Integrating 3,4-Dihydro-2H-1,4-oxazine into Peptides as a Modification: Silver Triflate-Catalyzed Cyclization of N-Propargyl N-Sulfonyl Amino Alcohols for SPPS Applications.

We present a methodology yielding 3,4-dihydro-2H-1,4-oxazine by cyclization of N-propargyl N-sulfonyl amino alcohols using silver triflate as a catalyst at ambient temperature. Additionally, we showcase the applicability of this methodology in solid phase peptide synthesis (SPPS) to introduce the oxazine heterocyclic ring into short peptides containing serine and threonine. Notably, Rink amide resin supported the on-resin formation of 3,4-dihydro-2H-1,4-oxazine, while 2-CTC resin facilitated the oxazine formation in a one-pot process involving peptide cleavage, deprotection, and subsequent C-O ring formation, thus offering a versatile method for the late-stage modification of peptides.

Long-term outcomes of urethral balloon dilation for anterior urethral stricture: A prospective cohort study.

Objective: To prospectively follow up a cohort of anterior urethral stricture disease patients managed with balloon dilation (BD) for 3 years to evaluate the long-term outcomes and to study factors that contribute to recurrence. Methods: This study included men who had urethral BD for significant anterior urethral stricture disease between January 2017 and March 2019. Data about the patient age, stricture characteristics, and recurrence date were recorded, along with information on postoperative indwelling catheter use and operative complications. Furthermore, information about the self-calibration procedure was collected and where available, free flow (FF) measurements during the follow-up period were recorded and analyzed. Success was defined as a lack of symptoms and acceptable FF rates (maximum flow rate>12 mL/s). Results: The final analysis was conducted on 187 patients. The mean follow-up period was 37 months. The long-term overall success rate at the end of our study was 66.8%. Our recurrence rate was 7.4% at 12 months, 24.7% at 24 months, and reached 33.2% at the end of our study. The time to recurrence ranged from 91 days to 1635 days, with a mean of 670 days. The stricture-free survival was significantly shorter with lengthy peno-bulbar (p=0.031) and multiple strictures (p=0.015), and in the group of patients who were not committed to self-calibration protocol (p<0.011). However, post-procedural self-calibration was the most important factor that may have decreased the incidence of recurrence (odds ratio=5.85). Adjuvant self-calibration after BD not only reduced the recurrence rate from 85.4% in the non-self-calibration group to 15.1% in the self-calibration one (p<0.001), but also improved the overall stricture-free survival and FF parameters. Conclusion: Urethral BD has a high recurrence rate in the long-term, especially with long and multiple strictures. Adjuvant self-calibration has proven to reduce the recurrence risk and the need for re-intervention.

Evaluation of Awareness Toward Various Treatment Options and Maintenance Practices among Removable Partial and Complete Denture Patients in Western Maharashtra - A Questionnaire-Based Study.

Introduction: Researchers must concentrate their focus on whether patients understand various treatment options available among removable complete and partial denture patients and whether they are aware of the maintenance protocol of the prosthesis. Materials and Methods: All the patients who completed removable partial or complete denture treatment in a period of 6 months were included in the study. Collected data were statistically analyzed using Chi-square test at a significance level of P < 0.05. Results: Awareness needs to be increased regarding the treatment options available for removable complete and partial denture treatment causes because many subjects in this study were only aware of the removable partial denture and complete denture treatment for missing teeth and not the other options, especially among individuals in the lower socioeconomic group. Conclusion: The findings indicate that awareness needs to be increased regarding the functions of prostheses such as esthetics and phonetics because many subjects in this study were only aware of the masticatory function performed by prosthesis.

Fast Marching based Tissue Adaptive Delay Estimation for Aberration Corrected Delay and Sum Beamforming in Ultrasound Imaging.

Conventional ultrasound (US) imaging employs the delay and sum (DAS) receive beamforming with dynamic receive focus for image reconstruction due to its simplicity and robustness. However, the DAS beamforming follows a geometrical method of delay estimation with a spatially constant speed-of-sound (SoS) of 1540 m/s throughout the medium irrespective of the tissue in-homogeneity. This approximation leads to errors in delay estimations that accumulate with depth and degrades the resolution, contrast and overall accuracy of the US image. In this work, we propose a fast marching based DAS for focused transmissions which leverages the approximate SoS map to estimate the refraction corrected propagation delays for each pixel in the medium. The proposed approach is validated qualitatively and quantitatively for imaging depths of upto ∼ 11 cm through simulations, where fat layer-induced aberration is employed to alter the SoS in the medium. To the best of the authors' knowledge, this is the first work considering the effect of SoS on image quality for deeper imaging.Clinical relevance- The proposed approach when employed with an approximate SoS estimation technique can aid in overcoming the fat-induced signal aberrations and thereby in the accurate imaging of various pathologies of liver and abdomen.

An In Vitro Study Comparing the Impact and Flexural Strength of Leucitone 199 Denture Base Resin and Conventional Denture Base Resin Enhanced With Glass Fibre Mesh and Polyethylene Fibre Mesh.

Purpose The purpose of this in vitro study was to compare and evaluate the impact and flexural strength of conventional denture base resin reinforced with glass fiber mesh and polyethylene fiber mesh with Leucitone 199 denture base resin (Dentsply Sirona, Charlotte, USA). Leucitone is an expensive denture base material. To come up with a cheaper solution for reinforced denture base resin with superior impact and flexural strength was the goal of this study Material and methods The specimens (maxillary denture bases) were fabricated using a standard polyvinylsiloxane mold with conventional heat-cured polymethyl methacrylate resin (ISO 1567:1999). The specimens were divided into three groups (n = 10). Group I specimens, or the control group, were pre-reinforced Leucitone 199. Group II and Group III specimens were reinforced with 3% by weight of glass fibers and polyethylene fibers in weave form, respectively. All the specimens were immersed in water for 1 week before testing. The impact strength was measured with a falling weight impact testing machine. One-way analysis of variance and Tukey's post hoc test were used for statistical analysis. The flexural strength was measured with the three-point bending test in a universal testing machine. Results The highest impact strength values were exhibited by the Leucitone 199 group, followed by the polyethylene fiber mesh group, followed by the glass fibers mesh group. The highest flexural strength was seen in the Leucitone 199 group, followed by the glass fiber mesh group. The least flexural strength was seen in the polyethylene fiber mesh-reinforced group.  Conclusion Reinforcement of maxillary complete dentures showed a significant increase in impact strength and flexural strength, but not in comparison to pre-reinforced Leucitone 199 dentures. By using pre-impregnated glass and polyethylene fibers in woven form (prepregs), the impact strength of the denture bases can be increased effectively.

Oligometastatic carcinoma prostate - An overview of the last decade.

Introduction: Oligometastatic prostate cancer (OMPC) has gained profound interest lately due to its different tumor biology and our ability to use multimodality therapy for cure or prolonged survival. Selecting the appropriate patient for treatment has become the aim of treating urologists, medical oncologists, and radiation oncologists. Through this review, we try to highlight the management of OMPC in light of recent literature. Methods: Literature search was performed on Pubmed, Scopus and Embase using keywords "Oligometastatic", " Prostate Cancer" using operators such as "And" & "Or". Relevant articles were screened and all the latest articles on this emerging entity were included in this review. Results: All trials relevant to oligometastatic prostate cancer defining the role of surgery, radiotherapy and systemic therapy were included and appropriate inferences were drawn. Relevant studies were compiled in tabular form for this article. Conclusion: The current standard of care of management for OMPC remains systemic therapy on the lines of hormone-sensitive metastatic prostate cancer. The evolving role of surgery, and radiotherapy along with systemic therapy is highlighted in this article.

Stage Migration in Renal Malignancies in COVID Era: A Single-Center Analysis.

The COVID-19 disease, caused by SARS-CoV-2 virus, attained the status of a pandemic by March 2020. There was apprehension among patients suffering from renal malignancies about balancing cancer treatment and preventing COVID-19 infection transmission. We analyzed 184 patients with renal malignancies retrospectively, who presented to our institute over 2 years: 91 patients of renal malignancies in pre-COVID era (March 2019-Feb 2020) and 93 patients in COVID era (March 2020-Feb 2021). The parameters analyzed were age, tumor size, clinical presentation, clinical stage, pathological stage, nuclear grade, and presence of metastasis. Level of significance was kept at 95%, and p value <0.05 was considered significant. The age of patients was comparable in both groups (p: 0.381). Clinical presentation was also similar in both groups whereas there were more cases diagnosed during routine evaluation in pre-COVID era (p: 0.022). Tumor size was 5.84 ± 3.03cm vs. 7.10±3.83cm (p: 0.017) in pre-COVID vs. COVID era, respectively. Patients in COVID era had significantly higher clinical stage (p = 0.041), pathological stage (p =0.027), nuclear grade (p = 0.007), and presence of metastasis (p = 0.005) as compared to pre-COVID era. Patients, who underwent Nephron-sparing surgery, also had higher pathological stage in COVID era. COVID overshadowed the management of renal malignancies. There was a clear shift and stage migration in patients of renal malignancies in COVID era as compared to pre-COVID era, probably because of less routine health check-ups and patients deferring hospital visits due to fear of contracting COVID infection.

Robot-assisted versus conventional open kidney transplantation: a propensity matched comparison with median follow-up of 5 years.

BACKGROUND: RAKT is a relatively newer approach for kidney transplant and has to be proven against the established approach, OKT. RAKT may be beneficial in obese patients as described in literature. Hence, we compared pre-, intra- and postoperative parameters with one year follow-up of both approaches by propensity matching similar characteristics patients. METHODS: Data of 28 OKT and 28 RAKT propensity matched patients was collected during 2014 to 2022 through the institutional transplant registry. OKT and RAKT patients were propensity matched for confounding factors like donor age, eGFR, side along with recipient age, BMI and comorbidities. All graft kidneys were harvested laparoscopically. RESULTS: Both the groups were comparable in terms of recipient age and BMI, donor age, creatinine, BMI, eGFR and comorbidities. Total ischemia time (P<0.001) and postoperative day (POD) 1 creatinine (P<0.001) was significantly more in RAKT. However, postoperative 1 month (P=0.12), 3 months (P=0.60) and 1 year (P=0.10) creatinine was comparable in both approaches. Postoperative complications (P=0.90) including hemoglobin drop (P=0.72) were comparable in both the groups. The days to half the creatinine from preoperative values was significantly less in OKT group (P=0.009). Serum Tacrolimus levels at day 3 (P=0.08) and day 7 (P=0.112) were also comparable in both the groups. Graft survival was 78.5% in OKT group and 82.14% in RAKT group with median follow-up of 60 months in both the groups. CONCLUSION: In this comprehensive propensity matched analysis of RAKT with OKT, we conclude that RAKT has similar outcomes as OKT at 1 year and 5 years follow-up. CIT, TIT, time to half creatinine and POD 1 creatinine values were higher in RAKT group, but eventually have comparable outcomes at further follow-up. Thus, RAKT, a novel approach is non-inferior to established OKT approach. However, further larger trials are required.

Outcomes of Hem-o-Lok clip migration at vesico-urethral anastomotic site post-robotic-assisted laparoscopic radical prostatectomy: a single centre experience.

BACKGROUND: Robotic-assisted laparoscopic prostatectomy (RALP) is the most preferred intervention for the management of prostatic malignancy worldwide. Hem-o-Lok clips (HOLC) are widely used for haemostasis and lateral pedicle ligation. These clips are prone to migrate and lodge at the anastomotic junction as well as inside the bladder causing lower urinary tract symptoms (LUTS) secondary to bladder neck contracture (BNC) or bladder calculi. The objective of this study is to describe the incidence, clinical presentation, management, and outcome of HOLC migration. METHODOLOGY: Retrospective analysis of the database of Post RALP patients who developed LUTS secondary to HOLC migration was done. Cystoscopy findings, number of procedures required, number of HOLC removed intra-operatively, and follow-up of the patients was reviewed. RESULTS: The incidence of HOLC migration requiring intervention was 1.78% (9/505). The mean age of the patient, BMI, Pre-operative Serum PSA were 62.8 years, 27.8 kg/m2, and 9.8 ng/mL, respectively. The mean duration of appearance of symptoms due to HOLC migration was 9 months. Two patients presented with Haematuria and 7 presented with LUTS. Seven patients required a single intervention while 2 required up to 6 procedures for recurrent symptoms secondary to recurrent HOLC migration. CONCLUSION: HOLC use in RALP may present with migration and associated complications. HOLC migration is associated with severe BNC and may require multiple endoscopic interventions. Severe dysuria and LUTS not responding to medical management should be treated using an algorithmic approach and there should be a low threshold for performing cystoscopy and intervention in these cases to improve outcomes.

Single-use flexible ureteroscopes: Comparative in vitro analysis of four scopes.

Objective: Single-use flexible ureteroscopes (fURSs) have recently been introduced by different companies. Goal of this in-vitro study was to compare four fURSs. Methods: We performed in vitro analysis of Uscope 7.5 Fr and Uscope 9.5 Fr (Pusen Ltd., Zhuhai, China), LithoVue 9.5 Fr (LithoVue™, Boston Scientific, MA, USA), and Indoscope 9.5 Fr (Bioradmedisys™, Pune, India). Optical characteristics (image resolution, color representation, and luminosity) were compared at various distances of 10 mm, 20 mm, and 50 mm. Deflection and irrigation were evaluated with and without accessories. Results: Color perception was comparable for all scopes at 10 mm (p<0.05), while Lithovue 9.5 Fr was comparable with Indoscope 9.5 Fr at the distances of 20 mm and 50 mm. Both scopes were statistically better than both Uscopes at the distances of 20 mm and 50 mm. Image resolution powers were comparable amongst all fURSs at the distances of 10 mm and 20 mm (3.56 line pairs per millimeter [lp/mm]). However, Indoscope (3.56 lp/mm) was superior to LithoVue and Uscope scopes (3.17 lp/mm) at the distance of 50 mm. Luminosity at the distance of 10 mm was comparable for LithoVue and Uscope 9.5 Fr. However, at the distances of 20 mm and 50 mm, LithoVue had the highest luminosity while Uscope 7.5 Fr had the lowest one. Indoscope had lower luminosity than other 9.5 Fr scopes at all distances. With empty working channel and 200 µm laser fiber, Indoscope had the maximum deflection (285°). With basket, Uscope 7.5 Fr had the maximum loss of deflection (30°) while Indoscope had no deflection loss. With empty working channel, all scopes had comparable irrigation flow rates in both deflected and undeflected state. Similarly, with 200 µm laser or basket, irrigation flow rates were comparable in all scopes. Conclusion: Color representation was equivalent for Indoscope and LithoVue, while being better than Uscope 7.5 Fr and Uscope 9.5 Fr. Image resolution was comparable in all scopes at the distances of 10 mm and 20 mm. Beyond the distance of 10 mm, luminosity of LithoVue was the highest and that of Uscope 7.5 Fr was the lowest. Deflection loss was the minimum with Indoscope and the maximum with 7.5 Fr Uscope. Under all scenarios, irrigation flow rates were comparable in all scopes.

Osteoporosis risk group: Screening for osteoporosis in dental clinics using panoramic radiographs.

Osteoporosis is a specific condition which is characterized by low bone mineral density (BMD) and deterioration of bone structure resulting in an increased susceptibility to fractures. It contributes to a great deal of morbidity and mortality, and is a large burden to the healthcare system, especially in the case of the elderly population. In the last four decades, a plethora of studies have reported characteristic oral radiographic findings in the early stages of osteoporosis, suggesting the possible use of oral radiographic signs for the early detection of the condition. Digital orthopantomographs (OPGs) are usually taken for the screening of dental patients during routine dental evaluations. These radiographs and the characteristic changes seen on them may have a significant role in the screening for initial osteoporotic changes. A number of precise radiomorphometric indices of the mandible have also been developed to allow quantification of the mandibular bone mass for identification of the initial signs of osteoporosis. The present review focuses on the possible role of panoramic radiographs in the initial screening for osteoporosis in dental clinics in high-risk groups.

In Vitro Comparative Evaluation of Bond Strength of CAD/CAM Monolithic Zirconia Copings Influenced by Luting Agents and Finish Line Design.

AIM: The aim of the in vitro study was to comparatively evaluate the bond strength of CAD/CAM monolithic zirconia copings using three luting agents and two different finish lines. MATERIALS AND METHODS: For the evaluation of bond strength, 60 extracted human maxillary first premolars were prepared to receive CAD/CAM monolithic zirconia copings. They were randomly divided into six groups of 10 samples each to receive CAD/CAM monolithic zirconia copings to bond with three different luting agents on two different finish lines. The luting agents used were RelyX U200, RMGIC, and Maxcem Elite with finish lines which were incorporated were 90° shoulder and radial shoulder finish lines. The tensile bond strength for all 60 samples was tested using the universal testing machine. RESULTS: Between and within the group differences in tensile bond strength were analyzed using one-way ANOVA test of significance with Tukey's post-hoc analysis. The statistical analysis revealed that the CAD/CAM zirconia copings used a combination of 90° shoulder and RelyX U200 as the luting agent (Group II) which offered the maximum bond strength. CONCLUSION: Within the constraints of this study, it could be concluded that CAD/CAM monolithic zirconia copings luted with RelyX U200 cement on a 90° shoulder finish line is the preferred method, taking the bond strength into consideration. CLINICAL SIGNIFICANCE: The results of this study can be extrapolated into a clinical scenario to help the clinician decide the most apt combination of finish line design and the luting agent to achieve superior bond strengths in CAD/CAM zirconia crowns and fixed dental prosthesis.

Outcome of post-COVID-19 fungal pyelonephritis: A single Indian tertiary center experience.

Introduction: COVID-19 pandemic is associated with secondary opportunistic fungal infections. These have an aggressive course with a high mortality rate. We present our experience of seven cases of post-COVID-19 fungal pyelonephritis. Methods: An observational study over a period of 8 months of May to December 2021 was carried out at our tertiary care hospital, including all patients with features of fungal pyelonephritis in post-COVID-19 setting. The patient demographics, details of previous COVID-19 infection, details of present admission and management were collected. The endpoints were either discharge from the hospital or death. Results: Seven patients were included. Mean age of presentation was 42 years (range: 20-63 years, standard deviation ± 14.2). Male-to-female ratio was 6:1. One patient was diabetic. Two patients were asymptomatic, one had mild infection, and four patients had severe COVID-19 infection as per National Institute of Health criteria. In the present admission, all patients had symptomatic pyelonephritis with laboratory parameters showing elevated D dimer, C reactive protein, and total leukocyte counts. In all seven patients, ultrasound of kidney ureter bladder region showed bulky kidney, color Doppler showed main renal arterial thrombosis in two patients, segmental arterial thrombosis in another patient. Computed tomography scan was suggestive of changes of pyelonephritis in all patients with multiple renal hypodense areas. All patients required nephrectomy with biopsy suggestive of changes of necrotizing fungal inflammation. Three patients expired. Conclusion: Management of post-COVID-19 fungal pyelonephritis should be aggressive and suspicious laboratory and imaging findings should be treated by early nephrectomy.

High-Power Holmium with MOSES Technology or Thulium Fiber Laser in MiniPerc with Suction: A New Curiosity.

Purpose: To present initial clinical comparison between high-power holmium laser with MOSES technology (HPH-M) and thulium fiber laser (TFL) during mini-percutaneous nephrolithotomy (PCNL) for renal calculi with specific emphasis on fragmentation efficiency, fragment size distribution, and stone-free rates (SFRs). Materials and Methods: Between August 2018 and December 2019, we performed mini-PCNL for renal calculi <3 cm using HPH-M (Lumenis, Israel) or TFL (Urolase SP, IPG Photonics). Data were collected prospectively in our institutional stone registry. Propensity score matching (1:1) was performed using stone size and density as predictors resulting in matched cohort of 51 patients in each group. Mini-PCNL with active suction sheath was standard across all patients. Primary end-point was SFR at immediate postprocedure and 1 month using CT/kidney, ureter, and bladder radiograph. Stone fragments were retrieved and segregated to assess proportion of dust (<1 mm), small (1-3 mm), and large (>3 mm) fragments. Result: Both groups were comparable in terms of stone size (p = 0.74), volume (p = 0.17), and density (p = 0.69). SFR at 48 hours was 78.43% in HPH-M group and 68.63% in TFL group. Patients with residual fragments were completely clear at 1 month. Lasing time (678.6 vs 551.95 seconds; p = 0.17), stone fragmentation rate (4.6 vs 5.2 mm3/s; p = 0.23), and total laser energy (21.9 vs 16.3 KJ; p = 0.09) were comparable in both arms. Both groups produced similar dusting (46.8 vs 46.41%; p = 0.93). TFL produced a greater proportion of fragments >3 mm (36% vs 22.68%, p = 0.002). On subset analysis based on stone density, all outcome parameters were comparable except a shorter total operative time with TFL (p ≤ 0.05). Conclusion: HPH-M and TFL showed similar SFR. Within constraints of the laser fiber size and energy settings, both modalities were equivalent in terms of fragmentation efficiency and proportion of dusting across stone densities.

Sporadic Creutzfeldt-Jakob disease.

Being considered among the most fatal neurological conditions, Creutzfeldt-Jakob disease is a transmissible spongiform encephalopathy characterized by its unknown etiology and rapidly progressive neurodegenerative symptoms that often lead to a mean survival of 6 to 12 months. The accumulation of the prionic protein causes brain matter degeneration, which leads to a set of clinical findings that include rapidly progressive dementia, myoclonus, tremors, cerebellar ataxia, and extrapyramidal signs. This clinical presentation is non-specific, which makes CJD a very difficult condition to diagnose, due to the low level of clinical suspicion. However, combining this clinical presentation with neuroimaging, a lumbar puncture and an encephalogram will help us make the correct diagnosis. We present the case of a 57-year-old male presenting to the Emergency department with complaint of personality change and intermittent memory loss. The patient's physical exam was significant for resting pill roll tremor, bilateral cogwheel rigidity, dysmetria, and shuffling gait. Magnetic resonance imaging of his brain showed symmetric bilateral diffusion signal abnormality involving the cortex, bilateral caudate heads and putamina. Continuous electroencephalogram revealed multiple bifrontal delta discharges with triphasic morphology. Lumbar puncture was significant for presence of 14-3-3 protein in cerebrospinal fluid. The multiple examinations performed in conjunction with the previous findings supported the diagnosis of acute encephalopathy secondary to sporadic CJD.

A prospective comparative study of mini-PCNL using Trilogy™ or thulium fibre laser with suction.

INTRODUCTION: There has been recent introduction of novel lithotripters and high-power lasers for stone disintegration. With miniaturization of PCNL, there is need of effective disintegration and faster stone-clearance. This study aimed to evaluate efficiency of Trilogy™ and Thulium fibre laser (TFL) in mini-percutaneous nephrolithotomy (mini-PCNL). METHODS: This is prospective study comparing efficiency and outcomes of Trilogy™ and TFL in mini-PCNL between January 2019 and February 2020. Primary objective was to compare stone fragmentation rates, with secondary objectives beings stone-free rates and complications. RESULTS: There were 60 mini-PCNL with suction using either Trilogy™ or TFL energy source. Mean stone size and density were 27.60 ± 10.17 mm, 22.04 ± 9.69 mm (p = 0.05) and 1172.9 ± 313.5HU, 1308.9 ± 333.9HU (p = 0.10) for Trilogy™ and TFL, respectively. Using 3D doctor imaging software from CT images, mean stone volumes were 3718.9 ± 3038.7mm3 for Trilogy™ and 3425.9 ± 3096.1mm3 for TFL(p = 0.77). Using probe-activation time or lasing time, stone-fragmentation rate was 5.98 ± 4.25mm3/sec for Trilogy™ and 3.95 ± 1.00mm3/sec for TFL(p = 0.015). Treatment time (puncture to complete clearance) was 32.48 ± 15.39 min for Trilogy™ and 28.63 ± 18.56 min for TFL(p = 0.38). Haemoglobin drop was 1.19 ± 0.76gm/dl for Trilogy™ and 0.99 ± 0.74gm/dl for TFL (p = 0.30). Trilogy™ arm had 96.6% complete clearance and TFL had 76.6% in TFL at 48 h. One patient in Trilogy™ arm required auxiliary RIRS for residual stone. Both arms had complete stone clearance at 1 month follow-up. Trilogy™ arm had 3 Clavien-Dindo grade-II complications while TFL had 2 Clavien-Dindo grade-II complications (UTI requiring antibiotics). There was no blood transfusion in either of arm. CONCLUSION: Trilogy™ had significantly better stone fragmentation rate than TFL in managing renal stones. However, stone-free rates and complications were comparable for Trilogy™ and TFL.

Size Distribution of Fragments by High-power Holmium Laser Lithotripsy in MiniPCNL with Suction.

PURPOSE OF REVIEW: Data are lacking on distribution of size of fragments created with the laser lithotripsy, stone density, and composition. Dust (< 1 mm) and small fragments (1-3 mm) may be too small to be efficiently removed with forceps compared to larger fragments (> 3 mm). We aim to report the size distribution of fragments formed during holmium laser lithotripsy. RECENT FINDINGS: One hundred ten patients with renal calculi < 3 cm underwent miniPCNL using ClearPetra sheath (Well Lead Medical Co., China) with controllable irrigation and suction system that minimizes fragment dispersion and maximizes fragment aspiration. Moses holmium laser (Lumenis INC, Israel) was used with predefined laser energy settings for lithotripsy. Proportion of fragment size < 1 mm was 46.36 ± 16.68%, 1-3 mm was 28.18 ± 10.01%, and > 3 mm was 25.19 ± 16.18% for the entire cohort. Complete stone clearance at 48 h was achieved in 77.3% cases. The remaining 22.7% patients had complete clearance at 1-month follow-up CT. In all the stone density, volume, and composition groups, majority of fragments created were either < 1 mm or 1-3 mm. Only 25% fragments were > 3 mm that would get aspirated out through the sheath with suction or could be retrieved with forceps. The combination of a high-power holmium laser and suction would help in complete stone clearance with effective aspiration of smaller stone fragments and dust simultaneously during lasing.

Candida dubliniensis: The New Culprit on the Block Causing Denture Stomatitis? An In Vivo Study.

AIM: The present study aimed to carry out DNA extraction and polymerase chain reaction (PCR) amplification to isolate the physiological and phenotypic traits of Candida albicans and Candida dubliniensis in denture wearer patients with and without denture-induced stomatitis. MATERIALS AND METHODS: A total sample size of 160 participants were divided into two equal groups (80 each), patients in the study group having 40 males and 40 females with Newton type II denture stomatitis, and in the control group, healthy 40 males and 40 females those who wear complete denture were selected. All the samples were collected from the hard palate with a sterile swab and inoculated on CHROM agar plate; samples that displayed dark green colored colonies were selected for DNA extraction. DNA isolation was done on agarose gel using electrophoresis. Biorad gene identification was used. Strands depicting the presence of DNA in particular samples were identified, and further standardization of the procedure was done. PCR amplification was done using Candida species-specific primer, preset to the hyphal wall of the protein 1 gene with the CRR forward and reverse primers, under strict standard conditions with reverse transcriptase technique. RESULTS: Results showed that prevalence of C. albicans was more in females with denture stomatitis which was 67.50% than in males, i.e., 52.50%, and prevalence of C. dubliniensis was found in one female and in one male who were having denture stomatitis and it was not isolated from patients without denture stomatitis. Statistical analyses were performed using the Chi-square test. CONCLUSION: Denture stomatitis is the most common problem faced by long-term denture wearers, with C. albicans as one of the causative organisms. However, recent findings show an emerging pathogenic yeast species, C. dubliniensis, which was isolated from denture-induced stomatitis candidates in the present study, which is closely related to the C. albicans species. The identification of candidal strains causing denture stomatitis with DNA extraction and PCR amplification and its management by determination of its susceptibility to antifungals may improve the treatment outcome of the same. CLINICAL SIGNIFICANCE: Candidiasis is the most frequently seen mucocutaneous infection of the oral cavity especially in denture wearers. It is caused mainly by the genus Candida. C. dubliniensis is phenotypically similar but genotypically different from C. albicans. This affects the treatment outcome drastically as there is enough literature suggesting resistance to the common antifungal drugs. Hence, drugs like fungus-specific calcineurin inhibitors should also be considered in resistant patients. Therefore, DNA identification of Candida genus plays a major role in deciding the treatment outcome. How to cite this article: Patil A, Boparai NK, Shankargouda SB, et al. Candida dubliniensis: The New Culprit on the Block Causing Denture Stomatitis? An In Vivo Study. J Contemp Dent Pract 2021;22(5):517-521.

Behavioral Biometric Data Analysis for Gender Classification Using Feature Fusion and Machine Learning.

Biometric security applications have been employed for providing a higher security in several access control systems during the past few years. The handwritten signature is the most widely accepted behavioral biometric trait for authenticating the documents like letters, contracts, wills, MOU's, etc. for validation in day to day life. In this paper, a novel algorithm to detect gender of individuals based on the image of their handwritten signatures is proposed. The proposed work is based on the fusion of textural and statistical features extracted from the signature images. The LBP and HOG features represent the texture. The writer's gender classification is carried out using machine learning techniques. The proposed technique is evaluated on own dataset of 4,790 signatures and realized an encouraging accuracy of 96.17, 98.72 and 100% for k-NN, decision tree and Support Vector Machine classifiers, respectively. The proposed method is expected to be useful in design of efficient computer vision tools for authentication and forensic investigation of documents with handwritten signatures.

Initial experience with slimmest single-use flexible ureteroscope Uscope PU3033A (PUSEN™) in retrograde intrarenal surgery and its comparison with Uscope PU3022a: a single-center prospective study.

PURPOSE: Single-use disposable digital flexible ureterorenoscope has become an attractive option to reusable scope with many advantages. Currently available single-use digital fURS have outer shaft diameter above 9 Fr which requires large access sheath insertion and sometimes double J stent placement. Recently, 7.5 Fr single-use digital fURS is introduced in market by Pusen. Objective of this study is to compare two Pusen single-use scopes in the clinical setting: 7.5 Fr Uscope PU3033A and 9.5 Fr Uscope PU3022A. METHODS: 30 patients, having renal stones < 2 cm, planned for RIRS were prospectively randomized to two groups: group 1 had 15 patients in which 7.5 Fr Uscope PU3033A and group 2 had 15 patients in which 9.5 Fr Uscope PU3022A was used. The various pre-operative, intra-operative, and post-operative parameters at 1 month along with complications were evaluated for both the scopes by a single surgical team. RESULTS: Pre-operative parameters including stone characteristics were comparable in both the groups. Three patients in group 2 needed ureteric dilatation prior to 11/13 access sheath insertion, while 10/12 Fr access sheath was placed in all patients in group 1 without manipulation (p = 0.06). Intra-operative vision was comparable in both scopes with an empty working channel and with laser. Hazy vision while lasing in two and one patient in group 1 and group 2, respectively (p = 0.54). In group 1, one had fever and UTI, while in group 2, one had fever post-operatively. CONCLUSION: 7.5 Fr Uscope PU3033A could be introduced with smaller access sheath. The vision, deflection, maneuverability is comparable to 9.5 Fr Uscope PU3022a.