The readability of online patient education materials on maxillomandibular advancement surgery.

STUDY OBJECTIVES: Maxillomandibular advancement (MMA) is an effective surgical option for patients suffering from obstructive sleep apnea (OSA). As a relatively new treatment option, patients may turn to the Internet to learn more. However, online patient education materials (OPEMs) on MMA may be written at a higher literacy level than recommended for patients. The aim of this study was to analyze the readability of OPEMs on MMA. METHODS: A Google search of "maxillomandibular advancement" was performed, and the first 100 results were screened. Websites that met eligibility criteria were analyzed for their readability using the Automated Readability Index (ARI), Coleman-Liau Index (CLI), Flesch-Kincaid Grade Level (FKGL), Gunning Fog (GF), and Simple Measure of Gobbledygook (SMOG) and compared to the recommended sixth-grade reading level using one-tailed t tests. Readability scores were compared based on the type of website, including hospitals/universities or physician clinics, using ANOVA tests. RESULTS: The mean (SD) for ARI, CLI, FKGL, GF, and SMOG was 11.91 (2.43), 13.42 (1.81), 11.91 (2.06), 14.32 (2.34), and 13.99 (1.56), respectively. All readability scores were significantly higher than a sixth-grade reading level (p < 0.001). After comparing readability scores between different website types (university/hospital, clinic, and other), there was no statistical difference found. CONCLUSIONS: The available OPEMs on MMA surgery for OSA are above the recommended sixth-grade reading level. Identifying and reducing the gap between the reading levels of OPEMs and the reading level of the patient are needed to encourage a more active role, informed decisions, and better patient satisfaction.

Correlation of echocardiographic parameters in prone and supine positions in normal adults using a novel approach.

BACKGROUND: Transthoracic echocardiography (TTE) in prone position is challenging. Innovative use of transesophageal echocardiography (TEE) probe to perform TTE for such patients has been described; but reproducibility and correlation of the TTE measurements by this technique with those obtained by the standard supine TTE study are still unknown. METHODS: We enrolled 30 non-COVID-19 individuals, with a mean (SD) age 35 (10.9) years and 11 females, to study the agreement between the transthoracic measurements of the left ventricular (LV), left atrial (LA), aortic dimensions, and ejection fraction (EF) obtained in prone position using an external TEE probe versus the standard supine position using the conventional TTE probe. RESULTS: There were no significant differences between LV end-diastolic and end-systolic diameters, septal wall thickness, posterior wall thickness, and aortic root dimensions in the prone versus the supine positions, while the mean EF (60.3% vs 63.1%, P = .014) and mean LA dimensions (1.8 vs 1.9 cm/m2 , P < .001) were significantly lower in the prone position. The mean time of scans was significantly longer in the prone as compared to the supine position (12.5 vs 4.5 minutes, P < .001). All supine studies had good quality while in the prone position four studies were of poor quality, and one was nondiagnostic. CONCLUSIONS: Assessment of cardiac dimensions and systolic function in the prone position using transthoracic TEE probe was feasible. LV and aortic dimensions agreed well with the standard TTE in supine position; however, LA dimensions and EF were lower in the prone position.

Additional diagnostic accuracy of global longitudinal strain at peak dobutamine stress in patients with moderate pretest probability of coronary artery disease.

BACKGROUND: Previous studies confirmed the feasibility of 2D speckle tracking echocardiography (2D STE) during dobutamine stress echocardiography (DSE) in assessing myocardial ischemia in patients with previous myocardial infarction. It is unknown whether it improves the diagnostic accuracy in young patients with intermediate pretest probability for coronary artery disease (CAD) and no prior cardiovascular events. METHODS: We prospectively studied 101 patients by DSE and STE, followed by coronary angiography within 1 month. Significant CAD was defined as diameter stenosis ≥ 50%. Receiver operating characteristic analysis obtained global longitudinal strain (GLS) cutoff values of significant area under the curve (AUC). RESULTS: Mean age: 53 ± 8 years, 56% females, 49 had significant CAD (group 1) and 52 had normal/mild CAD (group 2); no significant baseline differences except more males in group 1 (P: .002). DSE sensitivity and specificity for CAD were 79.6% and 92.3%, respectively, positive predictive value (PPV): 90.6%, negative predictive value (NPV): 82.7%, and diagnostic accuracy: 86%. At peak stress, all strain parameters were significantly lower in group 1. However, GLS had the highest AUC: 0.88, P: <.001. GLS cutoff value ≤ -20.5 had 89.8% sensitivity, 84.6% specificity, 84.6% PPV, 89.8% NPV, and 87% diagnostic accuracy. Combining GLS cutoff with DSE had higher AUC than either alone (0.9, P < .001): 95.9% sensitivity, 84.6% specificity, 85.5% PPV, 95.7% NPV, and 90% diagnostic accuracy. CONCLUSION: 2D-STE-derived GLS increases DSE precision to detect CAD in intermediate pretest probability patients: It improves DSE sensitivity, NPV, and accuracy. It is reproducible and has comparable specificity.

Impact of Dorsal Preservation Rhinoplasty Versus Dorsal Hump Resection on the Internal Nasal Valve: a Quantitative Radiological Study.

BACKGROUND: This study evaluates the impact of different hump takedown techniques, namely the conventional hump resection with midvault reconstruction, the push-down (PD) and the let-down (LD) procedures, on the INV dimensions. METHODS: In this cadaveric study, six heads were divided randomly into either the conventional hump resection technique (Group A; n = 6 sides) or DPR techniques (n = 6 sides). This latter group was subdivided such that initially a PD procedure was performed (Group B; n = 6 sides), followed by a LD procedure on the same heads (Group C; n = 6 sides). A validated radiological method was used to measure the INV angle and cross-sectional area (CSA) in a modified coronal plane both pre- and post-procedurally. RESULTS: Group A did not show significant reduction in the INV angle nor in CSA (p = 0.068 and p = 0.156, respectively). In the push-down group (B), we observed a mean change of 2.05° in the angles and 0.3 cm2 in the CSA (p = 0.0163 and p < 0.001, respectively). The LD group (C) did not show significant reduction in the INV angle nor in CSA (p = 0.437 and p = 0.331, respectively). CONCLUSION: Neither the conventional hump resection nor the LD DPR technique reduced the INV dimensions. However, the PD preservation technique significantly reduced the INV dimensions. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Injection Molded Novel Biocomposites from Polypropylene and Sustainable Biocarbon.

Achieving sustainability in composite materials for high-performance applications is a key issue in modern processing technologies. In this work, the structure-property relationships of injection molded polypropylene (PP)/biocarbon composites were investigated with a focus on the thermal properties and specific emphasis on the coefficient of linear thermal expansion (CLTE). Biocomposites were produced using 30 wt.% biocarbon in a PP matrix, and two different sources of biocarbon produced at ~650 and 900 °C were used. The overall results were compared with 30 wt.% glass- and talc-filled PP composites. Due to the lamellar morphology of the talc developed during the extrusion-injection molding processing, talc-filled composites showed an increase in the CLTE in the normal direction (ND), and a reduction in the flow direction (FD) with respect to the neat polymer. Glass fiber composites also showed an improvement in the CLTE with respect to the neat polymer. However, the biocarbon-based composites showed the best properties in the ND, with improved values in biocarbon produced at higher temperature. The FD values for both biocarbon composites were improved with respect to the matrix, while biocarbon created at lower temperature showed slightly lower expansion values. A comprehensive explanation of these overall phenomena is supported by a series of morphological, thermal, mechanical and rheological tests.

Sustainable Biocomposites from Recycled Bale Wrap Plastic and Agave Fiber: Processing and Property Evaluation.

Plastic recycling to make sustainable materials is considered one of the biggest initiatives toward a greener environment and socioeconomic development. This research aims to investigate the properties of a blend of recycled bale wrap linear low-density polyethylene (rLLDPE) and polypropylene (PP) (rLLDPE/PP 50:50 wt % matrix), which was further reinforced with 25 wt % agave fiber prepared by injection-molding. Different ratios of a combined industrial compatibilizer (maleic anhydride-grafted PP/PE) were used (1-3 wt %), which were compared with a synthesized compatibilizer made from maleic anhydride-PP/rLLDPE in terms of mechanical and thermomechanical properties of the biocomposites. Incorporation of the compatibilizer in the composite improved the interfacial adhesion between the hydrophobic matrix and the hydrophilic agave fiber, which further increased the mechanical properties and heat deflection temperature of the composite. Scanning electron microscopy showed enhanced compatibility and adhesion between the fiber and the matrix by inclusion of 2 wt % compatibilizer. The synthesized compatibilizer-blended composite showed better mechanical properties than the industrial one, which indicates the potential application of this composite (around 62% recycled material) in the manufacture of packaging materials and commodity products.

Co-delivery of norfloxacin and tenoxicam in Ag-TiO2/poly(lactic acid) nanohybrid.

A nanohybrid formulation of silver­titanium dioxide nanoparticles/poly(lactic acid) (Ag-TiO2/PLA) was designed for Norfloxacin/Tenoxicam (NOR/TENO) targeted delivery to maximize the bioavailability and minimize the side effects of the drugs. Ag-TiO2 nanoparticles were prepared via Stober method. NOR, TENO and a mixture of NOR/TENO (NT) were loaded onto Ag-TiO2 nanoparticles and coated by PLA via solution casting. The physical interaction between the drugs and carrier was confirmed by Fourier-transform infrared (FTIR) analysis. X-ray diffraction (XRD) demonstrated that Ag-TiO2 consists of a cubic phase of Ag with two phases of TiO2 (anatase and brookite). Ag nanoparticle fine spots coated with TiO2 were collected to form spheres averaging at 100 nm in size. In-vitro release behavior of drugs was studied at different pH (5.4, 7.4) and the release of drug from NT/Ag-TiO2/PLA was faster at pH 7.4. Gram-positive and Gram-negative bacteria were used to investigate antibacterial properties of the nanohybrid. Cytotoxicity of the nanohybrid using an MTT assay was studied against different tumor and normal cell lines. It was found that NT/Ag-TiO2/PLA has an excellent cytotoxic effect against various bacterial cells and tumor cell lines. In addition, antioxidant properties of the nanohybrids were tested using ABTS method and the nanohybrid showed moderate antioxidant activity.

Ocean plastics: environmental implications and potential routes for mitigation - a perspective.

This review provides a current summary of the major sources and distribution of ocean plastic contamination, their potential environmental effects, and prospects towards the mitigation of plastic pollution. A characterization between micro and macro plastics has been established, along with a comprehensive discussion of the most common plastic waste sources that end up in aquatic environments within these categories. Distribution of these sources stems mainly from improper waste management, road runoff, and wastewater pathways, along with potential routes of prevention. The environmental impact of ocean plastics is not yet fully understood, and as such, current research on the potential adverse health effects and impact on marine habitats has been discussed. With increasing environmental damage and economic losses estimated at $US 1.5 trillion, the challenge of ocean plastics needs to be at the forefront of political and societal discussions. Efforts to increase the feasibility of collected ocean plastics through value-added commercial products and development of an international supply chain has been explored. An integrative, global approach towards addressing the growing ocean plastic problem has been presented.

Poly(3-hydroxybutyrate)/poly(amine)-coated nickel oxide nanoparticles for norfloxacin delivery: antibacterial and cytotoxicity efficiency.

Sustained release dosage forms enable prolonged and continuous release of a drug in the gastrointestinal tract for medication characterized by a short half lifetime. In this study, the effect of blending polyamine on poly(3-hydroxybutyrate) (PHB) as a carrier for norfloxacin (NF) was studied. The prepared blend was mixed with different amounts of NiO nanoparticles and characterized using FTIR analysis, X-ray diffraction analysis, thermogravimetric analysis, dynamic light scattering, transmission electron microscopy and scanning electron microscopy. It was found that the drug released from the nanocomposite has a slow rate in comparison with NiO, PHB, and PHB/polyamine blend. The highest ratio of NiO content to the matrix (highest NF loading), leads to a slower rate of drug release. The release from the nanocomposites showed a faster rate at pH = 2 than that at pH = 7.4. The mechanisms of NF adsorption and release were studied on PHB/polyamine-3% NiO nanocomposite. In addition, the antimicrobial efficacy of nanocomposites loaded with the drug was determined and compared with the free drug. Inclusion of NiO into PHB/polyamine showed a higher efficacy against Streptococcus pyogenes and Pseudomonas aeruginosa than the free NF. Moreover, the cytotoxicity of PHB/polyamine-3% NiO against HePG-2 cells was investigated and compared with PHB and PHB/polyamine loaded with the drug. The most efficient IC50 was found for NF@PHB/polyamine-3% NiO (29.67 µg mL-1). No effect on cell proliferation against the normal human cell line (WISH) was observed and IC50 was detected to be 44.95 and 70 µg mL-1 for NiO nanoparticles and the PHB/polyamine-3% NiO nanocomposite, respectively indicating a selectivity of action towards tumor cells coupled with a lack of cytotoxicity towards normal cells.

Hybrid biocomposites from polypropylene, sustainable biocarbon and graphene nanoplatelets.

Polypropylene (PP) is an attractive polymer for use in automotive parts due to its ease of processing, hydrophobic nature, chemical resistance and low density. The global shift towards eliminating non-renewable resource consumption has promoted research of sustainable biocarbon (BioC) filler in a PP matrix, but this material often leads to reduction in composite strength and requires additional fillers. Graphene nano-platelets (GnPs) have been the subject of considerable research as a nanofiller due to their strength, while maleic anhydride grafted polypropylene (MA-g-PP) is a commonly used compatibilizer for improvement of interfacial adhesion in composites. This study compared the thermo-mechanical properties of PP/BioC/MA-g-PP/GnP composites with varying wt.% of GnP. Morphological analysis revealed uniform dispersion of BioC, while significant agglomeration of GnPs limited their even dispersion throughout the PP matrix. In the optimal blend of 3 wt.% GnP and 17 wt.% BioC biocontent, tensile strength and modulus increased by ~19% and ~22% respectively, as compared to 20 wt.% BioC biocomposites. Thermal stability and performance enhancement occurred through incorporation of the fillers. Thus, hybridization of fillers in the compatibilized matrix presents a promising route to the enhancement of material properties, while reducing petroleum-based products through use of sustainable BioC filler in composite structures.

Biportal transparotid dissection in the retromandibular approach for condylar fracture osteosynthesis: Efficacy of a novel technique.

OBJECTIVE: Facial nerve injury is a primary complication of open surgical management of condylar fractures. A new modification of the retromandibular transparotid approach, the "biportal transparotid dissection" (BTD), was developed to reduce these injuries in accidental nerve exposure. DESIGN: Prospective cohort study. SETTING: Tertiary referral center. METHODS: Patients managed by retromandibular transparotid approach for condylar fractures at Department of Otolaryngology - Head and Neck Surgery, Mansoura University were included between November 2015 and August 2019 with exclusion of cases managed endoscopically or by a closed approach. Three groups were identified: Group A included patients undergoing the BTD technique, which entails transparotid dissection above and below exposed nerve branches and minimal nerve retraction; Group B included patients undergoing traditional dissection and nerve retraction away from the surgical field; and Group C included patients with unidentified facial nerve branches. The function of facial nerve branches was documented postoperatively. RESULTS: Fifty-seven fractures were included in the study. Facial nerve branches' injury occurred in 13 cases (22.8%): two (of ten) in Group A (20%), seven (of ten) in Group B (70%) and four (of 37) in Group C (10.81%). Compared to patients with non-exposed branches, Groups A and B were found to have 2.06 (p = 0.447) and 19.25 (p = 0.001) greater odds of nerve injury, respectively. The results showed significant faster nerve recovery in the BTD group compared to traditional dissection (mean 5 versus 9 weeks) (p = 0.015). CONCLUSION AND RELEVANCE: Although avoiding facial nerve exposure minimizes injury the most, BTD approach reduces exposed nerve injury compared to the traditional method.

Hybrid Green Bionanocomposites of Bio-based Poly(butylene succinate) Reinforced with Pyrolyzed Perennial Grass Microparticles and Graphene Nanoplatelets.

Bio-based poly(butylene succinate) (BioPBS) was combined with pyrolyzed Miscanthus microparticles (biocarbon) and graphene nanoplatelets to create a hybrid bionanocomposite. Pyrolyzed biomass, known as biocarbon, was incorporated into a BioPBS matrix to improve the thermo-mechanical properties of the bioplastic while simultaneously increasing the value of this co-product. Biocomposites loaded with 25 wt % biocarbon showed 57, 13, and 32% improvements in tensile modulus, heat deflection temperature, and thermal expansion, respectively. Further improvements were found when graphene nanoplatelets (GnPs) were added to the biocomposite, forming a hierarchical hybrid bionanocomposite. Two processing methods were used to incorporate graphene into the composites: (I) graphene, BioPBS, and biocarbon were added together and directly compounded, and (II) a masterbatch of graphene and BioPBS was processed first and then diluted to the same ratios as those used in the direct compounding method I. The two methods resulted in different internal morphologies that subsequently impacted the mechanical properties of the composites; little change was observed in the thermal properties studied. Bionanocomposites processed using the direct compounding technique showed the greatest increase in tensile strength and modulus: 17 and 120%, respectively. Bionanocomposites processed using a masterbatch technique had slightly lower strength and modulus but showed almost twice the impact strength compared with the direct compounding method. This masterbatch technique was found to have a superior balance of stiffness and toughness, likely due to the presence of superclustered graphene platelets, confirmed through a scanning electron microscope and a transmission electron microscope.

Evaluation of antibacterial and anticancer properties of poly(3-hydroxybutyrate) functionalized with different amino compounds.

The chemical modification of biodegradable poly(3-hydroxybutyrate) (PHB) is useful for biomedical applications. In this study, the transesterification reaction of PHB was carried out under reflux conditions in the presence of 1,4-butanediol to form telechelic PHB-diol. Further modification of PHB-diol into PHB-diacrylate was carried out by the reaction of PHB-diol with acryloyl chloride. PHB-diacrylate was grafted with amino compounds such as 1,4-butanediamine, 1,3-propanediamine, 1,2-ethylenediamine, piperazine, cyclohexylamine, 2,2'-(ethane-1,2-diylbis(oxy)) diethanamine (jeffamine EDR 148) and morpholine via Michael-type addition reaction. The functionalized amino-PHB polymers were characterized by using FTIR and 1H NMR techniques. XRD showed that amino-PHB polymers have different crystallinity compared with neat PHB. Some biological activities of amino-PHB polymers were determined such as antibacterial, antioxidant and anticancer activities. In this regard, the results showed that PHB-ethylenediamine revealed a potent antibacterial activity against Staphlococcus aureus, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. All amino-PHB polymers under the study showed reasonable antioxidant activity. Among these polymers, PHB-piperazine showed a potent anticancer effect against in vivo Ehrlich ascetic carcinoma bearing mice.