Use of vitreous phenotype as a key clinical marker to identify Ocular-only Stickler syndrome in a family with Marfan syndrome.

This clinical report describes a family with both Marfan and ocular-only Stickler syndromes. We report 2 cases of ocular-only Stickler syndrome and 2 cases of Marfan syndrome concurrent with ocular-only Stickler syndrome. Type 1 Stickler syndrome and Marfan syndrome share many clinical similarities, and it can be difficult to differentiate them solely based on clinical presentation. Vitreous phenotyping allows for the identification of vitreous anomalies pathognomonic of Stickler syndrome, which can guide future gene sequencing. Having the accurate diagnosis of Marfan or type 1 Stickler syndrome is important, as patients with type 1 Stickler syndrome have higher rates of retinal detachment and will benefit from prophylaxis.

Enhanced cellulose nanofiber mechanical stability through ionic crosslinking and interpretation of adsorption data using machine learning.

Herein we report the fabrication of cationic functionalized cellulose nanofibers (c-CNF) having 0.13 mmol.g-1 ammonium content and its ionic crosslinking via the pad-batch process. The overall chemical modifications were justified through infrared spectroscopy. It is revealed that the tensile strength of ionic crosslinked c-CNF (zc-CNF) improved from 3.8 MPa to 5.4 MPa over c-CNF. The adsorption capacity of zc--CNF was found to be 158 mg.g-1 followed by the Thomas model. Further, the experimental data were used to train and test a series of machine learning (ML) models. A total of 23 various classical ML models (as a benchmark) were compared simultaneously using Pycaret which helped reduce the programming complexity. However, shallow, and deep neural networks are used that outperformed the classic machine learning models. The best classical-tuned ML model using Random Forests regression had an accuracy of 92.6 %. The deep neural network made effective by early stopping and dropout regularization techniques, with 20 × 6 (Neurons x Layers) configuration, showed an appreciable prediction accuracy of 96 %.

Highly targeted electrochemical disruption of microbes with minimal disruption to pulp cells.

INTRODUCTION: Pulpitis results from the infiltration of mixed populations of bacteria which trigger inflammation in the dental pulp, causing significant disruption to these tissues. Clinically, pulpitis frequently leads to devitalization or extraction, as disinfection of the dental pulp while maintaining its vitality is extremely difficult. Here we describe the use of an electrocatalytic titanium dioxide (TiO2)-based apparatus adapted from water purification technology, which can efficiently deliver anti-microbial oxidants (e.g., hydroxyl radicals) when low voltages are applied. As these oxidants are also potentially harmful to pulp cells, oxidant exposure protocols that disrupt oral bacteria, yet are innocuous to dental pulp cells must be established. METHODS: Stem cells from Human Exfoliated Deciduous teeth (SHEDs) and mixed salivary bacteria were exposed to apparatus generated oxidants for time points of 15, 100 or 300 s. SHED apoptosis, necrosis, and vitality post exposure were analyzed by florescent marker staining and flow cytometry. Destruction of mixed salivary bacteria was analyzed by post exposure counts of adherent bacterial cells. RESULTS: When applied to SHEDs the apparatus generated oxidants do not significantly induce apoptosis or necrosis at any exposure time. SHED cell vitality is not decreased with apparatus exposure. Exposure to apparatus generated oxidants destroys mixed salivary bacteria, with significant destruction seen at 15 s and maximal destruction achieved at 100 s. CONCLUSIONS: This technology has the potential to be useful in the disinfection of deep lesions and pulp tissues, efficiently producing oxidants which eliminate bacteria but do not harm native pulp cells after relatively brief exposures. CLINICAL SIGNIFICANCE: Incomplete disinfection of inflamed dental pulp is a significant cause of pulp destruction, leading to devitalization or extraction. Novel technology which enhances the disinfection of the pulp may provide clinicians with treatments options that preserve pulp vitality and tooth structure.

Clinical Utility Of Cavea2t2 Score For Assessing The Survival Of Brachiocephalic Arteriovenous Fistula.

BACKGROUND: There are not many error proof clinical scores to assess the native dialysis access. CAVeA2T2 score is a recent tool in use. Objective of the study is to assess the clinical utility of CAVeA2T2 scoring system in predicting the survival rate of brachiocephalic arteriovenous fistula (BC-AVF). METHODS: All consecutive patients fulfilling the inclusion criteria for BC-AVF from January 2016 to January 2018 were included. According to their CAVeA2T2 score they were divided into two groups (Group A: < 2 and Group B: ≥2). Cumulative primary and secondary patency survival of BC-AVF for both groups were measured. RESULTS: A total of 112 BC-AVFs were analysed. Mean age was 42±SD 14 years (M: F =5:1). Mean CAVeA2T2 score was 1.45±1.8. In terms of primary patency, there was no statistically significant difference between two groups (p=0.074, p = 0.229 and p=0.357 at 6 weeks, 6 months and 12 months respectively). However, the difference was significant in terms of secondary patency (p=0.002, p=0.036 and p=0.032 at 6 weeks, 6 months and 12 months respectively). On comparing the cumulative survival between two groups; a significantly low primary patency rate survival (Log Rank x2 = 12.9, p-value = 0.001) and secondary patency rate survival (Log Rank x2 = 7.6, p-value = 0.001) of BC-AVF was found in Group B. CONCLUSION: We found CAVeA2T2 score an easily applicable and useful tool to assess the patency and survival of BC-AVF. Patients have a poor patency and significantly low survival rate when their CAVeA2T2 score was ≥2.

Modelling and synthesis of Magnéli Phases in ordered titanium oxide nanotubes with preserved morphology.

The presence of Magnéli phases in titanium oxide nanotubes (NTs) can open up frontiers in many applications owing to their electrical and optical properties. Synthesis of NTs with Magnéli phases have posed a challenge due to the degradation and loss of morphology in NTs upon high-temperature treatments (>600 °C) in a reducing environment. This study reports on the synthesis of anodically formed NTs containing Magnéli phases through a double annealing route: oxygen (O2) annealing followed by annealing in 2% hydrogen with a nitrogen balance (2%H2-N2). The nucleation, growth, and transformation of anodized amorphous NTs into crystalline phases was investigated. The NTs obtained through this route were highly ordered and composed of mixed phases of anatase, rutile, and the Magnéli phase (Ti4O7). Experimental results from scanning electron microscopy (SEM), X-ray diffraction (XRD), scanning transmission electron microscopy (S/TEM), and Raman spectroscopy were combined with first principle calculations to develop an understanding of the sequential phase transformations during annealing. A predictive model was developed using density functional theory (DFT) to potentially predict the titanium oxides formed and their stability with reference to the mole fraction of oxygen. The change in the density of states (DOS), band structure, optical properties, and stability of phases are also discussed using DFT simulations. The combination of experimental characterization and modelling helped to understand the nucleation of anatase and rutile and the reorganization of these phases to form Magnéli phases on the anodized amorphous NTs through annealing treatment.

Axillary Artery Injury In Blunt Shoulder Trauma - An Uncommon Association With Proximal Humerus Fracture.

Axillary artery injury along with proximal humerus fracture as a result of blunt trauma is a rare incidence. We present a 65-year-old male with a pulseless cold hand, who had blunt trauma 3 days ago, leading to fracture of proximal end of humerus along with axillary artery injury. Surgical intervention revealed contusion of axillary artery with intravascular thrombosis causing complete occlusion. Internal fixation of fracture along with excision of contused axillary artery was done followed by interposition venous graft. The diagnostic modalities and treatment options for such a case are discussed.

Electrochemical Detection of E. coli O157:H7 in Water after Electrocatalytic and Ultraviolet Treatments Using a Polyguanine-Labeled Secondary Bead Sensor.

The availability of clean drinking water is a significant problem worldwide. Many technologies exist for purifying drinking water, however, many of these methods require chemicals or use simple methods, such as boiling and filtering, which may or may not be effective in removing waterborne pathogens. Present methods for detecting pathogens in point-of-use (POU) sterilized water are typically time prohibitive or have limited ability differentiating between active and inactive cells. This work describes a rapid electrochemical sensor to differentially detect the presence of active Escherichia coli (E. coli) O157:H7 in samples that have been partially or completely sterilized using a new POU electrocatalytic water purification technology based on superradicals generated by defect laden titania (TiO2) nanotubes. The sensor was also used to detect pathogens sterilized by UV-C radiation for a comparison of different modes of cell death. The sensor utilizes immunomagnetic bead separation to isolate active bacteria by forming a sandwich assay comprised of antibody functionalized secondary magnetic beads, E. coli O157:H7, and polyguanine (polyG) oligonucleotide functionalized secondary polystyrene beads as an electrochemical tag. The assay is formed by the attachment of antibodies to active receptors on the membrane of E. coli, allowing the sensor to differentially detect viable cells. Ultravioloet (UV)-C radiation and an electrocatalytic reactor (ER) with integrated defect-laden titania nanotubes were used to examine the sensors’ performance in detecting sterilized cells under different modes of cell death. Plate counts and flow cytometry were used to quantify disinfection efficacy and cell damage. It was found that the ER treatments shredded the bacteria into multiple fragments, while UV-C treatments inactivated the bacteria but left the cell membrane mostly intact.

Removal of lead from aqueous solution using polyacrylonitrile/magnetite nanofibers.

Lead is known for its toxic and non-biodegradable behavior. The consumption of lead-contaminated water is one of the major threat the world is facing nowadays. In this study, polyacrylonitrile (PAN) and magnetite (Fe3O4) composite nanofiber adsorbent was developed for Pb2+ removal in batch mode. The synthesis was done by a simple and scalable process of electrospinning followed by chemical precipitation of Fe3O4. The nanofibers thus obtained were characterized through FTIR, zeta potential analyzer, and scanning electron microscope (SEM) and were analyzed for their adsorption capability for Pb2+ ions. The amount of metal ion adsorbed was influenced by the initial metal ion concentration, the time the adsorbent was in contact, the amount of nanofiber, and the pH of the solution. The experimental data fitted well with pseudo 2nd-order and Langmuir adsorption isotherm model. The nanofibers showed high adsorption capability and could be recommended for Pb2+ removal successfully.

Three-dimensional printing in surgery: a review of current surgical applications.

BACKGROUND: Three-dimensional printing (3DP) is gaining increasing recognition as a technique that will transform the landscape of surgical practice. It allows for the rapid conversion of anatomic images into physical objects, which are being used across a variety of surgical specialties. It has been unclear which groups are leading the way in coming up with novel ways of using the technology and what specifically the technology is being used for. The aim of this article was to review the current applications of 3DP in modern surgical practice. MATERIALS AND METHODS: An electronic search was carried out in MEDLINE, EMBASE, and PsycINFO for terms related to 3DP. These were then screened for relevance and practical applications of the technology in surgery. RESULTS: Four hundred eighty-eight articles were initially found, and these were eventually narrowed down to 93 full-text articles. It was determined that there were three main areas in which the technology is being used to print: (1) anatomic models, (2) surgical instruments, and (3) implants and prostheses. CONCLUSIONS: Different specialties are at different stages in the use of the technology. The costs involved with implementing the technology and time taken for printing are important factors to consider before widespread use. For the foreseeable future, this is an exciting and interesting technology with the capacity to radically change health care and revolutionize modern surgery.

Treatment of ureteric calculi--use of Holmium: YAG laser lithotripsy versus pneumatic lithoclast.

OBJECTIVE: To compare the efficacy of Holmium: YAG laser and pneumatic lithoclast in treating ureteric calculi. METHODS: The study included total of 100 patients divided into two equal groups of laser lithotripsy (LL) and pneumatic lithoclast (PL). Study was conducted between September 2006 and February 2007. Inclusion criteria were patients with a ureteric stone of size 1-2 cm and negative urine culture. An x-ray KUB was mandatory. IVU and CT pyelogram were also done when required. Procedures were done under general anaesthesia after a single dose of pre-operative antibiotic. A 7.5 Fr semi rigid ureteroscope was used for ureteroscopy in all cases. Holmium: YAG laser with 365 microm wide probe was employed in laser group and frequency was set between 5 and 10 Hz at a power of 10 to 15 W. Swiss lithoclast with single or multiple fire technique was used accordingly in PL group. Postoperatively patients underwent radiography and helical CT as required at 4th week of follow up to asses stone clearance. RESULTS: The mean patient age in LL and PL group was 38 +/- 10 and 40 +/- 10 years respectively. The male to female ratio and stone size were similar between the groups. Stone migration up in pelvicalyceal system occurred in two patients of LL group while in eight patients of PL group. JJ Stent was placed in 5(10%) patients in laser group where as 13 (26%) patients required it in pneumatic lithoclast group. Stone free rate at 4 weeks was 92% in laser group as compared to 82% in pneumatic lithoclast group. Hospital stay was more than 24 hours in 2 patients of laser group as compared to 5 patients of pneumatic lithoclast group. Complication rate was 4% in LL group whereas it was 14% in PL group. CONCLUSION: Holmium: YAG laser lithotripsy is a superior technology compared to pneumatic lithoclast in terms of rate of stone clearance and complications, especially in upper ureteric stones.

Comparison of holmium: Yag laser and pneumatic lithoclast in percutaneous nephrolithotomy.

OBJECTIVE: To compare holmium Yag laser with lithoclast in patients with renal stones undergoing percutaneous nephrolithotomy (PCNL). METHODS: A comparative cross sectional study was performed on 60 patients undergoing PCNL. Patients with a 2.5 cm stone in renal pelvis, having preoperative negative urine culture, no coagulopathy and fit for general anaesthesia were included, pregnant females were excluded. They were randomly divided into 2 groups of 30 cases each depending on the energy source used. Group A included cases of PCNL subjected to laser treatment and group B had patients undergoing PCNL with pneumatic lithoclast. For each group duration of procedure, any per operative or postoperative complication, residual stone, duration of hospital stay and cost of each procedure were recorded. RESULTS: The average operative time was 125.7 +/- 31.1 minutes in group A and 98.5 +/- 18.7 minutes in group B (P = 0.0001). The overall complication rate was similar in both groups being 13.3% in group A and 23.3% in group B. Residual stone was observed in 17% cases in group A and 13% cases in group B (P = 0.5). The mean postoperative hospital stay was 3.17 +/- 1.6 days in group A and 4 +/- 2.3 days in group B (P = 0.4). Cost analysis showed that the initial capital cost of equipment was 40,000 Euro in laser and 24,000 Euro in pneumatic lithoclast. However because of reuse of fiber the per procedure cost was 60 Euro in laser and 50 Euro in lithoclast group. CONCLUSION: In our experience we found that Holmium: YAG laser and pneumatic lithoclast are both effective and safe lithotriptors for percutaneous stone removal. More operating time was required in laser, more complications encountered with pneumatic lithoclast and a high initial cost of laser. However with increasing experience with laser, more promising results are expected with this new technology. The cost can be compensated by using it in other procedures especially at a public sector hospital.

Soft tissue neck symptoms following high-energy road traffic accidents.

STUDY DESIGN: A single-blinded prospective study was performed into the occurrence and frequency of soft tissue neck symptoms of patients involved in high-energy road traffic accidents. OBJECTIVES: We studied the occurrence of incidental soft tissue neck symptoms in victims of high energy (defined as those severe enough to cause major trauma leading to an injury severity score >16) vehicular collisions causing significant musculoskeletal trauma requiring operative intervention. SUMMARY BACKGROUND DATA: Whiplash is considered to be a soft tissue injury of the neck sustained by occupants of motor vehicles. Use of the term in the past had been restricted to hyperextension injuries following a rear impact, but is commonly now used for all types of impact. No relationship has been found between velocity or force of injury and incidence or outcome of whiplash. The preponderance of whiplash after relatively minor vehicular accidents, the unpredictability of who will develop chronic symptoms and the lack of clinical and radiological evidence of a pathological mechanism suggests that psychosocial variables are important factors in determining the development of persistent neck pain. METHODS: A total of 36 consecutive patients were recruited who had been involved in high-energy road traffic accidents and had chest, musculoskeletal, or abdominal injuries (ISS > 16) requiring admission for treatment, but who had no diagnosed injury of the cervical spine. Patients were asked in a nonspecific or leading manner at the time of admission and again at least 6 to 8 weeks postinjury if they had any neck symptoms, headaches, or paresthesiae. RESULTS: Only 2 of the patients interviewed described any whiplash symptoms. All symptoms were resolved at the time of second interview. CONCLUSIONS: Our study demonstrates a surprisingly low incidence of neck symptoms following high-energy road traffic accidents in which patients sustained unrelated injuries requiring treatment.

Interactions of "ultra-low" doses of naltrexone and morphine in mature and young male and female rats.

Sex and age influence morphine analgesia in humans and animals. Mature rats show greater morphine analgesia in males than in females. Ultra-low doses of naltrexone enhance morphine analgesia. In mature rats (18-22 weeks), naltrexone (0.002-2.0 mg/kg)-morphine (2 mg/kg) cotreatment enhanced morphine analgesia in females, an effect inversely related to naltrexone dose. Conversely, in mature male rats, naltrexone tended to decrease morphine analgesia with increasing dose. In young rats (8-10 weeks), morphine analgesia was unrelated to sex and in both sexes the naltrexone-morphine interaction was negligible. These data show that dose, age, and sex alter the naltrexone-morphine interaction in rats.