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Gun violence (GV) and safety is a contentious topic in the United States, despite increasing morbidity and mortality among children and adolescents. It is important for physicians to take a role in preventing future GV. This article aims to present several methods that physicians can use to prevent GV in their own communities, ranging from implementation of large-scale intervention programs to simple screenings and anticipatory guidance. As the problem of GV persists, it is important for physicians to use their role to identify individuals who are at high-risk and advocate for changes that will benefit their future health. [ABSTRACT FROM AUTHOR]

The most common extra-alveolar sites for miniscrew placement are the infrazygomatic crest region (IZC) and mandibular buccal shelf region (MBS). The aim of the study is to determine the amount of distalization achieved with IZC and MBS mini screws, and if it has any correlation with the growth pattern. Pre-treatment scan (T1) and post-distalization (T3) scans of 30 patients were taken in whom en masse distalization with either IZC or MBS mini screws or both was achieved. T1 and T2 scans were then superimposed on OrthoAnalyzer software using landmark reference points on maxilla and mandible and assessed for the amount of distalization. The following statistical tests were conducted: Kappa statistics to assess the intra-observer reliability, Descriptive statistics for the amount of distalization by both IZC and buccal shelf mini screws, and its correlation with varying growth patterns and gender. The mean distalization achieved with IZC anchorage was 3.491 ± 0.471 mm and the mean distalization achieved with buccal shelf mini screw anchorage was 4.412 ± 0.904 mm. A weak negative correlation between growth pattern and amount of distalization was observed (r=-0.379; p=0.007). The present study suggests that both infrazygomatic and buccal shelf anchorage for arch distalization in borderline surgical class II and III cases are effective modalities. It also suggests that the skeletal facial pattern may favorably influence the amount of distalization in hypodivergent facial type, especially with MBS anchorage. [ABSTRACT FROM AUTHOR]

This research aimed to develop the phenytoin-loaded bionanosuspension by utilising the novel biopolymer from Juglans regia andreduce the long-term treatment cost of epilepsy and increase the efficiency of therapy. A novel biopolymer with remarkable inbuilt properties was isolated and used in the development of a nano capsulated dispersed system. The diverse proportions of phenytoin and biopolymer with different ratios 1:2, 1:3, 1:4, 1:5 and 1:8 were taken for the planning of details PJNC1-PJNC5. The bionanosuspension was assessed for dispersibility, pH, % entrapment efficiency, stability study and in vitro drug discharge. The formulation PJNC2 with 1:3 drug biopolymer proportion showed significant outcomes for various assessments with t50% of 16.51 h and r² estimation of 0.9884. PJNC2 showed 92.07%±2.5 drug delivery in 36h and was stable. The bionanosuspension was found to be stable and safe for the delivery of nanosized phenytoin utilising the biopolymer having a remarkable stabiliser cum retardant property. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is an age‐related neurodegenerative disorder affecting nearly 50 million individuals worldwide. Besides aging, various comorbidities can increase the risk of AD, such as asthma. However, the molecular mechanism(s) underlying this asthma‐associated AD exacerbation is unknown. This study was designed to explore the effects of house dust mite‐induced asthma on AD‐related brain changes using the AppNL‐G‐F transgenic mouse model. Method: Male and female C57BL/6 wild type and AppNL‐G‐F mice (8‐9 months old) were exposed to either saline or house dust mite (dose: 833µg/kg in saline) every alternate day for 16 weeks. Mice were sacrificed at the end of the experiment and broncho‐alveolar lavage fluid (BALF), lungs, blood, and brains were collected. BALF was analyzed for immune cell markers, inflammatory mediators, and LDH activity. Lung sections were stained with Alcian blue and Masson's Trichrome to examine mucus and collagen production, respectively. The serum was analyzed for cytokine levels. Brain sections were immunostained for Aβ, GFAP, and collagen‐4. Finally, frozen hippocampi and cortices were used to perform Aβ ELISAs and cytokine arrays, respectively. Result: Dust‐mite exposure increased inflammatory cells, cytokine levels, and LDH activity in the BALF and increased the mucus and collagen production in the lungs from both sexes and genotypes, suggesting induction of a severe asthma‐like condition. This correlated with increased levels of serum cytokines in all dust‐mite‐exposed groups. In agreement with this peripheral change, hippocampi from asthma‐induced male and female AppNL‐G‐F mice demonstrated elevated Aβ plaque load and increased soluble Aβ 1‐40/42 and insoluble Aβ 1‐40 levels. Dust‐mite exposure also increased astrogliosis in both sexes of AppNL‐G‐F mice, as indicated by GFAP immunoreactivity. Additionally, dust‐mite exposure‐induced asthma elevated cortical levels of several cytokines in both sexes and genotypes. Finally, dust‐mite exposed groups also showed a disturbed BBB integrity in the hippocampus of AppNL‐G‐F mice, as indicated by decreased collagen‐4 immunoreactivity. Conclusion: Dust‐mite exposure induced a severe asthma‐like condition that exacerbated Aβ pathology, astrogliosis, cytokine changes, and disturbed BBB integrity in the brains of male and female AppNL‐G‐F mice. Defining the mechanisms of secondary effects of asthma on the brain may provide a novel therapeutic approach for both asthma and AD. [ABSTRACT FROM AUTHOR]

This study was undertaken to evaluate if there are differences between visual estimation of blood loss (EBL) and quantitative blood loss (QBL) for maternal outcomes related to obstetrical hemorrhage. This retrospective study compared EBL (n = 500) to QBL (n = 501) for outcomes of length of stay, readmission within 30 days of discharge, percent receiving blood transfusions, time between delivery to receiving blood transfusion, and postpartum hemoglobin level. The QBL group had a significantly lower mean length of stay than the EBL group (2.6 vs 3.2 days, P < 0.001). Multivariate linear regression analysis adjusting for relevant covariates had a similar finding of lower length of stay for QBL vs EBL (B = −0.13, SE = 0.01, P < 0.001). Readmission within 30 days, blood transfusion, time to transfusion since delivery, and postpartum hemoglobin did not significantly differ between the QBL and EBL groups. We recommend that clinicians adopt QBL over EBL as standard practice since QBL is associated with lower length of stay and does not negatively impact other clinical outcomes. [ABSTRACT FROM AUTHOR]

One of the main domains of paediatric dentistry is providing oral health care, especially to the children with special needs, like those affected with autism spectrum disorder (ASD). Such children exhibit poor oral hygiene primarily due to their limited communication ability, lack of joint attention, oversensitivity to sensory stimuli and motor coordination deficits. In such cases, multiple studies suggest and emphasize on the importance of early use of interventional services. Children affected with ASD tend to be visual learners, and therefore, are better suited for visual interventional methods. Amongst which, picture exchange communication system (PECS), originally developed by Bondy-Frost, is gaining rapid momentum. It is suggested to help individuals to initiate requests and communicate their needs via picture cards; hence aid in acquiring functional communication and speech, improve socio-communicative impairments, and decrease the behavioural problems. This scoping review aims to raise awareness on PECS amongst the dental fraternity, by emphasizing its usage pertaining to dentistry. PECS though rated hard, has proved to be beneficial in improving oral hygiene practices among autistic children. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is an age‐related neurodegenerative disorder characterized by brain accumulation of amyloid beta (Aβ) plaques, neurofibrillary tangles, neuron death, robust gliosis, and neuroinflammation, affecting around 35 million individuals worldwide. It is well known that brain immune changes are a component of the disease, but immune dysfunction in secondary organs has also been reported. To assess peripheral immune changes in AD, we asked whether lung dysfunction and inflammatory change are present during the disease. Method: Male and female C57BL/6 wild type and AppNL‐G‐F mice (8‐9 months old) were sacrificed, and broncho‐alveolar lavage fluid (BALF) and lungs were collected. BALF was used to quantify immune cell phenotype by flow cytometry, and the BALF supernatant was used to determine Aβ and cytokine concentrations and total protein content. Lungs were sectioned and stained with hematoxylin and eosin, Alcian blue and Masson's trichrome. In addition, lung sections from wild‐type and AppNL‐G‐F mice and human AD patient and healthy controls were immunostained for APP, Aβ and claudin 4. Result: AD mice showed significantly increased pulmonary airway thickening and mucus and collagen production as indicated by hematoxylin and eosin, Alcian blue and Masson's trichrome staining, respectively, compared to the wild‐type controls. Female but not male AppNL‐G‐F mice also demonstrated reduced B cell and neutrophil numbers and elevated IL‐1β in their BALF compared to controls. Although there were no differences in BALF supernatant total protein content between wild‐type and AppNL‐G‐F mice, lungs from both sexes of AppNL‐G‐F mice had decreased claudin‐4 immunoreactivity suggesting altered epithelial permeability. BALF supernatant from male and female AppNL‐G‐F mice also contained soluble Aβ1‐40 and Aβ1‐42 correlating with lung APP immunoreactivity. Human AD male and female lungs had reduced claudin‐4 immunoreactivity and increased APP and Aβ staining compared to controls verifying lung changes are also present in human disease. Conclusion: These data demonstrate disease‐associated changes in the lungs of both human AD patients and the AppNL‐G‐F mouse model. Further characterization of lung dysfunction and its contribution to brain changes may define a novel lung‐to‐brain contribution to disease. [ABSTRACT FROM AUTHOR]

Objectives The present study was undertaken to characterise the viral polypeptide 2 (VP2) gene of parvovirus from domestic cats in India. Methods The faecal samples from diarrhoeic/healthy domestic cats were collected from different geographical regions of India for screening by PCR assay followed by sequence analysis of the VP2 gene. Results Canine parvovirus (CPV)/feline panleukopenia virus (FPV) infections were found in 12 (11.3%) of 106 faecal samples tested. Two new CPV-2a (297Ala and Asn426) and three FPV strains were identified by VP2 gene analysis. Several unique and existing amino acid mutations were found, suggesting continuous evolution and emergence of newer variants. The phylogenetic analysis of the CPV sequences revealed that the two new CPV-2a strains from Mumbai (MC8) and Puducherry (P15) were clustered together in a single clade but had evolved independently and were ancestrally related to Chinese CPV-2a isolates. The FPV sequences (T-C-6 and T-C-1) from Thrissur, Kerala, formed a different clade (FPV clade) and were closely related to each other and had an ancestral relationship with an FPV isolate from the USA. Another FPV isolate from Goa (GC1) was positioned in the same clade but had evolved independently. Conclusions and relevance Detection of CPV in both diarrhoeic/healthy cats and the occurrence of FPV infection in a vaccinated cat provide new insights into parvovirus infections in cats in India. [ABSTRACT FROM AUTHOR]

In the pursuit to develop practical sodium-ion batteries, safe negative insertion (anode) materials are essential. Recently, Na2Ti6O13 has been unveiled by conventional solid-state synthesis as a 0.85 V anode with 1-dimensional Na+ diffusion pathways. Here, an energy-savvy autocombustion synthesis has been successfully implemented to produce the target compound Na2Ti6O13 by restricting the annealing duration within 2 h. This drastic reduction in heat-treatment time involves minimal grain-growth hence forming homogeneous nanostructured particles (~100 nm). It benchmarks the shortest synthesis of Ti-based anodes for sodium-ion batteries. The current work describes various aspects of autocombustion route. The as-prepared compound delivers near theoretical capacity (ca. 40 mAh g-1) involving a Ti4+/Ti3+ redox potential centered at 0.83 V (vs. Na/Na+) with excellent reversibility. Using both experiment and bond valence site energy (BVSE) modeling, the electrochemical, Na+ diffusion pathways and corresponding energy barriers have been explained. [ABSTRACT FROM AUTHOR]

Marijuana is the second most commonly used inhalational agent after tobacco. It has been used for therapeutic benefits in cancer, epilepsy, inflammation and pain. Inhalation of marijuana causes reversible and irreversible lung injury. We present a 26-year-old female with cough, chest pain, epistaxis, hemoptysis, night sweats and breathlessness few hours after smoking marijuana. Physical exam was positive for tachycardia, tachypnea, and diminished coarse breath sounds. Further investigation revealed elevated white blood cell count, chest X-ray, computed tomography of the chest showed bilateral patchy infiltrates. The patient was managed with short term steroid, as antibiotics alone did not work. Radiological improvement of lung injury was noted within 36–48 h. There is a paucity of treatment guidelines for acute lung injury secondary to marijuana inhalation. We advocate early use of short-term steroids and also more awareness on quitting marijuana smoking to prevent life-threatening complications like myocardial infarction, diffuse alveolar hemorrhage and acute respiratory distress syndrome. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is an age‐related neurodegenerative disorder affecting around 35 million individuals worldwide. Besides aging, various comorbid factors increase the risk of AD, including air pollution and asthma. Epidemiological studies have reported a 2.17‐fold higher risk of dementia in asthmatic patients. However, the molecular mechanism(s) underlying this asthma‐associated AD exacerbation is unknown. This study was designed to explore house dust mite‐induced asthma effects on AD‐related brain changes using the AppNL‐G‐F transgenic mouse model. Method: Male and female C57BL/6 wild type and AppNL‐G‐F mice (8‐9 months old) were exposed to either saline or house dust mite (dose: 833μg/kg in saline) every alternate day for 16 weeks. Mice were sacrificed at the end of the experiment, and broncho‐alveolar lavage fluid (BALF), blood, and brains were collected. BALF was analyzed for immune cell markers, inflammatory mediators and total protein content. Serum was analyzed for cytokine and soluble Aβ1‐40/42 levels. In addition, brain sections were immunostained for Aβ and GFAP. Finally, frozen hippocampi and cortices were used to perform Aβ ELISAs and cytokine arrays, respectively. Result: As expected, dust mite exposure increased inflammatory cells, cytokine levels, and total protein content in the BALF from both sexes and genotypes, suggesting induction of a severe asthma‐like condition. This correlated with increased levels of serum cytokines in all dust‐mite exposed groups. Serum from the AppNL‐G‐F dust mite‐induced asthma group also had significantly increased soluble Aβ1‐42 levels in both sexes. In agreement with this peripheral change, hippocampi from asthma‐induced male and female AppNL‐G‐F mice demonstrated elevated Aβ plaque load and increased soluble Aβ 1‐40/42 and insoluble Aβ 1‐40 levels. Dust mite exposure also increased astrogliosis in both sexes of AppNL‐G‐F mice, as indicated by GFAP immunoreactivity. Finally, dust mite exposure‐induced asthma elevated cortical levels of several cytokines in both sexes and genotypes. Conclusion: Dust mite exposure was responsible for a severe asthma‐like condition in the lungs that exacerbated Aβ pathology, astrogliosis, and cytokine changes in the brains of male and female AppNL‐G‐F mice. Defining mechanisms of asthma effects on the brain may provide a novel therapeutic approach for both asthma and AD. [ABSTRACT FROM AUTHOR]

Background: Total thyroidectomy (TT) is the preferred operative approach to Graves’ disease. Current guidelines of the American Thyroid Association call for the administration of potassium iodide (KI) and achievement of euthyroid state before operation. Small numbers and a mixture of operative approaches spanning several decades hinder previous operative series. We present the outcomes for TT at a single high-volume center. Methods: A retrospective cohort study was conducted on 165 patients undergoing TT for Graves’ disease from July 2007 to May 2012. Results: Mean age was 43 years (range, 17−78), and 128 patients (78%) were female. A total of 95% of patients were on methimazole or propylthiouracil, and 42% remained hyperthyroid at time of TT. Only 3 (2%) patients received KI. Mean operative time was 132 minutes (range, 59−271). Mean gland size and blood loss were 41 g (range, 8−180) and 55 mL (range, 10−1050), respectively. No patient developed thyroid storm. Median follow-up was 7.5 months. Temporary and permanent hypocalcemia developed in 51 (31%) and 2 patients (1.2%), respectively. Temporary and permanent recurrent laryngeal nerve paresis occurred in 12 (7%) and one (0.6%) patient, respectively. Sixty-one (37%) patients experienced at least one complication. On multivariate analysis, patient age younger than 45 years (odds ratio 2.93, 95% confidence interval 1.39–6.19) and obesity (odds ratio 2.11, 95% confidence interval 1.00–4.43) were associated with the occurrence of complications. Conclusion: This high-volume surgeon experience demonstrates no appreciable detriment to patient outcomes when recommendations of the American Thyroid Association for routine use of KI and euthyroid state before thyroidectomy are not met. Transient hypocalcemia and hoarseness are frequent complications of TT for Graves’ disease, resolving within 6 months in most patients. Age younger than 45 years and obesity are risk factors for postoperative complications. [Copyright &y& Elsevier]

Crystalline hydroxyapatite were synthesized from synthetic/human urine through precipitation which were further doped with silver nanoparticle for effective biomedical application. The aim were to improve overall biological compatibility of the synthesized bone-graft material even in oncogenesis cases. The thermal calcinated material was characterized by several techniques including UV–vis, Laser Raman, Fourier transmittance infrared spectroscopy, X-ray diffraction analysis, Transmission Eelectron microscopy and X-ray fluorescence spectroscopy. The quantitative and qualitative analysis revealed that the synthesized material was highly crystalline and nanosized with majority of silver and phosphate components. The antibacterial, anticancer and invitro cytotoxicity of the synthesized material was evaluated with Escherichia coli , Hela cells and brine shrimp assay, respectively. The brine shrimp assay revealed that the synthesized material is compatible with biological system, whereas anticancer activity showed the application of the synthesized biomaterial in cancer treatment in which antibacterial activity adds more advantage on preventing the bone-graft from microbial attack. [ABSTRACT FROM AUTHOR]

Opioid overdose emergencies are increasing every year, naloxone is the antidote for the treatment of opioid overdose. Naloxone is being dispensed to even lay persons through some programs to prevent opioid overdose deaths. 23 year old patient presented with naloxone treated opioid overdose complained of chest pain, pink frothy sputum production and shortness of breath. Physical exam showed tachycardia, tachypnea and coarse breath sounds. Imaging of the lungs showed diffuse pulmonary edema. Within an hour after the administration of naloxone patient developed pulmonary edema and lung injury. Patient was managed with non-invasive positive pressure ventilation which improved patient's symptoms in less than 6 hours confirmed by radiological improvement in 24–36 hrs. There are no specific observation guidelines post naloxone treatment in opiate overdose patients. We recommend early treatment of naloxone induced pulmonary complications during the observation period with non-invasive positive pressure ventilation to reduce the morbidity. [ABSTRACT FROM AUTHOR]

Nanotechnology is the most enabling technology that can be applied almost in all fields such as pharmaceutical, health care, food and feed, biomedical science and drug delivery. Synthesis of copper nanoparticle (CuNPs) with biological properties plays an important role in the development of scientifically valuable product. In this study, biosynthesis of Copper nanoparticles using Indian traditional medicine, Panchagavya is used which is eco-friendly, simple, cost effective and non-toxic. Copper sulphate (25 mM) solution was mixed with Panchagavya filtrate for the synthesis of Copper nanoparticles. The Nano metallic dispersion was characterized ultra violet spectrophotometer, Fourier transmission infrared ray spectroscopy, X-ray diffraction, Dynamic light scattering, Laser Raman, Scanning electron microscope, High resolution transmission electron microscope, X-ray fluorescent microscope. In addition, we studied the antioxidant and also cytotoxicity activity. The characterization results revels that the copper nanoparticles are round shaped in the size 98 nm (nm) with −34.4mv stability. Further, the toxicity of biosynthesized Copper nanopartilces was tested to evaluate the cytotoxic effect that displayed LC 50 value of 95% confidence intervals. Image 1 [ABSTRACT FROM AUTHOR]

Background: Exploiting biologic imaging, studies have been performed to boost dose to gross intraprostatic tumor volumes (GTV) while reducing dose elsewhere in the prostate. Interest in proton beams has increased due to superior normal-tissue sparing they afford. Our goal was to dosimetrically compare 3D conformal proton boost plans with intensity-modulated radiation therapy (IMRT) plans with respect to target coverage and avoiding organs at risk., Methods: Treatment planning computer tomography scans of ten patients were selected. For each patient, two hypothetical but realistic GTVs each with a fixed volume were contoured in different anatomical locations of the prostate. IMRT and proton beam plans were created with a prescribed dose of 50.4 Gy to the initial planning target volume (PTV) including the PTV of the seminal vesicles (PSV), 70.2 Gy to the PTV of the prostate (PPS), and 90 Gy to the PTV of the gross tumor volumes (PGTVs). For proton plans, uncertainties of range and patient setup were accounted for; apertures were adjusted until the dose-volume coverage of PTVs matched that of the IMRT plan. For both plans, prescribed PTV doses were made identical to allow for comparing normal-tissue doses., Results: Protons delivered more homogeneous but less conformal doses to PGTVs than IMRT did and comparable doses to PSV and PPS. Volumes of bladder and rectum receiving doses higher than 65 Gy were similar for both plans. However, volumes receiving less than 65 Gy were significantly reduced, i.e., protons reduced integral dose by 45.6 % and 26.5 % for rectum and bladder, respectively. This volume-sparing was also seen in femoral heads and penile bulb., Conclusions: Protons delivered comparable doses to targets in dose homogeneity and conformity and spared normal tissues from intermediate-to-low doses better than IMRT did. Further improvement of dose sparing and changes in homogeneity and conformity may be achieved by reducing proton range uncertainties and from implementing intensity modulation.

Background: Pancreatic cancer is a highly aggressive malignancy. Chemoradiotherapy (CRT) is utilized in many cases to improve locoregional control; however, toxicities associated with radiation can be significant given the location of the pancreas. RTOG 0848 seeks to evaluate chemoradiation using either intensity-modulated radiation therapy (IMRT) or 3D conformal photon radiotherapy (3DCRT) modalities as an adjuvant treatment. The purpose of this study is to quantify the dosimetric changes seen when using IMRT or 3D CRT photon modalities, as well as proton radiotherapy, in patients receiving CRT for cancer of the pancreas treated per RTOG 0848 guidelines., Materials: Ten patients with pancreatic head adenocarcinoma treated between 2010 and 2013 were evaluated in this study. All patients were simulated with contrast-enhanced CT imaging. Separate treatment plans using IMRT and 3DCRT as well as proton radiotherapy were created for each patient. All planning volumes were created per RTOG 0848 protocol. Dose-volume histograms (DVH) were calculated and analyzed in order to compare plans between the three modalities. The organs at risk (OAR) evaluated in this study are the kidneys, liver, small bowel, and spinal cord., Results: There was no difference between the IMRT and 3DCRT plans in dose delivered to the kidneys, liver, or bowel. The proton radiotherapy plans were found to deliver lower mean total kidney doses, mean liver doses, and liver D1/3 compared to the IMRT plans. The proton plans also gave less mean liver dose, liver D1/3, bowel V15, and bowel V50 in comparison to the 3DCRT., Conclusions: For patients receiving radiotherapy per ongoing RTOG 0848 for pancreatic cancer, there was no significant difference in normal tissue sparing between IMRT and 3DCRT treatment planning. Therefore, the choice between the two modalities should not be a confounding factor in this study. The proton plans also demonstrated improved OAR sparing compared to both IMRT and 3DCRT treatment plans.