Search

Objectives This study aimed to compare the effects of N-acetylcysteine and benfotiamine in protection of ovarian tissue from ischemia caused by slow neovascularization injury due to intraperitoneal ovarian autotransplant in rats. Materials and methods Twenty-eight female rats were divided into 4 groups, each containing 7 rats. Group 1 only had the abdomen opened and closed, group 2 was the transplant-only group, group 3 received benfotiamine for 3 weeks starting 1 day before the transplant procedure, and group 4 received N-acetylcysteine for 3 weeks starting 1 day before the transplant procedure. At the end of the experimental period, malondialdehyde levels in ovarian tissues together with the apoptosis and fibrosis, proliferating cell nuclear antigen and vascular endothelial growth factor immunoreactivity, and ovarian reserves were investigated. Results Apoptosis was significantly increased in group 2 animals. Primordial follicle count was higher in groups 3 and 4 than in group 2. Vascular endothelial growth factor immunoreactivity was decreased in groups 3 and 4 compared with group 2. Proliferating cell nuclear antigen immunoreactivity was reduced in the secondary follicles in all transplant groups. Conclusions In autologous intraperitoneal ovarian transplant, both benfotiamine and N-acetylcysteine are equal and effective agents in protection of ovarian tissue against ischemic injury.

Despite numerous measures, bacterial sepsis associated with the transfusion remains a major threat. The incidence of septic events induced by platelets transfusion is approximately 10 times higher than with transfused red blood cells due to their storage temperature. This caused new Standard that implements the methods for the detection and reduction of bacteria in the platelet concentrates (PC). The aim is to consider the possibility of wider application of this tests in order to extend the shelf-life of PC. Sterility testing of PC is done once or twice per month using BacT/Alert BPA and BacT/Alert BPN bottles. If positive, all products from the initial unit were tested to confirm or deny the status. During six years period, 67236 PC units were made and 872 of them were tested. Only two were found initially positive. After testing the other products from the same initial unit, results were negative so, final results proclaimed false positive. Pretransfusion bacterial detection is an important potential method for reducing the risk of bacteriemia and transfusion-associated septic reactions. In addition to routine measures, Mirasol PRT pathogen inactivation system, could be included. This allows certain amount of PC to be inactivated during the first 32 hours. Untreated PC units would be stored in standard conditions and for given time (three days) potentially present bacteria would reach a detectable level. This way the quantity of samples for sterility testing could be reduced, taking only 2 ml of each of four units of PC. Samples would be planted at the same vial-aerobic bottle, which would also, double the capacity in BacT/Alert 3D automated system.

Early diagnosis and adequate surgical treatment are the key factors for the course of the laryngeal cancer of the head and neck and the outcome of the surgical treatment in these patients. The aim of the paper is to compare the characteristics of the surgically treated patients with the larynx carcinoma who developed recidivism to those who did not. The study was done as a retrospective observational case-control study on a total of 90 patients with the laryngeal cancer who had been successfully operated on and whose cases had been followed over a period of at least five years after the surgery. After that, they were shorted into two groups based on the development of recidivism, and clinical characteristics of the patients with and without recidive disease were compared. 19 out of 90 patients developed recidivism. Maximum diameter of the tumour was significantly larger in patients without local recidivism. In patients without local recidivism, most common clinical stages were 3 and 4 (32.4%, 40.8%, respectively), whereas in patients with local recidivism stages 1 and 2 were the most common (47.7%, 26.3%, respectively). The average time to disease recurrence in the 19 patients who developed local recidive disease was 648.10 (384.67-911.54) days. Pathohistological analysis showed that samller the size of the tumour and lower T grade at the moment of surgery are precautionary factors for further monitoring of patients with laryngeal cancer.

Tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD) are conditions related to renal failure that can rarely occur in association as a contiguous gene syndrome. Angiomyolipomas (AMLs) are renal tumors strongly related to TSC that may rupture and cause life-threatening bleedings. We present a patient with TSC, ADPKD, and renal AMLs with persistent hematuria requiring blood transfusion. The persistent hematuria was successfully treated through endovascular embolization, a minimally invasive nephron sparing technique. Keywords: Tuberous Sclerosis; Polycystic [...]

Background Male osteoporosis is under-diagnosed and poorly studied. With the ageing population, osteoporotic fracture in men is an emerging health problem. The aim of this study was to study the prevalence of osteoporosis and its association with serum testosterone and serum vitamin D in elderly men (>60 years old) attending the outpatient department (OPD). Methods An observational cross-sectional study was performed in elderly men (>60 years old) attending OPD of a tertiary care hospital of Western Maharashtra between April 2017 and June 2019. Patients with rheumatological disorders, history of vertebral/femoral fractures, chronic kidney disease, chronic liver disease, thyroid disorders and alcohol dependence were excluded. Data were analysed using the chi-square test and descriptive statistics. Results In total, 408 male patients were included. The mean age was 68.33 years. Osteoporosis was seen in 39.5% of patients (161/408) with a T score of ≤2.5. Osteopenia was noted in 48.3% of patients (197/408). T and Z scores had significant correlation (p = Conclusion Osteoporosis was noted in 39.5% of the elderly men. In addition, decreased testosterone, COPD and BPH were significantly associated with male osteoporosis. It is important to screen elderly men to diagnose osteoporosis early and prevent osteoporotic fractures.

Empagliflozin has a demonstrated cardiovascular benefit. It is co-prescribed as a glucose-lowering medication in patients with type II diabetes mellitus. Herein, we discuss dual-emergency side-effects, Fournier's gangrene (FG) and diabetic ketoacidosis with lower-than-anticipated glucose levels in a patient on Empagliflozin, a sodium-glucose transport protein 2 inhibitor (SGLT-2i). The pathophysiologic mechanism of FG in correlation with SGLT-2i is not yet elucidated. SGLT-2i increase predisposition to genital mycotic and urinary infections, a mechanism favouring FG. A patient with type II diabetes mellitus on SGLT-2i presented with acute necrotic infection of the scrotum and simultaneous diabetic ketoacidosis with lower-than-anticipated glucose levels. This dual emergency was managed with debridement and medical treatment on lines of diabetes ketoacidosis, respectively. A re-look at this group of glucose-lowering medications from bedside towards benchtop research may help to prod into any other mechanistic basis of these life-threatening clinical occurrences.

Background Non-small cell lung cancer (NSCLC) is the most common type of lung cancer with a high mortality rate and poor prognosis. miR-637 has been reported to regulate tumor progression and act as a prognosis biomarker of various cancers. Its functional role in NSCLC was investigated in this study. Methods The expression level of miR-637 in NSCLC tissues and adjacent normal tissues of 123 NSCLC patients was analyzed by qRT-PCR. The association between miR-637 and clinical pathological features in the prognosis of patients was analyzed. Cell transfection was performed to overexpress or knockdown miR-637 in H1299 and HCC827. The proliferation, migration, and invasion of H1299 and HCC827 were evaluated by CCK8 and Transwell assay. Results miR-637 expression was significantly decreased in NSCLC tissues and cell lines relative to normal tissues and cells. The survival rate of NSCLC patients with low miR-637 expression was lower than that of patients with high miR-637 expression. Additionally, miR-637 served as a tumor suppressor that inhibited cell proliferation, migration, and invasion of NSCLC. Conclusion Downregulation of miR-637 in NSCLC was associated with TNM stage and poor prognosis of patients and served as a tumor suppressor in NSCLC. These results provide a potential strategy to control NSCLC.

Resumen Introduccion La epilepsia es un conjunto de redes de estructuras cerebrales representadas bilateralmente, que estan funcional y anatomicamente conectadas; en la epilepsia, la actividad de cualquier parte del cerebro afecta la actividad de las demas. Esto es relevante para el entendimiento de la fisiopatologia, la etiologia, el diagnostico y la prognosis de esta enfermedad. Objetivo Revisar el estado del arte en cuanto al entendimiento de la vision neurofisiologica de la epilepsia como una enfermedad de redes neuronales. Resultados Se describen los principios basicos y avanzados de la epilepsia como enfermedad de redes neuronales usando distintos metodos clinicos y matematicos con una vision neurofisiologica, indicando las limitaciones de estos hallazgos en el contexto clinico. Conclusiones La epilepsia es una enfermedad de redes neuronales complejas cuyo entendimiento permitira mejorar los tratamientos disponibles y la certeza pronostica.

In speaking, shouting, and singing, vocal loudness is known to be regulated with lung pressure, but the degree to which vocal fold adduction and airway shape play a role in loudness control is less well known. When loudness is quantified in sones instead of sound pressure level (SPL), the regulatory mechanisms are even less obvious. Here it is shown computationally that loudness is insensitive to changes in SPL produced with variable adduction. A trade-off exists between a reduction in glottal flow amplitude and a flatter spectral slope. When the airway configuration is changed from a uniform tube to a "belt" or "call" shape, loudness can increase with a slight decrease in SPL. When the airway configuration is changed from a uniform tube to an operatic "ring" shape, loudness is increased with only a small increase in SPL.

Resumen Introduccion Las variantes C1236T, G2677T/A y C3435T del gen ABCB1 alteran la funcion de la glicoproteina P y el transporte de sustancias endogenas y exogenas en la barrera hematoencefalica; ademas, actuan como factores de susceptibilidad para algunas enfermedades neurodegenerativas. El objetivo del estudio fue determinar la asociacion de polimorfismos ABCB1 (C1236T, G2677T/A y C3435T), sus haplotipos y sus combinaciones de genotipos con la enfermedad desmielinizante. Metodo Se genotipifico a 199 pacientes con enfermedad desmielinizante y a 200 controles mestizos mexicanos mediante PCR-RFLP y secuenciacion Sanger para comparar las frecuencias de alelos, genotipos, haplotipos y combinaciones de genotipos entre pacientes y controles. El analisis estadistico se realizo con regresion logistica y χ2 de Pearson al 95% de confianza; se calculo la OR y se evaluo la asociacion con enfermedad desmielinizante. Resultados Los haplotipos TTT y CGC fueron los mas frecuentes en pacientes y controles. El alelo G2677 (OR = 1,79; IC 95%: 1,12-2,86; p = 0,015) muestra asociacion con enfermedad desmielinizante, asi como los genotipos GG2677 (OR = 2,72; IC 95% = 1,11-6,68; p = 0,025) y CC3435 (OR = 1,82; IC 95%: 1,15-2,90; p = 0,010) y su combinacion GG2677/CC3435 (OR = 2,02; IC 95%: 1,17-3,48; p = 0,010) y el haplotipo CAT (OR = 0,21; IC 95%: 0,05-0,66; p = 0,001). Los portadores TTTTTT presentaron la edad de inicio mas temprana (23,0 ± 7,7 vs. 31,6 ± 10,7; p = 0,0001). Conclusiones La combinacion de genotipos GG2677/CC3435 esta asociada al desarrollo de enfermedad desmielinizante en esta muestra, principalmente en el sexo masculino, en el cual puede darse acumulacion toxica de sustratos de glicoproteina P. En este estudio, la edad de inicio de la enfermedad desmielinizante podria ser modulada diferencialmente entre sexos por el alelo G2677 del gen ABCB1.

Resumen Introduccion El manejo de la epilepsia durante la gestacion requiere un control optimo de las crisis, evitando los potenciales efectos teratogenicos del tratamiento antiepileptico. Objetivos Describir las caracteristicas clinicas y los resultados perinatales de las pacientes con epilepsia gestantes. Analizar los factores que se asocian a la presencia de crisis durante la gestacion. Describir los farmacos antiepilepticos mas utilizados y analizar los cambios en el regimen terapeutico en dos periodos: de 2000-2010 y 2011-2018. Metodos Se realizo un estudio prospectivo observacional de pacientes con epilepsia que notificaron su gestacion en el periodo de 2000-2018. Se evaluo a las pacientes en el primer y segundo trimestre de gestacion, tras el parto y al ano. Se recogieron variables demograficas, relacionadas con la epilepsia, perinatales y obstetricas. Resultados Se incluyeron 101 gestaciones. La edad media fue de 32,6 anos, el 55,4% tenia una epilepsia focal, el 38,6% una epilepsia generalizada y el 5,9% indeterminada. Se registraron 90 nacidos vivos, nueve abortos espontaneos y cinco malformaciones congenitas, cuatro de ellas en monoterapia con valproato. En 40 gestaciones (39,6%) se registraron crisis, siendo tonico-clonicas generalizadas en 16 (40%). Las variables asociadas con la presencia de crisis durante el embarazo fueron el mal control el ano previo a la gestacion (66,7% vs. 15,1%, p Conclusiones Los factores asociados con la presencia de crisis durante la gestacion fueron el mal control previo, el tratamiento con dos o mas farmacos antiepilepticos y la ausencia de tratamiento. Los farmacos mas utilizados fueron lamotrigina, valproato y levetiracetam, con un incremento de este ultimo y un descenso de valproato en el periodo mas reciente (2011-2018).

The aim of the study was comparing the diagnostic role of the white light (WL) endoscopy, video laryngostroboscopy (VLS), and narrow-band imaging (NBI) in the evaluation of the benign vocal fold lesions.From March 2018 to June 2019, a total of 118 cases were enrolled in this study. Ninety-eight patients were suspected with vocal fold nodules, cysts, polyps, and sulcus vocalis and 20 patients without a history of dysphonia. Each patient was examined by WL, VLS, and NBI endoscopy. Recorded images and videos were analyzed and scored by three otorhinolaryngologists who had at least 3 years of experience in phoniatrics field. The evaluation results were compared between the methods and the physicians.A total of 118 cases were grouped by their confirmed diagnosis, vocal fold nodules (n = 28), vocal fold cyst (n = 24), vocal fold polyp (n = 9), and sulcus vocalis (n = 37). When the correct diagnosis rates of the physicians were compared, the statistical significance was found between the physicians in the WL and VLS method (P= 0.014, P= 0.027). No statistically significant difference was found among physicians in NBI method (P = 0.368). The difference between the diagnostic methods was found to be statistically significant in reaching the accurate diagnosis for benign vocal fold lesions (P0.001). While the difference between NBI-WL and VLS-WL was statistically significant (P0.001 and P0.001). The difference between NBI-VLS was not statistically significant while evaluating the vocal fold nodules, cysts, and sulcus vocalis separately (P= 0.102, P = 0.026, P = 0.157). Otherwise, it was statistically significant (P= 0.002) while evaluating total benign lesions in the study. The difference between NBI-VLS combination and VLS, NBI-VLS combination and VLS-WL combination were statistically significant (P0.001 and P= 0.001).This study showed that NBI assessments have similar accuracy and sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) to VLS and have a higher value than WL endoscopy in reaching the diagnosis for benign vocal fold lesions. Therefore, NBI can be accepted as a promising approach to identify benign laryngeal lesions due to its optical properties.

Background: Due to the interrupted blood supply in cerebral ischemic stroke (CIS), ischemic and hypoxia results in neuronal depolarization, insufficient NAD+, excessive levels of ROS, mitochondrial damages, and energy metabolism disorders, which triggers the ischemic cascades. Currently, improvement of mitochondrial functions and energy metabolism is as a vital therapeutic target and clinical strategy. Hence, it is greatly crucial to look for neuroprotective natural agents with mitochondria protection actions and explore the mediated targets for treating CIS. In the previous study, notoginseng leaf triterpenes (PNGL) from Panax notoginseng stems and leaves was demonstrated to have neuroprotective effects against cerebral ischemia/reperfusion injury. However, the potential mechanisms have been not completely elaborate. Methods: The model of middle cerebral artery occlusion and reperfusion (MCAO/R) was adopted to verify the neuroprotective effects and potential pharmacology mechanisms of PNGL in vivo. Antioxidant markers were evaluated by kit detection. Mitochondrial function was evaluated by ATP content measurement, ATPase, NAD and NADH kits. And the transmission electron microscopy (TEM) and pathological staining (H&E and Nissl) were used to detect cerebral morphological changes and mitochondrial structural damages. Western blotting, ELISA and immunofluorescence assay were utilized to explore the mitochondrial protection effects and its related mechanisms in vivo. Results: In vivo, treatment with PNGL markedly reduced excessive oxidative stress, inhibited mitochondrial injury, alleviated energy metabolism dysfunction, decreased neuronal loss and apoptosis, and thus notedly raised neuronal survival under ischemia and hypoxia. Meanwhile, PNGL significantly increased the expression of nicotinamide phosphoribosyltransferase (NAMPT) in the ischemic regions, and regulated its related downstream SIRT1/2/3-MnSOD/PGC-1α pathways. Conclusion: The study finds that the mitochondrial protective effects of PNGL are associated with the NAMPT-SIRT1/2/3-MnSOD/PGC-1α signal pathways. PNGL, as a novel candidate drug, has great application prospects for preventing and treating ischemic stroke.

Background The objective of this study was to evaluate pattern and distribution of neovascularization of optic disc (NVD) and elsewhere (NVE) in proliferative diabetic retinopathy (PDR). Methods A cross-sectional study was conducted among freshly detected cases of PDR. Fundus fluorescein angiographic images of 61 eyes were assessed. Parameters studied for NVD were their number and location and for NVE were their number, location, type of leak, and distance from center of optic disc. Results Of 61 eyes, 29 eyes (47.5%) had NVD with a total of 49 leaks. Of these 49 NVD leaks, the maximum was concentrated in the superotemporal quadrant with 21 leaks (42.9%; 95%CI 28.8–57.8%). Of 61 eyes, 50 eyes (82%) had NVE with 97 leaks. Of 97 NVE leaks, 41 were found in the superotemporal quadrant (42.3%; 95%CI 32.3–52.7%). Maximum NVE was found within the circle of radius 3–6 mm centered on optic disc (p value = 0.001) with no leaks in central macula. Of 29 eyes with NVD, only 7 eyes had >1/3 area of disc involvement. Also, of 18 eyes with concurrent NVD and NVE, only 2 eyes had >1/3 area of disc involvement which is a high-risk characteristic of PDR. Conclusion Neovascular lesions have a predilection for superotemporal part for both NVD and NVE. NVE leaks were almost double the number of NVD leaks. Maximum NVE leaks were found at posterior pole with no central macular involvement. This study provides comprehensive data and further adds to knowledge of neovascularization for early diagnosis and management of PDR.

Resumen Introduccion La polineuropatia relacionada con el deposito de amiloide por transtiretina (hATTR, por sus siglas en ingles) es una enfermedad poco comun, multisistemica, de inicio en la edad adulta con un pronostico ominoso sin tratamiento. Para reconocer la enfermedad en la etapa mas temprana posible, se ha propuesto un grupo de signos y sintomas, comunmente conocidos como «red flags», y su presencia puede indicar la presencia de una hATTR subyacente en pacientes con polineuropatia sensitivo-motora progresiva. Materiales y metodos Se analizo la frecuencia de «red flags» en el momento del diagnostico en 30 pacientes con hATTR de un area no endemica de Espana, con una mayoria de pacientes de inicio tardio. Resultados Las frecuencias de «red flags» fueron las siguientes: sindrome del tunel carpiano bilateral 15/30 (50%); disautonomia temprana en 17/30 (56%); sintomas gastrointestinales en 14/30 (46,6%); perdida inexplicable de peso en 8/30 (26,6%); enfermedad cardiaca en 12/30 (40%); hallazgos cardiacos asintomaticos en 13/30 (43,3%); enfermedad renal en 1/30 (3,3%); opacidades vitreas en 0/30 (0%); neuropatia familiar en 21/30 (70%); cardiopatia familiar en 15/30 (50%) y antecedentes familiares gastrointestinales en 3/30 (10%). Todos los pacientes presentaron al menos una «red flag» en el momento del diagnostico, con una mediana de 4 «red flags». Conclusion Las «red flags», incluso en los pacientes de inicio tardio, fueron hallazgos comunes en el momento del diagnostico y su presencia en un paciente con polineuropatia sensitivo-motora simetrica deberia alertarnos y conducir el diagnostico a lo largo de la hATTR hasta excluirlo, independientemente de la edad de inicio o de la region endemica.

Summary Objectives/Hypothesis The purpose of this study was to determine the relationships among cognitive loading, autonomic arousal, and acoustic measures of voice in healthy older adults. Study Design Prospective and observational. Methods Twelve healthy older adults (six females) produced a sentence containing an embedded Stroop task in each of two cognitive load conditions: congruent and incongruent. Three physiologic measures of autonomic arousal (pulse volume amplitude, pulse period, and skin conductance response amplitude) and four acoustic measures of voice (cepstral peak prominence, low-to-high spectral energy ratio, fundamental frequency, and sound pressure level) were analyzed in each cognitive load condition. Results A logistic regression model was used to predict the cognitive load condition using participant as a categorical predictor and the four acoustic measures and three autonomic measures as continuous predictors. Skin conductance response amplitude and pulse volume amplitude were both predictive of cognitive load; however, no acoustic measures of voice were statistically significant predictors of cognitive load for older adults. Conclusions These findings support the idea that increased cognitive load is associated with increased autonomic nervous system activity in older adults. The lack of changes in acoustic measures of voice with increased cognitive load may result from age-related changes in vocal quality and speech subsystems.

Glioblastoma (GBM) is the most common primary malignant brain tumor in adults. Homocysteine (Hcy) has a detrimental influence on human neurons, considering that human GBM cells undergo cell death already at D,L-Hcy concentrations in culture medium of 50 μM. This data demonstrate that Hcy is a potent gliotoxic agent capable of inducing the death of human glial cells already at concentrations reached in brain during hyperhomocysteinemia. The one retrospective study found that the serum vitamin B12 level can be used to predict survival time in metastatic cancer patients including neurological cancer. Cancer risk increases with elevated vitamin B12 level, mostly within the first year of the follow-up period, suggesting that vitamin B12 level could be used as a cancer diagnostic marker. In addition, the relationship between elevated vitamin B12 level and poor cancer survival time has been reported. Previous investigation suggests that the folate supplementation could be used as an adjuvant in antiglioma therapy to limit the low DNA methylation level because this confers a poor prognosis in glioblastoma multiforme patients. Taking into account all presented data, it can be concluded that effect of homocystein, folic acid and vitamin B12 on formation, development and outcome of treatment in patients with carcinoma is very intriguing question, whose response requires additional both experimental and clinical research. There lack of data in the literature on the incidence of elevated levels of Hcy in the blood, as well as the disorders of folic acid and vitamin B12, at malignant tumors of the brain.

Background: The procancer effect of TEA domain transcription factor 4 (TEAD4) has been gradually discovered. However, its expression in esophageal cancer (EC) cells and its effect on proliferation ...

Background Surgical staging in endometrial cancer includes a systematic lymphadenectomy with significant morbidity, although its therapeutic role is unclear. Sentinel lymph node (SLN) study is a less morbid alternative to identify nodes most likely to be metastatic, permitting selective removal and thus reducing morbidity without compromising oncological safety. This study was done using blue dye single labelling to study the feasibility and utility in identifying SLN in early disease. Methods Twenty-two patients of early-stage low-risk disease during surgical staging underwent cervical injection of methylene blue, SLN mapping, and sampling as per the standard algorithm, followed by a systematic lymphadenectomy in all cases. SLN were submitted separately for ultrastaging (US). Results Twenty patients underwent the procedure, and SLN could be identified in 18 patients with an overall mapping rate of 90% with a bilateral mapping rate of 70%, and a negative mapping rate of 10%. 57 SLN were identified along with two suspicious non-sentinel nodes and 11 were metastatic on US with a sensitivity of 66.7% and NPV of 87.5%. All patients with metastatic nodes, however, could be identified by applying the standard SLN algorithm for sampling. Conclusion SLN mapping algorithm with blue dye single labelling in early endometrial cancer, by identifying LN most likely to be metastatic enabling their selective removal may help avoid routine lymphadenectomies without compromising oncological safety. The procedure is simple and can be practiced at all centres and can also aid pathologists by pinpointing the likely metastatic nodes after a selective or complete lymphadenectomy.

Resumen Introduccion Dadas las altas tasas de recurrencia, el hematoma subdural cronico (HSDC) es una condicion que supone un reto para el clinico. La embolizacion endovascular de la arteria meningea media (EeAMM) ha surgido como una alternativa para aquellos pacientes con problemas de salud o con varias recurrencias de su HSDC. A pesar de la publicacion de algunos articulos prometedores referentes a esta tecnica, el perfil de seguridad, las indicaciones y las limitaciones no estan claramente establecidas. Desarrollo Nuestro objetivo es evaluar la evidencia actual sobre la EeAMM en el HSDC. Se realizo una revision sistematica de la literatura segun las guias PRISMA. Nuestra busqueda arrojo un total de 6 estudios, en los que 164 pacientes con HSDC se sometieron a EeAMM. La tasa de recurrencia entre todos los estudios fue del 6,7% y se produjeron complicaciones en hasta el 6% de los pacientes. Conclusion La EeAMM es una tecnica factible en el tratamiento del HSDC con una tasa de recurrencia relativamente baja y tasas aceptables de complicaciones. Se necesitan mas estudios prospectivos y aleatorizados para establecer formalmente un perfil de seguridad claro y su efectividad.

The well-being and mental health of principals is being threatened by changing working conditions such as a broader variety of roles and tasks. In this article, we argue that social capital might buffer against declining (mental) health. The purpose of this study was to investigate the potential influence of social capital, including both internal (bonding) and external (bridging and linking) social capital, on principals’ well-being. A longitudinal study was set up across three waves of data. Questionnaires were collected from 2084 Australian principals and 829 Irish principals, across six and two timepoints, respectively. The hypotheses were tested using a longitudinal path model approach using maximum likelihood estimation in lavaan for R. In line with our hypotheses, the results indicated that principals who reported higher levels of either internal or external social capital also reported higher levels of well-being. More specifically, support from colleagues outside the school and supervisor support (external social capital) and collaboration and trust in management (internal social capital) predicted well-being positively across time. The results of this study highlight the importance of having social support from colleagues and supervisors and possibilities for collaboration to maintain well-being as a school principal.

Measuring the impact of chronic cough on voice quality can be difficult and challenging in daily practice. Evidence about its potential effects on diagnostic tools used in voice evaluation is lacking. We hypothesized that the presence of chronic cough plays a role in patients' perception of dysphonia severity, leading to a mismatch between the subjective, objective, and perceptual evaluations.A retrospective chart review involving patients with a diagnosis of dysphonia and a complete speech voice evaluation was performed. A total of 311 patients were stratified into two different groups according to the presence of chronic cough. A total of 151 patients were assigned to the dysphonia and chronic cough group, while 160 patients were assigned to the dysphonia only group. During the initial evaluation, patients completed the Voice Handicap Index (VHI)-30, Glottal Function Index (GFI), and Reflux Symptoms Index (RSI). Voice evaluation also included aerodynamic/acoustic measures and the application of the GRBAS scale by a speech-language specialist. A paired t test and a linear regression analysis were used to compare subjective, perceptual, and aerodynamic/acoustic measures in both groups.The mean VHI-30 and GFI were elevated in both groups but significantly lower among patients with dysphonia and chronic cough when compared to patients with dysphonia only (P= 0.01). Additionally, a significantly higher RSI was found among patients with dysphonia and chronic cough (P0.01). No difference in aerodynamic/acoustic measures was found between groups (P0.05). Our linear regression model demonstrated a significant effect of the presence of chronic cough on the VHI-30, RSI, and GFI questionnaires (P0.05). Our model also found that the VHI-30 is a significant predictor for the (G), (B), (A), and (S) components of the GRBAS scale (P0.05).The presence of chronic cough has a significant impact on the different patient-reported outcome measures, including VHI-30, RSI, and GFI. The use of VHI-30 as a predictor for the GRBAS scale reinforces the importance of subjective and perceptual assessment among patients with voice disorders and establishes a new area for exploration.

In recent years, there has been an increasing interest in the development of arthroplasty registries, therefore, in our country, the Italian Arthroplasty Registry (RIAP), was issued by the National Law No. 221/2012. In the last decade, however, some European countries -namely Sweden, Denmark, Norway, and Germany (in development)- have introduced another nationwide orthopaedic registry than arthroplasty registers: the fracture registry. The development of this new tool aims to improve quality and safety in fracture management, thus trying to provide a better postoperative quality of life in trauma patients. Based on these findings, the AO-Trauma Italy Council encouraged the development of a national fracture registry in Italy. The present study aims to (1) provide an overview of the fracture registries in Europe and (2) to develop, for the first time, a pilot Italian Fracture Registry (RIFra). Thirteen AO-Trauma Italy members, chairmen of Level-I orthopaedic and trauma centres, diffused throughout Italy, were involved in the RIFra project. The RIFra form, developed between November 2019 and March 2020, consists of 5 main sections, namely: epidemiologic data, previous surgical procedure (if any), patient and fracture features, surgical procedure, surgical implant details. This study constitutes the first step to start, in future years, the bureaucratic procedure leading to the final establishment of a RIAP-like fracture registry in Italy.

PURPOSE To investigate the discoloration and surface properties of four CAD/CAM composite resins provoked by a variety of food solutions and cigarette smoke. MATERIALS AND METHODS A total of 74 specimens (N = 370) were prepared per material (Brilliant Crios [Coltene], CeraSmart [GC], Lava Ultimate [3M Espe], Shofu Block HC [Shofu], and SonicFill 2 [Kerr]). Discoloration (ΔE) was investigated with a spectrophotometer. Measurements were taken before immersion in the storage media for 2 weeks (carrot juice, curry, cigarette smoke, red wine, energy drink, and distilled water), immediately after immersion, and after manual polishing of the specimens following immersion. The mean surface roughness (Ra) was measured using a profilometer. Qualitative surface observation was performed with scanning electron microscopy (SEM). Data were analyzed using Kolmogorov-Smirnov, Mann-Whitney U, and one-way analysis of variance with Tukey post hoc tests. RESULTS The highest influence on ΔE after immersion was observed by the storage medium (ηP. = 0.878, P < .001), followed by the interaction between storage medium and material (ηP. = 0.770, P < .001) and the material (ηP. = 0.306, P < .001). For ΔE after polishing, the highest influence was indicated by the interaction of material and medium (ηP. = 0.554, P < .001), followed by the medium (ηP. = 0.244, P < .001) and the material (ηP. = 0.196, P < .001). Immersion in carrot juice led to the highest color change (ΔE: 8.0 to 10.4), whereas the lowest values were recorded in distilled water (ΔE: 2.0 to 2.4). Carrot juice and the energy drink provoked the highest Ra values (0.120 to 0.355 μm). SEM pictures indicated a loss of the organic matrix after manual polishing. CONCLUSION The different materials reacted dissimilarly in the various storage media in terms of discoloration. Surface roughness increased after immersion and polishing. Neither discoloration nor surface roughness could be reset to default by manual polishing.

Resumen Antecedentes y objetivo Los apendices pleurales son grasa extrapleural que cuelga de la pared toracica. Han sido descritos mediante videotoracoscopia, pero no se conocen exactamente ni el aspecto ni la frecuencia con que se observan apendices pleurales en tomografia computarizada (TC) ni tampoco si estan relacionados con la cantidad de grasa del paciente. Pretendemos describir el aspecto y conocer la prevalencia de los apendices pleurales observados en TC, asi como saber si su presencia, tamano y numero es mayor en pacientes obesos que en no obesos. Pacientes y metodos Se han revisado retrospectivamente las imagenes axiales de tomografia computarizada de 226 pacientes con neumotorax. Fueron excluidos del estudio los pacientes con antecedentes de enfermedad pleural, cirugia toracica o neumotorax pequenos. Se dividio a los pacientes en dos grupos segun el indice de masa corporal (IMC): obesos (IMC?≥?30) y no obesos (IMC Se recogieron el numero y tamano de apendices pleurales en cada paciente. Se emplearon una prueba de χ 2 y el test exacto de Fisher para evaluar las diferencias entre los dos grupos. Un valor de p Resultados 101 pacientes presentaron estudios de TC validos. Se identificaron apendices pleurales en 50 de los 101 pacientes (49,5%). La mayoria se presentan de forma solitaria (n = 31), en el seno cardiofrenico (n = 27) y tienen un tamano inferior a 5 cm (n = 39). No hubo diferencia significativa entre los pacientes obesos y los no obesos en relacion con la presencia o ausencia (p = 0,315), numero (p = 0,458) y tamano (p = 0,458) de apendices pleurales. Conclusiones Los apendices pleurales se observan en el 49,5% de los pacientes con neumotorax estudiados con TC en este estudio. No hubo diferencia significativa entre los pacientes obesos y los no obesos respecto a la presencia, numero y tamano de apendices pleurales.

Il trattamento della fibrillazione ventricolare (FV) con elettrodi esterni transtoracici negli esseri umani e conosciuto dal 1956, ma l’uso di defibrillatori semiautomatici (DSA) da parte dei soccorritori paramedici e non medici e consentito in Francia dal 1998 (decreto 98-239 del 27 marzo 1998). Il decreto del 4 maggio 2007 mette fine alle restrizioni all’uso di defibrillatori automatici esterni (DAE) e modifica il codice della salute pubblica in modo che qualsiasi persona, anche un non medico, abbia il potere di usare un DAE. In presenza di ogni arresto cardiaco, indipendentemente dall’eta o dalle circostanze, si raccomanda di associare alla rianimazione convenzionale l’utilizzo di un defibrillatore appena possibile. La defibrillazione esterna e piu efficace quando e precoce. La somministrazione di una scarica elettrica esterna da parte di un DAE e possibile solo in caso di rilevamento di una FV o di una tachicardia ventricolare (TV). Questa specificita e ottenuta attraverso un software di analisi dei segnali elettrocardiografici. E dimostrato che l’uso precoce dei DAE da parte del grande pubblico favorisce la prognosi di recupero degli arresti cardiaci. E, pertanto, necessario, nel 2015, moltiplicare la collocazione nei luoghi pubblici di DAE e, soprattutto, consentirne l’accessibilita segnalandoli in modo efficace. A tal fine, attualmente, esistono diverse applicazioni mobili e una localizzazione geografica della loro posizione al momento della chiamata ai servizi di urgenza dovrebbe consentire, in futuro, un aumento della sopravvivenza nei pazienti con arresto cardiaco.

Background Effects of the major ginsenoside Rg1 on mammalian longevity and physical vitality are rarely reported. Purpose To examine longevity, tumor, and spontaneous locomotor activity in rats consuming Rg1. Methods A total of 138 Wistar rats were randomized into 2 groups: control (N = 69) and Rg1 (N = 69). Rg1 (0.1 mg/kg per day) were orally supplemented from 6 months of age until natural death. Spontaneous mobility was measured by video-tracking together with body composition (dual energy x-ray absorptiometry) and inflammation markers at 5, 14, 21, and 28 months of age. Results No significant differences in longevity (control: 706 days; Rg1: 651 days, p = 0.77) and tumor incidence (control: 19%; Rg1: 12%, p = 0.24) were observed between the two groups. Movement distance in the control group declined significantly by ∼60% at 21 months of age, together with decreased TNF-α (p = 0.01) and increased IL-10 (p = 0.02). However, the movement distance in the Rg1 group was maintained ∼50% above the control groups (p = 0.01) at 21 months of age with greater magnitudes of TNF-α decreases and IL-10 increases. Glucose, insulin, and body composition (bone, muscle and fat percentages) were similar for both groups during the entire observation period. Conclusion The results of the study suggest a delay age-dependent decline in physical vitality during late life by lifelong Rg1 consumption. This improvement is associated with inflammatory modulation. Significant effects of Rg1 on longevity and tumorigenesis were not observed.

Background Emerging epidemiological evidence suggests that compared to engaging in 1 activity mode alone, a combination of moderate-to-vigorous physical activity (MVPA: brisk walking/jogging, cycling) and muscle-strengthening exercise (MSE: push-ups/sit-ups, using weight machines) has more favorable associations with optimal weight status. However, few studies have examined the dose-dependent and joint associations of MVPA and MSE with obesity. Methods Based on cross-sectional analyses of the European Health Interview Survey Wave 2 (2013–2014), we examined prevalence ratios (PRs) of joint and stratified associations between MVPA (4 categories: (i) 0 min/week, (ii) 1–149 min/week, (iii) 150–299 min/week, and (iv) ≥300 min/week) and MSE (3 categories: (i) 0 day/week, (ii) 1 day/week, and (iii) ≥2 days/week) with body mass index-defined obesity (body mass index of ≥30.0 kg/m2) using Poisson regression with robust error variance. PRs were examined unadjusted and adjusted for sociodemographic and lifestyle characteristics (e.g., sex, age, education, income, and smoking status). Results Data were available for 280,456 adults (≥18 years), of which 46,166 (15.5%) were obese. The interaction MVPA × MSE guideline adherence was statistically significant for obesity (p ≤ 0.05). The joint MVPA–MSE analysis showed that compared to the reference group (i.e., no MVPA and no MSE), the PRs followed a dose-dependent pattern, with the lowest observed among those reporting ≥150 MVPA min/week and ≥1 MSE days/week (PR: 0.43; 95% confidence interval: 0.41–0.46). When stratified across each MVPA strata, the PRs were mostly lower among those engaging in MSE 1 day/week, as compared to those doing MSE ≥2 days/week. Conclusion There was evidence for a dose-dependent association between joint MVPA–MSE with a reduced prevalence of obesity. Public health strategies for the prevention and management of obesity should recommend both MVPA and MSE.

Resumen La arteriopatia autosomica dominante cerebral con infartos subcorticales y leucoencefalopatia es una enfermedad autosomica dominante de pequenos vasos causada por mutaciones del gen NOTCH3. Tipicamente se presenta con migrana, eventos isquemicos cerebrales recurrentes y trastornos cognitivos. Las crisis epilepticas son inusuales como manifestacion inicial, pero aun mas infrecuente es su presentacion como status epilepticus no convulsivo 1 . Se presenta una serie familiar de 3 casos con esta arteriopatia, entre los cuales 2 de ellos tuvieron status epilepticus como manifestacion de la enfermedad.

Background Neonates at risk of hypoglycemia are often roomed in with mothers, but there is paucity of literature on the occurrence of hypoglycemia in these exclusively breastfed high-risk neonates. The primary objective was to estimate the incidence of hypoglycaemia in high-risk neonates on exclusive breastfeeding. The secondary objectives were to study the time of presentation, symptoms of hypoglycaemia, and the various maternal and neonatal risk factors. Methods This prospective observational study was carried out in a tertiary care teaching hospital of eastern India between January 2017 and June 2018. All neonates roomed in with mothers with high-risk factors such as low birth weight, preterm, small for gestational age, large for gestational age and infants of diabetic mothers were included. All included neonates were exclusive breastfed and underwent blood glucose monitoring at 2, 6, 12, 24, 48 and 72 h of life using glucometer strips and also whenever clinical features suggested hypoglycaemia. Hypoglycemia was defined as the blood glucose level ≤46 mg/dL. Results Of a total of 250 neonates studied, 52 (20.8%) developed hypoglycaemia in first 72 h. Hypoglycaemia was detected in most at 2 h with the second peak at 48 h of age. Only 8 (3.2%) neonates had symptomatic hypoglycaemia with jitteriness being the commonest symptom, followed by lethargy and poor feeding. Conclusion There is a need to closely monitor the blood glucose levels for at least first 48 h in high-risk neonates roomed in with mothers on exclusive breastfeeding.

Summary Objective The current paper examined the impact of dysphonia on the bandwidth of the first two formants of vowels, and the relationship between the formant bandwidth and vowel intelligibility. Methods Speaker participants of the study were 10 adult females with healthy voice and 10 adult females with dysphonic voice. Eleven vowels in American English were recorded in /h/-vowel-/d/ format. The vowels were presented to 10 native speakers of American English with normal hearing, who were asked to select a vowel they heard from a list of /h/-vowel-/d/ words. The vowels were acoustically analyzed to measure the bandwidth of the first and second formants (B1 and B2). Separate Wilcoxon rank sum tests were conducted for each vowel for normal and dysphonic speech because the differences in B1 and B2 were found to not be normally distributed. Spearman correlation tests were conducted to evaluate the association between the difference in formant bandwidths and vowel intelligibility between the healthy and dysphonic speakers. Results B1 was significantly greater in dysphonic vowels for seven of the eleven vowels, and lesser for only one of the vowels. There was no statistically significant difference in B2 between the normal and dysphonic vowels, except for the vowel /i/. The difference in B1 between normal and dysphonic vowels strongly predicted the intelligibility difference. Conclusion Dysphonia significantly affects B1, and the difference in B1 may serve as an acoustic marker for the intelligibility reduction in dysphonic vowels. This acoustic-perceptual relationship should be confirmed by a larger-scale study in the future.

Sulfur-containing amino acids are integral part of molecular mechanisms which underlie many aspects of cellular function and homeostasis, facilitated by reversible changes in oxidation states of sulfur atoms. Dysregulation of these pathways is associated with diverse pathologies, notably of the cardiovascular system, which are typically characterized by inappropriate plasma levels of sulfur-containing amino acids. The aim of this study was to assess the acute, direct effects of sulfur-containing amino acids and inorganic NaHS, as H2S donor, on cardiodynamic parameters in homocysteine treated rats. Moderate hyperhomocysteinemia did not cause significant decrease in myocardial contractility, but our findings suggest that NaHS and L-methionine cause negative effects on cardiac function in hearts of the rats treated with homocysteine, even in a single administration. Further investigations need to be carried out with purpose of better understanding and highlightening the impact of Hcy and sulphur amino acids on cardiac function.

Anaemia is a common complication of chronic kidney disease. The most important contributory factor is an abnormally low circulating concentration of erythropoietin, which is produced by the kidney peritubular cells. Anaemia of kidney disease is likely to develop once the glomerular filtration rate (GFR) is

Background Obesity is a chronic condition, affecting central and peripheral nervous system. Studies on cranial nerve conduction in obesity are scarce and unclear; therefore, we planned this study. The aim of this study was to evaluate optic and auditory nerve conductions in obesity. Methods It was a case-control study, with inclusion of 40 young males (20 obese and 20 controls) in age group of 18–30 years. We recorded pattern reversal visual evoked potential (PRVEP) and brainstem auditory evoked potential (BAEP). The PRVEP P100 latency and BAEP absolute and interpeak latencies were analyzed. Results In obese individuals, BAEP absolute latencies of wave V were significantly prolonged in both the ears and wave I in left ear. In addition, significant prolongation of interpeak latency III–V was observed in both the ears and I–V latency, in right ear among obese cases. A positive correlation was seen between body mass index and interpeak latency I–V. In PRVEP recordings, P100 latency did not show any significant difference in both the groups. Conclusion Therefore, we can conclude that obesity does not affect optic nerve conduction, but auditory nerve conduction is affected. BAEP I–V interpeak latency may be an indicator of subclinical auditory conduction defects in young obese males.

OBJECTIVE: Female sex is a known risk factor in most cardiac surgery, including coronary and valve surgery, but unknown in acute type A aortic dissection repair. METHODS: From 1996 to 2018, 650 patients underwent acute type A aortic dissection repair; 206 (32%) were female, and 444 (68%) were male. Data were collected through the Cardiac Surgery Data Warehouse, medical record review, and National Death Index database. RESULTS: Compared with men, women were significantly older (65 vs 57 years, P < .0001). The proportion of women and men inverted with increasing age, with 23% of patients aged less than 50 years and 65% of patients aged more than 80 years being female. Women had significantly less chronic renal failure (2.0% vs 5.4%, P = .04), acute myocardial infarction (1.0% vs 3.8%, P = .04), and severe aortic insufficiency. Women underwent significantly fewer aortic root replacements with similar aortic arch procedures, shorter cardiopulmonary bypass times (211 vs 229 minutes, P = .0001), and aortic crossclamp times (132 vs 164 minutes, P < .0001), but required more intraoperative blood transfusion (4 vs 3 units) compared with men. Women had significantly lower operative mortality (4.9% vs 9.5%, P = .04), especially in those aged more than 70 years (4.4% vs 16%, P = .02). The significant risk factors for operative mortality were male sex (odds ratio, 2.2), chronic renal failure (odds ratio, 3.4), and cardiogenic shock (odds ratio, 6.8). The 10-year survival was similar between sexes. CONCLUSIONS: Physicians and women should be cognizant of the risk of acute type A aortic dissection later in life in women. Surgeons should strongly consider operations for acute type A aortic dissection in women, especially in patients aged 70 years or more.

TruthSift is a cloud-based platform that logically combines members' contributions into a collective intelligence. Members add statements and directed connectors to diagrams. TruthSift monitors which statements have been logically established by demonstrations for which every challenge has beenrefuted by an established refutation, and the complement: which statements have been refuted by established refutations. When members run out of rational objections the result is a converged diagramsuccinctly representing the state of knowledge about a topic, including plausible challenges and how they were refuted. Previous computer systems for collaborative intelligence did not have a qualitatively better solution for combining contributions than voting, and are subject to group think, interest group capture, and inability to follow a multi-step logical argument. They did not settle issues automatically point by point and propagate the consequences up. I review indications that many practically important statements most people believe to be firmly established will be revealed to be firmly refuted upon computer assisted scrutiny. TruthSift also supports construction of powerful probabilistic models over networks of causes, implications, tests, and necessary factors.

Glucagon-like peptide-1(GLP-1) is a multifunctional polypeptide throughout the lifespan via activating Glucagon-like peptide-1 receptor (GLP-1R).GLP-1 can affect food ingestion, enhance the secretion of insulin from pancreatic islets induced by glucose and be utilized to treat type 2 diabetes mellitus(T2DM).But, accumulating evidences from the decades suggest that activation GLP-1R can not only regulate the blood glucose, but also sustain the homeostasis of intracellular environment and protect neuron from various damaged responses such as oxidative stress, inflammation, excitotoxicity, ischemia and so on. And more and more pre-clinical and clinical studies identified that GLP-1 and its analogues may play a significant role in improving multiple central nervous system (CNS) diseases including neurodegenerative diseases, epilepsy, mental disorders, ischemic stroke, hemorrhagic stroke, traumatic brain injury, spinal cord injury, chronic pain, addictive disorders, other diseases neurological complications and so on. In order to better reveal the relationship between GLP-1/GLP-1R axis and the growth, development and survival of neurons, herein, this review is aimed to summarize the multi-function of GLP-1/GLP-1R axis in CNS diseases.

Background In the literature, filum terminale arteriovenous shunts (FTAVSs) always feature a single shunt point. Nidus-type FTAVSs have rarely been reported, and the best treatment strategy is unclear. This is a report of 1 exceptional case of a nidus-type FTAVS and surgical treatment of the lesion. Case description The patient suffered from cauda equina syndrome for 9 months. Magnetic resonance imaging and spinal angiography revealed a nidus-type FTAVF at the L2 level. Surgical resection was performed in the hybrid operating room, and the nidus was completely resected with the assistance of intraoperative methylene blue angiography and neurophysiological monitoring. The postoperative neurological function was stable. Conclusions A nidus-type AVS could originate from the FT, and in such cases, complete surgical resection with intraoperative neurophysiological monitoring in a hybrid operating room should be suggested.

The phenomenon of plasticity in the striatum, and its relation with the striatum-nigra neuronal circuit has clinical and neurophysiological relevance to Parkinson and epilepsy. High frequency stimulation (HFS) can induce neural plasticity. Furthermore, it is possible to induce plasticity in the dorsal striatum and this can be modulated by substantia nigra activity. But it has not been shown yet what would be the effects in the striatum-nigra circuit after plasticity induction in striatum with HSF. Literature also misses a detailed description of the way back loop of the circuit: the striatal firing rate after substantia nigrás inhibition. We here conducted: First Experiment, application of HFS in dorsomedial striatum and measure of spontaneous and longlasting behavior expression in the open field three days later; Second, application of single pulses on dorsomedial striatum and measure of the evoked potentials in substantia nigra before and after HFS; Third Experiment: inhibition of substantia nigra and recording of the firing rate of dorsomedial striatum. HFS in dorsomedial striatum caused increased locomotion behaviors, but not classical stereotypy. However, rats had either an increase or decrease in substantia nigrás evoked potentials. Also, substantia nigrás inhibition caused an increase in dorsomedial striatum firing rate. Present data are suggestive of a potential application of HFS in striatum, as an attempt to modulate behavior rigidity and hypokinesia of diseases involving the basal ganglia, especially Parkinson´s Disease.

Background Impact of immeasurable time bias (IMTB) is yet to be examined in self-controlled designs. Methods We conducted case-crossover, case-time-control, and case-case-time-control analyses using Korea's healthcare database. Two empirical examples among elderly patients were used: 1) benzodiazepines-hip fracture; 2) benzodiazepines-mortality. For cases, the date of hip fracture diagnosis or death was defined as the index date, and the inherited date of their matched cases for controls or future cases. Exposure was assessed in the 1-30 day (hazard) and 61-90 day (control) windows preceding the index date. A non-missing exposure setting included in- and outpatient prescriptions and the pseudo-outpatient setting included only the outpatients. Conditional logistic regression was done to estimate odds ratio (OR) with 95% confidence intervals (CI), where the relative difference in OR among the two settings was calculated to quantify the IMTB. Results The IMTB had negligible impacts in the hip fracture example in the case-crossover (non-missing exposure setting OR 1.27, 95% CI 1.12-1.44; pseudo-outpatient setting 1.21, 1.06-1.39; magnitude 0.05), case-time-control (1.18, 0.98-1.44; 1.13, 0.92-1.38; 0.04), and case-case-time-control analyses (0.99, 0.80-1.23; 0.94, 0.75-1.18; 0.05). In the mortality example, IMTB had significant impacts in the case-crossover (1.44, 1.36-1.52; 0.72, 0.67-0.78; 1.00), case-time-control (1.38, 1.26-1.51; 0.68, 0.61-0.76; 1.03), and case-case-time-control analyses (1.27, 1.15-1.40; 0.62, 0.55-0.69; 1.05). Conclusions Although IMTB had negligible impacts on the drug's effect on acute events as these are unlikely to be accompanied with hospitalizations, it negatively biased the drug's effect on mortality, an outcome with prodromal phases, in the three self-controlled designs.

Background and purpose Mild traumatic brain injury (mTBI) in patients on antiplatelet (AP), anticoagulant (AC) or direct oral anticoagulant (DOAC) medication has become a systematic indication for head CT. However, the over-risk and impact of the intracranial hemorrhages (IH) detected with CT in this population remain unclear and need to be assessed. Materials and methods We prospectively assessed head CTs performed in adults taking AP/AC/DOAC referred after a mTBI to our Emergency Departments between September 2016 and January 2018. Frequency, type and severity of IH were described and frequency was analyzed as a function of treatment. Results 840 patients were prospectively included. 58.9% were treated with AP, 23.7% with AC, 11.7% with DOAC and 5.7% with a combination of antithrombotic agents. The rate of IH detected with head CT was 5.8% (n = 49), of which 81.6% (n = 40) and 18.4% (n = 9) with minor and intermediate severity respectively. No patient required surgical care and no death occurred. No statistically significant difference was found in treatment distribution between patients with or without IH (p = 0.98). Among the patients who discontinued their antithrombotic treatment after mTBI, three experienced thrombotic events during the hospitalization. Conclusions Our results showed a low frequency and severity of IH in mTBI patients indifferently treated with AP, AC or DOAC, without secondary neurological deterioration, death or need of surgical care. Our study suggests the limited benefit of systematic CT head scan as a standard practice for the management of mTBI patients under antithrombotic therapy.

A protocol for qualitatively reviewing the accuracy of fabricated implant surgical guides is presented. Once these guides have been inserted and fixed intraorally, cone beam computed tomography (CBCT) scans are made. Implant positions can be recalculated by processing the series of sleeve images on the CBCT scans. This protocol offers an opportunity for double-checking the accuracy of a fabricated guide before surgery in certain circumstances.

Abstract. As a follow-up to an earlier study demonstrating healthier cardiometabolic profiles among long-term multiple dietary supplement (LTMDS) users, we examined if cardiometabolic health benefits associated with LTMDS use persisted with aging. The study is based on LTMDS users from North America and 2007–2010 NHANES participants who were used for comparison to the LTMDS users. NHANES subjects were classified as non-dietary supplement (NS) users, single supplement/single purpose supplement (SS) users, multivitamin/mineral supplement (MVMS) users, and multiple dietary supplement (MDS) users. Supplement groups were compared for total, HDL and LDL cholesterol; triglycerides; glucose; insulin; CRP and HbA1c ≥ 6.5%, adjusting for age, sex, income, education, BMI, history of CVD, and medications for hypercholesterolemia and diabetes. Geometric mean (95% confidence interval) LDL cholesterol was significantly lower (P

Statement of problem Denture stomatitis and other oral infections are prevalent in denture wearers and can be treated effectively with an antimicrobial agent such as a silver nanoparticle-based polymer. However, the physical properties of the denture should not be adversely affected by the addition. Purpose The purpose of this systematic review and meta-analysis of in vitro studies was to analyze the effects of a silver nanoparticle-based antimicrobial resin on the properties of polymethyl methacrylate(PMMA)–based denture resin. Material and methods Full-length English language articles reporting silver nanoparticle-based PMMA resin were included in the review, with no limitation on the year till May 2020. Scopus, Web of Sciences, and PubMed databases were accessed for the literature survey. The review was formulated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and used the Consolidated Standards of Reporting Trials (CONSORT) guidelines and risk of bias Cochrane tool for quality assessment. A meta-analysis of flexural strength was performed by using a random-effects model at a 95% confidence interval. The other properties were analyzed descriptively. Results Silver nanoparticle reinforcement caused considerable differences in the inherent physical material properties of PMMA. Conclusions An antimicrobial polymer nanocomposite formulation can either negatively affect or bring no improvement to the physical properties of denture resin.

Background Individualized and reliable biomarkers are crucial for diagnosing Alzheimer’s disease (AD). However, lack of accessibility and neurobiological correlation are the main obstacles to their clinical application. Machine learning algorithms can effectively identify personalized biomarkers based on the prominent symptoms of AD. Methods Episodic memory–related magnetic resonance imaging (MRI) features of 143 patients with amnesic mild cognitive impairment (MCI) were identified using a multivariate relevance vector regression algorithm. The support vector machine classification model was constructed using these MRI features and verified in 2 independent datasets (N = 994). The neurobiological basis was also investigated based on cognitive assessments, neuropathologic biomarkers of cerebrospinal fluid, and positron emission tomography images of amyloid-β plaques. Results The combination of gray matter volume and amplitude of low-frequency fluctuation MRI features accurately predicted episodic memory impairment in individual patients with amnesic MCI (r = .638) when measured using an episodic memory assessment panel. The MRI features that contributed to episodic memory prediction were primarily distributed across the default mode network and limbic network. The classification model based on these features distinguished patients with AD from normal control subjects with more than 86% accuracy. Furthermore, most identified episodic memory–related regions showed significantly different amyloid-β positron emission tomography measurements among the AD, MCI, and normal control groups. Moreover, the classification outputs significantly correlated with cognitive assessment scores and cerebrospinal fluid pathological biomarkers' levels in the MCI and AD groups. Conclusions Neuroimaging features can reflect individual episodic memory function and serve as potential diagnostic biomarkers of AD.

Background The impact of online care on patients’ functional and psychological outcomes is critical to determine yet still unknown. Objective To evaluate how a novel online health model that facilitates physician-patient collaboration compares with in-person care for improving psoriasis patients’ functional status and mental health. Methods This 12-month randomized controlled equivalency trial randomized psoriasis patients 1:1 to online or in-person care. Functional impairment and depression were assessed at baseline and at 3-month intervals using the 5-level EuroQol-5 Dimensions (EQ-5D-5L) and Patient Health Questionnare-9 (PHQ-9). Results 296 patients were randomized to online or in-person groups. The between-group difference in overall improvement in EQ VAS (EuroQol Visual Analogue Scale) was -0.002 (95% CI -2.749, 2.745), falling within equivalence margin ±8. The between-group difference in overall improvement in EQ-5D-5L index was 0 (95% CI -0.003, 0.003), falling within equivalence margin ±0.1. The between-group difference in overall improvement in PHQ-9 was -0.33 (95% CI -1.20, 0.55), falling within equivalence margin ±3. Limitations Slightly different attrition rates between online and in-person arms (11% versus 9%), but no impact on outcomes. Conclusion The online health model was equivalent to in-person care for reducing functional impairment and depressive symptoms in psoriasis patients.

Statement of problem A comprehensive bibliometric analysis to determine different aspects of the Journal of Prosthetic Dentistry is lacking. Purpose The purpose of this bibliometric study was to analyze the characteristics of the Journal of Prosthetic Dentistry between 1970 and 2019. Material and methods The Web of Science Core Collection was used to retrieve 9 categories of the Journal of Prosthetic Dentistry, including keywords and terms used, cited documents published, the countries and organizations of the authors, references, and sources cited during this period. Data were exported to a software program and analyzed for each 10-year period and for the entire 50 years. The highest 10 in each category were reported. Co-occurrence, couthorships, and linkage were also reported. Results A total of 11 989 records were reached by the search on the Web of Science Core Collection database; of which, 10 638 (92.9%) were included in the analysis. Articles made up 91.1%, of all records, with 217 review documents (1.8%). The most productive decade was 1980 to 1989 with 2936 documents. The total number of citations of all documents (available period 1980 to 2019) including self-citations was 155 112. During the period 1970 to 2019, 14 837 terms were used. The total number of keywords was 4933 (available period 1990 to 2019). There were 15 382 authors, 82 countries, and 2113 organizations identified in articles published in the Journal of Prosthetic Dentistry during this period, with most from the United States. There were 43 027 authors, 95 324 references, and 14 594 sources cited in the Journal of Prosthetic Dentistry during the period surveyed. Conclusions This bibliometric analysis provided a comprehensive overview of the impactful role of the Journal of Prosthetic Dentistry in contemporary dentistry, particularly in the field of prosthodontics.

Retrofitting a crown to an existing removable partial denture (RPD) is a complex process and requires additional clinical and laboratory procedures. Various methods have been described for retrofitting a new tooth-supported crown. However, if an abutment tooth has to be extracted, descriptions of techniques for restoring a new edentulous site with an implant-supported crown retrofitted to an existing RPD are lacking. Therefore, this technical report describes a straightforward approach to fabricating an implant-supported surveyed crown fitted to an existing RPD by using an acrylic resin template.

Laparoscopic surgery is currently established as the primary modality for many procedures. In has been associated with a number of benefits over traditional open surgery, including reduced pain, shorter hospital stay and quicker return to work. Despite this, significant operative challenges and the potential for life-threatening complications exist. Surgeons must understand the specialist equipment that is required, along with how to troubleshoot common issues. Furthermore, an appreciation of the distinctive surgical techniques and technical challenges is critical in limiting the risk of significant complications. Through this article we discuss these topics in the context of the current literature, aiming to recognize common pitfalls that all surgeons should make a conscious effort to avoid. We will describe those patient groups, specifically obesity, pregnancy, elderly and bowel obstruction, in whom additional caution must be maintained. Finally, we will consider these principles in the context of the wider field of minimally invasive surgery, to include robotics, single incision, transanal microsurgery (TAMIS) and transanal total mesorectal excision (TaTME). Although the landscape of minimally invasive surgery is constantly evolving, a robust understanding of the underlying principles is essential for all surgeons.

Background and Objectives The literature supporting Mohs micrographic surgery and staged excision in treating primary cutaneous melanoma is growing but has not been critically reviewed for bias. Methods Articles concerning Mohs micrographic surgery and staged excision for melanoma were assessed using modified “Risk of Bias in Non-randomized Studies of Interventions” (ROBINS-I) criteria, which measures bias in 7 categories. Results Forty-seven of 48 (97.9%) studies reviewed had serious or critical bias. None were randomized controlled trials. The most frequent cause of critical bias was poorly defined outcomes. The least frequent form of bias observed was change in intervention. Limitations The modified ROBINS-I criteria cannot account for all study limitations. Modification of the criteria leads to some degree of subjectivity. Conclusion The current body of literature suffers from limitations due to serious or critical bias in 1 or more ROBINS-I criteria. Local recurrence rate definitions are often poorly defined or not defined at all. Longer follow-up times, clear tumor classifications, and prospective, randomized study designs are necessary to improve the quality of future research.