Significant Mean Decrease Research Articles

Evaluation of anterior segment parameters in pars plana vitrectomy and silicone oil injection

Purpose The aim of this study was to compare the changes in anterior segment parameters induced by pars plana vitrectomy (PPV) and silicone oil injection in phakic and pseudophakic eyes.Patients and methods This is a prospective comparative study that included 40 eyes with rhegmatogenous retinal detachment that underwent vitrectomy and silicone oil injection. They were divided equally into two groups. Group 1 included phakic eyes and group 2 included pseudophakic eyes. Anterior segment parameters were documented by using a CSO Camera (Costruzione Strumenti Oftalmici) before and 1 month after surgery. The changes in the following parameters were compared between the two groups: anterior chamber depth (ACD), anterior chamber volume (ACV), anterior chamber angle (ACA), central corneal thickness (CCT), corneal volume (CV), horizontal anterior chamber diameter, and surgically induced astigmatism.Results At 1 month postoperatively, in group 1, there was a significant decrease in the mean of ACA and ACV as compared with the preoperative values (P=0.024 and 0.011, respectively). In group 2, there was a significant decrease in the 1-month postoperative mean of ACD, ACA, and ACV as compared with the preoperative values (P=0.021, <0.0001 and 0.015, respectively) and a significant increase in the mean of CCT and CV values (P<0.0001 and 0.002, respectively). In group 2, there was more reduction in ACD, less reduction in ACA, and higher increase in CCT and CV as compared with group 1 (P=0.021, 0.001, <0.0001, and 0.023, respectively).Conclusion The presence of the crystalline lens acts as a barrier which decreases the changes in the anterior segment parameters and improves the functional outcome following PPV and silicone oil injection as compared with pseudophakia. Therefore, it may be useful to stabilize the anterior segment in patients with PPV and silicone oil injection.

Rigid bronchoscopic interventions for central airway obstruction - An observational study.

Background:Central airway obstruction (CAO) is a significant cause of morbidity and mortality in patients with thoracic malignancies. In this prospective study, we describe the role of rigid bronchoscopy (RB) in the multimodality management of CAO.Methods:Prospective description of different rigid bronchoscopic techniques used for CAO between July 2016 and July 2019.Results:A total of 152 procedures (124 therapeutic/palliative and 28 diagnostics) in 111 adults and 10 pediatric patients were performed. The mean age in 111 adults (66 males) and 10 pediatric (5 males) patients were 45.4 ± 15.8 (range 16–80) and 5.4 ± 3.6 (range 1–10) years, respectively. Palliation of the airway obstruction (48.8%) and establishment of diagnosis (23.2%) were the main indications of RB in our study. Mechanical debulking in 53 (57%) and airway dilatation in 40 (43%) patients were the most utilized interventions during the palliative or therapeutic RB. There was a significant decrease in mean (modified Medical Research Council) dyspnea scale from 3.9 ± 1.0 to 1.42 ± 0.63 and increase in mean Visual Analogue Scale from 2.06 ± 0.74 to 8.7 ± 0.54 after the procedure (P < 0.0001). Additional therapy was undertaken in 38 (31.4%) of 121 patients, and surgical excision was the primary form of definitive treatment in 17 patients Moderate bleeding was encountered in 13.3% of the procedures mainly in the diagnostic RB. The mean procedure duration was 28.4 (range, 11–49) min and 13.2 (7–22) min in the adults and pediatric patients, respectively. A total of 31 patients succumbed to the illness due to the progressive nature of their disease.Conclusions:An individualized approach to interventional procedures is safe and effective way to achieve and maintain palliation of CAO. RB with multimodality treatment achieves the goal in majority of the patients.

Clinical comparison between topical benzoyl peroxide 2.5% and diclofenac gel 1% versus benzoyl peroxide 2.5% and placebo in the treatment of mild to moderate facial acne vulgaris

The inflammation may play a critical role in the development of facial acne. Pro-inflammatory mediators, such as prostaglandins and leukotriene, have been implicated in the initiation of acne. Objective: This study aimed to evaluate the clinical efficacy and safety of 1% diclofenac gel compare with a placebo gel in the treatment of mild to moderate acne patients in 12 weeks. Methods: A 12 weeks, randomizing, double-blind, individual and split-face comparative trial was conducted in 24 volunteers. Patients with mild to moderate acne vulgaris, aged 18 to 30 years were enrolled. They received 2.5% benzoyl peroxide with 1% diclofenac gel and 2.5% benzoyl peroxide with placebo gel apply regularly at each side of the face. Results: 24 participants with mean (SD) age of 25.92 years were enrolled in the study. Statistically significant decrease in mean of comedone lesions was observed in 1% diclofenac gel group by acne lesion count at week 12 (P <0.05) superior than placebo gel. Moreover, post inflammatory hyperpigmentation also had statistically significant decrease superior to placebo group at week 4. Conclusions: The 1% diclofenac gel topical treatment has shown good clinical efficacy and safety in decreasing facial comedones at week 12 and post-inflammatory hyperpigmentation in 4 weeks

Effect of Implementing Birth Plan on Women Childbirth Outcomes and Empowerment

Background: The birth plan raises women’s knowledge, improves empowerment, and promotes childbirth outcomes. Aim of the study was to implement a birth plan and evaluate its effect on women childbirth outcomes and empowerment. Design: A quasi-experimental comparative design. Sampling: A purposive sample of 194 pregnant women was enrolled and equally allocated into two groups (the intervention group who engaged in a birth plan to receive planned care during childbirth, a control group who received routine hospital care) 97 women each. Setting: The study was conducted at the obstetrics outpatient clinic and in the delivery room of Benha University Hospital. Tools: four tools were used for data collection; A Structured Self-Administration Questionnaire, Birth plan fulfillment sheet, childbirth outcomes sheet, Childbirth related Empowerment Scale. Results: that there were highly significant difference in most items of designed birth plan care during 1st, 2nd and 3rd stage between control and study group (P ≤ 0.001) and there was a significant decrease in mean ± SD of 1st stage duration and the total duration of childbirth stages of the study group comparing to the control group (P ≤ 0.05). Before implementing the birth plan, there was no statistical significance difference between control and study group regarding childbirth-related empowerment scale as (p ˃ 0.05) while after implementation, there were highly statistically significant differences regarding most items of birth-related empowerment scale as (P ≤ 0.001). Conclusion: the birth plan has a higher implementation of designed childbirth care, a positive effect on maternal and fetal outcomes and there was a highly significant increase in the total women`s empowerment scores after implementing birth plan (p<0,001) compared to control group. Recommendation: Raising awareness of healthcare staff of the outpatient clinic, delivery ward to implement birth plan toward increasing childbirth empowerment.

Effect of nurse-led home-based biofeedback intervention on the blood pressure levels among patients with hypertension: Pretest-posttest study.

Aim:To investigate the effect of nurse-led home-based biofeedback intervention on the blood pressure levels among patients with hypertension.Background:Nurse-led interventions are emerging as cost-effective as well as clinically proven in chronic illness management. Hypertension, a leading long-term cardiovascular condition, has autonomic dysregulation and increased sympathetic tone as its pathophysiological background. Complementary interventions evidenced to interplay hypertension pathophysiology.Design:A pretest–posttest design.Materials and Methods:Uncomplicated primary hypertension outpatients were randomly assigned as study group (n = 173) and control group (n = 173) at a tertiary care hospital. Sociodemographic, clinical, and outcome variables [the baseline blood pressure and galvanic skin response (GSR)] were collected. Study group patients were given four teaching sessions of abdominal breathing-assisted relaxation facilitated by GSR biofeedback. Daily home practice was encouraged and monitored to measure the effects on blood pressure and GSR at the end of the 1st, 2nd, and 3rd month of intervention.Results:The study group participants showed significant decrease in mean (SD) systolic [140.77 (8.31) to 136.93 (7.96), F = 469.08] and diastolic blood pressure [88.24 (5.42) to 85.77 (4.66), F = 208.21]. In contrast, control group participants had a mild increase in the mean systolic (F = 6.02) and diastolic blood pressure (F = 4.70) values from pretest to posttests. GSR showed a significant increase from 559.63 (226.33) to 615.03 (232.24), (F = 80.21) from pretest to posttest III.Conclusions:Use of home-based biofeedback-centered behavioral interventions enabled BP reduction among hypertensive patients. Further studies should use biochemical markers of sympathetic nervous system activity to endorse this home-based chronic illness intervention.

Putaminal diffusion tensor imaging measures predict disease severity across human prion diseases.

Therapeutic trials of disease-modifying agents in neurodegenerative disease typically require several hundred participants and long durations for clinical endpoints. Trials of this size are not feasible for prion diseases, rare dementia disorders associated with misfolding of prion protein. In this situation, biomarkers are particularly helpful. On diagnostic imaging, prion diseases demonstrate characteristic brain signal abnormalities on diffusion-weighted MRI. The aim of this study was to determine whether cerebral water diffusivity could be a quantitative imaging biomarker of disease severity. We hypothesized that the basal ganglia were most likely to demonstrate functionally relevant changes in diffusivity. Seventy-one subjects (37 patients and 34 controls) of whom 47 underwent serial scanning (23 patients and 24 controls) were recruited as part of the UK National Prion Monitoring Cohort. All patients underwent neurological assessment with the Medical Research Council Scale, a functionally orientated measure of prion disease severity, and diffusion tensor imaging. Voxel-based morphometry, voxel-based analysis of diffusion tensor imaging and regions of interest analyses were performed. A significant voxel-wise correlation of decreased Medical Research Council Scale score and decreased mean, radial and axial diffusivities in the putamen bilaterally was observed (P < 0.01). Significant decrease in putamen mean, radial and axial diffusivities over time was observed for patients compared with controls (P = 0.01), and there was a significant correlation between monthly decrease in putamen mean, radial and axial diffusivities and monthly decrease in Medical Research Council Scale (P < 0.001). Step-wise linear regression analysis, with dependent variable decline in Medical Research Council Scale, and covariates age and disease duration, showed the rate of decrease in putamen radial diffusivity to be the strongest predictor of rate of decrease in Medical Research Council Scale (P < 0.001). Sample size calculations estimated that, for an intervention study, 83 randomized patients would be required to provide 80% power to detect a 75% amelioration of decline in putamen radial diffusivity. Putamen radial diffusivity has potential as a secondary outcome measure biomarker in future therapeutic trials in human prion diseases.

Assessment of Blood Storage Effect Using CPDA-1 on Packed Cell Volume, Oxyhaemoglobin and Methaemoglobin in Different ABO/Rhesus Blood Types

Aims: The aim of this study is to determine the effect of blood storage using CPDA-1 on packed cell volume, methaemoglobin and oxyhaemoglobin in different ABO/Rhesus blood types donated by some residents of Port Harcourt, Rivers State, Nigeria.&#x0D; Study Design: This is a comparative study aimed at evaluating the effect of storage on the levels of methaemoglobin, oxyhaemoglobin and packed cell volume using CPDA-1. A total of eight donors were recruited with each sample obtained from the eight (8) known blood groups A+,B+,O+,AB+, A-,B-,O-,AB- and analysis of samples were in triplicate. The donors were adult males with age ranging from 35-45 years and they were apparently healthy and free from transfusion transmissible infections. The different blood group samples were stored for 30 days and samples for analysis were collected at 5 days interval.&#x0D; Place and Duration of Study: The study was conducted in Port Harcourt, Rivers State, Nigeria. All blood donors were residents of Port Harcourt. Blood donated was stored at Military Hospital Blood Bank, Port Harcourt, in a blood bag of 450 ml containing 63 ml of citrate phosphate dextrose adenine-1 (CPDA-1). The analysis was carried out at Rivers State University, Post Graduate Laboratory within March 1st to May 27th, 2019.&#x0D; Methodology: A total of eight (8) different ABO/Rhesus blood types (A+,B+,AB+,O+,A-,B-,AB- and O-) were collected and stored using a blood bank refrigerator at temperature of 4°C. Day 0 was taken to be control and 5 days intervals in-between to day 30 acted as the test. Packed cell volume was estimated using micro-haematocrit method while oxyhaemoglobin and methaemoglobin levels were estimated spectrophotometrically as described by Evelyn and Malloy.&#x0D; Results: The result showed a significant decrease in mean packed cell volume, oxyhaemoglobin and methaemoglobin levels compared to a higher mean of these parameters in the control; and these differences were statistically significant (p&lt;0.05) across all blood groups under study. The decrease in values were as a result of haemolysis that occurs during storage.&#x0D; Conclusion: Storage of blood irrespective of the blood group type using CPDA-1 for 30 days indicates that there are “storage lesions”. This is attributed to red cell haemolysis and ageing of red blood cells. In general, all blood types showed no significant difference in their haematological (packed cell volume, methaemoglobin, oxyhaemoglobin) characteristic deterioration or storage lesion based on blood type differences. It is therefore necessary to state that storage lesion characteristics are the same irrespective of the blood type, and that fresh blood be transfused, and if blood is stored, prolonged storage beyond 10 days should be avoided.

Impact of Electrocautery on Fatigue Life of Spinal Fusion Constructs-An In Vitro Biomechanical Study.

Instrumentation failure in the context of spine surgery is attributed to cyclic loading leading to formation of fatigue cracks, which later propagate and result in rod fracture. A biomechanical analysis of the potential impact of electrocautery on the fatigue life of spinal implants has not been previously performed. The aim of this study was to assess the fatigue life of titanium (Ti) and cobalt-chrome (CoCr) rod-screw constructs after being treated with electrocautery. Twelve spinal constructs with CoCr and Ti rods were examined. Specimens were divided into four groups by rod material (Ti and CoCr) and application of monopolar electrocautery on the rods’ surface (control-group and electrocautery-group). Electrocautery was applied on each rod at three locations, then constructs were cyclically tested. Outcome measures were load-to-failure, total number of cycles-to-failure, and location of rod failure. Ti-rods treated with electrocautery demonstrated a significantly decreased fatigue life compared to non-treated Ti-rods. Intergroup comparison of cycles-to-failure revealed a significant mean decrease of almost 9 × 105 cycles (p = 0.03). No CoCr-rods failed in this experiment. Electrocautery application on the surface of Ti-rods significantly reduces their fatigue life. Surgeons should exercise caution when using electrocautery in the vicinity of Ti-rods to mitigate the risk of rod failure.

Developmental temperature affects phenotypic means and variability: A meta‐analysis of fish data

AbstractFishes are sensitive to their thermal environment and face an uncertain future in a warming world. Theoretically, populations in novel environments might express greater levels of phenotypic variability to increase the chance of surviving—and eventually thriving—in the new conditions. Most research on the effect of the early thermal environment in fish species focuses on average phenotypic effects rather than phenotypic variability, but to understand how fishes will respond to rising temperatures we need to consider both the average response of the population, as well as the breadth of individual responses. Here we present the first meta‐analysis on the effects of developmental temperature in fishes. Using data from 43 species and over 6,000 individual fish, we show that a change in developmental temperature induces a significant change in phenotypic means and variability, but differently depending on whether the temperature is increased or decreased. Decreases in temperature (cool environments) showed a significant decrease in phenotypic means and no change in phenotypic variability. Increases in temperature (warm environments) showed a non‐significant increase in phenotypic means and a marginally significant increase in phenotypic variability. Larger increases in temperature saw greater increases in phenotypic variability, but no increase in the mean phenotypic response. Together, our results suggest that fishes exhibit both directed and stochastic developmental plasticity in response to warming temperatures, which could facilitate or accelerate adaptation to a changing environment.

The short-term effects of hydrotherapy on pain and self-perceived functional status in individuals living with osteoarthritis of the knee joint.

BackgroundPeople living with knee osteoarthritis (OA) commonly present with difficulty in walking long distances, ascending and descending stairs or rising from sitting. These functional limitations have been shown to have a negative effect on their overall activities of daily living.ObjectivesThe aim of this study was to determine the effects of a 4-week hydrotherapy programme on measures of pain and self-perceived functional status in individuals living with knee OA.MethodA total of 18 participants with chronic knee OA participated in this study. Participants completed 4 weeks of hydrotherapeutic intervention provided by an independent physiotherapist. Outcome measures for the study included pain assessed using the visual analogue scale (VAS) and self-perceived functional status using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Outcome measures were assessed at baseline and after the 4 weeks of intervention.ResultsThe 4-week hydrotherapy programme resulted in a significant decrease in pain and a significant improvement in self-perceived functional status in all participants. There was a statistically significant mean decrease in VAS scores of 3.72 (± 2.45), p ≤ 0.05, with a 95% confidence interval ranging from 2.506 to 4.938. There was also a statistically significant mean decrease in WOMAC scores of 29.5 (± 15.51), p ≤ 0.05. with a 95% confidence interval ranging from 21.788 to 37.212.ConclusionThis study demonstrated that a 4-week hydrotherapeutic exercise programme results in significantly reduced pain and improved self-perceived functional status in individuals living with knee OA.Clinical implicationsFour weeks of hydrotherapy exercises twice a week in a heated pool can significantly decrease pain and improve functional status in individuals with knee OA.

Beneficial effect of antioxidant therapy on sperm DNA integrity is not associated with a similar effect on sperm chromatin integrity

Background: Sperm DNA damage has been associated with poor reproductive outcomes. While a number of studies have shown that antioxidants may lower sperm DNA fragmentation, little is known about the effect of oral antioxidants on sperm chromatin integrity. The goal was to evaluate the influence of an antioxidant supplement on sperm chromatin and DNA integrity in a cohort of men with idiopathic infertility. Methods: This is a retrospective study of 17 consecutive infertile men treated with an oral antioxidant supplement between May 2016 and November 2017. Sperm DNA fragmentation and chromatin integrity were examined before and 3 months after initiating treatment. Sperm DNA fragmentation was measured by a flow cytometry-based terminal deoxynucleotidyl transferase 2'-deoxyuridine 5'-triphosphate (dUTP) nick end labeling (TUNEL) assay and the results were expressed as DNA fragmentation index (%DFI). Sperm chromatin integrity was assessed by aniline blue (AB) staining and the results expressed as % chromatin damage. Results: It was observed that oral antioxidant therapy was associated with a significant decrease in mean [± standard error (SE)] %DFI (38.6%±1.7% to 26.6%±1.8%, P Conclusions: The data show that infertile men may experience a reduction in sperm DNA fragmentation, but not chromatin integrity after oral antioxidant therapy. This may be explained by the possible interference of antioxidants with the mild oxidative stress (OS) required for induction of sperm chromatin compaction. These data demonstrate the complex nature of sperm chromatin and the variable influence of OS on sperm chromatin targets.

Long-term Patterns of Age-Related Facial Bone Loss in Black Individuals.

Facial skeletal changes that occur with aging have critical importance to the aesthetics of the aging face and the field of facial rejuvenation. Patterns of bony change may differ based on race, but existing research is limited primarily to white or unspecified racial populations. To longitudinally document patterns of facial skeletal change among black individuals. This retrospective case series study evaluated the medical records of patients treated at an urban tertiary medical center and with at least 2 facial computed tomographic (CT) images obtained at least 6 years apart between 1973 and 2017. All patients were self-identified black adults initially aged 40 to 55 years with no history of facial surgery who required repeated facial CT imaging that included the entire midface and cranium. All data analysis took place between August 1, 2018, and October 31, 2018. Facial CT scans were analyzed for 2-dimensional measurements to document changes in glabellar angle, bilateral maxillary angles, frontozygomatic junction width, orbital width, and piriform width. A total of 20 patients were included in our analysis (6 men, 14 women). The patients' mean (SD) initial age was 46.8 (5.8) years, with a mean (SD) follow-up of 10.7 (2.9) years. There was a significant increase in mean (SD) piriform aperture width from 3.24 (0.37) cm to 3.31 (0.32) cm (P = .002) and mean (SD) female orbital width from 3.77 (0.25) cm to 3.84 (0.19) cm (P = .04). There was a significant decrease in mean (SD) frontozygomatic junction width from 5.46 (1.38) mm to 5.24 (1.42) mm (P < .001). No significant differences were found in glabellar angles, maxillary angles, or male orbital width between initial and final imaging time points. This study is the first to our knowledge to document longitudinal bony changes of the face among a population of black individuals. Although significant facial skeletal changes can be observed over an average 10-year period, they are minor in comparison to previously published data among whites. This study suggests that there may be significant differences in facial bony aging between races which may have an impact on the aesthetics of aging and hold implications for facial rejuvenation. NA.

Assessment of Hyaluronic Acid Gel Injection in the Reconstruction of Interdental Papilla: A Randomized Clinical Trial.

BACKGROUND:Various techniques have been implemented to reconstruct the deficient interdental papilla.AIM:The present trial was conducted to assess the effect of injection of hyaluronic acid gel for the reconstruction of deficient interdental papilla.MATERIAL AND METHODS:Thirty-six deficient interdental papilla sites in ten patients were randomly allocated into two equal groups; intervention group who received the injection of hyaluronic acid (HA) gel and control group who received the injection of saline solution as a placebo. Each deficient papilla received three injections. The first injection was given one week following the re-evaluation period (four weeks after performing full mouth supra-gingival scaling and sub-gingival debridement). The second and third injections were given after three and six weeks, respectively. The height and surface area of black triangles were recorded at baseline before the injection procedures. The participants were recalled after three and six months from the first injection for re-measuring the recorded parameters. At 6 months, patients’ satisfaction was also assessed.RESULTS:After three and six months from baseline, the results revealed a statistically significant higher mean decrease in height and surface area of black triangles in favour of the HA group. From three to six months, there was no statistically significant difference between the two groups in both parameters. At 6 months, the HA group showed a statistically significant higher mean satisfaction score than the saline group.CONCLUSION:The use of hyaluronic acid gel for the reconstruction of interdental papillary deficiency was effective with promising levels of patients’ satisfaction.

Observationally constrained aerosol\u2013cloud semi-direct effects

Absorbing aerosols, like black carbon (BC), give rise to rapid adjustments, and the associated perturbation to the atmospheric temperature structure alters the cloud distribution. The level of scientific understanding of these rapid cloud adjustments—otherwise known as semi-direct effects (SDEs)—is considered low, with models indicating a likely negative (−0.44 to +0.1 Wm−2) forcing. Recent studies suggest this negative SDE is primarily driven by decreases in high-level clouds and enhanced longwave cooling. Here, we investigate the SDE using multiple models driven by observationally constrained fine-mode aerosol forcing without dust and sea salt. Unlike aerosol simulations, which yield a relatively vertically uniform aerosol atmospheric heating profile with significant upper-tropospheric heating, observation-based heating peaks in the lower-troposphere and then decays to zero in the mid-troposphere. We find a significant global annual mean decrease in low- and mid-level clouds, and weaker decreases in high-level clouds, which leads to a positive SDE dominated by shortwave radiation. Thus, in contrast to most studies, we find a robust positive SDE, implying cloud adjustments act to warm the climate system. Sensitivity tests with identical average, but vertically uniform observationally constrained aerosol atmospheric heating result in a negative SDE, due to enhanced longwave cooling as a result of large reductions in high-level clouds. Our results therefore suggest that model simulations lead to a negatively biased SDE, due to an aerosol atmospheric heating profile that is too vertically uniform.

Projection resolved optical coherence tomography angiography to distinguish flow signal in retinal angiomatous proliferation from flow artifact.

PurposeTo investigate whether hyperreflective foci (HRF) exhibit flow projection artifact on OCTA, and study the efficacy of commercial projection artifact removal software (PAR-OCTA, Optovue, Inc), and a custom projection resolved OCTA (PR-OCTA) in distinguishing artifacts from true flow in retinal angiomatous proliferation (RAP).MethodsThe study included five eyes with HRF representing pigment migration in dry age-related macular degeneration (AMD), five eyes with leaking treatment-naïve RAP, and ten eyes with diabetic hard exudates. We examined flow signal on OCTA cross-sections using PAR, and performed PR-OCTA to study the effect of increasingly stringent projection removal thresholds. Flow signal intensity was analyzed and quantified using imageJ (NIH, Bethesda, MD, USA), by calculating the percentage of red pixels (R) representing flow, compared to green (G) and blue (B) pixels.ResultsPAR-OCTA cross sections revealed persistent flow signal in all HRF, including RAP, hard exudates and pigment migration. In RAP, PR-OCTA detected intransigent flow, irrespective of the flow removal threshold. Mean R in the five RAP lesions remained higher than mean G and B at the most stringent PR-OCTA threshold (40.96% vs 29.52 and 29.52%, respectively), denoting persistence of flow. In contrast, increasing the PR-OCTA threshold in pigment migration and hard exudates removed the flow signal, with a statistically significant decrease in mean R with increasing threshold. (p = 0.017 and 0.0029, respectively)ConclusionCommercial PAR-OCTA is not completely effective at removing artifactual flow in hard exudates and HRF related to pigment migration. Custom built PR-OCTA, using a sliding scale of threshold, allowed us to distinguish true flow in RAP from artifactual flow in avascular HRF. Further studies are needed to validate the optimum threshold for projection artifact removal, which would preserve true flow in RAP and the small intraretinal capillaries.

THE USE OF PLATELET-RICH FIBRIN COMBINED WITH FREE GINGIVAL GRAFT IN THE MANAGEMENT OF INSUFFICIENT ATTACHED GINGIVA AT TEETH WITH GINGIVAL RECESSION

Aim: This study was carried to evaluate the effect of the placement of PRF membrane beneath the free gingival graft in gingival augmentation surgeries regarding the changes by time in graft horizontal dimension, vertical dimension and total surface area.Subjects and Methods: Sixteen patients were selected. All the patients showed gingival recession with insufficient attached gingiva. The gingival augmentation surgery was decided to be performed as a primary surgery to increase the attached gingiva with no attempt to cover the recession during this study. Group 1 (test group) included eight patients where the gingival augmentation was performed using a free gingival graft in combination with a platelet rich fibrin membrane placed beneath the graft at the recipient site. Group 2 (control group) included eight patients where the gingival augmentation was performed using a free gingival graft only. The graft vertical dimension (GVD) and the graft horizontal dimension (GHD) were measured using William’s graduated periodontal probe. Plaque index, gingival bleeding index and probing depth were used to monitor the oral hygiene status and gingival health condition throughout the study. All the measures were obtained at 2 occasions; the day of the surgery and 1.5 months after the surgery.Results: Regarding the changes in GVD, a statistically significant greater mean and median percent decrease was noted in group 2 after 1.5 month. The same was obtained with the changes in GHD and graft surface area.Conclusion: Using platelet-rich fibrin beneath free gingival graft in gingival augmentation surgery resulted in successful increase in the attached gingiva with less dimensional changes by time in the transplanted free gingival graft compared to using free gingival graft alone.

B-mode and Doppler ultrasonography of cranial epigastric vein in healthy and diseased cows and buffaloes

The study was aimed to examine the right cranial epigastric vein (CEV) using B-mode and Doppler ultrasonography in clinically healthy non-gravid cows (20) and buffaloes (20); bovines suffering from traumatic reticuloperitonitis (15 cows and 20 buffaloes) and reticulo-diaphragmatic hernia (5 cows and 15 buffaloes). The data was statistically analyzed and compared between and within the groups. The Doppler parameters of cranial epigastric vein in healthy bovines showed a significant species difference. The blood flow velocities, peak systole (PS), end diastole (ED), time average maximum (TA max) and time average mean (TA mean) were significantly higher in cows compared to buffaloes. However, the pulsatility index (PI), the resistive index (RI), vessel diameter and the depth of the vein were significantly higher in buffaloes compared to cows. The highest per cent change in the Doppler parameters of cranial epigastric vein in between the healthy cows and buffaloes were recorded in the PI followed by the RI. A significant decrease in PS, ED, TA max, TA mean and blood volume flow/min was recorded in cows suffering from traumatic reticuloperitonitis (TRP) and reticulo-diaphragmatic hernia (RDH). The reduction was more in cows with RDH compared to TRP. The CEV was significantly more superficial in TRP affected cows. The PI of TRP affected cows and the TA mean of RDH affected cows recorded the highest per cent change compared to healthy cows. In buffaloes, only the PS was significantly increased in TRP affected buffaloes and those suffering from RDH. Significant species-specific differences exist in the blood flow parameters of healthy cows and buffaloes. Doppler blood flow parameters of diseased cows suffering from TRP and RDH was more significantly affected compared to that of buffaloes. The database generated for non-gravid crossbred Indian cows and buffaloes can be used as a reference range for further studies.

Immunological recovery in T-cell activation after sustained virologic response among HIV positive and HIV negative chronic Hepatitis C patients.

Rapid decreases in activated CD4+ and CD8+ (HLA-DR + and CD38+ co-expressed) T-lymphocytes have been described within 1-2weeks of initiating direct-acting antiviral (DAA) therapy among chronic Hepatitis C (CHC) patients. However, it is not known whether these changes are maintained past sustained virologic response (SVR), particularly in those who are HIV/HCV-coinfected. We investigated the changes in immune parameters of T-lymphocytes from pre-DAA therapy to post-SVR among HIV negative and HIV positive patients with CHC. Repeated measurements of activated CD4+ and CD8+ T cells were analyzed by flow cytometry at pre-DAA therapy, DAA therapy, end of treatment, SVR, and post-SVR. A general linear model for repeated measurements was used to estimate the mean outcome at each timepoint and change between timepoints. HCV-monoinfected (n = 161) and HIV/HCV-coinfected (n = 59) patients who achieved SVR with DAA therapy were predominately middle aged, male, black, and non-cirrhotic. At pre-DAA therapy, HCV-monoinfected patients had significantly higher CD4+ T cells and CD4+:CD8+ T-cell ratio, while significantly lower CD8+ and activated CD4+ and CD8+ T cells compared to HIV/HCV-coinfected patients (p < 0.0001). HCV-monoinfected and HIV/HCV-coinfected patients had a significant mean decrease from pre-DAA therapy to post-SVR year 1 for activated CD4+ (HCV-monoinfected: 4.8-3.9%, p < 0.0001; HIV/HCV-coinfected: 6.6-4.5%, p < 0.0001) and activated CD8+ T cells (HCV-monoinfected V: 13.8-11.8%, p = 0.0002; HIV/HCV-coinfected: 18.0-12.4%, p < 0.0001). This longitudinal study showed CHC patients treated with DAA therapy had continued decrease of T-lymphocytes from start of DAA therapy to after achievement of SVR suggesting improvement as HCV clearance normalizes activated T-cell phenotype.

Effect of Weight Bearing Exercises on Osteoporosis in Breast Cancer Patients Receiving Chemotherapy

AbstractBackground: Bone is a piezoelectric material and conse-quently, it exhibits the converse piezoelectric effect (mechanical deformation under the influence of an applied electric field).Aim of Study: To evaluate the efficacy of the treadmill weight bearing exercises on Bone Mineral Density (BMD) and T-score mean in cases of osteoporosis in breast cancer patients receiving chemotherapy.Material and Methods: Thirty breast cancer patients receiving chemotherapy and complaining from osteoporosis were randomly divided into two groups. Group (A) received aerobic exercise on treadmill as form of weight bearing exercise 20 minutes 3 times per week for 2 months and drug therapy (vitamin D supplements and calcium). Group (B) received only drug therapy (vitamin D supplements and calcium).Results: The results showed that the treadmill weight bearing exercises and drug therapy application) had a valuable effects more than application of the drug therapy alone in improving on the Bone Mineral Density (BMD) in cases of osteoporosis in breast cancer patients receiving chemotherapy.Conclusion: Application of the treadmill weight bearing exercises and drug therapy had fruitful effects more than application of the drug therapy alone in cases of osteoporosis in breast cancer patients receiving chemotherapy as evidenced by the highly significant decrease in BMD and T-score mean.

A comparative study to assess the modulation of stress by shirodhara in healthy individuals by psychometric and heart rate variability measures

Aim: Psychological stress is one of the risk factors for psychosomatic disorders and Shirodhara has been a standard treatment procedure for many such conditions in Ayurveda. Different liquid media are used for Shirodhara, which has not been explored extensively. In this study, we used heart rate variability (HRV) measures and subjective questionnaires for assessing the effects of Shirodhara with either takra (buttermilk) or jala (water) on psychological stress in normal healthy individuals. Methods: Thirty six healthy male subjects aged between 25-36 years were recruited for this study (2017-18). The recruited subjects were assessed with baseline parameters: Perceived Stress Scale (PSS), Depression, Anxiety, Stress Scale (DASS-21), WHO well-being questionnaire and HRV assessment by recording resting electrocardiogram for 15 minutes. The subjects underwent continuous 5 day Shirodhara with medicated Takra (buttermilk, n=18) or Jala (water, n=18) during evening (3-5:30pm) at the Ayurveda facility. After 5 days, all the parameters were re-assessed. Results: The subjects who underwent Shirodhara with Takra showed significant decrease in heart rate and root mean squared standard deviation (RMSSD). However, the age matched subjects who underwent Shirodhara with Jala did not show statistically significant changes in these parasympathetic parameters in HRV. On psychometric assessments: sleep quality, PSS and WHO well-being scales, subjects in both groups (Takra and Jala) showed significant improvement. DASS 21 scales showed improvement in Takra group only. Conclusions: These results suggest that 5 days of Shirodhara leads to modulation in autonomic balance along with stress reduction and improved well-being, particularly in those who underwent Shirodhara with Takra.