Normal Width Research Articles

A clinical prospective study on the surgical management of zygomatico-maxillary complex fractures using two-point fixation

The ZMC fractures are one of the most frequently occurring maxillofacial injuries due to its prominence and facial contour. The ZMC forms a principle buttress of face and helps transmit occlusal forces to skull base. Fracture of zygomatic bone leads aesthetic and functional deformity. Restoration to premorbid condition is most predictable by ORIF. In this study was to evaluate efficacy of two-point internal fixation using conventional miniplates and screws for ZMC fractures. 35 patients with established unilateral isolated ZMC fractures were operated using two-point fixation method i.e. the maxillary buttress and the fronto-zygomatic suture, followed up for 3 months. Patients were assessed clinically and radiographically at different follow up intervals. Charts of patients were reviewed for age, gender, etiology, malar height analysis and vertical dystopia. 35 patients in this study, underwent ORIF under GA with two-point fixation. Preoperatively, mean malar height of the patients recorded was 66.55 ± 3.02. There was a significant increase in malar height postoperatively (P < 0.0001). 70.24 ± 2.05, at 1st week, and 69.87 ± 1.98. in 3rd and 6th weeks. Preoperatively, mean vertical dystopia of patients was 2.24 ± 0.71. Postoperative resolution of vertical dystopia was statistically significant (P<0.0001), with value of 0.52 ± 0.52.Integrity of ZMC is important in maintenance of normal facial width and prominence of cheek. Two‑point fixation shows satisfactory results functionally, esthetically and also provides additional advantage by eliminating another surgical site. Thus we conclude that our study provides a basis for further research.

Quantitative characterization and fracture morphology in reservoirs with various lithologies: An experimental investigation

Accurately quantifying the development of hydraulic fractures is pivotal for further elucidating the relationship between reservoir physical properties and hydraulic fracture propagation. In this research, we centered on reservoirs featuring diverse lithologies, procured downhole full-diameter cores, conducted triaxial hydraulic fracturing experiments, and employed CT scanning and electron microscopy to characterize fracture morphology. The primary findings are summarized as follows: sandstones specimens typically exhibit bi-wing fractures inclined at a certain angle to σH, with internal microfractures predominantly comprised of corrugated shear fractures traversing mineral grains. Conversely, conglomerate specimens display a higher prevalence of branching fractures, with fracture zones forming in areas of gravel densities and weak heterogeneous matrices, along with the development of multiple microfractures. Volcanic rock specimens fractures primarily propagate via deflection following NF activation, showcasing two modes of microfracture propagation: through and alongside the NF. Quantitative parameters of fracture morphology indicate that the fractal dimension ranges from 2.02 to 2.08 for sandstone fractures, 2.19 to 2.22 for conglomerate fractures, and 2.11 to 2.13 for volcanic rock fractures. Notably, the NF filler in volcanic rock undergoes erosion by fracturing fluid, accumulating non-uniformly on the surface of rock crystals, thereby augmenting fracture tortuosity. Additionally, the fracture surface area of conglomerates surpasses that of sandstones and volcanic rocks by 1.3 times, with the stripping rate of conglomerate fracture surfaces exceeding 10%. Furthermore, the average normal width of conglomerate fractures surpasses 2 mm, whereas volcanic rock and sandstone measure 1.6 mm and 1.1 mm, respectively. Notably, sandstone fractures exhibit uniform normal width distribution, while conglomerate fractures, especially those around gravels and eroded by fracturing fluid, manifest larger widths. Moreover, NF influenced volcanic rock fractures also exhibit wider widths. Elucidating the quantitative attributes of fracture morphology in lithologically diverse reservoirs holds significant implications for formulating hydraulic fracturing and targeted optimization strategies aimed at enhancing fracturing efficacy.

Prospective measurement of the width of cerebrospinal fluid spaces by cranial ultrasound in neurologically healthy children aged 0–19 months

BackgroundUltrasound (US) is often the first method used to look for brain or cerebrospinal fluid (CSF) space pathologies. Knowledge of normal CSF width values is essential. Most of the available US normative values were established over 20 years ago, were obtained with older equipment, and cover only part of the age spectrum that can be examined by cranial US. This prospective study aimed to determine the normative values of the widths of the subarachnoid and internal CSF spaces (craniocortical, minimal and maximal interhemispheric, interventricular, and frontal horn) for high-resolution linear US probes in neurologically healthy infants and children aged 0–19 months and assess whether subdural fluid collections can be delineated.MethodsTwo radiologists measured the width of the CSF spaces with a conventional linear probe and an ultralight hockey-stick probe in neurologically healthy children not referred for cranial or spinal US.ResultsThis study included 359 neurologically healthy children (nboys = 178, 49.6%; ngirls = 181, 50.4%) with a median age of 46.0 days and a range of 1–599 days. We constructed prediction plots, including the 5th, 50th, and 95th percentiles, and an interactive spreadsheet to calculate normative values for individual patients. The measurements of the two probes and the left and right sides did not differ, eliminating the need for separate normative values. No subdural fluid collection was detected.ConclusionNormative values for the widths of the subarachnoid space and the internal CSF spaces are useful for evaluating intracranial pathology, especially when determining whether an increase in the subarachnoid space width is abnormal.

Biomechanical study of 3D-printed titanium alloy pad for repairing glenoid bone defect.

Background: The purpose of this study was to investigate the effect of 3D-printed technology to repair glenoid bone defect on shoulder joint stability. Methods: The shoulder joints of 25 male cadavers were tested. The 3D-printed glenoid pad was designed and fabricated. The specimens were divided into 5 groups. Group A: no bone defect and the structure of the glenoid labrum and joint capsule was intact; Group B: Anterior inferior bone defect of the shoulder glenoid; Group C: a pad with a width of 2mm was installed; Group D: a pad with a width of 4mm was installed; Group E: a pad with a width of 6mm was installed. This study measured the distance the humeral head moved forward at the time of glenohumeral dislocation and the maximum load required to dislocate the shoulder. Results: The shoulder joint stability and humerus displacement was significantly lower in groups B and C compared with group A (p < .05). Compared with group A, the stability of the shoulder joint of group D was significantly improved (p < .05). However, there was no significant difference in humerus displacement between groups D and A (p > .05). In addition, compared with group A, shoulder joint stability was significantly increased and humerus displacement was significantly decreased in group E (p < .05). Conclusion: The 3D-printed technology can be used to make the shoulder glenoid pad to perfectly restore the geometric shape of the shoulder glenoid articular surface. Moreover, the 3D-printed pad is 2mm larger than the normal glenoid width to restore the initial stability of the shoulder joint.

Sepal shape variability is robust to cell size heterogeneity in Arabidopsis.

How organisms produce organs with robust shapes and sizes is still an open question. In recent years, the Arabidopsis sepal has been used as a model system to study this question because of its highly reproducible shape and size. One interesting aspect of the sepal is that its epidermis contains cells of very different sizes. Previous reports have qualitatively shown that sepals with more or less giant cells exhibit comparable final size and shape. Here, we investigate this question using quantitative approaches. We find that a mixed population of cell size modestly contribute to the normal width of the sepal but is not essential for its shape robustness. Furthermore, in a mutant with increased cell and organ growth variability, the change in final sepal shape caused by giant cells is exaggerated but the shape robustness is not affected. This formally demonstrates that sepal shape variability is robust to cell size heterogeneity.

Parker Solar Probe Observations of Magnetic Reconnection Exhausts in Quiescent Plasmas near the Sun

Parker Solar Probe observations are analyzed for the presence of reconnection exhausts across current sheets (CSs) within R < 0.26 au during encounters 4–11. Exhausts are observed with nearly equal probability at all radial distances with a preference for quiescent Tp < 0.80 MK plasmas typical of a slow-wind regime. High Tp > 0.80 MK plasmas of a fast wind characterized by significant transverse fluctuations rarely support exhausts irrespective of the CS width. Exhaust observations demonstrate the presence of local temperature gradients across several CSs with a higher-Tp plasma on locally closed fields and a lower-Tp plasma on locally open field lines for an interchange-type reconnection. A CS geometry analysis directly supports the property that X-lines bisect the magnetic field rotation θ-angle, whether the fields and plasmas are asymmetric or not, to maximize reconnection rates and available magnetic energy. The CS normal width d cs distributions suggest that a multiscale reconnection process through nested layers of bifurcated CSs may be responsible for observed power-law distributions beyond the median d cs ∼ 1000 km with an exponential d cs distribution present for ion kinetic dissipation scales below this median. Magnetic field shear θ-angles are essentially identical at R < 0.26 and 1 au with medians at θ ∼ 55° near the Sun and θ ∼ 65° at 1 au. In contrast, the tangential flow shear distributions are different near and far from the Sun. A bimodal flow shear angle distribution is present near the Sun with strong shear flow magnitudes. This distribution is modified with radial distance toward a relatively flat distribution of weaker flow shear magnitudes.

MODELLING SPILLWAY FOR FLOOD CONTROL OPTIMIZATION IN EMBANKMENT DRY DAM

Purpose: The primary purposes of this present study are to show and compare 3 (three) different types of spillways, namely normal, differential, and labyrinth, by means of passing exceptional flood events with acceptable safety and margin for the dam and spillway while maintaining a hydraulic safety point of view. Theoretical reference: Ciawi dry dam is a homogenous type of dam with an inclined wet core built in the Ciliwung River, Jakarta, Indonesia. Its purpose is to retain 50 years of floods and cut the peak of floods as part of the Jakarta flood control system. It has been functioning since the year 2022 with another dry dam in the same River basin called the Sukamahi dry dam. Method: The flood control capacity of the dry dam with a spillway and gateless bottom outlets designed at the riverbed level is investigated with an analytical approach using a theoretical formula. Numerous design discharges were verified and compared for specific scenarios engaging the operation of bottom outlets reviewed based on flood control and the safety of the dam. In addition, a spillways type comparison is made for a scenario with one gate opening and one gate closing of the bottom outlet using PMF design discharge to confirm the satisfaction of dry dam outlet capacity. Result and Conclusion: The best design choice that can be recommended for the worst scenario is the Labyrinth spillway with a width of 155m and an angle of 18o while the spillway span width is kept to the same existing normal spillway width. This proposed design improvement option with labyrinth spillway for the PMF flood discharge still has a freeboard of 1.17 m allowance to the crest of the dam in the closed gate condition, 1.88 m of freeboard in 1 gate opened condition, and 2.55 m of freeboard while both gates are opened. Implication of research: This present study evaluates the performance of a dry dam design outlet in flood control by assessing the reservoir capacity to compare the existing built normal spillway with the other types of spillways, namely differential and labyrinth. It will recommend an alternative type of spillway for the Ciawi dry dam or another dam to face global climate change and a future challenge. Originality/value: The comprehensive investigation of the limitations and benefits of comparing 3 different types of spillways: normal, differential and labyrinth, with a combination scenario of 2 gates opening and closing in the embankment type of dry dam. This proposed type of spillway could be used for upgrading works and even for a new dam.

Utilizing peripheral blood inflammatory biomarker (PBIB) to predict response to systemic therapy in patients with breast cancer.

Inflammation is a recognized factor in cancer progression and resistance to treatments. Several studies correlated inflammation-related peripheral blood inflammatory biomarkers (PBIB) to disease progression and poor survival in various cancer types and different populations. Nonetheless, inflammation is affected by the distinctive characteristics and environmental exposure of each population. There is no prior study addressing the association of pre-treatment inflammatory markers with outcomes in patients with breast cancer (BC) from Saudi Arabia. In this study, we evaluated the prognosis of locally advanced breast cancer (LABC) in relation to several PBIB. We retrospectively analyzed the data of female patients with LABC undergoing neoadjuvant chemotherapy (NACT). Demographics, body mass index (BMI), clinicopathologic characteristics and stage of the tumor, follow-up status, and response to treatment were collected. Outcomes were evaluated in relation to pre-treatment peripheral blood indices that were grouped based on the local laboratory cutoff values. Objective response rate (ORR) was predefined and assessed according to the post-NACT magnetic resonance imaging (MRI) breast and subcategorized into complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD). A total of 172 female patients with BC met the eligibility criteria from January 2014 to December 2019. The mean age at diagnosis was 53.4 ± 11, and BMI was 31.2 ± 6. Left BC accounted for 54.7%, and the majority was invasive ductal carcinoma (85.5%), moderately differentiated (51%), stage III (AJCC 8th edition) (73%), and estrogen receptor (ER)-positive tumor (79.1%). Human epidermal growth factor receptor 2 (HER2)-positive BC was reported in 32% and triple-negative breast cancer (TNBC) in 10%. Radiologic CR accounted for the majority of ORR (71.5%). Higher percentage of patients with normal red cell distribution width (RDW) of red blood cell (RBC) and low neutrophil-lymphocyte ratio (NLR) had CR with a significant P value of 0.003 and 0.014, respectively. Among several peripheral blood indices, RDW and NLR significantly influenced ORR. They can be explored further to potentially predict response after systemic therapy in patients with LABC. The great advantage of these biomarkers stems from their availability and affordability in routine clinical practice.

Sudden Sensorineural Hearing Loss from a Jugular Bulb Diverticulum

A 19-year-old woman presented with an 11-month history of sudden-onset left sided hearing loss accompanied by vertigo and headache. Audiometric testing revealed profound left- sided hearing loss. A contrast-enhanced MRI of the internal auditory canal performed 5 months after symptom onset was interpreted as showing a vascular loop, probably the anterior inferior cerebellar artery, abutting and indenting on the left vestibulocochlear nerve; and a prominent and high-riding left jugular bulb. In this study, the internal auditory canals were assessed to be of normal width, with walls that were smooth and sharply defined. A cerebral CT angiogram subsequently performed did not show any abnormal findings related to the previously identified vascular loop. On the basis of these radiologic findings, the patient was advised surgery by physicians at a tertiary- care institution, presumably to address the identified vascular loop. A second opinion was sought by the patient.&#x0D; Review of the MRI initially focused on the axial high-resolution T2-weighted sequence (T2-DRIVE), as the fast spin-echo T2-weighted sequence has been recommended as a reliable and cost-effective MR screening protocol for the detection of masses in the IAC.1 In contrast to the official radiology report, stenosis of the left internal auditory canal by a protrusion (Figure 1, white asterisk) originating from the posteromedial wall of the internal auditory canal was noted. This protrusion, which had no MR signal intensity, appeared to abut and compress the cranial nerves within the IAC. Reconstruction of the images in non-orthogonal planes aligned with the orientation and direction of the left 8th cranial nerve showed the protrusion causing upward compression on and distortion of the nerve. (Figure 2, white arrows)&#x0D; Attention was directed to the axial high-resolution T1-weighted sequence (T1W-3D FFE), which revealed that the protrusion contained an isointense soft tissue structure (Figure 3, white asterisk) located within the petrous bone medial to the posterior semicircular canal. This structure appeared to be an upward extension of the jugular bulb.&#x0D; The axial high-resolution contrast-enhanced T1-weighted sequence (T1W-3D TFE Gd) showed smooth, vivid enhancement of the identified structure (Figure 4, black asterisk), which connected with the sigmoid sinus in lower cuts. This confirmed the presence of a high-riding jugular bulb that encroached on the internal auditory canal.&#x0D; Any doubt as to its true nature was dispelled by a review of the temporal bone structures on high-resolution CT which was fortunately available in the cerebral CT angiogram. This revealed a protrusion of the high-riding jugular bulb with a waist-like margin (Figure 5A and B, black arrows), allowing further characterization of the lesion as a jugular bulb diverticulum.2&#x0D; A high-riding jugular bulb that projects into the middle ear is not an uncommon anatomic variation. On the other hand, a jugular bulb diverticulum, which is an outpouching of the jugular bulb that can extend superiorly, medially, and posteriorly in the petrous bone, is a true venous anomaly that has been described rarely in the medical literature.3,4 When symptomatic, patients with this anomaly can present with sensorineural hearing loss, tinnitus, vertigo and auricular pain.3-5 Proper identification of a jugular bulb diverticulum in the evaluation of a patient with neurotologic symptoms is necessary to avoid inappropriate medical and surgical intervention.&#x0D; As demonstrated in this patient, a jugular bulb diverticulum may not be identified by a screening MRI that utilizes only a T2-weighted sequence. T1-weighted MRI sequences with and without contrast are necessary to demonstrate its soft tissue imaging characteristics. Although not the initial imaging study of choice for sudden sensorineural hearing loss, high-resolution bone-window CT may be necessary to delineate the bony anatomy of the jugular foramen and confirm the presence of this anomaly.

The effects of stance width during barbell hip thrust on power and velocity output among adolescent Silat athletes

Background and Study Aim. In the physically demanding combat sport of Silat, strength and power dominate. Consequently, applying various stance widths during barbell hip thrusts may tailor athletes' lower-body exercises to individual needs. This has the potential to optimize performance. The aim of this study is to investigate the impact on performance of power, speed, and stance width among Silat combat athletes. Material and Methods. Participants performed 10RM tests in three stance widths: wider than shoulder width (WSW), normal shoulder width (NSW), and narrower than shoulder width (NRW). This was done using a 72-hour counterbalance cross-over study design. Power and velocity were measured and analyzed using a mixed ANOVA design. Results. The results indicated a significant main effect of stance width on power (F(2,56) = 3.086, p &lt; 0.05) and velocity (F(2,56) = 3.683, p &lt; 0.03) output. Both males and females demonstrated the highest power in NRW (M = 413.26, SD = 131.76; M = 239.53, SD = 111.16), followed by WSW and NSW. A strong positive correlation between power and velocity was observed for all stance widths: WSW (r(28) = 0.77, p &lt; 0.001), NSW (r(28) = 0.79, p &lt; 0.001), and NRW (r(28) = 0.89, p &lt; 0.001). NRW was associated with superior power production, while WSW facilitated higher velocity. Conclusion. The results of this study demonstrate the importance of considering a variety of stance width techniques during exercise due to their effects on power and velocity during the barbell hip thrust exercise. Coaches can tailor training programs with a velocity-targeted strength and conditioning approach to enhance performance and competitiveness. Further research should investigate different athlete groups and age levels to refine training methodologies.

A candidate of binary black hole system in AGN with broad Balmer emission lines having quite different line widths

ABSTRACT In this paper, a candidate of sub-pc binary black hole (BBH) system is reported in SDSS J1257+2023 through different properties of broad Balmer emission lines. After subtractions of host galaxy contributions, Gaussian functions are applied to measure emission lines in SDSS J1257+2023, leading line width (second moment) 760 km s−1 of broad H β to be 0.69 times of line width 1100 km s−1 of broad H α, quite different from normal line width ratio 1.1 of broad H β to broad H α in quasars. The quite broader component in broad H α in SDSS J1257+2023 can be confirmed with confidence level higher than 5σ through F-test technique, through different model functions applied to measure emission lines. The broad Balmer emission lines having different line widths can be naturally explained by a BBH system with different obscurations on central two independent broad emission line regions. Meanwhile, through Zwicky Transient Facility (ZTF) light curves and corresponding phase folded light curves well described by sinusoidal function, BBH system expected optical quasi-periodic oscillations (QPOs) can be detected with periodicity about 1000 d, confirmed with confidence level higher than 3σ by generalized Lomb–Scargle periodogram. And through Continuous AutoRegressive process simulated light curves, confidence level higher than 2σ can be determined to support the optical QPOs in SDSS J1257+2023 not from intrinsic AGN activities, although the ZTF light curves have short time durations. Moreover, through oversimplified BBH system simulated results, studying different broad Balmer lines as signs of BBH systems in normal quasars with flux ratios around 4 of broad H α to broad H β could be done in near future.

Calculation of normal crack opening width of reinforced concrete beams under bending

When a reinforced concrete beam deflects, a process occurs that leads to the formation of cracks in the stretched area of the wall. In turn, cracks reduce the strength, bearing characteristics of the beam and, accordingly, have a direct effect on the increase in deflection, which worsens the bearing capacity of the entire structure, and leads to an emergency situation. The article considers the calculation of the opening of normal cracks of a reinforced concrete beam according to the methodology presented in SP 52-101-2003, SP 63.13330.2018, with pre-set parameters of the tested loads and strength characteristics of the beam. Keywords: reinforced concrete beam; normal cracks; strength characteristics.

Ultrasonographic Assessment of Normal Achilles Tendon Thickness and Width in the Asymptomatic Sudanese Population

Background: The goal of this study was to measure normal Achilles tendon (AT) thickness and width in adult asymptomatic Sudanese people using high-resolution ultrasound. Methods and Results: The study was conducted on members of a healthy Sudanese population (120 volunteers: 73/60.8% women and 47/39.2% men), who were chosen using simple random sampling. The study cases were all healthy people with no history of AT injuries or abnormalities. All patients were examined using a Toshiba Xairo200 linear transducer with a frequency range of 7-10MHz. All measurements were taken from a transverse scan at the calcaneus bone level of the AT insertion and 2 to 3cm above the calcaneus. The age group 20-27 had the most participants (44.2%), followed by 36-43 years (19.2%), 28-35 years (15.8%), 52-60 years (14.2%), and 44-51 years (6.7%). The study revealed that the mean age of participants was 34.19±12.29 years, height - 164±0.081 cm, weight - 67.22±15.97 kg, and BMI - 24.38±5.84 kg/m2. The mean thickness and width of the AT were 4.36±0.81 mm and 21.85±3.23 mm, respectively, at its insertion into the calcaneus, and 4.63±0.77 mm and 12.20±1.37 mm, respectively, at the level 2-3 cm above the insertion. We found significant differences according to gender between the AT thickness and width at insertion into the calcaneus and above insertion and no statistically significant differences between the AT measurement's right and left side data. Conclusion: The study found gender differences in the AT thickness and width at insertion into the calcaneus and 2-3 cm above the insertion. No statistically significant differences were detected between the AT measurement’s right and left side data.Age, weight, height, and BMI correlated with the thickness and width of the AT at its insertion into the calcaneus and 2-3 cm above. Furthermore, additional research should be conducted using an extended field-of-view technology to measure the length of the AT tendon in the Sudanese population.

Avoidance behaviours while circumventing to the left or right of someone with different shoulder widths and facing directions: How do side, width, or orientation matter?

BackgroundCollision avoidance during locomotion is influenced by a variety of situational factors. When circumventing around an inanimate object, the amount of clearance is dependent on the side of avoidance. When avoiding other pedestrians, individuals most often choose to walk behind a moving pedestrian, and avoid people differently depending on their body size. However, side of avoidance has not been evaluated with human obstacles, nor facing direction of a stationary pedestrian, nor the size of a single pedestrian. Therefore, the aim of this study is to evaluate these knowledge gaps concurrently. Research questionHow do people avoid a collision to the left-side or right-side of a single stationary pedestrian (interferer) of varying shoulder width and orientation? MethodsParticipants (n = 11) walked along a 10 m pathway towards a goal, while a stationary interferer stood 6.5 m from the start. The interferer faced one of three directions relative to the participant (orientation); forward, leftward, or rightward, with either their normal shoulder width or enlarged width created by wearing football shoulder pads. Participants were explicitly instructed as to which side of the interferer to avoid (forced-left vs forced-right). Each participant completed 32 randomized avoidance trials. Centre of Mass separation at the time of crossing was used to examine individual's avoidance behaviours. ResultsResults revealed no effect of interferer width, but a significant side of avoidance effect, where the centre of mass separation between the participant and interferer at the time of crossing was smallest when participants avoided to their left. SignificanceFindings suggest that changing the facing direction or artificially increasing the shoulder width of a stationary interferer will not affect one's avoidance behaviours. However, an asymmetry in side of avoidance is maintained similar to that observed in obstacle avoidance behaviours.

Validation of Inertial Sensors to Evaluate Gait Stability.

The portability of wearable inertial sensors makes them particularly suitable for measuring gait in real-world walking situations. However, it is unclear how well inertial sensors can measure and evaluate gait stability compared to traditional laboratory-based optical motion capture. This study investigated whether an inertial sensor-based motion-capture suit could accurately assess gait stability. Healthy adult participants were asked to walk normally, with eyes closed, with approximately twice their normal step width, and in tandem. Their motion was simultaneously measured by inertial measurement units (IMU) and optical motion capture (Optical). Gait stability was assessed by calculating the margin of stability (MoS), short-term Lyapunov exponents, and step variability, along with basic gait parameters, using each system. We found that IMUs were able to detect the same differences among conditions as Optical for all but one of the measures. Bland-Altman and intraclass correlation (ICC) analysis demonstrated that mediolateral parameters (step width and mediolateral MoS) were measured less accurately by IMUs compared to their anterior-posterior equivalents (step length and anterior-posterior MoS). Our results demonstrate that IMUs can be used to evaluate gait stability through detecting changes in stability-related measures, but that the magnitudes of these measures might not be accurate or reliable, especially in the mediolateral direction.

Single visit root canal treatment versus pulpotomy in management of pulpitis

AimTo clinically and radiographically evaluate single visit root canal treatment (RCT) and pulpotomy in management of mature teeth with irreversible pulpitis.Patients and methodsTwenty-four patients diagnosed with irreversible pulpitis in their mature permanent mandibular molars, were selected and randomly divided into two equal groups according to the treatment protocol either single visit RCT or pulpotomy. For single visit RCT group, ProTaper NEXT rotary system was used for canal preparation and obturation was done using cold lateral condensation technique. While in pulpotomy group, after coronal pulp amputation and hemostasis, Biodentine was used as the pulpotomy agent. The clinical examination of tested groups was performed immediately after completing the procedure (baseline), 3, 6, 9, and 12 months posttreatment. While the radiographic examination using cone-beam computed tomography was carried out at baseline and 12 months postoperatively. Statistical analysis was performed by χ2 test for clinical evaluation criteria and t test for radiographic data.ResultsSingle visit RCT had clinical success rate of 91.67%, while pulpotomy group showed 83.33% success rate. Radiographically, both groups showed normal width of periodontal ligament membrane space and normal bone density after follow-up. There was no statistically significant difference between two groups (P > 0.05).ConclusionsSingle visit RCT and pulpotomy had high success rate in management of mature permanent teeth diagnosed with irreversible pulpitis. Pulpotomy can be considered as an alternative treatment option.

Image-enhanced endoscopy for real-time differentiation between hyperplastic and fundic gland polyps in the stomach.

Fundic gland polyps (FGP) of stomach are benign, while some hyperplastic polyps (HP) may harbor dysplasia or malignancy. Conventional white light endoscopy (WLE) cannot reliably distinguish FGP from HP. We investigated the role of image-enhanced endoscopy in differentiating FGP from HP. Patients with gastric polyps were recruited prospectively. The characteristics of the polyps were assessed using WLE and magnification narrow band imaging (mNBI). The microsurface, intervening space (IS), and microvascular (V) features of polyps were evaluated on mNBI. The pattern characteristic of FGP and HP were determined. Histopathology of polyps was the gold standard for diagnosis. Finally, in the validation phase, five endoscopists applied the characteristic features identified in this study to predict the type of gastric polyp and their performance was assessed. Forty-five patients with a total of 70 gastric polyps (HP-46, FGP-24) were included in this study. On mNBI, the pattern characteristic of HP included peripheral curved type of white structures forming large circular/villous loops (microsurface), enlarged intervening space, and microvessels appearing as dark patches in the intervening space (p<0.001 vs. FGP). These were noted in 95.7% HP. In contrast, 95.8% FGP had a pattern characterized by dotted/elliptical/tubular white structures (microsurface), normal width of intervening space, and microvessels surrounding the white structures in a network pattern. This IS-V pattern classification had an accuracy of >90% in the validation phase with intra-class correlation coefficient of 0.95. The accuracy of mNBI was higher than WLE (97.1% vs. 67%) in predicting the type of gastric polyp. Image-enhanced endoscopy with mNBI (IS-V pattern) performs very well in differentiating HP from FGP.

Novel clinical data on cardiac contractility modulation in NYHA II patients – Results from the MAINTAINED Observational Study

Abstract Background Cardiac contractility modulation (CCM) is an FDA-approved device therapy for patients with medication refractory systolic heart failure and normal QRS width. Pivotal trials have been performed primarily in patients with advanced heart failure (NYHA class III or ambulatory IV). As observed in clinical practice, CCM might also be beneficial in patients with low-grade but persistent heart failure that limits daily activity (NYHA class II). Purpose To facilitate an individualized indication in these patients, we evaluated the long-term effects of CCM in patients with baseline NYHA class II versus baseline NYHA class III or ambulatory IV from our large clinical registry (MAINTAINED Observational Study). Methods CCM effectiveness was measured by changes in functional parameters (i.e., NYHA class, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), NT-proBNP levels, and KDIGO CKD stage). In addition, mortality within 3 years was compared with the prediction of the Meta-Analysis Global Group in Chronic (MAGGIC) heart failure survival risk score. Results 172 patients were included (10% with NYHA class II). Patients with NYHA class III/IV showed a significant improvement in NYHA class over 5 years of CCM (II: 0.1±0.6; p=0.96 vs. III/IV: −0.6±0.6; p&amp;lt;0.0001). In contrast, LVEF improved significantly in each group (II: 4.7±8.3; p=0.0072 vs. III/IV: 7.0±10.7%; p&amp;lt;0.0001; p=0.67 for the comparison of changes between both groups). TAPSE improved significantly only in NYHA class III/IV patients (II: 2.2±1.6; p=0.20 vs. III/IV: 1.8±5.2 mm; p=0.0397). NYHA class II patients had significantly lower NT-proBNP levels at baseline (858 [175/6887] vs. 2632 [17/28830] ng/L; p=0.0044), which was offset under therapy (399 [323/1497] vs. 901 [13/18155] ng/L; p=0.48). KDIGO CKD stage did not experience significant improvement in any group. Actual 3-year mortality was 17 and 26% vs. a predicted mortality of 31 and 42%, respectively (p=0.0038 for NYHA III/IV). Conclusions In clinical practice, CCM was infrequently performed in NYHA class II patients. No significant improvement in NYHA class/dyspnea was observed in these patients over 5 years. Because of the improvement in LVEF, sustainable positive effects on long-term cardiac reverse remodeling might be expected in young patients. Patients with advanced heart failure showed improvements in NYHA class, LVEF, and TAPSE also in clinical practice. Funding Acknowledgement Type of funding sources: None.

Should HFrEF patients with NYHA class II expect benefit from CCM therapy? Results from the MAINTAINED observational study.

Cardiac contractility modulation (CCM) is an FDA-approved device therapy for patients with refractory systolic heart failure and normal QRS width. Randomized trials demonstrated benefits of CCM primarily for patients with severe heart failure (> NYHA class II). To better understand individualized indication in clinical practice, we compared the effect of CCM in patients with baseline NYHA class II vs. NYHA classIII or ambulatory IV over the 5-year period in our large clinical registry (MAINTAINED Observational Study). Changes in NYHA class, left ventricular ejection fraction (LVEF), tricuspid annular plane systolic excursion (TAPSE), NT-proBNP level, and KDIGO chronic kidney diseasestage were compared as functional parameters. In addition, mortality within 3years was compared with the prediction of the Meta-Analysis Global Group in Chronic heart failure risk score. A total of 172 patients were included in the analyses (10% with NYHA class II). Only patients with NYHA class III/IV showed a significant improvement in NYHA class over 5years of CCM (II: 0.1 ± 0.6; p = 0.96 vs. III/IV: -0.6 ± 0.6; p < 0.0001). In both groups, LVEF improved significantly (II: 4.7 ± 8.3; p = 0.0072 vs. III/IV: 7.0 ± 10.7%; p < 0.0001), while TAPSE improved significantly only in NYHA class III/IV patients (II: 2.2 ± 1.6; p = 0.20 vs. III/IV: 1.8 ± 5.2mm; p = 0.0397). LVEF improvement was comparable in both groups over 5years of CCM (p = 0.83). NYHA class II patients had significantly lower NT-proBNP levels at baseline (858 [175/6887] vs. 2632 [17/28830] ng/L; p = 0.0044), which was offset under therapy (399 [323/1497] vs. 901 [13/18155] ng/L; p = 0.61). Actual 3-year mortality was 17 and 26% vs. a predicted mortality of 31 and 42%, respectively (p = 0.0038 for NYHAclass III/IVpatients). NYHA classIII/IV patients experienced more direct and extensive functional improvements with CCM and a survival benefit compared with the predicted risk. However, our data suggest that NYHA classII patients may also benefit from the sustained positive effects of LVEF improvement.

Do the Age of Implantation, the Widths of Internal Acoustic Canal and Bony Cochlear Nerve Canal Affect the Auditory Performance of Primary School Children with Bilateral Cochlear Implants?

Objective:To reveal the correlation between implantation age, the internal acoustic canal (IAC) width, bony cochlear nerve canal (BCNC) width, and auditory performance in primary school children with bilateral cochlear implantation (CI).Methods:Preoperative IAC and BCNC widths of 57 pre-lingually deaf children aged 7–11 years who had previously undergone bilateral CI in our institution were reviewed and cut-off values were calculated. Twenty-four patients who had additional problems and could not attend school and those who refused to participate in the study were excluded. The remaining 33 were invited to the hospital, and their speech perception tests, and language development scores were analyzed (16 of 33 patients had been operated on before the age of 24 months).Results:The cut-off values calculated from the 114 ears of 57 patients were 3.86 mm for IAC width and 1.56 mm for BCNC width. The auditory performances of the 33 patients after CI were not significantly different in the narrow and normal width groups. However, speech perception test results, and language development scores of patients implanted before the age of 24 months were significantly higher.Conclusion:There are some studies showing that children with bilateral sensorineural hearing loss have narrower IAC and BCNC widths. However, we concluded that the widths of the IAC and the bone cochlear nerve canal did not affect auditory performance. We found that implantation age is the single most important determinant of speech-language development after CI.