Silicon nanowire piezoresistor and its applications: a review.

Monocrystalline bulk silicon with doped impurities has been the widely preferred piezoresistive material for the last few decades to realize micro-electromechanical system (MEMS) sensors. However, there has been a growing interest among researchers in the recent past to explore other piezoresistive materials with varied advantages in order to realize ultra-miniature high-sensitivity sensors for area-constrained applications. Of the various alternative piezoresistive materials, silicon nanowires (SiNWs) are an attractive choice due to their benefits of nanometre range dimensions, giant piezoresistive coefficients, and compatibility with the integrated circuit fabrication processes. This review article elucidates the fundamentals of piezoresistance and its existence in various materials, including silicon. It comprehends the piezoresistance effect in SiNWs based on two different biasing techniques, viz., (i) ungated and (ii) gated SiNWs. In addition, it presents the application of piezoresistive SiNWs in MEMS-based pressure sensors, acceleration sensors, flow sensors, resonators, and strain gauges.

Germline ATM variants predispose to melanoma: a joint analysis across the GenoMEL and MelaNostrum consortia.

PURPOSE: Ataxia-Telangiectasia Mutated (ATM) has been implicated in the risk of several cancers, but establishing a causal relationship is often challenging. Although ATM single-nucleotide polymorphisms have been linked to melanoma, few functional alleles have been identified. Therefore, ATM impact on melanoma predisposition is unclear. METHODS: From 22 American, Australian, and European sites, we collected 2,104 familial, multiple primary (MPM), and sporadic melanoma cases who underwent ATM genotyping via panel, exome, or genome sequencing, and compared the allele frequency (AF) of selected ATM variants classified as loss-of-function (LOF) and variants of uncertain significance (VUS) between this cohort and the gnomAD non-Finnish European (NFE) data set. RESULTS: LOF variants were more represented in our study cohort than in gnomAD NFE, both in all (AF = 0.005 and 0.002, OR = 2.6, 95% CI = 1.56-4.11, p < 0.01), and familial + MPM cases (AF = 0.0054 and 0.002, OR = 2.97, p < 0.01). Similarly, VUS were enriched in all (AF = 0.046 and 0.033, OR = 1.41, 95% CI = 1.6-5.09, p < 0.01) and familial + MPM cases (AF = 0.053 and 0.033, OR = 1.63, p < 0.01). In a case-control comparison of two centers that provided 1,446 controls, LOF and VUS were enriched in familial + MPM cases (p = 0.027, p = 0.018). CONCLUSION: This study, describing the largest multicenter melanoma cohort investigated for ATM germline variants, supports the role of ATM as a melanoma predisposition gene, with LOF variants suggesting a moderate-risk.

Evaluation of validity of the STOP-BANG questionnaire in major elective noncardiac surgery.

BACKGROUND: The STOP-BANG questionnaire screens for obstructive sleep apnoea (OSA) in surgical patients. In prior research, the association of STOP-BANG scores with comorbidities and outcomes was inconsistent. The objective of this study was to evaluate the validity of the STOP-BANG score. METHODS: We conducted a retrospective cohort study of patients undergoing major elective noncardiac surgery at the University Health Network (Toronto, ON, Canada) between 2011 and 2015. Cross-sectional construct validity was evaluated based on proportions with diagnosed OSA across STOP-BANG strata. Concurrent construct validity was assessed based on the correlation of STOP-BANG with ASA Physical Status (ASA-PS), the Revised Cardiac Risk Index, and the Charlson Comorbidity Index. Predictive validity was assessed based on the adjusted associations of STOP-BANG risk with 30-day mortality (logistic regression), cardiac complications (logistic regression), and length-of-stay (negative binomial regression). RESULTS: Of 26 068 patients in the cohort, 58% were in the low-risk STOP-BANG stratum, 23% in the intermediate-risk stratum, and 19% in the high-risk stratum. The proportion with previously diagnosed OSA was 4% (n=615) in the low-risk stratum, 12% (n=740) in the intermediate-risk stratum, and 44% (n=2142) in the high-risk stratum. The correlations of STOP-BANG with ASA-PS (Spearman ρ=0.28), Revised Cardiac Risk Index (ρ=0.24), and Charlson Comorbidity Index (ρ=0.10) were weak, albeit statistically significant (P<0.001). After risk-adjustment, STOP-BANG risk strata were not associated with 30-day mortality, cardiac complications, or length-of-stay. CONCLUSIONS: The STOP-BANG questionnaire has modest construct validity but did not predict postoperative mortality, hospital length-of-stay, or cardiac complications.

Piezoresistive Composite Silicon Dioxide Nanocantilever Surface Stress Sensor: Design and Optimization.

In this paper, we present the design and optimization of a rectangular piezoresistive composite silicon dioxide nanocantilever sensor. Unlike the conventional design approach, we perform the sensor optimization by not only considering its electro-mechanical response but also incorporating the impact of self-heating induced thermal drift in its terminal characteristics. Through extensive simulations first we comprehend and quantify the inaccuracies due to self-heating effect induced by the geometrical and intrinsic parameters of the piezoresistor. Then, by optimizing the ratio of electrical sensitivity to thermal sensitivity defined as the sensitivity ratio (υ) we improve the sensor performance and measurement reliability. Results show that to ensure υ ≥ 1, shorter and wider piezoresistors are better. In addition, it is observed that unlike the general belief that high doping concentration of piezoresistor reduces thermal sensitivity in piezoresistive sensors, to ensure υ ≥ 1 doping concentration (p) should be in the range: 1E18 cm-3 ≤ p ≤ 1E19 cm-3. Finally, we provide a set of design guidelines that will help NEMS engineers to optimize the performance of such sensors for chemical and biological sensing applications.

Impact of Isolation and Immobilization Layers on the Electro-Mechanical Response of Piezoresistive Nano Cantilever Sensors.

In the last decade, piezoresistive nano cantilever sensors have been extensively explored, especially for chemical and biological sensing applications. Piezoresistive cantilever sensors are multi-layer structures with different constituent materials. Performance of such sensors is a function of their geometry and constituent materials. For a fixed material set, the pre-requisite for optimizing the performance of a composite piezoresistive cantilever sensor is careful geometrical design of its constituent layers. Even though, treatise encompasses various designs of such sensors, typically for computational simplicity the functional layers i.e., the isolation and immobilization layers are neglected in the modeling stages. In this paper, we elucidate the impact of the functional layers on the electro-mechanical response of composite piezoresistive nano cantilever sensors. Systematic and detailed computations are performed using theoretical models and numerical simulations. Results show that both the isolation and immobilization layers play a critical role in governing the sensor performance. Simulation results depict that compared to a sensor with an isolation layer of thickness 100 nm, a sensor without isolation layer has 36.29% and 42.51% better deflection sensitivity and electrical sensitivity respectively. Furthermore, it is found that when an immobilization layer of thickness 40 nm is added atop the isolation layer, the deflection sensitivity and electrical sensitivity reduces by 12.98% and 15.83% respectively. Through our investigation it is shown that the isolation and immobilization layers not only play a vital role in determining the stability and electro-mechanical response of the sensor but their negligence in the design stages can be detrimental. Apart from investigating the impact of the immobilization layer thickness, to model the sensor closer to real time operational conditions, we have performed analysis to understand the impact of non-uniformity in the immobilization layer thickness and non-uniform surface stress loading on the electro-mechanical response of the sensor. Results and inferences obtained from this study will help NEMS engineers to optimize the performance of piezoresistive nano cantilever sensors and to design multi-layer cantilever platform structures for other transducers.

Cross-cultural validation of the ICOAP and physical function short forms of the HOOS and KOOS in a multi-country study of patients with hip and knee osteoarthritis.

OBJECTIVE: To evaluate the internal consistency and construct validity of the Physical Function short-forms for the Hip and Knee Injury Osteoarthritis Outcome Scores (HOOS-PS/KOOS-PS) and the Intermittent and Constant Osteoarthritis Pain (ICOAP) in a nine country study of patients consulting for total hip or knee replacement (THR or TKR). METHODS: Patients completed HOOS-PS or KOOS-PS, ICOAP and Western Ontario and McMaster Universities' Osteoarthritis Index (WOMAC) pain and physical function subscales at their consultation visit. Internal consistency was calculated using Cronbach's alpha. The association of HOOS-PS/KOOS-PS and ICOAP with WOMAC pain and function subscales was calculated with Spearman correlation coefficients with 95% confidence intervals. RESULTS: HOOS-PS/KOOS-PS and ICOAP demonstrated high internal consistency across countries (alpha 0.75-0.96 (hip) and 0.76-0.95 (knee)). Both HOOS-PS and KOOS-PS demonstrated high correlations (0.76-0.90 and 0.75-0.91, respectively) with WOMAC function in all countries. ICOAP exhibited moderate to high correlations with WOMAC pain and function subscales (0.53-0.84 (hip) and 0.43-0.84 (knee)). CONCLUSION: The psychometric properties of the HOOS-PS/KOOS-PS, and ICOAP were maintained across all countries.

Utilization of in silico EST-SSR markers for diversity studies in castor (Ricinus communis L.).

Castor (Ricinus communis L.) a chief non-edible oilseed crop has numerous industrial applications. Systematic genetic diversity analysis utilizing DNA based markers has been quick and reliable method that ensures selection of diverse parents for exploitation of higher levels of heterosis in breeding programs. From NCBI database, 63,852 EST sequences of castor were mined. One thousand one hundred and five (1105) EST-SSRs and 1652 repeat motifs sequences were identified from 20,495 non-redundant unigene sequences. Repeat motifs consisted of 29.7 % mono nucleotide repeats, 24.8 % di nucleotide repeats, 27.27 % tri nucleotide repeats and 3.94 % tetra nucleotide repeats. Twenty eight primer pairs were chosen from SSR-containing ESTs to determine genetic diversity among 27 castor accessions. Twelve EST-SSRs showed polymorphism. Number of alleles detected were 2-3 with an average of 2.33 per locus. 150-400 bp was the size of an allele. Dendrogram analysis grouped the 27 accessions into two separate clusters. Genetic similarity coefficient of dendrogram ranged from 0.24 to 0.83. The polymorphic information content value of 0.28-0.49 revealed medium level of diversity in castor. Results of present study indicated that EST-SSRs to be efficient markers for genetic diversity studies. Knowledge on level of diversity existing in castor genotypes would be useful for breeders to plan efficient hybrid breeding programme.

Neural effects of cognitive-behavioural therapy on dysfunctional attitudes in depression.

BACKGROUND: Dysfunctional attitudes are a feature of depression that has been correlated with receptor binding abnormalities in limbic and cortical regions. We sought to investigate the functional neuroanatomy of dysfunctional attitudes in major depressive disorder (MDD) and the effects of treatment with cognitive-behavioural therapy (CBT). METHOD: Participants were 16 patients with unipolar depression in an acute depressive episode (mean age 40.0 years) and 16 matched healthy controls (mean age 39.9 years). Patients were medication free and received a course of treatment with CBT. All participants underwent functional magnetic resonance imaging (fMRI) scans at baseline and at week 16, prior to the initiation of therapy and following the course of CBT for patients. During each fMRI scan, participants indicated their attributions to statements from a modified Dysfunctional Attitudes Scale (mDAS-48). RESULTS: MDD patients in an acute depressive episode endorsed a greater number of extreme responses to DAS statements, which normalized following CBT treatment. Extreme attributions were associated with greater activation in the left hippocampal region, inferior parietal lobe and precuneus in MDD patients as compared with healthy controls as a main effect of group. An interaction effect was found in the left parahippocampal region, which showed less attenuation in MDD patients at the follow-up scan relative to healthy controls. CONCLUSIONS: Attenuation of activity in the parahippocampal region may be indicative of an improvement in dysfunctional thinking following CBT treatment in depression, while persistent engagement of regions involved in attentional processing and memory retrieval with extreme attributions reflects a trait feature of depression.

Disparities in access to kidney transplantation between donor service areas in Texas.

We examined the current status of pronounced disparities in waiting times to kidney transplantation (KTx) within the state of Texas first documented more than a decade ago. The state's three, geographically contiguous donor service areas (DSAs) were compared for rates of deceased donor KTx within 3 years of listing as well as population base; waiting list size; number of dialysis patients; annual eligible deaths; number and size of acute care hospitals; organ procurement organization performance; correspondence between DSA of residence versus DSA of listing; and distribution of alternative local units (ALUs). The data show that significant inequities of access to KTx are persistent, localized to one of the state's three DSAs and disproportionately affect Hispanics as well as counties with lower median family incomes. Imbalances in determinants of supply and demand, discordance between DSAs of residence versus listing and ALU dispositions dating to the 1990s were identified as underlying causes. Parity will not be established by upcoming revisions in national allocation policies that call for regionalizing initial offers of kidneys with the worst 15% of donor profile index scores and elimination of ALUs. Potential remedies include adopting more equitable maximums in waiting time differentials between DSAs within single states.

Reliability of the American Society of Anesthesiologists physical status scale in clinical practice.

BACKGROUND: Previous studies, which relied on hypothetical cases and chart reviews, have questioned the inter-rater reliability of the ASA physical status (ASA-PS) scale. We therefore conducted a retrospective cohort study to evaluate its inter-rater reliability and validity in clinical practice. METHODS: The cohort included all adult patients (≥18 yr) who underwent elective non-cardiac surgery at a quaternary-care teaching institution in Toronto, Ontario, Canada, from March 2010 to December 2011. We assessed inter-rater reliability by comparing ASA-PS scores assigned at the preoperative assessment clinic vs the operating theatre. We also assessed the validity of the ASA-PS scale by measuring its association with patients' preoperative characteristics and postoperative outcomes. RESULTS: The cohort included 10 864 patients, of whom 5.5% were classified as ASA I, 42.0% as ASA II, 46.7% as ASA III, and 5.8% as ASA IV. The ASA-PS score had moderate inter-rater reliability (κ 0.61), with 67.0% of patients (n=7279) being assigned to the same ASA-PS class in the clinic and operating theatre, and 98.6% (n=10 712) of paired assessments being within one class of each other. The ASA-PS scale was correlated with patients' age (Spearman's ρ, 0.23), Charlson comorbidity index (ρ=0.24), revised cardiac risk index (ρ=0.40), and hospital length of stay (ρ=0.16). It had moderate ability to predict in-hospital mortality (receiver-operating characteristic curve area 0.69) and cardiac complications (receiver-operating characteristic curve area 0.70). CONCLUSIONS: Consistent with its inherent subjectivity, the ASA-PS scale has moderate inter-rater reliability in clinical practice. It also demonstrates validity as a marker of patients' preoperative health status.

2-Carboxyl-atopyridinium-4-nitro-phenol (1/1).

In the title 1:1 adduct, C6H5NO3·C6H5NO2, both mol-ecules are almost planar (r.m.s. deviations for the non-H atoms = 0.027 and 0.023 Šfor 4-nitro-phenol and 2-carboxyl-atopyridinium, respectively). The pyridine mol-ecule crystallizes as a zwitterion (nominal proton transfer from the carb-oxy-lic acid group to the N atom in the ring). In the crystal, inversion dimers of the zwitterions linked by pairs of N-H⋯O hydrogen bonds generate R 2 (2)(10) loops; two 4-nitro-phenol mol-ecules link to the dimer by O-H⋯O hydrogen bonds, generating a four-molecule aggregate. These are linked by C-H⋯O inter-actions, forming a three-dimensional network.

1-Hy-droxy-isoquinolin-2-ium hydrogen succinate.

In the title salt, C9H8NO(+)·C4H5O4 (-), the isoquinolinium ring system is approximately planar [r.m.s deviation = 0.011 (2) Å]. In the crystal, adjacent cations and anions are linked by O-H⋯O and N-H⋯O hydrogen bonds, forming columns along the b axis. The columns are connected by weak C-H⋯O inter-actions into a three-dimensional network.

Manasamitra Vatakam on Scopolamine-Induced Amnesia in Female Wistar Rats.

Background: Neurodegenerative diseases induce amnesia, and effective treatment is still elusive. Aims and Objectives: The present study highlights the ameliorating effects of Manasa Mitra Vatakam (MMV) using behavioral parameters on scopolamine-induced memory loss in female Wistar rats. Materials and Methods: MMV was compared with DPZ as a standard in the present study to determine the behavioral parameters through elevated plus maze (Hebb William maze/rectangular maze)and locomotor activity in scopolamine-induced memory loss in female Wistar rats. Results and Discussion: The results of the study illustrate the effectiveness of MMV in reversing memory dysfunction and memory-enhancing effects. Conclusion: The study paves the way for exploring research in CNS disorders and its potential application in drug-induced neurotoxicity.

Return to work and workplace activity limitations following total hip or knee replacement.

OBJECTIVE: Total hip (THR) and knee (TKR) replacements increasingly are performed on younger people making return to work a salient outcome. This research evaluates characteristics of individuals with early and later return to work following THR and TKR. Additionally, at work limitations pre-surgery and upon returning to work, and factors associated with work limitations were evaluated. METHODS: 190 THR and 170 TKR of a total 931 cohort participants were eligible (i.e., working or on short-term disability pre-surgery). They completed questionnaires pre-surgery and 1, 3, 6 and 12 months post-surgery that included demographics, type of occupation, and the Workplace Activity Limitations Scale (WALS). RESULTS: 166 (87%) and 144 (85%) returned to work by 12 months following THR and TKR, respectively. Early (1 month) return to work was associated with, male gender, university education, working in business, finance or administration, and low physical demand work. People with THR returned to work earlier than those with TKR. For both groups, less pain and every day functional limitations were associated with less workplace activity limitations at the time return to work. CONCLUSIONS: The majority of individuals working prior to surgery return to work following hip or knee replacement for osteoarthritis (OA) and experience fewer limitations at work than pre-surgery. The changing workforce dynamics and trends toward surgery at younger ages mean that these are important outcomes for clinicians to assess. Additionally, this is important information for employers in understanding continued participation in employment for people with OA.

Management of oral pyogenic granuloma with sodium tetra decyl sulphate. A case series.

Pyogenic granuloma, or granuloma pyogenicum, is a common, tumor-like growth of the oral cavity or skin that is considered to be an exaggerated, localized connective tissue reaction to a minor injury or irritation. A total of five clinical cases of oral pyogenic granuloma were randomly selected in the age group between 26 and 41 years. All these cases were treated with sodium tetra decyl sulphate and examined for regression and reccurrence of the lesion for six months. Various treatment modalities consist of conservative surgical excision, cryosurgery, laser surgery and sclerotherapy. Sclerotherapy with sodium tetra decyl sulphate is a relatively simple and effective method for treating oral pyogenic granuloma.

Outcomes of transplantation using organs from a donor infected with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.

Transmission of pathogens from donor to recipient is a potential complication of organ transplantation. Herein, we describe the clinical course and outcomes of 4 transplant recipients who received tissues from a donor with multi-organ infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae. Recipient 1 underwent simultaneous liver and kidney transplantation for alpha-1 antitrypsin deficiency and alcohol-related cirrhosis, and acute tubular necrosis, respectively. Soon after transplantation, he developed an infected hematoma and peritonitis due to KPC-producing K. pneumoniae despite receiving tigecycline prophylaxis. He was treated with a prolonged course of tigecycline, amikacin, and meropenem, in conjunction with surgical evacuation and percutaneous drainage of the infected fluid collections. Recipient 2 underwent living-donor liver transplantation for cholangiocarcinoma and primary sclerosing cholangitis using vein graft from the donor infected with KPC-producing K. pneumoniae. Culture of the preservation fluid containing the vein graft was positive for KPC-producing K. pneumoniae. The patient received preemptive amikacin and tigecycline, and he did not develop any infection (as evidenced by negative surveillance blood cultures). The isolates from the donor and Recipients 1 and 2 were indistinguishable by pulsed-field gel electrophoresis. Recipients 3 and 4 underwent kidney and heart transplantation, respectively; both patients received perioperative tigecycline prophylaxis and did not develop infections due to KPC-producing K. pneumoniae. All transplant recipients had good short-term outcomes. These cases highlight the importance of inter-institutional communication and collaboration to ensure the successful management of recipients of organs from donors infected with multidrug-resistant organisms.

A Pragmatic Approach to Pancreatic Trauma: A Single-Center Experience From a Tertiary Care Center.

Introduction Pancreatic trauma is rare and is usually associated with adjacent organ and vascular injuries, which adds to the high morbidity and mortality. In the American Association for the Surgery of Trauma (AAST) pancreatic trauma (PT) grading system, the higher grades are a composite of less and more severe extents of injuries. We hereby present an observational study of PT with management based on an indigenous algorithmic approach. Our protocol incorporating both the extent of disruption of the main pancreatic duct (MPD) and its amenability to interventions (endoscopic, radiological, or surgical) is pragmatic. Methods Ours is a retrospective observational study of 28 consecutive cases of PT, done over a three-year period in an academic institution, by an expert Surgical Gastroenterology unit. All patients diagnosed with PT on a contrast abdominal CT scan were included. After stabilization, they were stratified and managed according to an indigenous protocol. The primary outcome measure was treatment success in terms of recovery. The secondary outcome measure was morbidity of any form. Results One patient with Grade 1 PT was operated on for associated hollow viscus injury. Two patients with AAST Grade 2 and two patients with AAST Grade 3 injury were managed successfully without surgery. Twelve of 21 patients with Grade 3 PT underwent Kimura's splenic vessel preserving distal pancreatectomy. Distal pancreatectomy with splenectomy and central pancreatectomy with Roux-en-Y pancreaticojejunostomy (PJ) was done for 7/21 and 2/21 patients, respectively, with Grade 3 PT. Two with Grade 5 injury underwent trauma Whipple. The overall mortality and morbidity rates in our series were 15.7% and 64%, respectively. Conclusion The pathogenesis in PT is a dynamic process and shows temporal evolution. These patients require serial and periodical clinical and radiological monitoring, especially in those managed conservatively initially. PT can be low or high grade. Patients with isolated low-grade PT can be managed according to the standard step-up approach for acute pancreatitis. A carefully selected subgroup of patients with partial MPD disruption either in the head or body of the pancreas can be managed by endotherapy. Complete distal parenchymal transections require early surgery tailored to individual patients in the form of either splenic vessel preserving distal pancreatectomy (SPDP) or distal pancreatectomy with splenectomy (DP+S). Damage control surgery is the dictum in unstable patients with Grades 4 and 5 injuries not responding to resuscitative measures. A trauma Whipple can be done in a carefully selected subgroup of stable patients with proximal massive disruptions in an experienced hepato-pancreatico-biliary (HPB) unit.

Evaluation of centralization ability and canal transportation of root canals prepared with three commercially available pediatric rotary files.

Background: The complex root canal anatomy of primary root canals is considered to be most challenging. The quality of the root canal preparation plays a significant role in the success of endodontic treatment. Now, there are very few root canal instruments that are capable of cleaning the canal three dimensionally. To evaluate the efficacy of root canal instruments, various technologies have been used; one of the most reliable strategies was cone-beam computed tomography (CBCT). Aim: The aim of this study is to compare the centralization ability and canal transportation of three commercially available pediatric rotary file systems using CBCT analysis. Materials and Methods: Thirty-three extracted human primary teeth with a minimum 7 mm root length were randomly divided into three groups (group I - Kedo-SG Blue, group II - Kedo-S Square, and group III - Pro AF Baby Gold). Biomechanical preparation was done according to the manufacturers instructions. Pre- and postinstrumentation CBCT images were taken for each group to evaluate the remaining dentin thickness thereby assessing the centering ability and the canal transportation ability of different file systems. Results: Significant difference was noticed in canal transportation and centering ability between the three tested groups. Mesiodistal canal transportation was significant at all three levels, whereas buccolingual canal transportation was significant only at the apical third of the root. However, Kedo-SG Blue and Pro AF Baby Gold showed lesser canal transportation compared to Kedo-S Square rotary file system. Mesiodistal centering ability was significant at cervical and apical thirds of the root with Kedo-S Square rotary file system maintaining less canal centricity. Conclusions: All three file systems tested in the study were effective in removing the radicular dentin. However, Kedo-SG Blue and Pro AF Baby Gold rotary file systems showed comparatively less canal transportation and more centering ability than Kedo-S Square rotary file system.

A Single-Center Experience of Internal Pancreatic Fistulas.

Background Internal pancreatic fistula (IPF) is a complex disease with different etiologies, varied clinical presentations, and multiple management options. Unlike postoperative pancreatic fistula, IPF lacks guidelines for classification and management. The rarity of the disease makes randomized control studies unlikely and difficult to formulate guidelines. This has resulted in different approaches to managing IPF. IPF associated with both acute and chronic pancreatitis is treated with a step-up approach. Chronic pancreatitis-associated IPF treated with the traditional step-up approach is associated with increased morbidity. Prolonged fasting, drainage of protein-rich pancreatic fluid, and extended hospital stay add to the morbidity. Early surgical intervention in patients with IPF associated with chronic pancreatitis can treat both the fistula and underlying disease processes simultaneously. This may contribute to reduced morbidity and hospital stay. Methodology A retrospective observational study was conducted between June 2018 and May 2019. IPF patients with fluid amylase >1,000 IU/L and fluid albumin >3 g/dL were included in the study. Results In total, 32 patients were included in the study. A total of 13 patients had acute pancreatitis and 19 were associated with chronic pancreatitis. Pseudocyst and walled-off pancreatic necrosis were present in 18 patients. The duration of treatment for the traditional group was 8-14 weeks, and for the early surgery group, it was 8-10 days. Patients were followed up for two years, and none of the patients in the early surgery group had a recurrence. Conclusions The overall mortality of IPF is low but it has high morbidity. The delay in treatment may contribute to high morbidity; hence, early surgical intervention may change the clinical course. The primary pathology of the pancreas can be addressed simultaneously as well. In our study, early surgical intervention was associated with lesser morbidity and decreased duration of hospital stay while recurrence rates and mortality were comparable to the traditional management protocol.

Comparative evaluation of chelating efficacy of nano-chitosan, pomegranate extract, and ethylenediaminetetraacetic acid on primary radicular dentin: An in vitro study.

Background: Irrigation is a crucial aspect of root canal treatment, and it is imperative to employ chelating agents to eliminate the smear layer during biomechanical preparation. They in turn react with mineral content of dentin, leading to decreased strength and increased susceptibility to fracture. Aims: This study aimed to assess and compare mineral loss and microhardness from primary root canal dentin following the usage of different irrigating solutions and determine the least detrimental irrigant among the tested solutions. Materials and Methods: Sixty-six primary anterior teeth were divided into three groups with 22 in each- Group I: 17% ethylenediaminetetraacetic acid (EDTA) Group II: 0.2% Nano chitosan Group III: Pomegranate extract. The decoronated teeth were split longitudinally. Half of it was directly subjected to Vickers test, and the other half was immersed in a magnetic stirrer bath containing test solution to record the mineral loss from solution. Postmicrohardness values were recorded on the specimen and compared with initial values. Statistical Analysis Used: Statistical analysis was done using SPSS software (Version 20, SPSS, IBM, Armonk, NY, U. S. A). Results: Descriptive statistics were calculated, and the groups were compared using analysis of variance test and post hoc Tukey test. Pomegranate extract showed least effect on mineral content and microhardness compared to 17% EDTA and 0.2% nano chitosan. P ≤ 0.05 was considered statistically significant. Conclusion: Pomegranate aril extract showed better results with selected parameters.