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Introduction: Epidemiological studies have implicated ovulation as a risk factor for ovarian high-grade serous carcinoma (HGSC) at the initiation stage. Precancerous lesions of HGSC commonly exhibit TP53 mutations attributed to DNA deamination and are frequently localized in the fallopian tube epithelium (FTE), a site regularly exposed to ovulatory follicular fluid (FF). This study aimed to assess the mutagenic potential of FF and investigate the expression levels and functional role of activation-induced cytidine deaminase (AID) following ovulation, along with the resulting TP53 DNA deamination., Methods: The mutagenic activity of FF toward premalignant and malignant FTE cells was determined using the hypoxanthine phosphoribosyl transferase (HPRT) mutation assay with or without AID knockdown. The sequential activation of AID, including expressional induction, nuclear localization, DNA binding, and deamination, was determined. AID inducers in FF were identified, and the times of action and signaling pathways were determined., Results: FF induced AID activation and de novo FTE cell mutagenesis in two waves of activity in accordance with post-ovulation FF exposure. The ERK-mediated early activity started at 2 min and peaked at 45 min, and the NF-κB-mediated late activity started at 6 h and peaked at 8.5 h after exposure. ROS, TNF-α, and estradiol, which are abundant in FF, all induced the two activities, while all activities were abolished by antioxidant cotreatment. AID physically bound to and biochemically deaminated the TP53 gene, regardless of known mutational hotspots. It did not act on other prevalent tumor-suppressor genes of HGSC., Conclusion: This study revealed the ROS-dependent AID-mediated mutagenic activity of the ovulatory FF. The results filled up the missing link between ovulation and the initial TP53 mutation and invited a strategy of antioxidation in prevention of HGSC., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Objective: Aortic stenosis (AS) is characterized by narrowing of the aortic valve opening, resulting in peak blood flow velocity that induces high wall shear stress (WSS) across the valve. Severe AS leads to heart failure and death. There is no treatment available for AS other than valve replacement. Platelet-derived transforming growth factor beta 1 (TGF-β1) partially contributes to AS progression in mice, and WSS is a potent activator of latent TGF-β1. N-acetylcysteine (NAC) inhibits WSS-induced TGF-β1 activation in vitro . We hypothesize that NAC will inhibit AS progression by inhibiting WSS-induced TGF-β1 activation. Approach: We treated a cohort of Ldlr(-/-)Apob(100/100) low density lipoprotein receptor (LDLR) mice fed a high-fat diet with NAC (2% in drinking water) at different stages of disease progression and measured its effect on AS progression and TGF-β1 activation. Results: Short-term NAC treatment inhibited AS progression in mice with moderate and severe AS relative to controls, but not in LDLR mice lacking platelet-derived TGF-β1 (TGF-β1 platlet-KO -LDLR). NAC treatment reduced TGF-β signaling, p-Smad2 and collagen levels, and mesenchymal transition from isolectin B 4 and CD45-positive cells in LDLR mice. Mechanistically, NAC treatment resulted in plasma NAC concentrations ranging from 75.5 to 449.2 ng/mL, which were sufficient to block free thiol labeling of plasma proteins and reduce active TGF-β1 levels without substantially affecting reactive oxygen species-modified products in valvular cells. Conclusions: Short-term treatment with NAC inhibits AS progression by inhibiting WSS-induced TGF-β1 activation in the LDLR mouse model of AS, motivating a clinical trial of NAC and/or other thiol-reactive agent(s) as a potential therapy for AS.

Purpose: The aim of this pilot study was to evaluate the knowledge and perception among dental educators regarding the use of relative value units (RVUs) in medicine, perceived benefits in dentistry, and the relative ranking of the components to define RVUs in dentistry., Methods: A convenience sample of dental educators participating in the American Dental Education Association's Leadership Institute (2023-2024) cohort was surveyed for their knowledge and perception regarding RVUs. The responses were stratified based on experience with RVUs prior to statistical analyses (α = 0.05)., Results: Twenty-six dental educators from 18 different North American dental schools and nine different dental specialties participated in this pilot study. Although not significant, a higher proportion of dental educators with prior experience perceived RVUs as a valuable tool in dental practice for assigning chair time, developing payment models, and tracking student-resident progress in a clinical course. There was a lack of consensus among dental educators regarding the components for determining dental procedural RVUs., Conclusion: This pilot study provides limited evidence that prior knowledge of RVUs may be related to its perceived benefits among dental educators, but a broader study design is needed to draw meaningful conclusions and universally acceptable components for determining RVUs in dentistry., (© 2024 American Dental Education Association.)

Introduction: International guidelines recommend definitive combination antibiotic therapy for the management of serious infections involving carbapenem-resistant Acinetobacter (CRAB) species. The commonly available combination options include high-dose sulbactam, polymyxins, tetracyclines, and cefiderocol. Scanty prospective data exist to support this approach., Methods: Patients with CRAB bacteraemia, ventilator-associated pneumonia (VAP), or both were categorized based on whether they received combination therapy or monotherapy. The 30-day mortality was compared between the two groups. Inverse probability treatment weighting (IPTW) was done using propensity score (PS) for a balanced comparison between groups., Results: Between January 2021 and May 2023, of the 161 patients with CRAB bacteraemia (n = 55, 34.2%), VAP (n = 46, 28.6%), or both (n = 60, 37.3%) who received appropriate intravenous antibiotic therapy, 70% (112/161) received monotherapy, and the rest received combination therapy. The overall 30-day mortality was 62% (99/161) and not different (p = 0.76) between the combination therapy (31/49, 63.3%) and monotherapy (68/112, 60.7%) groups. The propensity score matching using IPTW did not show a statistical difference (p = 0.47) in 30-day mortality for receiving combination therapy with an adjusted odds ratio (OR) P of 1.29 (0.64, 2.58)., Conclusion: Combination therapy for CRAB infections needs further study in a randomised controlled trial, as this observational study showed no difference in 30-day mortality between monotherapy and combination therapy., (© 2024. The Author(s).)

Slow maxillary expansion is a technique used to achieve correction of maxillary transverse deficiency or posterior crossbite in patients where the midpalatal suture has closed. This is mostly achieved by buccal tipping of maxillary posterior teeth. The aim of this case report is to discuss the orthodontic treatment of a 20-year-old patient with bilateral posterior crossbite. The patient had moderate maxillary crowding and severe mandibular crowding, crossbites bilaterally on his posterior teeth, and maxillary lateral incisors. The patient had thin gingival biotype with gingival recession on the mandibular right canine. Orthodontic treatment was done with full fixed appliances, and extraction of a mandibular right lateral incisor. This case report shows that slow maxillary expansion can be used in an adult to achieve the objectives set by both the orthodontist and patient while also considering treatment modalities most agreeable to the patient. Key words: Orthodontic treatment, slow maxillary expansion, maxillary expansion, RPE, Hyrax expander, case report., Competing Interests: The authors declare there is no conflict of interests., (Copyright: © 2024 Medicina Oral S.L.)

Energy is a crucial entity for the development and it has various alternative forms of energy sources. Recently, the synthesis of nanoparticles using benign biocatalyst has attracted increased attention. In this study, silver nanoparticles were synthesized and characterized using Azadirachta indica plant-derived phytochemical as the reducing agent. Biomass of the microalga Chlorella sp. cultivated in BG11 medium increased after exposure to low concentrations of up to 0.48 mg L -1 AgNPs. In addition, algal cells treated with 0.24 mg L -1 AgNPs and cultivated in BG11 0 medium which contained no nitrogen source showed the highest hydrogen yield of 10.8 mmol L -1 , whereas the untreated cells under the same conditions showed very low hydrogen yield of 0.003 mmol L -1 . The enhanced hydrogen production observed in the treated cells was consistent with an increase in hydrogenase activity. Treatment of BG11 0 grown cells with low concentration of green synthesized AgNPs at 0.24 mg L -1 enhanced hydrogenase activity with a 5-fold increase of enzyme activity compared to untreated BG11 0 grown cells. In addition, to improve photolytic water splitting efficiency for hydrogen production, cells treated with AgNPs at 0.24 mg L -1 showed highest oxygen evolution signifying improvement in photosynthesis. The silver nanoparticles synthesized using phytochemicals derived from plant enhanced both microalgal biomass and hydrogen production with an added advantage of CO 2 reduction which could be achieved due to an increase in biomass. Hence, treating microalgae with nanoparticles provided a promising strategy to reduce the atmospheric carbon dioxide as well as increasing production of hydrogen as clean energy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Ethyl-2-((8-cyano-3,5,9a-trimethyl-1-(4-oxo-4,5-dihydrothiazol-2-yl)-4-phenyl-3a,4,9,9a-tetrahydro-1 H -pyrazolo[3,4- g ]isoquinolin-7-yl)thio)acetate ( 5 ) was synthesized, and its structure was characterized by IR, MS, and NMR ( 1 H and 13 C) and verified by a single-crystal X-ray structure determination. Compound 5 adopts a "pincer" conformation. In the crystal, the hydrogen bonds of -H···O, C-H···O, and O-H···S form thick layers of molecules that are parallel to (101). The layers are linked by C-H···π(ring) interactions. The Hirshfeld surface analysis shows that intermolecular hydrogen bonding plays a more important role than both intramolecular hydrogen bonding and π···π stacking in the crystal. The intramolecular noncovalent interactions in 5 were studied by QTAIM, NCI, and DFT-NBO calculations. Based on structural activity relationship studies, leucine-rich repeat kinase 2 (LRRK2) was found to bind 5 and was further subjected to molecular docking studies, molecular dynamics, and ADMET analysis to probe potential drug candidacy., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Effective drug delivery for is the foremost requirement for the complete recovery of the disease. Nanomedicine and nanoengineering has provided so many spaces and ideas for the drug delivery design, whether controlled, targeted, or sustained. Different types of nanocarriers or nanoparticles are aggressively designed for the drug delivery applications. Clay minerals are identified as a one of the potential nanocarrier for the drug delivery. Owing to their biocompatibility and very low cytotoxicity, clay minerals showing effective therapeutic applications. In the present investigation, clay mineral, i.e., Halloysite nano tubes are utilized as a nanocarrier for the delivery of antibiotic cefixime (CFX), a third-generation cephalosporin. The HNT was first functionalized with the sulfuric acid and then further treated with the 3-(aminopropyl)triethoxysilane (APTES). The drug is loaded on three different classifications of HNTs, i.e., Bare-CFX-HNT, Acid-CFX-HNT, and APTES-CFX-HNT and their comparative analysis is established. Different characterization techniques such as X-ray diffractometry (XRD), Fourier transform infra-red (FT-IR), Transmission electron microscopy TEM), Brunauer-Emmett-Teller (BET), adsorption studies, and Thermogravimetric analysis (TGA) were performed to evaluate their chemical, structural, morphological, and thermal properties. TGA confirmed the encapsulation efficiency of Bare-CFX-HNT, Acid-CFX-HNT, and APTES-CFX-HNT as 42.65, 52.19, and 53.43%, respectively. Disk diffusion and MTT assay confirmed that the drug loaded HNTs have potential antibacterial activities and less cytotoxicity. The adsorption capacity of CFX with different HNTs are evaluated and Different adsorption and kinetic models have been discussed. Drug release studies shows that APTES-CFX-HNT showing sustained release of cefixime as compared to Bare-CFX-HNT and Acid-CFX-HNT., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background Gastrointestinal stromal tumors (GISTs) represent the most common mesenchymal neoplasms of the gastrointestinal tract, arising from the interstitial cells of Cajal. These tumors bridge the nervous system and muscular layers of the gastrointestinal tract, playing a crucial role in the digestive process. The incidence of GISTs demonstrates notable variations across different racial and ethnic groups, underscoring the need for in-depth analysis to understand the interplay of genetic, environmental, and socioeconomic factors behind these disparities. Linear regression analysis is a pivotal statistical tool in such epidemiological studies, offering insights into the temporal dynamics of disease incidence and the impact of public health interventions. Methodology This investigation employed a detailed dataset from 2009 to 2020, documenting GIST incidences across Asian, African American, Hispanic, and White populations. A meticulous preprocessing routine prepared the dataset for analysis, which involved data cleaning, normalization of racial terminologies, and aggregation by year and race. Linear regression models and Pearson correlation coefficients were applied to analyze trends and correlations in GIST incidences across the different racial groups, emphasizing an understanding of temporal patterns and racial disparities in disease incidence. Results The study analyzed GIST cases among four racial groups, revealing a male predominance (53.19%) and an even distribution of cases across racial categories: Whites (27.66%), Hispanics (25.53%), African Americans (24.47%), and Asians (22.34%). Hypertension was the most common comorbidity (32.98%), followed by heart failure (28.72%). The linear regression analysis for Asians showed a decreasing trend in GIST incidences with a slope of -0.576, an R-squared value of 0.717, and a non-significant p-value of 0.153. A significant increasing trend was observed for Whites, with a slope of 0.581, an R-squared value of 0.971, and a p-value of 0.002. African Americans exhibited a moderate positive slope of 0.277 with an R-squared value of 0.470 and a p-value of 0.201, indicating a non-significant increase. Hispanics showed negligible change over time with a slope of -0.095, an R-squared value of 0.009, and a p-value of 0.879, suggesting no significant trend. Conclusions This study examines GIST incidences across racial groups, revealing significant disparities. Whites show an increasing trend (p = 0.002), while Asians display a decreasing trend (p = 0.153), with stable rates in African Americans and Hispanics. Such disparities suggest a complex interplay of genetics, environment, and socioeconomic factors, highlighting the need for targeted research and interventions that address these differences and the systemic inequalities influencing GIST outcomes., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rammohan et al.)

Background Salpingectomy is a common surgical procedure in gynecology performed for various indications. Given its proximity to the ovaries and shared vascular supply, concerns have arisen regarding compromised ovarian reserve post-salpingectomy. Objective We aim to study the effect of two different energy sources (group 1: salpingectomy using bipolar electrocautery followed by division with scissors versus group 2: salpingectomy with ultrasonic shears) on residual ovarian reserve. The effect on ovarian reserve was assessed using serum levels of follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), antral follicle count (AFC), and ovarian size pre- and postoperatively. Materials and methods According to the inclusion criteria, 68 women were included in the study and randomized into the bipolar electrocautery group and the ultrasonic shear group. The final analysis included 34 women in the bipolar electrocautery group and 32 in the ultrasonic shear group. Preoperatively, the ovarian reserve of all women was assessed using FSH, AMH, AFC, and ovarian size. These parameters were then reassessed at three months postoperatively, and the percentage change was analyzed. Results The mean baseline serum AMH and serum FSH values in the bipolar electrocautery group were 3.9 ± 2.9 ng/ml and 6.6 ± 2.1 IU/L, respectively, comparable with the values in the ultrasonic shear group, where serum AMH was 3.2 ± 2.9 ng/ml and serum FSH was 7.3 ± 3.9 IU/L. AFC and ovarian size were comparable between the two groups preoperatively (bipolar electrocautery group AFC was 8 ± 2.2, ovarian size on the right side was 3.3 ± 0.7 cm and on the left was 3.2 ± 0.6 cm; ultrasonic shear group AFC was 5.7 ± 2.3, ovarian size on the right side was 3.4 ± 0.8 cm and on the left was 3.2 ± 0.8 cm). After three months of postoperative analysis, AFC showed a significant fall from the preoperative value in the bipolar electrocautery group compared to the ultrasonic shear group (AFC reduced from 8 ± 2.2 to 5.5 ± 2.3 vs. 8.6 ± 0.5 to 7.9 ± 2.3; p=0.002). The other parameters showed no statistically significant change. Conclusion Our study suggests that ultrasonic shear is safer than bipolar electrocautery for preserving ovarian reserve after salpingectomy. However, further research is needed to confirm these findings., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Zangmo et al.)

Introduction: The coronavirus disease 2019 (COVID-19) is a viral infection characterized by respiratory and gastrointestinal symptoms. The causative agent of this infection is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The genomic study helps in understanding the pathogenesis, epidemiology, and the development of therapeutic and preventive strategies in the combat against COVID-19., Materials and Methods: Nasopharyngeal and oropharyngeal swab samples were collected from asymptomatic and symptomatic patients during the time period of 2021-2022 for the detection of SARS-CoV-2 by employing real-time reverse transcriptase, cDNA synthesis, whole-genome sequencing by next-genome sequencing, analysis of SARS-CoV-2 sequence data and lineage and variant of concern assignment along with phylogenetic analysis., Results: Lineages BA.2.10 and BA.4.1.1 clustered with genomes from Senegal suggested the spread of infections. Similarly, high clustering among delta samples during the second wave showed possible importation and subsequent spread via local transmission., Conclusions: Studies like these are important to understand the characteristics and origins of locally circulating SARS-CoV-2 diversity in order to prevent further spread., Competing Interests: There are no conflicts of interest., (Copyright: © 2024 Journal of Family Medicine and Primary Care.)

Postoperative adhesions show a higher occurrence in females aged 16-60, especially after pelvic surgeries. This study explores the role of ovulation in adhesion formation in mice. Ovarian surgery in mice with normal- or super-ovulation led to pronounced adhesions, whereas ovulation-defective Pgr -KO mice showed minimal adhesions. Specifically, exposure to ovulatory follicular fluid (FF) markedly increased the adhesion. The hazardous exposure time window was one day before to 2.5 days after the surgery. Mechanistically, early FF exposure triggered adhesions via the blood coagulation cascade, while later exposure relied on the HGF/cMET signaling pathway. Prophylactic administration of a thrombin inhibitor pre-operatively or a cMET inhibitor postoperatively effectively mitigated FF-induced adhesions, while COX inhibitor treatment exhibited no discernible effect. These findings underscore ovulation as a pivotal factor in the development of pelvic wound adhesions and advocate for targeted preventive strategies such as c-MET inhibition, scheduling surgeries outside the ovulatory period, or employing oral contraceptive measures., Competing Interests: The authors declare no competing interests., (© 2024 The Authors. Published by Elsevier Inc.)

Liver function abnormalities are noted in a minority of pregnancies with multiple causes for the same. A small proportion of these develop severe liver injury and progress to acute liver failure (ALF). There is a discrete set of etiology for ALF in pregnancy and comprehensive understanding will help in urgent evaluation. Certain diseases such as acute fatty liver of pregnancy, hemolysis, elevated liver enzyme, low platelet (HELLP) syndrome and pre-eclampsia are secondary to pregnant state and can present as ALF. Quick and targeted evaluation with urgent institution of etiology-specific management, especially urgent delivery in patients with pregnancy-associated liver diseases, is the key to avoiding maternal deaths. Pregnancy, as also the fetal life, imparts a further layer of complication in assessment, prognosis and management of these sick patients with ALF. Optimal management often requires a multidisciplinary approach in a well-equipped centre. In this review, we discuss evaluation, assessment and management of pregnant patients with ALF, focussing on approach to pregnancy-associated liver diseases., (© 2024. Indian Society of Gastroenterology.)

The textiles for medical use and the purification of textile factory effluents have become the most crucial part of the human healthcare sector. In this study bioactive compounds produced by four distinct plant extracts were used for the synthesis of zinc oxide nanoparticles. The four different ZnO nanoparticles were comprehensively characterized by different analytical techniques. XRD analysis revealed the crystalline nature and phase purity of the ZnO nanoparticles. FTIR spectra provided information on the function of plant extracts in the stabilization or capping process. The size distribution and morphological diversity of the nanoparticles were further clarified by SEM and TEM images. The photocatalytic degradation activity of the four ZnO nanoparticles on two different dyes showed that ZnO nanoparticles prepared from A. indica were most effective for the degradation of 98 % and 91 % of Rhodamine B and Alizarin red dye respectively. The selected ZnO nanoparticles from A. indica were used to prepare ZnO-chitosan nanocomposites before coating on cotton fabrics. The hydrophobicity, UV protection factor, and antibacterial activity of ZnO-chitosan nanocomposites, when coated on cotton fabrics, were also examined. The overall results demonstrated the ZnO and ZnO-chitosan nanocomposite prepared in the present study as a promising material for environmental remediation application., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Idiosyncratic drug-induced liver injury (iDILI) causing acute liver failure (ALF) carries high short-term mortality and patients who meet King's College criteria for liver transplantation have 1-month survival of 34% without liver transplantation (PMID: 20949552). We present our experience with low-volume plasma exchange (PLEX-LV, 50% of estimated plasma volume exchanged per session) and low-dose steroid to treat iDILI ALF., Methods: We retrospectively analysed data of patients with iDILI (diagnosed as per RUCAM score), treated with PLEX-LV and low-dose steroid (prednisolone: 10 mg OD, with rapid taper) in our department from 2016 to 2022. Baseline and dynamic parameters (post-PLEX) were assessed as predictors of 1-month liver transplantation-free survival., Results: Twenty-two iDILI patients [probable: possible iDILI: 20:2, males: 9, age: 30 (14-84) years, median (range); MELD score: 30.5 (19-43)] underwent PLEX-LV for ALF during the study period. Causative agents were complementary and alternative medications (36%), antiepileptics (18%) antimicrobials (14%), antitubercular drugs (14%), antifungal drugs (9%) and others (9%). All patients had jaundice and encephalopathy; 9 patients also had ascites. None of the patients underwent liver transplantation. Study patients underwent 3 (1-7) PLEX sessions and 1.4 (0.6-1.6) litres of plasma was exchanged per session. One-month transplant-free survival was 59% (13/22) in the study population and 63% (12/19) among patients who fulfilled Kings College criteria for liver transplantation. Reduction of ≥25% in plasma von Willebrand factor (VWF) levels after PLEX-LV predicted improved survival (HR: 0.09, 95% CI: 0.01-0.65; AUROC: 0.81; 95% CI: 0.6-1.0)., Conclusion: Low-volume PLEX and low-dose steroid appears a promising treatment option in patients with iDILI-induced ALF not opting for liver transplantation. Dynamic changes in VWF level after PLEX predict 1-month survival in these patients., (© 2023 Indian National Association for Study of the Liver. Published by Elsevier B.V.)

Cochlear implantation is the most successful approach for people with profound sensorineural hearing loss. Manual insertion of the electrode array may result in damaging the soft tissue structures and basilar membrane. An automated electrode array insertion device is reported to be less traumatic in cochlear implant surgery., Objectives: The present work develops a simple, reliable, and compact device for automatically inserting the electrode array during cochlear implantation and test the device to observe intracochlear pressure during simulated electrode insertion., Methods: The device actuates the electrode array by a roller mechanism. For testing the automated device, a straight cochlea having the dimension of the scala tympani and a model electrode is developed using a 3D printer. A pressure sensor is utilized to observe the pressure change at different insertional conditions., Results: The electrode is inserted into a prototype cochlea at different speeds without any pause, and it is noticed that the pressure is increased with the depth of insertion of the electrode irrespective of the speed of electrode insertion. The rate of pressure change is observed to be increased exponentially with the speed of insertion., Conclusion: At an insertion speed of 0.15 mm/s, the peak pressure is observed to be 133 Pa, which can be further evaluated in anatomical models for clinical scenarios., Level of Evidence: N/A Laryngoscope, 134:1388-1395, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Introduction Colorectal cancer (CRC) remains a significant public health challenge globally, with its pathogenesis involving the transformation of benign adenomas into malignant carcinomas. Despite advancements in screening and early detection significantly improving outcomes, the rise of digital platforms like YouTube for disseminating health information presents new challenges. Concerns over the accuracy and reliability of content underline the necessity for rigorous evaluation of these digital health education tools. Methods Our study was conducted at Nassau University Medical Center, East Meadow, New York. We meticulously analyzed YouTube videos on "colon cancer screening awareness," employing strict selection criteria to ensure both relevance and quality, focusing on English-language content with pertinent audio. Videos were evaluated for their quantitative and qualitative attributes-views, subscriber counts, likes/dislikes, comments, and content type, classifying them as scholarly or personal. We assessed video credibility through scientific accuracy using the DISCERN instrument, Global Quality Score (GQS), and Patient Education Materials Assessment Tool (PEMAT), ensuring consistency in quality and reliability evaluation among seven researchers via the intraclass correlation coefficient. These tools - DISCERN for assessing reliability and quality, GQS for evaluating overall quality, and PEMAT for understandability and actionability - facilitated a comprehensive evaluation framework. Our analysis, leveraging descriptive and inferential statistics, scrutinized differences in content quality between academic and private institutions, employing t-tests to identify statistically significant disparities. The study utilized Microsoft Excel (version 16.73, Microsoft Corporation, Redmond, Washington, United States) and IBM SPSS Statistics for Windows, version 29.0 (released 2022; IBM Corp., Armonk, New York, United States). for robust data processing and analysis, confirming the educational value and trustworthiness of the examined YouTube content. Results Our study of 156 YouTube videos on educational content, split between academic (68 videos) and private sources (88 videos), revealed significant quality differences. Using the DISCERN, PEMAT, and GQS metrics, academic videos consistently outperformed private ones, with significant margins: DISCERN (54.61 vs. 34.76), PEMAT (3.02 vs. 2.11), and GQS (3.90 vs. 2.02), supported by low p-values indicating a statistically significant superiority. These findings suggest that the source of content-academic versus private-plays a crucial role in determining the quality and reliability of educational materials on platforms like YouTube, highlighting the academic sector's commitment to higher educational standards. Conclusion The study emphasizes the critical role of credible sources in enhancing the quality of health education content on YouTube, particularly concerning CRC screening. The superiority of academic institutions in providing high-quality content suggests a need for viewers to critically assess the source of information. It also calls for enhanced regulatory oversight and measures to ensure the accuracy and reliability of health information online., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Rammohan et al.)

Clay minerals such as Halloysite nanotubes (HNTs), abundantly available green nanomaterial, exhibit a significant advantage in biomedical applications such as drug delivery, antibacterial and antimicrobials, tissue engineering or regeneration, etc. Because of the mesoporous structure and high absorbability, HNTs exhibit great potential as a nanocarrier in drug delivery applications. The sulfuric acid treatment enhances the surface area of the HNTs and thereby improves their drug-loading capacity by enlarging their lumen space/inner diameter. In the present investigation, based on the literature that supports the efficacy of drug loading after acid treatment, a dual treatment was performed to functionalize the HNTs surface. First, the HNTs were etched and functionalized using sulfuric acid. The acid-functionalized HNTs underwent another treatment using (3-aminopropyl) triethoxysilane (APTES) to better interact the drug molecules with the HNTs surfaces for efficient drug loading. Augmentin, a potential drug molecule of the penicillin group, was used for HNTs loading, and their antibacterial properties, cytotoxicity, and cumulative drug release (%) were evaluated. Different characterization techniques, such as X-ray diffractometer (XRD) and Fourier Transform Infra-Red (FT-IR), confirm the loading of Augmentin to the APTES@Acid HNTs. TEM images confirm the effective loading of the drug molecule with the HNTs. The drug encapsulation efficiency shows 40.89%, as confirmed by the Thermogravimetric Analysis (TGA). Also, the Augmentin-loaded APTES@Acid HNTs exhibited good antibacterial properties against E. coli and S. aureus and low cytotoxicity, as confirmed by the MTT assay. The drug release studies confirmed the sustainable release of Augmentin from the APTES@Acid HNTs. Hence, the treated HNTs can be considered as a potential nanocarrier for effectively delivering Augmentin and promoting enhanced therapeutic benefits., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

The severity of aortic stenosis (AS) is associated with acquired von Willebrand syndrome (AVWS) and gastrointestinal bleeding, leading to anemia (Heyde's syndrome). We investigated how anemia is linked with AS and AVWS using the LA100 mouse model and patients with AS. Induction of anemia in LA100 mice increased transforming growth factor (TGF)-β1 activation, AVWS, and AS progression. Patients age >75 years with severe AS had higher plasma TGF-β1 levels and more severe anemia than AS patients age <75 years, and there was a correlation between TGF-β1 and anemia. These data are compatible with the hypothesis that the blood loss anemia of Heyde's syndrome contributes to AS progression via WSS-induced activation of platelet TGF-β1 and additional gastrointestinal bleeding via WSS-induced AVWS., Competing Interests: This work was supported by grant HL148123 (to Dr Ahamed), in part by HL167656 (to Dr Ahamed), HL19278 (to Dr Coller), a Clinical and Translational Science Award (TR000043) from the National Center for Research Resources and the National Center for Advancing Translational Sciences (NCATS), and National Institutes of Health; and by funds from the Oklahoma Center for Adult Stem Cell Research, Presbyterian Health Foundation, Centers of Biomedical Research Excellence, and Stony Brook University. The authors have reported that they have no relationships relevant to the contents of this paper to disclose., (© 2024 The Authors.)

Wastewater treatment remains the most significant delinquent issue world-wide. Generally, wastewater treatment involves filtration followed by acidified de-emulsification through photocatalytic reduction. The aim of the present study is to reduce the use of nanoparticles in wastewater treatment and also to find an appropriate alternative to replace cotton fiber filters used in water treatment plant. The cotton fiber filters are highly prone to bacterial film development leading to bactericidal degradation of the fibers. We developed a ZnO-chitosan nanocomposite coated fiber for wastewater treatment to enhance its photocatalytic activity under acidic condition. The fiber showed high degree of photocatalytic degradation activity, reducing rhodamine B dye, chemical oxygen demand and chromium levels in the synthetic wastewater to 37, 79 and 51% respectively under highly acidic condition. Additionally, ZnO-chitosan nanocomposite did not cause mortality on Danio rerio embryo after 72 h incubation. The ZnO-chitosan nanocomposite coated fiber showed strong antibacterial activity against Escherichia coli and Staphylococcus aureus with a reduction of 96% and 99% respectively. This study demonstrated the potential of a novel smart fiber in wastewater treatment and biomedical applications., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Background: This study evaluates the remineralization potential of enamel after bioactive glass (BAG) air abrasion, using Scanning Electron Microscopy with Energy Dispersive X-ray Spectroscopy Analysis (SEM-EDS), Electron Probe Microanalysis (EPMA), and Atomic Force Microscopy (AFM)., Material and Methods: Forty extracted human third molars were divided into four groups with ten samples each. Three groups were subjected to a demineralizing solution of 2.2 mM calcium chloride, 2.2 mM monopotassium phosphate, and 0.05 mM acetic acid, adjusted to a pH of 4.4 using 1 M potassium hydroxide at an intraoral temperature of 37°C for 96 hours. Of the three groups, two were subjected to air abrasion with BAG. One of the air abrasion groups was then further remineralized in 1.5 mM calcium chloride, 0.9 mM sodium phosphate, and 0.15 M potassium chloride, adjusted to a pH of 7.0 at 37°C. The teeth were then evaluated via SEM-EDS and EPMA to measure the calcium-to-phosphorous (Ca:P) ratios, and the surface morphology was investigated using AFM., Results: A measurable decrease in the Ca:P ratio was found after demineralization, which subsequently increased after remineralization. A thin layer of demineralized enamel was removed by the BAG air abrasion. AFM image analysis showed the presence of pits on the surface, which decreased in depth after demineralization, and further after BAG abrasion. Remineralized samples, in contrast, showed a slight increase in pit depth. While the observation of remineralization was statistically significant throughout our study, we could not find any evidence for BAG retention on the surface of the enamel., Conclusions: It is demonstrated that BAG, when delivered via air abrasion, indeed contributes to remineralization of the enamel; however, it does not seem to be a direct result of the presence of retained glass beads on the enamel surface. Given the increase of the Ca:P ratio after remineralization, a possible therapeutic benefit was observed, potentially reducing the probability of fractures in weakened enamel. Key words: Enamel, Demineralization, Remineralization, White Spot Lesions, Bioactive Glass, Air Abrasion, Energy Dispersive X-ray Spectroscopy, Electron Probe Microanalysis, Atomic Force Microscopy, Ca:P ratio, surface morphology., Competing Interests: Conflicts of interest None declared., (Copyright: © 2023 Medicina Oral S.L.)

Background: Cardiac valve disease is observed in 2.5% of the general population and 10% of the elderly people. Effective pharmacological treatments are currently not available, and patients with severe cardiac valve disease require surgery. PROX1 (prospero-related homeobox transcription factor 1) and FOXC2 (Forkhead box C2 transcription factor) are transcription factors that are required for the development of lymphatic and venous valves. We found that PROX1 and FOXC2 are expressed in a subset of valvular endothelial cells (VECs) that are located on the downstream (fibrosa) side of cardiac valves. Whether PROX1 and FOXC2 regulate cardiac valve development and disease is not known., Methods: We used histology, electron microscopy, and echocardiography to investigate the structure and functioning of heart valves from Prox1 ΔVEC mice in which Prox1 was conditionally deleted from VECs. Isolated valve endothelial cells and valve interstitial cells were used to identify the molecular mechanisms in vitro, which were tested in vivo by RNAScope, additional mouse models, and pharmacological approaches. The significance of our findings was tested by evaluation of human samples of mitral valve prolapse and aortic valve insufficiency., Results: Histological analysis revealed that the aortic and mitral valves of Prox1 ΔVEC mice become progressively thick and myxomatous. Echocardiography revealed that the aortic valves of Prox1 ΔVEC mice are stenotic . FOXC2 was downregulated and PDGF-B (platelet-derived growth factor-B) was upregulated in the VECs of Prox1 ΔVEC mice. Conditional knockdown of FOXC2 and conditional overexpression of PDGF-B in VECs recapitulated the phenotype of Prox1 ΔVEC mice. PDGF-B was also increased in mice lacking FOXC2 and in human mitral valve prolapse and insufficient aortic valve samples. Pharmacological inhibition of PDGF-B signaling with imatinib partially ameliorated the valve defects of Prox1 ΔVEC mice., Conclusions: PROX1 antagonizes PDGF-B signaling partially via FOXC2 to maintain the extracellular matrix composition and prevent myxomatous degeneration of cardiac valves., Competing Interests: Disclosures None.

Introduction: The objective of this study was to examine the evolution of carbapenem-resistant Klebsiella pneumoniae (CRKp) infections and their impact at a tertiary care hospital in South India., Methods: A comparative analysis of clinical data from two prospective cohorts of patients with CRKp bacteremia (C1, 2014-2015; C2, 2021-2022) was carried out. Antimicrobial susceptibilities and whole genome sequencing (WGS) data of selected isolates were also analyzed., Results: A total of 181 patients were enrolled in the study, 56 from C1 and 125 from C2. CRKp bacteremia shifted from critically ill patients with neutropenia to others (ICU stay: C1, 73%; C2, 54%; p = 0.02). The overall mortality rate was 50% and the introduction of ceftazidime-avibactam did not change mortality significantly (54% versus 48%; p = 0.49). Oxacillinases (OXA) 232 and 181 were the most common mechanisms of resistance. WGS showed the introduction of New Delhi metallo-β-lactamase-5 (NDM-5), higher genetic diversity, accessory genome content, and plasmid burden, as well as increased convergence of hypervirulence and carbapenem resistance in C2., Conclusions: CRKp continues to pose a significant clinical threat, despite the introduction of new antibiotics. The study highlights the evolution of resistance and virulence in this pathogen and the impact on patient outcomes in South India, providing valuable information for clinicians and researchers., (© 2023. The Author(s).)

A solvent casting technique was used for the preparation of biomimetic nanocomposites scaffolds at three various concentrations of Curcumin loaded gold nanoparticles (Cur-AuNPs-1, 1.5, and 2 ml) as filler materials with chitosan-sodium alginate composite. The physico-chemical properties of prepared Cu-Au NPs and biomimetic nanocomposites were analyzed using various characterization techniques. In vitro biocompatibility of biomimetic nanocomposites are determined using simulated body fluid for biomineralization property, HAp formation and phosphate buffer saline (PBS) for swelling property, protein adsorption. Antibacterial activity of Cur-Au NPs and their nanocomposites carried out against Escherichia coli ( E. coli ) and Staphylococcus aureus. In vitro cytotoxicity of Cur-AuNPs is identified against UC-6 and MDA-MB 231 cell lines. The use of above studies and activity of Cur-AuNPs with contain biomimetic nanocomposites can adoptable for nanotheranostics.

SIRT3 is a longevity factor that acts as the primary deacetylase in mitochondria. Although ubiquitously expressed, previous global SIRT3 knockout studies have shown primarily a cardiac-specific phenotype. Here, we sought to determine how specifically knocking out SIRT3 in cardiomyocytes (SIRTcKO mice) temporally affects cardiac function and metabolism. Mice displayed an age-dependent increase in cardiac pathology, with 10-month-old mice exhibiting significant loss of systolic function, hypertrophy, and fibrosis. While mitochondrial function was maintained at 10 months, proteomics and metabolic phenotyping indicated SIRT3 hearts had increased reliance on glucose as an energy substrate. Additionally, there was a significant increase in branched-chain amino acids in SIRT3cKO hearts without concurrent increases in mTOR activity. Heavy water labeling experiments demonstrated that, by 3 months of age, there was an increase in protein synthesis that promoted hypertrophic growth with a potential loss of proteostasis in SIRT3cKO hearts. Cumulatively, these data show that the cardiomyocyte-specific loss of SIRT3 results in severe pathology with an accelerated aging phenotype., (© 2022. The Author(s).)

Background: In a prior report, no patient with rodenticidal hepatotoxicity who met Kochi criteria (MELD score ≥36 or baseline INR ≥6 with hepatic encephalopathy) (PMID: 26310868) for urgent liver transplantation survived with medical management alone. Plasma exchange (PLEX) may improve survival in these patients., Objectives: We describe our experience with low-volume PLEX (PLEX-LV) in treating rodenticide ingestion induced hepatotoxicity in children., Methods: From prospectively collected database of rodenticidal hepatotoxicity patients managed as in-patient with department of Hepatology from December 2017 to August 2021, we retrospectively studied outcomes in children (≤18 years). Hepatotoxicity was categorized as acute liver injury (ALI, coagulopathy alone) or acute liver failure (ALF, coagulopathy and encephalopathy). Kochi criteria was used to assess need for urgent liver transplantation. The primary study outcome was one-month survival., Results: Of the 110 rodenticidal hepatotoxicity patients, 32 children (females: 56%; age: 16 [4.7-18] years; median, range) constituted the study patients. The study patients presented 4 (1-8) days after poison consumption (impulsive suicidal intent:31, accidental:1). Twenty children (62%) had ALI [MELD: 18 (8-36)] and 12 (38%) had ALF [MELD: 37 (24-45)].All children received standard medical care, including N-acetyl cysteine; ALF patients also received anti-cerebral edema measures. None of the patient families opted for liver transplantation. Seventeen children (ALI: 6, ALF: 11) were treated with PLEX-LV (3 [1-5] sessions, volume of plasma exchanged per session: 26 [13-38] ml/kg body weight) and peri-procedure low dose prednisolone.At 1 month, 28 of the 32 children (87.5%) were alive (4 ALF patients died). Of 10 children who met Kochi listing criteria for urgent liver transplantation, two children were ineligible for PLEX-LV (due to hemodynamic instability) and of the remaining 8 children treated by PLEX-LV, 6 (75%) survived., Conclusions: PLEX-LV shows promise as an effective non-liver transplant treatment in children with rodenticidal hepatotoxicity., (© 2022 Indian National Association for Study of the Liver. Published by Elsevier B.V. All rights reserved.)

Purpose: Identifying persistent bacteremia early in patients with neutropenia may improve outcome. This study evaluated the role of follow-up blood cultures (FUBC) positivity in predicting outcomes among patients with neutropenia and carbapenem-resistant gram-negative bloodstream infections (CRGNBSI)., Methods: This retrospective cohort study conducted between December 2017 and April 2022 included patients more than 15 years old with neutropenia and CRGNBSI, who survived for ≥ 48 h, receiving appropriate antibiotic therapy and had FUBCs. Patients with polymicrobial bacteremia within 30 days were excluded. The primary outcome was 30 day mortality. Persistent bacteremia, septic shock, recovery from neutropenia, prolonged or profound neutropenia, requirement of intensive care and dialysis, and initiation of appropriate empirical therapy were also studied., Results: In our study cohort of 155 patients, the 30 day mortality rate was 47.7%. Persistent bacteremia was common in our patient cohort (43.8%). Carbapenem resistant isolates identified in the study were K.pneumoniae (80%), E.coli (12.26%), P.aeruginosa (5.16%), A.baumanii (1.94%) and E.cloacae (0.65%). The median time for sending a FUBC was 2 days (IQR, 1-3 days). Patients with persistent bacteremia had higher mortality than those without (56.76% versus 32.1%; p < 0.001). Appropriate initial empirical therapy was given to 70.9%. Recovery from neutropenia occurred in 57.4% while 25.8% had prolonged or profound neutropenia. Sixty-nine percent (107/155) had septic shock and needed intensive care; 12.2% of patients required dialysis. Non-recovery from neutropenia (aHR, 4.28; 95% CI 2.53-7.23), presence of septic shock (aHR, 4.42; 95%CI 1.47-13.28), requirement of intensive care (aHR,3.12;95%CI 1.23-7.93), and persistent bacteremia (aHR,1.74; 95%CI 1.05-2.89) significantly predicted poor outcomes in multivariable analysis., Conclusion: FUBC showing persistent bacteremia predicted poor outcomes among neutropenic patients with carbapenem-resistant gram-negative bloodstream infections (CRGNBSI) and should be routinely reported., (© 2023. The Author(s).)

The primary aim of this study was to evaluate the clinical performance of nanofilled composite resin restorations in traumatized, endodontically treated maxillary incisors with structural loss of 40% or less. The performance of the restorations was assessed in terms of longevity (survival) and esthetics (success) over a 20-month period. The secondary objective was to employ a novel digital method to quantify preoperative tooth structure loss. Sixty-one fractured maxillary incisors in 55 patients were included in the study. The teeth were photographed with a digital single-lens reflex camera equipped with a macro ring flash. The amount of lost tooth structure was calculated with digital photography software. The teeth were restored with a nanohybrid composite resin and self-etching adhesive system bonding agent. To assess esthetics, color change in the blue-yellow axis (Δb*) of the composite resin restoration was evaluated digitally with the Commission Internationale de l'Eclairage (CIE) L*a*b color system. The Wilcoxon signed-rank test was used to assess Δb*, and a Kaplan-Meier survival analysis was used to assess the longevity of the restorations. The study findings showed a statistically significant difference between pretreatment and posttreatment b* values (P < 0.05), but the difference was too small to be clinically perceptible to the human eye. A total of 5 restorations (9.8%) failed. The remaining restorations survived for a mean (SD) period of 18.6 (4.4) months. The log-rank test did not show any significant association between the amount of residual tooth structure and success of the restoration. The results of this study showed that use of direct composite resin restorations in endodontically treated maxillary incisors resulted in acceptable survival and success rates. Trial registration: Clinical Trial Registry of India No. CTRI/2020/01/023019., Competing Interests: No conflicts of interest reported.

An efficient pathway was disclosed for the synthesis of 3-chloro-6-nitro-1 H -indazole derivatives by 1,3-dipolar cycloaddition on dipolarophile compounds 2 and 3 . Faced the problem of separation of two regioisomers, a click chemistry method has allowed us to obtain regioisomers of triazole-1,4 with good yields from 82 to 90% were employed. Also, the antileishmanial biological potency of the compounds was achieved using an MTT assay that reported compound 13 as a promising growth inhibitor of Leishmania major . Molecular docking demonstrated highly stable binding with the Leishmania trypanothione reductase enzyme and produced a network of hydrophobic and hydrophilic interactions. Molecular dynamics simulations were performed for TryR- 13 complex to understand its structural and intermolecular affinity stability in a biological environment. The studied complex remained in good equilibrium with a structure deviation of ∼1-3 Å. MM/GBSA binding free energies illustrated the high stability of TryR- 13 complex. The studied compounds are promising leads for structural optimisation to enhance the antileishmanial activity.

Study design Prospective randomised placebo-controlled clinical trial.Cohort selection and data analysis Sixty-two healthy adults who underwent single dental implant placement without previous infection of the surgical bed or the need for bone grafting were included in this clinical trial. They were randomly divided into two groups (test and control). The test group was given a single dose of oral clindamycin (600 mg) one hour before surgery and the control group with a placebo. The surgical procedures were carried out by one oral surgeon and all the patients were observed post-operatively on days 1, 7, 14, 28, and 56 by a single observer for clinical, radiological, surgical variables, adverse events, and complications. Statistical analysis was performed with STATA 15 software and the number required to treat or harm (NNT/NNH) was also evaluated.Results In the test group, the authors observed two implant failures and one patient experienced gastrointestinal disturbances and diarrhoea. They also observed post-operative infections in three patients (two in the control group and one in the test group which eventually failed).Conclusions The authors concluded that pre-operative clindamycin administration during dental implant surgery in healthy adults may not reduce implant failure or post-surgical complications., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

Background and Aim: Steroids have long been used in inducing remission of inflammatory bowel disease (IBD). Chronic use, defined as therapy greater than 3 months, has been implicated in complications including increased hospital length of stay (LOS), infections, and even death. In our retrospective study, we aim to identify the complications of chronic steroid use in patients with IBD., Methods: The fourth quarter of 2015-2019 National Inpatient Sample (NIS) was used in this study. International Classification of Diseases (ICD-10) codes were used to identify patients with a diagnosis of IBD and chronic steroid use. Adverse outcomes of chronic steroid use in IBD patients were analyzed, such as osteoporosis, opportunistic infections, mortality rate, and LOS. Cohorts were weighted using an algorithm provided by the NIS allowing for accurate national estimates., Results: A total of 283 970 patients had a diagnosis of IBD. Of those, 18 030 patients had concurrent chronic steroid use. Racial disparities existed, with 77.4% White, 12.7% Black, and 6.0% Hispanic. Patients with a history of IBD and chronic steroid use were found to have higher odds of developing osteoporosis, opportunistic infections, and acute thromboembolic events but did not have higher odds of mortality., Conclusion: There is much controversy about whether IBD patients should be on chronic steroids for maintenance therapy and this study highlights the importance of this decision as patients on chronic steroid use had higher odds of developing adverse effects. These results stress the importance of monitoring patients on steroids and avoiding chronic use., (© 2022 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: The purpose of this study was to evaluate general public's perception, knowledge and preferences on orthodontic treatment rendered by an orthodontist versus the "Do-It-Yourself" orthodontics (DIYO) concept without professional supervision. The secondary objective was to assess laypeople's awareness on the risks and limitations of DIYO., Material and Methods: A 24-question online survey questionnaire was administered to 526 laypeople who had no professional experience or background in dentistry and orthodontics. All data was collected over 3 days (July 20-23, 2020) by Qualtrics server and forwarded to the principal investigator. Statistical analysis was done with statistical software SPSS® version 26., Results: The most important reason for laypeople to opt for DIYO is financial reason. People who have undergone orthodontic treatment know the difference between a general dentist and an orthodontist, whereas people who have not had orthodontic treatment are less likely to know the difference. Of the 285 people who did not receive orthodontic treatment before by a dental professional, 43 have considered DIYO. 122 of the 526 people considered DIYO, and 79 of the 122 had orthodontic treatment before. 26 of the 122 did not consider the clinical exam and diagnostic records important and would be comfortable without in-person supervision. 83 of the 122 would be comfortable not having in-person supervision, and still considered this treatment modality "Doctor-Directed"., Conclusions: The main reason laypeople utilize DIYO is the low cost. Some DIYO users do not consider risks involved and a small percentage consider their own dentist to be responsible if any issues arise with DIYO. One third of survey respondents will consider DIYO in the future. Key words: Do-It-Yourself (DIY), Direct-To-Consumer (DTC), Adult, Orthodontics, Dentistry, Surveys and Questionnaires., Competing Interests: Conflicts of interest None declared., (Copyright: © 2022 Medicina Oral S.L.)

Background: The purpose of this survey study and case review was to identify 1) the common causes related to filing a malpractice claim against an orthodontist and, 2) the factors mitigating against a potential malpractice claim in the United States (U.S). The objectives of the case review were to examine the current state of orthodontic malpractice litigation from a cause and mitigating point of view., Material and Methods: Data for this research was collected and reviewed using the following two methods: 1) A survey questionnaire on aspects of malpractice liability was electronically distributed to 2,241 active U.S. members of the American Association of Orthodontists (AAO). 2) Legal cases were reviewed on the online legal research database Lexis Advance Research, and 35 cases were analyzed., Results: Survey questionnaire results and legal case review results are as follows: 1) 77 orthodontists completed the survey. 9.1% of the respondents reported a malpractice claim having been filed against them with periodontal issues accounting for most of the claims. Survey participants reported good doctor-patient communication as being the most relevant contributory factor and most relevant mitigating factor in malpractice claims. 2) Negligence is the main reason patients sue a doctor for clinically related litigation, and failure to obtain a proper informed consent from the patient is the main cause of action for non-clinically related litigation., Conclusions: Most respondents reported doctor-patient communication, periodontal issues, and a lack of informed consent as the main triggering elements of a lawsuit, which is similar to other studies and case review analysis. Good doctor-patient rapport was ranked as being most helpful in mitigating a potential claim, which is also similar to other studies. Another aspect of the survey questionnaire that was evaluated was whether a non-orthodontist can provide expert testimony against an orthodontist, with most respondents reporting that this is not possible. It has been ruled, though, that a general dentist can be an expert witness and provide expert testimony against an orthodontist in a lawsuit depending on the circumstances. Negligence was the most common cause of clinically related orthodontic litigation, and a failure of the practitioner to obtain a proper informed consent from the patient was the most common cause of non-clinically related orthodontic litigation. Key words: Orthodontist, malpractice, legal, lawsuit, liability, medicolegal., Competing Interests: Conflicts of interest None declared., (Copyright: © 2022 Medicina Oral S.L.)

Study design Retrospective cohort study.Cohort selection and data analysis In total, 89 implants were placed in 34 patients (19 men and 15 women; average 62.1 years of age) using computer-guided implant surgery with cone beam computed tomography (CBCT). All patients included in this study were adults and the computed-guided implant surgery was planned according to a digital guide protocol based on CBCT. Group 1 patients received the implants with the guide and flapped surgical approach, Group 2 with the guide and flapless approach. Group 3 was the drop-out group which included other patients in who the implant could not be placed according to the guide. CBCT data from before and after the surgeries were superimposed to evaluate the accuracy of implant positioning among all the groups. The differences in distance of the entry point (deviation distance) and in the degree of the insertion angle (deviation angle) were measured on the superimposed CBCT. Statistical analysis was performed with SPSS software and an independent sample t-test was done to analyse the difference of measurements among the groups.Results The authors observed greater accuracy in Group 2 in terms of deviation distance and angulation when compared to Group 1. The deviated position of the implant fixtures was greater in the drop-out group when compared to the guided groups in terms of the displacement of entrance point and the degree of insertion.Conclusions The authors concluded that flapless guided implant surgery is more accurate than flap guided implant surgery. The results of this study can be useful to clinicians in making decisions between flapless surgical approach and flapped approach when using a guide for implant placement., (© 2022. The Author(s), under exclusive licence to the British Dental Association.)

Nanostructured materials possess unique structural and functional properties that play a crucial position in tissue engineering applications. Present investigation is aimed to synthesize chitosan-sodium alginate (CS) nanocomposite using hydrothermally prepared zirconia nanoparticles. In this, three different weight percentages of (0.5, 1, and 1.5) zirconia nanoparticles are utilized for the preparation of biomimetic nanocomposite scaffolds (CSZ) employing 4 wt% of CS by a solvent casting technique. Physico-chemical and thermal behavior of the prepared nanoparticles and their CSZ scaffolds are comprehensively characterized. Bioactivity of the prepared zirconia nanoparticles and CSZ scaffolds are explored in terms of in vitro biocompatibility, protein absorption in simulated body fluid (SBF), and phosphate buffered saline (PBS). Agar disc diffusion method is employed to identify the antibacterial property against Staphylococcus aureus and Escherichia coli. In vitro cytotoxicity of zirconia nanoparticles and CSZ scaffolds is identified against human urothelial carcinoma (UC6) and osteosarcoma (MG-63) cells. These studies explore that zirconia nanoparticles are suitable for biomedical applications while it is interacted with chitosan and sodium alginate (CS) due to their promising biocompatibility. Biomimetically obtained chitosan/sodium alginate scaffold contain 1 wt% zirconia nanoparticles show higher biocompatibility amenable for tissue engineering applications., (© 2022 Wiley Periodicals LLC.)

Background: Obstructive Sleep Apnea (OSA), a sleep-related breathing disorder that can affect both children and adults with systemic co-morbidities beyond disrupted sleep yet remains underdiagnosed in a substantial portion of the pediatric and adult orthodontic patient populations. The objective of this study was to assess the prevalance of orthodontists screening patients for OSA, their confidence level in screening, and to identify the various screening methods most commonly used in practice., Material and Methods: A survey on screening for OSA was emailed to 6,675 members of the American Association of Orthodontists (AAO) in the United States. Frequency distribution of different responses and their association with various demographic factors was assessed., Results: Out of 234 orthodontists completing the survey, 62% reported screening all of their patients for OSA, while 38% reported doing no OSA screening at all. More hours of continuing education (CE) and younger ages were observed to be statistically significantly associated with practice of screening for OSA ( p <0.001 and 0.034, respectively, on regression analysis). Role of longer practice duration observed to be significant on univariate analysis, lost its statistical significance on regression analysis., Conclusions: CE hours on OSA seemed to be the most important factor that motivated the orthodontist to screen for OSA. A majority of orthodontists in the 35-54 year old age-group were screening their patients for OSA. Key words: Orthodontics, obstructive sleep apnea, screening, survey study., Competing Interests: Conflicts of interest None declared., (Copyright: © 2022 Medicina Oral S.L.)

Transforming growth factor β1 (TGF-β1) regulates a wide variety of events in adult bone marrow (BM), including quiescence of hematopoietic stem cells, via undefined mechanisms. Because megakaryocytes (MKs)/platelets are a rich source of TGF-β1, we assessed whether TGF-β1 might inhibit its own production by comparing mice with conditional inactivation of Tgfb1 in MKs (PF4Cre;Tgfb1flox/flox) and control mice. PF4Cre;Tgfb1flox/flox mice had ∼30% more MKs in BM and ∼15% more circulating platelets than control mice (P < .001). Thrombopoietin (TPO) levels in plasma and TPO expression in liver were approximately twofold higher in PF4Cre;Tgfb1flox/flox than in control mice (P < .01), whereas TPO expression in BM cells was similar between these mice. In BM cell culture, TPO treatment increased the number of MKs from wild-type mice by approximately threefold, which increased approximately twofold further in the presence of a TGF-β1-neutralizing antibody and increased the number of MKs from PF4Cre;Tgfb1flox/flox mice approximately fourfold. Our data reveal a new role for TGF-β1 produced by MKs/platelets in regulating its own production in BM via increased TPO production in the liver. Additional studies are required to determine the mechanism., (© 2022 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Studies have shown that factors in the blood of young organisms can rejuvenate the old ones. Studies using heterochronic parabiosis models further reinforced the hypothesis that juvenile factors can rejuvenate aged systems. We sought to determine the effect of juvenile plasma-derived factors on the outcome following hemorrhagic shock injury in aged mice. We discovered that pre-pubertal (young) mice subjected to hemorrhagic shock survived for a prolonged period, in the absence of fluid resuscitation, compared to mature or aged mice. To further understand the mechanism of maturational dependence of injury resolution, extracellular vesicles isolated from the plasma of young mice were administered to aged mice subjected to hemorrhagic shock. The extracellular vesicle treatment prolonged life in the aged mice. The treatment resulted in reduced oxidative stress in the liver and in the circulation, along with an enhanced expression of the nuclear factor erythroid factor 2-related factor 2 (Nrf2) and its target genes, and a reduction in the expression of the transcription factor BTB and CNC homology 1 (Bach1). We propose that plasma factors in the juvenile mice have a reparative effect in the aged mice in injury resolution by modulating the Nrf2/Bach1 axis in the antioxidant response pathway., Competing Interests: Competing Interests Authors do not have any competing interests., (Copyright: © 2022 Chu et al.)

Porous carbon (PC) based materials is a proficient impetus for upgrading supercapacitor thanks to its traits of high surface area, meso, micropores, and replication morphology. Mainly, single and dual heteroatom doping in PC material is one of the amazing strategies for enhancing the supercapacitor activity due to the interaction of carbon and heteroatom material along with the excessive contribution of by functional groups. Here, we have synthesized nitrogen (N) and boron (B) dual doped PC (NBPC) with the assistance of Santa Barbara Amorphous (SBA-15) silica material and afterward investigated their doping impact of the heteroatom which is investigated for supercapacitor application. Among all, NBPC material delivered a high specific capacitance of 375 F/g at 2 A/g current density in 1 M H 2 SO 4 electrolyte with excellent rate capability and capacitance retention. Such an attractive property of NBPC is a reflection of its high specific surface area (809 m 2 /g) rendered by N and B functional groups. In addition, the introduction of dual redox additive materials to the electrolyte synergistically enhanced the specific capacity of the symmetric supercapacitor cell. An unprecedented high specific capacity of 929 C/g at 3 A/g current density is observed and a 56% of initial specific capacity was retained when current density increased to 20 A/g. The fabricated symmetric cell using NBPC electrode in 1 M H 2 SO 4  + 0.01 M ammonium metavanadate + Ferrous (II) sulfate dual redox additive electrolyte delivered an energy density of 48.4 W h/kg which is five folds higher than the bare electrolyte (10.1 W h/kg). Similarly, the NBPC electrode delivered a power density of 15 kW/kg in the redox additive electrolyte which is three folds higher than the bare electrolyte (5 kW/kg)., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The 2D/2D layered materials are gaining much-needed attention owing to the unprecedented results in supercapacitors by their robust structural and electrochemical compatibility. Here, a facile scalable synthesis of 2D/2D MXene/boron carbon nitride (BCN) heterostructure through no residue direct pyrolysis is reported. The process allows the in-situ growth of BCN nanosheets unravelling the surfaces of MXene synergistically that provide an interconnected conductive network with wide potential window, augmented proportion of Ti sites at elevated temperature removing terminal groups enabling high pseudocapacitive activity and impressive stability. As a result, the as-assembled MXene/BCN electrode records a high specific capacitance of 1173 F g -1 (1876 C g -1 ) at 2 A g -1 and an energy density of 45 Wh kg -1 . Further, the fabricated solid-state device exhibits an ultra-high cyclability of 100% capacitive retention after 100 000 cycles. This will be an epitome for future 2D/2D heterostructures with commendable electrochemical properties as an expedient solution for energy storage applications., (© 2021 Wiley-VCH GmbH.)

The present experimental work is carried out to analyse the performance, combustion, and exhaust emission characteristics of variable compression ratio (VCR) diesel engine using blended biofuel (B20) with nanoadditives. Transesterified biodiesel was prepared from waste cooking oil (WCO). The cerium oxide nanoparticles (CERIA) were produced and categorized by precipitation technique, SEM and XRD analysis. These nanoadditives mixed with biofuel blend by magnetic stirrer and then by ultrasonication. The test procedure was carried out under the following fuel blends: 20% of biodiesel added to 80% diesel (B20), 15ppm, 30ppm, 45ppm, 60ppm and 75ppm cerium oxide nanoparticles added with B20 blend (diesel, B20, B20+CERIA15, B20+CERIA30, B20+CERIA45, B20+CERIA60, B20+CERIA75). The engine was operated at fixed compression ratio 20:1 and constant speed at various load conditions 0%, 25%, 50%, 75% and 100%, and results were compared to diesel at 100% load. The improvement in B20 fuel characteristics was observed by adding cerium oxide nanoparticles. The outcomes indicate better improvement in the blended sample of B20+CERIA45 ppm with brake thermal efficiency increased by 3.62% and specific fuel consumption decreased by 3.3% than the neat diesel. Presence of added particles gives better atomization which prompts total burning in the combustion chamber and builds up the amplified pressure data. The emission of CO and HC outflow dimnishes by the addition of CERIA nanoparticles in blended biofuel. Additionally, there is a reduction in NO x by expanding the CERIA dosage in the fuel mixer. This occurs due to CERIA particles presented in a fuel blend behaving as an oxygen buffer and engaging the O 2 for decreasing the NO x formation., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The supercapattery, an ideal electrochemical energy storage device, which can deliver high energy like battery and high power like supercapacitor. Transition metal sulphides' energy storage capabilities have unfurled beyond the realm of ruthenium and manganese-based oxides by the versatile affordable sulphospinel transition metal sulphides such as MnCo 2 S 4 (MCS). The advancement of synergistic nano-architectures of these transition metal sulphides with two-dimensional MXene material adulated the conductivity and highly reversible redox nature. The hybrid MCS-MXene was synthesised through facile cost effective hydrothermal method and the material were characterised using basic X-Ray Diffraction (XRD) to advanced tools as like electron energy loss spectroscopy (EELS). The electrochemical results depict that the supercapattery electrode of 2D synergistic MCS-MXene hybrid architectures shows highly improved specific capacitance of 600 C/g at 1 A/g current density than pristine MXene and MCS. The fabricated asymmetric supercapattery using hybrid MCS-MXene and bio-derived activated carbon (AC) shows a high specific energy and power density of 25.6 Wh/kg and 6400 W/kg, respectively with excellent cycling stability of 100% capacitance retention after 12,000 cycles., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

The transition metal ions (TMIs) such as Co 2+ and Zn 2+ doped NiMn 2 O 4 (NMO)/rGO nanocomposite synthesized by facile sol-gel method was used for the fabrication of supercapacitor. The presence of metal ions in the nanocomposite was confirmed by X-ray photoelectron spectroscopy (XPS) and high resolution transmission electron microscope (HR-TEM) mapping techniques. The fabricated electrode showed high specific capacitance of 710 F/g which was 3-fold higher than NMO (254 F/g). The addition of RGO in the nanocomposite increased the cycle stability of TMIs doped NMO significantly from 51 to 91%. In addition, the symmetric supercapacitor (SSC) fabricated using TMIs doped NMO/rGO nanocomposite with 3.5 M KOH as an electrolyte delivered a maximum energy density of 43 Wh/kg and power density of 10 kW/kg. Furthermore, the SSC device retained 90% of capacitance retention over 10,000 cycles with coulombic efficiency of 99% at 5 A/g. These result suggested that the TMIs doped NMO/rGO nanocomposite electrode is a promising material for high-energy supercapacitors., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: A survey was done on practicing Orthodontists in the United States on their experience with lingual orthodontics. The objectives of this survey study were to assess 1) the satisfaction level with cases treated with lingual orthodontics, 2) factors that influence clinicians' decision to utilize or not utilize lingual braces in their current practices, and 3) intention of using lingual braces in their future practices, if not used currently, in the U.S., Material and Methods: A survey questionnaire was electronically distributed to 2,200 active U.S. members of the American Association of Orthodontists (AAO)., Results: 85 orthodontists completed the survey. About 25% of respondents practiced lingual orthodontics. Direct mentorship was the most common approach used by orthodontists to learn lingual technique. The most used lingual system among the clinicians that use lingual braces was INBRACE® (34.6%). All respondents were either satisfied or very satisfied with their treatment outcome of cases treated with lingual braces. Improved esthetics and practice differentiation were perceived to be the biggest advantages of practicing lingual orthodontics. Biggest challenges with lingual orthodontics were found to be patient discomfort, cost, longer chair time and technical difficulties. Most common reason for not using lingual braces was technical difficulty, followed by availability of alternative appliances, lack of demand and patient discomfort. Approximately, 70% of those that did not use lingual orthodontics in their current practices responded that they were very likely to incorporate lingual orthodontics in their future practices., Conclusions: Overall outcome satisfaction level with cases treated with lingual braces was high among the orthodontists that practiced lingual orthodontics. There seemed to be a strong interest in incorporating lingual orthodontics in future practices by clinicians that did not use lingual braces in their current practices. Some of the factors that influenced clinicians' decision to practice lingual orthodontics were improved esthetics, practice differentiation and increased case acceptance. Technical difficulties, availability of alternative appliances, lack of demand and patient discomfort were some of the factors that were identified to have influenced practitioners' decision to not offer lingual orthodontics in their current practices. Key words: Orthodontic brackets, Lingual braces, Lingual orthodontics., Competing Interests: Conflicts of interest None declared., (Copyright: © 2021 Medicina Oral S.L.)

This work demonstrates a high-performance hybrid asymmetric supercapacitor (HASC) workable in very high current density of 30 A g -1 with in-situ pyrolytic processed sulfur-doped graphitic carbon nitride/cobalt disulfide (S-gC 3 N 4 /CoS 2 ) materials and bio-derived carbon configuration and achievement of high electrochemical stability of 89% over 100,000 cycles with the coulombic efficiency of 99.6%. In the electrochemical studies, the S-gC 3 N 4 /CoS 2 -II electrode showed a high specific capacity of 180 C g -1 at 1 A g -1 current density in the half-cell configuration. The HASC cell was fabricated using S-gC 3 N 4 /CoS 2 -II material and orange peel derived activated carbon as a positive and negative electrode with a maximum operating cell potential of 1.6 V, respectively. The fabricated HASC delivered a high energy density of 26.7 Wh kg -1 and power density of 19.8 kW kg -1 in aqueous electrolyte. The prominent properties in specific capacity and cycling stability could be attributed to the CoS 2 nanoparticles engulfed into the S-gC 3 N 4 framework which provides short transport distance of the ions, strong interfacial interaction, and improving structural stability of the S-gC 3 N 4 /CoS 2 -II materials., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Inc. All rights reserved.)

While diverticulosis is a common phenomenon in the large intestine, it is a rare disease found in the small intestine accounting for only 0.06% to 1.3% of cases. Although most cases are asymptomatic, roughly 30% to 40%, it is crucial that it is on the differential of acute abdominal pain as it can be life-threatening and potentially require surgical management. Here, we describe a case of a 61-year-old Hispanic man who was found to have a perforated jejunal diverticula after initially presenting with left upper quadrant abdominal pain.

Data sources Data was collected from six databases (Medline, Embase, Web of Science, The Cochrane Central Register of Controlled Trials [CENTRAL], China National Knowledge Infrastructure [CNKI] and Chinese Biomedical Literature Database). Studies published in English and Chinese languages comparing ceramic and metal-ceramic implant-supported fixed dental prostheses (FDPs) were searched. The literature search was performed on studies published until 2018. Manual search of the reference lists of the identified articles was also performed to find related review articles and studies.Study selection Randomised controlled trials (RCTs), prospective and retrospective cohort studies involving the comparison of ceramic and metal-ceramic implant-supported FDPs were selected using the PICOS model for the meta-analysis. For ceramic and metal-ceramic single crowns, the survival rate, marginal adaptation, marginal bone loss, pocket probing depth, crown colour match and mucosal discolouration were assessed. The authors also included studies on survival rate of implant-supported fixed partial dental prostheses (FPDPs) in this meta-analysis.Data extraction and synthesis Two investigators independently screened the articles from the literature search and extracted and analysed data from the included studies. The quality of the included RCTs were assessed using the Cochrane collaboration tool for assessment of risk of bias. For the selected non-randomised studies, the quality and risk of bias were assessed using the Newcastle-Ottawa scale. Twenty studies were included in data synthesis.Results Of the selected 20 studies, ten were RCTs and ten were prospective or retrospective cohort studies.Conclusions The results of this study can be useful to clinicians in making decisions between ceramic and metal-ceramic implant-supported single crowns. This study concluded that the ceramic implant-supported single crown has better crown colour match over a metal-ceramic single crown, but poorer marginal adaptation, and there was no difference observed in other parameters studied (survival rate, marginal bone loss, pocket probing depth and mucosal discolouration). The conclusions on survival rate of implant-supported FPDPs needs to be further evaluated with RCTs with larger samples., (© 2021. British Dental Association.)

Improvements in electro-optical responses of LC devices by doping organic N-benzyl-2-methyl-4-nitroaniline (BNA) and Morpholinium 2-chloro-4-nitrobenzoate (M2C4N) in nematic liquid crystals (LCs) have been reported in this study. BNA and M2C4N-doped LC cells have the fall time that is fivefold and threefold faster than the pristine LC cell, respectively. The superior performance in fall time of BNA-doped LC cell is attributed to the significant decrements in the rotational viscosity and threshold voltage by 44% and 25%, respectively, and a strong additional restoring force resulted from the spontaneous polarization electric field of BNA. On the other hand, the dielectric anisotropy (Δ ε ) of LC mixture is increased by 16% and 6%, respectively, with M2C4N and BNA dopants. M2C4N dopant induces a large dielectric anisotropy, because the phenyl-amine/hydroxyl in M2C4N induces a strong intermolecular interaction with LCs. Furthermore, BNA dopant causes a strong absorbance near the wavelength of 400 nm that filters the blue light. The results indicate that M2C4N doping can be used to develop a high Δ ε of LC mixture, and BNA doping is appropriate to fabricate a fast response and blue-light filtering LC device. Density Functional Theory calculation also confirms that BNA and M2C4N increase the dipole moment, polarization anisotropy, and hence Δ ε of LC mixture.

An interaction of homophthalonitrile with salicylaldehydes proceeds as a novel domino reaction and results in the formation of nineteen 12H-chromeno[2,3-c]isoquinoline-5-amine derivatives. Four new bonds and two cycles are forged in a single synthetic operation, employing cheap and eco-friendly ammonium formate, acting both as a catalyst and a reducing agent. The in vitro cytotoxicity tests revealed antiproliferative activities against five human tumor cell lines, including the cisplatin-resistant ovarian carcinoma one (A2780cp8), with inhibitory potency data (IC 50 ) in the low micromolar range in most cases. Molecular docking calculations and fluorescence quenching studies revealed possible binding properties with DNA of the active compounds., (Copyright © 2020 Elsevier Inc. All rights reserved.)