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Sara Ghoneim,1 Aun Shah,1 Aneesh Dhorepatil,1 Muhammad Umer Butt,2 Nisheet Waghray3 1Department of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA; 2Division of Cardiology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USA; 3Division of Gastroenterology, Case Western Reserve University at MetroHealth Medical Center, Cleveland, OH 44109, USACorrespondence: Sara GhoneimDepartment of Internal Medicine, Case Western Reserve University at MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109, USATel +1-216-777-0498Email saragho@gmail.comBackground: Inflammatory bowel disease (IBD) has been associated with an increased risk of cardiovascular events, but the risk of cerebrovascular accidents (CVA) remains unknown. Hypercoagulability and systemic inflammation are two proposed mechanisms by which the presence of IBD might lead to the development of CVA.Objective: To assess the risk of CVA in patients with IBD compared to those without IBD with known traditional risk factors for CVA.Methods: We reviewed data from a large commercial database (Explorys, IBM) that aggregated records from 26 health-care systems nationwide. Using systemized nomenclature of medicine – clinical terms, we identified adult patients diagnosed with IBD (ulcerative colitis or Crohn’s disease) between September 1994 and September 2019. We then examined the risk of CVA in these patients. Known risk factors such as age ≥ 65-years old, diabetes mellitus (DM), hypertension (HTN), female gender, atrial fibrillation (Afib) were collected. A univariate binary logistic model was constructed using CVA as the dependent variable and other variables as independent variables. To adjust for possible confounding, a multivariable model adjusting for all covariates was created to test for CVA.Results: A total of 52,176,550 patients were included in this analysis, and 261,890 had IBD. The prevalence of CVA was higher in IBD patients compared to non-IBD patients (6.24% versus 0.48%, p < 0.0001). The univariate binary logistic regression showed 13.7 times higher odds of having CVA in IBD patients than without IBD (odds ratio (OR) 13.74, p < 0.0001). In multivariate binary logistic regression, after adjusting for traditional risk factors for CVA (Afib, HTN, female gender, DM, age ≥ 65 years), odds ratio of CVA in IBD patients remained significantly higher (OR 8.07, 95% CI: 7.9– 8.2, p< 0.0001).Conclusion: In our large cohort of patients, IBD appears to be an independent risk factor for CVA. Further prospective studies are needed to understand the underlying mechanisms by which IBD increases the risk of CVA. This may lead to early identification and intervention to reduce the risk of CVA in this highly heterogeneous group of patients.Keywords: inflammatory bowel disease, cerebrovascular accident, IBD, CVA

The design of semiconductor-based heterojunction structures can be turned useful to raise the efficiency of nuclear micro-batteries. In this study, we have investigated a micro-power alphavoltaic battery by using a lab-made software. The nuclear battery consists of an In0.49Ga0.51P/GaAs heterostructure irradiated by americium-241 (Am241) alpha particles with an average kinetic energy of 5.485 MeV. The alphavoltaic battery exhibits an overall active area of 1 cm². Based on a comprehensive analytical model, the device current density-voltage J(V) and output electric power P(V) characteristics are simulated extracting the energy conversion efficiency. The model takes into account the reflection of the incident alpha particles, the ohmic losses, the effect of the boundary between the two layers, and the depletion region borders. Different values of the radioisotope apparent activity density, the emitter and base dopant concentrations, and the surface recombination velocities in both the front and back layers are considered during the simulations to optimize the battery performance. The present study reports that by irradiating by a 2.4 mCi/cm² Am241 source, the obtained energy conversion efficiency of the battery can reach 10.31% with a maximum output power density of 16.07 μW/cm². Therefore, In0.49Ga0.51P/GaAs heterostructure coupled with Am241 seems a promising design for long- term energy supply in harsh environments. [ABSTRACT FROM AUTHOR]

Reem A Alansari,1 Dimah A Faydhi,2 Basoum S Ashour,2 Doaa H Alsaggaf,1 Muhannad T Shuman,3 Salma H Ghoneim,1 Amal I Linjawi,1 Hussain YA Marghalani,1 Rania R Dause1 1Department of Orthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia; 2Dental Interns, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi; 3Private Practice, Jeddah, Saudi ArabiaCorrespondence: Reem A AlansariKing Abdulaziz University, Faculty of Dentistry, Department of Orthodontics, Alsulemaneya, PO Box 80209, Jeddah 21589, Saudi ArabiaTel +966 505533276Fax +966 12 692 1262Email Reem.alansari@kau.edu.saIntroduction: Pursuing an esthetically-pleasing orthodontic outcome, orthodontic patients must consider and choose from the different available options of orthodontic appliance. Practitioners need to be better informed of their customers’ preferences to make better practice management decisions and satisfy their patients’ needs.Purpose: To explore adult laypeople’s perceptions of the attractiveness, acceptability, preference and economic value of different orthodontic appliances when they consider these appliances for themselves and for their children.Patients and methods: This cross-sectional survey included 199 adults (110 females). The average age of participants was 27.7 years. Participants answered a questionnaire evaluating and comparing multiple smiling images of an adult wearing different orthodontic appliances. Participants rated each appliance for: (1) attractiveness on a Likert scale; (2) acceptability of having the appliance placed for themselves and their children (with a yes/no response); (3) preference (by ranking all appliances in order); and (4) economic value (by providing the additional amount they are willing to pay for each appliance for themselves and their children).Results: We found a statistically significant difference in the attractiveness scores between the different orthodontic appliances (p< 0.0001). The most attractive appliances were clear aligners and lingual brackets. The least attractive appliances were colored o-tied-brackets followed by shaped-brackets. Clear aligners were the most acceptable appliances among our participants to have placed on themselves (86.9%) and their children (84.9%). Shaped brackets were the least acceptable appliances among our participants to have placed on themselves (24.1%) and their children (36.2%). The most preferred appliances were lingual brackets (39.2%), followed by clear aligners (34.17%). The least preferred appliances were colored o-tied-brackets (4%). Participants varied with regards to how much more they were willing to pay for each of the different orthodontic appliances. The majority were willing to pay more for clear aligners and lingual brackets to have them placed on themselves but not to have them placed on their children.Conclusion: Adults preferred more innovative esthetic appliances over traditional ones and were willing to pay more to have them placed on themselves but not on their children.Keywords: smile, attractiveness, esthetics, value

Abstract Purpose To systematically review the literature pertaining to the link between cocaine and either arterial or venous thrombosis. Procedures Narrative systematic review of Medline, CINAHL, Embase, Psycinfo and Cochrane databases supplemented by hand trawling of relevant journals and reference lists up to April 2007. In-vivo studies and those with clinical endpoints were included in the review. Results A total of 2458 abstracts led to 186 full-text papers being retrieved. 15 met the criteria for inclusion in the review. The weight of evidence would support cocaine as a pro-thrombotic agent. There is evidence of it activating thrombotic pathways. The effect of cocaine upon clinical endpoints has not been quantified though there is evidence of an association between cocaine and myocardial infarction particularly amongst young adults. Cocaine may also be a causal agent in cerebrovascular accident though studies lacked sufficient power to determine a statistically significant effect. There is a gap in the evidence pertaining to the issue of cocaine and venous thrombosis. Conclusion Clinicians should consider questioning for cocaine use particularly amongst young adults who present with cardiac symptoms. More epidemiological work is required to quantify the effect of cocaine upon both arterial and venous clotting mechanisms.

Purpose: Scaphocapitate fusion (SCF) is an important surgical option for carpal pathologies, which are difficult to manage as Kienböck's disease. With the advantages of arthroscopy combined with percutaneous fixation techniques, arthroscopic scaphocapitate fusion can have the best outcome for the patient from a functional perspective. This study aims to evaluate the clinical, radiological, and functional results of arthroscopic SCF., Methods: The study included thirty patients with stage IIIB and IIIC Kienböck's disease. The articular surfaces were prepared using arthroscopic burr then fixed by Herbert screw. The mean follows up period was about 29 months., Results: SCF was achieved in approximately seven weeks. There was a statistically significant difference in pre- and post-operative grip strength and Mayo wrist score., Conclusion: According to our study findings, arthroscopic SCF may be performed with significant improvements and satisfactory clinical and functional results in patients with stage IIIB and IIIC Kienböck's disease., Competing Interests: Declarations. Ethics approval: The Ethics Committee of the Faculty of Medicine—Alexandria University reviewed and approved this study (Serial number 0201500). Consent to participate: Written informed consent was obtained from all individual participants included in the study. Consent to publish: The authors affirm that human research participants provided informed consent for publication of the images in Figure 1. Conflict of interest: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2024. The Author(s).)

Competing Interests: Disclosure All authors disclosed no financial relationships.

Background: Tumor necrosis factor (TNF-α) inhibitors and the α4β7 integrin antagonist, vedolizumab, have been investigated as treatment options for patients with steroid-refractory microscopic colitis., Aims: To evaluate the benefit of vedolizumab and TNF-α inhibitors in patients with steroid-refractory microscopic colitis., Methods: Retrospective studies and case series involving patients with steroid-refractory MC who either received vedolizumab, adalimumab, or infliximab were eligible for inclusion. Pooled proportional meta-analyses were used to calculate the rate of clinical remission at induction, clinical response, maintenance of remission, histologic remission, and overall medication related adverse effects. Statistical analysis was performed in R using the metafor and meta packages., Results: A total of 14 studies involving 164 patients were included. Pooled analysis showed a clinical remission rate of 63.5% [95% CI (0.483; 0.776), I 2 =43% P =0.08], 57.8% [95% CI (0.3895; 0.7571), I 2 =0%, P =0.7541], and 39.3% [95% CI (0.0814; 0.7492), I 2 =66%, P =0.02] for vedolizumab, infliximab, and adalimumab, respectively. The maintenance of remission rates were 65.9% [95% CI (0.389; 0.889), I 2 =67%, P =0.02], 45.3% [95% CI (0.1479; 0.7747), I 2 =0%, P =0.36] and 32.5% [95% CI (0.000; 0.8508), I 2 =53%, P =0.14] in patients who received vedolizumab, infliximab, and adalimumab, respectively. Rate of biological-related adverse events warranting discontinuation of therapy was 12.2%, 32.9%, and 23.0% for the vedolizumab, infliximab, and adalimumab groups, respectively., Conclusion: Vedolizumab and anti-TNF-α agents demonstrated a clinical benefit in the treatment of steroid-refractory microscopic colitis and with a tolerable safety profile. Future randomized controlled trials are needed to compare vedolizumab with TNF-α inhibitors and examine treatment effect on patients' quality of life., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)