Group-wise Comparisons Research Articles

The natural history of cerebral infundibula: A retrospective cohort study.

Debate exists regarding the true pathogenicity of cerebral infundibula (CI). Pre-aneurysmal lesions and benign anatomical variants have both been proposed. In this study, we present the largest single cohort series on the natural history of CI. Retrospective review of prospective surveillance of 420 CI was undertaken in a single tertiary cerebrovascular centre. All CI diagnosed by a neuroradiologist, diagnosed on either a Magnetic resonance angiography (MRA), Computed tomography angiography (CTA) or Digital subtraction angiography (DSA) were eligible for inclusion. Imaging and demographic characteristics were recorded at baseline. CI growth and aneurysm transformation were the outcomes of interest. Groupwise comparison was conducted via Fischer exact testing. Kaplan Meir curves and Cox proportional hazard ratios were used to assess variables of interest with respect to time on surveillance. 402 patients with 420 CI were surveyed over 2418 infundibula-years. Eleven CI (2.62%) grew on surveillance, and three (0.7%) transformed into aneurysms. Median time to growth was 85 months (36-263) and median time to aneurysm transformation was 112 months (96-142). Of the CI that grew, male sex and CI >2 mm at diagnosis were significant predictors of growth (all p<0.05). Of the CI that grew in surveillance, 2/11 (18.2%) transformed into aneurysms (p=0.001). Aneurysm transformation occurred at a rate of 1.27 per 1000 infundibula years. CI growth on surveillance (p= 0.00016) and size at diagnosis (p=0.038) remained significant predictors of aneurysm transformation on Kaplan Meir curves. The transformation of a CI to an aneurysm occurs at a low rate. A history of growth on surveillance imaging represents significant risk for aneurysm transformation.

A comparative evaluation of the antimicrobial efficacy of triple antibiotic paste, clindamycin, and linezolid as an intracanal medicament against Enterococcus faecalis: An in vitro study

ABSTRACT Aim: The aim of the present study was to evaluate and compare the antimicrobial efficacy of three medicaments, triple antibiotic paste (TAP), clindamycin (CLID), and linezolid (LZ) against Enterococcus faecalis, using spectrophotometry. Methods: Seventy-two single-rooted human premolars were collected and prepared using standard protocol and were decoronated to obtain standardized lengths. A pure culture of E. faecalis (ATCC 29212) was procured, grown on blood agar, obtained using a wired loop, and suspended in brain heart infusion (BHI) broth for 24 h. After contaminating the canals with E. faecalis, the prepared samples were divided into three groups, with 24 teeth each, based on the intracanal medicament used, Group A: TAP (ciplox×500 mg, metrogyl 400 mg, minoz 100 mg) + normal saline (NS), Group B: CLID (capsule clid 150) + NS, Group C: LZ (Lizoforce, dry syrup) + NS. The medicaments were syringed into the roots and which were then incubated. After 24 h, 12 samples per group were thoroughly rinsed for removal of intracanal medicaments (ICMs), and instrumented using #4 GG drill to obtain dentinal shavings, which were allowed to fall into sterile BHI broth. The turbidity of the broth was assessed and the optical density (OD) was recorded using spectrophotometer to estimate the concentration of E. faecalis after 1 day. After a period of 7 days, the remaining 12 samples per group underwent identical processing. Results: At the end of day 1, all three antibiotics presented comparable values of OD indicating comparable antimicrobial efficacy. Group-wise comparison revealed that TAP continued to be superior to the other two antibiotics even at the end of 7 days. However, the difference was significant only between TAP and LZ with no significant difference between TAP and CLID and between CLID and LZ. Conclusion: The present study concludes that the use of single-antibiotic CLID and LZ may serve as an effective alternative to the multidrug combination TAP, as an ICM.

Biomarkers of mitochondrial stress and DNA damage during pediatric catheter-directed neuroangiography - a prospective single-center study.

Neuroangiography represents a critical diagnostic and therapeutic imaging modality whose associated radiation may be of concern in children. The availability of in vivo radiation damage markers would represent a key advancement for understanding radiation effects and aid in the development of radioprotective strategies. Determine if biomarkers of cellular damage can be detected in the peripheral blood mononuclear cells (PBMC) of children undergoing neuroangiography. Prospective single-site study of 27 children. Blood collected pre and post neuroangiography, from which PBMC were isolated and assayed for biomarkers of mitochondrial stress (mitochondrial membrane potential (MMP), reactive oxygen species (ROS), and mitochondrial DNA (mtDNA)) and DNA damage (γH2AX). Dose response of biomarkers vs. radiation dose was analyzed using linear regressions. The cohort was divided into higher (HD) and lower dose (LD) groups and analyzed using linear mixed models and compared using Welch's t-tests. No biomarker exhibited a dose-dependent response following radiation (γH2AX: R2 = 0.0012, P = 0.86; MMP: R2 = 0.016, P = 0.53; mtDNA: R2 = 0.10, P = 0.11; ROS: R2 = 0.0023, P = 0.81). Groupwise comparisons showed no significant differences in γH2AX or ROS after radiation (γH2AX: LD: 0.6 ± 6.0, P = 0.92; HD: -7.5 ± 6.3 AU, P = 0.24; ROS: LD: 1.3 ± 2.8, P = 0.64; HD: -3.6 ± 3.0 AU, P = 0.24). Significant changes were observed to mitochondrial markers MMP (-53.7 ± 14.7 AU, P = 0.0014) and mtDNA (-1.1 ± 0.4 AU, P = 0.0092) for HD, but not the LD group (MMP: 26.1 ± 14.7 AU, P = 0.090; mtDNA: 0.2 ± 0.4, P = 0.65). Biomarkers of mitochondrial stress in PBMC were identified during pediatric neuroangiography and warrant further investigation for radiation biodosimetry. However, isolating radiation-specific effects from those of procedural stress and general anesthesia requires further investigation.

Comparative biochemical analysis of platelet-rich plasma-chitosan and platelet-rich fibrin-chitosan for treating tibial bone defects in rabbits.

Fracture healing can cause serious complications, both preoperatively and postoperatively, including malunion or non-union. Biomaterials can enhance the fracture healing process. This study aimed to compare platelet-rich plasma (PRP)-chitosan and platelet-rich fibrin (PRF)-chitosan on the basis of biochemical parameters for fracture treatment in rabbits. This study involved 12 clinically healthy rabbits. After preparing PRP and PRF, a 3-mm bone defect was created in the tibia of each rabbit. The animals were divided randomly into two groups (A and B). Group A received PRP-Chitosan, and Group B received PRF-Chitosan. Bone healing was assessed using biochemical parameters (calcium [Ca], phosphorus [P], serum alkaline phosphatase [ALP], and osteocalcin [Ocn]) at 2-, 4-, 6-, and 8-week postoperatively. The data were compared using repeated-measures analysis of variance (p < 0.05) with Statistical Package for the Social Sciences statistical software. Group-wise comparison showed no significant differences (p > 0.05) between the groups, except for ALP levels, which were significantly higher in Group B than in Group A (p < 0.05). In the week-wise comparison, there was a significant difference between both groups, as Ca and ALP levels showed significant differences at all weeks postoperatively, whereas Ocn showed a significant difference at 2- and 4-week postoperatively (p < 0.05). However, there was no difference in P levels between the groups at any post-operative week (p > 0.05). Both combinations enhanced bone regeneration. However, PRF-Chitosan is a better combination for bone repair than PRP-Chitosan. There were some limitations of this study, such as a small sample size, only male rabbits were used, and a lack of mechanical testing; these limitations should be addressed in future studies. The insights gained from the present study may open a new approach to the use of a combination of biomaterials for bone healing, which should be further investigated clinically and in other animal models as a future scope.

Associations Between Brain Metabolites Measured With MR Spectroscopy and Head Impacts in High School American Football Athletes.

While changes in brain metabolites after injury have been reported, relationships between metabolite changes and head impacts are less characterized. To investigate alterations in neurochemistry in high school athletes as a function of head impacts, concussion, and the use of a jugular vein compression (JVC) collar. Prospective controlled trial. A total of 284 male American football players, divided into JVC collar and noncollar groups; 215 included in final analysis (age = 15.9 ± 1.0 years; 114 in collar group). 3 Tesla/T1-weighted gradient echo, 1H point resolved spectroscopy, acquired between August and November 2018. Head impacts were quantified using accelerometers. Concussion was diagnosed by medical professionals for each team. Pre- to postseason differences in total N-acetylaspartate (tNAA), total choline (tCho), myo-inositol (myoI), and glutamate + glutamine (Glx), in primary motor cortex (M1) and anterior cingulate cortex (ACC), relative to total creatine (tCr), were determined. Group-wise comparisons were performed using Wilcoxon signed-rank, Friedman's, and Mann-Whitney U tests. Relationships between ∆metabolite/tCr and mean g-force were analyzed using linear regressions accounting for concussion and JVC collar. Significance was set at P ≤ 0.05. In participants without concussion, a significant decrease in tCho/tCr (0.233 ± 1.40 × 10-3 to 0.227 ± 1.47 × 10-7) and increase in Glx/tCr (1.60 ± 8.75 × 10-3 to 1.63 ± 1.08 × 10-2) in ACC were observed pre- to postseason. The relationship between ∆tCho/tCr in M1 and ACC and mean g-force from >80 g to >140 g differed significantly between participants with and without concussion (M1 β ranged from 3.9 × 10-3 to 2.1 × 10-3; ACC β ranged from 2.7 × 10-3 to 2.1 × 10-3). Posthoc analyses revealed increased tCho/tCr in M1 was positively associated with mean g-force >100 g (β = 3.6 × 10-3) and >110 g (β = 2.9 × 10-3) in participants with concussion. Significant associations between in ACC and mean g-force >110 g (β = -1.1 × 10-3) and >120 g (β = -1.1 × 10-3) were observed in the collar group only. Diagnosed concussion and the use of a JVC collar result in distinct neurochemical trends after repeated head impacts. 2 TECHNICAL EFFICACY: Stage 3.

Antigliadin antibodies and the brain in people without celiac disease: a case-control study.

Anti-gliadin antibodies (AGA) occur in approximately 10% of the general population, produced as a response to gluten. Autoimmune gluten-related disorders can have detrimental neurological effects if not properly controlled but the relevance of such "incidental" AGA is not properly established; any harm caused would indicate the gluten-free diet as a means for affected people to protect their brain health. We explored this question by comparing brain MRI scanning, cognitive testing and other measures between healthy volunteers with and without AGA. Healthy volunteers aged 50-70 (without celiac disease, on a gluten-containing diet) underwent blood testing to confirm AGA status. Any AGA+ subjects were matched to AGA- controls on age, sex, BMI, level of education, hypertension diagnosis and smoking history. These subgroups underwent a cognitive test battery, quality-of-life (QoL) surveys and brain MRI scanning. Groups were compared between all outcome measures. Secondary analyses correlated AGA titre with outcomes across the whole cohort. Groupwise comparisons of cognitive, QoL and MRI studies were all negative. Repeating these analyses as correlations with AGA titre across the cohort, a single significant result was found concerning the error rate on the subtle cognitive impairment test, in a direction indicating increased IgG AGA to predict worse performance. This did not survive multiple comparisons correction. Our analysis is the most comprehensive to date and utilises a number of outcome measures known to be sensitive to subtle shifts in neurophysiology and cognition. Incidental AGA does not appear to be associated with any indications of neuropsychological deficit.

Transcriptome profiling reveals the impact of various levels of biochar application on the growth of flue-cured tobacco plants

BackgroundBiochar, a carbon-rich source and natural growth stimulant, is usually produced by the pyrolysis of agricultural biomass. It is widely used to enhance plant growth, enzyme activity, and crop productivity. However, there are no conclusive studies on how different levels of biochar application influence these systems.Methods and resultsThe present study elucidated the dose-dependent effects of biochar application on the physiological performance, enzyme activity, and dry matter accumulation of tobacco plants via field experiments. In addition, transcriptome analysis was performed on 60-day-old (early growth stage) and 100-day-old (late growth stage) tobacco leaves to determine the changes in transcript levels at the molecular level under various biochar application levels (0, 600, and 1800 kg/ha). The results demonstrated that optimum biochar application enhances plant growth, regulates enzymatic activity, and promotes biomass accumulation in tobacco plants, while higher biochar doses had adverse effects. Furthermore, transcriptome analysis revealed a total of 6561 differentially expressed genes (DEGs) that were up- or down-regulated in the groupwise comparison under different treatments. KEGG pathways analysis demonstrated that carbon fixation in photosynthetic organisms (ko00710), photosynthesis (ko00195), and starch and sucrose metabolism (ko00500) pathways were significantly up-regulated under the optimal biochar dosage (600 kg/ha) and down-regulated under the higher biochar dosage (1800 kg/ha).ConclusionCollectively, these results indicate that biochar application at an optimal rate (600 kg/ha) could positively affect photosynthesis and carbon fixation, which in turn increased the synthesis and accumulation of sucrose and starch, thus promoting the growth and dry matter accumulation of tobacco plants. However, a higher biochar dosage (1800 kg/ha) disturbs the crucial source-sink balance of organic compounds and inhibits the growth of tobacco plants.

Cold Hypersensitivity and Sleep Quality: A Cross-sectional Community-based Study

Background: Cold hypersensitivity (CH) and sleep disorders are not limited to patients with specific diseases, as they are also commonly observed in the general population. The objective of this study was to investigate the relationship between CH and sleep quality.Methods: This cross-sectional study analyzed data from a cohort of 5,052 individuals living in South Korea. Based on the results of a questionnaire on CH, the participants were classified into four groups: non-CH, CH in the hands (CHH), CH in the feet (CHF), and CH in the hands and feet (CHHF). Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Multiple regression was used for groupwise comparisons of total PSQI scores and the scores for each component, and logistic regression was used to find the odds ratios of being a “poor sleeper” (PSQI≥8.5).Results: The CHF and CHHF groups showed significantly higher scores than the non-CH group on the overall PSQI as well as on the following sleep components: subjective sleep quality, sleep latency, habitual sleep efficiency, sleep disturbance, and sleep medication use. The odds ratios for being a “poor sleeper” were significant in the CHF (1.84; CI=1.38-2.43) and CHHF groups (1.54; CI=1.25-1.89), but the CHH group did not show any difference from the non-CH group. We identified a correlation between CH in the feet and poor sleep quality.Conclusions: These findings help to elucidate the relationship between sleep and CH and highlight the need to clarify the underlying mechanism.

Infant Feeding Outcomes From a Culturally-Adapted Early Obesity Prevention Program for Immigrant Chinese American Parents

ObjectiveTo examine whether a cultural adaptation of an early childhood obesity prevention program promotes healthy infant feeding practices. MethodsProspective quasi-experimental study of a community-engaged multiphasic cultural adaptation of an obesity prevention program set at a federally qualified health center serving immigrant Chinese American parent-child dyads (N = 298). In a group of historical controls, we assessed early infant feeding practices (breastfeeding, sugar-sweetened beverage intake) in 6-month-olds and then the same practices alongside early solid food feeding practices (bottle weaning, fruit, vegetable, sugary or salty snack consumption) in 12-month-olds. After implementation, we assessed these practices in an intervention cohort group at 6 and 12 months. We used cross-sectional groupwise comparisons and adjusted regression analyses to evaluate group differences. ResultsAt 6 months, the intervention group had increased odds of no sugar-sweetened beverage intake (aOR: 5.69 [95% confidence interval (CI): 1.65, 19.63], P = .006). At 12 months, the intervention group also had increased odds of no sugar-sweetened beverage intake (aOR: 15.22 [95% CI: 6.33, 36.62], P < .001), increased odds of bottle weaning (aOR: 2.34 [95% CI: 1.05, 5.23], P = .03), and decreased odds of sugary snack consumption (aOR: 0.36 [0.18, 0.70], P = .003). We did not detect improvements in breastfeeding, fruit, vegetable, or salty snack consumption. ConclusionsA cultural adaptation of a primary care-based educational obesity prevention program for immigrant Chinese American families with low income is associated with certain healthy infant feeding practices. Future studies should evaluate cultural adaptations of more intensive interventions that better address complex feeding practices, such as breastfeeding, and evaluate long-term weight outcomes.

Evaluation of postoperative pain in endodontic retreatment with apical periodontitis using ozonated 2% chlorhexidine and 0.1% octenidine application: A randomized clinical trial.

This study aimed to evaluate and compare postoperative pain (PP) in single-visit nonsurgical endodontic retreatment (SV NSER) with 2% chlorhexidine (CHX), 0.1% octenidine (OCT) with or without ozone, and 5.25% sodium hypochlorite (NaOCl). In this randomized, parallel, prospective, double-blind, clinical trial, 132 single-rooted, root-filled teeth with symptomatic apical periodontitis (AP) requiring NSER were allocated into six groups randomly (n = 22/group): 2% CHX with NaOCl (CHXH), 2% Ozonated CHX without NaOCl (OCHX), 2% Ozonated CHX with NaOCl (OCHXH), 0.1% OCT with NaOCl (OCTH), 0.1% Ozonated OCT without NaOCl (OOCT), and 0.1% Ozonated OCT with NaOCl (OOCTH). Standard NSER protocol was followed groups were irrigated with 15 ml of ozonated or nonozonated irrigant (CHX/OCT) for 3-5 min with ultrasonic agitation. PP at baseline, after 6, 12, 24, 48 h, and 7 days was recorded using the Visual Analog Scale (VAS). Logistic regression of predictor variables was compared using the Chi-square test. For group-wise and time-wise comparisons, a two-way analysis of variance followed by the post hoc Bonferroni test was carried out. None of the patient-related variables in logistic regression obtained a statistically significant (P > 0.05) role in PP. The VAS score after 6 h was OCHX (4.72) > OOCT (4.42) > CHXH (4.23) > OCTH (3.95) > OCHXH (3.42) > OOCTH (3.21). OOCTH and OCHXH groups demonstrated statistically significant reductions in VAS scores at various time intervals (P < 0.05). SV NSER with ozonated OCT, CHX irrigation, and NaOCl resulted in lesser PP at all time intervals, i.e., 6, 12, 24, 48 h, and 7 days in patients with symptomatic AP.

Incomplete microvascular reperfusion in a swine model of recanalized acute ischemic stroke

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): CONTRAST CONSORTIUM (CVON, Dutch Heart Foundation) Background Incomplete microvascular reperfusion (IMR) could be a detrimental factor impairing regained functionality in stroke patients despite early recanalization. However, the presence of this phenomenon remains to be ascertained. Gyrencephalic large-animal models of acute ischemic stroke (AIS) such as swine are gaining attention as a next step in translation of preclinical to clinical stroke research, with brain anatomy and hemostasis more similar to humans. However, the occurrence and relevance of IMR in swine models of AIS is not well described yet, since most models do not include recanalization. Purpose We aimed to study the presence of IMR after brain ischemia in a translational swine model of AIS. Methods Anesthetized female Yorkshire-Landrace pigs (n=23) underwent craniotomy to occlude the right-sided middle cerebral arteries with aneurysm clips. Clips were released after 1 (n=5), 2 (n=5), and 4 (n=5) hours of occlusion to allow recanalization for 4 hours (recanalized AIS, n=15) or left in place for 8 hours (non-recanalized AIS, n=5). Three animals underwent the craniotomy without vessel clipping (Sham, n=3). 3D angiography was used to confirm occlusion and recanalization. Brains were collected after sacrifice, stained with TTC and then processed for histologic analysis. Infarct size was determined by TTC staining and expressed as percentage of the infarcted hemisphere. Histologic sections of the upper quadrant of the left and right hemispheres were immuno-stained with CD61 to visualize platelet aggregates in the microvasculature. Intravascular platelet aggregates (Figure 2A) were quantified using automated software analysis (Orbit) (CD61+ aggregates/mm2). Results All animals survived until the end of the procedure. Figure 1 shows differences in infarct size depending on the duration of occlusion (p=0.006). Figure 2 depicts an overall higher presence of platelet (CD61+) aggregates in the right hemisphere (infarct) compared to the left hemisphere (intact) (Figure 2B). There was a significant difference in platelet aggregates between left and right hemisphere but groupwise comparison showed only a trend (p=0.075) for more aggregates in the right hemisphere, compared to left, after 4 hours occlusion. Linear regression model could not identify whether infarct size and duration of occlusion were independent predictors of the number of platelet aggregates in the right hemisphere (p=0.191). Conclusions IMR occurs after brain ischemia in a swine model of AIS as a result of microvascular platelet aggregates. Further analysis and experiments are needed to elucidate which predictors can explain intravascular platelet aggregation.Infarct SizePlatelet aggregates

Mitral regurgitation increases systolic strains in remote zone and worsens left ventricular dyssynchrony in a swine model of ischemic cardiomyopathy.

Ischemic mitral regurgitation (IMR) imposes volume overload on the left ventricle (LV), accelerating adverse LV remodeling. In this study, we sought to investigate the impact of volume overload due to IMR on regional myocardial contractile mechanics. Ten Yorkshire swine were induced with myocardial infarction (MI) by occluding the left circumflex coronary artery (LCx). Cardiac MRI was performed at baseline (BL) and 2.5 months (2.5M) post-MI. IMR was quantified with epicardial echocardiography 3 months post-MI. The animals were then assigned to 2 groups: no/mild MR (nmMR, n = 4) and moderate/severe MR (msMR, n = 6). MRI images were analyzed to assess infarction size, end-diastolic and end-systolic volume (EDV and ESV, respectively), ejection fraction (EF), longitudinal strain (LS), circumferential strain (CS), and systolic dyssynchrony index (SDI). The myocardial region was divided into infarction, border, and remote zones based on the LCx-supplied region. There was no difference in the infarction size. Group-wise comparison of LS and CS between BL and 2.5M demonstrated that LS and CS in the infarction zone and the border zone decreased at 2.5M in both groups. However, LS and CS in the remote zone were elevated only in the msMR group (LS: -9.81 ± 3.96 vs. -12.58 ± 5.07, p < 0.01; CS; -12.78 ± 3.81 vs. -16.09 ± 3.33, p < 0.01) at 2.5M compared to BL. The SDI of CS was significantly elevated in the msMR group (0.1255 vs. 0.0974, p = 0.015) at 2.5M compared to BL. Elevated LS and CS in the remote zone were observed in moderate/severe MR and ventricular dyssynchrony. These elevated cardiac strains, coupled with ventricular dyssynchrony, may contribute to the progression of MR, thereby accelerating heart failure.

Interpersonal violence against women and maternity care in Migori County, Kenya: evidence from a cross-sectional survey.

Interpersonal violence (IPV) is an issue of major public health concern, with 24% of Kenyan women reporting physical violence perpetrated by a current husband or partner. IPV has profound impacts on physical and mental health outcomes, particularly for pregnant women; it has been found to increase the risk of perinatal mortality, low birth weight, and preterm birth. This study aims to identify variables associated with IPV and assess the effects of IPV experience on prenatal and peripartum maternal healthcare in Migori County, Kenya. Findings build on a previous study that investigated a smaller region of Migori County. Responses to cross-sectional household surveys conducted in six wards of Migori County, Kenya in 2021 from female respondents aged 18 and older were analyzed. The survey contained validated screening tools for interpersonal violence. Group-wise comparisons, and bivariate and multivariate logistic regression analyses were performed to describe community prevalence, factors associated with IPV against women, and the effect of IPV exposure on prenatal and peripartum health care. This study finds that 2,306 (36.7%) of the 6,290 respondents had experienced lifetime IPV. IPV experience was associated with the age group 25-49 (adjusted odds ratio (aOR) 1.208; 95%CI: [1.045-1.397]; p = 0.011), monogamous marriage [aOR 2.152; 95%CI: (1.426-3.248); p < 0.001], polygamous marriage [aOR 2.924; 95%CI: (1.826-4.683); p < 0.001], being widowed/divorced/separated [aOR 1.745; 95%CI: (1.094-2.786); p < 0.001], feeling an attitude of "sometimes okay" toward wife beating [aOR 2.002 95%CI: (1.651, 2.428); p < 0.001], having been exposed to IPV in girlhood [aOR 2.525; 95%CI: (2.202-2.896); p < 0.001] and feeling safe in the current relationship [aOR 0.722; 95%CI: (0.609, 0.855); p < 0.001]. A depression score of mild [aOR 1.482; 95%CI: (1.269, 1.73); p < 0.001] and severe [aOR 2.403; 95%CI: (1.429, 4.039); p = 0.001] was also associated with IPV experience, and women who experienced emotional abuse were much more likely to have experienced IPV [aOR 10.462; 95% CI: (9.037, 12.112); p < 0.001]. Adjusted analyses showed that having experienced IPV was negatively associated with attending at least four antenatal care visits during the most recent pregnancy (OR 0.849, p = 0.044) and with having a skilled birth attendant (OR 0.638, p = 0.007). IPV is prevalent in Migori County, Kenya, with increased prevalence among women aged 25-49, those residing in West Kanyamkago, those in a monogamous or polygamous marriage, those who have been widowed/divorced/separated, and those with severe depressive symptoms. Further, IPV exposure is associated with lower use of maternal care services and may lead to worse maternal health outcomes. There is need for enhanced effort in addressing social and gender norms that perpetuate IPV, and this study can contribute to guiding policy interventions and community responses towards IPV.

APOE Genotype, ApoE Plasma Levels, Lipid Metabolism, and Cognition in Monozygotic Twins with, at Risk of, and without Affective Disorders.

Background: Lipids influence brain function and mental health. Understanding the role of apolipoproteins in affective disorders could provide valuable insights and potentially pave the way for novel therapeutic approaches. Methods: We examined the apolipoprotein E genotype and ApoE-levels, lipid profiles, and the correlation with cognition in 204 monozygotic (MZ) twins with unipolar or bipolar disorder in remission or partial remission (affected, AT), their unaffected co-twins (high-risk, HR), and twins with no personal or family history of affective disorder (low-risk, LR). Results: The APOE genotype was not associated with affective disorders. No significant group differences in ApoE levels were found between the three risk groups. Post hoc analysis group-wise comparisons showed higher ApoE levels in the AT than HR twins and in the concordant AT twin pairs relative to the discordant twin pairs. Within the discordant twin pairs, higher ApoE levels were observed in the affected twins (AT = 39.4 mg/L vs. HR = 36.8 mg/L, p = 0.037). Limitations: The present study could benefit from a larger sample size. We did not assess dietary habits. Conclusions: The results did not support our main hypothesis. However, exploratory post hoc analysis suggests a role for plasma ApoE and triglycerides in affective disorders. Future research is needed.

399 Infundibulum Study: A Retrospective Analysis of Cerebral Vascular Infundibula. An Analysis on Growth and Its Significance at an Australian Tertiary Neurosurgical Centre

INTRODUCTION: Debate exists regarding the natural history of cerebral infundibula. Pre-aneurysmal lesions and benign anatomical variants have both been proposed. To date there are no large cohort studies defining natural history. METHODS: Retrospective surveillance infundibula were undertaken in a single tertiary cerebrovascular centre. All Infundibula diagnosed on either MRA, CTA or DSA and followed up for 5 years were eligible for inclusion. Radiological and demographic characteristics were recorded at baseline. Infundibula growth, rupture and aneurysmal formation were outcomes of interest. Kaplan Meir curves were used to assess variables of interest with respect to time on surveillance. Groupwise comparison as conducted via Fischer exact testing. RESULTS: 420 cerebral infundibula were followed prospectively, across 402 patients over 2418 infundibula-years. Eleven (2.62%) grew on surveillance, and three (0.7%) formed de-novo aneurysms. Median time to growth was 85 months (36-263) and median time to aneurysm formation was 112 months (96-142). Of the Infundibula that grew, the proportion that were male sex was significant higher compared to those that did not (p &lt; 0.007). Of the Infundibula that grew in surveillance, 2/11 (18.2%) formed aneurysms (p = 0.001). With respect to Kaplan Meir analysis, male sex remained a significant predictor of growth (p = 0.007) and growth on surveillance (p &lt; 0.001) remained a significant predictor of aneurysm formation. CONCLUSIONS: Growing infundibula are high risk of forming aneurysms and warrant ongoing surveillance.

Beat-to-beat cardiac repolarization lability increases during hypoxemia and arousals in obstructive sleep apnea patients.

Obstructive sleep apnea (OSA) is associated with the progression of cardiovascular diseases, arrhythmias, and sudden cardiac death (SCD). However, the acute impacts of OSA and its consequences on heart function are not yet fully elucidated. We hypothesized that desaturation events acutely destabilize ventricular repolarization, and the presence of accompanying arousals magnifies this destabilization. Ventricular repolarization lability measures, comprising heart rate corrected QT (QTc), short-time-variability of QT (STVQT), and QT variability index (QTVI), were calculated before, during, and after 20,955 desaturations from lead II electrocardiography signals of 492 patients with suspected OSA (52% men). Variations in repolarization parameters were assessed during and after desaturations, both with and without accompanying arousals, and groupwise comparisons were performed based on desaturation duration and depth. Regression analyses were used to investigate the influence of confounding factors, comorbidities, and medications. The standard deviation (SD) of QT, mean QTc, SDQTc, and STVQT increased significantly (P < 0.01), whereas QTVI decreased (P < 0.01) during and after desaturations. The changes in SDQT, mean QTc, SDQTc, and QTVI were significantly amplified (P < 0.01) in the presence of accompanying arousals. Desaturation depth was an independent predictor of increased SDQTc (β = 0.405, P < 0.01), STVQT (β = 0.151, P < 0.01), and QTVI (β = 0.009, P < 0.01) during desaturation. Desaturations cause acute changes in ventricular repolarization, with deeper desaturations and accompanying arousals independently contributing to increased ventricular repolarization lability. This may partially explain the increased risk of arrhythmias and SCD in patients with OSA, especially when the OSA phenotype includes high hypoxic load and fragmented sleep.NEW & NOTEWORTHY Nocturnal desaturations are associated with increased ventricular repolarization lability. Deeper desaturations with accompanying arousals increase the magnitude of alterations, independent of confounding factors, comorbidities, and medications. Changes associated with desaturations can partially explain the increased risk of arrhythmias and sudden cardiac death in patients with OSA, especially in patients with high hypoxic load and fragmented sleep. This highlights the importance of detailed electrocardiogram analytics for patients with OSA.

Evaluating a Single Surgeon's Learning Curve for Laparoscopic Totally Extraperitoneal Repair of Inguinal Hernia with Telescopic Dissection: A Cumulative Sum Control Chart Analysis.

Background: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair (IHR) reduces risk of injury to intraperitoneal structures. Balloon dissection is more costly and has theoretical risk of injury to the surrounding structures compared with telescopic dissection (TD). This study aims to evaluate the learning curve (LC) for TEP IHR with TD of a single surgeon. Methods: This is a 3-year retrospective cohort study from January 2020 to December 2022 on patients who underwent elective laparoscopic TEP unilateral IHR with TD. Exclusion criteria were recurrent inguinal hernia. Cumulative sum (CUSUM) analysis was performed to evaluate the number of cases required to surmount the LC, that is, NLC for operating time (OT) and open conversion. One way analysis of variance was used to perform groupwise comparison. Results: There were 69 patients who underwent laparoscopic TEP unilateral IHR with TD. The median age was 58.0 years (range 24.0-80.0) and body mass index was 23.0 (range 18.6-30.0). Majority of the hernia was indirect (n = 48, 69.6%). The median OT was 70 minutes (range 35-210). Three cases (4.3%) had open conversion. One-year recurrence was 4.2% (n = 1/24). CUSUM analysis showed improvement in OT after the eighth case. However, this was followed by multiple inflection points with no apparent stabilization in OT. Pairwise comparison showed a decrease in OT between cases 18-36 and cases 37-54. There was no incidence of open conversion until the 56th case. Conclusion: Laparoscopic TEP IHR using TD is safe in the absence of a practor. A minimum of 36 cases is required to surmount the initial LC.

Impact of diabetes mellitus and other systemic diseases on oral health and tooth mortality.

Poor oral health in systemically diseased individuals besides worsening the glycaemic status also has functional, social consequences such as masticatory inefficiency and stigmatized social participation, respectively. Periodontal problems remain one of the most common reasons for tooth mortality along with tooth decay and trauma. The study was conducted in the outpatient department of teaching dental institution among the individuals visiting the institution. Persons with systemic illness were included in the study. In the preliminary step, interviews were conducted among the study participants regarding health status followed by an oral health examination. The oral health examination included recording of community periodontal index and dentition status. Data were collected and statistical analyses were performed. Chi-square test, one-way ANOVA and Bonferroni post-hoc tests were used to analyze the data. Patients with diabetes showed the highest (3.56 ± 2.98) number of missing teeth, followed by other systemic diseases (2.78 ± 2.74), and the patients who were not having any systemic diseases (1.81 ± 1.54). This distinction was found to be statistically significant (P = 0.001), and Bonferroni post-hoc shows statistical significance (P < 0.05) in group-wise comparisons. The number of teeth last due to caries among diabetics was higher (20.8%) when compared to nondiabetic (12.2%), and the most tooth loss due to periodontitis was also observed within the patients with diabetes (21%) when compared to patients with other systemic diseases (12%), which is statistically significant (P = 0.001). The current study revealed tooth loss is more common in the patients who have systemic diseases when compared to the patients who do not have any systemic diseases, while dental caries and periodontal problems are the principle causes of tooth mortality.

Global citrus root microbiota unravels assembly cues and core members.

Citrus is one of the most important fruit crops worldwide, and the root-associated microbiota can have a profound impact on tree health and growth. In a collaborative effort, the International Citrus Microbiome Consortium investigated the global citrus root microbiota with samples collected from nine citrus-producing countries across six continents. We analyzed 16S rDNA and ITS2 amplicon sequencing data to identify predominant prokaryotic and fungal taxa in citrus root samples. Comparative analyses were conducted between root-associated microbial communities and those from the corresponding rhizosphere and bulk soil samples. Additionally, genotype-based group-wise comparisons were performed to assess the impact of citrus genotype on root microbiota composition. Ten predominant prokaryotic phyla, containing nine bacterial phyla including Proteobacteria, Actinobacteria, Acidobacteria, and Bacteroidetes and one archaeal phylum (Thaumarchaeota), and multiple fungal phyla including Ascomycota and Basidiomycota were identified in the citrus root samples. Compared with the microbial communities from the corresponding rhizosphere and bulk soil samples from the same trees, the prokaryotic and fungal communities in the roots exhibited lower diversity and complexity but greater modularity compared to those in the rhizosphere. In total, 30 root-enriched and 150 root-depleted genera in bacterial community were identified, whereas 21 fungal genera were enriched, and 147 fungal genera were depleted in the root niche compared with the rhizosphere. The citrus genotype significantly affected the root prokaryotic and fungal communities. In addition, we have identified the core root prokaryotic genera comprising Acidibacter, Allorhizobium, Bradyrhizobium, Chitinophaga, Cupriavidus, Devosia, Dongia, Niastella, Pseudomonas, Sphingobium, Steroidobacter and Streptomyces, and the core fungal genera including Acrocalymma, Cladosporium, Fusarium, Gibberella, Mortierella, Neocosmospora and Volutella. The potential functions of these core genera of root microbiota were predicted. Overall, this study provides new insights into the assembly of microbial communities and identifies core members of citrus root microbiota across a wide geographic range. The findings offer valuable information for manipulating root microbiota to enhance plant growth and health.

Multisensory Hallucinatory Experiences in Migraine: A Preliminary Basis for Olfactory, Somatic-Tactile, and Gustatory Auras.

Visual auras in migraine have been extensively studied, but less is known about unusual experiences in other sensory domains, including whether they should be diagnostically considered as part of aura symptoms. This study aimed to examine the prevalence of multisensory aura experiences in migraine and their phenomenologic and clinical correlates. Respondents were 729 participants with probable migraine, who completed an online study examining unusual sensory experiences. These comprised aura experiences in the auditory, visual, olfactory, somatic-tactile, and gustatory domains. Basic demographic and clinical information and migraine symptomatology were also collected. To facilitate groupwise comparisons, participants with probable migraine were divided into those with and without (visual) aura experiences. Endorsement of visual aura experiences was the highest (42.1%), whether in a single modality (44.2%) or multiple (55.8%) modalities, followed by somatic-tactile (32.0%), gustatory (21.9%), olfactory (18.6%), and auditory (11.0%) domains. Phenomenologic similarities, for instance, in frequency, personification, and controllability, existed across sensory domains. Somatic-tactile and gustatory auras conversely exhibited greater duration and negative emotional valence. Participants with probable migraine with visual aura tended to report significantly more severe migraine symptoms relative to those with nonvisual or no aura. Our findings provide preliminary indication that unusual olfactory, somatic-tactile, and gustatory experiences in migraine are common and could be clinically significant as aura symptoms. Increased clinician and patient awareness and effective management of these symptoms are essential for a holistic therapeutic approach to migraine.