Pilot Study Investigating Brain Natriuretic Peptide, Troponin, Galectin-3, and miRNA-126a-5p as Biomarkers of Persistent Pulmonary Hypertension in Neonates with Hypoxic-Ischemic Injury Receiving Therapeutic Hypothermia.

OBJECTIVE: The objective was to evaluate the utility of brain natriuretic peptide (BNP), troponin, galectin-3 (Gal-3), and microRNA (miRNA)-126a-5p as screening biomarkers for persistent pulmonary hypertension of the newborn (PPHN) by comparing expression in serum of infants with hypoxic-ischemic injury that develop PPHN to those that do not. STUDY DESIGN: This was a prospective, observational pilot study including neonates with hypoxic-ischemic injury undergoing therapeutic hypothermia (TH) at two regional perinatal medical centers. PPHN in this population was diagnosed clinically and confirmed by echocardiogram. Serial measurements of biomarkers were performed from 6 to 96 hours post-TH initiation in 40 patients. RESULTS: Of 40 infants in the study, 10 (25%) developed PPHN and 30 (75%) did not. Baseline demographics and hemodynamics were similar between the groups. Patients with PPHN had a significantly higher need for vasopressors compared with patients without PPHN (70 vs. 27%, p = 0.007). Mean serum BNP and troponin levels were significantly higher in the PPHN group peaking at 12 to 24 hours and decreasing following PPHN treatment initiation. miRNA-126a-5p expression was increased in patients with PPHN compared with patients without, with statistical significance detected at 12 hours (p = 0.005) and 96 hours (p = 0.01). Mean circulating Gal-3 levels were not statistically different between the two groups; however, Gal-3 was elevated in all patients with hypoxic-ischemic injury on TH compared with healthy infants from prior studies. CONCLUSION: BNP and troponin are readily available, low-cost biomarkers that showed significant serial elevations in the PPHN group of the study and, thus, may have value in screening for PPHN in the setting of hypoxic-ischemic encephalopathy (HIE). Gal-3 was elevated in all patients with HIE and may be a useful biomarker of hypoxic injury in infants being evaluated for TH. Elevations in miRNA-126a-5p were not consistently seen in this study. Larger studies are required to establish an association between PPHN and these biomarkers in patients with and without HIE. KEY POINTS: · Serum biomarkers of persistent pulmonary hypertension of the newborn. · Serum biomarkers of hypoxic-ischemic injury.

A novel in situ methodology for visual detection of Clostridium perfringens in pork harnessing saltatory rolling circle amplification.

Clostridium perfringens (C. perfringens), a prolific toxin-producing anaerobe is an important foodborne pathogen with a huge public health concern. Rapid and on-site detection of C. perfringens is of specific importance in developing countries. In the present study, saltatory rolling circle amplification (SRCA) assay was developed for culture-independent, rapid and visual detection of C. perfringens and evaluated in meat with pork as a model. The specificity of the SRCA assay was ascertained by using 62 C. perfringens and 18 non- C. perfringens strains. The analytical sensitivity of the developed SRCA, conventional and real-time PCR assays were 80 fg, 800 fg and 800 fg DNA per tube, respectively. The limit of detection of the SRCA assay was 80 CFU/g of pork in the absence of enrichment and 8 CFU/g after short enrichment of 6 h. The detection limits of 80 CFU/g and 8 CFU/g of pork were attained within 120 min and 8 h, respectively. Real-world or field relevancy of the developed assay was evaluated by screening 82 raw and processed pork samples. As the developed assay is simple, user-friendly, cost-effective and sophisticated-equipment free, it would be more suitable for on-site testing of C. perfringens in foods. To our information, this is the first report to apply SRCA for the detection of C. perfringens.

Oral Health-related Quality of Life among Psychiatric In- and Outpatients Diagnosed with Different Disorders in Indore, Central India.

AIM: To assess oral health-related quality of life among psychiatric patients. MATERIALS AND METHODS: A total of 400 inpatients and outpatients reporting to the Department of Psychiatry was taken as the final sample. Subjects diagnosed with mental illness and on medication for at least 1 year, who were able to respond to the pro forma and oral health impact profile (OHIP) questionnaire, were included. A guided, self-administered structured questionnaire was designed to include sociodemographic characteristics and short form of the OHIP-14 consisting of 14 items covering 7 domains: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability and handicap. It was used to assess the impact of oral conditions on well-being and quality of life. The data collected were subjected to statistical analysis using SPSS IBM version 20.0. RESULTS: The highest mean OHIP score for the disorders was seen among the patients diagnosed with schizophrenia for functional limitation (2.73 ± 1.194), 2.91 ± 1.111 for psychological discomfort, 2.67 ± 1.203 was recorded for physical disability, 2.79 ± 1.156 was the mean score for psychological disability followed by a score of 2.87 ± 1.172 for social disability. The highest mean score for the handicap domain was recorded for schizophrenia patients (2.73 ± 1.241) whereas for physical pain, a mean score of 3.01 ± 1.261 was recorded for patients diagnosed with bipolar disorder. CONCLUSION: Based on the findings of the study, it can be stated that the psychiatrists should pay attention to the dental anxiety concerns of the patients and encourage them to visit oral health professionals. CLINICAL SIGNIFICANCE: The study highlights the importance of incorporating dental health education to psychiatric rehabilitation programs.

Regioselective synthesis of tetrahydroquinolines via syn- and anti-nucleopalladation-initiated cascade processes.

Palladium(ii)-catalyzed regioselective syn-chloropalladation and anti-acetoxypalladation-initiated cascade processes were developed for the synthesis of functionalized tetrahydroquinolines. A series of N-propargyl arylamines tethered with an α,ß-unsaturated carbonyl scaffold underwent atom economical cascade reactions to deliver chloro- and acetoxy-substituted tetrahydroquinolines bearing an exocyclic double bond in high yields. A mechanism is proposed for these cascade processes involving a sequential syn-chloropalladation or anti-acetoxypalladation of alkynes followed by intramolecular olefin insertion (6-exo-trig) and protonolysis steps. The reaction was completely regioselective and the terminal aryl/alkyl group of the propargyl moiety dictated the regiochemistry of the initial nucleopalladation. The role of the bidentate nitrogen ligand is crucial to trigger the acetoxypalladation-initiated cascade sequence in contrast to the chloropalladation-initiated process.

Context-dependent spatially periodic activity in the human entorhinal cortex.

The spatially periodic activity of grid cells in the entorhinal cortex (EC) of the rodent, primate, and human provides a coordinate system that, together with the hippocampus, informs an individual of its location relative to the environment and encodes the memory of that location. Among the most defining features of grid-cell activity are the 60° rotational symmetry of grids and preservation of grid scale across environments. Grid cells, however, do display a limited degree of adaptation to environments. It remains unclear if this level of environment invariance generalizes to human grid-cell analogs, where the relative contribution of visual input to the multimodal sensory input of the EC is significantly larger than in rodents. Patients diagnosed with nontractable epilepsy who were implanted with entorhinal cortical electrodes performing virtual navigation tasks to memorized locations enabled us to investigate associations between grid-like patterns and environment. Here, we report that the activity of human entorhinal cortical neurons exhibits adaptive scaling in grid period, grid orientation, and rotational symmetry in close association with changes in environment size, shape, and visual cues, suggesting scale invariance of the frequency, rather than the wavelength, of spatially periodic activity. Our results demonstrate that neurons in the human EC represent space with an enhanced flexibility relative to neurons in rodents because they are endowed with adaptive scalability and context dependency.

Triplet sensitized photolysis of a vinyl azide: direct detection of a triplet vinyl azide and nitrene.

Photolysis of vinylazide 1, which has a built-in acetophenone triplet sensitizer, in argon-saturated toluene results in azirine 2, whereas irradiation in oxygen-saturated toluene yields cyanide derivatives 3 and 4. Laser flash photolysis of azide 1 in argon-saturated acetonitrile shows formation of vinylnitrene 1c, which has a λmax at ∼300 nm and a lifetime of ∼1 ms. Vinylnitrene 1c is formed with a rate constant of 4.25 × 10(5) s(-1) from triplet 1,2-biradical 1b. Laser flash photolysis of 1 in oxygen-saturated acetonitrile results in 1c-O (λmax = 430 nm, τ ≈ 420 µs acetonitrile). Density functional theory (DFT) calculations were used to aid in the characterization of the intermediates formed upon irradiation of azide 1 and to validate the proposed mechanism for its photoreactivity.

Effectiveness of multimodality treatment for autoimmune limbic epilepsy.

We evaluated the outcome of multimodality treatment in autoimmune limbic epilepsy in 3 consecutive patients (2 male and 1 female; age 33-55 years) presenting with a combination of focal non-convulsive status epilepticus, memory impairment, and psychosis. MRI showed right or bitemporal T2 or FLAIR hyperintensity. Video-EEG showed seizures of right temporo-occipital or bitemporal independent onset. Extensive workup failed to reveal infectious aetiology or an underlying tumour. However, the autoantibody panel was positive for one or more of these antibodies: anti-VGKC, anti-GABAB, anti-VGCC (P/Q, N types), and anti-GAD65. All patients received: (1) conventional antiepileptic drugs including levetiracetam, lacosamide, phenobarbital, lamotrigine, and valproate; (2) immunomodulatory therapy including methylprednisolone, plasmapheresis, and intravenous immunoglobulin; and (3) rituximab. After a 4-6-week in-hospital course, the seizures resolved in all patients but 2 had persistent memory impairment. None had treatment-related complications. At the time of last follow-up, 2-3 months later, 2 patients remained seizure-free while 2 had residual memory impairment. Our findings suggest that multimodality treatment with a combination of conventional AEDs, immunomodulatory therapy, and rituximab is effective and safe in autoimmune limbic epilepsy.

Processing of auditory feedback in perisylvian and insular cortex.

When we speak, we not only make movements with our mouth, lips, and tongue, but we also hear the sound of our own voice. Thus, speech production in the brain involves not only controlling the movements we make, but also auditory and sensory feedback. Auditory responses are typically suppressed during speech production compared to perception, but how this manifests across space and time is unclear. Here we recorded intracranial EEG in seventeen pediatric, adolescent, and adult patients with medication-resistant epilepsy who performed a reading/listening task to investigate how other auditory responses are modulated during speech production. We identified onset and sustained responses to speech in bilateral auditory cortex, with a selective suppression of onset responses during speech production. Onset responses provide a temporal landmark during speech perception that is redundant with forward prediction during speech production. Phonological feature tuning in these "onset suppression" electrodes remained stable between perception and production. Notably, the posterior insula responded at sentence onset for both perception and production, suggesting a role in multisensory integration during feedback control.

Visible Light Degradable Acridine-Containing Polyurethanes in an Aqueous Environment.

Light degradable polymers hold significant promise in a wide range of applications including the fabrication of optically recyclable materials, responsive coatings and adhesives, and controlled drug delivery. Here, we report the synthesis of polyurethanes that can be degraded under irradiation of visible light (≤450 nm) from commercial LED (3-15 W) light sources. The photolysis occurs in an aqueous environment via photocleavage of an acridine moiety incorporated within the backbone of the polymer chains. Analysis of the quantum yield as a function of wavelength reveals highly efficient photoreactivity at up to 440 nm activation, which is red-shifted compared to the UV-vis absorbance of the chromophore. The potential of our chemical system in biomaterials is demonstrated by the fabrication of an in situ forming hydrogel that can be degraded by visible light.

Immunogenicity and safety of HavisureTM vaccine developed by Human Biologicals Institute in healthy subjects of 12 months to 49 years of age: A phase II/III, randomized, single blind, non-inferiority study.

BACKGROUND: Hepatitis A is an inflammation of the liver caused by the hepatitis A virus (HAV). It is transmitted mainly because of poor personal hygiene via the faecal/oral route through ingestion of contaminated food or water or through the direct contact with an infectious person. Though most of the infected individuals recover from the infection, a few may develop fatal fulminant hepatitis. In this randomized, multicenter study, immunogenicity and safety of Havisure™ vaccine of Human Biologicals Institute was compared with Havrix® vaccine. METHODS: The study was carried out in 528 eligible healthy subjects, in two age groups across eight centres in India. Group A included subjects of 19-49 years and Group B subjects of 12 months to below 19 years of age. All subjects received two doses of either Havisure™ vaccine or Havrix® vaccine as per randomization at six months interval. Blood samples for antibody titre estimation were collected before vaccination and 4-6 weeks after 2nd dose of vaccination. Immunogenicity was assessed by estimating seroconversion rate, seroprotection rate, and geometric mean titres of antibodies. Safety was evaluated by collection and analysis of data on solicited and unsolicited adverse events. RESULTS: Of 528 enrolled subjects, 493 subjects completed the study. There was 100% seroconversion and seroprotection in both the vaccine arms. There was no statistical difference in the geometric mean titres between the two vaccine arms. Pain and swelling at the site of injection were the most common local adverse events whereas fever and headache were the most common systemic adverse events observed in both vaccine arms. No serious adverse event was reported in the study. CONCLUSION: The study results indicate that the Havisure™ vaccine is immunogenic and safe when administered to healthy subjects of 12 months to 49 years of age, and is non-inferior to Havrix® Vaccine.

Extracting transport parameters in GaAs nanopillars grown by selective-area epitaxy.

We investigate the transport properties in p-type GaAs nanopillars (NPs) grown on GaAs(111) B substrates using selective-area epitaxy by studying single-NP field-effect transistors. Experimental results indicate that normalized resistance and field-effect mobility are highly sensitive to NP dimensions. Both in situ and ex situ chemical surface passivation techniques are found to significantly improve conductivity and mobility, especially for the smaller diameter NPs. A semi-empirical model based on diameter dependent mobility is used to extract actual doping levels and surface state density by fitting normalized resistance as a function of NP diameter. Surface state densities before and after passivation are found to be 5 × 10(12) cm(-2) eV(-1) and 7 × 10(10) cm(-2) eV(-1), respectively.

Raman-spectroscopy-based noninvasive microanalysis of native lignin structure.

A new robust, noninvasive, Raman microspectroscopic method is introduced to analyze the structure of native lignin. Lignin spectra of poplar, Arabidopsis, and Miscanthus were recovered and structural differences were unambiguously detected. Compositional analysis of 4-coumarate-CoA ligase suppressed transgenic poplar showed that the syringyl-to-guaiacyl ratio decreased by 35% upon the mutation. A cell-specific compositional analysis of basal stems of Arabidopsis showed similar distributions of S and G monolignols in xylary fiber cells and interfascicular cells.

A comparative evaluation of the vertical root fracture resistance of endodontically treated teeth using different root canal sealers: an in vitro study.

OBJECTIVE: The objective of this study is to evaluate the vertical root fracture resistance of endodontically treated teeth obturated with - Tubli-Seal EWT/Gutta-percha, AH Plus/Gutta-percha, Epiphany SE sealer/Epiphany point. STUDY DESIGN: Sixty-five single rooted premolars were decoronated and root length was 14 mm for each specimen. Fifty five teeth were enlarged up to ISO size 40 master apical file with stainless steel K-files using standardized preparation and remaining ten teeth were served as negative control. Then teeth were randomly assigned into different groups depending on sealer used for obturation as follows: Group 1: Negative control-no instrumentation was performed. Group 2: Positive control-gutta-percha with out the use of any sealer. Group 3: Experimental group-gutta-percha and Tubli-Seal EWT root canal sealer. Group 4: Experimental group-gutta-percha and AH Plus. Group 5: Experimental group-epiphany SE sealer and epiphany points. After 72 hours, the specimens were embedded in autopolymerizing resin leaving 7 mm of each root exposed and were subjected to fracture testing under universal testing machine at a crosshead speed of 1.0 mm per minute until the root fractured. Results were statistically analyzed using one-way ANOVA and independent t-test. RESULTS: Showed that Epiphany SE sealer/Epiphany points showed highest mean fracture resistance and Tubli-Seal EWT group showed the least fracture resistance of all the materials tested. There was no statistically significant difference among experimental groups. CONCLUSION: Epiphany SE sealer/Epiphany points demonstrated highest fracture resistance values than the other materials tested and intact tooth had highest resistance against vertical root fracture. CLINICAL SIGNIFICANCE: Epiphany SE sealer/Epiphany points may be one of the materials of choice in the endodontic treatment of teeth.

Region-Based Segmentation and Classification for Ovarian Cancer Detection Using Convolution Neural Network.

Ovarian cancer is a serious sickness for elderly women. According to data, it is the seventh leading cause of death in women as well as the fifth most frequent disease worldwide. Many researchers classified ovarian cancer using Artificial Neural Networks (ANNs). Doctors consider classification accuracy to be an important aspect of making decisions. Doctors consider improved classification accuracy for providing proper treatment. Early and precise diagnosis lowers mortality rates and saves lives. On basis of ROI (region of interest) segmentation, this research presents a novel annotated ovarian image classification utilizing FaRe-ConvNN (rapid region-based Convolutional neural network). The input photos were divided into three categories: epithelial, germ, and stroma cells. This image is segmented as well as preprocessed. After that, FaRe-ConvNN is used to perform the annotation procedure. For region-based classification, the method compares manually annotated features as well as trained feature in FaRe-ConvNN. This will aid in the analysis of higher accuracy in disease identification, as human annotation has lesser accuracy in previous studies; therefore, this effort will empirically prove that ML classification will provide higher accuracy. Classification is done using a combination of SVC and Gaussian NB classifiers after the region-based training in FaRe-ConvNN. The ensemble technique was employed in feature classification due to better data indexing. To diagnose ovarian cancer, the simulation provides an accurate portion of the input image. FaRe-ConvNN has a precision value of more than 95%, SVC has a precision value of 95.96%, and Gaussian NB has a precision value of 97.7%, with FR-CNN enhancing precision in Gaussian NB. For recall/sensitivity, SVC is 94.31 percent and Gaussian NB is 97.7 percent, while for specificity, SVC is 97.39 percent and Gaussian NB is 98.69 percent using FaRe-ConvNN.

Phase coding of spatial representations in the human entorhinal cortex.

The grid-like activity pattern of cells in the mammalian entorhinal cortex provides an internal reference frame for allocentric self-localization. The same neurons maintain robust phase couplings with local field oscillations. We found that neurons of the human entorhinal cortex display consistent spatial and temporal phase locking between spikes and slow gamma band local field potentials (LFPs) during virtual navigation. The phase locking maintained an environment-specific map over time. The phase tuning of spikes to the slow gamma band LFP revealed spatially periodic phase grids with environment-dependent scaling and consistent alignment with the environment. Using a Bayesian decoding model, we could predict the avatar's position with near perfect accuracy and, to a lesser extent, that of heading direction as well. These results imply that the phase of spikes relative to spatially modulated gamma oscillations encode allocentric spatial positions. We posit that a joint spatiotemporal phase code can implement the combined neural representation of space and time in the human entorhinal cortex.

Ictal high-frequency oscillations in neocortical epilepsy: implications for seizure localization and surgical resection.

PURPOSE: To investigate the characteristics of intracranial ictal high-frequency oscillations (HFOs). METHODS: Among neocortical epilepsy patients who underwent intracranial monitoring and surgery, we studied patients with well-defined, unifocal seizure onsets characterized by discrete HFOs (≥70 Hz). Patients with multifocal or bilateral independent seizure onsets, electroencephalography (EEG) acquired at <1,000 Hz sampling rate, and nonresective surgery were excluded. Based on a prospectively defined protocol, we defined the seizure-onset zone (SOZ) presurgically to include only those channels with HFOs that showed subsequent sustained evolution (HFOs+ channels) but not the channels that lacked evolution (HFOs- channels). We then resected the SOZ as defined above, 1 cm of the surrounding cortex, and immediate spread area, modified by the presence of eloquent cortex in the vicinity. For purposes of this study, we also defined the SOZ based on the conventional frequency activity (CFA, <70 Hz) at seizure onset, although that information was not considered for preoperative determination of the surgical boundary. We investigated the temporal and spatial characteristics of the ictal HFOs post hoc by visual and spectral methods, and also compared them to the seizure onset defined by the CFA. KEY FINDINGS: Of 14 consecutive neocortical epilepsy patients, six patients met the inclusion criteria. Magnetic resonance imaging (MRI) was normal or showed heterotopia. All had subdural electrodes, with additional intracerebral depth electrodes in some. Electrode coverage was extensive (median 94 channels), including limited contralateral coverage. Seizure onsets were lobar or multilobar. Resections were performed per protocol, except in two patients where complete resection of the SOZ could not be done due to overlap with speech area. Histology was abnormal in all patients. Postoperative outcome was class I/II (n = 5, 83%) or class III over a mean follow-up of 27 months. Post hoc analysis of 15 representative seizures showed that the ictal HFOs were widespread at seizure onset but evolved subsequently with different characteristics. In contrast to HFOs-, the HFOs+ were significantly higher in peak frequency (97.1 vs. 89.1 Hz, p = 0.001), more robust (nearly twofold higher peak power, p < 0.0001), and spatially restricted [mean 12.2 vs. 22.4 channels; odds ratio (OR) 0.51, 95% confidence interval (CI) 0.42-0.62; p < 0.0001]. The seizure onset defined by HFOs+ was earlier (by an average of 0.41 s), and occurred in a significantly different and smaller distribution (OR 0.27, 95% CI 0.21-0.34, p < 0.0001), than the seizure onset defined by the CFA. As intended, the HFOs+ channels were 10 times more likely to have been resected than the HFOs- channels (OR 9.7, 95% CI 5-17, p < 0.0001). SIGNIFICANCE: Our study demonstrates the widespread occurrence of ictal HFOs at seizure onset, outlines a practical method to localize the SOZ based on their restricted pattern of evolution, and highlights the differences between the SOZs defined by HFOs and CFA. We show that smaller resections, restricted mainly to the HFOs channels with evolution, can lead to favorable seizure outcome. Our findings support the notion of widespread epileptic networks underlying neocortical epilepsy.

Elastomeric impression materials: a comparison of accuracy of multiple pours.

AIM: The aim of the present study is to compare the various elastomeric impression materials in terms of accuracy and dimensional stability, with respect to obtaining multiple casts from a single elastomeric impression at various times of pours. MATERIALS AND METHODS: Three master dies were prepared for the impression making, two of these were made of brass containing a central hole with undercuts. The third die simulated a conventionally prepared typodont maxillary central incisor. Three elastomeric impression materials were chosen for the study. Each impression was poured at various time periods. Casts thus obtained were evaluated under a traveling microscope to evaluate various dimensional changes. RESULTS: Addition silicones provided dies which were shorter in height and bigger in diameter. Polyethers provided dies which were shorter in both height and diameter. Condensation silicones showed insignificant changes from the master die at the immediate pour but deteriorated rapidly after that in subsequent pours. CONCLUSION: None of the impression material showed a consistent behavior up to the fourth pour. They occasionally showed deviation from the pattern, but all these values were statistically insignificant. Polyethers showed lesser ability than both the addition silicones as well as the condensation silicones to recover from induced deformation. CLINICAL SIGNIFICANCE: Addition silicones as well as the condensation silicones have better ability to recover from induced deformation when compared to polyether.

Comparative evaluation of pain, tenderness and swelling followed by radiographic evaluation of periapical changes at various intervals of time following single and multiple visit endodontic therapy: an in vivo study.

AIM: This clinical study was undertaken to evaluate the postoperative sequelae following single-visit versus multiplevisit endodontic therapy at various interval of time in vital as well as nonvital teeth. MATERIALS AND METHODS: Thirty-two cases were randomly assigned to the following four groups, group I, group II, group III and group IV. After gaining the access to the pulp chamber, establishing the working length , thorough cleaning and shaping was done for all the cases. Obturation was done by protaper (variable taper) gutta-percha and AH-PLUS sealer using lateral and vertical condensation technique. All the cases were recalled after 48 hours, 1 week, 4 weeks and 6 weeks following obturation and were evaluated for postoperative pain, tenderness and swelling. RESULTS: There was no statistically significant difference amongst all the four groups in the incidence and severity of postoperative pain, tenderness and swelling at the end of one week. However, within 48 hours groups I, II and IV showed more pain when compared to group III. And groups I, II and III showed more tenderness compared with groups IV. Postoperative swelling was not reported. Radiographic investigation at the end of 6 weeks showed significant change in the appearance of the periapical region in group II and group IV cases. CONCLUSION: On strict adherence to biological principles and proper case selection, no significant difference in the success, postoperative pain and tenderness exist when treated with either single-visit or multiple-visit therapy. CLINICAL SIGNIFICANCE: No significant difference in the success rate or postoperative pain, tenderness, and swelling exists when treated with either single-visit or multiple-visit endodontic therapy. Hence, one can readily integrate one-visit endodontic therapy into the routine clinical practice of dentistry.

A comparative study of impression procedures for distal extension removable partial dentures.

AIM: This study was carried out with the purpose of comparing three impression methods as to which of them placed tissues most favorably. METHODS: The methods used were Hindels method, selective tissue placement method and functional reline method. The measurements obtained were analyzed to determine which of the three impression methods placed the mucosal tissues maximally. To compare and measure tissue placements, autopolymerizing acrylic resin platforms were constructed to the height of the occlusal surfaces of the remaining teeth. 15 orthodontic buccal tubes were placed on each side of the platform. They were arranged in three sets of five and attached to the platform over selected reference regions by means of autopolymerizing resin. The selected reference areas were in anterior, middle and posterior areas of the ridge on either side. RESULTS: No significant difference was seen in tissue placement in the anterior middle and posterior regions in each of the three methods when each method was assessed separately. Selective tissue placement method placed the tissues maximally (7.547 mm) followed by Hindels method (7.2110 mm) and the least placement was by functional reline method (5.856 mm). Tissue placement was significantly higher in Hindels method as compared to functional reline method (p < 0.001). CONCLUSION: Tissue placement was maximum in the posterior region, followed by the middle region and least in the anterior region of the mandibular ridge for all three methods. Selective tissue placement method showed the maximum overall tissue placement followed by the Hindels method and minimum placement was by functional reline method. CLINICAL SIGNIFICANCE: Selective tissue placement method provided maximum overall tissue placement and can be a preferred technique for impression making for bilateral distal extension removable partial denture fabrication.

Sequential intrarectal diazepam and intravenous levetiracetam in treating acute repetitive and prolonged seizures.

In this retrospective study of institutionalized patients with mental retardation, we present the efficacy and safety of sequential treatment with intrarectal diazepam (IRD) gel (Diastat) and intravenous levetiracetam (IVL) in comparison with either treatment alone for acute repetitive or prolonged seizures (ARPS). We defined ARPS as >or=3 seizures of any type within 1 h or a single seizure of any type lasting >or=3 min. Eighty-eight ARPS episodes were treated in 25 patients (14 female, age 21-72 years), with mainly symptomatic generalized epilepsy. There were no adverse events directly attributable to the administration of IRD or IVL. Seizure recurrence within 4 h of treatment, the primary outcome measure, was significantly lower after combined sequential IRD + IVL treatment (3 of 36) compared to IRD alone (6 of 24, p = 0.048) or IVL alone (10 of 28, p = 0.039). There was no statistically significant difference between the individual IRD and IVL treatments (p = 0.604). The estimated odds ratio (OR) indicated that the risk of seizure recurrence was higher after IRD or IVL monotherapy compared to combined IRD + IVL treatment. Subsequent emergency room (ER) transfers following seizure recurrence were least likely after IVL treatment (10%) compared to combined IRD + IVL (67%) or IRD (83%) treatment. These findings suggest that although IRD or IVL monotherapy is efficacious, the combination is superior in controlling ARPS in this special group of institutionalized patients. In addition, we speculate that a more reliable onset of action after IVL treatment results in rapid seizure control and fewer ER transfers, despite seizure recurrence.