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Objectives: Computed tomography CT scan is a medical device used in diagnosis; however, the radiation of CT will affect the human body such as blood components. Materials and Methods: In this study, the blood component of diabetic patients will examine the effect of CT radiation on blood components by withdrawing samples of 2 cc from diabetes patients’ blood before and after a CT scan on the body for patients who are exposed to the head, chest, and abdomen. Results: There were no significant statistical differences were between blood counts (WBC, RBC, and Hg) before and after the CT scan for the head, chest, and abdomen. Conclusions: The main conclusion of the current study is that, depending on the results, the CT scan is safe for patients.

This paper proposes a new method for network screening on rural low-volume roads. These roads are important as they provide critical access to agricultural land and tourist attractions. Most low-volume roads belong to the lowest functional class (local rural roads) and thus are built to lower design standards. Conventional hot spot network screening techniques may not be appropriate for low-volume roads due to the sporadic nature of crashes occurring on these roads. Conversely, sophisticated network screening approaches require extensive roadway and traffic data that are often unavailable to local agencies due to a lack of resources, and/or a lack of technical expertise. This research attempts to address these obstacles to low-volume road network screening which aims to identify candidate sites for safety improvements. The research used an extensive low-volume road sample from the state of Oregon and Empirical Bayes expected number of crashes in developing the proposed models for network screening. The proposed models do not require exact measurements of roadway geometric features as all geometric variables were classified into categories that are easy to compile by local agencies. Further, the method could be used with and without traffic data, without compromising the effectiveness of the network screening process.

This project aims to create a 316L stainless steel coated with a biocomposite based on chitosan for use in the biomedical industry. To completely coat the material, the dip-coating technique was used to apply plain chitosan, chitosan nanosilver, chitosan biotin, and chitosan-nanosilver-biotin in that order. This coating’s surface morphology was investigated with field emission scanning electron microscopy (FESEM). Surface roughness, average size distribution, and 2D and 3D surface tomography were all investigated using scanning probe microscopy and atomic force microscopy (SPM and AFM). The Fourier transform infrared (FTIR) spectroscopy technique was used to quantify changes in functional groups. To evaluate the coated samples’ wettability, contact angle measurements were also performed. The chitosan (CS) + nanosilver, CS + biotin, and CS + biotin + nanosilver-coated 316L stainless steel showed roughness values of about 8.68, 4.21, and 3.3 nm, respectively, compared with the neat chitosan coating, which exhibits 12 nm roughness, indicating a strong effect of biotin and nanosilver on surface topography whereas the coating layers were homogenous, measuring around 33 nm in thickness. For CS + nanosilver and CS + biotin, the average size of agglomerates was approximately 444 nm and 355 nm, respectively. The coatings showed adequate wettability for biomedical applications, were homogeneous, and had no cracks. Their contact angles were around 51–75 degrees. All of these results point to the composite coating’s intriguing potential for use in biological applications.

Background Microglia have been implicated in the pathophysiology of neuropathic pain. Here, we sought to investigate whether cerebrospinal fluid (CSF) might be used as a proxy-measure of microglial activation in human participants. Methods We preformed fluorescence-activated cell sorting (FACS) of CSF immune cell populations derived from individuals who experienced pain with neuropathic features. We sorted CD4+, CD8+ T cells and monocytes and analyzed their transcriptome using RNA sequencing. We also performed Cellular Indexing of Transcriptomes and Epitopes (CITE) sequencing to characterize the expression of all CSF immune cells in a patient with postherpetic neuralgia and in a patient with neuropathic pain after failed back surgery. Results Immune cell numbers and phenotypes were not obviously different between individuals regardless of the etiology of their pain. This was true when examining our own dataset, as well as when comparing it to previously published single-cell RNA sequencing data of human CSF. In all instances, CSF monocytes showed expression of myeloid cell markers commonly associated with microglia (P2RY12, TMEM119 and OLFML3), which will make it difficult to ascertain the origin of CSF proteins: do they derive directly from circulating CSF monocytes or could some originate in spinal cord microglia in the parenchyma? Conclusions We conclude that it will not be straightforward to use CSF as a biomarker for microglial function in humans.

Statement of Problem: As part of the overall facial analysis, smile analysis is an essential component of diagnosis and treatment planning in the esthetic rehabilitation of a patient with missing anterior teeth. Purpose: The aim of this study was to investigate the effect of age and gender on the amount of maxillary anterior teeth and associated lip position during smiling in the Kurdish population to establish guidelines for rehabilitating edentulous patients. Material and methods: Video equipment was used to capture images of 80 Kurdish subjects divided into two groups by age and sex: Forty young subjects (20 women and 20 men aged 21–24 years), and another forty old subjects (20 women and 20 men aged 45–65 years). Three frames for each subject were selected: one representing the entire length of maxillary anterior teeth, another the posed smile frame and the third representing the spontaneous widest smile. These images were used to quantify a dentogingival exposure for each anterior tooth on either side using standardized measurement techniques. The Kruskal-Wallis test was used to evaluate and compare differences in teeth and gingival display and the Chi-square test was used to explore the frequency of smile line types (α = 0.05). Results: There were no significant age or sex differences in the anterior teeth display of posed smile. However, women displayed more maxillary anterior teeth in both age groups. The highest display was for lateral incisors, followed by central incisors and canine (61.3%, 58.9%, and 49.05% in the young group vs 62.05%, 54.5%, and 53.3% in the old group). On the other hand, a significant age difference was observed in dentogingival display of maxillary anterior teeth during a spontaneous smile, including mainly the lateral incisors length with their overlying gingiva (98.5%, 1.46 mm in young vs 92.1%, 0.47 mm in old). Women show insignificant excess gingival display than men. Low smile line (class IV) was the predominant type of smile in posed smiles (60%–62.5%). While the average smile line (class III) was the dominant type of young (52.5%) and the high (class II) of old (40%) in spontaneous smiles. Conclusions: Age influences the dental and gingival display of anterior teeth in spontaneous smiles but not in posed smiles. Women generally show more gingiva and teeth in all the parameters evaluated than men. The predominant type of smile changed from (class IV) in posed smile to (class III) of young and to (class II) of old subjects in a spontaneous smile. Dental treatments should be individually planned according to age-related dynamic norms.

Erika A Petersen,1,* Timothy R Deer,2,* Stana Bojanic,3 Lauren R Sankary,4 Natalie H Strand,5 Adnan Al Kaisy,6 Frank Huygen,7 Dawood Sayed,8 Monique Steegers,9 Paul Verrills,10 Michael E Schatman11,12 1Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA; 2Spine and Nerve Center of the Virginias, Charleston, WV, USA; 3Department of Neurosurgery, John Radcliffe University Hospitals NHS Trust, Oxford, UK; 4Neuroethics Program, Cleveland Clinic, Cleveland, OH, USA; 5Department of Anesthesiology, Mayo Clinic, Phoenix, AZ, USA; 6The Pain Management and Neuromodulation Centre, Guy’s & St. Thomas’ NHS Foundation Trust, London, UK; 7Department of Anesthesiology, Center of Pain Medicine, Erasmus MC, Rotterdam, the Netherlands; 8Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA; 9Departments of Anesthesiology and Pain and Palliative Medicine, Amsterdam UMC, Amsterdam, the Netherlands; 10Pain Medicine, Metro Pain Clinic, Melbourne, Australia; 11Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA; 12Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA*These authors contributed equally to this workCorrespondence: Erika A Petersen, Department of Neurosurgery, University of Arkansas for Medical Science, 4301 West Markham Slot #507, Little Rock, AR, 72205, USA, Tel +15016865270, Email eapetersen@uams.eduAbstract: The COVID-19 pandemic caught many areas of medicine in a state of unpreparedness for conducting research and completing ongoing projects during a global crisis, including the field of pain medicine. Waves of infection led to a disjointed ability to provide care and conduct clinical research. The American Society of Pain and Neuroscience (ASPN) Research Group has created guidance for pragmatic and ethical considerations for research during future emergency or disaster situations. This analysis uses governmental guidance, scientific best practices, and expert opinion to address procedure-based or device-based clinical trials during such times. Current literature offers limited recommendations on this important issue, and the findings of this group fill a void for protocols to improve patient safety and efficacy, especially as we anticipate the impact of future disasters and spreading global infectious diseases. We recommend local adaptations to best practices and innovations to enable continued research while respecting the stressors to the research subjects, investigator teams, health-care systems, and to local infrastructure.Keywords: research, pain, emergency, pandemic, protocols

Recently, geopolymers have received widespread attention due to their ability to completely replace ordinary cement with better efficiency, lower cost, and less damage to the climatic environment. This paper aimed to prepare MK-based geopolymer cement at ambient temperature with different alkaline activators and processing parameters. XRD, PSA, DTA-TGA, SEM, and other techniques have characterized the prepared samples. ANOVA test was employed to identify the main effect of the processing parameters. Results showed that the incorporation of potassium ions has a negative effect on the physical properties of GP, in which the presence of such ions tends to decrease the density of GP. Furthermore, the apparent porosity and water absorption were increased. For Na and K, Na-activated GP, it was also concluded that the density of GP increases by increasing Si/Al ratios. Despite the Na-based GP processes having a larger density in compared to the K, Na-based ones. The results also suggested a strong effect of the W\MK ratio on physical properties, in which decreasing this ratio is necessary to achieve GP with better properties. The findings also revealed that a one-minute mixing period was sufficient for producing a homogeneous and dense GP paste.

The research presented in this paper examines a new proposed approach for identifying safety improvement sites on rural highways. Unlike conventional approaches, the proposed approach does not require crash history, but rather utilizes classified variables for traffic volume, geometric features, and roadside characteristics that do not require access to exact data or extensive technical expertise. The research validates the performance of the proposed approach using field data from a large sample of rural two-lane highway segments in the state of Oregon including traffic, roadway, and crash data. A mathematical model for the prediction of the EB expected number of crashes using multivariate regression analysis is developed and used as the network screening criterion. The model’s independent variables include roadway geometry, roadside characteristics, and traffic exposure, while the dependent variable is the EB expected number of crashes. Using observed crash history as a reference, the performance of the proposed approach was compared to two of the well-established methods in practice, namely, the Empirical Bayes (EB) and the potential for safety improvement (PSI) methods. The study results suggest that by using crash density for highway segments, the performance of the proposed method was lower than that of the EB and PSI methods. This is despite the high R-square value of the predictive model used in the proposed method. However, when using crash frequencies for highway segments, the performance of the proposed method was found comparable to the well-established EB and PSI methods.

The Global Navigation Satellite System—Real-Time Network (GNSS-RTN) is a satellite-based positioning system using a network of ground receivers (also called continuously operating reference stations (CORSs)) and a central processing center that provides highly accurate location services to the users in real-time over a broader geographic region. Such systems can provide geospatial location data with centimeter-level accuracy anywhere within the network. Geospatial location services are not only used in measuring ground distances and mapping topography; they have also become vital in many other fields such as aerospace, aviation, natural disaster management, and agriculture, to name but a few. The innovative and multi-disciplinary applications of geospatial data drive technological advancement towards precise and accurate location services available in real-time. Although GNSS-RTN technology is currently utilized in a few industries such as precision farming, construction industry, and land surveying, the implications of precise real-time location services would be far-reaching and more critical to many advanced transportation applications. The GNSS-RTN technology is promising in meeting the needs of automation in most advanced transportation applications. This article presents an overview of the GNSS-RTN technology, its current applications in transportation-related fields, and a perspective on the future use of this technology in advanced transportation applications.

316L stainless steel alloys are extensively used in orthopedic applications for the fixations and substitutions of defective bone tissues in the human body because of their excellent combination of mechanical and biological behavior. However, just like other metallic implants, they tend to release some toxic ions that may lead to serious health issues. Therefore, this study attempts to increase the alloy's resistance against corrosion while maintaining its good mechanical properties by applying a modified coating layer of PMMA-based composites titanium carbide as reinforcement material using dry electrostatic spray deposition (ESD) under constant conditions (25 kV, 15-20 cm distance, compressed air of 15 psi, and spraying angle about 45.0o for 3 0sec). The titanium carbide was added with ratios of (5, 10, 15, 20) wt. % respectively. The coatings’ surface morphology and phases were studied using Field Emission Scanning Electron Microscope, Energy-dispersive X-ray spectroscopy, and X-ray diffraction. Also, the biological behavior of the composite coated samples was studied by investigating their corrosion and wetting attributes. The results revealed that homogenous, uniform, crack-free coating layers and high surface wettability were obtained. Indicating the suability of PMMA/TiC for biomedical applications due to the alloy's improved corrosion resistance and biocompatibility.

Abstract Background Initial evidence have shown the short-term efficacy of sTMS in the acute and preventive treatment of migraine. It is unknown whether this treatment approach in the long-term is effective and well tolerated in difficult-to-treat migraine. Methods This is a prospective, single centre, open-label, real-world analysis conducted in difficult-to-treat patients with high-frequency episodic migraine (HFEM) and chronic migraine (CM) with and without medication overuse headache (MOH), who were exposed to sTMS therapy. Patients responding to a three-month sTMS treatment, continued the treatment and were assessed again at month 12. The cut-off outcome for treatment continuation was reduction in the monthly moderate to severe headache days (MHD) of at least 30% (headache frequency responders) and/or a ≥ 4-point reduction in headache disability using the Headache Impact test-6 (HIT-6) (headache disability responders). Results One hundred fifty-three patients were included in the analysis (F:M = 126:27, median age 43, IQR 32.3–56.8). At month 3, 93 out of 153 patients (60%) were responders to treatment. Compared to baseline, the median reduction in monthly headache days (MHD) for all patients at month 3 was 5.0 days, from 18.0 (IQR: 12.0–26.0) to 13.0 days (IQR: 5.75–24.0) (P = 0.002, r = − 0.29) and the median reduction in monthly migraine days (MMD) was 4.0 days, from 13.0 (IQR: 8.75–22.0) to 9.0 (IQR: 4.0–15.25) (P = 0.002, r = − 0.29). Sixty-nine out of 153 patients (45%) reported a sustained response to sTMS treatment at month 12. The percentage of patients with MOH was reduced from 52% (N = 79/153) at baseline to 19% (N = 29/153) at month 3, to 8% (N = 7/87) at month 12. There was an overall median 4-point reduction in HIT-6 score, from 66 (IQR: 64–69) at baseline to 62 at month 3 (IQR: 56–65) (P

Two-lane highways refer to roadways consisting of two lanes in the cross section, one for each direction of travel. Occasionally, passing lanes may be added to one or two sides of the roadway extending the cross section to three or four lanes at those locations. In this entry, two-lane highways strictly refer to roads in rural areas meeting the previous definition and do not include urban and suburban streets.

The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has led to major healthcare and everyday life challenges. Every day, new disease associations and systemic manifestations are being explored and reported. Peripheral facial nerve paralysis or Bell’s palsy has been reported to be caused mainly by viral infections. This case represents a COVID-19-positive patient with Bell’s palsy making SARS-CoV-2 as the most likely culprit of his condition.

Krishnan Chakravarthy,1,2 Rajiv Reddy,1 Adnan Al-Kaisy,3 Thomas Yearwood,3 Jay Grider4 1Department of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, San Diego, CA, USA; 2VA San Diego Healthcare System, San Diego, Ca, USA; 3Pain Management and Neuromodulation Centre at Guy’s and St. Thomas’ NHS Trust, London, UK; 4Division of Pain Medicine, Department of Anesthesiology, University of Kentucky College of Medicine, Lexington, KY, 40536, USACorrespondence: Krishnan ChakravarthyDepartment of Anesthesiology and Pain Medicine, University of California San Diego Health Sciences, 3350 La Jolla Village Drive, San Diego, CA 92161, USATel +1 858-246-2392Email kvchakravarthy@health.ucsd.eduAbstract: Spinal cord stimulation has seen unprecedented growth in new technology in the 50 years since the first subdural implant. As we continue to grow our understanding of spinal cord stimulation and relevant mechanisms of action, novel questions arise as to electrical dosing optimization. Programming adjustment — dose titration — is often a process of trial and error that can be time-consuming and frustrating for both patient and clinician. In this report, we review the current preclinical and clinical knowledge base in order to provide insights that may be helpful in developing more rational approaches to spinal cord stimulation dosing. We also provide key conclusions that may help in directing future research into electrical dosing, given the advent of newer waveforms outside traditional programming parameters.Keywords: neural dosing, pharmacology, neuromodulation, spinal cord stimulation, electrical dosing

This work aims preparation of polymer-based biocomposite coating by electrostatic spray method onto 316L stainless steel substrate, the present work will compare the effects of incorporation of Al2O3 and TiO2 particles at a different percentage of (10,15 and 20 % wt. from Al2O3 and TiO2 with (90,85 and 80% wt. PMMA - based electrostatic deposition coating is studied. The structure and chemical composition of composite coatings were studied by using (SEM) & (EDS) and mechanical properties (Microhardness and adhesion strength) of Al2O3-TiO2-PMMA composite coating. The SEM&EDX result showed that the composite coating to be dense with uniform dispersants and continuous with a well homogenous mixture within coating exhibits a much-increased Microhardness and remarkably improved adhesion strength.

Metal matrix nanocomposite coatings are promising for tribological applications given their superior hardness and wear resistance compared to metals. The point of this study was to describe the shape and long‐term performance of nickel‐based coatings that were put on stainless steel using electroless codeposition and made stronger with nanoparticles of zirconia (ZrO2) and alumina (Al2O3). Scanning electron microscopy showed the uniform incorporation of nanoceramics within nickel matrices. Pin‐on‐disk tribotests evaluated wear performance across loads from 5 to 15 N and sliding speeds up to 480 cm/min. Increasing nanoparticle content from 2 to 4 g/L markedly reduced wear rate due to enhanced hardness and density. At all tested loads, Ni‐ZrO2 and Ni‐Al2O3 nanocomposites exhibited considerably lower wear than monolithic nickel. The nanometal matrix particles hindered plastic deformation, with weight losses up to 68% lower than base nickel. Initially, wear resistance rose proportionally with sliding speed resulting from protective oxide layers until abrasive wear prevailed. The nanoparticle reinforcement dramatically extended durability, making it ideal for tribological systems involving mixed or abrasive conditions. More research needs to be done to find the best compositions and other matrix materials to use for these nanoscale strengthening effects. [ABSTRACT FROM AUTHOR]

The goal of the current work is to prepare coated layers of polymer-based bio composite onto a commercially pure titanium substrate utilizing an electrostatic spray approach. To obtain the coating made of bio composite Different percentages of (2.5,5,7.5, and 10) wt.% of bioactive glass (BG) with (97.5,95,92.5, and100) wt.% of PMMA powder. The coated layers' surface morphology was assessed using FTIR, XRD, and SEM techniques. The coated samples exhibited distinct biological behavior examined using the contact angle test, which demonstrated their good wetting properties the percentage of (10% BG) percent was the lowest angle, which is 18.643, and the percentage of (2.5%BG). was the highest angle 77.697. It was possible to create homogenous, uniform, and crack-free coating layers in addition to a high surface wettability. When the mechanical qualities were assessed using Vickers microhardness, it became clear that the polymeric coating's hardness had increased due to the ceramic particle addition which is 246 HV. Furthermore, the evaluation of scratch hardness was carried out to evaluate the coating's adherence. Where with increasing percentage of BG THE Hardness increased to (14.8835) MPa (10%BG). [ABSTRACT FROM AUTHOR]

This paper presents an empirical investigation into approach saturation headways at All-Way Stop-Controlled (AWSC) intersections. The mean approach saturation headway is a surrogate measure for approach capacity, which is largely a function of traffic demand on other intersection approaches. Video data was collected over four days at an AWSC intersection site in Bozeman, Montana. The site is characterized by single-lane approaches and a high level of vehicular and pedestrian traffic. Using strict protocols, video records were processed at the individual vehicle level and several information metrics were extracted for each vehicle in the data set on all approaches. Study results indicate that the mean approach saturation headways varied in a wide range due to variations in pedestrian activity, level of conflict, and the intended movement of the subject vehicle. The results suggest that, when no pedestrians were present, the maximum approach capacity in the absence of vehicular conflicts was in the order of 570 vph versus only 360 vph when conflicts were present on all other approaches. Statistical tests confirmed that the three study variables: pedestrian crossing activity, level of conflict, and subject vehicle movement all had significant effects on approach saturation headways. The pedestrian crossing activity was found to have the most significant impact on saturation headways, followed by the level of conflict and the subject vehicle movement, respectively. The results presented in this paper offer valuable information on approach saturation headways and capacity, a major input to operational analyses for this important type of intersection. [ABSTRACT FROM AUTHOR]

In the present study, the impact strength, flexural modulus, and wear rate of poly methyl methacrylate (PMMA) with eggshell powder (ESP) composites have been investigated. The PMMA used as a matrix material reinforced with ESP at two different states (including untreated eggshell powder (UTESP) and treated eggshell powder (TESP)). Both UTESP and TESP were mixed with PMMA at different weight fractions ranged from (1-5) wt.%. The results revealed that the mechanical properties of the PMMA/ESP composites were enhanced steadily with increasing eggshell contents. The samples with 5 wt.% of UTESP and TESP additions give the maximum values of impact strength, about twice the value of the pure PMMA sample. The calcination process of eggshells powders gives better properties of the PMMA samples compared with the UTESP at the same weight fraction due to improvements in the interface bond between the matrix and particles. The wear characteristics of the PMMA composites decrease by about 57% with increases the weight fraction of TESP up to 5 wt.%. The flexural modulus values are slightly enhanced by increasing of the ESP contents in the PMMA composites.

This work aims preparation of Ni-based nanocomposite coating by electroless deposition method onto stainless steel (316L) substrate, the present work will compare the effects of incorporation of ZrO2 nanoparticles at different percentages (1.25 wt %, 2.25 wt %, and 4.25 wt %) Ni-based electroless deposition coating of the bath nanocomposite on the phase structure, microhardness, and corrosion resistance is studied. Where the structure and chemical composition of nanocomposite coatings were studied by using (X-ray), (SEM) and (EDS). of Ni - ZrO2 nanocomposite coating exhibits much-increased microhardness and remarkably improved corrosion resistance

Abstract Introduction Chronic neuropathic low back pain (CNLBP) is a debilitating condition in which established medical treatments seldom alleviate symptoms. Evidence demonstrates that high-frequency 10 kHz spinal cord stimulation (SCS) reduces pain and improves health-related quality of life in patients with failed back surgery syndrome (FBSS), but evidence of this effect is limited in individuals with CNLBP who have not had surgery. The aim of this multicentre randomised trial is to assess the clinical and cost-effectiveness of 10 kHz SCS for this population. Methods This is a multicentre, double-blind, randomised, sham-controlled trial with a parallel economic evaluation. A total of 96 patients with CNLBP who have not had spinal surgery will be implanted with an epidural lead and a sham lead outside the epidural space without a screening trial. Patients will be randomised 1:1 to 10 kHz SCS plus usual care (intervention group) or to sham 10 kHz SCS plus usual care (control group) after receiving the full implant. The SCS devices will be programmed identically using a cathodal cascade. Participants will use their handheld programmer to alter the intensity of the stimulation as per routine practice. The primary outcome will be a 7-day daily pain diary. Secondary outcomes include the Oswestry Disability Index, complications, EQ-5D-5 L, and health and social care costs. Outcomes will be assessed at baseline (pre-randomisation) and at 1 month, 3 months and 6 months after device activation. The primary analyses will compare primary and secondary outcomes between groups at 6 months, while adjusting for baseline outcome scores. Incremental cost per quality-adjusted life year (QALY) will be calculated at 6 months and over the lifetime of the patient. Discussion The outcomes of this trial will inform clinical practice and healthcare policy on the role of high-frequency 10 kHz SCS for use in patients with CNLBP who have not had surgery. Trial registration Clinicaltrials.gov, NCT03470766. Registered on 20 March 2018. Disclaimer The views expressed here are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health. The NIHR had no role in the study design, writing of the manuscript or the decision to submit for publication. Roles and Responsibilities AK, SP, DP, SW, RST, AC, SE, LM, RD and JF all contributed to the trial design and to securing trial funding. AK, JR, SP, DP, and SE are involved in the recruitment, the intervention and the follow-up. SW will perform data collection and analysis. RST will be responsible for the statistical analysis, and RD will be responsible for the health economic analysis. All authors read and approved the final manuscript.

Abstract: Background: Subcutaneous emphysema is a common presentation to the emergency department. The presence of emphysema in the head and neck region due to dental procedure is not common, and the presence of pneumomediastinum is exceedingly rare. Case Report: A young lady, presented to the emergency department with chest pain, found to have pneumomediastinum following a dental procedure including a wisdom tooth extraction. Conclusion: Complications following dental procedures are not uncommon, hence there should be a high index of suspicion for the emergency physicians for such patients, especially those where air turbine dental tools have been used.

Objective This case series retrospectively reviewed the outcomes in patients implanted with combined, synchronous dorsal root ganglion stimulation (DRGS) and spinal cord stimulation (SCS) connected to a single implantable pulse generator (IPG) in a tertiary referral neuromodulation centre in the United Kingdom. Methods Twenty-six patients underwent a trial of DRGS+SCS for treating focal neuropathic pain between January 2016 and December 2019, with a follow-up in February 2022. A Transgrade approach was employed for DRGS. Patients were provided with 3 possible stimulation programs: DRGS-only, SCS-only, or DRGS+SCS. Patients were assessed for pain intensity, patients' global impression of change (PGIC), preferred lead(s) and complications. Results Twenty patients were successful and went on for full implantation. The most common diagnosis was Complex Regional Pain Syndrome. After an average of 3.1 years follow-up, 1 patient was lost to follow-up, and 2 were non-responders. Of the remaining 17 patients, 16 (94%) continued to report a PGIC of 7. The average pain intensity at Baseline was 8.5 on an NRS scale of 0–10. At the last follow-up, the average NRS reduction overall was 78.9% with no statistical difference between those preferring DRGS+SCS (n  = 9), SCS-only (n  = 3) and DRGS-only (n  = 5). The combination of DRGS+SCS was preferred by 53% at the last follow-up. There were no serious neurological complications. Conclusions This retrospective case series demonstrates the potential effectiveness of combined DRGS+SCS with sustained analgesia observed at an average follow-up of over 3 years. Implanting combined DRGS+SCS may provide programming flexibility and therapeutic alternatives. [ABSTRACT FROM AUTHOR]

Objective: During the late 2019, a group of patients had unexplained chest infections in Wuhan which turned out to be the new pandemic coronavirus disease 2019 (COVID-19). New neurological symptoms have been reported in COVID-19 patients. Posterior reversible encephalopathy syndrome (PRES) is a new neurological finding and is associated or caused by COVID-19. Case Presentation: A 32-year-old lady, with no medical background had COVID-19 infection and needed mechanical ventilation. After surviving the intensive care, she started to have multiple seizures that required general anesthesia to be aborted. The patient turned out to have PRES. Conclusion: PRES is a neurological syndrome causing seizures, headaches, and blurred vision. It is usually associated with high blood pressure, renal failure, and other risk factors. The patient in this case had nearly normal blood pressure, but still had a diagnosis of PRES. The new reported neurological symptoms associated with COVID-19 infection need further research and attention from the academic society to predict and prevent the morbidity and mortality of COVID-19 patients.

Introduction Lead migration during spinal cord stimulator (SCS) trials is relatively neglected in the literature and presents a different set of challenges compared with fully implanted leads. There is no consensus on what constitutes a clinically significant amount of radiographic lead migration during SCS trials. We wished to evaluate the incidence and extent of radiographic lead migration during percutaneous SCS trials, to investigate the risk factors for lead migration and whether this has impacted on trial success. Methods This prospective observational study of percutaneous SCS trials took place in a tertiary referral center in the UK between April 2021 and January 2022. Radiographs of SCS lead position were taken at baseline and prior to lead removal. Lead migration =50% of a vertebral level was deemed significant. Results One hundred trials were included comprising 162 leads. Mean migration distance was 0.55 vertebral levels (SD 0.85) or 12.5 mm (SD 18.2) in a caudal direction. Significant radiographic migration occurred in 50% of all leads (81 of 162 leads), at least one lead in 62% of cases and all leads in 44% of cases. Radiographic lead migration was not found to be associated with reduced trial success. A single lead and mechanical anchors were associated with greater incidence of lead migration. Conclusion Radiographic lead migration of approximately half of a vertebral level in a caudal direction can be expected during percutaneous SCS trials and this can be anticipated by siting leads half of a vertebral level higher to accommodate for this. Additional factors should be considered in the setting of radiographic lead migration to determine whether this can be considered clinically significant. [ABSTRACT FROM AUTHOR]

Objectives: Computed tomography CT scan is a medical device used in diagnosis; however, the radiation of CT will affect the human body such as blood components. Materials and Methods: In this study, the blood component of diabetic patients will examine the effect of CT radiation on blood components by withdrawing samples of 2 cc from diabetes patients’ blood before and after a CT scan on the body for patients who are exposed to the head, chest, and abdomen. Results: There were no significant statistical differences were between blood counts (WBC, RBC, and Hg) before and after the CT scan for the head, chest, and abdomen. Conclusions: The main conclusion of the current study is that, depending on the results, the CT scan is safe for patients. [ABSTRACT FROM AUTHOR]

The current work aims to enhance the biocompatibility and antibacterial properties of titanium implants using chitosan/Na alginate matrix composite as a coating layer reinforced with various ratios of hydroxyapatite (HAP) and ZnO by the Sol-Gel Dip method resulting in a product of exceptional purity, a limited dispersion of particle sizes, and the creation of a homogeneous nanostructure. The coating layer is characterized by FE-SEM for microstructure observation. From the results, it was concluded that the precipitation of a bio-composite coating layer by Sol-Gel Dip was suitable for creating a strong, adherent biocompatible layer of chitosan/alginate with a thickness of about (126.9µm). While the average diameter is approximately (21.5µm). The results showed that the dip-coating deposition method is very suitable for making CS-based composite coatings reinforced with ZnO and HAP. From the anti-bacterial test results, it was found that the addition of ceramic particles (HAP or ZnO) to the microstructure for the coating samples revealed a uniform distribution of all types of the natural polymer coating layer on the implants, indicating a suitable preparation and type of coating process (Sol-Gel Dip Composite Coating), which also enhanced the coating's roughness property and effective at inhibiting bacterial growth. This work revealed the assets of chitosan/Na alginate matrix composites in various percentages, which have not been tried up to now and could be very important for the development of the biomedical field. [ABSTRACT FROM AUTHOR]

This paper proposes a new method for network screening on rural low-volume roads. These roads are important as they provide critical access to agricultural land and tourist attractions. Most low-volume roads belong to the lowest functional class (local rural roads) and thus are built to lower design standards. Conventional hot spot network screening techniques may not be appropriate for low-volume roads due to the sporadic nature of crashes occurring on these roads. Conversely, sophisticated network screening approaches require extensive roadway and traffic data that are often unavailable to local agencies due to a lack of resources, and/or a lack of technical expertise. This research attempts to address these obstacles to low-volume road network screening which aims to identify candidate sites for safety improvements. The research used an extensive low-volume road sample from the state of Oregon and Empirical Bayes expected number of crashes in developing the proposed models for network screening. The proposed models do not require exact measurements of roadway geometric features as all geometric variables were classified into categories that are easy to compile by local agencies. Further, the method could be used with and without traffic data, without compromising the effectiveness of the network screening process. [ABSTRACT FROM AUTHOR]

Road safety is considered one of the fundamental factors for sustainable mobility, which requires establishing effective highway safety management programs and processes. Identifying safety improvement sites (network screening) is a critical step in the state roadway safety programs. The overall effectiveness of these programs largely relies on the robustness of the network screening method in identifying sites with high potential for safety improvements. This study investigates the network screening performance of a new proposed methodology that employs heuristic scoring schemes to account for roadway and roadside characteristics, crash history, and traffic exposure. The new method, originally proposed for use on rural low-volume roads, is simplistic in that it does not require exact and detailed information on traffic and geometric characteristics and can still be applied in the absence of crash data. The performance evaluation is conducted using a sample of 1495 miles of rural two-lane highway segments in Oregon. The effectiveness of the proposed method is assessed using observed crash history and compared to the well-established Empirical Bayes method as a reference. The effect of traffic level on the performance of the proposed method was evaluated using separate analyses for lower and higher traffic volume segments. The study findings indicate that the effectiveness of the proposed method in identifying sites with potential safety improvements is overall high and slightly exceeded that of the more sophisticated and data-intensive Empirical Bayes method. When data were stratified by traffic volume, the proposed method was found to be more effective for lower volume roads; however, the Empirical Bayes method outperformed the proposed method for higher volume roads. [ABSTRACT FROM AUTHOR]

BackgroundThe effect of spinal cord stimulation (SCS) amplitude on the activation of dorsal column fibres has been widely studied through the recording of Evoked Compound Action Potentials (ECAPs), the sum of all action potentials elicited by an electrical stimulus applied to the fibres. ECAP amplitude grows linearly with stimulus current after a threshold, and a larger ECAP results in a stronger stimulus sensation for patients. This study investigates the effect of stimulus frequency on both the ECAP amplitude as well as the perceived stimulus sensation in patients undergoing SCS therapy for chronic back and/or leg pain.MethodsPatients suffering with chronic neuropathic lower-back and/or lower-limb pain undergoing an epidural SCS trial were recruited. Patients were implanted according to standard practice, having two 8-contact leads (8 mm inter-electrode spacing) which overlapped 2–4 contacts around the T9/T10 interspace. Both lead together thus spanning about three vertebral levels. Neurophysiological recordings were taken during the patient’s trial phase at two routine follow-ups using a custom external stimulator capable of recording ECAPs in real-time from all non-stimulating contacts. Stimulation was performed at various vertebral levels, varying the frequency (ranging from 2 to 455 Hz) while all other stimulating variables were kept constant. During the experiments subjects were asked to rate the stimulation-induced sensation (paraesthesia) on a scale from 0 to 10.ResultsFrequency response curves showed an inverse relationship between stimulation sensation strength and ECAP amplitude, with higher frequencies generating smaller ECAPs but stronger stimulation-induced paraesthesia (at constant stimulation amplitude). Both relationships followed logarithmic trends against stimulus frequency meaning that the effects on ECAP amplitude and sensation are larger for smaller frequencies.ConclusionThis work supports the hypothesis that SCS-induced paraesthesia is conveyed through both frequency coding and population coding, fitting known psychophysics of tactile sensory information processing. The inverse relationship between ECAP amplitude and sensation for increasing frequencies at fixed stimulus amplitude questions common assumptions of monotonic relationships between ECAP amplitude and sensation strength.

In this study, we aimed to figure out how the depolymerization of polyethylene terephthalate produces monomers, dimers, trimers, and other oligomers of bis (2-hydroxyethyl) terephthalate. Polymerization was achieved in a bubble column reactor with 0.05 wt% 40–50 nm magnesium oxide nanoparticle as a catalyst. A bubble column reactor was used to perform the recycling process at the boiling point of ethylene glycol and atmospheric pressure. Depolymerized polyethylene terephthalate (DPET) was mixed with poly(methyl methacrylate) and reinforced with 1% Nano Al2O3. The nanoparticles acted as a composite coating in low carbon steel protection. Adhesion strength and mechanical and structural properties were investigated for the composite, and the average coating thickness was 28.39 µm. The results showed that the hardness and adhesion forces between the substrate and composite coating increased with an increase in the amounts of DPET and nano-Al2O3 per polymer resin. On the other hand, the thermal conductivity of the composite coating decreased with the addition of DPET because of an increase in the end chain movement in the composite coating induced by the retardant and an increase in cross-linking force. Furthermore, the bubble column demonstrated outstanding heat and mass transfer phenomena that reduced the reaction time to just 40 min for complete depolymerzation and also reduced energy consumption.

Introduction; Trauma is considered to be a major cause of morbidity and mortality all over the world. This is a descriptive study that emphasizes on the mechanism and patterns of trauma, with a consideration of why trauma code was activated, and the imaging results in regard to the severity of the trauma. Material and Methods; A descriptive study was conducted in Al Ain Hospital over the year of 2017. 886 patients were included who presented with trauma and considered dangerous according to hospital guidelines. They underwent a full-body trauma CT and got admitted to the hospital. We looked at the mechanisms, patterns, time of the day, and radiological findings. Injury severity score (ISS) and Revised trauma score (RTS) were calculated, and the cause of trauma code activation was evaluated. Results: The study shows that; Positive imaging findings were found in 364 (41%) of patients while 524 (59%) had normal radiological tests. The principal mechanism of injury was motor vehicle accident (54.4%) followed by falls (21%) then pedestrian accidents (10.1%). Overall, 69.75% (618 patients) were admitted to hospital, 22 patients needed immediate interventions and 36 patients needed ICU admission. Only 2 patients died in the emergency room Conclusions; The hospital policy in activating a trauma code should be revised, with more care being paid to the mechanisms of injury and the condition of the patient, without missing any injury that could harm the patient. So, the emergency physician should be better prepared to do a detailed physical examination and weigh the risk of radiation against missing a dangerous injury.