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Background:. Minor procedures in the emergency department (ED) can be distressing for patients. The emergence of virtual reality (VR) offers a promising new tool by immersing patients in an engaging three-dimensional world. Prior studies have shown VR’s effectiveness during procedures in reducing pain, anxiety, and procedure duration but have not assessed its efficacy in the ED. This study aims to evaluate the efficacy of VR in managing pain and anxiety during ED minor hand procedures. Methods:. This was a prospective, interventional study at a level I trauma center examining adult patients requiring minor hand procedures. Patients were provided the Oculus Quest 2 VR headset, offering various immersive three-dimensional experiences. Pre- and postprocedure surveys assessed previous VR use, anxiety and pain levels, VR efficacy, and possible adverse effects. Responses were rated on a 10-point Likert scale with paired t tests used to compare scores. Results:. The study included sixteen patients, seven of whom were first-time VR users. Patients experienced a significant decrease in both anxiety and pain levels. Survey results indicated overall benefits from VR in several aspects, with no adverse effects reported, and unanimous patient recommendation of the VR experience to others. Conclusions:. VR is an effective tool to optimize the patient experience during ED hand procedures. The study observed a significant decrease in anxiety and a declining trend in pain levels. Patients believed VR helped manage their pain and would recommend it to others. Given the benefits and high safety profile, VR should become a standard offering in ED minor hand procedures.

Purpose: To present a case of periorbital and orbital necrotizing fasciitis (PONF) from an odontogenic source with a distinct microbiologic profile and highlight the need for emergent multidisciplinary management. Observations: A 39-year-old man presented with periorbital swelling, pain, and erythema following facial trauma. Imaging revealed peri-dental collections, accompanying maxillary sinusitis, and pre- and post-septal involvement. Immediate surgical debridement of necrotic tissue along with broad-spectrum antibiotics were pursued for management. Cultures grew multiple organisms, most notably Streptococcus milleri group and Staphylococcus lugdunensis. Conclusions and Importance: PONF is a rare yet potentially fatal disease. Streptococcus milleri group and a fulminant course are to be suspected when the source is odontogenic. Timely multidisciplinary surgical debridement and medical management with intravenous antibiotics is critical for best outcomes.

Background: A successful endodontic treatment requires a comprehensive knowledge of the root canal morphology. This study compared the diagnostic accuracy of cone-beam computed tomography (CBCT) and the sectioning technique for the assessment of mandibular first molar (MFM) root canal morphology. Materials and Methods: In this in vitro, experimental study, 48 eligible MFMs were mounted in 12 blocks (groups of 4) made of acrylic resin and sheep bone powder and underwent CBCT. Next, the teeth were mounted in transparent self-cure acrylic blocks, and their roots were sectioned at three points with 3 mm intervals. Images underwent multiplanar reconstruction in NNT Viewer software and were analyzed by one radiologist with the cooperation of an endodontist. The sections were also evaluated by an endodontist under a stereomicroscope (gold standard). The frequency and percentage of single-canal, and two-canal roots were determined by each technique. The agreement between CBCT and the Gold standard was analyzed by calculating the kappa coefficient (P < 0.05). Results: The diagnostic accuracy of CBCT for the assessment of the MFM root canal morphology was 80% on the mesial surface, 99% in the distal surface, and 96% in total. In the mesial surface, 94.2% of two-canal roots and 66.7% of single-canal roots were correctly detected by CBCT. These values were 100% and 97.4% in the distal surface, and 95.2% and 95.8% in total, respectively. A significant agreement was noted between CBCT and the Gold standard with κ =0.412 for the mesial, 0.939 for the distal, and 0.907 for the total surfaces (P < 0.001). Conclusion: CBCT can be reliably used for the assessment of the complex root canal morphology of MFMs when other modalities fall short.

The study of galaxy evolution hinges on our ability to interpret multiwavelength galaxy observations in terms of their physical properties. To do this, we rely on spectral energy distribution (SED) models, which allow us to infer physical parameters from spectrophotometric data. In recent years, thanks to wide and deep multiwave band galaxy surveys, the volume of high-quality data have significantly increased. Alongside the increased data, algorithms performing SED fitting have improved, including better modeling prescriptions, newer templates, and more extensive sampling in wavelength space. We present a comprehensive analysis of different SED-fitting codes including their methods and output with the aim of measuring the uncertainties caused by the modeling assumptions. We apply 14 of the most commonly used SED-fitting codes on samples from the CANDELS photometric catalogs at z ∼ 1 and z ∼ 3. We find agreement on the stellar mass, while we observe some discrepancies in the star formation rate (SFR) and dust-attenuation results. To explore the differences and biases among the codes, we explore the impact of the various modeling assumptions as they are set in the codes (e.g., star formation histories, nebular, dust and active galactic nucleus models) on the derived stellar masses, SFRs, and A _V values. We then assess the difference among the codes on the SFR–stellar mass relation and we measure the contribution to the uncertainties by the modeling choices (i.e., the modeling uncertainties) in stellar mass (∼0.1 dex), SFR (∼0.3 dex), and dust attenuation (∼0.3 mag). Finally, we present some resources summarizing best practices in SED fitting.

Convincing clinical evidence exists to support early surgical decompression in the setting of cervical spinal cord injury (SCI). However, clinical evidence on the effect of early surgery in patients with thoracic and thoracolumbar (from T1 to L1 [T1?L1]) SCI is lacking and a critical knowledge gap remains. This randomized controlled trial (RCT) sought to evaluate the safety and efficacy of early (

Low impact development (LID) practices, such as bioretention and sand filter basins, are stormwater control measures designed to mitigate the adverse impacts of urbanization on stormwater. LID treatment performance is highly dependent on the media characteristics. The literature suggests that bioretention media often leach nutrients in the stormwater effluent. The objective of this study was to analyze the treatment performance of different sand and bioretention soil mixtures. Specifically, this investigation aimed to answer whether the use of limestone and recycled glass could improve the treatment performance of bioretention systems. Column experiments were designed to assess (1) the removal efficiencies of different sand and bioretention soil mixtures and (2) the impact of plant uptake on removal rates. Enhanced pollutant removal was observed for the custom blends with addition of limestone sand, indicating mean dissolved and total phosphorus removal of 44.5% and 32.6% respectively, while the conventional bioretention soil mixtures leached phosphorus. Moreover, improved treatment of dissolved and total copper was achieved with mean removal rates of 70.7% and 93.4%, respectively. The results suggest that the nutrient effluent concentration decreased with the addition of plants, with mean phosphorus removal of 72.4%, and mean nitrogen removal of 22% for the limestone blend.

Purpose: To characterize and quantify the pre- and postoperative foveal structural and functional patterns in full-thickness macular holes. Methods: Subjects presenting with a full-thickness macular hole that had pre- and postoperative imaging were included. En face optical coherence tomography (OCT) and OCT angiography (OCTA) was performed. Foveal avascular zone (FAZ) area, macular hole size, number and size of perifoveal cysts were measured. Results: Five eyes from 5 patients were included in the study. The hole was closed in all eyes after the initial surgery. OCTA showed enlargement of the FAZ and delineation of the holes within the FAZ. Mean preoperative FAZ area was 0.41 ± 0.104 mm2. Visual acuity was improved and mean FAZ area was reduced to 0.27 ± 0.098 mm2 postoperatively (P

Droplet microfluidic systems have evolved as fluidic platforms that use much less sample volume and provide high throughput for biochemical analysis compared to conventional microfluidic devices. The variety of droplet fluidic applications triggered several detection techniques to be applied for analysis of droplets. In this review, we focus on label-free droplet detection techniques that were adapted to various droplet microfluidic platforms. We provide a classification of most commonly used droplet platform technologies. Then we discuss the examples of various label-free droplet detection schemes implemented for these platforms. While providing the research landscape for label-free droplet detection methods, we aim to highlight the strengths and shortcomings of each droplet platform so that a more targeted approach can be taken by researchers when selecting a droplet platform and a detection scheme for any given application.

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Background: Naloxone has been used as an opioid antagonist to prevent multiple adverse side effects of opioid-like tolerance and hyperalgesia. This study has investigated naloxone combined with morphine to limit pain hypersensitivity. In addition, the expression of brain-derived neurotrophic factor (BDNF) and K + Cl - cotransporter2 (KCC2) were also studied., Methods: Forty-eight adult male Wistar rats (180-220 g) were divided into eight groups, with six rats in each group. Rats were divided into two tolerance and hyperalgesia groups; the sham group, the morphine group, the treatment group (naloxone along with morphine), and the sham group (naloxone along with saline) for eight consecutive days. Tail-flick test was performed on days 1, 5, and 8, and the plantar test on days 1 and 10. On days 8 and 10, the lumbar segments of the spinal cord were collected, and BDNF and KCC2 expression were analyzed using western blotting and immunohistochemistry, respectively., Results: Results showed that tolerance and hyperalgesia developed following eight days of repeated morphine injection. BDNF expression significantly increased, but KCC2 was downregulated. Co-administration of naloxone and morphine decreased tolerance and hyperalgesia by decreasing BDNF and increasing KCC2 expression, respectively., Conclusion: This study suggests that BDNF and KCC2 may be candidate molecules for decreased morphine tolerance and hyperalgesia., Competing Interests: Declaration of Competing Interest The authors declare that they have no conflict of interests., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: In comparison with the general population, women with bleeding disorders are more prone to develop obstetrical and gynecological problems. However, no comprehensive evaluation has investigated the prevalence of hemorrhagic ovarian cysts (HOCs) in rare bleeding disorders (RBDs). In this study, we sought to determine the prevalence of HOCs in a large cohort of Iranian patients with RBDs., Methods: A total of 210 symptomatic patients suspected of HOCs with RBD were included. The median age of the study population was 24 years. Patients were diagnosed with fibrinogen disorders (n = 7, 3%), factor (F) II (n = 4, 2%), FV (n = 28, 13%), FVII (n = 4, 2%), FX (n = 6, 3%), FXIII (n = 122, 58%), combined FV and FVIII (n = 8, 4%), Glanzmann's thrombasthenia (n = 10, 5%), and von Willebrand disease (VWD) type 3 (n = 21, 10%)., Results: Following further clinical and ultrasound examinations of these 210 patients, 68 (32.4%) were confirmed with a diagnosis of HOCs. Of which, FXIII deficiency with 46 cases (67.6%), followed by VWD type 3 (6 cases, 8.8%) showed the highest number. Other coagulation defects associated with HOCs were including fibrinogen deficiency (n = 2, 3%), FII (n = 2, 3%), FV (n = 4, 6%), FVII (n = 2, 3%), FX (n = 1, 1.5%), combined FV and FVIII (n = 2, 3%), and Glanzmann's thrombasthenia (n = 3, 4.5%)., Conclusion: This study found a high prevalence of HOCs in patients with RBDs, indicating the importance of early diagnosis and optimal management of obstetric and gynecological complications in these patients., Competing Interests: Conflict-of-interest disclosure The authors declare no conflicts of interest relevant to this manuscript., (Copyright © 2023. Published by Elsevier Ltd.)

Recent studies have shown that the ephrin/Eph signaling pathway may contribute to the pathology of neuropathic pain. Drugs like progesterone may be used to counteract both thermal hyperalgesia and mechanical allodynia in different models of neuropathic pain. The present study was designed to determine progesterone's modulatory role on neuropathic pain and spinal expression of ephrin-B2 following chronic constriction nerve injury (CCI). Thirty-six adult male Wistar rats were used. The sciatic nerve was chronically constricted. Progesterone (5 mg/kg and 15 mg/kg) was administrated for 10 days (from day 1 up to day10) following sciatic constriction. Behavioral tests were performed before surgery (day 0) and on days 1, 3, 7, and 14 after CCI and before progesterone administration on the same days. Western blotting was performed on days 3, 7, and 14th post-surgery. The findings showed that after CCI, the expression of spinal cord ephrin-B2 increased significantly in parallel with mechanical allodynia and thermal hyperalgesia. Post-injury administration of progesterone (15 mg/kg but not 5) decreased mechanical allodynia, thermal hyperalgesia, and the expression of spinal ephrin-B2. It is concluded that post-injury repeated administration of progesterone could be an effective way of alleviating neuropathic pain by suppressing ephrin-B2 activation and helps to make the better design of steroid-based therapies to inhibit pain after peripheral injury., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022. Published by Elsevier Inc.)