Incidence of Mortality and Its Relation to Comorbidity in Ludwig's Angina: A Retrospective Study.

Introduction: Ludwig's angina is a serious life-threatening infective condition of maxillofacial region due to odontogenic origin which is clinically diagnosed by its clinical signs and symptoms. Airway management and early surgical decompression is the main stay of management. The mortality rates in Ludwig's angina remains multivariate. There is a paucity in literature regarding the mortality rates of this disease. Aim and Objectives: Aim of this retrospective study is to describes the characteristics, probable cause of death and mortality rates of patients with co-morbidities presenting to the emergency department (ED) who were subsequently admitted with a primary diagnosis of Ludwig's angina. Materials and Method: Study was conducted in the department of maxillofacial surgery in a tertiary care teaching hospital from Jan 2011 to Dec 2022. Data of 17 patients who were clinically diagnosed as Ludwig's angina were included in the study. The comorbidity, source of odontongenic cause, mode of intubation and the outcome of the disease were evaluated. Result: Comparison of categorical variables was done using Fishers exact test. A p-value of <0.7 was considered statistically significant. The results suggested that Out of 17 patients 12 patients (70.5%), 7 male and 5 females had comorbidities and four cases (23.5%) had complication of death, all having co-morbidities. Summary: It concludes that associated comorbidity has a significant role in progress and outcome of the disease and incidence of death is more common in cases having associated comorbidity.

Osteomyelitis and Pathologic Fracture of Mandible in Undiagnosed Osteopetrosis.

Osteopetrosis (OP) is a heterogeneous group of rare, heredity bone disorders with variable clinical features involving the bones of the body. OP is characterized by increased bone density, which is caused by aberrant osteoclast-mediated bone resorption. This syndromic disorder comes with a series of problems and, unless recognized and treated early, can lead to a multitude of further grave complications. We report a rare case of a female patient who reported chronic unhealed extraoral draining sinus present over the left submandibular region with pathologic fracture of the left mandibular angle, which, if, was diagnosed early with the identification of the osteopetrosis syndrome, could have been managed more conservatively.

Histopathological Interpretation of TMJ Osteophyte: Report and Review.

Introduction: Osteophytes are osseocartilaginous structures which are commonly found in common degenerative joint diseases. It can be free or attached to nature. There is a paucity of information in the literature regarding the histopathological interpretation of osteophytes in Temporomandibular Joint (TMJ). Purpose: To report the incidental finding of osteophytes in cases of chronic protracted TMJ dislocation. Material and Method: To present case of an elderly 72-year-old female and a 35-year-old male with chronic protracted TMJ dislocation who were treated surgically for their condition with an incidental finding of an osteophyte in TMJ intraoperatively. Result: The histopathological examination revealed fibrocartilaginous core tissue surrounded by bone formation due to dystrophic calcification. Conclusion: The microscopic examination is mandatory in order to study and understand the pathophysiology of an osteophyte. This study presents rare histopathological evidence of an osteophyte. It reflects the process of its formation and the possibilities of fate of an osteophyte in TMJ.

The first probe of a FLASH proton beam by PET.

The recently observed FLASH effect related to high doses delivered with high rates has the potential to revolutionize radiation cancer therapy if promising results are confirmed and an underlying mechanism understood. Comprehensive measurements are essential to elucidate the phenomenon. We report the first-ever demonstration of measurements of successive in-spill and post-spill emissions of gammas arising from irradiations by a FLASH proton beam. A small positron emission tomography (PET) system was exposed in an ocular beam of the Proton Therapy Center at MD Anderson Cancer Center to view phantoms irradiated by 3.5 × 1010protons with a kinetic energy of 75.8 MeV delivered in 101.5 ms-long spills yielding a dose rate of 164 Gy s-1. Most in-spill events were due to prompt gammas. Reconstructed post-spill tomographic events, recorded for up to 20 min, yielded quantitative imaging and dosimetric information. These findings open a new and novel modality for imaging and monitoring of FLASH proton therapy exploiting in-spill prompt gamma imaging followed by post-spill PET imaging.

Theileria orientalis Buffeli pathotype in cows in a theileriosis-endemic region of India.

Oriental theileriosis caused by Theileria orientalis is a growing health concern of lactating cows in its endemic areas. Rapid and sensitive diagnostic tests are demand areas for appropriate and effective prophylactic and therapeutic measures. Quantitative polymerase chain reaction (qPCR) is the answer for both detection and quantification of parasites. Present study deals with qPCR for detection of parasitemia level of T. orientalis in apparently healthy and clinically affected cows. Major piroplasm surface protein (MPSP) gene present in T. orientalis was cloned in pUC57 vector and transformed into E. coli Top 10 cells. Single and mixed infections of hemoprotozoa other than T. orientalis, causing anemia were differentiated through blood smear examination and PCR tests. T. orientalis was detected in 108 (63.15%) ill and 48 (26.66%) healthy cows. Piroplasms detected per 1000 red blood cells (RBCs) was 0-1 in the healthy group as compared to 3-22 in those showing clinical signs. Parasitemia in ill cows ranged between 6.9 × 102 and 4.5 × 103 parasites / µl of blood which was significantly higher (p<0.05) than healthy group (2.6 × 102 - 5.7 × 102 parasites / µl of blood). Phylogenetic study of the isolates showed similarity with Buffeli type that unfolded its pathogenic form in apparently healthy and ill cows.

The first PET glimpse of a proton FLASH beam.

We demonstrate the first ever recorded positron-emission tomography (PET) imaging and dosimetry of a FLASH proton beam at the Proton Center of the MD Anderson Cancer Center. Two scintillating LYSO crystal arrays, read out by silicon photomultipliers, were configured with a partial field of view of a cylindrical poly-methyl methacrylate (PMMA) phantom irradiated by a FLASH proton beam. The proton beam had a kinetic energy of 75.8 MeV and an intensity of about 3.5 × 1010protons that were extracted over 101.5 ms-long spills. The radiation environment was characterized by cadmium-zinc-telluride and plastic scintillator counters. Preliminary results indicate that the PET technology used in our tests can efficiently record FLASH beam events. The instrument yielded informative and quantitative imaging and dosimetry of beam-activated isotopes in a PMMA phantom, as supported by Monte Carlo simulations. These studies open a new PET modality that can lead to improved imaging and monitoring of FLASH proton therapy.

"Bridging the Breach": Cranioplasties Using Different Reconstruction Materials-An Institutional Experience.

Introduction: Cranioplasty is a time tested surgical procedure to restore the form and function of either congenital or acquired calvarial defects. Both autologous bone flaps and alloplastic substitutes have been surgically explored over time to achieve the pre-morbid contour and eliminate the existing and anticipated complications like the "Sinking flap Syndrome". Though autologous bone flap, if preserved, is generally considered the first choice for reconstruction, however its absence/large defect reconstruction calls for alternative options. The selection of the reconstructive material is governed by various patient factors and material-related issues. The current study is an institutional experience of calvarial reconstruction with different materials. Though the aim of the surgery is always maximum patient comfort and satisfaction, post-operative outcome may vary from case to case. Materials and Method: Patients with calvarial defects post decompressive craniectomy, referred to the Department of OMFS from the Department of Neurosurgery/Neurology at our tertiary care centre, were successfully managed for the same using autologous Bone flap, customized Titanium and PEEK patient specific implant (PSI). Post-op evaluation for aesthetics, ease of adjustment/workability, thermal conductivity and infection/exposure was done at 01 and 06 months. Results: Fifteen patients of cranial defects post decompressive craniectomy were taken up of calvarial reconstruction using autologous Bone flap (n = 5), Titanium (n = 5) and PEEK (n = 5) patient specific implant (PSI). Satisfactory restoration of cranial contour was seen in all cases immediately after surgery. One patient underwent flap necrosis in bone flap group, while thermal conductivity was reported in 2 out of 5 cases of titanium PSI. Ease of workability was relatively low in all cases of PEEK group while increased overall surgical duration was encountered in bone flap group owing to second surgical site in abdomen. Conclusion: A variety of reconstruction materials may be used for cranial contouring depending on the defect and surgeon's experience, however the results may vary from case to case thus mandating tailor-made treatment for each patient.

Kernelized convolutional transformer network based driver behavior estimation for conflict resolution at unsignalized roundabout.

The modeling of driver behavior plays an essential role in developing Advanced Driver Assistance Systems (ADAS) to support the driver in various complex driving scenarios. The behavior estimation of surrounding vehicles is crucial for an autonomous vehicle to safely navigate through an unsignalized intersection. This work proposes a novel kernelized convolutional transformer network (KCTN) with multi-head attention (MHA) mechanism to estimate driver behavior at a challenging unsignalized three-way roundabout. More emphasis has been placed on creating convolution in non-linear space by introducing a kervolution operation into the proposed network. It generalizes convolution, improves model capacity, and captures higher-order feature interactions by using Gaussian kernel function. The proposed model is validated using the real-world ACFR dataset, where it outperforms current state-of-the-art in terms of behavior prediction accuracy and provides a significant lead time before potential conflict situations.

Correlating Nasal Patency with Obstructive Sleep Apnea in Obese Versus Non-Obese Patients: An Acoustic Rhinometry Study.

The aim of this study was to correlate nasal patency with Obstructive Sleep Apnea (OSA) in obese versus non-obese patients using Acoustic Rhinometry (AR). Eccovision® Acoustic Rhinometer equipment was used to compare nasal cross-sectional areas (CSA1,2 & 3 corresponding to nasal valve region, anterior portion of middle & inferior turbinate and posterior portion of middle & inferior turbinate respectively) and volume in age and gender matched sample divided into three groups: Group 1: Non-obese patients without OSA (25 patients, 13 males and 12 females); Group 2: Non-obese patients with OSA (25 patients, 14 males and 11 females); Group 3: Obese patients with OSA (25 patients, 13 males and 12 females). The mean nasal cross-sectional areas and volume were lower in Group 2 compared to Group 1 but statistically non-significant (P value > 0.05 for all). The mean nasal cross-sectional areas and volume were significantly lower in Group 3 as compared to Groups 1 and 2 (P value < 0.05 for all). BMI showed a statistically significant positive (direct) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). The nasal cross-sectional areas and volume showed a statistically significant negative (inverse) correlation with AHI in Groups 2 and 3 (P value < 0.05 for both). OSA diagnosed cases with high BMI may not present with an obvious nasal obstruction; the nasal patency may still be compromised due to reduced nasal lumen secondary to obesity. AR, being cost-effective and non-invasive modality; is advocated to evaluate pre-treatment nasal patency, as well as follow up evaluation to ascertain improvement after the intervention.

Rehabilitation of acquired mandibular defect with two-piece, magnet-retained salivary reservoir.

Resection of large tumors involving mandible is the most common reason for mandibulectomy in patients. Adjunct therapies complicate the clinical situation and advocates innovations in conventional design concepts and treatment protocols. Xerostomia is one of the most common complications arising post-radiotherapy. Incorporation of a salivary reservoir in the design has been frequently used in xerostomia patients using acrylic dentures. The purpose of the article is to highlight a technique and steps in rehabilitation of a large acquired mandibular defect using a two-piece, magnet-retained acrylic removable partial denture with salivary reservoir.

Effect of milking environment enrichment through music on production performance and behaviour in cattle.

Enrichment of milking environment through music has been proposed to help animals to cope with divergent stressors. In sight of the above, a study was conducted to evaluate the effect of Indian instrumental music-based environmental enrichment played in yaman raga on milk production performance and behaviour in cattle. A total of 21 lactating dairy cattle (Vrindavani crossbred cows) having similar parity and stage of lactation were selected in three groups - T1, T2 and T3, each consisting of seven animals. The T1 and T2 groups were exposed to instrumental flute and sitar, respectively, 10 min prior to the start of milking and continued till completion of milking; while the T3 group served as control. Musical enrichment of the environment was done using recorded-tape of flute and sitar was played in yamen raga at 40-60 (dB) decibel intensity. The results revealed a non-significant difference in milk yield, rectal temperature, respiration rate, T3 (triiodothyronine) and T4 (thyroxine) hormones. However, there exhibited a significant (p < 0.05) difference in milking time, milking speed, cortisol hormones and behavioural parameters such as milk let-down in the animals exposed to music compared to the control group. Thus, the results have significant implications relating to the behavioural fitness and welfare of dairy animals and reducing residual milk.

Long-Term Study of Relapse After Mandibular Orthognathic Surgery: Advancement Versus Setback.

Background: Relapse is a continuing process and should be evaluated on a long rather than short term. Materials and Methods: Treatment records of 46 patients who underwent mandibular orthognathic surgery were divided into two groups, i.e. Group 1: Mandibular Advancement (MA) surgery (n = 26) and Group 2: Mandibular Setback (MS) surgery (n = 20). Lateral cephalograms were traced at T0 (01 week before surgery), T1 (01 week after surgery), T2 (01 year after surgery) and T3 (minimum 05 years after surgery) to study short- and long-term skeletal and dental relapse in horizontal, vertical and angular parameters selected for the study. Relapse was correlated with gender, age, amount of surgical movement and intra-operative change in mandibular plane angle to study effect of these factors on relapse. Results: All horizontal, vertical and angular parameters studied showed significant relapse at short term (from T1 to T2) which continued significantly till long-term evaluation (T2 to T3) in both groups (P value < 0.001). Horizontal relapse in all parameters, vertical relapse in all parameters (except Pog and overbite at T1-T2) and angular relapse in all parameters (except Ramus inclination at T1-T2) was significantly higher in Group 2 compared to Group 1 (P value < 0.001 for all). Relapse showed significant and positive correlation with amount of surgical movement and intra-operative change in mandibular plane angle in both groups (P value < 0.05 for all). Conclusion: Both MA and MS surgeries show significant relapse on both short- and long-term evaluation which it is higher in MS as compared to MA surgeries.

Effect of Mandibular Setback Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The changes in length and height of tongue following mandibular setback (MS) surgery may affect pharyngeal airway dimensions. There is limited literature correlating tongue dimensional changes with linear and volumetric airway changes following MS with bilateral sagittal split ramus osteotomy (BSSRO) in skeletal class III patients. MATERIALS AND METHODS: Treatment records of 18 patients who underwent MS with BSSRO were evaluated for changes in tongue and linear airway dimensions, mean airway volume and area at T1 (1-week pre-surgery), T2 (6-month post-surgery) and T3 (2-year post-surgery). Amount of MS was recorded from case sheets of patients. Mean tongue length reduced, whereas mean tongue height increased at T2 compared to T1 (P value = 0.001 for both). Linear, area and volumetric airway parameters at T2 were significantly reduced (P value = 0.001). All parameters showed statistically nonsignificant increase from T2 to T3 (P value > 0.05). Correlation analysis showed that change in tongue length at T3 did not show statistically significant correlation with amount of MS, changes in linear, area and volumetric airway parameters (P value > 0.05). However, the change in tongue height at T3 showed a significant (P value < 0.05) negative correlation (r value = - 0.742) with change in posterior airway space (PAS). CONCLUSIONS: The appraisal of tongue length and height after MS surgery should be an integral part of diagnosis and treatment planning. The retro-positioning of tongue and increase in its height after MS surgery may compromise pharyngeal airway especially PAS. Additional options such as bi-jaw surgery, debulking of tongue volume and genioplasty should be explored to minimize adverse effects post-surgically.

Evaluation of Airway Dimensions Following Mandibular Setback with Surgery-First Orthognathic Versus Conventional Orthognathic Approach.

BACKGROUND: To evaluate changes in airway dimensions following mandibular setback with conventional orthognathic approach (COA) and surgery-first orthognathic approach (SFOA). MATERIALS AND METHODS: Treatment records of 20 patients who underwent mandibular setback with SFOA/COA were divided into two groups (COA and SFOA, ten patients in each group). Acoustic pharyngometry values were obtained at T0 (01 week prior to surgery), T1 (01-month post-surgery) and T2 (01-year post-surgery). Percentage change in mean volume and area was obtained at T1 (T1-T0) to evaluate airway changes and at T2 (T2-T1) to compare relapse of airway changes in both groups. Changes in airway per mm setback at T1 (T1-T0) and T2 (T2-T1) were also obtained in both groups. RESULTS: For both parameters, SFOA showed greater reduction at T1 and greater relapse at T2 as compared to COA. The reduction in airway volume at T1 was 0.56 mm/mm setback in COA compared to 1.06 mm/mm setback in SFOA (P-value > 0.05). The relapse in airway volume at T2 was 0.15 mm/mm setback in COA compared to 0.25 mm/mm setback in SFOA (P-value > 0.05). The reduction in area at T1 was 0.062 mm/mm setback in COA compared to 0.110 mm/mm setback in SFOA (P-value > 0.05). The relapse in area at T2 was 0.016 mm/mm setback in COA compared to 0.034/mm setback in SFOA (P-value < 0.05). CONCLUSION: In setback cases, SFOA has greater airway reduction immediate post-surgically and greater relapse at 01-year follow-up. Predicting these changes at diagnostic and treatment planning stage may prevent potential adverse events on airway.

Failures in cranioplasty - A clinical audit & review.

INTRODUCTION: Cranioplasty, like any other surgical procedure also comes with risk of complications and failure. Failure of cranioplasty may be early or delayed and further can be attributed to the surgical procedure itself or to the reconstruction material used for the procedure. The aim of this clinical audit is to analyze the causes of failure of 14 cases of cranioplasty procedure. MATERIALS AND METHODS: This retrospective study analyses the causes of failure of 14 cases of cranioplasty over 8 â€‹years â€‹at a tertiary care centre and identifies major etiological factors for failure including local and systemic. Further, a correlation between the reconstruction material used for cranioplasty and failure was studied along with other attributable factors such as systemic status of the patient and other local factors. RESULTS: The study established that there exists a correlation between failure and the biomaterial used for reconstruction. Various etiological factors like infection, flap break down, fixation protocol and foreign body were identified along with time frame of failure. After failure of cranioplasty, feasibility of a secondary cranioplasty has also been factored into this study, with 8 out of the 14 cases being successfully re-operated. CONCLUSION: Cranioplasty is a technically demanding and demands certain levels of operator skill levels. While formulating a treatment plan for reconstruction of cranial defects, one has to tailor make a strategy considering several factors such as systemic condition of the patient, status of the cranial surgical site, etiology behind craniectomy, choice of reconstruction material, duration from craniectomy and age of the patient. Inspite of best efforts and ideal reconstruction attempts, failures remain a nagging reality.

Neonatal vascular malformation of parietal bone.

Vascular malformations (VaMs) are congenital lesions and are present at birth. They grow commensurately with age. These lesions often affect the soft tissues with intraosseous involvement of the scalp being rare. Here, we discuss a case of intraosseous VaM in a 2-month-old infant which was involving the parietal bone.

Selection and validation of differentially expressed metabolic and immune genes in weaned Ghurrah versus crossbred piglets.

In the present investigation, differentially expressed genes (DEGs) were studied using RNA sequencing (RNA-seq) technique in porcine peripheral blood mononuclear cells (PBMC) of weaned Ghurrah and crossbred piglets at 3-month age. Transcriptomic analysis was done using three different packages, namely, EBSeq, DESeq2, and edgeR, to identify the DEGs between Ghurrah and crossbred piglets. Total 7717 DEGs were commonly identified by all three packages, out of which 4151 genes found to be up-regulated, and 3566 genes were down-regulated. Functional annotation of these DEGs indicated metabolism as the most commonly enriched category followed by the immune response. Genes related to metabolism and growth were up-regulated in crossbred piglets as compared with Ghurrah piglets, whereas immunity-related genes were up-regulated in Ghurrah piglets elucidating the disease resistance nature of this indigenous breed over crossbred counterparts. Further, eight DEGs, namely, LRP-1, ADCY4, ERRFI1, LDHD, ARG1, OASL, MGARP, and S100A8, were validated by qRT-PCR in a separate set of biological samples and found to be in concordance with RNA-seq results. Finding in the present study provides insight into genes and their molecular mechanisms governing difference in growth performance between Ghurrah and crossbred pigs.

Effect of Mandibular Advancement Surgery on Tongue Length and Height and Its Correlation with Upper Airway Dimensions.

INTRODUCTION: The spatial position and dimensions of oral and pharyngeal soft tissues change post-mandibular advancement (MA) surgery which involves changes in position of soft palate, tongue and associated musculature. There is no study which simultaneously evaluates changes in tongue length and height post-MA surgery and correlates these changes with changes in upper airway dimensions and the amount of MA. MATERIALS AND METHODS: Treatment records of 18 patients that underwent MA with bilateral sagittal split ramus osteotomy were evaluated at T1 (01 week before surgery) and T2 (06 months post-surgery). Linear airway and tongue measurements were done on lateral cephalogram. Mean volume and mean pharyngeal area values were recorded from the acoustic pharyngometry (AP) records of patients. RESULTS: A statistically significant increase in tongue length (P value < 0.001) and nonsignificant change in tongue height were observed at T2 (P value > 0.05). A statistically significant increase in airway parameters recorded on both lateral cephalogram and AP was observed at T2 (P value < 0.001). Correlation analysis did not show a statistically significant correlation of change in tongue length and tongue height at T2 with the amount of MA, change in airway parameters on lateral cephalogram and AP (P value > 0.05). CONCLUSIONS: Mandibular advancement surgery is a viable option for improvement in pharyngeal airway in skeletal Class II patients with retrognathic mandible. Changes in tongue length observed in our study may correspond to the stretch of protruders of tongue, especially genioglossus, and may point toward possible relapse on a long-term follow-up.