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The diagnosis and management of gastrointestinal (GI) bleeding are complicated. A multitude of pathologic processes results in GI bleeding, and often, the bleeding is intermittent in nature. Of the available diagnostic tools, angiography has been the gold standard. Management of patients requires a multidisciplinary approach involving gastroenterologists, interventional radiologists, and surgeons. Therapeutic arterial interventions include pharmacologic control with the use of intraarterial vasopressin, embolization with temporary and permanent embolizing materials, and catheter-induced vasospasm. [ABSTRACT FROM AUTHOR]

Abstract Background Pulpectomy continues to be the standard treatment recommendation for management of vital primary molars diagnosed with symptomatic irreversible pulpitis. The recent decade has seen a paradigm shift in the treatment concepts of how vital mature permanent molars diagnosed with irreversible pulpitis can be more conservatively managed using vital pulp therapy techniques like pulpotomy. However, despite emerging evidence indicating similarities between primary and permanent tooth pulp response to dental caries, there is limited research on whether pulpotomy can be similarly used as a definitive treatment modality for vital primary teeth with irreversible pulpitis. This randomised controlled trial (RCT) aims to compare the treatment effectiveness of pulpotomy versus pulpectomy in management of vital primary molars diagnosed with symptomatic irreversible pulpitis over a two-year period. Methods/design This clinical study is a parallel, two-armed, open label, non-inferiority RCT with a 1:1 allocation ratio between the experimental intervention arm (pulpotomy) and the active comparator arm (pulpectomy). Healthy cooperative children, between 4–9 years of age, who have painful primary molars with clinical symptoms typical of irreversible pulpitis will be recruited after obtaining informed consent from their parents/legal guardians. 50 vital primary molars clinically diagnosed with symptomatic irreversible pulpitis will be randomly distributed between the two treatment arms. The primary outcomes that will be assessed are clinical and radiographic success after six-months, one-year and two-years of the trial interventions. The influence of baseline pre-operative variables (age; gender; tooth type; site of caries; pre-operative furcal radiolucency; pre-operative pain intensity) and intra-operative factors (time taken to achieve haemostasis) on treatment outcomes will also be assessed. The secondary outcome evaluated will be the immediate (24 h and 7 d) post-operative pain relief afforded by the two treatment interventions. Discussion This trial seeks to provide evidence on whether pulpotomy treatment can be no worse than the standard pulpectomy treatment for the management of symptomatic irreversible pulpitis in vital primary molars. Trial registration ClinicalTrials.gov (NCT06183203). Registered on 30 January 2024.

Background: The advent of technology in dentistry compels the safeguard of intellectual property to guarantee a steady flow of ideas. A guarantee preserves the idea/invention which is conductive to the subsequent financial gain or marketing of the said product for the patentee. The main objective of the present study was to illuminate the trends in the dental patents filed in India over the past decade and to analyze these in context with the recent developments in dental markets. Methodology: A total of 641 dental patent applications retrieved from the Indian Government Official Website between 2010 and 2020 were scanned for field of invention, type or status of application along with details regarding date of publication or filing of application, etc., The dataset was collaboratively analyzed using Panda's Library in Python software as analysis tool for data preparation and frequency analysis. The estimates were presented as mean differences and 95% confidence intervals. Results: The results showed that Indian Patent Office (IPO) has granted 54 dental patents in the last decade. The maximum applications of the IPO processes are the patent co-operation treaty National Phase applications (53.3%), mostly in the bio-engineering field (36.8%). Chiefly, patents were filed by individuals and companies (n = 180) and average time for grant was 4.90 years and 5.34 years, respectively. Conclusion: The process of patent application in India although has become digitalized needs to be more comprehensible and time bound, with more awareness disseminated to entrepreneurs and dental students alike.

Background: The posterior approach to the humeral shaft is commonly used for surgical procedures on the humeral shaft. We present our experiences using the modification of the surgical exposure described by Gerwin M. which we have found useful at the time of revision surgery. Methods: Between 2014 and 2019, six patients who underwent a revision surgical procedure for a nonunion of the humeral shaft where a prior surgical procedure was performed through a posterior incision were included. The approach used a modification of the posterior approach described by Gerwin M. where the lower lateral cutaneous nerve branch of the radial nerve is used to identify trace, mobilize, retract, and protect the radial nerve to achieve adequate exposure of the humeral shaft. Results and Discussion: None of the patients had a postoperative nerve deficit.Adequate exposure to aid hardware removal, osteosynthesis, and bone grafting was achieved in all patients. Conclusion: The modification of the posterior approach described by Gerwin M. is useful at the time of revision or redo surgery on the humeral shaft where other bony and soft tissue landmarks are altered to prevent an iatrogenic injury to the radial nerve while providing adequate exposure to treat a nonunion.

Background: Geographic barriers, inadequate infrastructure, and large-scale logistics severely limit telemedicine and e-health systems' ability to make orthopedic care accessible to masses in rural centers. With

Summary: Background: The Lancet Commission on Global Surgery established the Three Delays framework, categorising delays in accessing timely surgical care into delays in seeking care (First Delay), reaching care (Second Delay), and receiving care (Third Delay). Globally, knowledge gaps regarding delays for fracture care, and the lack of large prospective studies informed the rationale for our international observational study. We investigated delays in hospital admission as a surrogate for accessing timely fracture care and explored factors associated with delayed hospital admission. Methods: In this prospective observational substudy of the ongoing International Orthopaedic Multicenter Study in Fracture Care (INORMUS), we enrolled patients with fracture across 49 hospitals in 18 low-income and middle-income countries, categorised into the regions of China, Africa, India, south and east Asia, and Latin America. Eligible patients were aged 18 years or older and had been admitted to a hospital within 3 months of sustaining an orthopaedic trauma. We collected demographic injury data and time to hospital admission. Our primary outcome was the number of patients with open and closed fractures who were delayed in their admission to a treating hospital. Delays for patients with open fractures were defined as being more than 2 h from the time of injury (in accordance with the Lancet Commission on Global Surgery) and for those with closed fractures as being a delay of more than 24 h. Secondary outcomes were reasons for delay for all patients with either open or closed fractures who were delayed for more than 24 h. We did logistic regression analyses to identify risk factors of delays of more than 2 h in patients with open fractures and delays of more than 24 h in patients with closed fractures. Logistic regressions were adjusted for region, age, employment, urban living, health insurance, interfacility referral, method of transportation, number of fractures, mechanism of injury, and fracture location. We further calculated adjusted relative risk (RR) from adjusted odds ratios, adjusted for the same variables. This study was registered with ClinicalTrials.gov, NCT02150980, and is ongoing. Findings: Between April 3, 2014, and May 10, 2019, we enrolled 31 255 patients with fractures, with a median age of 45 years (IQR 31–62), of whom 19 937 (63·8%) were men, and 14 524 (46·5%) had lower limb fractures, making them the most common fractures. Of 5256 patients with open fractures, 3778 (71·9%) were not admitted to hospital within 2 h. Of 25 999 patients with closed fractures, 7141 (27·5%) were delayed by more than 24 h. Of all regions, Latin America had the greatest proportions of patients with delays (173 [88·7%] of 195 patients with open fractures; 426 [44·7%] of 952 with closed fractures). Among patients delayed by more than 24 h, the most common reason for delays were interfacility referrals (3755 [47·7%] of 7875) and Third Delays (cumulatively interfacility referral and delay in emergency department: 3974 [50·5%]), while Second Delays (delays in reaching care) were the least common (423 [5·4%]). Compared with other methods of transportation (eg, walking, rickshaw), ambulances led to delay in transporting patients with open fractures to a treating hospital (adjusted RR 0·66, 99% CI 0·46–0·93). Compared with patients with closed lower limb fractures, patients with closed spine (adjusted RR 2·47, 99% CI 2·17–2·81) and pelvic (1·35, 1·10–1·66) fractures were most likely to have delays of more than 24 h before admission to hospital. Interpretation: In low-income and middle-income countries, timely hospital admission remains largely inaccessible, especially among patients with open fractures. Reducing hospital-based delays in receiving care, and, in particular, improving interfacility referral systems are the most substantial tools for reducing delays in admissions to hospital. Funding: National Health and Medical Research Council of Australia, Canadian Institutes of Health Research, McMaster Surgical Associates, and Hamilton Health Sciences.

Purpose: To prospectively evaluate whether time to debridement has any correlation with union, infection, and quality of life in high-grade lower limb fractures in a tropical setting. Methods: A prospective cohort study was conducted at a tertiary care center in South India. Two hundred fifty-four adult skeletally mature patients with 301 grade 3 fractures involving the femur, tibia, or fibula were recruited. The cohort was empirically divided into two groups (early and late) based on the time to debridement (less than or more than 12 h from injury). Outcome: The primary outcome was nonunion. Secondary outcomes were deep infection rates and patients’ quality of life. Short form-36 (SF-36) and short musculoskeletal functional assessment (SMFA) questionnaires were also used. Patients were followed up for 9 months. Results: The follow-up rate was 93%. The late group had a significantly higher risk of nonunion (odds ratio(OR): 6.5, 95% confidence interval (CI): 2.82–14.95) and infections (OR: 6.05, 95% CI: 2.85–12.82). There was a 4% increase in the infection risk for each hour of delay for the initial 50 h ( p < 0.0001). SF-36 and SMFA scores were superior in the early group ( p < 0.0001). Conclusion: The study contradicts findings reported in the literature from the West. Our study was in agreement with our hypothesis and proved that debridement within 12 h resulted in significantly lower rates of nonunion and infections and an overall improved quality of life in high-grade open lower limb fractures in a developing country. Level of evidence: Level II Trial registration: German Clinical Trials Register DRKS00015186

Background. In the modern tech-savvy era, scientific literature publication remains the optimal way to disperse knowledge, even if it has transformed from print to mostly electronic. With the new and improved publication methods, also come more scrutiny and analytic criticism of the scientific work. It becomes even more important in this context to rectify flawed scientific work responsibly. This present study was undertaken to help clarify the process and causes of retractions occurring in the dental community and analyse its reasons. Methodology. A total of 8092 PubMed indexed articles were scanned from the online libraries, and individually scanning for author details, place of study, subspecialty of research, funding, dates of original publication, and retraction notices issued along with journal specifics such as type and impact factors, country of publishing was compiled and analysed by two authors. The dataset was then collaboratively analysed using Panda’s Library in Python software as an analysis tool for data preparation and for frequency analysis. The estimates were presented as mean differences (MD) and 95% confidence intervals (95% CI). Results. The present study had a compiled dataset of 198 articles after screening and revealed that maximum retractions of dentistry-related research originated from India (25.3%) and, on average, took 2.6 years to be issued a retraction notice. We also deciphered that the USA retracted maximum dental articles (34.8%), and plagiarism was cited as the most common (38.02%) reason for doing so. The present study also brought to light that there was a trend for lower impact factor-dental journals in retracting maximum articles, most of which were nonfunded (62.16%). The results signify that 63.78% of all retracted papers continued to be cited postretractions. Conclusions. The retractions happening in the field of dental literature are currently too time-consuming and often unclear to the readers. The authors would like to conclude that the retracted papers were mostly from India and Spain mostly related to endodontics or prosthodontic research. All of this warrants the need for better scrutiny and reforms in the area.

Hunter's Syndrome or mucopolysaccharidosis Type II is a rare metabolic disorder caused by the deficiency of lysosomal enzyme iduronate-2-sulfatase. It results in progressive accumulation of deramatan and heparan sulfates in tissues leading to a wide clinical spectrum of systemic manifestations. This is a case report of a 6-year-old boy with classical features of Hunter's Syndrome who presented with a chief complaint of multiple decayed teeth. The purpose of this case report is to highlight the role of a pediatric dentist in the management of such special children with advanced dental care.

There is an increased incidence of submandibular gland duct developing sialoliths. Among them the sialoliths attaining a size of more than 1.5 cms are rare. Here we present a case with an abnormally sized sialolith in Wharton’s duct and a review of the literature about the abnormally sized sialoliths and various anatomical and physiological considerations of the duct which contribute to the higher incidence of sialolith in the duct.

Cellulose macro- and nanofibers have gained increasing attention due to the high strength and stiffness, biodegradability and renewability, and their production and application in development of composites. Application of cellulose nanofibers for the development of composites is a relatively new research area. Cellulose macro- and nanofibers can be used as reinforcement in composite materials because of enhanced mechanical, thermal, and biodegradation properties of composites. Cellulose fibers are hydrophilic in nature, so it becomes necessary to increase their surface roughness for the development of composites with enhanced properties. In the present paper, we have reviewed the surface modification of cellulose fibers by various methods. Processing methods, properties, and various applications of nanocellulose and cellulosic composites are also discussed in this paper.

Background: Despite some evidence of improved survival with intraoperative cholangiography during cholecystectomy, debate has raged about its benefit, in part because of its questionable benefit, time, and resources required to complete., Methods: An International Prospective Register of Systematic Reviews-registered (ID CRD42018102154) meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using PubMed, Scopus, Web of Science, and Cochrane library from 2003 to 2018 was undertaken including search strategy "intraoperative AND cholangiogra* AND cholecystectomy." Articles scoring ≥ 16 for comparative and ≥ 10 for noncomparative using the Methodological Index for Non-Randomized Studies criteria were included. A dichotomous random effects meta-analysis using the Mantel-Haenszel method performed on Review Manager Version 5.3 was carried out., Results: Of 2,059 articles reviewed, 62 met criteria for final analysis. The mean rate of intraoperative cholangiography was 38.8% (range 1.6%-96.4%).There was greater detection of bile duct stones during cholecystectomy with routine intraoperative cholangiography compared with selective intraoperative cholangiography (odds ratio = 3.28, confidence interval = 2.80-3.86, P value < .001). While bile duct injury during cholecystectomy was less with intraoperative cholangiography (0.39%) than without intraoperative cholangiography (0.43%), it was not statistically significant (odds ratio = 0.88, confidence interval = 0.65-1.19, P value = .41). Readmission following cholecystectomy with intraoperative cholangiography was 3.0% compared to 3.5% without intraoperative cholangiography (odds ratio = 0.91, confidence interval = 0.78-1.06, P value = .23)., Conclusion: The use of intraoperative cholangiography still has its place in cholecystectomy based on the detection of choledocholithiasis and the potential reduction of unfavorable outcomes associated with common bile duct stones. This meta-analysis, the first to review intraoperative cholangiography use, identified a marked variation in cholangiography use. Retrospective studies limit the ability to critically define association between intraoperative cholangiography use and bile duct injury., (© 2020 The Authors.)

Purpose: Applications of diffusion-weighted magnetic resonance imaging outside the brain have gained increasing importance in recent years, and recent studies have shown the usage of diffusion-weighted (DW) imaging in diagnosing pyelonephritis based on renal cortical and medullary apparent diffusion coefficient (ADC) values. The aim of this study was to assess the validity of DW magnetic resonance (MR) imaging in comparison with contrast-enhanced computed tomography (CECT) in diagnosing pyelonephritis., Material and Methods: A cross-sectional observational study was conducted for a period of six months in a tertiary hospital in Coimbatore. All patients with clinical and laboratory diagnosis of acute pyelonephritis, who were referred for radiological imaging (CECT), were taken into the study. Out of 112 patients with a clinical and laboratorial diagnosis of acute pyelonephritis (APN), who underwent both DW MR and CECT, diagnosis of APN was made in 100 patients based on CECT, while in 12 cases the investigation (CECT) was negative. Finally, these 100 patients were included in the study. The validity of DW MR imaging in diagnosing APN was assessed by deriving sensitivity, specificity, and positive and negative predictive value in comparison with CECT findings., Results: The validity report of DW MR imaging in the detection of APN showed a very high sensitivity (96-100%) and specificity (86-90%) and very low false positives (6-10%) and negatives (< 5%), and it also showed that in the areas of affected renal parenchyma ADC values were consistently lower compared to unaffected renal parenchyma., Conclusion: Based on the generated hypothesis, DW MR imaging of the kidneys seems to be highly sensitive and specific for the detection of focal or diffuse infections within the kidney in comparison with CECT., Competing Interests: The authors declare no conflict of interest., (Copyright © Polish Medical Society of Radiology 2020.)

The compilation and cleaning of data needed for analyses and prediction of species distributions is a time consuming process requiring a solid understanding of data formats and service APIs provided by biodiversity informatics infrastructures. We designed and implemented a Taverna-based Data Refinement Workflow which integrates taxonomic data retrieval, data cleaning, and data selection into a consistent, standards-based, and effective system hiding the complexity of underlying service infrastructures. The workflow can be freely used both locally and through a web-portal which does not require additional software installations by users.