Comparison of non-contrast abbreviated MRI and ultrasound as surveillance modalities for HCC.

BACKGROUND & AIMS: Ultrasonography (US) is recommended for HCC surveillance in high-risk patients but has limited performance in detecting early-stage HCC. We aimed to compare the diagnostic performance of biannual US and annual non-contrast abbreviated magnetic resonance imaging (NC-AMRI) as HCC surveillance modalities in high-risk patients. METHODS: This prospective, multicenter cohort study enrolled participants with an estimated annual risk of HCC greater than 5% between October 2015 and April 2017. Participants underwent six rounds of HCC surveillance at 6-month intervals, with both US and NC-AMRI at rounds 1, 3, and 5, and only US at rounds 2, 4, and 6. The sensitivity, diagnostic yield (DY), and false referral rate (FRR) for HCC detection by US and NC-AMRI were compared. RESULTS: In total, 208 participants underwent 980 US and 516 NC-AMRI examinations during 30 months of follow-up. Among them, 34 HCCs were diagnosed in 31 participants, with 20 (64.5%) classified as very early-stage and 11 (35.5%) as early-stage HCC. The sensitivity of annual NC-AMRI (71.0%, 22/31) was marginally higher than that of biannual US (45.2%, 14/31; p = 0.077). NC-AMRI showed a significantly higher DY than US (4.26% vs. 1.43%, p <0.001), with a similar FRR (2.91% vs. 3.06%, p = 0.885). A simulation of alternating US and NC-AMRI at 6-month intervals yielded a sensitivity of 83.9% (26/31), significantly exceeding that of biannual US (p = 0.006). CONCLUSIONS: Annual NC-AMRI showed a marginally higher sensitivity than biannual US for HCC detection in high-risk patients. The DY of annual NC-AMRI was significantly higher than that of biannual US, without increasing the FRR. Thus, alternating US and NC-AMRI at 6-month intervals could be an optimal surveillance strategy for high-risk patients. IMPACT AND IMPLICATIONS: Current guidelines permit the use of magnetic resonance imaging (MRI) as a surveillance tool for hepatocellular carcinoma in patients in whom ultrasonography (US) is inadequate. However, the specific indications, imaging sequences, and intervals for MRI surveillance remain unclear. In our study, we found that annual non-contrast abbreviated MRI exhibited marginally higher sensitivity and significantly better diagnostic yield than biannual US in patients at high risk of hepatocellular carcinoma. Alternating US and non-contrast abbreviated MRI at 6-month intervals led to significantly improved sensitivity compared to biannual US, making it a potentially optimal surveillance strategy for high-risk patients. GOV IDENTIFIER: NCT02551250.

Regeneration of As(V) loaded granular activated carbon through desorption in FeCl3, CaCl2 and MgCl2 aqueous solutions.

As(V) adsorption on granular activated carbon (GAC) and subsequent desorption in dH2O was modeled using the pseudo-first and pseudo-second order kinetic models. Regeneration was achieved by immersing loaded GAC in NaCl, FeCl3, CaCl2 and MgCl2 aqueous solutions. As(V) detection after desorption was highest for NaCl but subsequent adsorption was lowest. Regeneration was highest in FeCl3 solution of pH 2 followed closely by pH 3, but As(V) precipitation appeared superior at pH 3. Molar ratios of Fe, Ca and Mg to As were tested in the range of 0.75:1 to 12:1 where a logarithmic relation was found between the molar ratio and As(V) desorption as diluted in HNO3 and H2O and subsequent adsorption. Precipitation was nearly complete in FeCl3, limited in MgCl2 at a ratio of 12:1 and not observed in CaCl2. While kinetic values were lower than in previous tests, the pseudo-first and pseudo-second order models could accurately describe desorption in CaCl2 and MgCl2 but not in FeCl3 due to precipitation. Desorption in FeCl3 was most effective in precipitating As(V), being highest at a molar ratio of 6:1, but regeneration was slightly higher at a molar ratio of 12:1.

In ovariectomy-induced osteoporotic rat models, BMP-2 substantially reversed an impaired alveolar bone regeneration whereas PDGF-BB failed.

OBJECTIVES: We previously suggested an ovariectomy (OVX)-induced osteoporotic rat model showing an impaired alveolar bone defect healing. This study aimed to evaluate and compare the effects of recombinant human bone morphogenetic protein-2 (rhBMP-2) and recombinant human platelet-derived growth factor-BB (rhPDGF-BB) on alveolar bone defect healing in OVX-induced osteoporotic rats. MATERIALS AND METHODS: A total of forty-one female rats were divided into four groups: a collagen group (n=10), a PDGF-BB group (n=11), a BMP-2 group (n=10), and a control group (n=10). Four months after OVX, alveolar bone drill-hole defects were created and grafted with collagen gel, rhPDGF-BB/collagen gel, or rhBMP-2/collagen gel. The defects in the control group were not grafted with any material. Defect healing was evaluated by histological, histomorphometric, and microcomputed tomographic (micro-CT) analyses at 2 and 4 weeks. RESULTS: According to the micro-CT analysis, the BMP-2 group exhibited the greatest bone volume fraction among all groups, while the PDGF-BB group did not show significant differences compared with the collagen group. The histomorphometric analysis showed a significantly larger amount of new bone area in the BMP-2 group than in the control and collagen groups at 4 weeks; however, the PDGF-BB group did not reach significant superiority compared with the other groups. CONCLUSIONS: Alveolar bone regeneration was significantly enhanced by the local use of rhBMP-2/collagen gel compared with the use of rhPDGF-BB/collagen gel in OVX-induced osteoporotic rats. CLINICAL RELEVANCE: A treatment modality using rhBMP-2 may be a promising approach to promote alveolar bone regeneration in patients suffering from postmenopausal osteoporosis.

Surface Topography of Titanium Affects Their Osteogenic Potential through DNA Methylation.

It is widely accepted that sandblasted/large-grit/acid-etched (SLA) surfaces of titanium (Ti) have a higher osteogenic potential than machined ones. However, most studies focused on differential gene expression without elucidating the underlying mechanism for this difference. The aim of this study was to evaluate how the surface roughness of dental Ti implants affects their osteogenic potential. Mouse preosteoblast MC3T3-E1 cells were seeded on machined and SLA Ti discs. The cellular activities of the discs were analyzed using confocal laser scanning microscopy, proliferation assays, and real-time polymerase chain reaction (PCR). DNA methylation was evaluated using a methylation-specific PCR. The cell morphology was slightly different between the two types of surfaces. While cellular proliferation was slightly greater on the machined surfaces, the osteogenic response of the SLA surfaces was superior, and they showed increased alkaline phosphatase (Alp) activity and higher bone marker gene expression levels (Type I collagen, Alp, and osteocalcin). The degree of DNA methylation on the Alp gene was lower on the SLA surfaces than on the machined surfaces. DNA methyltransferase inhibitor stimulated the Alp gene expression on the machined surfaces, similar to the SLA surfaces. The superior osteogenic potential of the SLA surfaces can be attributed to a different epigenetic landscape, specifically, the DNA methylation of Alp genes. This finding offers novel insights into epigenetics to supplement genetics and raises the possibility of using epidrugs as potential therapeutic targets to enhance osteogenesis on implant surfaces.

Supplemental periodontal regeneration by vertical ridge augmentation around dental implants. A preclinical in vivo experimental study.

OBJECTIVES: To evaluate the supplemental periodontal regeneration on adjacent teeth by vertical ridge augmentation around dental implants. MATERIAL AND METHODS: The second premolar and the fourth premolar were extracted from both sides of the mandible in four beagle dogs. After 2 months, defects of 3 mm and 5 mm deep were formed. In the test group, vertical ridge augmentation was performed around a dental implant, and in the control group, vertical ridge augmentation was performed without implant placement. The animals were euthanized 3 months after the procedure, and radiographic and histomorphometric analyses were performed. RESULTS: Overall, the test group showed better results than the control group. The presence of new cementum in the histological examination of the test group confirmed that vertical ridge augmentation with proper space maintaining could contribute to periodontal regeneration of adjacent teeth. Statistically significant difference in new bone height (%) was found in group I (5-mm defect depth and implant placement, GBR) when compared with group III (5-mm defect depth, GBR) and IV (3-mm defect depth, GBR). New bone area (%) was statistically different between groups I and IV. CONCLUSIONS: In conclusion, within the limitation of this study using mandibular residual ridges after extraction of a single tooth in dogs, grafted space was maintained by dental implants better in the deep defect (5-mm depth) than the shallow defect (3-mm depth). Vertical ridge augmentation around dental implants also promoted neighboring periodontal regeneration.

Diagnostic value of magnetic resonance cholangiopancreatography to detect bile duct stones in acute biliary pancreatitis.

OBJECTIVES: This study aims to evaluate the diagnostic value of magnetic resonance cholangiopancreatography (MRCP) in detecting common bile duct (CBD) stones in acute biliary pancreatitis (ABP). METHODS: The medical records of patients presenting with ABP from January 2008 to July 2013 were reviewed to assess the value of MRCP in detecting CBD stones in ABP. Endoscopic retrograde cholangiopancreatography (ERCP) was used as the reference standard to assess the diagnostic yield of MRCP in detecting choledocholithiasis. When ERCP was unavailable, intraoperative cholangiography or clinical follow-up was used as the reference standard. RESULTS: Seventy-eight patients who underwent MRCP were diagnosed with ABP, and thirty of the 78 patients (38%) were confirmed to have CBD stones per the study protocol. The sensitivity of MRCP in detecting CBD stones in ABP was 93.3% compared to 66.7% for abdominal CT (P < 0.008). The overall accuracy of MRCP in detecting choledocholithiasis was 85.9% compared to 74.0% for abdominal CT (P < 0.041). The area under the receiver operating characteristic curve (AUC) of MRCP in detecting CBD stones was 0.882, which was more accurate than the AUC of 0.727 for abdominal CT (P = 0.039). In 38 patients who underwent ERCP, the sensitivity and negative predictive value of MRCP in detecting CBD stones were both 100% regardless of the dilatation of the bile duct (≥7 mm versus < 7 mm). CONCLUSION: MRCP is an effective, noninvasive modality to detect CBD stones in ABP and can help identify patients who require ERCP.

Use of alternative curing salts for processing salamis.

OBJECTIVE: This study was performed to determine effects of different curing salts on the quality of salamis and to assess feasibility of using NaCl-alternative salts. METHODS: Various types of curing salts (KCl or MgCl2) as well as NaCl (sun-dried or refined) were incorporated for processing of salamis. The proximate composition, fatty acids, nucleotide-related compounds, and free amino acids of the salamis were analyzed during 40 days of ripening. RESULTS: The substitution of NaCl by KCl caused higher fat and ash content, but lower moisture content of the salami after 20 days of ripening (p<0.05). Compared with the sun-dried NaCl, use of KCl in salami also led to greater inosine 5'-monophosphate whereas refined NaCl had more inosine (p<0.05). KCl-added salami also had a higher C12:0, C17:1, and C20:0 than other types of salami (p<0.05). MgCl2-added salami had higher content of free amino acids compared to the other salamis (p<0.05). CONCLUSION: Alternative curing salts such as KCl and MgCl2 could substitute NaCl in consideration of quality factor of a fermented meat product. Especially replacement of NaCl with KCl will be a suitable strategy for developing relatively low sodium salami products without compromising product quality.

Impact of the Cross-Sectional Location of Multidetector Computed Tomography Scans on Prediction of Serosal Exposure in Patients with Advanced Gastric Cancer.

BACKGROUND: The extent of serosal exposure varies depending on the cross-section of the stomach that is viewed, affected by the visceral peritoneum of the omentum. Although multidetector computed tomography (MDCT) is the most useful method to predict serosal exposure, the MDCT criteria for such exposure by cross-sectional location remain to be established. METHODS: The MDCT of gastric cancer patients who underwent surgery, and for whom pathological reports were available, were reviewed by radiologists. The MDCT criteria for invasion depth were divided into five grades: (1) smooth margin; (2) undulating margin; (3) streaky margin within vessels; (4) nodular margin within perigastric vessels; and (5) streaky or nodular margin over the perigastric vessels. The five grades were compared in terms of pathological tumor depth by curvature and wall group. RESULTS: A total of 125 patients of stage ≥ T2 were enrolled. The five MDCT grades correlated with tumor depth (P < 0.001). Exposed serosal lesions of grade 3 (P = 0.031) and 5 (P = 0.030) constituted significantly the largest proportion of wall and curvature cancers, respectively. The accuracy of MDCT in terms of T staging using the five grades was calculated by cross-sectional location. The highest accuracies were associated with curvature- and wall-located tumors (55.1 and 64.3%, respectively) when serosal exposure was graded 5 and 3, respectively. The highest overall accuracy for T staging was 59.2% when the various MDCT criteria were applied by reference to the cross-sectional location. CONCLUSIONS: The MDCT criteria for serosal exposure vary by the cross-sectional location of the gastric cancer.

Comparison of biannual ultrasonography and annual non-contrast liver magnetic resonance imaging as surveillance tools for hepatocellular carcinoma in patients with liver cirrhosis (MAGNUS-HCC): a study protocol.

BACKGROUND: Ultrasonography (US) is recommended as a standard surveillance tool for patients with a high risk of developing hepatocellular carcinoma (HCC). However, the low sensitivity of US for small HCC can lead to surveillance failure, resulting in advanced stage tumor presentations. For the early detection of HCC in high-risk patients and to improve survival and prognosis, a new efficient imaging tool with a high sensitivity for HCC detection is needed. The purpose of this study is to evaluate and compare the feasibility and efficacy of non-contrast magnetic resonance imaging (MRI) with US as a surveillance tool for HCC in patients with liver cirrhosis. METHODS: MAGNUS-HCC is a prospective, multicenter clinical trial with a crossover design for a single arm of patients. This study was approved by six Institutional Review Boards, and informed consent was obtained from all participants. All patients will undergo liver US every 6 months and non-contrast liver MRI every 12 months during a follow-up period of 3 years. If a focal liver lesion suspected of harboring HCC is detected, dynamic liver computed tomography (CT) will be performed to confirm the diagnosis. After the last surveillance round, patients without suspicion of HCC or who are not diagnosed with HCC will be evaluated with a dynamic liver CT to exclude false-negative findings. The primary endpoint is to compare the rate of detection of HCC by US examinations performed at 6-month intervals with that of yearly non-contrast liver MRI studies during a 3-year follow-up. The secondary endpoint is the survival of the patients who developed HCC within the 3-year follow-up period. DISCUSSION: MAGNUS-HCC is the first study to compare the feasibility of non-contrast MRI with US as a surveillance tool for the detection of HCC in high-risk patients. We anticipate that the evidence presented in this study will establish the efficacy of non-contrast MRI as a surveillance tool for HCC in high-risk patients. TRIAL REGISTRATION: The date of trial registration ( NCT02551250 ) in this study was September 15, 2015, and follow-up is still ongoing.

Noncontact Sleep Study by Multi-Modal Sensor Fusion.

Polysomnography (PSG) is considered as the gold standard for determining sleep stages, but due to the obtrusiveness of its sensor attachments, sleep stage classification algorithms using noninvasive sensors have been developed throughout the years. However, the previous studies have not yet been proven reliable. In addition, most of the products are designed for healthy customers rather than for patients with sleep disorder. We present a novel approach to classify sleep stages via low cost and noncontact multi-modal sensor fusion, which extracts sleep-related vital signals from radar signals and a sound-based context-awareness technique. This work is uniquely designed based on the PSG data of sleep disorder patients, which were received and certified by professionals at Hanyang University Hospital. The proposed algorithm further incorporates medical/statistical knowledge to determine personal-adjusted thresholds and devise post-processing. The efficiency of the proposed algorithm is highlighted by contrasting sleep stage classification performance between single sensor and sensor-fusion algorithms. To validate the possibility of commercializing this work, the classification results of this algorithm were compared with the commercialized sleep monitoring device, ResMed S+. The proposed algorithm was investigated with random patients following PSG examination, and results show a promising novel approach for determining sleep stages in a low cost and unobtrusive manner.

Epigenetic Priming Confers Direct Cell Trans-Differentiation From Adipocyte to Osteoblast in a Transgene-Free State.

The bone marrow of healthy individuals is primarily composed of osteoblasts and hematopoietic cells, while that of osteoporosis patients has a larger portion of adipocytes. There is evidence that the epigenetic landscape can strongly influence cell differentiation. We have shown that it is possible to direct the trans-differentiation of adipocytes to osteoblasts by modifying the epigenetic landscape with a DNA methyltransferase inhibitor (DNMTi), 5'-aza-dC, followed by Wnt3a treatment to signal osteogenesis. Treating 3T3-L1 adipocytes with 5'-aza-dC induced demethylation in the hypermethylated CpG regions of bone marker genes; subsequent Wnt3a treatment drove the cells to osteogenic differentiation. When old mice with predominantly adipose marrow were treated with both 5'-aza-dC and Wnt3a, decreased fatty tissue and increased bone volume were observed. Together, our results indicate that epigenetic modification permits direct programming of adipocytes into osteoblasts in a mouse model of osteoporosis, suggesting that this approach could be useful in bone tissue-engineering applications.

Quality Characteristics of Dry-cured Ham Made from Two Different Three-way Crossbred Pigs.

This study was conducted to compare the physicochemical traits of dry-cured hams made from two different three-way crossbred pigs: Yorkshire×Landrace×Duroc (YLD) and Yorkshire×Berkshire×Duroc (YBD). Animals were slaughtered at a live weight of 110 to 120 kg and cooled at 0°C for 24 h in a chilling room, the ham portion of the carcasses were cut and processed by dry-curing for physico-chemical analyses. While the moisture and crude protein contents of dry-cured ham were higher in YLD than in YBD, crude fat and ash content were higher in YBD (p<0.05). The salt contents of ham from YBD were higher than those from YLD (p<0.05). YBD ham samples showed a higher L* and b* values than those from YLD, while YBD ham showed lower a* value (p<0.05). Thiobarbituric acid reactive substances (TBARS) and volatile basic nitrogen (VBN) values of YLD hams were lower than those of YBD samples (p<0.05). Hardness, gumminess, chewiness, and shear force values of YBD ham were higher than those of YLD sample (p<0.05). Saltiness was significantly higher in YBD ham than in YLD samples (p<0.05). YLD ham displayed a superior quality than YBD. Considering the meat quality parameters of two-way crossbred ham, YLD hams could be more suitable for the production of dry-cured products.

Effect of Fat Level and the Ripening Time on Quality Traits of Fermented Sausages.

The objective of this study was to investigate the effect of the fat reduction on the physicochemical and microbiological characteristics of fermented sausages during ripening and drying. Low fat fermented sausages were produced with different fat levels (30%, 20%, 10%, and 5%) under ripening conditions and fermented process. Samples from each treatment were taken for physicochemical and microbiological analyses on the 0, 1, 2, 3, 4, 5, 7, 10, 14, and 21st day of ripening. In proximate analysis, the fat reduction in sausages produced an increase in moisture, protein and ash contents during ripening and drying (p<0.05). The weight losses were significantly higher in high fat formulations during the first 4 days, whereas those were higher in low fat ones after 10 days of storage (p<0.05). Fat reduction was responsible for an increase in shear force values after 3 days of storage. The volatile basic nitrogen (VBN) value of the low fat samples was significantly higher (p<0.05). Low fat sausages reduced the extent of lipid oxidation. The lower fat level produced redder sausages. Total plate bacteria and Pseudomonas counts of sausages showed no significant differences. Production of low fat sausages resulted in the physicochemical and microbiological attributes equal to or better than the high fat sausages without negative effects, except only a higher VBN and weight loss.

Epigenetic modifications and canonical wingless/int-1 class (WNT) signaling enable trans-differentiation of nonosteogenic cells into osteoblasts.

Mesenchymal cells alter and retain their phenotype during skeletal development through activation or suppression of signaling pathways. For example, we have shown that Wnt3a only stimulates osteoblast differentiation in cells with intrinsic osteogenic potential (e.g. MC3T3-E1 pre-osteoblasts) and not in fat cell precursors or fibroblasts (3T3-L1 pre-adipocytes or NIH3T3 fibroblasts, respectively). Wnt3a promotes osteogenesis in part by stimulating autocrine production of the osteoinductive ligand Bmp2. Here, we show that the promoter regions of the genes for Bmp2 and the osteoblast marker Alp are epigenetically locked to prevent their expression in nonosteogenic cells. Both genes have conserved CpG islands that exhibit increased CpG methylation, as well as decreased acetylation and increased methylation of histone H3 lysine 9 (H3-K9) specifically in nonosteogenic cells. Treatment of pre-adipocytes or fibroblasts with the CpG-demethylating agent 5'-aza-2'-deoxycytidine or the histone deacetylase inhibitor trichostatin-A renders Bmp2 and Alp responsive to Wnt3a. Hence, drug-induced epigenetic activation of Bmp2 gene expression contributes to Wnt3a-mediated direct trans-differentiation of pre-adipocytes or fibroblasts into osteoblasts. We propose that direct conversion of nonosteogenic cells into osteoblastic cell types without inducing pluripotency may improve prospects for novel epigenetic therapies to treat skeletal afflictions.

Usefulness of Two-Dimensional Values Measured Using Preoperative Multidetector Computed Tomography in Predicting Lymph Node Metastasis of Gastric Cancer.

BACKGROUND: Multidetector computed tomography (MDCT) is essential for the prediction of lymph node (LN) metastasis in gastric cancer. However, the measurement method and size criteria for metastatic LNs using MDCT are unclear. METHODS: MDCTs of gastric cancer patients who underwent surgery and had pathological staging were reviewed by radiologists. The two-dimensional cutoff values for LNs with suspected metastasis were calculated, and clinicopathological data were analyzed using those cutoff values. RESULTS: The total number of enrolled patients was 327. The cutoff values of the maximal area with metastatic LNs were obtained significantly at stations 3, 4, and 6, and those values were 112.09, 33.79, and 85.88 mm(2), respectively. The common cutoff value was 112.09 mm(2), and the area under the curve was 0.617 (P = 0.002). The overall survival rate of the patients with LNs less than 112.09 mm(2) was significantly better than those with LNs greater than 112.09 mm(2) (P < 0.001). In multivariate analysis, the maximal LN area was an independent prognostic factor (adjusted hazard ratio, 1.697 [95% confidence interval 1.116-2.582]). CONCLUSIONS: Using two-dimensional values for LNs measured by MDCT is a practical method of predicting metastatic LNs in gastric cancer. The maximal LN area value would be useful in both the preoperative staging and prognosis prediction of gastric cancer.

Bone reconstruction after surgical treatment of experimental peri-implantitis defects at a sandblasted/acid-etched hydroxyapatite-coated implant: an experimental study in the dog.

OBJECTIVES: The objective of this study was to evaluate bone formation/osseointegration following surgical treatment of experimental peri-implantitis at dental implants with different surface characteristics exposed to ligature-induced breakdown conditions. METHODS: Ten turned (control), 10 sandblasted/acid-etched (SA), and 10 SA/hydroxyapatite nanocoated (HA) implants were installed into the edentulated posterior mandible in five Beagle dogs and allowed to osseointegrate for 12 weeks. Ligature-induced breakdown defects were then induced over 23 weeks using stainless steel wire ligatures. The ligatures were removed and soft tissues were allowed to heal for 3 weeks. Next, exposed implant surfaces were decontaminated followed by guided bone regeneration using a collagen membrane and submerged wound healing. The animals were euthanized for histometric analysis at 12 weeks post-surgery. RESULTS: The radiographic analysis showed vertical bone loss following ligature-induced breakdown without statistically significant differences among implant technologies. The histometric analysis showed significantly enhanced bone formation (height) at SA and SA/HA compared with turned implants (p = 0.028) following reconstructive surgery. Bone formation area was greater at SA/HA compared with turned implants, however the difference did not reach statistical significance. CONCLUSIONS: While ligature-induced defect progression does not appear implant surface dependent in this animal model, bone formation at the decontaminated implant surfaces appears more favourable at SA and SA/HA over turned implants following reconstructive surgery.

Extraction sockets: erratic healing impeding factors.

AIM: The aim of this exploratory study was to analyse prevalence of extraction sockets showing erratic healing and evaluate factors potentially impeding healing. METHODS: Erratic healing was defined as extraction sites showing clinical observations of fibrous scar tissue occupying the extraction site rather than bone following 12 or more weeks of healing. Computerized tomography was used to evaluate characteristics and calculate Hounsfield unit scores for sites showing erratic healing. RESULTS: A total of 1226 dental records from Seoul National University Dental Hospital archives including patients subject to extractions prior to implant placement were evaluated. Seventy subjects (5.71%) and 97 sites (4.24%) exhibited erratic extraction socket healing. Maxillary incisor/canine sites showed the lowest (0.47%), whereas mandibular molar sites the highest (5.41%) occurrence. In the multivariable analysis, erratic healing was more likely to occur in subjects <60 years old (OR = 2.23, 95%CI = 1.26-3.94), subjects with hypertension (OR = 2.37, 95%CI = 1.24-4.55), in molar sites (OR = 4.91, 95%CI = 1.41-17.07), and following single tooth extractions (OR = 2.98, 95%CI = 1.36-6.53). Computerized tomography showed the highest incidence of bone loss for the buccal wall (49.3%). CONCLUSION: Erratic extraction socket healing appears a not uncommon sequel and local factors seem to be major contributors to its occurrence.

Risk factors associated with nephrocalcinosis in preterm infants.

PURPOSE: The objective was to identify the risk factors associated with nephrocalcinosis (NC) in preterm infants. METHODS: NC was diagnosed by renal sonography at 4 or 8 weeks of life, and 10 infants who had findings of type 3 or 4 NC were classified as the NC group. Various clinical and laboratory factors were compared between NC and control groups. RESULTS: Serum sodium (Na) on day 1, serum creatinine and fractional excretion of calcium (FeCa) at 1 and 2 weeks, and serum calcium (Ca), fractional excretion of sodium (FeNa), and urine Na on 2 weeks of life were significantly different between the two groups: the NC group showed significantly higher serum creatinine, FeNa, and FeCa than the control group, suggesting a greater decrease in renal function in the NC group. Differences of the laboratory findings disappeared after 4 weeks of life. The strongest risk factor was birth weight. CONCLUSION: A transient decrease in renal function during the first 2 weeks of life was associated with development of NC in preterm very low-birth-weight infants, and the risk of NC increased as birth weight decreased.

Regeneration of As(V)-loaded granular activated carbon through electrocoagulation.

As(V)-loaded granular activated carbon was regenerated through electrocoagulation assisted by elution with NaCl. Adsorption of As(V) by activated carbon was highest at pH 6, and subsequent desorption in water was highest at pH 11, followed by pH 3. Lower initial pH improved arsenic removal during electrocoagulation, NaCl concentration was insignificant, but removal increased with current density. Adding Fe(II) before electrocoagulation led to an improved removal efficiency up to a concentration of 30 mg/L. Regeneration of As(V)-loaded activated carbon increased with current density and time up to a maximum of 85%. An increase in NaCl concentration to 6000 mg/L further improved regeneration to 92%. Regeneration at a lower current density only dropped slightly from 54% to 51% when doubling activated carbon concentration, demonstrating excellent scalability. Repeated adsorption-desorption tests were performed, where 81% and 69% regeneration were obtained after four regenerations with NaCl concentrations of 6000 and 750 mg/L, respectively. NaCl concentration in the tested range did not influence electrocoagulation but improved regeneration through elution. The combination of electrocoagulation and elution facilitated a higher regeneration efficiency, meanwhile removing As(V) from the solution through adsorption on iron hydroxide. PRACTITIONER POINTS: As(V)-loaded activated carbon was regenerated by electrocoagulation with elution. Regeneration increased with regeneration time and current density up to 85%. Addition of 6000 mg/L NaCl further increased regeneration to 93%. Regeneration of 82% was achieved after four regenerations. NaCl did not affect electrocoagulation but improved regeneration through elution.

Quadriplegia, Dysphagia and Ataxia Manifested in a Child With COVID-19 Related Acute Necrotizing Encephalopathy: A Case Report.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, presents primarily with respiratory symptoms. However, children with COVID-19 are usually asymptomatic or mild acute symptoms and also neurological manifestations have also been observed. We report the case of a 7-year-old girl who presented with high fever and altered mental status, leading to a diagnosis of COVID-19 and acute necrotizing encephalopathy (ANE). The patient received intensive medical care in the intensive care unit and subsequently underwent rehabilitation programs due to neurological functional sequelae. Neurological complications in COVID-19, including ANE, may result from potential viral nerve involvement, cytokine storms, and the blood-brain barrier disruption. Early rehabilitation plays a pivotal role in managing COVID-19-related neurological complications and enhancing patients' functional outcomes. Further research is essential to gain a better understanding of the mechanisms and treatment strategies for neurological manifestations in pediatric COVID-19 patients, particularly those with multisystem inflammatory syndrome in child.