No effects of transcranial direct current stimulation on visual evoked potential and peak gamma frequency.

Evidence suggests that the visual evoked potential (VEP) and gamma oscillations elicited by visual stimuli reflect the balance of excitatory and inhibitory (E-I) cortical processes. As tDCS has been shown to modulate E-I balance, the current study investigated whether amplitudes of VEP components (N1 and P2) and peak gamma frequency are modulated by transcranial direct current stimulation (tDCS). Healthy adults underwent two electroencephalography (EEG) recordings while viewing stimuli designed to elicit a robust visual response. Between the two recordings, participants were randomly assigned to three tDCS conditions (anodal-, cathodal-, and sham-tDCS) or received no-tDCS. tDCS electrodes were placed over the occipital cortex (Oz) and the left cheek with an intensity of 2 mA for 10 min. Data of 39 participants were analysed for VEP amplitudes and peak gamma frequency using mixed-model ANOVAs. The results showed no main effects of tDCS in any metric. Possible explanations for the absence of tDCS effects are discussed.

Validation of the effectiveness of the Dental Practicality Index in predicting the outcome of root canal retreatments.

AIM: To assess the effectiveness of the Dental Practicality Index (DPI) in predicting the outcome of root canal retreatment in posterior teeth. METHODOLOGY: One hundred and thirty-seven posterior teeth with symptoms and/or signs of post-treatment endodontic disease requiring root canal retreatment and previously included in a clinical trial were selected. Clinical and radiographic examinations including digital periapical and cone beam computed tomography (CBCT) were obtained pre-treatment and 1-year postoperatively from a previous study. Two calibrated and trained assessors who were unaware of the treatment outcome assessed the pre-treatment clinical records of these cases using the DPI. The DPI score was then compared to the outcome of the root canal retreatment. A Chi-square/Fisher's exact test was used to establish a relationship between categorical variables, the total score of DPI vs outcome. RESULTS: Retreated teeth with DPI scores equal to 6 or above had an unfavourable outcome of 50% vs 14% of teeth with DPI below 6. Teeth with DPI score equal to 3 or above had an unfavourable outcome of 23% versus 2%, for teeth below 3. Molar teeth with a DPI score below 3 had a favourable outcome percentage of 96%. CONCLUSIONS: This study highlighted that using the DPI gave a good outcome prediction for root canal retreatments. However, further research, including the prospective assessment of a wider range of cases undertaken by a larger group of examiners is needed to further validate the DPI.

Cross-talk between apelin and vasopressin in response to different osmotic stimuli in type 2 diabetic rats.

Apelin, a peptide hormone that has been linked to insulin resistance, obesity and glucose metabolism, coexists with arginine vasopressin (AVP) in hypothalamic magnocellular neurons that control body fluid homeostasis. The significant correlation between serum glucose and serum osmolarity in uncontrolled DM indicates the need for adequate compensation, but how apelin and AVP contribute to this is still unsettled. This study aims to investigate the interaction between apelin and AVP in osmotic regulation in type 2 diabetes mellitus (T2DM), and to explore the underlying mechanism. Forty-eight adult male albino rats were divided into six groups: control (isotonic, ip 0.9% NaCl; hypotonic, ip distilled water; hypertonic, ip 2% NaCl) groups and T2DM (isotonic, hypotonic, hypertonic) groups. Serum levels of AVP, apelin, Na, glucose, serum and urine osmolarity were measured; kidney samples were taken for Aquaporin 2 channels (AQP2) and epithelial sodium channel gamma subunit (ENaCγ) gene expression. Hypothalamic tissue sections were used for immunohistochemical staining of apelin and AVP. Both in control and diabetic groups serum apelin, showed a significant negative correlation with serum AVP (r=-0.533, p≤ 0.001). Serum apelin and AVP were inversely proportional to their hypothalamic protein expression. Serum apelin and AVP were significantly higher in diabetic rats (P= 0.001) yet their percentage change in response to hypo and hyper-osmotic stimuli (1.5±0.7, -0.34±0.15 and -0.38±0.13, 1.95±0.36, respectively) was less pronounced when compared to control rats (3.28±0.52, -0.59±0.12 and -0.45±0.13, 2.58±0.93, respectively). Na and ENaCγ levels significantly increased in hypertonic rats, while AQP2 gene expression significantly increased in hypotonic rats. Both apelin and AVP reacted to osmotic stimuli in T2DM but with less sensitivity than in control rats. In spite of its abnormal increased levels in diabetic rats, apelin maintained its role through counteracting AVP action.

A novel method for soft tissue retraction during periapical surgery using 3D technology: a case report.

AIM: This case report describes a new approach to isolation and soft tissue retraction during endodontic surgery using cone-beam computed tomography (CBCT), computer-aided design (CAD) and three-dimensional (3D) printing. SUMMARY: A 53-year-old patient presented for endodontic treatment of her maxillary left central incisor. It was decided to treat this tooth with a microsurgical approach. The data from the diagnostic CBCT scan were also used to make a physical model of the operative site, and CAD software was used to design a soft tissue retractor to be used during the patient's surgery. A custom retractor was then fabricated using a 3D printer. The custom-made retractor enhanced visualization and soft tissue handling during the patient's surgery. The patient was asymptomatic at a 1-year review. No abnormalities were detected during her clinical examination, and radiographic examination revealed complete healing of the surgical site. KEY LEARNING POINTS: The significance of proper soft tissue retraction in periapical microsurgery is underemphasized. Geometric data from CBCT scans may be harvested for a variety of uses, adding value to the examination. 3D printing is a promising technology that may potentially have many uses in endodontic surgery.

Smart consultation for musculoskeletal trauma: accuracy of using smart phones for fracture diagnosis.

INTRODUCTION: Musculoskeletal trauma occupies a significant proportion of the daily workload of most Emergency and Radiology departments. The diagnosis and management of patients with musculoskeletal trauma often require assessment of radiographs along with clinical assessment. With the advent of smart phones we hypothesised that they could be used as a means of smarter communication, particularly for the transfer of radiographic images between healthcare professionals. PATIENTS AND METHOD: We performed a cross sectional study using thirty radiographs each of the distal radius, ankle and hip. The study was approved by Ethics Committee and all data were anonymized in accordance to Caldicott guidelines and data protection act 1998. Photographs of radiographs were taken using an iphone camera and sent to three independent Orthopaedic Registrars via Multimedia messaging service (MMS). Each Registrar independently assessed these images on their smart phone display in their own time and recorded the specific diagnosis along with the classification of fractures and specific treatment plan. The accuracy of diagnosis on smart phone was measured against the radiology report; and inter observer agreement was assessed among registrars for classification and treatment plan. RESULTS: The overall accuracy of fracture diagnosis was 97.7% with sensitivity of 100% and specificity of 94.4%. The inter observer agreement analysis showed kappa (k) values of 0.67, 0.67 and 0.71 for classification of wrist, ankle and hip fractures respectively showing substantial agreement while kappa values for management plan were 0.65, 0.88 and 0.65 for the three fractures respectively showing substantial to near perfect agreement. CONCLUSION: This study suggests that smart phone can be used as a safe and accurate tool for skeletal trauma consultation among oncall doctors and can help reduce the waiting time in emergency departments.

Pulsatile nanofluid flow with variable pressure gradient and heat transfer in wavy channel.

This research contributes to the comprehension of nanofluid behaviour through a wavy channel, emphasizing the significance of considering diverse influences in the modelling process. The study explores the collective influence of pressure gradient variation, magnetic field, porosity, channel waviness, nanoparticle concentration, and heat transfer on nano-blood flow in a two-dimensional wavy channel. In contrast to prior research assuming a constant pulsatile pressure gradient during channel waviness, this innovative study introduces a variable pressure gradient, significantly influencing several associated parameters. The mathematical model characterizing nano-blood flow in a horizontally wavy channel is solved using the perturbation technique. Analytical solutions for fundamental variables such as stream function, velocity, wall shear stress, pressure gradient, and temperature are visually depicted across different physical parameters values. The findings obtained for differing parameter values in the given problem demonstrate a significant influence of the amplitude ratio parameter of channel waviness, Hartmann number of the magnetic field, permeability parameter of the porous medium, volume fraction of nanoparticles, radiation parameter, Prandtl number, and the suction/injection parameter on the flow dynamics. The simulations provide valuable insights into the decrease in velocity with increasing magnetic field and its increase with higher permeability. Additionally, the temperature is observed to escalate with a rising nanoparticle volume fraction and radiation parameter, while it declines with increasing Prandtl number.

Impact of glycogen synthase kinase-3ß inhibition on rats' temporomandibular joint collagen-induced rheumatoid arthritis with correlation to miRNA-155/miRNA-24 expression.

OBJECTIVE: The current study considered assessing the role of miRNA-155 and miRNA-24 in collagen-induced rheumatoid arthritis (RA) in rats' temporomandibular joint (TMJ). Their role in histological aggressiveness of the disease and therapy response to glycogen synthase kinase (GSK) inhibitor 4-benzyl-2-methyl-1,2,4-thiadiazolidine-3,5-dione (TDZD-8) will be studied. MATERIALS AND METHODS: Rats were randomly distributed to four groups (8 rats/group): group I negative control, group II collagen-induced rheumatoid arthritis (CIA), group III Control+TDZD-8 treated group, and group IV CIA+TDZD-8 treated group. Then were euthanized 42 days after the start of the experiment. H&E staining, Masson trichrome staining, and immunohistochemical antibodies against S100 were performed. qRT-PCR of miRNA-155 and miRNA-24 were done for frozen synovial tissues. RESULTS: Histological analysis showed that the most affected structure in induced rheumatoid arthritis of TMJ is the articular disc, condylar head, and subchondral bone. Combined treatment with TDZD-8 improved histological status in the joint. Masson's trichrome (MTC) histochemical staining revealed disarrangement of collagen fibers and adherence between the articular disc and condylar cartilage. Meanwhile, the morphology and collagen composition of the disc and condyle in CIA+ TDZD-8 were similar to those of healthy tissues. Immunohistochemical analysis for S100A4 revealed increased immunoreactivity staining in the CIA group. The immunoreactivity was significantly decreased in CIA+ TDZD-8 treated group. TDZD-8 significantly decreased the levels of miRNA-155 and miRNA-24 in synovial tissue. CONCLUSIONS: Our results reveal for the first-time correlation of miRNA-155 and miRNA-24 that might be implicated in the onset of TMJ RA. Consequently, the treatment of CIA with GSK inhibitor (TDZD-8) yields encouraging results. We predicted the TDZD-8 might protect against CIA by suppressing miRNA-155, miRNA-24, and S100A4 protein levels.

The detection of periapical pathosis using periapical radiography and cone beam computed tomography - part 1: pre-operative status.

AIM: Part 1 of this 2 part study aims to compare the prevalence of periapical lesions on individual roots viewed with intraoral (periapical) radiographs and cone-beam computed tomography (CBCT) of teeth treatment planned for endodontic treatment. METHODOLOGY: Diagnostic periapical radiographs and CBCT scans were taken of 151 teeth in 132 patients diagnosed with primary endodontic disease. The presence or absence of periapical lesions was assessed by a consensus panel consisting of two calibrated examiners, a consensus agreement was reached if there was any disagreement. The panel viewed the images under standardised conditions. Part 2 will compare the radiographic outcome 1 year after completion of primary root canal treatment. RESULTS: Two hundred and seventy-three paired roots were assessed with both radiological systems, periapical lesions were present in 55 (20%) and absent in 218 (80%) roots assessed with periapical radiographs. When the same 273 sets of roots were assessed with CBCT, lesions were present in 130 (48%) and absent in 143 (52%) roots. Seventy-five additional roots were detected with CBCT. CONCLUSION: The limitations of periapical radiographs which may hinder the detection of periapical lesions are overcome with CBCT. This results in firstly, more roots being assessed, and secondly, more periapical lesions being detected with CBCT.

The detection of periapical pathosis using digital periapical radiography and cone beam computed tomography - part 2: a 1-year post-treatment follow-up.

AIM: Part 2 of this clinical study aims to compare the radiographic change in periapical status of individual roots determined using digital periapical radiographs versus cone beam computed tomography (CBCT) 1year after primary root canal treatment and to determine the radiological outcome of treatment for each tooth. METHODOLOGY: Periapical radiographs and CBCT scans of 123 teeth in 99 patients assessed 1year after completion of primary root canal treatment by a single operator were compared with their respective pre-treatment (diagnostic) periapical radiographs and CBCT scans. The presence or absence as well as the increase or decrease in size of existing periapical radiolucency was assessed by a consensus panel consisting of two calibrated examiners. The panel viewed the images under standardized conditions. Paired comparison of the outcome diagnosis of individual roots and teeth was performed using generalized McNemar's or Stuart-Maxwell test of symmetry analysis. RESULTS: The 'healed' rate (absence of periapical radiolucency) for all roots combined was 92.7% using periapical radiographs and 73.9% for CBCT (P<0.001). This rate increased to 97.2% and 89.4%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included (P<0.001). A statistically significant difference in outcome diagnosis of single roots was observed between DPA and CBCT in single-rooted teeth and the buccal or mesio-buccal roots of multi-rooted teeth (P<0.05). Analysis by tooth revealed that the 'healed' rate (absence of periapical radiolucency) was 87% using periapical radiographs and 62.5% using CBCT (P<0.001). This increased to 95.1% and 84.7%, respectively, when the 'healing' group (reduced size of periapical radiolucency) was included (P<0.002). Outcome diagnosis of teeth showed a statistically significant difference between systems (P<0.001). Reconstructed CBCT images revealed more failures (17.6%) in teeth with no pre-operative periapical radiolucencies compared with periapical radiographs (1.3%) (P=0.031). In teeth with existing pre-operative periapical radiolucencies, reconstructed CBCT images also showed more failures (13.9%) compared with periapical radiographs (10.4%). CONCLUSION: Diagnosis using CBCT revealed a lower healed and healing rate for primary root canal treatment than periapical radiographs, particularly in roots of molars. There was a 14 times increase in failure rate when teeth with no pre-operative periapical radiolucencies were assessed with CBCT compared with periapical radiographs at 1year.

Ewing Sarcoma/Primitive Neuroectodermal Tumor Involving the Duodenum.

Background: Ewing sarcoma/primitive neuroectodermal tumor (ES/PNET) is a soft tissue malignancy arising from the neuroectoderm. While the locations of these extraskeletal manifestations are diverse, origin from the small bowel and small bowel mesentery is extremely rare. Intra-abdominal manifestations of ES/PNETs are nonspecific, and patients present with a wide range of symptoms, most frequently vague abdominal pain. Case Report: A 66-year-old female initially presented with vague and nonspecific symptoms of hypotension, anemia, dyspnea, and coffee-ground emesis. Imaging workup with computed tomography and fluorodeoxyglucose positron emission tomography demonstrated a metabolically active large mass involving the duodenum and measuring 10.3 × 8.8 × 12.3 cm. The mass was characterized as an ES/PNET on histopathologic diagnosis. The patient was treated with chemotherapy followed by radical resection and was disease-free at 1 year postpresentation. Conclusion: This case highlights that while ES/PNETs are rare tumors of the abdomen, they should be considered in cases of large soft tissue masses in patients presenting with nonspecific symptoms. To the best of our knowledge, this case is the fourth report in the literature of an ES/PNET involving the duodenum.

How will the second wave of the dreadful COVID-19 be with the increasing number of the infected cases and mortality in Iraq?

Since the first period of the virus's emergence in Iraq, the government and health-related authorities have rushed to impose home quarantine and suspend work in all facilities of the country besides prescribed the sear measures for doubtful cases. From that time, the detected cases elevated with the number of mortality. Our study aims to take an overview of the disease during the past seven months, and a general review of the effects of quarantine measures that have resulted in an altitude graphic curve for both injuries and deaths. Data were analyzed using statistical software with significant values. The number of cases and mortality was elevated in a linear curve. The quarantine has been a factor for containing the virus in the early stages, but on the contrary, no impact was observed recently. The World Health Organization has warned that Iraq will face a second wave of coronavirus next fall, due to the lack of commitment of citizens to the comprehensive implementation of the ban and shortcomings rules of social spacing, proceed to hold special events, and increased activity in the markets. To see the country free from COVID-19, the responsible necessity to focus on the indigence to meet the public health requirements at a proper time.

Desde la primera aparición del virus en Irak, el gobierno y las autoridades sanitarias se apresuraron a imponer cuarentena domiciliaria y suspender el trabajo en todas las instancias del país, además de prescribir medidas de búsqueda para casos dudosos. Desde ese momento, los casos detectados se elevaron, al igual que el número de muertes. El objetivo de nuestro estudio es establecer una visión de la enfermedad durante los últimos siete meses, así como una revisión general de los efectos de las medidas sobre cuarentena, que han derivado en una curva gráfica de incremento de lesiones y muertes. Se analizaron los datos utilizando software estadístico con valores significativos. El número de casos y muertes se elevó en una curva lineal. La cuarentena ha sido un factor de contención del virus en las primeras etapas, pero, por el contrario, no se ha observado impacto alguno recientemente. La Organización Mundial de la Salud ha advertido que Irak se enfrentará a una segunda ola de coronavirus el próximo otoño, debido a la falta de compromiso de los ciudadanos con la implementación amplia de la prohibición y la carencia de normas sobre distanciamiento social, celebración de eventos especiales e incremento de actividad en los mercados. Para ver al país libre de COVID-19, existe la necesidad responsable de centrarse en la indigencia para satisfacer los requisitos sobre salud pública en el momento adecuado.

Dermatofibrosarcoma Protuberans Presenting in a Patient With Neurofibromatosis Type 1: Potential Implications on Treatment.

Dermatofibrosarcoma protuberans (DFSP) is a rare soft tissue sarcoma. Neurofibromatosis type 1 (NF1) is a neurocutaneous syndrome that affects multiple organ systems. We present the case of a 47-year-old African American male with a two-year history of a slowly enlarging right lower back lesion. Upon workup, the 3 × 2 cm mass was biopsied confirming a diagnosis of DFSP. This was identified in concert with axillary freckling, café-au-lait spots, and pedunculated plaques evaluated with biopsy. The findings were consistent with neurofibromas, leading to a new diagnosis of NF1. The patient was definitively treated with wide local excision of the DFSP lesion without tumor recurrence over six years. DFSP has a favorable prognosis when treated with wide local excision and negative surgical margins. However, lesions may recur with inadequate margins. Although deferred in our patient, treatment with imatinib mesylate, a tyrosine kinase inhibitor, may be employed in the setting of advanced disease, metastasis, positive surgical margins, or irresectable locations. Imatinib has also been used to treat NF1. Hence, we posit that the concomitant presentation of these two disease entities in our patient highlights a potentially unique treatment with imatinib mesylate. To our knowledge, this is the second reported case of both entities in the same patient.

Nerve Sheath Myxoma in the Lower Extremity: A Rare Case with Description of Magnetic Resonance Imaging and Sonographic Findings.

BACKGROUND This report is of a nerve sheath myxoma presenting as a slow-growing mass in the back of the left ankle of a 36-year-old man that was investigated by ultrasound and magnetic resonance imaging (MRI) before the diagnosis was confirmed by histopathology. CASE REPORT We report a nerve sheath myxoma of the ankle in a 36-year-old man. The palpable abnormality was falsely assumed to be a ganglion cyst prior to advanced imaging. Magnetic resonance imaging demonstrated a lobular mass with high T2 and intermediate T1 signal as well as moderate enhancement. T2 sequences also demonstrated distinctive internal septae. These internal septae were also noted on sonographic evaluation prior to biopsy. The patient was treated with surgical excision, and pathologic analysis showed myxoid nodules with loose arrangements of spindled cells separated by fibrous septae. S-100 protein and glial fibrillary acidic protein positivity by immunohistochemistry staining was demonstrated. Follow-up imaging at 12 months showed no evidence of tumor recurrence. CONCLUSIONS This case highlights that while nerve sheath myxomas are rare tumors, they should be considered in cases of cutaneous soft-tissue masses with myxoid imaging features. Ultrasound and magnetic resonance imaging features of thin internal septae may be present and correspond well with the unique histopathological characteristics of these lesions. This report shows the importance of imaging of peripheral soft-tissue masses, including ultrasound and MRI, which can identify localized and benign features and the solid, cystic, and myxoid areas, which were characteristic in this case of benign nerve sheath myxoma.

Wet ball milling of niobium by using ethanol, determination of the crystallite size and microstructures.

This study investigates the effect of using ethanol as the process control agent during the wet ball milling of niobium (Nb). Dried nanocrystal Nb powders, of high purity, with particle sizes, ranging from 8.5 to 14.3 nm, were synthesized by ball milling. Commercial Nb powder of particle sizes of - 44 µm was employed by using the planetary ball mill equipped with stainless still vials with still balls in ethanol. A ball-to-powder mass ratio of 10:1 was used at a rotation speed of 400 rpm, an interval of 15 min with an interval break of 5 s, and a milling time of 10 h. The powder was dried in vacutec at a temperature of 100 °C, using a speed of 15 rpm in the vacuum of 250 mbar at a time of approximately 653 min. The crystal phase of the dried powders was analyzed using X-ray diffraction (XRD) with CuKɑ radiation, and by modification of the Scherrer equation, a single crystallite size of 11.85 nm was obtained. The morphology of the particles was observed using scanning electron microscopy (SEM) with energy-dispersive X-ray spectroscopy (EDS). The XRD results show that the pure crystal sizes in nanometre (nm), which decreases as the 2θ and the full width at half maximum (FWHM) increases.

Incidence of delirium in the critical care unit and risk factors in the Central Region, Saudi Arabia.

OBJECTIVES: To determine the incidence and risk factors of delirium in the cardiac care unit (CCU) and intensive care unit (ICU). METHODS: This multicenter prospective observational study was conducted between July 2019 and November 2019 in the central region of Saudi Arabia. All patients admitted to the critical care units were enrolled, and their demographic data and risk factors of delirium were reported. RESULTS: A total of 165 patients were included: 76 (46.1%) admitted to the CCU and 89 (53.9%) admitted to the ICU. The mean age was 55.1±18 years, and 45 (27.3%) were women. We found that 24/165 (14.5%) patients developed delirium during admission. Importantly, variables significantly associated with delirium group were female gender: (24.5% versus 10.8%, p=0.028), malnutrition (29.2% versus 5%, p<0.001), the presence of urinary catheter (75% versus 30.5%, p=0.001), septicemia (50% versus 14.9%, p<0.001), intubation (41.7% versus 10.6%, p=0.001), low hemoglobin (10.79±2.91 versus 12.05±2.77, p=048), and prolonged prothrombin time (PT) (15.87±5.17 versus 13.60±3.28, p=0.011). CONCLUSION: The incidence of delirium was 14.5% among patients admitted to critical care units in the central region of Saudi Arabia. Septicemia, prolonged PT, malnutrition, and urinary catheter are significant predictors of delirium.

Microtechnologies in implant and restorative dentistry: a stroll through a digital dental landscape.

This is an explanatory article introducing the combination of various technologies used in implant and restorative dentistry. The aim of the article is to provide an overview of some of the techniques supporting the restorative treatment plan at various stages to provide contemporary, state-of-the-art bridgework based on dental implants. It is a discussion of the way existing technologies used in fields of engineering and medicine are brought together to form a complete process.

Mutated COVID-19 may foretell a great risk for mankind in the future.

Coronavirus disease 2019 SARS-CoV-2 (COVID-19) is a zoonotic virus causing a variety of severe respiratory diseases. SARS-CoV-2 is closest to SARS-CoV and MERS-CoV in structure. The high prevalence of COVID-19 is a result of a lack of symptoms at onset. Our study aimed to present an overview of the virus in terms of structure, epidemiology, symptoms, treatment and prevention. Whole genome sequences and some viral proteins were investigated to determine gaps and changes in alternation of nucleotides and amino acid sequences. We evaluate 11 complete genome sequences of different coronaviruses using BAST and MAFFT software. We also selected seven types of structural proteins. We conclude that COVID-19 might produce new mutations, specifically in glycoproteins, so caution and complete preparation by health authorities is required.

AST/ALT ratio predicts the functional severity of chronic heart failure with reduced left ventricular ejection fraction.

OBJECTIVE: Despite previous research that focused on liver transaminases as predictors of cardiovascular disease, there has been limited research evaluating the predictive value of AST/ALT ratio in patients with heart failure. We aimed to investigate AST/ALT ratio as an indicator of the functional severity in chronic heart failure with reduced left ventricular ejection fraction. RESULTS: Overall, 105 patients previously diagnosed with HFrEF from Buraidah-Al Qassim province, Saudi Arabia were included in this retrospective cross-sectional study. Data on study variables, including demographic data, left ventricular ejection fraction, NYHA class, and AST/ALT ratio, were collected from patients' records. The patients were divided into two groups, namely group-1 (AST/ALT ratio < 1) and group-2 (AST/ALT ratio ≥ 1), to identify any differences in their cardiac function profiles. NYHA class and NT-proBNP were higher and LVEF was lower in group-2 than in group-1. We found a mild significant correlation between AST/ALT ratio and APRI, FIB-4 score, NYHA-class, and LVEF (r = 0.2, 0.25, 0.26, and - 0.24, respectively; P < 0.05). Multivariate linear regression analysis model and ROC curve showed that AST/ALT ratio could independently predict HFrEF functional severity with a best cut-off value of 0.9, sensitivity of 43.6%, and specificity of 81.4%.

Changes in Heart Rate Variability and Baroreflex Sensitivity During Daytime Naps.

BACKGROUND AND OBJECTIVES: Changes in autonomic cardiac activity during night sleep are well documented. However, there is limited information regarding changes in the autonomic cardiac profile during daytime naps. Heart rate variability (HRV) and baroreflex sensitivity (BRS) are reliable measures of autonomic cardiac activity. The purpose of this study was to determine the changes in HRV and BRS during daytime naps in healthy men. METHODS: This was a cross-sectional study of 25 healthy men. Polysomnographic recording with electrocardiogram monitoring was conducted for all volunteers during a 50-80 min nap between 3.30 pm and 5.30 pm. Five-minute segments during pre-nap wakefulness, non-rapid eye movement (NREM) sleep stages (N1, N2, and N3), rapid eye movement (REM) sleep stage, and post-nap wakefulness were used to measure changes in the variation in HRV parameters, including inter-beat interval (RR-interval), total spectral power (TP), high-frequency power (HF), low-frequency power (LF), and low frequency/high-frequency ratio (LF/HF). BRS was also measured for 10 min during pre- and post-nap wakefulness using finger arterial pressure measurement (Finometer Pro ®). RESULTS: HRV increased significantly during NREM sleep compared with that during pre-nap wakefulness (p < 0.05), as reflected by RR-interval prolongation, higher HF, and increased HFnu (normalized units). Furthermore, there was a parallel reduction in TP, LF, and LF/HF ratio during NREM sleep, indicating parasympathetic predominance over cardiac autonomic activity. HF and HFnu were significantly reduced during REM sleep compared with that during NREM sleep (p < 0.05). BRS did not show significant differences between pre- and post-nap wakefulness. CONCLUSION: We observed a progressive increase in parasympathetic activity during daytime sleep as NREM sleep deepened compared with that during wakefulness and REM sleep. Daytime nap may have a favorable cardiovascular impact.

New dimensions in endodontic imaging: part 1. Conventional and alternative radiographic systems.

Conventional radiographs used for the management of endodontic problems yield limited information because of the two-dimensional nature of images produced, geometric distortion and anatomical noise. These factors often act in combination. This review paper assesses the limitations of periapical radiographs and seeks to clarify three-dimensional imaging techniques that have been suggested as adjuncts to conventional radiographs. These include tuned aperture computed tomography, magnetic resonance imaging, ultrasound, computed tomography and cone beam computed tomography (CBCT). Of these techniques, CBCT appears to be an effective and safe way to overcome some of the problems associated with conventional radiographs.