Reliable Option Research Articles

Reversal of Direct Oral Anticoagulants (DOACs) for Critical Bleeding or Urgent Procedures

The advent of direct-acting oral anticoagulants (DOACs) has transformed the care of patients requiring prevention and treatment for thrombotic disease. Many randomized clinical trials have demonstrated the efficacy and safety of these agents and their comparative advantages over conventional anticoagulants such as vitamin K antagonists (VKAs). While historically clinicians and patients raised questions about the reversal of DOAC-associated bleeding, federal approval in recent years of targeted DOAC reversal agents, along with adjunctive modalities, has given clinicians reliable pharmacologic options. Yet, optimal reversal strategies for bleeding at specific anatomic locations and in specific clinical scenarios remains uncertain. We present here a narrative review of the literature on the reversal of DOAC-associated bleeding or for urgent procedures. The totality of the reversal literature synthesized here yields several clear conclusions: (1) targeted DOAC reversal with specific agents demonstrates superior efficacy for both bleeding and urgent surgical indications when compared to the use of non-specific agents, such as prothrombin complex concentrates (PCCs); (2) at the same time, high-quality data suggest potentially increased thrombotic risks, particularly for ischemic stroke, when using the specific targeted agent andexanet; (3) in all cases of life-threatening bleeding, timely reversal is of the essence; (4) in particular, there is growing consensus that DOAC-associated intracranial hemorrhage (ICH) should be reversed promptly, with a goal door-to-reversal time of 60 min; (5) future research will focus on optimizing clinical pathways for reversal to address “calls to action” from professional groups on this critical topic.

Toughened Bamboo-Fiber-Modified Epoxy Resin: A Novel Polymer Coating for Superior Interfacial Compatibility

Epoxy resin is regarded as a reliable option for coating advanced materials owing to its outstanding strength, adhesion, and stability. However, its relatively weak toughness compared to common materials has limited its application. In this study, the toughness of epoxy resin was enhanced by incorporating bamboo fibers, and a novel polymer coating material for bamboo-fiber-reinforced epoxy resin was developed. Different fiber pretreatment methods were employed to address the issue of poor interfacial performance between bamboo fibers and epoxy resin, aiming to optimize its performance as an advanced material coating. The effects of curing agents, fiber mesh sizes, fiber contents, and fiber pretreatment methods on the mechanical properties of the fiber-modified resin composites were investigated. The findings indicate that the JH45 and T31 curing agents were more effective in promoting the homogeneous dispersion of fibers within the epoxy resin. Additionally, bamboo fibers modified with KH550 exhibited enhanced interfacial properties: the tensile strength of the composite demonstrated a respective increase of 31.1% and 27.0% compared to untreated fibers. Increasing the mesh size proved advantageous for improving tensile properties, albeit potentially impacting the compressive properties. Particularly noteworthy was the significantly enhanced interfacial compatibility between bamboo fibers treated with the silane coupling agent KH550 and the epoxy resin. Analysis using Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), and X-ray diffraction (XRD) revealed that treating bamboo fibers with sodium hydroxide effectively enhanced bonding at the fiber–resin interface. This enhancement was attributed to the combined effects of bamboo fiber hydrolysis and delamination reactions. The silane coupling agent promoted the chemical reaction between bamboo fibers and epoxy resin through grafting, thereby strengthening the cross-linking property of the composites. These findings offer valuable insights into the design and fabrication of natural-fiber-reinforced polymer composites suitable for coating advanced materials.

Venoocclusive erectile dysfunction: up-to-date review and clinical guide

Erectile dysfunction (ED) is one of the most frequently reasons for patient presentation in the urological practice. Despite fundamental progress in the understanding of ED pathophysiology, there are some vascular forms of ED where the diagnostic and therapeutic pathway is not clear (cavernous venous insufficiency).What is the right procedure when venous leakage is suspected? How important are venous ligation surgery and radiological interventions?Narrative literature review of the available sources on cavernous venous insufficiency.The reasons for venous cavernous insufficiency are heterogenous. The most effective and reliable therapy option is penile prothesis implantation. Venous ligation surgery or radiological interventions are not reliable options, because of the risk of recurrence.Patients with venous cavernous insufficiency are candidates for penile prosthesis implantation. In this group of patients, vascular interventions may be performed as options for clinical study.

Buccinator myomucosal neurovascular Island flap: anatomic cadaveric study and clinical experience.

Utilization of peninsular buccal flaps for primary cleft palate repair is well-documented in the literature. However, there is no report on the application of an island flap for primary cleft palate repair. This study aims to reveal the clinical application of an axial neurovascular propeller buccinator myomucosal flap. An anatomical study was performed by injection into the buccal pedicle of twenty-two fresh hemifacial cadavers. Additionally, we analyzed palatal healing and flap outcomes in twenty-five primary cleft palate reconstructions utilizing thirty-six pedicled propeller flaps. Cadaver study: the mean buccal artery diameter was 1±0.3 mm, the neurovascular pedicle entered the flap 11.4±2.9 mm anterior to the pterygomandibular raphe (1/6 th the length of the flap), and the buccal artery advanced inside the flap as much as 66.8%±6.0% of the total flap length. Clinical experience: all reconstructions were performed using a modified Furlow palatoplasty. Mean age of patients was 15.3 months and mean maximum cleft width was 11.7 mm. Eleven cases utilized bilateral flaps. The flap always reached the contralateral pillar, and the buccal nerve was always preserved. 11.11% flaps (4/36) underwent scar revision, and 5.56% flaps (2/36) were lost. Follow-up period was 11.3 months. This study suggests the utilization of axial neurovascular pedicled propeller buccinator myomucosal flaps is a safe and reliable option in primary cleft palate reconstruction. Our anatomical dissections and clinical outcomes reveal the consistent and robust nature of buccal neurovascular pedicle, and our modified surgical technique allows for preservation of the buccal nerve.

Campus Heaven: AI-Powered Student Accommodation and Services Hub

The growing demand for student accommodations has led to inefficiencies in finding reliable housing near educational institutions. "Campus Heaven" aims to bridge this gap by leveraging AI and ML to provide a seamless accommodation and service hub for students. This paper explores the need, architecture, methodologies, and implementation details of the proposed system. The system integrates machine learning for sentiment analysis on reviews, an AI chatbot for assistance, and a comprehensive services module for student necessities. Key findings indicate that the platform improves user satisfaction by offering reliable service options and fostering community interaction among students. However, challenges related to user adoption and data privacy are noted. Future enhancements could include expanding service offerings and improving community engagement features

Diverse Applications of Saphenous Vein Graft in Oral and Maxillofacial Reconstruction.

The greater saphenous vein (GSV) is widely used as an autologous graft in reconstructive surgeries, particularly in coronary artery bypass grafting and peripheral vascular interventions. This study explores the applicability of the GSV as a valuable graft option in oral and maxillofacial reconstructions, focusing on complex head and neck cases. Given the unique anatomic challenges of these areas, including proximity to vital structures and the need for extensive tissue resection, the GSV serves as an effective conduit in reconstructive strategies. This article provides a detailed overview of the typical GSV harvesting technique and presents case studies demonstrating the diverse applications of GSV grafts, including mandibular defect reconstruction, replacement of the internal jugular vein after radical neck dissection, and maxillary reconstruction after oncologic resection. The discussion addresses common anatomic and technical considerations, such as variable GSV diameters, vessel size mismatches, and donor site morbidity. A number of advanced anastomotic techniques is evaluated to address graft-recipient vessel discrepancies, ensuring optimal outcomes. Emphasizing careful patient evaluation and precise surgical techniques, this study concludes that the GSV is a reliable autogenous graft option, extending its versatility to challenging head and neck reconstructions. Preoperative anatomic assessment through Doppler analysis, patient consultation, and meticulous graft handling are essential to optimize graft function and minimize complications.

Retrograde Femoral Lengthening Below a Total Hip Arthroplasty.

Limb length discrepancy (LLD) after total hip arthroplasty (THA) is a common occurrence and can lead to back pain, disordered gait, and decreased functional outcomes. Femoral lengthening ipsilateral to a THA using a retrograde motorized intramedullary lengthening nail (MILN) is a hip-sparing option for limb equalization. There has been little published on the technique and results of this method. We retrospectively reviewed all patients at our institution who underwent unilateral femoral lengthening using a retrograde MILN ipsilateral and distal to a THA between April 2016 and June 2022. We describe the technique and considerations for this procedure in detail and report the patient demographic variables, etiology and magnitude of LLD, concomitant deformity, knee range of motion, time to union, and all adverse events and complications. Eleven lengthening procedures were included in this cohort. Etiology for LLD included osteonecrosis (4); postinfection (3); and one each of post-trauma, congenital deficiency, hip dysplasia, and iatrogenic discrepancy secondary to the index THA procedure. The mean lengthening was 35.7 ± 14.7 mm (range 20 to 70 mm) with a lengthening index of 1.5 ± 1.2 months until union per cm of lengthening. Complications included two patients who required reamed exchange nailing to achieve union and one interprosthetic fracture treated with removal of the MILN and plate fixation. No adverse effects on THA function were documented. Femur lengthening using a retrograde MILN ipsilateral to a THA is a safe and reliable hip-sparing option for post-THA limb length equalization.

The 'Checklist of Leisure, Interests and Participation': A contemporary leisure checklist.

The Modified Interest Checklist (MIC) is a tool used by therapists to understand past and present occupational engagement, however, is now outdated and lacks contemporary occupations. The aim of this study was to develop an updated valid and reliable checklist tool inclusive of contemporary leisure activities for clinical practice. The study consisted of four phases, including feedback in relation to the MIC, two phases of development of an updated tool, and occupational therapists' opinions on the tool. There was no consumer or community involvement in the development of this manuscript. More than 50% of participants in phases I and II expressed a need for a contemporary leisure inventory with specific detail to the inclusion of modern activities such as video games. An updated tool was developed, the 'Checklist of Leisure, Interests and Participation' (CLIP). The CLIP presents as a valid and reliable option for leisure profile assessment. Findings suggest that this tool could be used for assessments within mental and physical health services. The Modified Interest Checklist (MIC) is a commonly used occupational therapy tool used to assess people's leisure and interests. The tool was created in 1982 and is outdated for modern activities that people like to do in their spare time. This tool is typically used to understand what activities people like, dislike, and would like to do. This study aimed to develop and update the tool that includes contemporary activities such as social media and video games. The study included four online surveys in total. The first survey explored participants views of whether the MIC included modern activities that people like to do. A second survey was developed with a new tool called the Checklist of Leisure, Interests and Participation (CLIP) and asked people for feedback. More than 50% of the respondents from survey one and two indicated a need for an updated tool. A third survey gained further feedback on the CLIP. The final survey explored occupational therapists' perspective on whether the tool could be used with patients. The tool was viewed as suitable for patient use in Australian by occupational therapist and would be beneficial to understand people's leisure interests. This tool could be used by occupational therapists who work with adults in a range of settings such as mental and physical health settings. The surveys were collected online through social media, which could limit the variety of interests from the people who responded to the survey. This study provides information on how people like to spend their time. Further research is required to understand how occupational therapists can use this tool in more practice settings.

Effects of denosumab and zoledronic acid on postmenopausal osteoporosis, bone density, and fat-free mass.

Denosumab (DMAB) and zoledronic acid (ZOL), which are strong antiresorptive agents, are used to treat osteoporosis in postmenopause. Nonetheless, the data on their comparative efficacy in drug-naïve patients remain limited. Our research compared the therapeutic efficacy of DMAB and ZOL in drug-naïve postmenopausal Korean women with osteoporosis. In total, 120 women were enrolled and equally divided to the DMAB and ZOL groups. The bone density and biochemical parameters of the patients were monitored over 3years. Furthermore, the changes in fat-free mass (FFM), which comprises muscle mass, were assessed by bioelectric impedance analysis. Baseline characteristics, including age, BMI, and the prevalence of fractures, were similar between the groups at the onset of the study. Serum 25(OH), calcium and, phosphorus levels and baseline bone mineral density (BMD) were also comparable between the groups. Following 3years of treatment, both groups exhibited a significant increase in BMD versus the baseline value. In particular, BMD increased by 9.7% and 5.1% at the lumber spine and total hip, respectively, in the DMAB group, versus increases of 7.1% and 4.4%, respectively, in the ZOL group. The increase in FFM was greater in the DMAB group. BMI-adjusted FFM decreased by 1.3% in the ZOL group, versus an increase of 3.6% in the DMAB group. Conclusively, both DMAB and ZOL are effective antiresorptive agents that improved BMD over 3years in drug-naïve individuals. Moreover, DMAB might represent a more reliable initial option for patients with osteoporosis accompanied by low muscle mass.

Expanded Forehead Flaps Based on the Frontal Branch of the Superficial Temporal Artery: Patterns, Techniques, and Outcomes in Cervicofacial Reconstruction.

The expanded forehead flap based on the frontal branch of the superficial temporal artery (STA-Fbr) is a versatile technique for reconstructing cervicofacial defects. The aim of this study was to summarize STA-Fbr forehead flap harvesting patterns. Between July 2003 and July 2023, 66 patients (43 males) underwent face and neck defect reconstruction using STA-Fbr-based forehead flaps. These were divided into pattern I (vascular-pedicled) and pattern II (cutaneous-pedicled) flaps. Pattern II was subdivided into unilateral (IIa) and bilateral (IIb) cutaneous-pedicled flaps. Pattern IIa flaps were categorized as traditional or scarless based on pedicle location. Of the 66 flaps, 62 survived without perfusion-related complications. There were 10 Pattern I and 56 pattern II flaps (11 traditional IIa, 19 scarless IIa, and 26 IIb). Venous congestion occurred in 3 pattern I and 1 scarless IIa flap. After conservative management, 3 flaps survived; 1 pattern I flap developed distal necrosis. Defects were located in the temporal region, eyebrow, eyelid, nose, cheek, ear, mentum, and neck. Expanders ranged from 50 to 400mL (average: 236mL), with expansion times of 3 to 16 months (average: 5.9mo). Defect dimensions ranged from 3 × 2cm to 27 × 8cm (average: 10.8 × 5.3cm), and flap dimensions ranged from 4 × 3cm to 30 × 9cm (average: 16.3 × 6.6cm). The STA-Fbr-based forehead flap remains a reliable and effective option for cervicofacial defect reconstruction, delivering functional and aesthetic outcomes. Successful surgery requires thorough anatomical knowledge, meticulous flap design, and in-depth patient communication.

A phase II study of anlotinib as first-line maintenance therapy for advanced ovarian cancer.

Anlotinib, a tyrosine kinase inhibitor, has shown encouraging antitumor activity in platinum-resistant/refractory ovarian cancer. The efficacy of anlotinib as maintenance therapy in advanced ovarian cancer remains unclear. Therefore, we designed this study to evaluate the efficacy and safety of anlotinib maintenance therapy following first-line treatment with paclitaxel and platinum-based chemotherapy in advanced ovarian cancer. In this single-arm, phase II clinical trial, patients with newly diagnosed advanced ovarian cancer were received anlotinib monotherapy as maintenance therapy once after a response to platinum-based chemotherapy until tumor progression or intolerable toxicity. The primary endpoint was progression-free survival. From April 2020 to June 2021, 24 patients were enrolled in this study. The median follow-up was 40.17 months (interquartile range, 32.40-47.93 months). Of 21 patients with efficacy value, the median progression-free survival and median overall survival were 15.8 months (95% confidence interval, 6.8-24.8 months) and 43.8 months (95% confidence interval, 25.45-62.15 months). The quality-adjusted progression-free survival was 14.4 months and there were no observed treatment-related deaths or serious treatment-emergent adverse events, demonstrating the safety of anlotinib in maintenance therapy. Anlotinib shows significant potential as a first-line maintenance therapy for advanced ovarian cancer, extending survival and providing a reliable treatment option.

P-1872. Dalbavancin workflow for inpatient discharges: a multidisciplinary model

Abstract Background The role of dalbavancin (DAL) for the treatment of deep-seated infections is of growing interest. The long half-life, extensive tissue distribution, and ease of administration makes it ideal for use in populations that have physical or social barriers to treatment with standard antibiotics for infections such as endocarditis, septic arthritis, and osteomyelitis. A workflow for DAL in high-risk populations has previously not been well described. Our aim is to describe the multidisciplinary approach to DAL on discharge and describe impact on readmissions, length of stay and adherence.Figure 1:Dalbavancin inpatient to discharge workflow Methods A multidisciplinary approach at a tertiary academic healthcare system included nursing, antimicrobial stewardship (ASP), infectious diseases (ID) and addiction medicine (AM) to develop a workflow to identify DAL patients and improve adherence (figure 1). Patients had to be clinically stable with evidence of deep-seated infection from confirmed or strongly suspected Gram-positive organisms with plausible susceptibility to DAL and lack of any reliable oral antibiotic options (feasibility, drug toxicity, drug-drug interactions, resistance, or inability to comply with oral medication due to socioeconomic barriers). DAL had to be recommended by ID or ASP. Patients on buprenorphine (BUP) had their second dose aligned with an AM appointment. Patients were excluded if they left against medical advice prior to DAL, had lack of source control, persistent bacteremia, severe vancomycin allergy, or were discharged to a rehab or skilled nursing facility.Table 1:Patient Demographics Results Seventy patients were treated with DAL; six patients via the AM pathway and 64 via the standard pathway. In total, 57 patients (81.4%) completed the recommended treatment. In patients who had two doses prescribed, there was 67% completion. In total, 1691 hospital days were avoided. There were 14 readmissions, none were due to DAL failure. Two patients experienced anaphylaxis with their 2nd dose. Table 2: Patient Outcomes Conclusion This approach demonstrates that in high-risk populations, DAL can be an effective treatment strategy for invasive infections resulting in high rates of treatment completion. Our data is limited as it does not evaluate outcomes in comparison to standard of care. Disclosures Alexandra Hanretty, PharmD, Abbvie: Advisor/Consultant

Satsuma Orange Tolerance to Spring and Autumn Indaziflam Applications in Georgia

Citrus is a major crop in the SE US, with groves located primarily in Florida, but adapted cultivars have allowed for the expansion of commercial production into the Coastal Plains region of Georgia. Indaziflam, a cellulose biosynthesis inhibiting residual herbicide, controls numerous grass and broadleaf weed species. Research conducted in Georgia from 2020 to 2022 determined the optimal rate and tree response to indaziflam applications. Biannual treatments applied in April and November in established satsuma citrus groves included residual herbicides indaziflam, flumioxazin, diuron, pendimethalin, simazine, and norflurazon. The data indicated no negative impact on tree diameter growth over 30 months after application initiation. Indaziflam provided residual activity in the first year with >80% weed control for bermudagrass and pink purslane and >70% of cutleaf evening primrose, cutleaf geranium, and wild radish. Greater than 69% of weed control was maintained with indaziflam after sequential application for 2 years. All other herbicides provided inadequate residual weed control. Indaziflam PRE applied in citrus groves in Georgia can provide growers with a reliable herbicide option that has been proven to be safe for trees and season-long weed control.

Comparative outcomes of thulium laser enucleation by prostate volume: a three-group analysis from a single-center study in Vietnam

sPurposeTo evaluate the impact of prostate volume on the safety and efficacy of Thulium Laser Enucleation of the Prostate (ThuLEP) in treating benign prostatic enlargement (BPE) across different prostate volume groups.Materials and MethodsThis prospective study included 92 BPE patients who underwent ThuLEP, stratified into three groups based on prostate volume: Group A (< 50 ml), Group B (50–80 ml), and Group C ( >80 ml). Preoperative and postoperative functional outcomes, intraoperative parameters, and complications were analyzed and compared among the groups. Statistical analysis was performed using IBM SPSS Statistics 27.ResultsOperative time significantly increased with prostate size (Group C: 105 ± 32.74 min vs. Group A: 71.45 ± 33.87 min, p < 0.001). Enucleation time per ml of prostate tissue was most efficient in Group C (0.98 ± 0.55 min/ml, p < 0.001). Postoperative improvements in IPSS, Qmax, QoL, and PVR were significant across all groups, with no notable differences among the groups at 6 months (p > 0.05). The overall complication rate was low (11.96%), with major complications (Clavien-Dindo grade II or higher) accounting for only 6.52%. No significant differences in complication rates were observed among the groups.ConclusionsThuLEP demonstrated excellent safety and efficacy in treating BPE, regardless of prostate size. Larger prostates required longer operative times but achieved comparable functional outcomes with low complication rates. These findings support ThuLEP as a reliable and versatile surgical option for a wide range of prostate volumes.

Selective use of ferumoxytol-enhanced magnetic resonance angiography in patients with renal insufficiency: insights from a pilot study.

The use of conventional contrast agents in computed tomography (CT) and magnetic resonance (MR) imaging is often limited in patients with chronic kidney disease (CKD) due to potential nephrotoxicity. Ferumoxytol, originally developed for iron supplementation, has emerged as a promising alternative MR contrast agent that is safer for patients with CKD. This study aims to present our center's experience with ferumoxytol as a contrast agent in CKD patients. We retrospectively reviewed 24 MR imaging studies of the chest, abdomen, and pelvis performed in CKD patients at our center. All patients were deemed suitable for ferumoxytol administration, receiving a dose of 4mg/kg with post-injection monitoring. The imaging quality of the ascending, descending, suprarenal and infrarenal aortic segments was assessed by three independent observers using a qualitative scoring system (nondiagnostic, poor vascular definition, good vascular definition, and excellent vascular definition). Quantitative analyses, including signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and heterogeneity index, were also performed. No adverse reactions to ferumoxytol were observed. Of the 72 vascular segments evaluated, 90.8% of the images were rated as excellent vascular definition, and 9.2% were rated as good vascular definition. Inter-observer agreement was substantial (k = 0.647), with no statistically significant differences in ratings between observers. Ferumoxytol is a safe and effective alternative to conventional contrast agents for MR vascular imaging, particularly in patients with renal insufficiency. These findings support its selective use in appropriate clinical scenarios, offering a reliable imaging option for CKD patients.

DIEP flap reconstruction for sacrectomy defects: Two case reports.

Vertical rectus abdominis myocutaneous (VRAM) flap is the most common option for large sacral defect reconstruction but is known to have donor-site abdominal morbidity compared to deep inferior epigastric perforator (DIEP) flaps. Fifty-seven and 63 year-old men were admitted for large sacral soft tissue defects after tumour excisions. They both underwent an inferiorly based pedicled vertical DIEP flap passed transabdominally with successful postoperative outcomes and not any abdominal wall complication. Since the introduction of perforator flaps, using DIEP flap allows reducing donor-site complication rate. These two cases are the first DIEP flaps in sacral defects coverage suggesting DIEP flap may be a reliable option with superiority due to low donor-site morbidity compared to the gold standard VRAM flap.

Retrospective Long-Term Survival Rate and Clinical Performance of Zirconium Oxide Restorations over the Past 5 Years: A Comparative Study Between Single Crowns and Fixed Dental Prostheses

Background and Objectives: This five-year retrospective study evaluated the survival and clinical performance of 1143 zirconium oxide restorations, including both monolithic (144) and layered (999) restorations. Materials and Methods: The analysis included clinical records and follow-up data of patients treated with zirconium oxide restorations. Failures in layered restorations were examined, particularly focusing on chipping caused by unsupported feldspathic ceramic exceeding 1.5 mm. Monolithic restorations were used as a benchmark for durability. Results: The results demonstrated a high overall survival rate of 96.3%, with monolithic restorations achieving a perfect survival rate of 100%, while layered restorations had a survival rate of 95.8%. Failures in the layered restorations were primarily associated with chipping, especially when the unsupported feldspathic ceramic exceeded 1.5 mm. Conclusions: This finding highlights the importance of maintaining adequate support for the ceramic layer to prevent such complications. Monolithic restorations, in contrast, showed superior durability, with no failures reported, making them a more reliable option for long-term success. These findings emphasize the need for the careful selection of zirconium oxide restoration types based on the clinical context, particularly in cases where durability is critical.

Evaluation of Internal and Marginal Accuracy (Trueness and Precision) of Laminates Using DLP Printing and Milling Methods.

This study evaluated the internal and marginal accuracy (trueness and precision) of zirconia laminate veneers fabricated using the DLP printing and milling method, employing 3D analysis software program. The maxillary central incisor tooth of a typodont model was prepared by a dentist and scanned using a desktop scanner. An anatomical zirconia laminate was designed using computer-aided design (CAD) software and saved in a standard tessellation language (STL) format. Thirty zirconia laminates were manufactured using a milling machine (MLL group) and a DLP printer (PTL group). All the specimens were scanned, and their internal and marginal areas were edited accordingly. The root-mean-square value was used to assess the accuracy of the internal and marginal areas of the zirconia laminates. Statistical significance was evaluated using the Mann-Whitney U test. Statistically significant differences were found in RMS values for both groups in the internal and marginal areas (p < 0.001 and p = 0.034, respectively). The MLL and PTL groups differed significantly in terms of precision (p = 0.017), but not at the margin (p = 0.361). DLP-printed zirconia laminates demonstrated stable and consistent performance, making the technique a reliable option for producing esthetic prostheses.

Lateral rectus superior plication using non-absorbable sutures for adult onset esotropia

ABSTRACT Introduction: divergence insufficiency esotropia is a common cause for acquired esotropia and diplopia in adults. We present a novel procedure, superior plication of the lateral rectus using non-absorbable sutures, to address this condition and analyze the surgical outcomes. Methods: This is a retrospective cohort analysis. Adult patients operated on by a single surgeon for adult-onset esotropia between 1/2022 and 6/2023 were included. Demographic and medical histories, as well as measurements of deviation preoperatively and postoperatively were extracted and compared. Intraoperative and postoperative complications were noted. Results: Included were 15 patients with a mean age of 51.1 ± 12.6 years, 67% were female and 67% were myopic. All underwent normal neuroimaging and negative myasthenia work up, and all reported diplopia. On last postoperative follow-up (mean 9.1 ± 6.1 months) only one case had manifest deviation. Overall mean distance deviation decreased from 25.7 ± 11 prism diopters (PD) to 0.16 ± 0.8 PD (p < .001) and near from 19.4 ± 16 PD to 0 ± 0 PD (p < .001). No patients had diplopia or required prisms postoperatively. Suture extrusion was documented in two cases, and one case of pyogenic granuloma was noted and was responsive to topical therapy. Discussion: This study presents a novel surgical procedure for the treatment of adult-onset esotropia. Among consecutive cases operated using the technique, one patient had mild esotropia on follow-up and no patients had diplopia. Minimal postoperative complications were noted, with suture extrusion being the most common. Superior lateral rectus plication appears to be a safe and reliable option for the treatment of adult-onset esotropia.

Pradofloxacin Minimum Inhibitory Concentration Profiling of Streptococcus suis Isolates: Insights into Antimicrobial Susceptibility in Swine.

This study evaluated the minimum inhibitory concentration (MIC) of pradofloxacin against various swine respiratory pathogens, including Bordetella bronchiseptica, Glaesserella parasuis, Mycoplasma hyopneumoniae, Pasteurella multocida, and Streptococcus suis (S. suis), associated with disease in swine. This research was conducted in two phases: the initial phase examined isolates from the lungs that could be either commensal or pathogenic, while the second phase focused on systemic S. suis strains that spread from the respiratory tract to the brain. The pradofloxacin MIC values of the second phase were within the MIC range of the initial phase, with MIC50 and MIC90 values highlighting its potential as an effective antimicrobial agent. Quality control data validated the reliability of our MIC findings, with all pradofloxacin MIC values for control organisms within approved ranges. These findings suggest that pradofloxacin has broad-spectrum activity against Gram-positive and Gram-negative bacteria and may serve as a reliable therapeutic option for managing S. suis and other swine respiratory infections. This study highlights pradofloxacin as an alternative antimicrobial therapy for swine respiratory diseases, offering a potential solution amidst rising concerns over antibiotic resistance.