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gonadotoxic treatment fertility preservation and gestational surrogacy provides a promising alternative for achieving a biological offspring.

Spontaneous remission of secondary hyperparathyroidism after kidney transplantation requires time to occur. The aim of the present study was to investigate factors that may be related to the reduction of parathyroid hormone (PTH) after transplantation as well as the rate of its reduction.

We studied 81 kidney transplant recipients at our transplantation center between January 2014 and September 2017. The relationship of PTH values during the first year after transplant with renal function, type of kidney graft origin (deceased or living), and delayed renal graft function was examined. Moreover, we determined the correlation of the rate of PTH reduction within the first year with the value of PTH before transplant.

Of the total of 81 recipients, 28 (35.1%) were women and 53 (64.8%) were men, with a mean age of 47 ± 11.87 years. At the same time, there was a decrease of PTH by 33% in the first half of the first year after transplantation and by 57% in the second. In addition, a statistically significant correlation of PTH with renal function was found (P=.001), with PTH values decreasing as the glomerular filtration rate increased. Finally, transplants from deceased donors were associated with higher values of PTH, whereas the value of PTH before transplant was positively correlated with the value after it (P=.001).

Secondary hyperparathyroidism, which accompanies end-stage chronic renal failure, usually resolves adequately after transplantation. The determinants of this resolution are the recipient's renal function, the kidney graft origin (deceased), and the pretransplant PTH values.

Secondary hyperparathyroidism, which accompanies end-stage chronic renal failure, usually resolves adequately after transplantation. The determinants of this resolution are the recipient's renal function, the kidney graft origin (deceased), and the pretransplant PTH values.Going back to Ross (1967) and Chomsky (1973), researchers have sought to understand what conditions permit long-distance dependencies in language, such as between the wh-word what and the verb bought in the sentence 'What did John think that Mary bought?'. In the present work, we attempt to understand why changing the main verb in wh-questions affects the acceptability of long-distance dependencies out of embedded clauses. In particular, it has been claimed that factive and manner-of-speaking verbs block such dependencies (e.g., 'What did John know/whisper that Mary bought?'), whereas verbs like think and believe allow them. Here we provide 3 acceptability judgment experiments of filler-gap constructions across embedded clauses to evaluate four types of accounts based on (1) discourse; (2) syntax; (3) semantics; and (4) our proposal related to verb-frame frequency. The patterns of acceptability are most simply explained by two factors verb-frame frequency, such that dependencies with verbs that rarely take embedded clauses are less acceptable; and construction type, such that wh-questions and clefts are less acceptable than declaratives. We conclude that the low acceptability of filler-gap constructions formed by certain sentence complement verbs is due to infrequent linguistic exposure.

First Contact Physiotherapy (FCP) is a primary care model where expert musculoskeletal (MSK) physiotherapists undertake the first patient consultation, to enhance MSK-patient care and free-up GP capacity. The authors report the qualitative findings from the FCP National Evaluation (Phase 3) which evaluated the FCP model against pre-agreed success criteria.

A mixed-methods 24-month service evaluation involving FCP sites across England.

Data were collected at 2 time points, year 1 and year 2. Data were collected using individual interviews and focus groups, transcribed verbatim and analysed using a hybrid inductive and deductive thematic analysis. Participants were recruited from all stakeholder groups; patients, physiotherapists, general practitioners and administration staff.

A total of 6 sites were recruited over both rounds of data collection demonstrating a wide range of service models. Thirty-nine participants were recruited including fourteen patients. All six qualitative success criteria were met. GPs' discourse reflected confidence in the FCP service and competence of the FCPs. Patient discourse reflected self-efficacy and confidence in self-management techniques and reported FCP as a positive experience. FCPs saw providing advice about work related issues as integral to their role and patient discourse reflected perceived benefit from the advice offered. Staff discourse reflected a positive experience of working with, and in, the FCP services.

Ahead of the planned scale-up of the FCP primary care model across the UK, this evaluation provides useful insights and recommendations to facilitate successful FCP implementation in terms of patient outcome and experience, and staff experience.

Ahead of the planned scale-up of the FCP primary care model across the UK, this evaluation provides useful insights and recommendations to facilitate successful FCP implementation in terms of patient outcome and experience, and staff experience.

Pediatric inflammatory bowel disease (IBD) carries significant morbidity and requires extensive medical and often surgical intervention. The aim of this study was to evaluate the impact of a dedicated Multidisciplinary clinic on the outcomes of children with IBD.

A retrospective review of a prospective database, established to track quality and outcomes of children undergoing an abdominal operation for IBD, was performed. Children who were managed before (09/2017-03/2019) and after (04/2019-06/2020) establishment of the multidisciplinary clinic were examined. The clinic instituted several care process protocols including early recovery (ERAS) and garnered additional resources for patients (wound ostomy, nutrition, social work, etc.) Primary outcomes were unanticipated return to the operating room, length of stay, ER visits within 30 days of surgery and hospital readmissions within 30 days of surgery.

We identified 41 children who underwent a total of 80 major abdominal operations; 46.3% of procedures occurred before and 53.7% occurred after instituting our clinic. There were no notable changes in disease distribution (e.g., ulcerative colitis vs. Crohn's), disease severity, medication exposure, or case urgency (elective vs. emergent). ER visits within 30 days of surgery decreased (4 (9.3%) vs. 10 (27%), p=0.04) as did readmissions within 30 days of surgery (1 (2.3%) vs. 9 (24.3%), p=0.005).

Implementation of a dedicated multidisciplinary clinic for IBD and its attendant focus on protocols and appropriate use of adjunctive resources was associated with decreased emergency department visits and hospital readmissions in the post-operative setting.

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This study aimed to identify risk factors for chronic syndesmotic instability following syndesmotic fixation.

We performed a retrospective review of consecutive patients who had sustained ankle fractures requiring syndesmotic fixation. Patients available for a minimum 5 years of follow-up were classified into 2 groups according to the presence of syndesmotic instability. Statistical binary logistic regression analyses were performed to investigate the significance of various risk factors. Functional outcomes were assessed using the FAOS.

In total, 166 patients who met the study inclusion criteria underwent analysis. The overall postoperative instability rate was 20.5%, which was significantly affected due to BMI (p = 0.018; OR 6.72), and concomitant posterior malleolar fracture (p = 0.032, OR 2.77). The mean scores in the syndesmotic instability (SI) group were significantly lower than those in the no syndesmotic instability (NSI) group (p = 0.021).

Obesity and concomitant posterior malleolar fracture were significant risk factors for postoperative syndesmotic instability.

Obesity and concomitant posterior malleolar fracture were significant risk factors for postoperative syndesmotic instability.The Opioid substitution treatment (OST) has been highly argumentative in ways that raise important ethical issues. The stigma in treating opioid addiction continues to be a major barrier to effective management plan. It prevents individuals from seeking treatment and is associated with poor mental and physical health. Poly(vinylalcohol) OST are considered to improve outcomes in opioid dependency. They are legitimate therapeutic options because they comply with the four principles of bioethics autonomy, no maleficence, beneficence and justice. OST plan should conceived in a way that outcomes only giving a medication to the patient. It has many ethical aspects that should be valued fairness, respect and solidarity. However, OST may be misused or diverted, resulting in negative treatment outcomes, here comes the important role of the multidisciplinary treatment plan to contain and prevent from misuse. We will be discussing in this paper the ethical aspect of the OST and the values that should be promoted, in order to cherish and enhance the dignity of the human being, by replacing a deadly disease with a chronic one giving the patient a chance to lead a normal life.

COVID-19 is a global pandemic that has raised worldwide public health concerns. The wide spread of the virus has led to unprecedented disturbance to regular life for people around the globe and impacted their mental health.

The aims of the current study were to investigate the prevalence of psychiatric symptoms related to insomnia, depression, and anxiety, and identify risk factors contributing to psychological stress in Lebanese young population during COVID-19 pandemic.

A cross-sectional study was done on the Lebanese young population. Participants were 4397 males and females aged 18 to 35 years who filled a self-administered online questionnaire. Three validated scales were used to measure the mental health status of the participants during the COVID-19 pandemic 7-item Insomnia Severity Index for insomnia, the Patient Health Questionnaire 9-item depression module for depression, and the 7-item Generalized Anxiety Disorder scale for anxiety.

The median interquartile range scores for anxiety, insomnie young population's mental status such as anxiety, depression and insomnia. Further follow-up studies are warranted to assess the long-term mental effects that can be imposed by the pandemic.More than 100 million people ascend to high mountainous areas worldwide every year. At nonextreme altitudes ( less then 5500m), 10-85% of these individuals are affected by acute mountain sickness, the most common disease induced by mild-moderate hypobaric hypoxia. Approximately 140 million individuals live permanently at heights of 2500-5500m, and up to 10% of them are affected by the subacute form of mountain sickness (high-altitude pulmonary hypertension) or the chronic form (Monge's disease), the latter of which is especially common in Andean ethnicities. This review presents the most relevant general concepts of these 3 clinical variants, which can be incapacitating and can result in complications and become life-threatening. Proper prevention, diagnosis, treatment and management of these conditions in a hostile environment such as high mountains are therefore essential.