Successful restoration of failed Achilles tendon surgery with semitendinosus and gracilis tendon graft: a case report.

Objective: This case presentation aims to highlight the challenges and outcomes associated with a partial tear of the Achilles tendon (AT) in an elite marathon runner. The objective was to restore tendon anatomy and optimize strength recovery through surgical intervention. Method: We present the case of a marathon runner who suffered a partial AT tear and underwent an initial surgery that failed. A revision surgery was then performed using a semitendinosus and gracilis tendon graft. Results: The patient underwent surgery 14 weeks after the initial AT injury, but unfortunately experienced a complete AT tear after 6 months. However, the novel aspect of this case is the successful restoration of the failed double-row suture technique through the utilization of a semitendinosus and gracilis tendon graft. Notably, the graft remained intact even under high tendon loading during the 2-year follow-up period. Conclusion: Differential diagnosis should consider partial tears of the AT as a possible diagnosis in the patients with heel pain. Furthermore, it is crucial to prioritize a well-paced post-surgical rehabilitation process in AT surgeries. In cases of failed AT surgery, the utilization of gracilis and semitendinosus tendon grafts can serve as viable options for repairing reruptures.

Evaluation of the effect of green tea extract on postoperative pain management following surgical removal of impacted mandibular third molar.

Background: Pain following surgical removal of impacted molars has remained a principal concern among practitioners. Since green tea has anti-inflammatory and anti-bacterial properties, the current study aimed to evaluate the efficacy of green tea extract local application in controlling postoperative pain following surgical extraction of the impacted mandibular third molar teeth. Materials and Methods: In a double-blinded randomized controlled trial study with a split-mouth design, 32 patients underwent bilateral removal of impacted third molars in a 2-month time interval; afterward, the sterile gauzes impregnated with green tea extract and saline were applied randomly to the surgical sites. Postoperative pain was evaluated 6, 12, 24, and 48 h after surgery using a questionnaire based on the Visual Analog Scale (VAS) and the number of analgesics used after surgery. Data were subjected to exact and Chi-square tests with the significance level set at 0.05. Results: There was a decrease in the mean scores of the VAS and the mean number of analgesic consumptions in the first 2 days after surgery. Chi-square test results showed a significant reduction in the VAS scores after applying the green tea extract only 6 and 12 h after surgery (P < 0.05). Moreover, the number of analgesic consumptions was significantly lower in the green tea group compared to the control group. Conclusion: Green tea extract may be an appropriate and safe choice for postoperative pain control after surgical extraction of the impacted mandibular third molar teeth.

Increasing Use of Telemedicine for Neurological Disorders During the COVID-19 Pandemic: A Mini-Review.

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious viral infection. In addition to its association with common pulmonary and gastrointestinal complications, COVID-19 is also associated with numerous neurological and neuropsychiatric conditions. This minireview aims to cover current literature addressing the application of telemedicine in neurological disorders and neuropsychiatric conditions, especially in response to the COVID-19 pandemic. This article revealed that quarantine, masking, and social distancing policies practiced during the COVID-19 pandemic involved restrictions and challenges to providing medical services, especially for patients with neurological disorders with or without COVID-19 infection. During the pandemic, both healthcare administrators and clinicians, including neurologists, have rapidly adapted or introduced telemedicine technologies for delivering specialty care. In some areas in the world, telemedicine has been successfully applied to reduce the impact imposed by COVID-19. Conclusively, this article supports the idea that telemedicine is an effective tool for providing specialized healthcare for patients with neurological conditions while adhering to social distancing or lockdown policies instituted during the COVID-19 pandemic. Government and medical/healthcare authorities, physicians and healthcare providers need to work together to expand the adoption of telemedicine applications, even after the COVID-19 crisis.

Hybrid Distractor for Continuous Mandibular Distraction Osteogenesis.

Distraction osteogenesis (DO) is a reconstruction method for repairing bone deficiencies in the oral and maxillofacial area. Manual DO techniques have shown the functionality of the DO method for bone tissue reconstruction. The DO method can improve treatment conditions, as well as the quality of the reconstructed bone, compared with conventional techniques. Recently, continuous DO devices have been proposed to enable an automatic DO process while using a continuous force for moving the bone segment (BS). Animal studies and clinical trials have shown the successful application of continuous distractors in terms of improving DO factors, including rate and rhythm. The continuous DO technique can shorten the treatment time and enhance the quality of the regenerated tissue. However, the developed continuous distractors are yet to be used in human applications. In this study, by combining motor-driven and hydraulic techniques, a hybrid distractor is proposed. The hybrid distractor is capable of generating a continuous distraction force while controlling the position of the BS in a linear vector, with a high positioning accuracy. Results of modelling and experimental study revealed that the proposed hybrid distractor met all required factors for enabling a continuous DO procedure in humans. The proposed distractor is capable of eliminating the drawbacks of exiting techniques in terms of generating and transferring a controlled distraction force to the BS. The wireless control, as well as the small size of the device, makes this device a suitable solution for use in the reconstruction of bone defects in the maxillofacial area in humans.

Association of Blood Pressure Indices with Right and Left Cardio-Ankle Vascular Index (CAVI) and Its Mathematically Corrected Form (CAVI0) for the Evaluation of Atherosclerosis.

BACKGROUND AND OBJECTIVES: The cardio-ankle vascular index (CAVI) is an index for arterial stiffness that is theoretically independent of blood pressure. CAVI0 is the mathematically corrected formula of CAVI that has been claimed to be less dependent on blood pressure changes. The association of right and left CAVI and CAVI0 with blood pressure indices can reveal the importance of considering the blood pressure of the patient despite their theoretical independency. In this study, we assessed the right and left CAVI and CAVI0 and evaluated the main effect of blood pressure indices on them with respect to age. MATERIALS AND METHODS: We collected the following data of 136 community-dwelling individuals: age; sex; weight; height; body mass index; right and left CAVI and CAVI0; and systolic (SBP), diastolic (DBP), and mean blood pressure (MBP). The association of right and left CAVI and CAVI0 with blood pressure indices was evaluated using regression analysis. RESULTS: Regression analysis revealed that SBP, DBP, and MBP were associated with right and left CAVI (independent of age). Moreover, SBP was associated with both right and left CAVI0 (independent of age), whereas DBP was not associated with right or left CAVI0. CONCLUSION: Right and left arterial stiffness measured using CAVI has no different associations with SBP, DBP, and MBP. Both right and left CAVI0 were independently associated with SBP, whereas neither left nor right CAVI0 was independently associated with DBP. MBP was only associated with the right-side CAVI0 in community-dwelling individuals.

Two-Axis Continuous Distractor for Mandibular Reconstruction.

The application of Distraction Osteogenesis (DO) techniques in the reconstruction of skeletal deficiencies is a relatively new topic in the fields of oral and maxillofacial surgeries. In many reconstruction applications, using DO is the preferred technique, as opposed to conventional reconstruction techniques, as there are more advantages and fewer side effects when it is used. The first generation of DO devices is made up of manual distractors that can apply an intermittent distraction force to the bone segment during the distraction process. Manual DO techniques have shown the functionality of the DO technique. Further research has recently been performed on the development of automatic devices for generating a controlled continuous force. However, the existing automatic techniques have limitations, and are yet to be used in reconstruction applications in humans. There is still a gap between the developed techniques and an ideal distractor to be used in mandibular reconstruction surgeries. In this research, a two-axis continuous distractor is proposed for use in mandibular reconstruction applications. The proposed distractor can generate two continuous distraction forces that can be applied to two independent distraction vectors. The proposed device can perform the standard distraction process using the predetermined distraction factors. The control system has a high positioning accuracy and resolution in controlling the position of the intra-oral end effectors while applying two continuous forces for moving the bone segment. The proposed two-axis continuous distractor meets the current requirements, and can be used as an ideal continuous DO device for different mandibular reconstruction applications.

Potential Role of Foliar Application of Azotobacter on Growth, Nutritional Value and Quality of Lettuce under Different Nitrogen Levels.

Vegetables can be treated with biofertilizers as an alternative to chemical fertilizers because of their low toxicity. We investigated the effects of foliar spraying of Azotobacter under different levels of nitrogen (100, 150 and 200 mg/L in nutrient solution) on the growth, nutritional value, nitrate accumulation and antioxidant enzyme activities of hydroponically grown lettuce. The experiment was laid out in a completely randomized design with four replicates in a factorial combination. Plants treated with Azotobacter and 200 mg/L nitrogen had greater leaf area and photosynthetic pigments than plants treated with 200 mg/L nitrogen without spraying with Azotobacter. Increasing nitrogen levels increased leaf number, fresh and dry weights, leaf area and nitrate accumulation in lettuce plants. Peroxidase (POD) activity increased by 95.4% at a nitrogen level of 200 mg/L compared to a nitrogen level of 100 mg/L. Ascorbate peroxidase (APX) activity and leaf phosphorous (P) and potassium (K) concentrations were the highest in plants treated with a nitrogen source of 100 mg/L without foliar application of Azotobacter. As nitrogen levels increased in all treatments, nitrate reductase (NR) activity decreased and reached a minimum at the 200 mg/L nitrogen level. In general, foliar application of Azotobacter sp. can be used to promote plant growth and reduce nitrate accumulation in lettuce.

An Application of Cold Atmospheric Plasma to Enhance Physiological and Biochemical Traits of Basil.

This study aimed to investigate the effects of dielectric barrier discharge cold atmospheric plasma on the performance of basil (Ocimum basilicum L. cv. Genovese Gigante). Evaluations were carried out on several physiological and biochemical traits, including ion leakage, water relative content, proline and protein accumulation, chlorophyll and carotenoid contents, and antioxidant activity. Before planting, basil seeds were treated by cold atmospheric plasma under voltages of 10, 15, and 20 kV for 10, 20, and 30 min. The ion leakage rate in plants was significantly affected by the interaction between plasma and radiation time. In most treatments, the application of plasma significantly reduced the ion leakage rate. The application of plasma (10 and 20 kV) for 10 min significantly increased the relative water content of basil leaves. The maximum amount of total chlorophyll and carotenoid content occurred after applying plasma for 20 min with 15 kV. Furthermore, 10 and 15 kV treatments of atmospheric cold plasma for 10 min caused a significant increase in antioxidant activity. The highest total flavonoids were obtained after applying 15 kV treatments for 20 min and 20 kV for 30 min, respectively. Cold atmospheric plasma significantly increased the activity of peroxidase as an antioxidant enzyme. Moreover, the minimum and maximum values of microbial load based on logarithm ten were reached after applying 10 kV for 30 min and in the control group, respectively. In general, the results showed that dielectric barrier discharge cold atmospheric plasma could significantly improve basil plants' physiological and biochemical traits.

Precision Health Care Elements, Definitions, and Strategies for Patients with Diabetes: A Literature Review.

Diabetes is a prevalent disease with a high risk of complications. The number of people with diabetes worldwide was reported to increase every year. However, new integrated individualized health care related to diabetes is insufficiently developed. PURPOSE: The objective of this study was to conduct a literature review and discover precision health care elements, definitions, and strategies. METHODS: This study involved a 2-stage process. The first stage comprised a systematic literature search, evidence evaluation, and article extraction. The second stage involved discovering precision health care elements and defining and developing strategies for the management of patients with diabetes. RESULTS: Of 1337 articles, we selected 35 relevant articles for identifying elements and definitions of precision health care for diabetes, including personalized genetic or lifestyle factors, biodata- or evidence-based practice, glycemic target, patient preferences, glycemic control, interdisciplinary collaboration practice, self-management, and patient priority direct care. Moreover, strategies were developed to apply precision health care for diabetes treatment based on eight elements. CONCLUSIONS: We discovered precision health care elements and defined and developed strategies of precision health care for patients with diabetes. precision health care is based on team foundation, personalized glycemic target, and control as well as patient preferences and priority, thus providing references for future research and clinical practice.

Review of physical stimulation techniques for assisting distraction osteogenesis in maxillofacial reconstruction applications.

Distraction Osteogenesis (DO) is an emerging limb lengthening method for the reconstruction of the hard tissue and the surrounding soft tissue, in different human body zones. DO plays an important role in treating bone defects in Maxillofacial Reconstruction Applications (MRA) due to reduced side effects and better formed bone tissue compared to conventional reconstruction methods i.e. autologous bone graft, and alloplast implantation. Recently, varying techniques have been evaluated to enhance the characteristics of the newly formed tissues and process parameters. Promising results have been shown in assisting DO treatments while benefiting bone formation mechanisms by using physical stimulation techniques, including photonic, electromagnetic, electrical, and mechanical stimulation technique. Using assisted DO techniques has provided superior results in the outcome of the DO procedure compared to a standard DO procedure. However, DO methods, as well as assisting technologies applied during the DO procedure, are still emerging. Studies and experiments on developed solutions related to this field have been limited to animal and clinical trials. In this review paper, recent advances in physical stimulation techniques and their effects on the outcome of the DO treatment in MRA are surveyed. By studying the effects of using assisting techniques during the DO treatment, enabling an ideal assisted DO technique in MRA can be possible. Although mentioned techniques have shown constructive effects during the DO procedure, there is still a need for more research and investigation to be done to fully understand the effects of assisting techniques and advanced technologies for use in an ultimate DO procedure in MRA.

Factors Influencing Self-Efficacy and Self-Management among Patients with Pre-End-Stage Renal Disease (Pre-ESRD).

AIM: Chronic kidney disease (CKD) is an emerging major public health issue that leads to end-stage kidney disease (ESRD). Factors influencing the self-management and self-efficacy of ESRD patients are still under investigation. The objective of this study is to evaluate the association of depression and anxiety with self-management and self-efficacy in patients with pre-ESRD. METHODS: Patients in the department of nephrology of a regional hospital in Taiwan were invited to participate and were included in our study if they had a confirmed diagnosis of early-stage CKD, were more than 20 years old, and could converse in Mandarin Chinese or Taiwanese. Patients diagnosed with depression, who could not execute self-care, or who had cognitive deficits were excluded. In total, this cross-sectional study included 112 pre-ESRD patients. We used the Chinese versions of the hospital anxiety and depression scale (HADS), the chronic kidney disease self-efficacy instrument (CKD-SE), and the chronic kidney disease self-management instrument (CKD-SM) as the questionnaire. Spearman's rank correlation and logistic regressions were used to analyze the data. RESULTS: The top quartile of self-management and self-efficacy scores (28 patients) was defined as high self-management and -efficacy, respectively, and the lower three quartiles as low self-management and -efficacy. The logistic regression analysis showed that having depression decreased the odds of having high self-management by 75.4% and high self-efficacy by 75.1%. Having an education level of senior high school or above increased the odds ratios for having high self-management and high self-efficacy to 4.47 and 3.56 (all p-values < 0.05). CONCLUSION: Controlling depression as well as increasing the level of education can potentially increase self-management and self-efficacy in pre-ESRD patients.

Injection of Lidocaine Alone versus Lidocaine plus Dexmedetomidine in Impacted Third Molar Extraction Surgery, a Double-Blind Randomized Control Trial for Postoperative Pain Evaluation.

Objectives: Administration of medications such as dexmedetomidine as a topical anesthetic has been suggested in the pain control in dentistry. This double-blind randomized control trial study evaluated postoperative pain and associated factors following impacted third molar extraction surgery. Lidocaine alone was taken as the control and lidocaine plus dexmedetomidine as the intervention. Materials and Methods: Forty patients undergoing mandibular third molar extraction entered the study and were randomly allocated to the control and interventional groups. 0.15 ml of dexmedetomidine was added to each lidocaine cartridge and the drug concentration was adjusted to 15 µg for the intervention group while only lidocaine was used in the control group. A visual analog scale was used to measure and record pain levels at the end of the surgery and 6, 12, and 24 hours after the surgery and number of painkillers taken by the patients after the surgery was also recorded. Results: Pain scores of the intervention group decreased significantly during the surgery and also 6, 12, and 24 hours after the surgery compared to the control group. The pain score was correlated significantly with our intervention during the surgery and also 6 and 12 hours after that (all P value < 0.05). There was a nonsignificant reduction in the number of painkillers taken by the patients at 6, 12, and 24 hours after surgery (all P value > 0.05). Conclusion: In patients undergoing molar surgery, administration of a combination of dexmedetomidine and lidocaine is beneficial for the pain control. Clinical Relevance. Compared to the injection of lidocaine alone, combination of dexmedetomidine and lidocaine can be used for a better pain control in molar surgeries.

Histological and Radiological Evaluation of Low-Intensity Pulsed Ultrasound Versus Whole Body Vibration on Healing of Mandibular Bone Defects in Rats.

Background and Objectives: Mechanical stimulation can improve the structural properties of the fracture site and induce the differentiation of different cell types for bone regeneration. This study aimed to compare the effect of low-intensity pulsed ultrasound stimulation (LIPUS) versus whole body vibration (WBV) on healing of mandibular bone defects. Materials and Methods: A mandibular defect was created in 66 rats. The rats were randomly divided into two groups of rats. Each group was subdivided randomly by three groups (n = 11) as follows: (I) control group, (II) treatment with LIPUS, and (III) treatment with WBV. The radiographic changes in bone density, the ratio of lamellar bone to the entire bone volume, the ratio of the newly formed bone to the connective tissue and inflammation grade were evaluated after 1 and 2 months. Results: LIPUS significantly increased the radiographic bone density change compared to the control group at the first and second month postoperatively (p < 0.01). WBV only significantly increased the bone density compared to the control group at the second month after the surgery (p < 0.01). Conclusions: Application of LIPUS and WBV may enhance the regeneration of mandibular bone defects in rats. Although LIPUS and WBV are effective in mandibular bone healing, the effects of LIPUS are faster and greater than WBV.

Combination of exercise training and resveratrol attenuates obese sarcopenia in skeletal muscle atrophy.

Obese sarcopenia is a progressive loss of skeletal muscle mass and strength with increases in adipocytes. The aim of this study was to investigate the effects of combination of exercise training and resveratrol on the pathological pathway from obesity to sarcopenia, and potential therapy for skeletal muscle declines in physical function. Two animal models were experimented: (1) C57BL/6J male mice were fed either a high-fat diet (HFD) for 8 weeks to induce obesity and resveratrol (low-, middle-, and high-dose) for 4 weeks. (2) senescence-accelerated mouse prone 8 (SAMP8) mice with sarcopenia were used. Skeletal muscle function of SAMP8 mice expressed an age-associated decline. In SAMP8 mice, resveratrol (150 mg/Kg BW, daily) was administered by oral gavage two times a week for 1 month of the experimental period. Exercise training based on adaptations in the muscle is training twice a week for 4 weeks. SAMP8 mouse skeletal muscle in each group was analyzed by H and E staining, transferase dUTP nick end labeling, and Western blot analysis. Mitochondrial function expression, apoptosis and relative hypertrophy signaling in HFD-induced obesity mice and SAMP8 mice were determined by Western blot analysis. Results of the present study indicate that effect of resveratrol on skeletal muscles of HFD-induced obesity mice is linked to an increase in Bcl-2 and phosphatidylinositol 3 kinase/AKT expressions. On the other hand, resveratrol, and its combination with exercise training, attenuate the aging-related mitochondrial dysfunction involving Bad, caspase 3, and interleukin-6 expressions in SAMP8 mice. Combination of exercise training and resveratrol induced hypertrophy in skeletal muscles of sarcopenia SAMP8 mice. Therefore, we suggest combination of exercise training and resveratrol as a therapeutic potential in obese sarcopenia.