Clinical Comparison Research Articles

Clinical and radiological comparisons of isolated posterior malleolar fractures treated surgically and conservatively.

Isolated posterior malleolar (PM) fractures are rare fractures without consensus regarding treatment decisions and functional outcomes. The study aims to compare the clinical and radiological results of patients treated surgically or conservatively for isolated PM fractures. The study included 30 patients who presented with an isolated PM fracture and were treated conservatively (n = 15) or with surgery (n = 15). The two groups were compared regarding demographic data, clinical results, and radiological outcomes. The effect of PM fragment size covering less than or more than 25% of the joint surface on clinical and radiological outcomes was also evaluated. The Ankle Fracture Scoring System (AFSS), Visual Analog Scale (VAS), and satisfaction scores of the patients in the surgical group were determined to be better than those of the conservatively treated group (p = 0.015, p = 0.029, p = 0.021). A higher rate of osteochondral lesion (OCL) in the talus was observed in the surgical group (p = 0.007). In the patients with fracture size > 25%, the AFSS-1, VAS, and patient satisfaction scores were found to be better in the surgical group than in the conservative group (p = 0.004, p = 0.036, p = 0.014), with no difference determined between the groups in respect of the OCL rate. Independently of the fracture size, surgical treatment of patients with PM fracture provides better clinical results. It does not change the joint ROM however may increase the OCL rate. While surgical treatment does not affect the clinical results in patients with a fracture size smaller than 25%, it positively affects the clinical results in patients with a larger fracture size. Level IV, retrospective cohort study.

Biomechanical Properties of Meniscal Repair Versus Meniscectomy for Horizontal Meniscal Tears: A Systematic Review.

Limited biomechanical evidence exists describing how horizontal meniscus tears (HMTs), meniscal repair (MR), and meniscectomy alter the knee's biomechanical environment. To evaluate changes in knee contact mechanics following HMTs, MR, and meniscectomy. Systematic review; Level of evidence, 5. PubMed, EMBASE, and CINAHL databases were systematically searched for biomechanical cadaveric studies of HMTs up to January 16, 2023, using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies that (1) did not examine MRs or meniscectomies, (2) did not report contact area (CA) or pressure, (3) involved concomitant injuries (eg, anterior cruciate ligament tear), (4) were nonbiomechanical studies (eg, review, technique, and clinical), and (5) were non-English language articles were excluded. The endpoints were peak contact pressure (PCP) and mean CA. Out of 1526 initial results, 6 studies were included for final review. PCP and CA were measured in 59 intact menisci, 59 HMTs, 59 partial meniscectomies (PM), 59 complete meniscectomies (CM), and 33 MR. Among all HMTs versus the intact state, pooled PCP increased by 14.2%, and pooled CA decreased by 7.1%. Among all PMs versus the intact state, 4 of 6 studies found significantly increased PCP (27.1%), and 5 found significantly reduced CA (22.1%). Among all CMs versus the intact state, all 6 studies found significantly increased PCP (54.5%), and 5 found significantly reduced CA (33%). Among the 3 studies directly comparing PM to CM, 2 studies found PM to have significantly smaller increases in PCP (23.3% vs 52.4%) and significantly smaller reductions in CA (16.7% vs 28.1%) from the intact state.) The 3 studies evaluating MR versus the intact state found no significant difference in PCP or CA. After an HMT, MR had the smallest deviations in contact mechanics; only MR restored contact mechanics to the uninjured state. These findings support MR's superiority, illustrate that maintaining contact mechanics requires preserving meniscal tissue, and are consistent with clinical evidence. More clinical comparisons are needed to understand the differences among treatments.

The Prevalence and Intensity of Dental Diseases Among Workers with Dangerous Working Conditions, Depending on the Presence or Absence of Previous Oral Sanitation

Relevance: to substantiate programs for the prevention of dental diseases at nuclear industry enterprises with dangerous working conditions, comparative studies of the dental status of employees, depending on the presence or absence of previous oral sanitation, are relevant. The purpose of the study: clinical and radiological comparison of indicators of the dental status of nuclear power plant workers with hazardous working conditions (OT), depending on the presence or absence of previous oral sanitation. Materials and methods: 78 employees of the Kalinin nuclear power plant with dangerous working conditions in the key age group of 35–44 years, who underwent therapeutic and surgical sanitation of the oral cavity a year ago, were examined. For comparison, 69 workers with OT of an identical gender and age group who refused to sanitize the oral cavity during periodic medical examinations were examined. The sequence of clinical and radiological examination corresponded to the modified WHO Dental Status Assessment Map (1995). Results: the positive effect of oral sanitation due to the removal of destroyed teeth, treatment of caries and its complications, as well as periodontal diseases is to reduce the prevalence of signs of dysfunction of the temporomandibular joint by 52.5 %, non-carious offspring 22.7 %, diseases of the oral mucosa 24.1 %, periodontal diseases 6.0 %. As a result of sanitation, the detection of poor oral hygiene is reduced by 54.7 %. The intensity of caries and periodontal diseases a year after sanitation is 12.8 and 27.8 % lower in comparison with workers with an unsanitized oral cavity. After rehabilitation, the prevalence of orthopedic treatment increases by 43.4 %. Conclusions: oral sanitation significantly improves the basic indicators of dental status for workers with dangerous working conditions at nuclear power plants. The positive effect of oral sanitation is largely preserved after a year in comparison with non-sanitized workers. Oral sanitation at the age of 35–44 years does not affect the prevalence of caries.

Translational and clinical comparison of whole genome and transcriptome to panel sequencing in precision oncology

Precision oncology offers new cancer treatment options, yet sequencing methods vary in type and scope. In this study, we compared whole-exome/whole-genome (WES/WGS) and transcriptome sequencing (TS) with broad panel sequencing by resequencing the same tumor DNA and RNA as well as normal tissue DNA for germline assessment, from 20 patients with rare or advanced tumors, who were originally sequenced by WES/WGS ± TS within the DKFZ/NCT/DKTK MASTER program from 2015 to 2020. Molecular analyses resulted in a median number of 2.5 (gene panel) to 3.5 (WES/WGS ± TS) treatment recommendations per patient. Our results showed that approximately half of the therapy recommendations (TRs) of both sequencing programs were identical, while approximately one-third of the TRs in WES/WGS ± TS relied on biomarkers not covered by the panel. Eight of 10 molecularly informed therapy implementations were supported by the panel, the remaining two were based on biomarkers absent from the panel, highlighting the potential additional clinical benefit of WGS and TS.

Immediate Full-Arch Restorations Supported by Conventional Implants Plus Uni- or Bilateral Zygomatic Implants: A Three to Five Years Retrospective Radiologic and Clinical Comparison.

The study aimed to compare the short-term outcomes (3.7±0.4yrs) of full-arch immediately loaded fixed maxillary prostheses supported by conventional and unilateral single zygomatic implants versus those supported by conventional and bilateral single zygomatic implants. A retrospective analysis was conducted on patients suffering severe bone loss in the posterior area of the maxilla. The success of zygomatic implants was defined following Offset-Rhinosinusitis-Infection-Stability (ORIS) criteria. The criteria used to define success of standard dental implants were absence of mobility, pain, discomfort/neurologic disorder, and of persistent or chronic infection. The level of significance was 0.01. Thirty-eight patients received 2-5 standard implants plus two zygomatic implants (bilateral), whereas 10 patients had 3-5 standard implants plus a single zygomatic implant (unilateral). The cumulative success rate for standard implants was 99% and 97.3%, respectively, in the bilateral and unilateral groups. Four patients showed symptoms of acute rhinosinusitis (R-criterion): 1 in the unilateral and 3 in the bilateral group. Following the O-criterion, just 2 dental implants in the bilateral group showed a success grade 1. One zygomatic implant, belonging to the group bilateral, developed peri-implant mucositis with a success grade 3 (I-criterion). All zygomatic implants were checked individually and did not show either any signs of mobility or rotation after applying forces to the implant (S-criterion). The ORIS criteria divided the implants into three groups according to the success grades I,II,III: 32,36,8 for the bilateral, and 6,1,3 for the unilateral group, with no significant difference between the two groups. No zygomatic implant failure occurred so that the same zygomatic implant success rate (100%) was recorded for both groups. A prosthetic failure was registered in the unilateral group. The overall prosthesis success rates were 89.5% and 70%, respectively, in the bilateral and unilateral groups. A high degree of success was achieved for both groups treated with zygomatic implants, although in group unilateral there was one failure of a standard dental implant placed in the posterior area. This suggested that the use of zygomatic implants could provide adequate support to the fixed full-arch prostheses even in the configuration with a single unilateral zygomatic implant.

Clinical, Histopathological, and Serological Comparisons between Primary and Secondary Sjogren's Syndrome

Clinical, Histopathological, and Serological Comparisons between Primary and Secondary Sjogren's Syndrome

Comparative Prognostic Value of Glomerular Filtration Rate, Serum Cystatin C, Beta-2-Microglobulin and Albuminuria for Death and Chronic Kidney Disease Progression.

Serum creatinine and albuminuria are the core of most CKD prediction and progression risk models. Several biomarkers have been introduced to improve these results such as beta-2-microglobulin (B2M) and cystatin C (CysC). Nevertheless, few clinical comparisons of these biomarkers are available. We have compared serum B2M levels with albuminuria, CysC levels, and the CKD-EPI GFR equations. A sample of 434 patients were studied: 234 males and 200 females, the mean age was 58.3 ± 15.0 years, and 33.4% have diabetes mellitus. In all patients, plasma B2M, CysC, creatinine, and urinary albumin excretion were analyzed. EGFR was calculated using CKD-EPI equations for creatinine, CysC, and creatinine-CysC. The risk of death and CKD progression was evaluated using ROC curves and Cox proportional hazards survivorship models. For mortality, the highest area under the curve (AUC) was for CysC (0.775, 0.676-0.875). The lowest sensitivity was shown by eGFR (creatinine) (0.298, 0.195-0.401, p < 0.001), eGFR (CysC) (0.216, 0.118-0.314, p < 0.001), and eGFR (creatinine + CysS) (0.218, 0.124-0.312, p < 0.001). For progression to advanced CKD, the highest AUC was for CysC (0.908, 0.862-0.954). The lowest sensitivity was shown by eGFR (creatinine) (0.184, 0.106-0.261, p < 0.001), eGFR (CysC) (0.095, 0.048-0.14, p < 0.001), and eGFR (creatinine+ CysC) (0.087, 0.040-0.134, p < 0.001). CysC, after age, was the second-best marker of life risk. Contrariwise, for CKD progression, CysC, and albuminuria were the best markers. The best biomarker of mortality and risk of progression to CKD was CysC. Albuminuria and B2M were the next best options to be used. The lowest sensitivity was shown by estimated eGFR.

PLEK2: a potential biomarker for metastasis and prognostic evaluation in uveal melanoma.

Uveal melanoma (UVM) is an aggressive tumor known for its high metastatic rate, making it necessary to delineate potential molecules that may promote the development of UVM. PLEK2 has been found to promote the progression and metastasis of some tumors, but its role in UVM has not yet been reported. Through this study, we hope to explore the effect of PLEK2 on the prognosis of UVM patients and to discover the potential functional role and intrinsic mechanism of PLEK2. The GEO datasets GSE211763 and GSE149920 were analyzed using GEO2R to identify differentially expressed genes that may be associated with UVM progression and metastasis. A Protein-Protein Interaction Network (PPI) was constructed to identify key molecules. The correlation between PLEK2 expression and overall survival was evaluated via GEPIA2, and clinical characteristics of UVM patients were compared based on PLEK2 levels. PLEK2 expression in UVM cell lines was assessed using the CCLE database and confirmed by qPCR and western blot. A weighted correlation network analysis (WGCNA) was performed, followed by gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. Finally, a search for miRNAs potentially regulating PLEK2 expression was performed using TargetScan, miRWalk, and TarBase databases. Comparative analysis of the GEO datasets unveiled 79 commonly up-regulated genes and 238 commonly down-regulated genes. The PPI network identified 9 hub genes, with PLEK2 significantly linked to reduced overall survival. Clinical comparisons indicated significant differences in cancer status (p = 0.013) and tumor diameter (p = 0.039) between high and low PLEK2 expression groups. Elevated PLEK2 mRNA levels were confirmed in UVM cell lines compared to retinal pigment epithelial cells. PLEK2 was enriched in the calcium signaling pathway and associated with the Wnt/Ca2+ signaling pathway. A total of 21 miRNAs potentially regulating PLEK2 were predicted. PLEK2 is upregulated in UVM and correlates with poor patient prognosis, likely influencing the calcium signaling pathway. PLEK2 represents a promising prognostic biomarker and therapeutic target for UVM.

Analytical and clinical comparison between two different analytical methods for the measurement of circulating insulin in patients with metabolic-dysfunction associated steatotic liver disease

Analytical and clinical comparison between two different analytical methods for the measurement of circulating insulin in patients with metabolic-dysfunction associated steatotic liver disease

Exome Sequencing Identified Susceptible Genes for High Residual Risks in Early-Onset Coronary Atherosclerotic Disease.

Despite the tremendous improvement in therapeutic medication and intervention for coronary atherosclerotic disease (CAD), residual risks remain. Exome sequencing enables identification of rare variants and susceptibility genes for residual risks of early-onset coronary atherosclerotic disease (EOCAD) with well-controlled conventional risk factors. We performed whole-exome sequencing of subjects who had no conventional risk factors, defined as higher body mass index, smoking, hypertension and dyslipidemia, screened from 1950 patients with EOCAD (age ≤ 45 years, at least 50% stenosis of coronary artery by angiography), and selected control subjects from 1006 elder (age ≥ 65 years) with < 30% coronary stenosis. Gene-based association analysis and clinical phenotypic comparison were conducted. Subjects without defined conventional risk factors accounted for 4.72% of young patients. Totally, 6 genes might be associated with residual risk of EOCAD, namely CABP1 (OR = 22.19, p = 0.02), HLA-E (OR = 22.19, p = 0.02), TOE1 (OR = 33.6, p = 0.002), HPSE2 (OR = 11.1, p = 0.04), CHST14 (OR = 22.19, p = 0.02) as well as KLHL8 (OR = 22.19, p = 0.02). Phenotypic analysis displayed the levels of low-density lipoprotein cholesterol in carriers of mutations from CABP1, HLA-E, TOE1, and HPSE2 were significantly elevated compared to noncarriers. Notably, extracellular matrix-associated CHST14 and fibrinogen-associated KLHL8 both displayed possible correlation with increased neutrophil proportion and decreased monocyte percentage (both p < 0.05), exerting potential effects on the residual inflammatory risks of EOCAD. The study identified six genes related to dyslipidemia and inflammation pathways with potential association with residual risk of EOCAD, which will contribute to precision-based prevention in these patients. The GRAND study was registered at www. gov on July 14, 2015, and the registry number is NCT02496858.

Clinical Comparison of Decentration and Tilt Effects in Iris-Claw and Trans-scleral Plug Lenses: Wavefront Analysis With a Pyramidal Sensor Aberrometer.

To compare the aberrometric profile of the Artisan Aphakia lens (Opthec BV) and transscleral plug FIL-SSF lens (Soleko) and to assess the impact of tilt and decentration on their optical performance. This retrospective observational study was conducted at Azienda Ospedaliera Universitaria Careggi, Florence, Italy, with a consecutive cohort of aphakic eyes undergoing secondary lens implantation with an Artisan or FIL-SSF lens. Wavefront analysis was performed using a pyramidal wavefront-based aberrometer (Osiris-T; CSO). Tilt and decentration were calculated using anterior segment optical coherence tomography (MS-39; CSO). The study included 47 eyes from 45 patients: 24 eyes in the FIL-SSF group and 23 eyes in the Artisan group. Decentration was 0.39 ± 0.14 mm in the FIL-SSF group and 0.51 ± 0.16 mm in the Artisan group (P = .02). The mean tilt value was 6.6 ± 2.35 degrees in the FIL-SSF group and 5.9 ± 1.86 degrees in the Artisan group (P = .13). Internal higher order aberrations (HOAs) were 0.23 ± 0.07 μm in the FIL-SSF group and 0.29 ± 0.13 μm in the Artisan group (P = .02). The point spread function (PSF) Strehl ratio was 0.12 ± 0.05 in the FIL-SSF group and 0.10 ± 0.04 (P = .11) in the Artisan group. The PSF Strehl ratio without lower order aberration (PSFw2) was 0.28 ± 0.12 in the FIL-SSF group and 0.23 ± 0.09 in the Artisan group (P = .01). The Artisan and FIL-SSF lenses provide comparable optical performance in terms of the PSF Strehl ratio. However, the Artisan lens appears to be more susceptible to decentration, which may result in increased higher order aberrations and a consequently lower PSFw2 Strehl ratio. [J Refract Surg. 2024;40(12):e926-e933.].

Clinical and radiographic comparison of primary molar pulpotomy using formocresol, portland cement, and NeoMTA plus: a randomized controlled clinical trial

The present study aimed to compare the clinical and radiographic success rates of Formocresol (FC), Portland Cement (PC), and NeoMTA Plus in primary molar pulpotomy. Ninety-six primary molars in ninety-six children aged 3‒9 years were randomly assigned to FC, PC, and NeoMTA Plus groups. Radiographic and clinical follow-up evaluations were performed at six and twelve months. After six and twelve months, clinical success rates were 100% in the three groups. The radiographic success rates in the 6-month follow-up were 96.7 and 96.7% in the FC and PC groups and 100% in the NeoMTA Plus group. At 12 months, radiographic success rate was 93.8, and 93.8% in the FC and PC groups and 96.9% in the NeoMTA Plus group. There were no significant differences between the three groups at all follow-up evaluations. NeoMTA Plus showed highest success rate, clinically and radiographically. PC and NeoMTA Plus can be considered as an alternative to FC.

Clinical Outcomes After Dental Surgery with Two Antiseptic Protocols.

Background: Little has been written in the literature about the clinical comparison between the single use of chlorhexidine (CHX) and its combination with cetylpyridinium chloride (CPC). The purpose of this study is to compare the clinical effectiveness of two at-home antiseptic regimens. Methods: Healthy subjects scheduled for dental surgery were enrolled. After the surgery, patients were randomly allocated to the first group (group A), which received a manual ultrasoft toothbrush (Mentadent Professional®), an antiseptic toothpaste with 0.12% CHX and Vitamin B3 (Mentadent Professional Azione Intensiva Gengive®), and an antiseptic mouthwash with 0.12% CHX and 0.07% CPC. The second group (group B) solely received an antiseptic mouthwash with 0.2% CHX in conjunction with an anti-discoloration system (Curasept ADS/DNA®) and were encouraged to use their usual toothbrush and toothpaste. Patients were instructed to use the products twice a day and to rinse for 30 s. On day 7, patients were examined for the early healing score (EHS), visual plaque index (VPI) of the sutures, numerical rating scale (NRS), and mouthwash taste. Results: Group A showed a statistically significant level of EHS and taste satisfaction. VPI and NRS were different but not significant among the studied groups. Conclusions: The regimen based on CHX used in conjunction with vitamin B3 in the toothpaste and CPC in the mouthwash resulted in superior clinical outcomes and satisfaction compared to CHX alone.

Clinical comparison of laparoscopic and open surgical approaches for uterus-preserving myomectomy: a retrospective analysis on patient-reported outcome, postoperative morbidity and pregnancy outcomes.

Uterine fibroids pose clinical challenges due to varied symptoms and impact on fertility. Aim of this research is to compare open and laparoscopic myomectomy, with focus on evaluating their effects on patients' quality of life and analyzing their implications for pregnancy outcomes. This retrospective study compares open and laparoscopic myomectomy outcomes in 168 patients treated October 2017 and July 2023. Preoperative characteristics and postoperative outcomes in terms of symptoms and pregnancy outcomes were examined. The patient cohort comprised patients with a high symptom burden. Only 51.2% expressing a desire for future pregnancies, highlighting diverse motivations for uterus-preservation. No significant differences were observed in preoperative symptoms. Larger and multiple myomas were associated with a higher likelihood of laparotomy. Recurrence rates were lower after laparoscopy (10.2% vs. 23.8%, p = 0.02). Cesarean section recommendations were more frequent post-laparotomy group (36.6% vs. 86.6%, p = 0.000). Morbidities and satisfaction showed no significant differences between approaches, with slightly better bleeding improvement after laparotomy. Despite similar pregnancy outcomes, a high proportion of patients did not conceive postoperatively (75.4%). Among patients who became pregnant postoperatively (n = 31), most patients conceived after one year or more, with no dependence on the surgical approach (p = 0.227). Both open and laparoscopic myomectomy surgeries showed high patient satisfaction, symptom alleviation, and comparable pregnancy results. A preference emerged for laparoscopy in terms of cesarean section recommendations and recurrence risk. Laparoscopic procedures tended to offer higher operative satisfaction and fewer complications. The study emphasized the complexity of therapeutic decision-making.

Clinical and Dermoscopic Comparison of the Efficacy and Safety of 5% Fluorouracil Topical Cream and 1% Niacinamide Topical Gel in the Treatment of Actinic Keratosis: A Randomized Controlled Trial.

Actinic keratosis (AK) is a common skin condition treated by dermatologists; however, the effectiveness, superiority, and potential side effects of current treatment protocols are still debated. This study aimed to compare the effectiveness and safety of 5% fluorouracil topical cream and 1% niacinamide topical gel in patients with AK. In a randomized clinical trial, 26 patients with 95 AK lesions were assigned to receive either 5% fluorouracil topical cream twice daily for 4 weeks or 1% niacinamide topical gel twice daily for 3 months. Photography and dermoscopy before and after treatment were used to evaluate the outcomes. The study included 26 patients who underwent randomization and treatment. Analysis of the improvement response after treatment through photography and dermoscopy scores, as well as patients' perspectives, showed that the fluorouracil group had significantly better outcomes than the niacinamide group. However, treatment complications including burning, itching, and erythema were significantly more frequent in the fluorouracil group than in the niacinamide group. Although 5% fluorouracil cream is more effective than 1% niacinamide gel in treating AK lesions, it is also associated with more frequent side effects.

Clinical and laboratory comparison of severe (Group B and C) Dengue cases with molecular characterization from 2019 epidemics in Dhaka, Bangladesh.

Acute arboviral infections like dengue have a significant negative socioeconomic and health impact on many tropical and subtropical areas of the world. About 3.9 billion Individuals are at risk of contracting the dengue virus and Asia bears the brunt of that load. Bangladesh, like other south-east Asian countries faced a massive outbreak of dengue in 2019. This cross sectional study was done in three tertiary care centers in Dhaka, Bangladesh during this worst outbreak of dengue. The study was conducted from 1st July to 31st December, 2019 with an aim to describe the clinical and laboratory variations among severe dengue cases and to conduct a serotype survey. This might help to understand the future changes in the clinical or serological profile of the circulating dengue virus. The study enrolled 1978 participants who were grouped into group B (Patients with warning signs or risk factors who should be admitted for close observation as they approach critical phase) and C (Patients having severe plasma leakage leading to dengue shock and/or fluid accumulation with respiratory distress, severe organ impairment and severe metabolic abnormalities) according to national guidelines. Furthermore, 81 samples were serotyped using Qiagen One step RT-PCR kit (Cat. No: 210212). In addition sequencing (ABI sequencing platform) of partial C-prM gene of five DENV-3 isolates were done and analyzed (BLAST tool of NCBI) for phylogenetics (MEGA6 software package). Among the 1978 enrolled participants group B and C patients were 1580 (80%) and 398 (20%) respectively. The median (IQR) age of the patients were 26(11 to 41). Maximum proportion of the enrolled were male (72.3%) (p = 0.0002). Most common co- morbidities were hypertension (90; 4.5%) and DM (70; 3.5%). Group C patients more commonly presented with vomiting (p 0.133), diarrhea (p<0.0001) and abdominal pain (p 0.0203). The common mode of bleeding was melaena (12%). Thirteen (0.7%) patients succumbed to death, 12 of them belonged to group B who mostly presented with GI manifestations (99.9%) and melaena (12%). Only 5.6% of the cases were secondarily infected. In group C cases low hemoglobin and hematocrit was observed with high AST (p 0.004, 0.006 and 0.0016 respectively). Fluid requirement was also more in the same group (p<0.0001). Group B patients had a higher platelet requirement (p = 0.0070). Twelve patients (0.7%) required ICU. The management profile of these cases are showcased here which highlights minimal use of antibiotics and no application of steroids, which abides by the current national protocol. Furthermore, 81 samples from enrolled participants were serotyped and majority (79%) yielded DENV-3, followed by DENV 2 & 3 co-infection (13.6%) and DENV-2 alone (7.4%). Following phylogenetic analysis DENV-3 and DENV2 were deemed to be of genotype I and cosmopolitan variety respectively. This study presents the first instance of heterogeneous co-infection with several serotypes since 2000 in Bangladesh. It also gives an overview of serotype prevalence, management evaluation and clinical results that promises to navigate future control planning.

An Updated Review on the Mechanisms, Pre‐Clinical and Clinical Comparisons of Nicotinamide Mononucleotide (NMN) and Nicotinamide Riboside (NR)

ABSTRACTThe study of nicotinamide adenine dinucleotide (NAD+) biology has gained popularity recently. Research discovered that two NAD+ biosynthesis intermediates, nicotinamide riboside (NR) and nicotinamide mononucleotide (NMN), are biosynthetic precursors of NAD+, an essential chemical for metabolism. Many studies show that NAD+ levels fall considerably with aging, with NAD+ regeneration in aging animals increasing longevity and enhancing health. According to research on the two molecules, NMN and NR, supplementation with either raises NAD+ levels during aging. The objective of this review is to highlight current developments in the biology of NAD+ in relation to NR or NMN supplement. This review highlightings significant discoveries about NR and NMN supplementation in relation to NAD+ biological activities and health benefits.

Efficacy of the preformulated irrigation solution Bactisure® in acute periprosthetic joint infection debridement surgery: study protocol for a randomized controlled trial

BackgroundDespite significant progress in orthopaedic surgery, the prevalence of periprosthetic joint infections (PJIs) remains persistent, and future increases are expected due to the increasing number of joint arthroplasties. PJIs are intricately connected to biofilm-producing bacteria, which encase infected prostheses, impairing the effectiveness of antibiotics and the immune system. Acute PJIs with immature biofilms are traditionally managed with debridement, antibiotics, and implant retention (DAIR). However, to date, there has not been a conclusive direct clinical comparison (in vivo) demonstrating the superiority of one irrigation solution over others. Recently, there has been a growing interest in irrigation solutions with antibiofilm properties demonstrated in in vitro studies, exemplified by the preformulated Bactisure® irrigation solution, which contains ethanol, acetic acid, sodium acetate, benzalkonium chloride, and sterile water. The main objective of this study was to evaluate the effectiveness (infection cure rate) of preformulated Bactisure® irrigation solution in vivo compared with saline solution in a control group of patients with acute knee and/or hip periprosthetic infections treated with DAIR.MethodsProspective single-centre randomized controlled trial involving patients with acute or haematogenous PJI who received standard DAIR surgery from December 2022 to December 2024. The type of irrigation solution used during surgery will include two groups allocated at a 1:1 ratio: a control group (n = 25) with saline solution and an experimental group (n = 25) receiving the Bactisure® preformulated solution. The sample size was calculated based on an expected reduction in reinfection rates from 45% in the control group to 10% in the experimental group. Data on baseline patient characteristics, clinical and radiological information, and healthcare questionnaires will be recorded. All patients will be followed for minimum of 12 months. The infection cure rate at 1 year will be the primary outcome.DiscussionThis study is the first to compare the effectiveness of preformulated Bactisure® irrigation solution with that of saline solution in real clinical practice (in vivo) in patients with acute knee and/or hip periprosthetic infections treated with DAIR. Our main hypothesis is that, compared with saline solution, Bactisure® provides a better infection cure rate at 1 year post-DAIR.Trial registrationInternational Standard Randomized Controlled Trial Number (ISRCTN): https://doi.org/10.1186/ISRCTN10873696. Registered on December 19, 2023.

Quantifying head and withers movement asymmetry in sound and naturally forelimb lame horses trotting on a circle on hard and soft surfaces.

Reliable lameness thresholds for vertical head displacement for trotting on a circular path and on different surfaces have yet to be defined. Withers movement in lame horses could help improve the diagnostic accuracy of sensor technology. To define head movement lameness threshold ranges and describe the relationship between head and withers movement during trotting under different circumstances in sound and forelimb lame horses. Retrospective analysis of clinical data and comparison with control group. Fifty-five sound and thirty-four naturally lame horses were trotted under field conditions on a hard surface on a straight line and on both directions on soft and hard surfaces. Movement asymmetry was analysed by measuring differences in displacement minima for head and withers using an inertial measurement unit sensor-based gait analysis system. Receiver operating characteristic (ROC) analysis was performed to define threshold ranges. Relationships between head and withers data were identified by calculating the correlation with linear regression analysis. Estimated lameness threshold values for vertical head movement asymmetry ranged from 11.5 to 12.5 mm. On both surfaces, a head movement asymmetry threshold range from 24.5 to 26.5 mm could be found for the circle. Lame horses showed significant correlations between head and withers movement on hard ground straight line (R2 0.714, p < 0.001) and inner leg lame horses on the lunge (R2 0.915, p < 0.001). Different sources of lameness were not distinguished. Radius and speed during lungeing could not be perfectly controlled. Inclusion in the sound group was based on a subjective examination by one clinician and in the lame group two clinicians subjectively determined inner and outer leg lameness creating an extra amount of uncertainty. Lameness thresholds for quantifying head movement asymmetry on the lunge were proposed. A significant correlation was observed between head and withers movement asymmetry under several conditions.

Synthesis Methods of Loratadine and Its Clinical Application Comparison in Antihistamines

Loratadine is a second-generation antihistamine widely used in treating allergic diseases such as allergic rhinitis, urticaria, and conjunctivitis. Compared to first-generation antihistamines, loratadine has fewer central nervous system side effects, such as drowsiness and cognitive impairment, and exhibits prolonged efficacy. This paper comprehensively reviews the chemical structure, mechanism of action, and organic synthesis methods of loratadine. Loratadine’s tricyclic structure and selective binding to peripheral histamine H1 receptors allow it to effectively relieve allergic symptoms at low doses while minimizing side effects. The article also analyzes various classical and improved loratadine synthesis routes, comparing their advantages and disadvantages in terms of reaction conditions, yields, and environmental impact. By introducing novel catalysts and optimizing reaction conditions, the improved synthesis methods not only enhance yields and cost-effectiveness but also reduce environmental pollution. Additionally, this paper discusses the comparison of loratadine with other antihistamines in terms of efficacy and safety, highlighting its significant clinical advantages. Nonetheless, there remains a need for further optimization of its synthesis process and exploration of its potential in personalized treatment to meet the needs of different patients.