Reducing posttreatment relapse in cleft lip palatal expansion using an injectable estrogen-nanodiamond hydrogel.

Patients with cleft lip and/or palate (CLP), who undergo numerous medical interventions from infancy, can suffer from lifelong debilitation caused by underdeveloped maxillae. Conventional treatment approaches use maxillary expansion techniques to develop normal speech, achieve functional occlusion for nutrition intake, and improve esthetics. However, as patients with CLP congenitally lack bone in the cleft site with diminished capacity for bone formation in the expanded palate, more than 80% of the patient population experiences significant postexpansion relapse. While such relapse has been a long-standing battle in craniofacial care of patients, currently there are no available strategies to address this pervasive problem. Estrogen, 17ß-estradiol (E2), is a powerful therapeutic agent that plays a critical role in bone homeostasis. However, E2's clinical application is less appreciated due to several limitations, including its pleiotropic effects and short half-life. Here, we developed a treatment strategy using an injectable system with photo-cross-linkable hydrogel (G) and nanodiamond (ND) technology to facilitate the targeted and sustained delivery of E2 to promote bone formation. In a preclinical expansion/relapse model, this functionalized E2/ND/G complex substantially reduced postexpansion relapse by nearly threefold through enhancements in sutural remodeling compared with unmodified E2 administration. The E2/ND/G group demonstrated greater bone volume by twofold and higher osteoblast number by threefold, compared with the control group. The E2/ND/G platform maximized the beneficial effects of E2 through its extended release with superior efficacy and safety at the local level. This broadly applicable E2 delivery platform shows promise as an adjuvant therapy in craniofacial care of patients.

Accuracy of Three-Dimensional Soft Tissue Prediction in Orthognathic Cases Using Dolphin Three-Dimensional Software.

INTRODUCTION: Orthodontists and surgeons have been looking for more accurate methods to plan and predict surgical outcomes in patients with skeletal discrepancies. METHODS: The sample consisted of 20 subjects from the surgical clinic of a graduate orthodontic program who had been treated with Le Fort I maxillary movement, bisagittal split osteotomy, with or without genioplasty. All subjects had to have preoperative (T0) and at least 6 months postoperative (T1) cone-beam computed tomographies that were imported to Dolphin three-dimensional (3D) software version 11.9 in digital imaging and communications in medicine format. Three-dimensional voxel-based superimposition on the cranial base was performed for T0 and T1 to accurately measure the skeletal surgical movements. A virtual orthognathic surgery was performed on T0 to mimic the actual skeletal osteotomies using the treatment simulation tool in Dolphin 3D. A prediction 3D soft tissue image (Tp) was generated based on the Dolphin virtual skeletal planning. The differences between Tp and T1 for all patients were measured using linear and angular measurements visualized by surface mapping. RESULTS: Significant differences were found between Tp and T1 in Nasolabial angle, Soft tissue A point, and Subalar area. CONCLUSIONS: The soft tissue prediction accuracy after double jaw surgery using Dolphin 3D is limited in some areas, especially upper lip and base of the nose.

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

OBJECTIVES: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR). METHODS: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs). RESULTS: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries. CONCLUSIONS: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.

Global, regional, and national levels of neonatal, infant, and under-5 mortality during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: Remarkable financial and political efforts have been focused on the reduction of child mortality during the past few decades. Timely measurements of levels and trends in under-5 mortality are important to assess progress towards the Millennium Development Goal 4 (MDG 4) target of reduction of child mortality by two thirds from 1990 to 2015, and to identify models of success. METHODS: We generated updated estimates of child mortality in early neonatal (age 0-6 days), late neonatal (7-28 days), postneonatal (29-364 days), childhood (1-4 years), and under-5 (0-4 years) age groups for 188 countries from 1970 to 2013, with more than 29,000 survey, census, vital registration, and sample registration datapoints. We used Gaussian process regression with adjustments for bias and non-sampling error to synthesise the data for under-5 mortality for each country, and a separate model to estimate mortality for more detailed age groups. We used explanatory mixed effects regression models to assess the association between under-5 mortality and income per person, maternal education, HIV child death rates, secular shifts, and other factors. To quantify the contribution of these different factors and birth numbers to the change in numbers of deaths in under-5 age groups from 1990 to 2013, we used Shapley decomposition. We used estimated rates of change between 2000 and 2013 to construct under-5 mortality rate scenarios out to 2030. FINDINGS: We estimated that 6·3 million (95% UI 6·0-6·6) children under-5 died in 2013, a 64% reduction from 17·6 million (17·1-18·1) in 1970. In 2013, child mortality rates ranged from 152·5 per 1000 livebirths (130·6-177·4) in Guinea-Bissau to 2·3 (1·8-2·9) per 1000 in Singapore. The annualised rates of change from 1990 to 2013 ranged from -6·8% to 0·1%. 99 of 188 countries, including 43 of 48 countries in sub-Saharan Africa, had faster decreases in child mortality during 2000-13 than during 1990-2000. In 2013, neonatal deaths accounted for 41·6% of under-5 deaths compared with 37·4% in 1990. Compared with 1990, in 2013, rising numbers of births, especially in sub-Saharan Africa, led to 1·4 million more child deaths, and rising income per person and maternal education led to 0·9 million and 2·2 million fewer deaths, respectively. Changes in secular trends led to 4·2 million fewer deaths. Unexplained factors accounted for only -1% of the change in child deaths. In 30 developing countries, decreases since 2000 have been faster than predicted attributable to income, education, and secular shift alone. INTERPRETATION: Only 27 developing countries are expected to achieve MDG 4. Decreases since 2000 in under-5 mortality rates are accelerating in many developing countries, especially in sub-Saharan Africa. The Millennium Declaration and increased development assistance for health might have been a factor in faster decreases in some developing countries. Without further accelerated progress, many countries in west and central Africa will still have high levels of under-5 mortality in 2030. FUNDING: Bill & Melinda Gates Foundation, US Agency for International Development.

Optimization of Pulsed Laser Ablation and Radio-Frequency Sputtering Tandem System for Synthesis of 2D/3D Al2O3-ZnO Nanostructures: A Hybrid Approach to Synthesis of Nanostructures for Gas Sensing Applications.

In this paper, a unique hybrid approach to design and synthesize 2D/3D Al2O3-ZnO nanostructures by simultaneous deposition is presented. Pulsed laser deposition (PLD) and RF magnetron sputtering (RFMS) methods are redeveloped into a single tandem system to create a mixed-species plasma to grow ZnO nanostructures for gas sensing applications. In this set-up, the parameters of PLD have been optimized and explored with RFMS parameters to design 2D/3D Al2O3-ZnO nanostructures, including nanoneedles/nanospikes, nanowalls, and nanorods, among others. The RF power of magnetron system with Al2O3 target is explored from 10 to 50 W, while the ZnO-loaded PLD's laser fluence and background gases are optimized to simultaneously grow ZnO and Al2O3-ZnO nanostructures. The nanostructures are either grown via 2-step template approach, or by direct growth on Si (111) and MgO<0001> substrates. In this approach, a thin ZnO template/film was initially grown on the substrate by PLD at ~300 °C under ~10 milliTorr (1.3 Pa) O2 background pressure, followed by growth of either ZnO or Al2O3-ZnO, using PLD and RFMS simultaneously under 0.1-0.5 Torr (13-67 Pa), and Ar or Ar/O2 background in the substrate temperate range of 550-700 °C. Growth mechanisms are then proposed to explain the formation of Al2O3-ZnO nanostructures. The optimized parameters from PLD-RFMS are then used to grow nanostructures on Au-patterned Al2O3-based gas sensor to test its response to CO gas from 200 to 400 °C, and a good response is observed at ~350 °C. The grown ZnO and Al2O3-ZnO nanostructures are quite exceptional and remarkable and have potential applications in optoelectronics, such in bio/gas sensors.

Laparoscopic management of cecum and ascending colon hernia through the foramen of Winslow.

Herniation of gastrointestinal structures through the foramen of Winslow is rare, with patients presenting with nonspecific symptoms. We describe a 47-year-old woman who presented with generalized, intermittent, colicky abdominal pain for a duration of 4 days. An abdominal computed tomography scan revealed findings consistent with herniation of the ileocecal junction through the foramen of Winslow. Laparoscopic assisted internal hernia reduction with ileocecal resection and side-to-side ileocolic anastomosis were done. The cecum and terminal ileum were resected due to signs of ischemia. Her postoperative was uneventful, and she was discharged in the second postoperative day. She did not show any signs or symptoms suggestive of complications or recurrence during her follow-up.

Prevalence of fall injuries and risk factors for fall among hospitalized children in a specialized childrens hospital in Saudi Arabia.

BACKGROUND: Fall injuries among children during hospital stay is a major patient safety issue. Inpatient pediatric falls can lead to numerous negative consequences. In contrast to adults, there is a paucity of information on the prevalence and risk factors associated with children's falls during hospitalization. OBJECTIVES: Identify the prevalence of fall injuries among hospital.ized children and describe the demographic and environmental factors that could predict a higher risk of severe outcomes of fall. DESIGN: Descriptive, cross-sectional prevalence study. SETTING: Specialized children's hospital. PATIENTS AND METHODS: Data was obtained through the electronic Safety Reporting System (SRS). All reported fall events during hospitalization in children less than or equal 14 years of age for the period from 1 April 2015 to 30 April 2016 were included. Fall events that occurred in the day care unit and the outpatient clinic were excluded. MAIN OUTCOME MEASURES: Prevalence and possible risk factors for fall events. SAMPLE SIZE: 48. RESULTS: The prevalence of falls among the 4860 admitted children was 9.9 (95% CI=7.5, 13.1) per 1000 patients (48/4860). A majority of the falls were among boys (n=26, 54%), in the age group from 1-5 years old (n=22, 46%), in children at high risk of falling (n=35, 73%), with normal mobility status (n=21, 44%), and with no history of previ.ous falls (n=33, 69%). Severe injuries accounted for 25% of falls (n=12). However, falls among the moderate risk category (n=9, 69%) were more often severe than falls among the high risk category of children (n=12, 34%) (P=.03). CONCLUSION: Risk factor identification is required to prevent falls and their severe outcomes. LIMITATIONS: Underreporting and single-centered study. CONFLICT OF INTEREST: None.

Acylated pregnane glycosides from Caralluma russeliana.

The chloroform extract of the aerial parts of Caralluma russeliana yielded four acylated pregnane glycosides, namely russeliosides E-H, three were found now. The structures of the compounds were elucidated using MS, 1H NMR, 13C NMR, 1H-1H COSY, HMQC, NOESY and HMBC experiments.

Impact of type 1 diabetes mellitus on academic performance.

OBJECTIVE: To examine the effect of type 1 diabetes on academic performance. METHODS: Ethnically Saudi students with type 1 diabetes, and age, sex, ethnicity and socio-economic status-matched nondiabetic control students were recruited from eight schools. Overall academic grades were recorded, based on the scores obtained in written examinations in English, mathematics, physics, chemistry, biology and humanities. RESULTS: Students with type 1 diabetes (n = 36) obtained significantly lower academic grades compared with their nondiabetic control classmates (n = 36) (86.58 ± 1.48 vs 90.62 ± 1.36). CONCLUSIONS: Overall academic performance is significantly lower in students with type 1 diabetes compared with their nondiabetic classmates. This decline in academic performance may be explained by an association between diabetes and cognitive function.

Natural antifouling compound production by microbes associated with marine macroorganisms: A review

In the marine environment, all hard surfaces including marine macroorganims are colonized by microorganisms mainly from the surrounding environment. The microorganisms associated with marine macroorganisms offer tremendous potential for exploitation of bioactive metabolites. Biofouling is a continuous problem in marine sectors which needs huge economy for control and cleaning processes. Biotechnological way for searching natural product antifouling compounds gained momentum in recent years because of the environmental pollution associated with the use of toxic chemicals to control biofouling. While, natural product based antifoulants from marine organisms particularly sponges and corals attained significance due to their activities in field assays, collection of larger amount of organisms from the sea is not a viable one. The microorganisms associated with sponges, corals, ascidians, seaweeds and seagrasses showed strong antimicrobial and also antifouling activities. This review highlights the advances in natural product antifoulants research from microbes associated with marine organisms.