Investigating the associations between early labour onset symptoms and self-diagnosed labour onset in a cohort study of primiparas.

OBJECTIVE: The early recognition of possible labour onset symptoms may be pivotal to identifying the beginning of early labour and are usually recognised by the birthing women themselves. The present study illustrates the interrelationship among five labour-onset symptoms and explores the association of these labour-onset symptoms with the self-diagnosed labour onset of primiparas. METHODS: A prospective cohort study on a sample of 69 primigravida in Giessen, Germany, expecting spontaneous onset of labour at term. The participants filled in a diary from ≥37 + 0 weeks gestation until self-diagnosed labour onset. Descriptive, bivariate and inferential analysis explored association of labour onset symptoms with self-diagnosed labour onset while accounting for maternal and newborn characteristics. RESULTS: Self-diagnosed labour onset was positively associated with all symptoms and clinical characteristics, apart from irregular pain and maternal weight and age. Moreover, regular pain was negatively correlated with irregular pain; having regular pain increased the odds of self-diagnosed labour onset substantially (OR: 10.18, 95 % CI: 2.39-66.27), followed by gastrointestinal symptoms (OR: 2.07, 95 % CI: 0.40-13.10) and emotional symptoms (OR: 2.05, 95% CI: 0.30-13.98). CONCLUSION: Being the initiator of intrapartum care without any birth experience, primiparas are prone to experiencing dissatisfaction in care and may enter professional care too late or too early. The present study showed that regular pain may signify primiparas to self-diagnose labour onset within 24 h and indicate early labour symptoms that may be relevant for a self-diagnosed labour onset.

Measuring the extent and impact of urban expansion in an agricultural-urbanized landscape in Central Iran.

The unplanned urban expansion is a major environmental challenge in Iran resulting in vast degradation of agricultural lands. Focusing on an agricultural-urbanized landscape in Central Iran, the spatial pattern of built-up expansion was assessed from Landsat data processed in 1992 (TM), 2002 (ETM+), 2012 (TM), and 2022 (OLI). Multi-year crop NDVI was also used as a proxy for cropland suitability to assess the intensity of the urban growth impact. Results showed that (1) the area of built-up surfaces increased almost up to double than that of 1992 and passed 36% (413.42 km2) by 2022, (2) the region experienced a coalescence-diffusion transition phase with decreasing spatial connectivity of newly developed patches with old ones, (3) the most suitable croplands were lost in the middle period (2002-2012) when urban patches started to diffuse, and (4) a significantly positive spatial (Spearman's) relationship (r (22100) = 0.181, p = 0.000) was found between the area and quality of croplands which further highlights the high importance of cropland protection in the region.

Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood

Abstract Objective: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. Methods: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. Results: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. Conclusion: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring

New exploration of creativity: Cross-validation analysis of the factors influencing multiteam digital creativity in the transition phase.

Multiteam digital creativity (MTDC) is a new domain of creativity study that fits the new developments of the digital era, thus scholars have called for exploring MTDC in the fine-graining phase. This paper responds to this call, and adopts two studies and cross-validation analysis to explore the theoretical framework of the impact factors of MTDC in the transition phase. Study 1 adopts the qualitative analysis method of rooted theory to explore a more comprehensive impact factor and to maximize the new theory's saturation. Study 2 adopts the CL-WG DEMATEL method, one analysis method of group decision-making and optimized concept lattice, which could cross-validation analyze the results of Study 1 and further determine the importance of the factors. The results of the studies indicate that the influencing factors of MTDC are multilevel, and the factors such as the organizational digital climate, team psychological empowerment, individual digital cognition and emotion, and leadership competence have greater impacts on MTDC. This indicates that the transition phase has a unique internal mechanism. This paper constructs a theoretical framework of factors influencing MTDC in the transition phase and provides new theoretical and practical references for how organizations could fully stimulate MTDC in the digital era. In addition, the cross-validated analytical method further enriches the study tools in the domain of organizational behavior.

Training cessation and subsequent retraining of a world-class female Olympic sailor after Tokyo 2020: A case study.

Olympic sailing is a complex sport where sailors are required to predict and interpret weather conditions while facing high physical and physiological demands. While it is essential for sailors to develop physical and physiological capabilities toward major competition, monitoring training status following the competition is equally important to minimize the magnitude of detraining and facilitate retraining. Despite its long history in the modern Olympics, reports on world-class sailors' training status and performance characteristics across different periodization phases are currently lacking. This case study aimed to determine the influence of training cessation and subsequent retraining on performance parameters in a world-class female sailor. A 31-year old female sailor, seventh in the Women's Sailing 470 medal race in Tokyo 2020, completely stopped training for 4 weeks following the Olympics, and resumed low-intensity training for 3 weeks. Over these 7 weeks, 12.7 and 5.3% reductions were observed in 6 s peak cycling power output and jump height, respectively, with a 4.7% decrease in maximal aerobic power output. Seven weeks of training cessation-retraining period induced clear reductions in explosive power production capacities but less prominent decreases in aerobic capacity. The current findings are likely attributed to the sailor's training characteristics during the retraining period.

Osteometabolic profile and bone mass in the transition phase: ethnic differences in Brazilians treated with somatropin during childhood.

OBJECTIVE: The main growth hormone action is to promote linear growth increasing protein synthesis stimulation and osteoblastic activity. Peak bone mass extends from adolescence to 30 years of age. Several factors may influence this acquisition and prevent fracture risk in adulthood, such as genetic potential, GH, ethnicity, and lifestyle factors. This study aims to compare bone mass and osteometabolic profile of white and Afro-descendant Brazilian adolescents in the transition phase, who were treated with human recombinant growth hormone in childhood. METHODS: The authors selected 38 adolescents from the Transition Outpatient Clinic of the University of São Paulo. Lumbar spine and total body bone mineral density (BMD) and bone mineral content (BMC), serum calcium, 25-OH-vitamin D and bone markers were analyzed at the rhGH withdrawal. RESULTS: The mean age was 16.8 ± 1.6 years. There were 21 Afro-descendant and 17 whites. Thirty-four percent of the sample presented vitamin D insufficiency, 66% inadequate calcium intake and 44.7% physical inactivity. The Afro-descendants showed a lower lumbar spine and total body Z scores than those of the whites (p = 0.04 and p = 0.03, respectively), as well as their mean body weight (p = 0.03). There were no differences in the remaining osteometabolic parameters. CONCLUSION: As most adolescents had vitamin D insufficiency, low calcium intake, and physical inactivity, calcium, and cholecalciferol supplementation and lifestyle changes should be encouraged. The Brazilian Afro-descendant may be a vulnerable group for low bone mass, requiring special strategies to increase bone accrual and body weight. More studies are necessary to compare ethnic differences in this population.

Oral health characteristics of patients living with intellectual disability at transition phase from pediatric dental service to adult dental service: A systematic review.

AIM: A systematic review was conducted to evaluate the available literature to ascertain the oral health characteristics of patients living with intellectual disability when they transfer from pediatric dental service to adult dental service. MATERIAL AND METHODS: The electronic search was performed between June 2020 and July 2020 using the following databases: MEDLINE and EMBASE. Cochrane database, gray literature, and Google Scholar were also searched. References of articles obtained from the electronic searches were scanned through. Journals and regulation agency websites were also hand searched. This systematic review used a defined search strategy keywords for all the electronic databases. The strength of evidence in these studies was evaluated using the British Medical Journal quality assessment tool. RESULTS: The search process identified 45 eligible articles. Of these, 35 studies were excluded, and 10 observational studies were included. CONCLUSION: It seems that a considerable percentage of patients living with intellectual disability in their transition phase, aged between 18 and 25 years, have a high prevalence of dental caries, gingivitis, and periodontal disease when compared to the general population.

Physiotherapy for Multiple Sclerosis Patients From Early to Transition Phase: A Scoping Review.

Multiple sclerosis (MS) is a chronic neurological disease that has an impact when they are at the most susceptible aspects of personal, professional, and social development. MS affects about 2.2 million individuals worldwide, with the majority of individuals experiencing relapses regularly. The progression of the disease's complex nature, the challenges in selecting the appropriate intervention, and a multitude of symptoms necessitate a systematic approach to the individual that includes both pharmacology and neurorehabilitation. Kinesiotherapy, exercise rehabilitation, massage, and hydrotherapy are all forms of physiotherapy that are used as part of rehabilitation. Physical exercise will mitigate the potential effects of akinesia and so enhance the functioning capacities of all bodily systems, regardless of the severity of the illness. An early examination by a physical therapist who is familiar with MS is advised to develop a customized training and/or lifestyle physical exercise program. Although hospital-based rehabilitation programs appear to have a higher impact, numerous studies have found that home-based rehabilitation is helpful. The constraint imposed by COVID-19 has an influence on the well-being of persons with multiple sclerosis. People with MS would be particularly affected, since they might be considered an at-risk group for serious COVID-19 in a variety of ways, and MS health-related data requirements increased significantly.

Adult health and transition stage-specific rotenone-mediated Drosophila model of Parkinson's disease: Impact on late-onset neurodegenerative disease models.

Parkinson's disease (PD) affects almost 1% of the population worldwide over the age of 50 years. Exposure to environmental toxins like paraquat and rotenone is a risk factor for sporadic PD which constitutes 95% of total cases. Herbicide rotenone has been shown to cause Parkinsonian symptoms in multiple animal models. Drosophila is an excellent model organism for studying neurodegenerative diseases (NDD) including PD. The aging process is characterized by differential expression of genes during different life stages. Hence it is necessary to develop life-stage-matched animal models for late-onset human disease(s) such as PD. Such animal models are critical for understanding the pathophysiology of age-related disease progression and important to understand if a genotropic drug/nutraceutical can be effective during late stages. With this idea, we developed an adult life stage-specific (health and transition phase, during which late-onset NDDs such as PD sets in) rotenone-mediated Drosophila model of idiopathic PD. Drosophila is susceptible to rotenone in dose-time dependent manner. Rotenone-mediated fly model of sporadic PD exhibits mobility defects (independent of mortality), inhibited mitochondrial complex I activity, dopaminergic (DAergic) neuronal dysfunction (no loss of DAergic neuronal number; however, reduction in rate-limiting enzyme tyrosine hydroxylase (TH) synthesis), and alteration in levels of dopamine (DA) and its metabolites; 3,4-Dihydroxyphenylacetic acid (DOPAC) and Homovanilic acid (HVA) in brain-specific fashion. These PD-linked behaviors and brain-specific phenotypes denote the robustness of the present fly model of PD. This novel model will be of great help to decipher life stage-specific genetic targets of small molecule mediated DAergic neuroprotection; understanding of which is critical for formulating therapeutic strategies for PD.

The return process of physiological umbilical herniation in human fetuses: The possible role of the vascular tree and umbilical ring.

The human intestine elongates during the early fetal period, herniates into the extraembryonic coelom (EC), and subsequently returns to the abdominal cavity (AC). The process by which the intestinal loop returns to the abdomen remains unclear. This study aimed to document positional changes in the intestinal tract with the superior mesenteric artery (SMA) and branches in 3D to elucidate the intestinal loop return process (transition phase). Serial histological cross-sections from human fetuses (crown-rump length [CRL] range: 30-50 mm) in the herniation (n = 1), transition (n = 7), and return (n = 2) phases were selected from the Blechschmidt Collection. The distribution of the SMA trunk and all intestinal and sister branches entering the intestines was visualized so that positional changes in branches were continuous from the herniation to return phases. Positional changes in SMA branches proceeded in an orderly and structured manner; this is essential for continuous blood supply via the SMA to the intestine during transition and for safe intestinal return. Changes in the SMA distribution proceeded prior to the detection of initiation of intestinal tract return, which might start earlier and last much longer than our consensus (i.e., that the return of the herniated intestine begins when the CRL is approximately 40 mm and ends within a short time). In the cross-section of the umbilical ring in the herniation and transition phases, one proximal limb and one distal limb were observed with SMA intestinal branches, which were fully packed in the umbilical ring. The SMA branches were aligned from inferior to superior along the SMA main trunk. In the herniation phase, the distribution of 3rd-13th branches aligned from proximal inferior medial to distal superior left with a slight spiral in the EC, the tips of which suggested an orderly running course of the small intestine. In the transition phase, SMA branches running across the umbilical ring that fed the small intestine were observed, suggesting that the intestine was uncoiled and ran across the umbilical ring almost vertically. The estimated curvature value supported the phenomenon of uncoiling at the umbilical ring; the value at the umbilical ring was lesser than that in the AC and EC. During the transition phase, the proximal and distal limbs transversely ran side by side in the AC, umbilical ring, limbs on the cranial side, and mesentery on the caudal side. The SMA trunk and its branches ran in parallel, cranially to caudally aligned in the mesentery. This layout of the umbilical ring was maintained during the transition phase. In the return phase, the SMA trunk was gently curved from the upper left to the lower right of the AC; around 12 branches spread with a winding staircase appearance. The intestinal tract reached its definitive position immediately after all tissues crossed the umbilical ring and released any restriction. Each SMA branch and the corresponding region of the intestinal tract form a unit and change their position, though the conformation may change within each unit when running across the umbilical ring. We suggest that the slide-stack model requires revision.

Dropout during a 12-week transitional exercise-based cardiac rehabilitation programme: a mixed-methods prospective cohort study.

AIMS: Investigate the dropout rate during a 12-week transitional exercise-based cardiac rehabilitation (exCR) programme focusing on a halfway transition phase between hospital and the municipality-based cardiac rehabilitation. Secondly, investigate patient characteristics associated with dropout at the transition. METHODS AND RESULTS: Patients with coronary heart disease, heart failure, or heart valve surgery referred to exCR were included in a prospective cohort study conducted between 1 March 2018 and 28 February 2019 at Zealand University Hospital. Exercise-based cardiac rehabilitation was initiated at the hospital with a halfway transitional to local healthcare centres in the municipalities. Dropouts were identified every third week through telephone interviews. A Kaplan-Meier time-to-event analysis was used to investigate time to dropout, while multiple logistic regression assessed associations between patient characteristics and dropout at the transition. Of 560 patients eligible for exCR, 279 participated in the study. Fourteen patients were lost to follow-up and 103 dropped out, resulting in a dropout rate of 39% [95% confidence interval (CI) 33-45%]. Of the 103 dropouts, 72 patients (70%) dropped out at the transition. In the adjusted analysis, patients attached to the labour market were associated with dropout at the transition [odds ratio (OR) = 6.31 (95% CI 2.04-19.54)]. Furthermore, odds of dropping out at transition were reduced for each extra exercise session attended [OR = 0.79 (95% CI 0.66-0.94)]. CONCLUSION: The transition phase constitutes a critical dropout period in exCR, in which increased attention on patient adherence is needed. In clinical practice, communication and strategies addressing patient retention across settings could be essential to prevent dropout in transitional exCR.

Shear Elastic Coefficient of Normal and Fibrinogen-Deficient Clotting Plasma Obtained with a Sphere-Motion-Based Acoustic-Radiation-Force Approach.

Blood coagulation is a process involving several chemical reactions governed by coagulation factors, during which the shear elastic coefficient, µ, varies as the medium transitions from liquid to gel phase. This work used ultrasound to measure µ during the clotting of human plasma samples by tracking the motion of a glass sphere located inside a cuvette filled with the plasma. A 2.03 MHz ultrasonic system generated an impulsive acoustic radiation force acting on the sphere, and a 4.89 MHz pulse-echo ultrasonic system tracked the sphere displacement induced by that force. Measurements of µ were determined by fitting a µ-dependent theoretical model to the motion waveform of the sphere immersed in clotting normal plasma and plasma samples with fibrinogen (FI) concentrations of 1.2 (FI-deficiency) and 3.6 (FI-normal) g/L. For normal plasma, µ started at 14.22 Pa and increased rapidly until 2 min, then slowly until it reached 210.23 Pa at 35 min after the clotting process started. A similar trend was exhibited in plasma samples with FI concentrations of 1.2 and 3.6 g/L, with µ reaching 120.55 and 679.42 Pa, respectively. A theoretical model, related to the kinetics of clot-structure formation, describes the time changes of µ for the clotting plasma samples. The sphere-motion-based acoustic-radiation-force approach allowed us to measure the shear elastic coefficient during the coagulation process of plasma samples with normal and deficient FI concentrations. Our results suggest that the method used in this study is capable of being used to detect bleeding disorders.

Length of Nutritional Transition Associates Negatively with Postnatal Growth in Very Low Birthweight Infants.

Very low birthweight (VLBW, <1500 g) infants may be predisposed to undernutrition during the nutritional transition phase from parenteral to enteral nutrition. We studied the associations among the length of the transition phase, postnatal macronutrient intake, and growth from birth to term equivalent age in VLBW infants. This retrospective cohort study included 248 VLBW infants born before 32 weeks of gestation and admitted to the Children's Hospital, Helsinki, Finland during 2005-2013. Daily nutrient intakes were obtained from computerized medication administration records. The length of the transition phase correlated negatively with cumulative energy, protein, fat, and carbohydrate intake at 28 days of age. It also associated negatively with weight and head circumference growth from birth to term equivalent age. For infants with a long transition phase (over 12 d), the estimates (95% CI) for weight and head circumference z-score change from birth to term equivalent age were -0.3 (-0.56, -0.04) and -0.44 (-0.81, -0.07), respectively, in comparison to those with a short transition phase (ad 7 d). For VLBW infants, rapid transition to full enteral feeding might be beneficial. However, if enteral nutrition cannot be advanced, well-planned parenteral nutrition during the transition phase is necessary to promote adequate growth.

Educational Environment In The Transition Phase Of Curriculum At Ayub Medical College Abbottabad, Pakistan.

BACKGROUND: Evaluation of the educational environment is key to the delivery of high-quality medical education. Especially, when an institute is in the transition phase of curriculum. In curriculum transformation phase of Ayub Medical College Abbottabad, no such evaluation has been done. This study aimed to find the direction of Educational environment in the transition phase curriculum of Ayub Medical College Abbottabad and compare different domains of educational environment with gender, residency, pre-medical education's medium of instruction, and doctors among sibling or parents. METHODS: This descriptive cross-sectional survey was conducted among students of integrated and traditional curriculum of Ayub Medical College, Abbottabad from 1st December 2019 to 29th February 2020. By Non-probability convenience sampling technique, pre-validated Dundee Ready Educational Environment Measure questionnaire was used. Descriptive and inferential statistics were calculated in SPSS v22. RESULTS: A total 149 (100%) participants, 66 (44.3%) males and 83 (55.7%) females with mean age of 20.5±1.07 years responded. Among total, 76 (51%) were from integrated curriculum and 73 (49%) were of traditional curriculum. Significant difference was found among different aspect of education environments and both classes. CONCLUSIONS: The current transitional phase of curriculum at Ayub Medical College Abbottabad is more positive than negative. Some areas like student social-self-perception still need improvement. Moreover, gender and place of birth affect student's perception about their learning environment.

Dynamic assessment of plasma clotting in samples with distinct fibrinogen concentrations using impulsive acoustic radiation force.

While some diseases reduce fibrinogen concentration, others increase the amount of this clotting factor in the blood. Some studies have shown that the fibrinogen concentration in the blood is related to the stiffness of the formed clot. Hence, the aim of this study was to employ an ultrasonic method based on impulsive acoustic radiation force (IARF) to identify the fibrinogen concentration (coagulation factor I) in a plasma sample by means of peak-displacement (PD), time of peak-displacement (TPD), and shear modulus (µ) as well as to identify the change of plasma samples during the clot formation process. The IARF-based ultrasonic system transmitted bursts with a frequency of 2.03 MHz, duration of 246.31 µs, amplitude of 118 VPP, and pulse with 1.25 Hz repetition frequency to generate an IARF on a glass sphere (2.99 mm in diameter and 2500 kg/m3 in density) embedded in a plasma sample, causing a displacement that was monitored by a pulse-echo system with a center frequency of 4.89 MHz. The values of the shear moduli were 124.14 ± 3.02, 556.99 ± 11.76, and 670.39 ± 9.77 Pa, for fibrinogen concentrations of 1.2, 2.4, and 3.6 g/L 20 to 36 min after the beginning of the coagulation process. The TPD values obtained in the same period were 5.28 ± 0.09, 3.03 ± 0.02, and 2.83 ± 0.01 s. The results indicate that an IARF-based ultrasonic system can be used clinically because it uses small amounts of plasma and has the ability to detect differences in PD, TPD, and µ as a function of fibrinogen concentrations.

Transition Phase Regulator AbrB Positively Regulates the sip1Ab1 Gene Expression in Bacillus thuringiensis.

Bacillus thuringiensis secreted insecticidal proteins (Sip) are a secretion that is toxic to coleopteran pests. However, the transcriptional mechanism of sip genes is still unknown. The transcriptional regulation of the sip1Ab1 gene and the expression of the Sip1Ab1 protein were investigated in this study. The results demonstrated that the secretion of the Sip1Ab1 protein in HD73 was almost the same as that in the original QZL38 strain during the transition phase. Analysis of the ß-galactosidase activities of sip1Ab1-lacZ in both the HD73 and abrB mutant strains indicated that the transcription of sip1Ab1 is dependent on AbrB. Electrophoretic mobility shift assays showed that AbrB could bind with the sip1Ab1 promoter, and two binding sites of AbrB in the region of the promoter of sip1Ab1 were determined by DNase I footprinting assays. All of the above-described results proved that AbrB positively regulates the sip1Ab1 gene. IMPORTANCE Bacillus thuringiensis Sip proteins are secreted insecticidal toxins that are toxic to coleopteran pests. In this study, we investigated the transcriptional mechanism of the sip gene and showed strong evidence that Sip1Ab1 is secreted in the transition phase and that AbrB, a transition phase regulator that is usually a repressor, positively and directly regulates sip1Ab1. Reports of AbrB positive regulation are rare, even in Bacillus subtilis. To the best of our knowledge, no toxic gene has been reported to be positively regulated by AbrB in Bacillus species.

Pre-exercise skin temperature evolution is not related with 100 m front crawl performance.

During the transition between warm-up and competition there is a change in core, muscle and (eventually) skin temperature that may affect swimming performance. We have aimed to assess skin temperature evolution during transition phases of different durations before a typical front crawl effort and to investigate its relationship with performance. Following a standardized warm-up, nine adolescent male swimmers performed three maximal randomized 100 m maximum front crawl trials after 10, 20 and 45 min transition phases. Skin temperature, performance (time, stroke frequency, length and index, and propelling efficiency), heart rate, lactate and perceived effort were assessed. Data showed a skin temperature log increase over time (R2 > 0.96, p < 0.01) without differences from the 15 min with the following instants. Performance and psychophysiological variables were similar between transition phases. However, skin temperature at the end of the transition periods, i.e., just before the 100 m trials, was lower in the 10 min than the 20 and 45 min transitions (32.0 ± 0.6 vs 33.0 ± 0.4 and 33.5 ± 0.5 °C, respectively). The main finding was that no relevant relationships were observed between pre-test skin temperature and performance times (|r| < 0.6, p > 0.05) for the studied transition phases. We have concluded that transitions longer than 10 min will not present thermal changes and that, within the physiologic limits studied, pre-exercise skin temperature does not influence swimming performance.

Growth hormone deficiency and replacement in children.

Growth hormone deficiency (GHD) is a rare but treatable cause of short stature. The diagnosis requires a careful evaluation of clinical history, physical examination and appropriate interpretation of longitudinal growth, with specific features for each period of life. Other clinical findings, in addition to growth failure, may be present and can be related to the etiology and to associated hormone deficiencies. Despite more than 50 years since the first reports of provocative tests of growth hormone (GH) secretion for the diagnosis of GHD, the interpretation of the results remains a matter of debate. When GHD is confirmed, GH treatment is recommended. Treatment is effective and safe, but requires daily injections during many years, which can affect adherence. At the end of longitudinal growth, during the transition phase, it might be necessary to re-evaluate GH secretion. This review summarizes and updates the recent information related to GHD in children, as well the recommendations for treatment.

Effectiveness of two thermal activated orthodontic archwire sequences based on transition temperature range during alignment: A randomized non-controlled comparative study.

INTRODUCTION: It has been suggested that heat-activated NiTi archwires (HANT) speed up crowding alleviation. HANT wires are available with different austenite finish temperatures. OBJECTIVE: The aim of the present study was to compare the effectiveness of two alignment sequences using thermally activated archwires with different austenite activation temperatures for the correction of mandibular anterior crowding. MATERIAL AND METHODS: The following NiTi archwire sequence was used for both groups: 0.012 in (conventional NiTi), 0.018 in (heat-activated NiTi archwires), 0.016×0.022 in (heat-activated NiTi archwires) and 0.019×0.025 in (conventional NiTi). The conventional NiTi used for both groups belongs to the same commercial brand. Two different austenite activation temperatures (35°C and 37°C) were used for the heat-activated archwires. The primary outcome was the degree of crowding correction measured on study models. The secondary outcome was crowding survival time over a six-month period. This RTC included fifty-four patients that were randomly allocated to the two different archwire sequences. A Mann-Whitney test was used to compare the groups regarding crowding alleviation. A survival curve was created using the Kaplan-Meier method to illustrate the reduction of crowding over time. A Mantel-Cox log-rank test was used to compare survival times (until correction of crowding). RESULTS: No differences in crowding alleviation were identified between both groups (log-rank test; P=0.77). CONCLUSIONS: The two alignment sequences with different thermal activated archwires at 35°C and 37°C achieved similar clinical results during the correction of mandibular anterior crowding.

An especial transition phase of hospitals: the adaptation of hospital operations to the development of COVID-19 and policy adjustments.

The ongoing pandemic coronavirus disease 19 (COVID-19) remains a significant issue for global health, economics, and society. In order to balance epidemic control and economic recovery, many countries have successively announced the gradual relaxation of some lockdown restrictions. Hospitals and medical staff constitute the backbone in this war against COVID-19. In response to this serious situation, many hospitals went into emergency and impaired healthcare access to patients with conditions other than COVID-19. Therefore, gradually promoting hospital operations and functions back to the new normal is important, especially when this outbreak has been effectively controlled. In this study, we introduce existing and potential problems that could seriously affect people's health. Additionally, we propose that an especial transition phase between the emergency and regular modes of hospitals can be well adapted to the current situation.