Dunn's Multiple Comparison Test Research Articles

Antimicrobial effect of bioceramic sealer in necrotic primary molars

BackgroundPulpally infected primary teeth should be retained until exfoliation whenever possible, as deciduous teeth are ideal space maintainers. Removing bacteria from the root canal is essential for a successful root canal treatment. Therefore, the present study compared the antimicrobial effects of resorbable bioceramic sealer with pastes of calcium hydroxide and iodoform mixed with zinc oxide and zinc oxide eugenol when used as intracanal medication on microorganisms of necrotic primary molars. The materials used in the study were: Paste A: Non-setting calcium hydroxide paste mixed with iodoform, Paste B: Zinc oxide eugenol, Paste C: Metapex with zinc oxide, Paste D: Metapex with zinc oxide eugenol, Paste E: Bio-C Pulpecto. Polymicrobial growth inhibition zone diameters around each of the five pastes were measured in mm to determine antimicrobial activity. The collected data were presented, tabulated, and statistically analyzed.ResultsComparison among all groups demonstrated a significant difference between them (P < 0.0001) using the Kruskal–Wallis test. Furthermore, Dunn's multiple comparisons test revealed that: Paste C (0.93 ± 3.55) and Paste A (2.13 ± 2.67) exhibited significantly the lowest antibacterial activity with no significant difference between them. Subsequently, Paste D (5.2 ± 5.89) and Paste E (8.73 ± 1.36) displayed no significant difference between them. In contrast, Paste B (11.8 ± 1.58) demonstrated significantly the highest antibacterial activity.ConclusionsBioceramic sealers could be utilized as filling material for root canal in primary molars because of their antimicrobial and biological properties.

Radiology resident proficiency in identifying misplaced lines, tubes, and devices: a simulation-based study using WIDI SIM.

Accurate placement of medical devices is crucial in critical care to prevent severe complications. This study aims to evaluate radiology residents' proficiency in identifying four specific critical misplacements of medical devices using the Wisdom in Diagnostic Imaging Simulation (WIDI SIM). A retrospective analysis was conducted on 1,102 responses from radiology residents who participated in the WIDI SIM between 2010 and 2022. The majority were first- and second-year residents from multiple institutions. The simulation presented four specific cases featuring misplacements of an endotracheal tube in the esophagus, an intrauterine device embedded in the myometrium, a peripherally inserted central catheter in the right internal jugular vein, and an umbilical venous catheter in the splenic vein. Residents provided free-text interpretations scored on a 0-10 scale by subspecialty radiologists. Errors were categorized as observational (failure to identify misplacement) or interpretive (misinterpretation of identified misplacement). Statistical analyses were performed using Kruskal-Wallis and Dunn's multiple comparisons tests. Across all cases, residents' average scores did not meet the acceptable standard of 7 points. Observational errors were predominant, indicating a failure to recognize these specific device misplacements. Effective report rates were low: 58% for the endotracheal tube case, 35% for the intrauterine device, 19% for the peripherally inserted central catheter, and 25% for the umbilical venous catheter. Significant performance improvements were observed between first- and second-year residents in three of the four cases (p-values ranging from < 0.0001 to 0.0238), but overall proficiency remained suboptimal even among senior residents. This study reveals gaps in radiology residents' ability to identify these specific misplaced lines, tubes, and devices accurately. The consistent pattern of underperformance, primarily due to observational errors, suggests a need for targeted educational interventions to improve resident proficiency in this aspect of emergency radiology.

Oral supplementation with Nicotinamide Riboside treatment protects RGCs in DBA/2J mouse model.

The aim of this study was to test whether oral administration of nicotinamide riboside (NR), the nicotinamide adenine dinucleotide (NAD+) precursors, protect retina ganglion cells (RGCs) from neurodegeneration in DBA/2J (D2) mice, which is a widely used mouse model of age-related inherited glaucoma. Oral NR or NAM administration (NR low dose: 1150mg/kg; NR high dose: 4200mg/kg; NAM low dose group: 500mg/kg; NAM high dose: 2000mg/kg of body weight per day) essentially started when D2 mice were 4 or 9 months old and continued up to 12 months old. Control cohort identically received food/water without NAM or NR. Intraocular pressure (IOP) was measured every month until experiment completion. Pattern electroretinography (PERG) was recorded. Retinas were harvested for whole mount immunofluorescence staining with RGCs marker Brn3a and imaged by fluorescent confocal microscopy. Optic nerves were harvested for axon staining and quantification. Retinal NAD+ levels were enzymatically assayed. NR oral supplementary treatment started at 4 months old robustly increased retinal NAD+ levels in D2 mice (NRHigh vs. vehicle: 273.7±23.59% vs. 108.70±12.10%, p<0.001). In aged vehicle group (12 months old), there was significantly diminution of the P1 and N2 components of PERG response compare with naïve group (naïve vs. vehicle: P1: 7.82± 0.70uV vs 1.63± 0.17uV, p<0.0001; N2: -13.29± 0.83uV vs. -3.22± 0.27uV, p<0.0001; Kruskal-Wallis test with Dunn's multiple comparison test). NR treatment preserved aged D2 visual function when mice were 9 and 12 months old. In addition, long-term NR high dose treatment significantly protected against total RGCs loss and optic nerve atrophy (RGC: NRHigh vs. vehicle: 1412±62.00vs 475.2±94.68 cells/field, p<0.00001; axon numbers: NRHigh vs. vehicle: 23990±1159 vs 8573±1160, n=41-53, p<0.0001). Furthermore, long-term NR supplementation prevent iris depigmentation and delayed IOP elevation. NR oral supplementary treatment significantly preserved RGC and axon numbers, potentially preserves retinal function via elevated retinal NAD+ level in aged D2 mice. Interestingly, NR treatment also prevented iris atrophy, delayed IOP elevation associated with this glaucoma model. NR oral supplementation thus treated several aspects of murine pigment dispersion glaucoma. Given parallels between this model and glaucoma in human, out data indicate that NR is worth exploring as a therapeutic candidate in treatment of glaucoma.

Impact of different activation procedures on sodium hypochlorite penetration into dentinal tubules after endodontic retreatment via confocal laser scanning microscopy

BackgroundInfected dentinal tubules are a possible source of bacteria that are responsible for the failure of root canal treatment. Therefore, disinfection of dentinal tubules by increasing the penetration of the irrigation solution is important for success in retreatment cases. This study utilized confocal laser scanning microscopy (CLSM) to assess and compare the impact of XPR, ultrasonic irrigation (UI) and sonic activation (SA) on NaOCl penetration into dentinal tubules following endodontic retreatment.MethodsA total of forty mandibular premolars were enrolled in this investigation. Following root canal preparation up to ProTaper X3 file (30/0.07), root canals were obturated with gutta-percha and bioceramic root canal sealer with single cone technique. The root canal filling materials were removed using ProTaper nickel-titanium rotary retreatment files until the working length was reached. The retreatment procedure was finalized using the ProTaper Next X4 (40/0.06). The teeth were divided into four groups based on the irrigation activation technique: control (conventional needle irrigation), SA, UI and XPR. During the final irrigation procedure, Rhodamine B dye was introduced to 5% NaOCl for visualization via CLSM. Subsequent to image acquisition, the maximum penetration, penetration percentage, and penetration area were calculated. Data were statistically analyzed using the Kruskal-Wallis, Friedman, and Bonferroni Dunn multiple comparison tests through R software (p < 0.05).ResultsIn the middle third, UI yielded a significantly higher penetration percentage than the control group (p < 0.05). The UI and XPR groups showed increased penetration percentages in the coronal and middle thirds compared with the apical third (P < 0.05). Maximum penetration was notably reduced in the apical third than in comparison with the coronal and middle thirds in all groups (p < 0.05). In the control, SA and XP groups, the penetration area was ranked in descending order as coronal, middle and apical (p < 0.05). Conversely, in the ultrasonic group, the penetration area was significantly lower in the apical third than in the middle and coronal thirds (p < 0.05).ConclusionsUI enhanced the penetration percentage in the middle third of the root compared with that in the control group. XPR and SA showed no significant effect on NaOCl penetration following retreatment.

Same-Day Repeatability and 28-Day Reproducibility of Xenon MRI Ventilation in Children With Cystic Fibrosis in a Multi-Site Trial.

MRI with xenon-129 gas (Xe MRI) can assess airflow obstruction and heterogeneity in lung diseases. Specifically, Xe MRI may represent a sensitive modality for future therapeutic trials of cystic fibrosis (CF) therapies. The reproducibility of Xe MRI has not yet been assessed in the context of a multi-site study. To determine the same-day repeatability and 28-day reproducibility of Xe MRI in children with CF. Four-center prospective, longitudinal. Thirty-eight children (18 females, 47%), median interquartile range (IQR) age 12 (9-14) years old, with mild CF (forced expiratory volume in 1 second (FEV1) ≥85% predicted). 3-T, two-dimensional (2D) gradient-echo (GRE) sequence. Xe MRI, FEV1, and nitrogen multiple-breath wash-out for lung-clearance index (LCI2.5) were performed. To assess same-day reproducibility, Xe MRI was performed twice within the first visit, and procedures were repeated at 28 days. Xe hypoventilation was quantified using ventilation-defect percentage (VDP) and reader-defect volume (RDV). For VDP, hypoventilated voxels from segmented images were identified using a threshold of <60% mean whole-lung signal and expressed as a percentage of the lung volume. For RDV, hypoventilation was identified by two trained readers and expressed as a percentage. Inter-site comparisons were conducted using Kruskal-Wallis nonparametric tests with Dunn's multiple-comparisons tests. Differences for individuals were assessed using Wilcoxon matched-pairs tests. Bland-Altman tests were used to evaluate same-day repeatability, 28-day reproducibility, and inter-reader agreement. A P-value ≤0.05 was considered significant. Median FEV1 %-predicted was 96.8% (86%-106%), and median LCI2.5 was 6.6 (6.3-7.4). Xe MRI had high same-day reproducibility (mean VDP difference 0.12%, 95% limits of agreement [-3.2, 3.4]; mean RDV difference 0.42% [-2.5, 3.3]). At 28 days, 26/31 participants (84%) fell within the same-day 95% limits of agreement. Xe MRI may offer excellent same-day and short-term reproducibility. 2 TECHNICAL EFFICACY: Stage 2.

Association between salivary inflammatory mediators and oral mucositis in patients with cancer undergoing chemotherapy.

Oral mucositis is a severe adverse event in patients undergoing chemotherapy and radiotherapy that may lead to the termination of cancer treatment. This study aimed to elucidate the relationship between salivary inflammatory mediators and oral mucositis in patients undergoing chemotherapy. This prospective cohort study included 167 patients who underwent chemotherapy at our institution between June 2020 and November 2023. We evaluated the association between chemotherapy-induced oral mucositis and salivary inflammatory mediators using multiple comparison tests and logistic regression analyses. Of the 167 patients, 67 (40.1%) had oral mucositis. Dunn's multiple comparison test revealed that interleukin-6 was significantly higher in oral mucositis of grades 2 and ≥ 3 (P < 0.01) and tumor necrosis factor (TNF)-α was significantly higher in oral mucositis of grades 3-4 (P < 0.01). Logistic regression analysis showed that the risk of oral mucositis was significantly higher for tumor necrosis factor (TNF)-α > 4.4pg/mL than for TNF-α ≤ 4.4pg/mL (adjusted odds ratio, 2.4; 95% confidence interval, 1.1-5.3; P = 0.03). Saliva is useful in evaluating inflammation in patients with chemotherapy-induced oral mucositis. Furthermore, TNF-α may be a predictive marker for the severity of oral mucositis in patients undergoing chemotherapy.

Evaluation of YouTube as an Information Source for Use of Laser in Root Canal Treatment

Objective: At the present time patients in developed countries widely use online resources to access medical information. YouTube is a widely used website to get knowledge. In the past, medical and dental data were accessed only by doctor and dentist examinations. This research was aimed to assess the quality and quantity of the knowledge content in popular YouTube™ videos about laser root canal treatment (LRCT). Method: Google Trends showed that "laser root canal treatment" was the most searched keyword on the topic. Included videos were assessed as the video's name, universal resource locators, the number of video display, time of adding in website, total numbers of likes, dislikes and comments and total video time. Each video was classed into the 3 groups according to their information source as dentist, commercial, dental clinic. This video was classified according to the quality of information content as ‘good’, ‘poor’, or ‘bad’. In the evaluation of the data, the distribution of variables was examined with the Shapiro-Wilk normality test, the intergroup comparison of variables that did not show a normal distribution was examined with the Kruskal Wallis test. Comparison of subgroups was examined with Dunn's multiple comparison test and comparison of qualitative data was analyzed with Chi-square test. The results were evaluated at the significance level of p

GRAM-POSITIVE BACTERIA WITHIN THE INTERVERTEBRAL DISC AND THEIR POTENTIAL INFLUENCE

IntroductionMultiple studies have identified Cutibacterium acnes (C.acnes) and other microbes in intervertebral disc tissue using 16S DNA Sequencing and microbial cultures. However, it remains unclear whether these bacteria are native to the discs or result from perioperative contamination. Our study aimed to detect Gram-positive bacteria in non-herniated human disc samples and explore correlations with Toll-like receptors (TLR) 2, TLR4, NLRP3, and Gasdermin D.MethodsImmunohistochemical staining was conducted on 75 human IVD samples for Gram-positive bacteria, S. aureus, C.acnes, TLR2, TLR4, NLRP3, and Gasdermin D. Cell detection and classification were performed using QuPath. NP cells were treated with Lipopolysaccharide (LPS) and Peptidoglycan (PGN) in monolayer and alginate beads for up to 72 hours, followed by secretome analysis using Luminex. Statistical analysis included Kruskal-Wallis, Dunn's multiple comparison test, and Pearson correlation.ResultsImmunohistochemical staining revealed Gram-positive bacteria exclusively within cells, with C. acnes positivity ranging from 5–99% and correlating with patient age (r=0.41, p= 0.007). TLR2 positivity ranged from 5–99% and TLR4 from 3–72%, showing a strong correlation (r= 0.62, p= 1.5e-006). Females with mid-degenerative grades exhibited significantly decreased TLR2 expression compared to those without degeneration signs. Treatment with LPS and PGN increased catabolic cyto- and chemokines associated with IVD degeneration.ConclusionIn conclusion, this study confirms Gram-positive bacteria presence in non-herniated human disc samples and highlights their role in triggering a catabolic response in disc cells.No conflicts of interest Sources of fundingThis project is part of the Disc4All Training network to advance integrated computational simulations in translational medicine, applies to intervertebral disc degeneration and funded by Horizon 2020 (H2020-MSCA-ITN-ETN-2020 GA: 955735)

Elevated cerebrospinal fluid galectin-3 and associated cytokines after severe traumatic brain injury in patients.

This study aimed to investigate the galectin-3 and associated cytokines levels in the cerebrospinal fluid (CSF) of severe traumatic brain injury (sTBI) patients. Temporal CSF expression of galectin-3 and associated cytokines levels in sTBI patients within 1-week post-injury were studied using the multiplex bead array. STBI patient group was stratified using the Modified Rankin Score (mRS) into 3 groups: mRS 6 (died), mRS 5 (severely disabled) and mRS 1-4 (mild-to-moderately disabled) group. Analysis for bead array data using Kruskal-Wallis test with post hoc Dunn's multiple comparisons test, and temporal changes and correlation analysis using Spearman's correlation were carried out. At day 1 post-injury, CSF galectin-3 and interleukin-6 (IL-6), interleukin-10 (IL-10), cysteine-cysteine motif chemokine ligand-2 (CCL-2), and cysteine-cysteine motif chemokine ligand-20 (CCL-20), but not interleukin-1β (IL-1β) and tumor necrosis factor (TNF-α) levels were significantly elevated in mRS 5 group compared to non-TBI controls. Temporal correlation analysis at 1-7 days showed decreased IL-10 level in the mRS 6 group, decreased IL-10 and CCL-2 levels in mRS 5 group, and decreased IL-6, CCL-2, and CCL-20 levels in the mRS 1-4 group. Receiver operating characteristic curve analyses revealed a significant area under the curve for comparison between mRS 6 and mRS 5 groups for galectin-3 and IL-6. No significant differences in sex, age, Glasgow Coma Scale score, C-reactive protein levels and types of TBI-induced hemorrhages were observed between the groups. CSF galectin-3 and associated cytokines, especially IL-6, CCL-2 and CCL-20 levels were different within sub-groups of sTBI patients, suggesting their potential use in sTBI prognostics.

Glycemic Control and Cardiometabolic Risk in Black Zimbabweans with Type 2 Diabetes Mellitus.

Type 2 diabetes mellitus (T2DM) frequently presents with modified cardiometabolic risk profiles, indicative of an elevated susceptibility to cardiovascular disease (CVD). Cardiometabolic risk factors such as obesity, hyperglycemia, hypertension, insulin resistance and dyslipidemia are known contributors to increased CVD hazard in individuals with T2DM. This study evaluated the glycemic control-based cardiometabolic risk profiles of black Zimbabweans with T2DM. A cross-sectional study of 116 T2DM patients recruited from diabetic clinics at Parirenyatwa and Sally Mugabe Hospitals, Harare, Zimbabwe, was conducted. Blood samples were collected for glycated hemoglobin (HbA1c) and lipid profile assessment. The Framingham risk scores (FRS) based on body mass index (BMI) and lipid profile were used to determine CVD risk. Parametric variables were analyzed using one-way analysis of variance (ANOVA) with post hoc Bonferroni correction, while non-parametric variables were compared using the Kruskal-Wallis test with post hoc Dunn test for multiple comparisons. The overall frequency of dyslipidemia was 83.6% (n=97) and hypoalphalipoproteinemia was the most prevalent dyslipidemia (79.3%). Median HDLC levels were significantly lower in participants with poor glycemic control (1.12 mmol/L) compared to those with good glycemic control group (1.37 mmol/L) (p=0.011). Despite lack of significant variations in Framingham Risk Scores, there was a trend towards lower FRS-BMI in the good control group (29.8%) compared to the inadequate control (35.4%) and poor control (32.7%) groups (p=0.078). Duration since DM diagnosis was observed to be an important risk factor for poor glycemic control being significantly shorter in those with good glycemic control compared to those with inadequate and poor control. Overall, there was no significant difference in HbA1c status by age but individuals with poor glycemic control were significantly older than those with good control. The most prevalent dyslipidemia among the study participants was hypoalphalipoproteinemia which is reportedly associated with genetic predisposition, warranting further investigations.

Nonverbal Cognitive Skills in Children With Aicardi Goutières Syndrome.

Aicardi Goutières syndrome (AGS) is type I interferonopathy characterized by severe neurologic impairment. Although many children with AGS demonstrate motor and expressive language deficits, the magnitude of receptive language impairment is uncharacterized. We sought to characterize cognitive function in AGS-affected children using assessment tools with reduced dependence on motor abilities and compare cognitive testing outcomes with overall severity and parental assessment of adaptive behavior. We performed a cross-sectional study. Children were recruited as part of the Myelin Disorders Biorepository Project at the Children's Hospital of Philadelphia. We included individuals with a confirmed diagnosis of AGS. We administered the Leiter International Performance Scale, third edition (Leiter-3), and the Vineland Adaptive Behavior Scale, third edition (VABS-3), in the context of research encounters. Motor skills were categorized by AGS Severity Scale mobility levels. Descriptive statistics and Spearman's rank correlation were used to compare assessments. Mann-Whitney and Kruskal-Wallis tests with correction with Dunn's multiple comparison test were used to compare test performance between mobility groups. Cognitive and adaptive behavior performance was captured in 57 children. The mean age at encounters was 8.51 (SD 5.15) years. The median (IQR) Leiter-3 score was 51 (interquartile range [IQR] 60), with administration failure in 20 of 57 (35%) individuals. On the VABS-3, the Motor Domain (median 29, IQR 36.25) was more impacted than the Communication (median 50, IQR 52), Daily Living Skills (median 52, IQR 31), and Socialization (median 54, IQR 40) Domains (p < 0.0001). The AGS Scale correlated with VABS-3 (r = 0.86, p < 0.0001) and Leiter-3 (r = 0.87, p < 0.0001). There was correlation between VABS-3 Domains and Leiter-3 (r-range 0.83-0.97). Gross motor and fine motor categories, respectively, correlated with VABS-3 (H = 39.37, p < 0.0001; U = 63, p < 0.0001) and Leiter-3 (H = 40.43, p < 0.0001; U = 66, p < 0.0001). Within each gross motor and fine motor category of the AGS Scale, a subset of children scored within normal IQ range. Parental assessment of function by the VABS-3 correlated with directly assessed performance measures. Our data underscore the potential value of VABS-3 and Leiter-3 as tools to assess psychometric function in AGS. With a deeper understanding of our patients' abilities, we can better guide clinicians and families to provide appropriate support and personalized interventions to empower children with leukodystrophies to maximize their communication and educational potential.

Free-Breathing Functional Pulmonary Proton MRI: A Novel Approach Using Voxel-Wise Lung Ventilation (VOLVE) Assessment in Healthy Volunteers and Patients With Chronic Obstructive Pulmonary Disease.

In respiratory medicine, there is a need for sensitive measures of regional lung function that can be performed using standard imaging technology, without the need for inhaled or intravenous contrast agents. To describe VOxel-wise Lung VEntilation (VOLVE), a new method for quantifying regional lung ventilation (V) and perfusion (Q) using free-breathing proton MRI, and to evaluate VOLVE in healthy never-smokers, healthy people with smoking history, and people with chronic obstructive pulmonary disease (COPD). Prospective pilot. Twelve healthy never-smoker participants (age 30.3 ± 12.5 years, five male), four healthy participants with smoking history (>10 pack-years) (age 42.5 ± 18.3 years, one male), and 12 participants with COPD (age 62.8 ± 11.1 years, seven male). Single-slice free-breathing two-dimensional fast field echo sequence at 3 T. A novel postprocessing was developed to evaluate the MR signal changes in the lung parenchyma using a linear regression-based approach, which makes use of all the data in the time series for maximum sensitivity. V/Q-weighted maps were produced by computing the cross-correlation, lag and gradient between the respiratory/cardiac phase time course and lung parenchyma signal time courses. A comparison of histogram median and skewness values and spirometry was performed. Kruskal-Wallis tests with Dunn's multiple comparison tests to compare VOLVE metrics between groups; Spearman correlation to assess the correlation between MRI and spirometry-derived parameters; and Bland-Altman analysis and coefficient of variation to evaluate repeatability were used. A P-value <0.05 was considered significant. Significant differences between the groups were found for ventilation between healthy never-smoker and COPD groups (median XCCV, LagV, and GradV) and perfusion (median XCCQ, LagQ, and GradQ). Minimal bias and no significant differences between intravisit scans were found (P range = 0.12-0.97). This preliminary study showed that VOLVE has potential to provide metrics of function quantification. 2 TECHNICAL EFFICACY: Stage 1.

Accumulation of Ambient Black Carbon Particles Within Key Memory-Related Brain Regions

Ambient air pollution is a worldwide problem, not only related to respiratory and cardiovascular diseases but also to neurodegenerative disorders. Different pathways on how air pollutants could affect the brain are already known, but direct evidence of the presence of ambient particles (or nanoparticles) in the human adult brain is limited. To examine whether ambient black carbon particles can translocate to the brain and observe their biodistribution within the different brain regions. In this case series a label-free and biocompatible detection technique of nonincandescence-related white light generation was used to screen different regions of biobanked brains of 4 individuals from Belgium with neuropathologically confirmed Alzheimer disease for the presence of black carbon particles. The selected biological specimens were acquired and subsequently stored in a biorepository between April 2013 and April 2017. Black carbon measurements and data analysis were conducted between June 2020 and December 2022. The black carbon load was measured in various human brain regions. A Kruskal-Wallis test was used to compare black carbon loads across these regions, followed by Dunn multiple comparison tests. Black carbon particles were directly visualized in the human brain of 4 individuals (3 women [75%]; mean [SD] age, 86 [13] years). Screening of the postmortem brain regions showed a significantly higher median (IQR) number of black carbon particles present in the thalamus (433.6 [289.5-540.2] particles per mm3), the prefrontal cortex including the olfactory bulb (420.8 [306.6-486.8] particles per mm3), and the hippocampus (364.7 [342.0-448.7] particles per mm3) compared with the cingulate cortex (192.3 [164.2-277.5] particles per mm3), amygdala (217.5 [147.3-244.5] particles per mm3), and the superior temporal gyrus (204.9 [167.9-236.8] particles per mm3). This case series provides evidence that ambient air pollution particles are able to translocate to the human brain and accumulate in multiple brain regions involved in cognitive functioning. This phenomenon may contribute to the onset and development of neurodegenerative disorders.

Design of a Stem Cell-Based Therapy for Ependymal Repair in Hydrocephalus Associated With Germinal Matrix Hemorrhages.

In preterm birth germinal matrix hemorrhages (GMHs) and the consequent posthemorrhagic hydrocephalus (PHH), the neuroepithelium/ependyma development is disrupted. This work is aimed to explore the possibilities of ependymal repair in GMH/PHH using a combination of neural stem cells, ependymal progenitors (EpPs), and mesenchymal stem cells. GMH/PHH was induced in 4-day-old mice using collagenase, blood, or blood serum injections. PHH severity was characterized 2 weeks later using magnetic resonance, immunofluorescence, and protein expression quantification with mass spectrometry. Ependymal restoration and wall regeneration after stem cell treatments were tested in vivo and in an ex vivo experimental approach using ventricular walls from mice developing moderate and severe GMH/PHH. The effect of the GMH environment on EpP differentiation was tested in vitro. Two-tailed Student t or Wilcoxon-Mann-Whitney U test was used to find differences between the treated and nontreated groups. ANOVA and Kruskal-Wallis tests were used to compare >2 groups with post hoc Tukey and Dunn multiple comparison tests, respectively. PHH severity was correlated with the extension of GMH and ependymal disruption (means, 88.22% severe versus 19.4% moderate). GMH/PHH hindered the survival rates of the transplanted neural stem cells/EpPs. New multiciliated ependymal cells could be generated from transplanted neural stem cells and more efficiently from EpPs (15% mean increase). Blood and TNFα (tumor necrosis factor alpha) negatively affected ciliogenesis in cells committed to ependyma differentiation (expressing Foxj1 [forkhead box J1] transcription factor). Pretreatment with mesenchymal stem cells improved the survival rates of EpPs and ependymal differentiation while reducing the edematous (means, 18% to 0.5% decrease in severe edema) and inflammatory conditions in the explants. The effectiveness of this therapeutical strategy was corroborated in vivo (means, 29% to 0% in severe edema). In GMH/PHH, the ependyma can be restored and edema decreased from either neural stem cell or EpP transplantation in vitro and in vivo. Mesenchymal stem cell pretreatment improved the success of the ependymal restoration.

Transcranial electrical stimulation during functional magnetic resonance imaging in patients with genetic generalized epilepsy: a pilot and feasibility study.

A third of patients with epilepsy continue to have seizures despite receiving adequate antiseizure medication. Transcranial direct current stimulation (tDCS) might be a viable adjunct treatment option, having been shown to reduce epileptic seizures in patients with focal epilepsy. Evidence for the use of tDCS in genetic generalized epilepsy (GGE) is scarce. We aimed to establish the feasibility of applying tDCS during fMRI in patients with GGE to study the acute neuromodulatory effects of tDCS, particularly on sensorimotor network activity. Seven healthy controls and three patients with GGE received tDCS with simultaneous fMRI acquisition while watching a movie. Three tDCS conditions were applied: anodal, cathodal and sham. Periods of 60 s without stimulation were applied between each stimulation condition. Changes in sensorimotor cortex connectivity were evaluated by calculating the mean degree centrality across eight nodes of the sensorimotor cortex defined by the Automated Anatomical Labeling atlas (primary motor cortex (precentral left and right), supplementary motor area (left and right), mid-cingulum (left and right), postcentral gyrus (left and right)), across each of the conditions, for each participant. Simultaneous tDCS-fMRI was well tolerated in both healthy controls and patients without adverse effects. Anodal and cathodal stimulation reduced mean degree centrality of the sensorimotor network (Friedman's ANOVA with Dunn's multiple comparisons test; adjusted p = 0.02 and p = 0.03 respectively). Mean degree connectivity of the sensorimotor network during the sham condition was not different to the rest condition (adjusted p = 0.94). Applying tDCS during fMRI was shown to be feasible and safe in a small group of patients with GGE. Anodal and cathodal stimulation caused a significant reduction in network connectivity of the sensorimotor cortex across participants. This initial research supports the feasibility of using fMRI to guide and understand network modulation by tDCS that might facilitate its clinical application in GGE in the future.

Correlation of the HPV 16 Genotype Persistence in Women Undergoing LEEP for CIN3 with the Risk of CIN2+ Relapses in the First 18 Months of Follow-Up: A Multicenter Retrospective Study.

Specific hr-HPV genotypes have different natural histories and different oncogenic capacity. This study aimed to investigate the risk of CIN2+ recurrence of the individual genotypes and evaluate how the duration of HPV persistence influences the risk of developing recurrent 16 cervical dysplasia of high grade (CIN2+). Data from patients with persistent HPV infection after primary conization were retrospectively extracted. Kaplan-Meier proportional hazards models were used to evaluate associations between the duration of HPV persistence and the risk of developing recurrent CIN2+. Kruskal-Wallis testing with Dunn's multiple comparison test was used to test whether there was a statistically significant difference in the time to development of tumor recurrences between different genotypes. Overall, 333 patients met the inclusion criteria. In 285 cases the HPV infection was persistent, in 48 cases (18%) it was transient, i.e., different genotypes after LEEP. Overall were diagnosed 39 relapses (13.7%), 79.5% (31/39 cases) were due to genotype 16, 20.5% (8/39) were linked to the other genotypes. Persistence of genotype 16 showed a 7-fold increased risk of developing a CIN2+ relapse, OR = 7.08 (95%CI: 3.12-16.08). Furthermore, the majority of relapses (38/39) occurred within 24 months of persistence with a cut-off represented by 18 months (p = 0.001) in which the relapse rate is maximum and the most frequently found genotype was the 16th with 31 (79.5%) cases of recurrence. Kruskal-Wallis test with Dunn's multiple comparisons has shown statistically significant difference in the time of development of CIN2 relapses among HPV16 and other genotypes. (p < 0.05). Kaplan-meier analysis has shown statistically significant difference between the time to CIN2+ relapse onset in patients with HPV 16 infection and patients with other hrHPV genotypes. (p < 0.05) Conclusions: the study results suggest that persistent HPV infection after LEEP with the same HR genotype present before surgery represents one of the most important predictive factors of the risk of CIN2+ recurrence. The persistence of HPV16 for the first 18 months strongly correlates with the risk of developing a CIN2+ recurrence.

HEMŞİRELERE YÖNELİK PSİKOLOJİK ŞİDDET İLE ÇATIŞMA EYLEM STİLLERİ ARASINDAKİ İLİŞKİ: KESİTSEL BİR ÇALIŞMA

Aims: This study aimed to evaluate correlation between psychological violence and conflict action styles against nurses and in order to identify factors affecting.. Materials and Methods: This is a descriptive and correlational study. All registered nurses who communicate with patients and colleagues and work in a hospital setting were included in the study. The data of the study were collected using the "Personal Data Collection Form", "Workplace Psychological Violence Instrument (WPVBI)" and "Conflict Activity Styles Inventory (CASI)". Mann Whitney U test was determined by the Kruskal Wallis H test for independent groups. Dunn's multiple comparison test was used to determine the differences between groups. Extension of Generalized Linear Models (GDM) for assumptions of regression analysis were used. Results:The current study found that the CASI and WPVBI subscale scores of the nurses statistically differ in relation to the clinics they work in, the type of hospital they are in, their working hours, the number of patients they are caring for, the number of nurses working in shifts, the belief in teamwork, manager support, and the level of communication with the clinicians (p&amp;lt;0.05). Further analysis demonstrated that the total score effects of avoidant and compulsive approaches on WPVBI scores were statistically significant (p&amp;lt;0.05). Conclusions: Nurses should be taught to use effective conflict action styles in order not to be exposed to psychological violence.

Early in life stressful events induce chronic visceral pain and changes in bladder function in adult female mice through a mechanism involving TRPV1 and alpha 1A adrenoceptors.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a chronic pain disorder with multiple phenotypes, one of which is associated with an overactive adrenergic system. We investigated if the maternal deprivation model (MDM) in female and male mice mimics IC/BPS phenotype and if the overstimulation of alpha 1A adrenoceptor (A1AAR) and the crosstalk with transient receptor potential vanilloid-1(TRPV1) are involved in the generation of pain and bladder functional changes. C57BL/6 female and male mice were submitted to MDM. TRPV1knockout (KO) mice were used to study TRPV1 involvement. Silodosin administration to MDM mice was used to study A1AAR involvement. The primary outcome was chronic visceral pain measured by Von Frey filaments analysis (effect size: 3 for wild type, 3.9 for TRPV1KO). Bladder changes were secondary outcome measurements. Unpaired T test, Mann-Whitney test, one-way analysis of variance followed by Newman-Keuls multiple comparisons test, and Kruskal-Wallis followed by Dunn's multiple comparisons test were used where appropriate. MDM induces pain behavior in female and not in male mice. Bladder afferents seem sensitize as MDM also increase the number of small volume spots voided, the bladder reflex activity, and urothelial damage. These changes were similarly absent after A1AAR blockade with silodosin or by TRPV1 gene KO. The main limitation is the number/type of pain tests used. MDM induced in female mice is able to mimic IC/BPS phenotype, through mechanisms involving A1AAR and TRPV1. Therefore, the modulation of both receptors may represent a therapeutic approach to treat IC/BPS patients.

Improving Vessel Visibility and Applying Artificial Intelligence to Autodetect Brain Metastasis for a 3D MR Imaging Sequence Capable of Simultaneous Images with and without Blood Vessel Suppression.

The purposes of this study were 1) to improve vessel visibility of our MR sequence by modifying k-space filling and 2) to verify the usefulness of applying artificial intelligence (AI) for volume isotropic simultaneous interleaved bright- and black-blood examination (VISIBLE) with compressed sensitivity encoding (CS) in autodetecting brain metastases. We modified 3 sequences of VISIBLE (Centric, Reversed Centric, and Startup Echo 30). The Centric sequence is a prototype. The Reversed Centric filled the k-space in a reversed centric manner to improve vessel visibility. The Startup Echo 30 implemented dummy echoes to further improve vessel visibility. Vessel visibility was evaluated in one slice at the level of the centrum semiovale. The sensitivity, specificity, the area under the curve (AUC), and false positives of detecting brain metastases using AI were evaluated among 3 sequences. Statistical comparisons were performed using a one-way analysis of variance, followed by Friedman and Dunn's multiple comparison tests. The number of visualized vessels was significantly lower in the Centric (39.3 ± 9.7, P < 0.05) and Reversed Centric (44.2 ± 9.8, P < 0.05) methods than in the magnetization-prepared rapid gradient echo (49.3 ± 9.1) but comparable in the Startup Echo 30 method (44.9 ± 8.8, P > 0.05). No significant differences existed in sensitivity, specificity, and AUC among the 3 methods. False positives achieved using the Reversed Centric method were significantly fewer (54 false positives) than those achieved using the Centric (85 false positives) and Startup Echo 30 (68 false positives) methods (P = 0.0092). Vessel visibility was improved by modifying the k-space filling, which may reduce false positives. The AI model for VISIBLE with CS achieved good performance in autodetection of brain metastases. The AI model for VISIBLE with CS can help radiologists diagnose brain metastases in clinical practice.

The effect of breastfeeding on reducing pain induced by pentavalent vaccine in infants: a randomized clinical trial.

To analyze the effect of breastfeeding on reducing Pentavalent vaccination pain in infants and to identify the necessary breastfeeding interval for antinociceptive action. Open parallel randomized clinical trial. Ninety mother-infant dyads participated, distributed into intervention group 1 (n = 30), which breastfed five minutes before vaccination; intervention group 2 (n = 30), which breastfed five minutes before and during vaccination; and control group (n = 30), which did not breastfeed. The outcome variable was the pain level measured by the FLACC Scale. Data analysis was conducted using descriptive and inferential statistics, applying Fisher's Exact, Kolmogorov-Smirnov, Kruskal-Wallis and Dunn's multiple comparison tests, with 0.05 significance level. Pain induced by the Pentavalent vaccine was reduced in intervention groups 1 and 2 (mean pain of 6.06 versus 3.83, respectively) compared to the control group (mean of pain of 7.43), which was significant for intervention group 2 (p < 0.001), indicating that, to achieve lower levels of pain, breastfeeding should be carried out before and during vaccination. Longer breastfeeding, conducted five minutes before and during vaccination, reduces the pain induced by the Pentavalent vaccine. No vaccination risks were identified to outweigh the benefits. These results endorse that health professionals should encourage breastfeeding at least five minutes before and during vaccine injection for an antinociception effect. Brazilian Clinical Trials Registry: RBR-9vh37wr.