Group BG Research Articles

Correlation between quality of obturation and outcome of pulpectomized primary molars following root canal instrumentation with pediatric rotary file systems

IntroductionThe success of root canal treatment is influenced by several factors including the type and technique of root canal preparation, the type of irrigants used, the quality of obturation, and post-endodontic restoration. Recent systematic reviews have concluded that there is no substantial evidence to establish the superiority of rotary file systems over hand files in terms of clinical and radiographic success in pulpectomized teeth. AimTo determine the correlation between quality of obturation and long-term outcome of pulpectomized primary molars following root canal instrumentation with pediatric rotary file systems and a hand file system. MethodsThe study involved 100 primary molars from children aged 4–7 years that required pulpectomy. The teeth were divided into four groups, each consisting of 25 teeth. In the first, second, third, and fourth groups, root canal instrumentation was carried out with Pedo-Flex pediatric rotary files (Group PF), Kedo-SG pediatric rotary files (Group KS), Pro-AF Baby Gold pediatric rotary files (Group BG), and hand nickel titanium K files (Group HF), respectively. Obturation was performed with zinc oxide eugenol cement using an engine-driven Lentulo-spiral. The quality of the root filling was assessed immediately after obturation through radiographic examination. The pulpectomized teeth were then evaluated both clinically and radiographically over a two-year period. ResultsThe quality of obturation was superior in the root canals instrumented with pediatric rotary file systems compared to hand files. At the end of follow-up period, the clinical success rate was 100% and the radiological success rates were 88%, 92%, 92%, and 80% in Groups PF, KS, BG, and HF, respectively. The optimally filled pulpectomized primary molars resulted in a superior success rate than compared to underfilled or overfilled teeth. ConclusionThe quality of obturation significantly influences the success rate of pulpectomized teeth. Therefore, the use of pediatric rotary files is recommended as rotary files contribute to a greater number of optimally filled canals.

Systematic hybrid laparoscopic and endovascular treatment of median arcuate ligament syndrome: A single-center experience.

Median arcuate ligament syndrome (MALS) is caused by celiac trunk (CT) compression by the median arcuate ligament. Clinically, this pathology varies from postprandial pain (Dunbar syndrome) to a life-threatening hemorrhage because of a rupture of a gastroduodenal artery aneurysm (GAA). Due to the low prevalence of this disease, there is no standard management for MALS. This was a single-center, retrospective study of 13 patients. Two groups were identified on the basis of the initial clinical presentation: those operated for a GAA rupture (bleeding group-BG) and those operated electively for Dunbar syndrome (Dunbar syndrome group-DG). The primary endpoint was 30-day postoperative complications of a systematic laparoscopic release of the median arcuate ligament and stenting during the same procedure. Seven patients (54%) underwent elective surgery. Six patients (46%) underwent semiurgent repair under elective conditions post-embolization for GAA bleeding. The total operative time was longer in the BG (p = 0.06). Two patients in the BG suffered early major complications and needed reintervention, and those in the DG had a lower comprehensive complication index. No mortality was reported at 30 days. Overall median length of stay was 5 days (IQR: 3.5-15.3). Patients in the DG had a significantly shorter length of stay (p = 0.02). At 6 months, the primary and secondary CT stent patencies were 82% and 100%, respectively. There were no high-flow GAA recurrences. A combined approach of laparoscopic release of the median arcuate ligament and stenting during the same procedure is feasible and safe, and this approach must be systematically discussed in symptomatic patients.

Polydioxanone Membrane Compared with Collagen Membrane for Bone Regeneration

Guided bone regeneration (GBR) is an approach that induces osteopromotion through the regenerative membranes. These barriers exhibit bioactive behavior and mechanical function. Polydioxanone is a synthetic option, already used in medicine and dentistry, with good results in bone regeneration. This study aimed to evaluate bone repair in critical defects in rat calvaria using a polydioxanone membrane (Plenum® Guide) compared with a commercially available collagen-based membrane (Bio-Gide®). The bone defects were filled with Plenum® Osshp, a synthetic bone graft, hydroxyapatite:β-tricalcium phosphate, 70:30%, Group PG (Plenum® Guide + Plenum® Osshp), and Group BG (Geistlich Bio-Gide® + Plenum® Osshp). The specimens were submitted to immunohistochemical (RUNX2 and OPN), gene expression (RUNX2, IBSP, and VEGF), histometric, and microtomography analyses after 07, 15, 30, and 60 days postoperative. PG group showed greater immunolabeling area for RUNX2 and OPN, higher gene expression of VEGF (3.15 ± 0.85), and IBSP (24.9 ± 0.59). However, there was no statistical difference between groups in the histometric analysis regarding the percentage of connective tissue PG (0.83 ± 0.45), BG (0.70 ± 0.34), neoformed bone PG (0.60 ± 0.4), BG (0.65 ± 0.51), and remaining biomaterial PG (0.84 ± 0.31), BG (0.91 ± 0.33). In addition, there was no statistical difference between groups by micro-CT analysis. The absorbable-synthetic membrane, Plenum® Guide, is an effective membrane for guided bone regeneration.

Elastin Barrier Membranes for Guided Tissue Regeneration Technologies

This article discusses the prospects for the use of new elastin barrier membranes manufactured using adapted technologies for the selective isolation of the elastin component from the extracellular xenogenic matrix of the pericardium ligamentous apparatus: (1) by high-temperature extraction under pressure; (2) cyanogen bromide method. A commercial material, Geistlich Bio–Gide® membrane (BG), was used as a control comparison group. It is shown that the materials of group (1) have a high degree of biocompatibility, exceeding the indicators of the control group BG. Based on the results of an study in a model of subcutaneous heterotopic implantation in rats, it was shown that elastin BM has a chemoattractant effect on the mesenchymal recipient cells and, unlike the control, is able to integrate to a high degree into the surrounding recipient tissues. At the same time, the materials of group (1) had a pronounced proangiogenic effect. Thus, it has been shown that elastin BM groups (1) have a medium-term barrier function and are able to induce full-fledged cellular repopulation and local neoangiogenesis, which can be useful in clinical practice, primarily in GTR technologies (with gingival flap augmentation) or when used together with other BM as an angiogenesis inducer to ensure formation of the vascular bed in GBR technologies of bone tissue.

Vocal Function Exercises With and Without Maximally Sustained Phonation: A Randomized Controlled Trial of Individuals With Normal Voice

To determine the effect of maximally sustained phonation on efficacy of Vocal Function Exercises as measured by percent of maximum phonation time goal attained. The hypothesis was that maximally sustained phonation would result in greater improvements in percent of maximum phonation time goal attained. Randomized controlled trial. A convenience sample of individuals with normal voice were recruited in a university academic clinic setting. Of 34 participants who volunteered for the study, 31 completed baseline assessment and 23 completed all study procedures. Participants were randomized to complete Vocal Function Exercises (traditional group TG), modified Vocal Function Exercises with reduced requirement for maximally sustained phonation (midpoint group MG), or modified Vocal Function Exercises with removed requirement for maximally sustained phonation (baseline group BG). The primary outcome measure was percent of maximum phonation time goal obtained during Vocal Function Exercises. The MG (p=0.008) and TG (p=0.001) groups significantly improved percent of maximum phonation time goal attained after six weeks of exercise, while the BG group (p=0.0202) did not (ɑ=0.0125). Difference among groups was not statistically significant (p=0.67, ɑ=0.0125). Hedges' g effect sizes of 0.29 (-0.66, 1.25) and 0.51 (-0.57, 1.58) were obtained comparing MG and TG groups, and BG and TG groups, respectively. Greater requirements for maximally sustained phonation improved efficacy of Vocal Function Exercises in enhancing normal voice as measured by percent of maximum phonation time goal attained. Maximally sustained phonation may be modified to some extent while preserving efficacy of Vocal Function Exercises, however complete elimination of maximally sustained phonation may attenuate improvement. Additional research in a clinical population is warranted.

The effect of stress hyperglycemıa seen ın acute ST-segment elevatıon ın myocardıal ınfarctıon on ın-hospıtal mortalıty.

The brief rise in blood glucose level during acute physiological stress in patients with no previous symptoms of diabetes mellitus is called stress hyperglycemia. This study is conducted with 1033 patients over the age of 18 who are diagnosed with STEMI and who did not meet the exclusion criteria for 1year. Patients were divided into 2 groups as DM and non-DM and their blood glucose levels, demographic data (age, sex, cardiovascular risk factors, DM, HT presence/absence, history of smoking), vital signs, fatal arrhythmia requiring intervention (ventricular tachycardia and ventricular fibrillation), cardiac insufficiency development according to Killip score, length of hospital stay, mortality and cardiogenic shock conditions were evaluated. Statistical analysis was made using SPSS 23.0 for Windows® (IBM Inc. Chicago, IL, USA). Results were considered significant at p < 0.05, with a 95% confidence interval. In non-DM group, BG has been found to be significantly higher in mortal cases compared to surviving cases (289.25 ± 106.35mg/dL for mortal cases; whereas 156.99 ± 58.60mg/dL for surviving cases; p < 0.001). Likewise, in DM group BG has been found to be higher in mortal cases compared to surviving cases. (328.38 ± 77.13mg/dL for mortal cases while 237.16 ± 95.00mg/dL for surviving cases; p < 0.001). For patients who are admitted to the hospital with STEMI, stress hyperglycemia in the non-DM group and hyperglycemia in the DM group are associated with both mortality and adverse conditions; thereby, glucose levels of those patients must be evaluated.

Metabolomic Profiling Reveals Protective Effects and Mechanisms of Sea Buckthorn Sterol against Carbon Tetrachloride-Induced Acute Liver Injury in Rats.

The present study was designed to examine the efficacy and protection mechanisms of sea buckthorn sterol (SBS) against acute liver injury induced by carbon tetrachloride (CCl4) in rats. Five-week-old male Sprague-Dawley (SD) rats were divided into six groups and fed with saline (Group BG), 50% CCl4 (Group MG), or bifendate 200 mg/kg (Group DDB), or treated with low-dose (Group LD), medium-dose (Group MD), or high-dose (Group HD) SBS. This study, for the first time, observed the protection of SBS against CCl4-induced liver injury in rats and its underlying mechanisms. Investigation of enzyme activities showed that SBS-fed rats exhibited a significant alleviation of inflammatory lesions, as evidenced by the decrease in cyclooxygenase-2 (COX-2), prostaglandin E2 (PGE2), and gamma-glutamyl transpeptidase (γ-GT). In addition, compared to the MG group, the increased indices (superoxide dismutase (SOD), glutathione peroxidase (GSH-Px), catalase (CAT), total antioxidant capacity (T-AOC), and total protein (TP)) of lipid peroxidation and decreased malondialdehyde (MDA) in liver tissues of SBS-treated groups showed the anti-lipid peroxidation effects of SBS. Using the wide range of targeted technologies and a combination of means (UPLC-MS/MS detection platform, self-built database, and multivariate statistical analysis), the addition of SBS was found to restore the expression of metabolic pathways (e.g., L-malic acid, N-acetyl-aspartic acid, N-acetyl-l-alanine, etc.) in rats, which means that the metabolic damage induced by CCl4 was alleviated. Furthermore, transcriptomics was employed to analyze and compare gene expression levels of different groups. It showed that the expressions of genes (Cyp1a1, Noct, and TUBB6) related to liver injury were regulated by SBS. In conclusion, SBS exhibited protective effects against CCl4-induced liver injury in rats. The liver protection mechanism of SBS is probably related to the regulation of metabolic disorders, anti-lipid peroxidation, and inhibition of the inflammatory response.

Intermittent Manually Controlled versus Continuous Infusion of Propofol for Procedural Sedation during Interventional Endoscopic Procedures: A Single-blinded Randomised Study

Introduction: Sedation with propofol during interventional gastrointestinal endoscopy is usually accomplished with two main modes-intermittent manually controlled using a syringe, and continuous infusion using an infusion device. Aim: To compare the effect of bolus administration and infusion of propofol on recovery profile during sedation in patients undergoing interventional endoscopy procedures. Materials and Methods: The present study was a singleblinded randomised study in which 120 patients, belonging to American Society of Anaesthesiologists (ASA) grade I and II, of either gender, and age 18-70 years, were randomly assigned to receive intermittent bolus (Bolus Group, BG) or continuous infusion (Infusion Group, IG) of propofol sedation after induction with 2 mg Midazolam for deep sedation. BG patients received an initial dose of propofol, 1%, according to body weight (&lt;60 kg: 40 mg, &gt;60 kg: 60 mg), followed by boluses of 10- 20 mg adjusted to maintain a Modified Observer’s Assessment of Alertness /Sedation Scale (MOAA/S) of 0 or 1. In the IG, continuous propofol infusion (4-6 mg/kg/hr) via Graseby 2000 (Smiths Medical) was administered after a bolus of 1 mg/ kg of propofol. Vital signs, recovery time, quality of recovery, total dose of propofol, side-effects as well as patient and endoscopist satisfaction score were evaluated. The data was compiled systematically and analysed using unpaired Student’s t-test and Chi-square test. The p-value &lt;0.05 was considered significant. Results: The demographic profile of patients was comparable in both the groups. The recovery time (6.30±2.06 minutes in BG versus 5.71±2.19 minutes in IG) and total propofol dose (327.74±45.52 mg in BG versus 314.46±64.52 mg in IG) were comparable. Similarly, the quality of recovery was identical in both groups. At 10 and 15 minutes after induction, arterial blood pressure was significantly lower in group BG as compared to group IG (114±16.96 in BG versus 120.34±8.78 in IG; p-value=0.031). The endoscopist’s satisfaction score was better in IG (p-value=0.001), whereas, the patient satisfaction score was comparable in both the groups (p-value=0.162). Conclusion: Both regimes allowed good controllability of propofol sedation. However, endoscopist satisfaction score was significantly better and haemodynamic fluctuations were less in infusion group.

Microsurgical management of midbrain cavernous malformations: does lesion depth influence the outcome?

BackgroundThe purpose of this study was to clarify whether the intrinsic depth of midbrain cavernous malformations (MCMs) influenced the surgical outcome.MethodsThe authors conducted a retrospective study of 76 consecutive patients who underwent microsurgical resection of a MCM. The vascular lesions were categorized into 4 distinct groups based on how these lesions had altered the brainstem surface. Additionally, it was verified whether the actual aspect of the brainstem surface could be predicted only by evaluating the pertinent preoperative MRI slices. Clinical outcome was assessed by determining the modified Rankin Scale Score (mRS) before and after surgery.ResultsTwenty-three MCMs (30.3%) were located deeply within the midbrain. The overlying midbrain surface appeared to be normal (group nl). In 33 patients (43.4%), the midbrain surface showed only a yellowish discoloration (group yw). In another 14 individuals (18.4%), the midbrain surface was distorted by the underlying MCM and bulging out while the vascular lesion still remained covered by a thin parenchymal layer (group bg). In the smallest group comprising 6 patients (7.9%), the exophytic MCM had disrupted the midbrain surface and was clearly visible at microsurgical exposure (group ex). The mean mRS decreased in the group nl from 1.43 preoperatively to 0.61 at follow-up.ConclusionThis study demonstrates in a large patient population that a deep intrinsic MCM location is not necessarily associated with an unfavorable clinical outcome after microsurgical lesionectomy. Predicting the aspect of the midbrain surface by evaluating preoperative MR images alone was not sufficiently reliable.

Ex vivo comparison ofhand‐suturedversus circular stapled anastomosis in canine large intestine

To compare leakage pressures of colonic anastomoses performed with circular staplers to conventional hand-sewn techniques in dogs. Ex-vivo study. Colon from 11 canine cadavers. Thirty-two colonic anastomoses were performed. Four segments from each colon were randomly assigned to one of four techniques: hand-sewn colonic anastomoses performed with 4-0 glycomer 631 (G) and 4-0 barbed glycomer 631 (BG), and circular stapled colonic anastomoses using 4.8 mm End-to-End Anastomosis (EEA C4.8mm) and 3.5 mm End-to-End Anastomosis (EEA C3.5mm), 21 mm diameter circular staples in cadaveric canine colon. Leakage pressure was defined as the pressure at which dye-containing solution was first observed to leak from the anastomosis site. Leakage pressures were 49.5 mmHg (range:16-72) in group G, 45.5 mmHg (range:19-80) in group BG, 5.3 mmHg (range:0-31) in group C3.5mm, and 29.5 mmHg (range:23-50.3) in group C4.8mm. Anastomoses leaked at lower pressures when stapled rather than hand-sewn (C4.8mm-G p=.0313, C4.8mm-BG p=.0131, C3.5mm-G p=.0469, C3.5mm-BG p=.0313). Two of the C3.5mm constructs leaked immediately after saline infusion with 4/6 leaking at <5.3 mmHg. End-to-end colonic anastomoses closed with circular stapler leaked at lower pressures than hand-sutured anastomoses. Use of the EEA stapler with a staple height of 3.5 mm did not result in safe colonic anastomoses. These results provide evidence to support hand-suturing colonic anatomoses with G and BG in dogs. The 4.8 mm staples may be considered in anatomical locations difficult to reach.

Comparison of Surgical Results of the Bridge Crane Technique Versus Laminectomy for the Treatment of Thoracic Myelopathy Caused by Ossification of the Ligamentum Flavum.

A retrospective study. This study aimed to evaluate the safety and effectiveness of the bridge crane technique versus laminectomy for the treatment of thoracic myelopathy caused by ossification of the ligamentum flavum (OLF). Totally 41 patients who underwent surgical decompression due to thoracic OLF from May 2017 to June 2018 in our institution were enrolled in this study and were divided into group BG (bridge crane technique, n = 19) and group L (laminoectomy, n = 22). Demographic data was collected from medical records and the modified Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological outcomes during the follow-up. Surgery-related complications were analyzed. The mean duration of follow-up was comparable between group BG (19.4 ± 1.5 months) and group L (19.6 ± 1.4 months). No statistical differences were observed between two groups in terms of gender, age, duration of symptoms, preoperative occupying rate, involved levels, operation time, intraoperative blood loss, and complications. The JOA score significantly increased at the final follow-up in both groups. However, patients in group BG had higher JOA score and recovery rate (P < 0.05). Four patients in group L experienced complications, including 3 cerebrospinal fluid (CSF) leakage and one postoperative hematoma. Only one patient in group BG had CSF leakage. The results of this study suggested that bridge crane technique may be relatively safe and effective for patients with symptomatic thoracic OLF with more satisfactory clinical improvement. However, high-quality studies are still required to validate the results of this study.

Management of anticoagulated patients in dentoalveolar surgery: a retrospective study comparing bridging with heparin versus unpaused vitamin K antagonist medication

BackgroundThe aim of this study was to investigate the occurrence of postoperative bleeding following dentoalveolar surgery in patients with either continued vitamin K antagonist medication or perioperative bridging using heparin.MethodsA retrospective study was performed analyzing patients who underwent tooth extraction between 2012 and 2017. Patients were retrospectively allocated into two comparative groups: un-paused vitamin K antagonist medication versus bridging using heparin. A healthy, non-anticoagulated cohort with equivalent surgery served as a control group. Main outcome measures were: the occurrence and frequency of postoperative bleeding, the number of removed teeth, the surgical technique of tooth removal (extraction/osteotomy/combined extraction and osteotomy) and the prothrombin time.Results In total, 475 patients were included in the study with 170 patients in the group of un-paused vitamin K antagonist medication VG, 135 patients in the Bridging group BG and 170 patients in the control group CG. Postoperative bleeding was significant: CG versus VG p = 0.004; CG versus BG p < 0.001, BG versus VG p < 0.001. A significant correlation of number of the extracted teeth in the BG (p = 0.014) and no significance in VG (p = 0.298) and CG (p = 0.210) and in the BG versus VG and CG with p < 0.001 in terms of surgical intervention extraction. No difference observed in terms of prothrombin time.ConclusionsBridging with heparin increases the risk for bleeding compared to un-paused vitamin K antagonist medication. The perioperative management of anticoagulated patients requires a well-coordinated interdisciplinary teamwork to minimize or at best avoid both: postoperative bleeding and thromboembolic incidences.

Evaluation of Osteoconduction of a Synthetic Hydroxyapatite/β-Tricalcium Phosphate Block Fixed in Rabbit Mandibles.

(1) Background: This study aimed to evaluate the incorporation of hydroxyapatite/β-tricalcium phosphate blocks grafted in rabbit mandibles. (2) Methods: Topographic characterization of biomaterial was performed through scanning electron microscopy coupled with energy-dispersive X-ray spectroscopy (SEM-EDX). Ten rabbits randomly received autogenous bone graft harvested from the tibia (Autogenous Group—AG) or synthetic biomaterial manufactured in β-tricalcium phosphate (Biomaterial Group—BG) at their right and left mandibular angles. Euthanasia was performed at 30 and 60 postoperative days; (3) Results: SEM-EDX showed a surface with the formation of crystals clusters. Histological analyses in BG at 30 days showed a slower process of incorporation than AG. At 60 days, BG showed remnants of biomaterial enveloped by bone tissue in the anabolic modeling phase. Histometric analysis showed that mean values of newly formed bone-like tissue in the AG (6.56%/9.70%) were statistically higher compared to BG (3.14%/6.43%) in both periods, respectively. Immunohistochemical analysis demonstrated early bone formation and maturation in the AG with more intense osteopontin and osteocalcin staining. (4) Conclusions: The biomaterial proved to be a possible bone substitute, being incorporated into the receiving bed; however, it showed delayed bone incorporation compared to autogenous bone.

Assessment of Postural Balance in Women Treated for Breast Cancer.

Background and objectives: Surgery is the primary and most effective treatment of breast cancer. Unilateral mastectomy disrupts the distribution of muscle tension between the right and the left sides of the body. The aim of the study was to evaluate postural balance in patients treated for breast cancer by mastectomy. Materials and methods: A controlled clinical study was conducted on 90 patients who have undergone surgical treatment for breast cancer (mastectomy) 5–6 years prior (Breast Group—BG). The control group (CG) consisted of 74 healthy female volunteers. Analysis of balance was performed using the Alfa stabilography platform. A static test (Romberg’s test) with open and closed eyes was used to assess balance. The following balance parameters were analyzed: path length, statokinesigram area, parameters of deflection and velocity of the foot pressure center. Results: The study demonstrated that patients from BG (5–6 years after surgery) obtained worse results in both tests with open (maximum back deviation, maximum forward deviation, average Y deviation, average Y velocity, path length and path surface area) (p < 0.05) as well as with closed eyes (maximum backward deviation, maximum forward deviation, mean Y deviation and path length) (p < 0.05). Conclusions: Our study demonstrated that women 5–6 years after surgery for breast cancer have impaired balance compared to healthy women, despite physiotherapy.

Blood glucose level during induction phase chemotherapy in childhood acute lymphoblastic leukemia

Background Steroids and L-asparaginase (L-Asp) are agents used in induction phase chemotherapy for childhood acute lymphoblastic leukemia (ALL). Both agents are often reported to have the side effect of hyperglycemia, and native L-Asp is also reported to cause hypoglycemia. In ALL patients, hyperglycemic events during chemotherapy can cause lower 5-year overall and relapse-free survival.&#x0D; Objective To investigate the incidence of abnormal blood glucose level (BG) as the side effect of prednisone and L-Asp during induction phase chemotherapy, its predisposing factors, and its effect on remission status.&#x0D; Methods This cohort prospective study was conducted in 36 children aged 1-18 years who were newly diagnosed with childhood ALL at Dr. Moewardi Hospital, Surakarta, Central Java. Subjects’ nutritional status consist of wellnourished and undernourishment. Subjects underwent BG monitoring. At the end of induction phase chemotherapy, subjects underwent bone marrow puncture (BMP) evaluation to assess their response to chemotherapy and the effect of abnormal BG on remission status.&#x0D; Results Hypoglycemia, a combination of hypoglycemia and hyperglycemia, hyperglycemia, as well as euglycemia, were experienced by 9, 7, 6, and 14 subjects, respectively. Nutritional status was found to be a significant risk factor for abnormal BG. There was no significant difference in remission status at the end of induction phase chemotherapy between the euglycemic group and abnormal BG groups (P=0.533).&#x0D; Conclusion Abnormal BG during induction phase chemotherapy did not affect remission status at the end of induction phase. Undernourishment is also found to be a predisposing factor in abnormal BG.

A randomized masked pilot clinical trial to compare the efficacy of topical 1% voriconazole ophthalmic solution as monotherapy with combination therapy of topical 0.02% polyhexamethylene biguanide and 0.02% chlorhexidine in the treatment of Acanthamoeba keratitis.

To compare the efficacy of topical voriconazole 1% and the combination therapy of 0.02% polyhexamethylene biguanide (PHMB) and 0.02% chlorhexidine for the treatment of Acanthamoeba keratitis (AK). This is a prospective, pilot, double-masked randomized comparative study. Twenty-three eyes of 23 patients with microbiologically (smear and/or growth on culture) confirmed AK were randomized to group BG (PHMB 0.02% and chlorhexidine 0.02%) or group VZ (voriconazole 1%). Primary outcome measure was change in geometric mean (GM) of the corneal ulcer size at final visit. Secondary outcome measures were change in visual acuity. Out of 71 patients with confirmed AK seen during study period, 23 patients were recruited and 18 patients completed minimum 2 weeks of treatment and further analyzed. Ten patients received BG, whereas eight received VZ. Median ulcer size measured as GM of infiltrate decreased from 5.7 mm (IQR, 5.3-6.5 mm) (p = 0.02) to 1 mm (IQR, 0-4.3 mm) in group BG and from 4.5 mm (IQR, 1.8-5.1 mm) (p < 0.05) to 0.7 mm (IQR, 0-1.6 mm) in VZ group. Median visual acuity improved from 1.79 (IQR, 1.48-2.78) to 1.10 (IQR, 0.48-1.79) in BG group (p = 0.02) and from 1.60 (IQR, 1.00-2.78) to 0.80 (IQR, 0.48-1.30) in VZ group (p = 0.18). These outcomes suggest that topical VZ as a monotherapy in AK treatment is effective and comparable to BG combination therapy but needs trials with larger sample size and longer follow-up to provide conclusive evidence.

Comparison of Dexmedetomidine and Dexamethasone as Adjuvant to Bupivacaine in Supraclavicular Brachial Plexus Block

Objective: Brachial plexus block is one of the commonly used anesthetic technique for upper limb procedures in orthopedics. A number of drugs have been used as adjuvants to local anesthetic agents, to prolong the duration and enhance the quality of the block. Some of these are clonidine, dexmedetomidine, ketamine, dexamethasone and magnesium sulfate. We conducted this study to evaluate dexmedetomidine and dexamethasone with respect to the onset and duration of sensorimotor block. Their effects on hemodynamic parameters as well as duration of analgesia after surgery were also recorded. Study Design: Prospective Randomized controlled design. Settings: Anesthesia, ICU and pain management department of Services Hospital/SIMS, Lahore Pakistan. Duration: From 15th September 2019 till 15th March 2020. Methodology: Sixty patients fulfilling the inclusion criteria were enrolled in the study after taking informed written consent for upper limb procedures under supraclavicular brachial plexus block. These patients were divided into two groups BD and BG with 30 patients in each group. Patients in Group BD received 32ml of 0.375% bupivacaine (30 ml) with 100microgram of dexmedetomidine(2ml). Group BG patients received 32ml of 0.375% bupivacaine(30ml) with 8mg of dexamethasone (2ml). The onset and duration of sensory and motor block, time to request for first rescue analgesic and hemodynamic changes in both groups of patients were recorded. Results: The results of our study revealed that the patients in group BD had earlier onset and longer duration of sensory and motor block with minimal hemodynamic changes. Conclusion: Dexmedetomidine is superior to dexamethasone as an adjuvant, in terms of rapid onset and prolonged duration of sensorimotor block and postoperative analgesia after supraclavicular block, with minimal hemodynamic changes.

In vivo biocompatibility of silicon dioxide nanofilm used as antimicrobial agent on acrylic surface.

the focus ofthis study was to testthe hypothesisthatthere would be no difference betweenthe biocompatibility of silicon dioxide nanofilms used as antimicrobial agents. Sixty male Wistar rats were divided into 4 groups (n=15): Group C (Control,Polyethylene), Group AR (Acrylic Resin), Group NP (Acrylic Resin coated with NP-Liquid), Group BG (Acrylic Resin coated with Bacterlon).the animals were sacrificed with 7,15 and 30 days and tissues analyzed as regardsthe events of inflammatory infiltrate, edema, necrosis, granulation tissue, mutinucleated giant cells, fibroblasts and collagen. Kruskal-Wallis and Dunn tests was used (P<0.05). Intense inflammatory infiltrate was shown mainly in Groups BG and AR, with significant difference from Control Group inthe time interval of 7days (P=0.004). Necrosis demonstrated significant difference between Group BG and Control Group (P<0.05) inthe time intervals of 7 days. For collagen fibers,there was significant difference betweenthe Control Group and Groups AR and BG inthe time interval of 7 days (P=0.006), and between BG and Control Groups inthe time intervals of 15 days (P=0.010).the hypothesis was rejected. Bacterlon demonstratedthe lowest level, and NP-Liquid Glassthe highest level of tissue compatibility, and best cell repair.the coating with NP-Liquid Glass was demonstrated to be highly promising for clinical use.

Uniqueness of Coxeter structures on Kac–Moody algebras

Let g be a symmetrizable Kac–Moody algebra, and Uħg the corresponding quantum group. We showed in [1,2] that the braided Coxeter structure on integrable, category O representations of Uħg which underlies the R-matrix actions arising from the Levi subalgebras of Uħg and the quantum Weyl group action of the generalized braid group Bg can be transferred to integrable, category O representations of g. We prove in this paper that, up to unique equivalence, there is a unique such structure on the latter category with prescribed restriction functors, R-matrices, and local monodromies. This extends, simplifies and strengthens a similar result of the second author valid when g is semisimple, and is used in [3] to describe the monodromy of the rational Casimir connection of g in terms of the quantum Weyl group operators of Uħg. Our main tool is a refinement of Enriquez's universal algebras, which is adapted to the PROP describing a Lie bialgebra graded by the non-negative roots of g.

A multivariate approach to the diagnosis of gastrointestinal infection in ewes

Diagnosing the effects of helminth infections is an efficient way to manage the problem in ruminant production systems. Selection of animals in a flock that are infected with Haemonchus has traditionally involved differential packed cell volume measurements (PCV), and in recent years, the FAMACHA© system has been used. However, few small analytical changes have been made. The objective of this study was to examine the influence of different diagnoses linked to packed cell volume (PCV) and FAMACHA© system scores in native ewes, using a multivariate approach. Ewes were classified into three categories according to their score in the FAMACHA© system (FS) and their packed cell volumes (PCV) as follows: Group AG (FS between 1 and 2 and PCV ≥ 30%); Group BG (FS score of 3 and PCV between 21 and 29%); Group CG (FS between 4 and 5 and PCV ≤ 20%). The animals were evaluated using performance characteristics, parasitological examinations, blood values and serum biochemistry. The data show that the use of a multivariate approach for different diagnoses using the FAMACHA© system and PCV measurements gives similar results, although they have particular pathophysiological indicator patterns.