPMAm) hydrogels were structurally characterized by Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). The amount of unreacted monomers was analyzed using high pressure liquid chromatography (HPLC) to evaluate conversion of monomers into polymers. The swelling behavior was monitored in dependence of pH and temperature changes. The previous aim of gamma-ray radiation was the further the cross-linkage of the obtained hydrogel sample in the gelatinous, paste-like state, but the gamma-ray radiation caused decomposition. After absorbing irradiation doses, they transformed into the liquid phase. The results obtained by the gel permeation chromatography (GPC) method indicated that only oligomers and monomers were present in the irradiated liquid material, without molecules with a higher average molar mass, i.e., that the decomposition of the hydrogels occurred. Additionally, the irradiated liquid material was analyzed using the static headspace gas chromatography mass spectrometry (HSS-GC/MS) and gas chromatography/flame ionization detection (HSS-GC/FID) methods. The presence of unchanged initiator molecule and a dominant amount of four new molecules that were different from homopolymers and the reactant (monomer and cross-linker) were determined.

mHealth Interventions for Health System Strengthening in China: A Systematic Review.

BACKGROUND: With rapidly expanding infrastructure in China, mobile technology has been deemed to have the potential to revolutionize health care delivery. There is particular promise for mobile health (mHealth) to positively influence health system reform and confront the new challenges of chronic diseases. OBJECTIVE: The aim of this study was to systematically review existing mHealth initiatives in China, characterize them, and examine the extent to which mHealth contributes toward the health system strengthening in China. Furthermore, we also aimed to identify gaps in mHealth development and evaluation. METHODS: We systematically reviewed the literature from English and Chinese electronic database and trial registries, including PubMed, EMBASE, Cochrane, China National Knowledge of Infrastructure (CNKI), and World Health Organization (WHO) International Clinical Trials Registry Platform. We used the English keywords of mHealth, eHealth, telemedicine, telehealth, mobile phone, cell phone, text messaging, and China, as well as their corresponding Chinese keywords. All articles using mobile technology for health care management were included in the study. RESULTS: A total of 1704 articles were found using the search terms, and eventually 72 were included. Overall, few high quality interventions were identified. Most interventions were found to be insufficient in scope, and their evaluation was of inadequate rigor to generate scalable solutions and provide reliable evidence of effectiveness. Most interventions focused on text messaging for consumer education and behavior change. There were a limited number of interventions that addressed health information management, health workforce issues, use of medicines and technologies, or leadership and governance from a health system perspective. CONCLUSIONS: We provide four recommendations for future mHealth interventions in China that include the need for the development, evaluation and trials examining integrated mHealth interventions to guide the development of future mHealth interventions, target disadvantaged populations with mHealth interventions, and generate appropriate evidence for scalable and sustainable models of care.

Comparison of the efficiency of clomiphene citrate and letrozole in combination with metformin in moderately obese clomiphene citrate-resistant polycystic ovarian syndrome patients.

INTRODUCTION: Polycystic ovary syndrome is the most common endocrinopathy in women of reproductive-age. Therapy for those who want to get pregnant involves ovulation induction using clomiphene citrate, metformin, letrozole and gonadotropins. OBJECTIVE: The aim of the study was to compare the efficacy of combinations of clomiphene citrate-metformin and letrozole-metformin in obese patients who are resistant to clomiphene citrate alone. METHODS: The investigation was conducted as a retrospective study involving 60 moderately obese patients with polycystic ovary syndrome. Thirty-one of them received the clomiphene citrate-metformin, and 29 letrozole-metformin therapy. Stimulation was carried out for the procedures of intrauterine insemination (IUI). RESULTS: The age of patients, duration of infertility, and body mass index in both groups were similar. There was statistically significant difference in the thickness of the endometrium in favor of the group having the letrozole-metformin therapy (8.9 ± 1.7 mm) compared with the group receiving the clomiphene citrate-metformin treatment (6.3 ± 1.3 mm). The number of follicles was not statistically significantly different. Pregnancy rate in the first cycle of IUI in the clomiphene citrate group was 6.4%, and 17.2% in the letrozole group, which also was not statistically different. After the third IUI cycle, the pregnancy rate was significantly higher in the letrozole group (20.6%), while in the clomiphene citrate group it was (9.6%). CONCLUSION: This retrospective study demonstrated the advantages of the use of letrozole over clomiphene citrate in combination with metformin in moderately obese patients with polycystic ovary syndrome who are resistant to stimulation with clomiphene citrate alone.

Appearance of fetal pain could be associated with maturation of the mesodiencephalic structures.

Fetal pain remains a controversial subject both in terms of recognizing its existence and the time-frame within which it appears. This article investigates the hypothesis that pain perception during development is not related to any determined structures of the central nervous system (CNS), on the contrary, the process of perception could be made with any structure satisfying conditions that the perception of pain is the organization, identification, and interpretation of sensory information in order to represent and understand the environment. According to this definition, chronic decerebrate and decorticate experimental animals, anencephalic, and hydranencephalic patients demonstrate that the basic, most general, appropriate interaction with the environment can be achieved with a functional mesodiencephalon (brain stem, and diencephalon) as the hierarchically highest structure of the CNS during development. In intact fetuses, this structure shows signs of sufficient maturation starting from the 15th week of gestation. Bearing in mind the dominant role of the reticular formation of the brain stem, which is marked by a wide divergence of afferent information, a sense of pain transmitted through it is diffuse and can dominate the overall perception of the fetus. The threshold for tactile stimuli is lower at earlier stages of gestation. The pain inhibition mechanisms are not sufficiently developed during intrauterine development, which is another factor that leads to increased intensity of pain in the fetus. As a conclusion it could be proposed that the fetus is exposed to rudimentary painful stimuli starting from the 15th gestation week and that it is extremely sensitive to painful stimuli.

[The Presence of Non-Carious Lesions in Children].

INTRODUCTION: A non-carious lesion (NCL) is the loss of hard dental tissue on the neck, tuberculum and incisal edges of the teeth. Interest in clinical presence and in unclear etiology of these lesions allows for their future prevention and treatment. OBJECTIVE: The aim of the study was to determine presence and clinical characteristics of NCLs and dentine hypersensitivity (DH), as well as their possible risk factors in children, in the population of the city of Novi Sad. METHODS: A total of 55 subjects were included in the present study, aged between three and 18 years. Each subject completed a structured questionnaire related to the etiological factors, and all teeth of each subject were examined by two independent clinical dentists to determine NCLs and DH. In the case of small children, their parents or guardians filled out the questionnaire. Teeth with NCLs and DH were diagnosed according to the Basic Erosive Wear Examination (BEWE) index and by a blast of air according to Schiff and Hypersensitivity Index. The review was carried out by inspection and probing. RESULTS: The data were analyzed by clinical examination and comparison of the answers to the questionnaires. We observed an increased presence of non-caries lesions on primary teeth, compared to permanent teeth, with a statistically significant difference (X2=3.86, df=1, p=0.04). The changes were observed in 82 teeth, and were most frequent on the canine deciduous teeth (65%) and canine permanent teeth (51%). BEWE index was 10-11% to 92-100% in permanent, and 51-57% in deciduous teeth. Majority of patients with primary teeth (89.36%) did not respond to air stimulus, while most patients with permanent teeth (74.29%) did not react to Schiff Index. In the estimate of sensitivity, the respondents reported hypersensitivity on 6.38% of the deciduous teeth and 22.86% of the permanent teeth. Comparison of etiology factors did not reveal a direct link with the appearance of NCLs. CONCLUSION: Research has shown that despite the lack of subjective symptoms, these lesions have distinct clinical characteristics. The fact that they occur even in deciduous dentition justifies the need for further investigations.

Examination of the bioelectrical activity of the masticatory muscles during Angle's Class II division 2 therapy with an activator.

BACKGROUND/AIM: The muscles of the orofacial region have great influence on the development of dentition and occlusion formation. It is known that improper function of these muscles is one of the major etiological factors in malocclusion. A correlation between function disorders of orofacial muscle and occlusion disorders has been confirmed, as well as a correlation between the bioelectric activity of the masticatory muscles, recorded by electromyography, and bite force upon maximal voluntary contraction of these muscles. The aim of the study was to analyze the bioelectriacal activity of temporal and masseter muscles. METHODS: The sample consisted of 100 subjects of both sexes, divided into the control group (n = 30) with neutral and complete dental arches, and the study group (n = 70) of patients with distal occlusion. Electromyographic measurement of bioelectric potentials in all the subjects was conducted for the examined muscles in the physiologic rest position, central mandible occlusion, and during maximal voluntary contraction of muscles and saliva swallowing, in Angle Class I and II/2 occlusal relationships, prior to treatment, after one year of the orthodontic treatment and after the treatment with an activator. RESULTS: Comparing the values of the bioelectrical activity in the control and the study group before the treatment, a decreased muscle activity was established in all the three positions in the study group. After the first year of orthodontic treatment the results showed an elevation in the bioelectrical activity in both muscles. After treatment with an activator, the bioelectrical activity in both muscles in the study group was higher than before the treatment, as it is confirmed by a positive highly significant coefficient of correlation. CONCLUSION: In all the three measured positions of the mandible with Angle Class II/2 malocclusion, bioelectrical activity was lowest at baseline and increased during the first year of treatment, and at the end of the treatment it partially reduced close to the approximate values in normal occlusion. Research on electromyographic activity of masticatory muscles is useful in everyday clinical practice, especially in present distinctive skeletal discrepancy before, during and after orthodontic treatment, if on the bases of the results we can evaluate the treatment, but also determine the start and duration of the retention period and retention device type.

Blunt chest trauma--an audit of injuries diagnosed by the MDCT examination.

BACKGROUND/AIM: Multidetector computed tomography (MDCT) characterised by speed and precision is increasingly accessible in emergency wards. The aim of our study was to determine the most common injuries to the chest region, as well as type associated extrathoracic injuries, and the treatment outcome. METHODS: This prospective study included 61 patients with blunt trauma who were submitted to computed tomography (CT) of the thorax. The number of injuries was evaluated by organs and organ systems of the chest. The cause of the injury, the length and the outcome of the treatment, and the presence of injuries in other regions were assessed. RESULTS: Chest injuries were associated with injuries to other regions in 80.3% cases, predominantly injuries to extremities or pelvic bones in 54.1% cases, followed by head injuries in 39.3% patients. Associated thoracic injuries were present in 90.9% of patients with lethal outcome. Lung parenchymal lesions, pleural effusions and rib fractures were the most common injuries affecting 77.1%, 65.6% and 63.9% of the cases, respectively. CONCLUSION: Blunt chest trauma is a significant problem affecting predominantly males in their forties and it is usually caused by a motor vehicle accident. In case of pneumomediastinum or mediastinal haematoma, the use of 3D reconstructions is advised for diagnosing possible tracheobronchial ruptures and thoracic aorta injuries. Increased resolution of CT scanners yielded a large number of findings that are occult on radiography, especially in the event of lung parenchymal and pleural injuries. However, none imaging modality can replace surgical judgement.

[Impact of the level of metabolic control on the non-surgical periodontal therapy outcomes in diabetes mellitus type 2 patients--clinical effects].

INTRODUCTION: Diabetes mellitus as a complex metabolic disease influences functioning of numerous organs. Chronic periodontitis is one of frequent diabetic complications. OBJECTIVE: The aim of this study was to compare the clinical effects of non-surgical periodontal therapy between diabetes mellitus type 2 patients (DM type 2) and non-diabetic individuals (control group). METHODS: Our study included 41 DM type 2 subjects and 21 non-diabetic individuals, all of them with chronic periodontitis. The diabetic group was divided into two subgroups based on the level of glycosylated hemoglobin (HbA1c) as follows: D1 - 18 subjects with good metabolic control (HbA1c < 7%), and D2 - 23 subjects with poor metabolic (HbA1c > or = 7%). State of oral hygiene and periodontal clinical parameters of subjects, such as: plaque index (PI), gingival index (GI), papilla bleeding index (PBI), probing pocket depth (PPD) and clinical attachment level (CAL), were evaluated at the baseline and 3 months after scaling and root-planning. RESULTS: ANOVA test showed that there was no statistically significant difference of treatment success between studied groups in relation to GI (p = 0.52), PBI (p = 0.36) and CAL (p = 0.11). Reduction of PI and PPD in the control group (deltaPI = 0.84; deltaPPD = 0.35 mm) was significantly higher (p < 0.05) than the reduction of PI and PPD in patients with the diabetes (group D1 deltaPI = 0.60, deltaPPD = 0.11 mm; group D2 deltaPI = 0.53, deltaPPD = 0.11 mm). CONCLUSION: Although there were differences in treatment success between DM subjects and non-diabetic individuals, they were not significant for the most measured parameters. The results of this study did not absolutely support the assumption that the level of glycemic control significantly affected the periodontal therapy outcome in diabetics.

Study of the risk factors associated with the development of malocclusion.

BACKGROUND/AIM: Research of the most common causes of irregularities of jaws and teeth is designed in order to find the most efficient mode of their prevention. Frequency of orthodontic malformations (malocclusions) is as high as 60% to 80% in this region with an increasing tendency. Researching the risk factors for orofacial irregularities is designed with the purpose of creating a standardized methodology for risk evaluation, frequency and degree of orthodontic irregularities of face, jaws and teeth. The aim of the study was to identify and analyze the causal factors that lead to forming malocclusions in patients from the Province of Vojvodina and create a uniform methodology for epidemiological research. METHODS: The research included 127 patients from the current casuistics of the Vojvodina Stomatology Clinic--Department for Jaw Orthopedics. Data for Questionnaire for Epidemiological Surveillance were obtained from medical records of patients, heteroanamnesis, objective findings, functional analysis of stomatognathic system, and additional diagnostic methods. RESULTS: The average number of the risk factors was 2.59 per patient, of which 56% were morphological factors, and 44% functional. Acquired risk factors made up 61% of the total number, while congenital risk factors made up 39%, of which 15% were hereditary and 24% were nonhereditary. CONCLUSION: Implementing the Questionnaire for Epidemiological Surveillance, general distribution of anomalies could be presented by the Anomaly index (AI), which dictates the introduction of a standardized questionnaire for epidemiological screening, which would preclude ambiguousness and the differences between the epidemiological research data would be cut to the minimum.

Variations of serum copper values in pregnancy.

INTRODUCTION: Copper is essential micronutrient and has an important role in the human body. The serum copper increases during pregnancy and is doubled at full term. Lower levels of serum copper in pregnancy are connected with some pathological conditions. OBJECTIVE: The aim of this study was to estimate the levels of serum copper in normal and pathological pregnancies, comparing them with values of serum copper in non-pregnant women, to determine if serum copper is lower in some pathological pregnancies and if this is of some importance. METHODS: A total of 2170 plasma samples for copper analyses were made in the following groups: healthy non-pregnant women; healthy pregnant women from the 5th-40th gestational week, during the first delivery stage and during the first three postpartum weeks, in pregnant women with habitual abortion, imminent abortion, abortion in progress, missed abortion (9th-24th weeks), missed labour and premature rupture of membranes (29th-40th weeks). Levels of serum copper were determined by colorimetric technique of bathocuproin with disulphate as a chromogen. RESULTS: Serum copper values in non-pregnant women range from 11.6-25.8 micromol/L. In healthy pregnant women, there is a constant trend of the increase of serum copper. The mean serum copper values revealed three significant peaks at the 22nd, 27th and 35th gestational week. Serum copper values in the patients with some pathological pregnancies in relation to the serum copper values of the healthy pregnant women were significantly lower. CONCLUSION: Serum copper values can be used as an indicator of some pathological pregnancies.