ris

Background: Adipose tissue is one of the main sites of energy homeostasis that regulates whole body metabolism with the help of adipokines. Disruption in its proper functioning results in adipose tissue remodeling (primarily hypertrophy and hyperplasia) which directly influences the secretion of said adipokines. Obesity characterized as chronic low-grade inflammation of the adipose tissue is one such condition that has far reaching effects on whole body metabolism. Inflammation in turn results in immune cells infiltrating into the tissue and further promoting adipocyte dysfunction. Purpose: In our study we explored this adipose tissue-innate immunity axis by differentiating adipose tissue derived stem cells (ADSCs) into white and beige adipocytes. We further stimulated our cultures with lipopolysaccharide (LPS), flagellin, or meteorin-like, glial cell differentiation regulator (METRNL) to trigger an inflammatory response. We then evaluated Toll-like receptor (TLR) mRNA expression and secretion of interleukin (IL-6), interleukin-8 (IL-8), brain-derived neurotrophic factor (BDNF), and nerve growth factor (NGF) in these cultures. Results: We found that TLR2 is the highest expressed receptor in adipocytes. Further, LPS and METRNL are strong activators of TLR2 in white and beigeBMP7(-) adipocytes. TLR4 was not significantly expressed in any of our cultures despite LPS stimulation. TLR9 expression is upregulated in ADSCs upon LPS and METRNL stimulation. IL-6 and IL-8 secretion is increased upon LPS stimulation in white adipocytes. METRNL activates both IL-6 and IL-8 expression in adipocyte cultures. Lastly, BDNF and NGF is secreted by all adipocyte cultures with beigeBMP7(-) and beigeBMP7(+) secreting slightly higher amounts in comparison to white adipocytes. Conclusion: ADSCs and adipocytes alike are capable of expressing TLRs, but white adipocytes remain the highest expressing in both control and stimulated cultures. TLR2 is highly expressed in white and beige adipocytes whereas TLR4 showed no significant expression. LPS and METRNL trigger IL-6 and IL-8 secretion in adipocytes. Products of white adipocyte “browning” are capable of secreting higher amounts of BDNF and NGF in comparison to white adipocytes.

Four mestranol moieties were chemically linked to Zn(II) phthalocyanine (4) by cycloaddition “Click” reaction using a tetra-azidoethoxy substituted Zn(II)-phthalocyanine (3). The alkyl-azido coupling reaction was realized between azido groups of 3 and alkyl group of mestranol. The alkylation reaction was carried out to obtain cationic Zn(II) phthalocyanine derivative (5). The new compounds were chemically characterized by the known analytical methods. The absorption and fluorescence properties were studied in comparison. The absorption maxima of phthalocyanines 3, 4 and 5 were recorded at approx. shifts of 8 - 12 nm in the far- red region (680 - 684 nm) and the fluorescence maxima (692 - 693 nm) as compared to unsubstituted ZnPc (672 nm, 680 nm) in DMSO. The studies of singlet oxygen generation of 3, 4 and 5 showed relatively high values such as 0.52 for 3; 0.51 for 4 and 0.46 for 5. The fluorescence lifetime of 3.15 ns (3), 3.25 ns (4) and 3.46 ns (5) were determined with lower than the value than for the used standard ZnPc (3.99 ns). The high photo stability was observed for compounds 3, 4 and 5. In addition, the photosensitized oxidation of cholesterol was compared for 3 and 4 with much lower values of oxidation potential than for unsubstituted ZnPc which suggests that the substitution groups influenced on the photooxidation index of the target molecule.

Behavioral dentistry is an interdisciplinary science, which needs to be learned, practiced and reinforced in the context of clinical care and within the community oral health care system. The objective of this science is to develop in a dental practitioner an understanding of the interpersonal, intrapersonal, social forces that influence the patients’ behavior. The clinician must acquire knowledge to develop appropriate behavioral skills with an improved quality of communication and management of patients. Behavior dentistry also teaches to develop a recognition and understanding that the body and mind are not separate entities and focuses on patients’ social, emotional and physiological dental experiences. Behavior is an observable act. It is defined as any change observed in the functioning of an organism. Learning as related to behavior is a process in which experience or practice results in relatively permanent changes in an individual’s behavior. Self-perceptions of dental-facial appearance begin with aesthetic values shared within families and based generally on social norms, but that they may be strongly influenced by peer values and specific experiences of individual children, particularly those involving social responses. Theories incorporating concepts of social comparison and self-efficacy suggest that individuals evaluate themselves in comparison with others in their social environment. Children who perceive themselves to be attractive will reflect those perceptions in their behaviors and generally will receive confirming social responses. The comparison group may express an attractiveness norm that reflects negatively on the individual’s behavior. This, in turn, can affect the individual perceived sense of self-efficacy or adequacy within that group and lead to behaviors that reflect more negative beliefs about the self, thereby inviting still more negative social responses. Patient cooperation is the single most important factor every dentist must contend with. Major considerations are • Regularity in keeping appointments • Compliance in wearing removable appliances • Refraining from chewing hard and tenacious substances that are likely to distort or damage the teeth or crowns • Maintenance of oral hygiene. Laxity in following these instructions may lead not only to compromised treatment but also to slow progress of treatment, loss of chair time and frustration. What may be more interesting to the Dentist than the shaping of self-perceptions in the shaping of behavior that will ensure a successful result of treatment, that is, the patient’s adherence to prescribed routines for self-care and other regimens during Dental treatment. It is helpful in this regard to know that most patients expect improved dental-facial appearance as an outcome of treatment, but there is much more to know about factors influencing cooperation. Poor motivation can also contribute to non-compliance. The regulatory loop requires a motivational system to adjust behavior to coincide with the recommended regimen. A patient may recognize that the regimen is not being followed and yet simply not be motivated to correct the discrepancy. Poor motivation can also result from a lack of concern over the long-term health consequences of one’s behavior and/or a lack of belief in the treatment. Cognitive approaches that emphasize the personal relevance of the regimen or address misconceptions about the treatment may enhance motivation. Several approaches may be useful in treating poor compliance. Providing incentives or rewards for compliant behavior might be a useful strategy to enhance motivation. The cause of noncompliance is multifactorial and strategies to improve compliance must be tailored to fit each situation. Current Dental research focuses on a critical aspect of the feedback; specifically, the input received by the comparator that quantifies the actual amount of adherent behavior. Likewise, Patients, parents, and clinicians need a way to ascertain this information.

Introduction: Obesity is a global-level epidemic. Together with this disease, called chronic subclinical inflammatory disease, many other diseases, known as comorbidities, arise. Objective: To show that the association between low-level laser therapy and physical exercise is supported, by experimental and clinical studies, being an instrument that maximizes the treatment of obesity as well as its comorbidities. Conclusion: This manuscript brings a compendium of accomplished work by our group that allows understand the mechanism base of interaction between the photonic technology and the physical exercise, allowing to potentiate the treatment of the obesity.

The etiology of abdominal obesity is multifactorial and has environmental factors as its most expressive risk factors. This study cross-sectional analyzed the association of abdominal fatness with physical inactivity and food inadequacy of 1,557 subjects, both genders, over 35yrs. old, enrolled in an ongoing epidemiological study. Waist circumference (WC) was the primary variable and demographic, social-economic, anthropometric and dietary intake data, were the co-variables. NCEP-ATP III, WHO, IPAQ-long (version 8) and Healthy Eating Index were used for functional definition of variables. Furthermore, longitudinal data from 50 subjects in an exercise protocol for 10 week receiving either regular diet (G1, n=22) or 30g fiber adequacy (G2; =28), were analyzed. The performed statistical analyses used software SAS for Windows, version 9.1 with p=0.05. In a predominantly female sample (74%), 76% aging 35-60yrs, 64% completed elementary school, 73% were living in a low income household, 77.5% overweight. The 62.5% presenting altered WC values were predominantly older, presented higher body fatness, and were consuming low variety-poor quality diet rich in fat (mainly saturated) and lower in fruit. WC correlated negatively with fruit intake and aerobic capacity (VO2max) but only carbohydrate (positive) and fruit intake (negative) were considered independent risk factors for abdominal obesity. In the longitudinal study, both G1 and G2 groups were similar at baseline and G1 maintained the anthropometry values throughout the experiment. Conversely, G2 decreased total body (4%) and WC (7%) fatness, reducing severe obesity by 16%, minimally affecting overweight and eutrophic rates. G2 presented 211% increase in fiber intake and 150% increase in plasma beta-carotene (colorful-fiber marker). Thus, in conclusion, recommended dietary fiber intake (increased fruit and low CHO intake) and physical activity would be the recommended changes against abdominal obesity and, by associating both physical exercises and dietary fiber there was indeed a decrease in abdominal fatness and obesity, predominantly at its higher grade.

Objective: To investigate the effect of kinesio tape and therapeutic ultrasound on pain and hand grip strength associated with tennis elbow. Material and Methods: Twenty male and female patients with age from 20-50 years suffering from lateral epicondylitis were participated in this study. All patients were randomly selected from orthopaedic surgeon. They were dividing into two groups. Group (A) (ultrasound and exercises group). Group (B) (kinesio tape and exercises group). The hand-held dynamometer was used to provide a detailed and objective measurement of wrist joint strength throughout its range of motion, the pressure being registered in kilogram (Kg) and Visual Analogue Scale (VAS) was used to record the degree of pain intensity. Result: The result shows no significant difference between group A and B in their ages, weights, heights, and BMI where their t and P-values were (0.8, 0.43), (0.03, 0.97), (0.98, 0.33), and (0.9, 0.37) respectively. In Group A the significant differences in hand grip strength between pre and post-test which shows 31.59), compared to the pre-test (27.35), while in group B (33.17) compared to the pre-test (23.88). According the pain scale for group A and group B there are significant differences where the results were (2.50), compared to the pre-test (5.90) and (2.00), compared to the pre-test (7.30), retrospectively. Conclusions: The treatment was improvement between both groups. However, the kinesio tape is better than therapeutic ultrasound.

In 1955, nutrient malabsorption following upper gut surgery was shown to be related to altered upper gut microbiome. In individuals with abdominal symptoms after Roux-en-Y gastric bypass, we have reported that small intestinal glucose malabsorption is associated with upper gut bacterial overgrowth. We hypothesize that individuals with abdominal symptoms after vertical sleeve gastrectomy have glucose malabsorption associated with upper gut bacterial overgrowth, and to test this hypothesis, bacterial overgrowth and potential glucose malabsorption are examined after sleeve gastrectomy. This is a retrospective study of individuals with medically-complicated obesity who underwent sleeve gastrectomy from 2013 to 2016 with subsequent glucose hydrogen breath testing to evaluate abdominal symptoms. A fasting breath hydrogen or methane of ≥10 PPM or rise of ≥8 PPM ≤45 minutes after oral glucose is bacterial overgrowth, while glucose malabsorption is a second rise of ≥8 PPM at >45 minutes. Seven females (mean age: 48.0 years; mean body mass index at surgery: 45.7 kg/m2) are described. Five subjects (71%) have an early rise in hydrogen or methane, while three (43%) have a second rise in hydrogen or methane >45 minutes after glucose. The mean percent excess weight loss at one year was 40% in three individuals with a second peak and 46% in four subjects without a second peak. After sleeve gastrectomy, subjects have glucose malabsorption associated with the presence of bacterial overgrowth. Completion of a larger prospective study is needed to confirm and expanding upon these findings. Further work should examine the potential effects of bacterial overgrowth on expression of intestinal glucose transporters.

Vestibular disorders and anxiety are closely related, probably because they share some neuronal pathways. Ageing and patient comorbidities are important facilitating factors, and multiple vascular risk factors could contribute to the onset of a vestibular syndrome called vascular vertigo. White matter lesions (WML) are often seen on magnetic resonance imaging (MRI) scans of elderly people and are related to various geriatric disorders, including dizziness. The cause of this correlation could be the disruption of neuronal networks that mediate higher vestibular cortical function. Numerous neuronal pathways link the vestibular network with limbic structures and the prefrontal cortex modulates anxiety through its connections to amygdala. The aim of the present work was to investigate the correlation between WML, amygdala and cognitive functions.

Background: The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended. Aim: To clarify and figure out food habits and different lifestyle pattern among a sample of Palestinian women attending the nutrition center in the Gaza Strip. Methods: A cross-sectional study involved 116 women were randomly chosen by purposive census sampling. They aged 25 to 60 years with a diagnosis of obesity. The data collected by interview questionnaire that included social factors, lifestyle habits, and health/disease history. Results: Age group variable has distributed significantly (p=0.024), (31.0%) of morbid obese were ≥35 years group compared to (13.5%) of morbid obese amongst the younger group. The higher intakes of legumes (OR: 2.134, P=0.003), nuts (OR: 3.917, P=0.019), eggs (OR: 6.840, P=0.009), fast foods (OR: 4.461, P=0.005), and soda drinks (OR: 2.230, P=0.004) were the risk factors linked to the increased risk of morbid obesity. Moreover, the higher intakes of legumes (OR: 8.439, P=0.011), eggs (OR: 6.900, P=0.041), chips (OR: 5.049, P=0.012), sugar (OR: 2.068, P=0.011), and fast foods (OR: 3.029, P=0.025) are risk factors of chronic diseases. Conclusion: The study identified several lifestyle factors and improper dietary habits associated with obesity among women in Gaza city. There is a great need to change these habits to avoid the increased risk of obesity. Gene-environment interaction can explain the high incidence of obesity. A national plan of action to overcome obesity is urgently needed to reduce its economic and health burden

Background: Cochlear implants (CI) are nowadays a widely accepted treatment for sensorineural hearing loss SNHL. Aim: This study aimed to describe the epidemiological characteristics and the surgical approach and to evaluate the outcomes of our experience in cochlear implantation. Setting: Department of Otolaryngology-Head and Neck Surgery of University Hospital Mohammed VI Marrakech Morocco. Methods: A retrospective chart review was conducted on 113 patients with severe to profound hearing loss who underwent a cochlear implantation between 2007-2018. Results: There were 65 females and 48 males with severe to profound bilateral deafness, of whom 103 had prelingual deafness. The mean age of pediatric cochlear implantation was 5.25 years. Implantation was unilateral in all patients. The procedure was followed by regular adjustments and speech therapy. The evaluation was carried out by the same team each month during the first 6 months, then every 6 months. The average duration of follow-up was 37.54 months. All patients benefited from their implants with inter individual variability. The good results were correlated with early implantation, significant parental investment and a steady follow-up of speech therapy. Conclusion: Cochlear implantation has revolutionized the management of severe to profound deafness. It is a safe and effective technique when it is aimed at correctly selected populations.

Objectives: Natural disasters confront individuals, communities and governments with the challenge of rebuilding and addressing psychosocial sequelae. With the increasing number of natural disasters it is timely to evaluate the efficacy of interventions and strategies to address the mental health needs of individuals and the community. Method: An evaluation of literature related to the psychological impact of natural disasters, treatment efficacy and government strategies to confront the social and psychological impact of natural disasters for the period 1983-2016 was undertaken. Results: Epidemiological studies following natural disasters despite the use of differing psychological measures demonstrate significant psychological morbidity - anxiety (7-42%), complicated grief (28-41%), depression (6.5-38%), post-traumatic stress disorder (11-89%) and substance misuse (1.3-24%). Intervention studies post-disaster demonstrate efficacy variability. Conclusions: The increase in the number and impact of meteorological and hydrological events since the 1980s and the psychological, social and economic consequences of these events has resulted in the development and implementation of government policies to confront the immediate and long-term adverse outcomes. The focus is typically on resources and infrastructure redevelopment with less focus on social and mental health interventions with long-term evaluation of interventions uncommon. The consequence of natural disasters emphasizes the importance developing strategies to ensure effective evaluated psychosocial interventions are available across at-risk communities.

Introduction: Recent research has explored the role that personality traits play in health and weight determination. This study extends current research by evaluating the extent to which behavior mediates the impact of neuroticism and body weight using polygenic risk as a measure of neurotic tendency. Methods: Structural equation modelling disaggregates the effect of neurotic tendency on BMI into direct and indirect effects. Indirect effects-those transmitted through mediating health behaviors—allow for the simultaneous comparison of multiple behavioral mediators— exercise frequency, smoking intensity, sleep sufficiency and screen time. Results: While health-related behavior-screen time, sleep, smoking and exercise-directly influence BMI, neurotic tendency showed no direct effect. The strong association between neurotic tendency and behavior, however, indicated that polygenic risk of neuroticism indirectly influenced BMI through two health related behaviors-screen time and smoking. Therefore, the relationship between neurotic disposition and BMI is transmitted through behavioral pathways rather than directly. Conclusion: This research offers novel insight into the relationship between personality and health outcomes. If behavior manifests through personality disposition, then understanding the relationship between personality, behavior and BMI will help guide weight management interventions to focus on strategies to help manage responses to stress to elicit desired weight outcomes.

Ra-223 dichloride is a first-in-class alpha-emitting radiopharmaceutical recently introduced into clinical practice for treatment of men with Castration-Resistant Prostate Cancer (CRPC) and symptomatic bone metastases. Due to the proven benefit on Overall Survival and the favorable toxicity profile, Ra-223 therapy is gaining widespread use in both US and Europe. In this article, we describe the routinary management of patients undergoing Ra-223 treatment in our Institution. Currently, Ra-223 therapy is indicated for 6 intravenous injections (55 kBq per kg of body weight) administered every 28 days. In comparison to other radiopharmaceuticals, Ra-223 handling and administration do not need any additional training for authorized users. Due to the minimal external dose rate emission, Ra-223 dichloride can be delivered in an outpatient setting. Moreover, no particular precautions other than standard hygiene measures must be taken by patients’ family members or caregivers. Ra-223 therapy is associated to a favorable hematologic toxicity profile, while non-hematologic adverse events are generally mild and easy to manage. Given the favorable toxicity profile of this treatment, clinical trials are currently ongoing to evaluate efficacy and safety of Ra-223 treatment in combination or sequence with recently approved drugs such as abiraterone acetate, enzalutamide and sipuleucel-T. In addition, the recent interest in Ra-223 bone lesion dosimetry could open the way to a dosimetric-based therapeutic approach with Ra-223. In this new scenario, results of these promising clinical trials may help clarifying the optimal sequencing of new therapeutic possibilities for metastatic CRPC and the appropriate eligibility criteria for Ra-223 treatment in oncologic patients.

The well recognized white adipose tissue is an endocrinal organ secreting various hormones and this article simply indicates to the physiologic concepts brown fat tissues (BAT) which are extremely active endocrine organs and play various metabolic active roles in intermediate metabolism. The physiologic function of Brown adipose tissues contributes to energy-producing parts of the cell. Its amount is rare up to approximately one hundred and thirty gram and implies important characteristics for mammals. An increase in energy expenditure could be an aim by activation of BAT, seems futurity to reduce body weight that needs a vast majority of fundamental research to facilitate its occurrence [1]. Brown fat tissue generates heat and has valuable importance for human metabolism [2,3]. Brown fat tissue is decreased in overweight and obese people and possibly activating brown fat tissue might help for reducing weight and weight-related metabolic disorders like insulin resistance.

Background: The use of a custom-made orthotic plantar device is referenced as a true sensor-motor facilitation tool for the control of the postural orthostatic and orthodynamic position in patients with Parkinson’s disease. Aim: To outline the postural and kinematic effect of a pro-ergonomic multilayer foot insole versus a custom-made carbon-kevlar dynamic foot insole in a cohort of patients affected by extrapyramidal disease. Setting: A rehabilitation institute for the treatment of neurological and orthopaedic gait disorders. Methods: A sample of 8 patients (mean age of 82.6), of whom 4 affected by Parkinson’s disease (P) and 4 by Parkinsonism (PS) were recruited for the aim of this study. In line with our inclusion criteria (clinical-functional diagnosis of Parkinson’s disease or Parkinsonism, Webster scale ≤ 20, Mini-mental State Examination (MMSE) ≥ 18), the study design developed in 2 times: a. time T1 (or evaluation time), in which recruited patients affected by Parkinson’s disease or Parkinsonism were evaluated at the Hospital and Noble Resting House Paolo Richiedei through an accurate functional (Conley scale, Barthel Index scale, Tinetti scale and the Berg Balance Scale), postural evaluation (VPA) and walking examination (VGA, baropodometric evaluation, kinematic gait evaluation through WIVA system); to each group of patients of our study were therefore entrusted 4 foot-insoles, of which 2 synthetic and 2 carbon-kevlar custom-made foot-insoles called PRODYNAMIC; at the end of this step, patients started with our integrated rehabilitative treatment course. b. time T2 (or experimental time; 90 days from T1), a new clinical-instrumental evaluation of each patient was performed, repeating the clinical-functional and instrumental evaluation performed at the time T1 in a specular way; this assessment was performed in FW condition, with personal footwear and previously acquired foot-insoles used during the evaluation at the T1 time. Results: Most of our patients have been able to find benefit from the use of the plantar orthosis and integrated rehabilitation treatment so as to bring some modifications within personal postural attitude, recording an improvement but not uniform change within the sample. The results obtained by comparing the VPA at time T1 and at time T2 explain how patients affected by both clinical forms tend to establish incorrect postural attitudes due to stiffness and appearance of hypertonic plasticity, which become then structured and only partially modifiable. There was a general performance improvement in line with the VGA: within the P.B group, we observed with the use of the Prodynamic insole a partial or even complete normalization of the dynamic heel-contact phase, a better alignment of the COP in its excursion from the 1st to the 2nd rocker phase of the step, a notable facilitation to the inertial thrust in progress in the 3rd and 4th rocker phase, an improvement in the eccentric control of the patellofemoral alignment in the acceptance phase of the so-called load-response in stance and, finally, the acquisition of a more physiological propulsion structure of the trunk basin unit with an improvement of the clearance and fixation skills in the sequential phases of the step. This trend was evident but not uniform in the other groups considered. Analysis of the evolution of the degree of functionality in the daily life activities expressed by the Barthel index, passing from time T1 to the time T2, showed an improvement and consistent change in all groups considered within our study that we can find in a more or less way for the other clinical outcome data. An objective time-related and intra-group comparison of the raw static and dynamic baropodometric data acquired in our 4 study conditions showed different time-related trends for the two groups taken into consideration. A specific WIVA profile was found for each pathology group, highlighting different trends passing from time T1 to time T2 in particular of the gait cadence and gait speed. In particular, in the “Prodynamic” study condition the gait cadence shows in the Parkinson group a significant increase from time T1 to time T2, passing respectively from an average value of 41.9 ± 11.7 to 54.9 ± 1.1; patients of the Parkinsonism group showed a value of the average gait cadence at time T1 higher than the other study conditions at the same evaluation time, with an increase of this data from T1 to T2, passing from 43.1 ± 11.8 to 47.4 ± 4.4. If we consider the gait speed time-related trend, in the “Prodynamic” study condition at T1 the gait speed in Parkinson patients is similar to that recorded in the “shoe” study condition; in Parkinsonism the gait speed recorded at time T1 is higher than that recorded in the other study conditions; at time T2 there is a less evident increase in speed compared to that observed in patients with Parkinson’s. Conclusion: In today’s management of the profile of complexity of extrapyramidal pathology, the association of several health figures is of fundamental importance, with professional profiles and diversified skills, in such a way as to be able to guarantee a comprehensive management of the patient. From this point of view, the figure of the orthopedic technician will be able to play a new role within the rehabilitation team, which will be responsible for the best possible functional response (deriving from an optimal integration between orthotic and rehabilitation treatment) of patients with Parkinson’s disease.

Oxygen therapy is the main supportive treatment in hypoxemic respiratory failure and has traditionally been delivered using low and high flow devices. However, the maximal flow rates that these devices can deliver are limited because of the insufficient heat and humidity provided to the gas administered. Low flow devices such as the nasal cannula, conventional face mask and reservoir bag deliver a flow rate of up to 15 L/min by administering more variable oxygen fractions (FiO2), depending on the patient’s respiratory pattern, peak inspiratory flow and characteristics of the devices. Conventional high flow devices, such as venturi type masks, utilize a constant flow of oxygen through precisely sized ports, entraining the ambient air, using the Bernoulli principle, providing a more constant inspired oxygen fraction. However, they are less tolerated than nasal cannulas because they are less comfortable and the insufficient humidification and heating of the gas delivered [1]. In the last two decades, new devices have been developed to administer high humidified and heated flow through a nasal cannula (HFNC) that also allows the delivery of oxygen with a known FiO2 up to 100%. In the literature, this technique has also been called mini CPAP (continuous positive airway pressure), transnasal insufflation, high nasal flow ventilation, high flow oxygen therapy, and high flow nasal cannula oxygen therapy [2]. It is considered that high flow nasal cannula has certain benefits compared to those of oxygen therapy previously detailed. HFNC manages a flow of more than 30 L/min, which is able to surpass the peak inspiratory flow of the patient, being able to reach values ​​between 60-80 L/min depending on the flow used. The gas source, which may be delivered by an air/oxygen blender, fans, or a flow generating turbine, is connected by an active humidifier to a nasal cannula and the FiO2 can be adjusted independently of the flow. From a clinical point of view, there is some confusion between venturi and high flow nasal cannula devices. In the literature, both have been considered as high flow oxygen therapy devices. In our opinion this is not appropriate because the high nasal cannula flow is much more than a simple system for administering oxygen therapy [3]. Venturi-type masks provide the patient with a gas mixture with a controlled FiO2, but do not exert additional benefits on the ventilator mechanics of the patient. Nevertheless, HFNC allows the delivery of a high flow, which can also add oxygen therapy, providing a series of physiological effects that imply an active treatment to respiratory failure. Effects related to HFNC include the following: 1. Delivery of higher and more stable FiO2 values, ​​because the flow delivered is greater than the patient’s inspiratory demand. 2. The anatomical dead space decreases by washing the nasopharynx, consequently increases alveolar ventilation. This improves the thoracoabdominal synchrony. 3. Respiratory work decreases because it acts as a mechanical stent in the airway and markedly attenuates inspiratory resistance. 4. The gas administered is warmed and humidified, improving mucociliar clearance, reducing the risk of atelectasis, improving ventilation perfusion and oxygenation ratio. 5. There is a CPAP-like effect. The dynamic positive espiratory airway pressure generated by HFNC reaches a value between 6-8cmH2o depending on the flow and the size of the cannula. This positive pressure distends the lungs and ensures their recruitment. 6. Pulmonary end-expiratory volume is higher with HFCN than with conventional high-flow oxygen therapy. 7. In addition, the technique is considered easy and simple for the medical staff and nurses, and can be used in different areas (emergency, hospitalization, critical care unit, weaning centers) and even at home [4]. Currently available evidence has demonstrated that HFNC therapy is an alternative for the treatment of acute hypoxemic respiratory failure, hypercapnic respiratory failure, acute heart failure, as rescue therapy preventive therapy in post-extubation respiratory failure and in specific conditions such as bronchoscopy [5]. We believe that high-flow nasal cannula treatment should not be confused with high flow oxygen therapy of venturi masks. According to detailed mechanisms of action, HFNC is not limited to being only an oxygen therapy system but also behaves as a true treatment that can be used in different clinical scenarios, generating physiological benefits that result in the reduction of respiratory work. In addition, in venturi type masks, the air is not humidified and complications such as dryness and nasal pain are common, generating a poor tolerance to oxygen therapy. The benefits of proper humidification and heating of the gas delivered with HFNC therapy allow better comfort and tolerance of the patient with easy adherence to the treatment. All this contributes to making HFNC be considered a technique of choice in patients with hypoxemic respiratory failure. The growth in its use associated with easy acceptance for patients and the expansion in its application show us that HFNC is a promising therapy.

Since December 2019, an outbreak of novel corona virus disease was reported in Wuhan, which has subsequently affected more than 160 countries worldwide. The ongoing outbreak has been declared as a pandemic by WHO, a global public health emergency. Several countries are successfully fighting with the pandemic by taking strict measures like nationwide lockdown or by sequestering the areas that were suspected of having risk of community spread. The corona virus pandemic has upended our educational system worldwide [1-3]. The academic calendar all over the world has been disturbed as a result of lockdown. Even after lockdown it would take probably many more months for universities, colleges and schools to reinstate. Caught in the turmoil, some parts of urban Indian education system have turned towards delivery of education via internet or online education. The NCAER skills report 2018 discussed the immense potential of online learning, conversely as complementary to more traditional methods. Centuries old, lecture based approaches, institutional biases, and outmoded classrooms changed. Covid 19 has become an impetus for educational institutions worldwide to search for innovative solutions in a relatively short duration. In the prevailing situation, online education is turning out as an alternative to traditional modes [2,4,5]. Contemporary/E-learning prepares students across all curriculum and learning stages with skills and potential to flourish in a rapidly changing and interlinked world. It connects students and engages their sense of inquisitiveness. E-teachers know and understand the needs and talents of their students. They are trained, flexible and select from a wide range of effective teaching strategies based on need. The new learning environment and resources galvanize students to be leaders of their independent learning. Thus students collaborate and use critical and creative thinking to solve complex problems and become apprehensive and sentient global citizens [4-6]. In physiotherapy, apart from traditional institution based learning, there implies a need for technological inputs and E-learning as a need to develop critical, creative thinking and reasoning. These technological arrays do provide better concepts and understanding regarding academics and practice [6]. As physiotherapy is advancing and growing in academics, research and practice, the need for an interlinking platform through which learning becomes unconditional and globally accessible was never addressed. Covid- 19 lockdown and strategies imposed us to think apart from institutional mode, ostensibly got a worldwide acceptance. Research suggests that online learning has been shown to increase retention of information, and take less time. On average, students retain 25% - 60% more information when learning online compared to only 8% - 10% in a classroom. E-learning requires 40-60% less time to learn and understand than in a traditional setting, because students can learn at their own pace, re-reading, skipping or accelerating through concepts as they choose. Contemporary learning or E-learning at present situation is intended to have the desired effect such as physical distancing, schedule flexibility, cost effective, fast learning, course variety, boost memory, reasoning and innovative teaching [2,4]. Adoption of online learning will continue to persist post pandemic, and how such a shift would impact the worldwide education market should be studied. Some believe that the unplanned and rapid move to online learning with no training, insufficient bandwidth, and inadequate preparation will result in a poor user experience that is deleterious to sustained growth [5,8]. The current crisis has acted as a thwack to encourage digital education among physiotherapy institutions. However, to achieve its prospective in the long run, physiotherapy institutions and universities should implement a digital platform, training as well as a curriculum regulation. “We believe that, the integration of information technology, E-learning in education will be further accelerated and eventually transpire to an integral component of physiotherapy education and practice”.

The barium is often used in radiocontrast examinations of the digestive system because of mucosal absorption is limited. Massive barium aspiration is a rare complication, especially when there is no anatomic or neurological deficit. The depending on barium concentration can cause various lung effects. When the literature is reviewed, barium aspiration may be asymptomatic or lethal in massive amounts. Rarely, large amounts of barium sulphate are aspirated into the lung, there is no literature study how often this is happening. We present a case of massive barium aspiration in this subject. The case is related to a patient’s diagnostic esophagography who complaints swallowing problems. The massive barium aspiration couldn’t notice because of the absence of acute symptoms and surgical operation of gastrointestinal tract which the patient had undergone previously. When the patient applied our Pediatric Chest Diseases Polyclinic after three months, as a result of the examinations and deep research it was understood that the case was about massive barium aspiration. The patient was directed to our center because there was a radiological appearance of bone density signs on chest X-ray. Such a complaint was not reported by the family neighter in his biography, nor was written in the epicrisis. We will share acute and chronic changes in the lungs, diagnosis and treatment approaches of this case. The infant who has ileostomy was previously operated because of necrotizing enterocolitis. And also still has severe gastro-esophageal reflux and under conservative and medical treatment, a possible fundoplication surgery is planning.

Chronic obstructive pulmonary disease (COPD) is the third leading cause of death and its prevalence and incidence is also related to smoking behavior [1]. COPD is still a chronic inflammatory and progressive disease caused by multifactorial agents including environmental pollutants [2]. Besides that, it is emerging that endogenous epigenetic factors induced by lifestyle and environment [3] could play a role in the etiopathogenesis of the disease [4]. In the last years, several authors suggested that low vitamin D levels seem to be related with the increase of COPD manifestations [5]. Moreover, a multicentre, double-blind, randomised controlled trial documented that vitamin D supplementation protects against moderate or severe exacerbation of the disease, but not by upper respiratory infections [6]. However, low levels of vitamin D can be extended to many other diseases, including multiple sclerosis, diabetes, colon rectal cancer, headache or drug use [7-11]. Moreover, it is also important to remember that Vitamin D deficiency is common in high latitude regions, such as northern Europe, New Zealand, northern USA, and Canada where weaker ultraviolet B rays is not able to produce enough vitamin D. Finally, methodological factors (using low sensitivity methods) could contribute to misleading evaluation of circulating vitamin D levels. In any case, here we shall remind that vitamin D has a fundamental role in immunity [12]. In particular, it has been reported that vitamin D is able to shift the pro-inflammatory T-helper cell 1 to anti-inflammatory T-helper cell 2 [13]. Therefore, benefits of vitamin D supplementation in chronic diseases which directly or indirectly affect immune system are obvious. Today, the burden of COPD in never smokers is higher than previously believed. Therefore, more research is needed to unravel the characteristics of non-smokers COPD [1]. Notably, vitamin D levels are reported to be significantly lower in smoker’ssubjects than in non-smokers ones [14]. Therefore, low plasma vitamin D levels in COPD seems to be more a causality than a correlation.

Blood plays an important role in oxygen absorption and its transfer to organs and tissues in vertebrates, as well as in a number of invertebrate species. Numerous interactions between cellular and non-cellular blood components constantly occur. A special role in these interactions belongs to erythrocytes and leukocytes, between which oxygen is constantly exchanged and activated, which we showed directly in whole blood. Blood is a liquid tissue, which is a complex cooperative system and has many inherent functions and the most important one is the ability to maintain the homeostasis of the body. Our experience has shown that despite its high optical density, undiluted blood of humans and animals can be a source of radiation due to the transformation of the energy of electron-excited (EEE) states and secondary processes occurring in the whole blood system. Parameters of this radiation - ultra-weak photons emission (UWPE) from blood - depend upon its physiological properties and reflect the physiological state of a donor. Analysis of UWPE from non-diluted blood is a simple and sensitive method that allows to monitor the course of treatment of a patient. In spite of high opacity of non-diluted blood it may be a strong source of UWPE both in the presence and absence of UWPE enhancers. Analysis of patterns of UWPE from blood reveals its highly non-linear, stable non-equilibrium and cooperative properties. Characteristic of a living system.