Comparative evaluation of dentinal tubule penetration and push-out bond strength of new injectable hydraulic calcium disilicate based root canal sealer: A single blinded in vitro study.

Objective: To evaluate and compare dentinal tubule penetration and push-out bond strength of BIO-C ION+, AH Plus and NanoSeal-S using Confocal Laser Scanning Microscopy (CLSM) and Universal Testing Machine (UTM). Materials & method: Sixty human mandibular premolars were prepared using ProTaper Gold till F3. Samples were then divided into 3 groups: Group I (n = 20) BIO-C ION + sealer, Group II (n = 20) AH Plus and Group III (n = 20) NanoSeal-S sealer. Groups were then sub-divided into two sub groups: In Subgroup A (n = 10) samples were obturated using single-cone with 0.1 % Rhodamine B dye and in Subgroup B (n = 10) samples were obturated using single cone. The samples were then transversely sectioned into coronal, middle and apical segments, samples in subgroup A & B were then submitted to CLSM analysis and UTM respectively. Results: The Bond Strength data showed following means (MPa): Group I Subgroup B: (BIO-C ION+) coronal (1.64), middle (1.25), apical (0.93); Group II Subgroup B: (AH Plus) coronal (2.20), middle (1.85) apical (1.38) and Group III Subgroup B: (NanoSeal-S) coronal (1.26), middle (0.94), apical (0.58). The dentinal tubule penetration data showed following means: (µm) Group I Subgroup A (BIO-C ION+) coronal (1184.69), middle (997.03), apical (637.26); Group II Subgroup-A AH Plus (864.14) and NanoSeal-S (495.64). Statistical analysis (two-way ANOVA, Tukey's Post Hoc Test) showed significant difference among sealers (p < 0.001) and root canal thirds (p < 0.001). Conclusion: The results of the study concluded that BIO-C ION + sealer showed maximum dentinal tubule penetration and AH Plus demonstrated maximum push-out bond strength.

Healing Assessment of Spinal Tuberculosis: A Systematic Review.

OBJECTIVE: Deciding the healing end point in spinal tuberculosis (STB) remains a controversial topic. The current systematic review aims to address the controversy existing in the literature to find a comprehensive method to assess healing in STB. METHODS: A thorough literature search was carried out for studies with the assessment of healing parameters in STB. Data extraction was carried out manually, which included study characteristics and healing criteria evaluated in each study. RESULTS: Qualitative analysis of 8 included studies showed that healing parameters were described in 3 domains: clinical, hematologic, and radiologic response of the patient to antitubercular chemotherapy. Each domain included various individual parameters, with clinical and radiologic assessment criteria being used in most of the studies. Improvement in terms of pain, constitutional symptoms, weight gain, neurology; variation in erythrocyte sedimentation rate and C-reactive protein; and changes in radiography, magnetic resonance imaging, and positron emission tomography/computed tomography were found to be promising predictors in the assessment of healing. CONCLUSIONS: Radiologic response parameters emerged as the maximally used criteria to assess healing in STB. However, in the absence of any statistical analysis and an observed lag in radiologic response, the cumulative effect of all the parameters in 3 domains (clinical, hematologic, and radiologic) can be used to declare a spinal tubercular lesion nonhealing, healing, or healed.

Retinoblastoma: A review of the molecular basis of tumor development and its clinical correlation in shaping future targeted treatment strategies.

Retinoblastoma is a retinal cancer that affects children and is the most prevalent intraocular tumor worldwide. Despite tremendous breakthroughs in our understanding of the fundamental mechanisms that regulate progression of retinoblastoma, the development of targeted therapeutics for retinoblastoma has lagged. Our review highlights the current developments in the genetic, epigenetic, transcriptomic, and proteomic landscapes of retinoblastoma. We also discuss their clinical relevance and potential implications for future therapeutic development, with the aim to create a frontline multimodal therapy for retinoblastoma.

Experimental analysis of enhanced solar still operating with induced turbulence.

This work experimentally investigates the performance of solar still with induced turbulence (SWIT) which operates with a novel approach for improved productivity. A metal wire net has been submerged in basin water of still and direct current vibration micro motor has been used to develop small intensity vibrations in wire net. These vibrations serve to induce turbulence in basin water and also break the thermal boundary layer between still surface and water to enhance the evaporation. The energy-exergy-economic-environment analysis of SWIT has been performed and compared with conventional solar still (CS) of identical size. The overall heat transfer coefficient of SWIT is found to be 66% more in comparison of CS. The SWIT provided 53% increase in yield and it is 55% more thermally efficient than CS. The average exergy efficiency of the SWIT is found to be 76% higher than that of CS. The cost of water from SWIT is 0.028 $ with a payback period of 0.74 years and the carbon credit gained by SWIT is found to be 105 $. The productivity of SWIT has also been compared for intervals of 5, 10, and 15 min between the induced turbulence to find suitable interval duration.

Accumulation of resveratrol, ferulic acid and iron in seeds confer iron deficiency chlorosis tolerance to a novel genetic stock of peanut (Arachis hypogaea L.) grown in calcareous soils.

Peanut is mostly grown in calcareous soils with high pH which are deficient in available iron (Fe2+) for plant uptake causing iron deficiency chlorosis (IDC). The most pertinent solution is to identify efficient genotypes showing tolerance to limited Fe availability in the soil. A field screening of 40 advanced breeding lines of peanut using NRCG 7472 and ICGV 86031 as IDC susceptible and tolerant checks, respectively, was envisaged for four years. PBS 22040 and 29,192 exhibited maximum tolerance while PBS 12215 and 12,185 were most susceptible. PBS 22040 accumulated maximum seed resveratrol (5.8 ± 0.08 ppm), ferulic acid (378.6 ± 0.31 ppm) and Fe (45.59 ± 0.41 ppm) content. Enhanced chlorophyll retention (8.72-9.50 µg ml-1), carotenoid accumulation (1.96-2.08 µg ml-1), and antioxidant enzyme activity (APX: 35.9-103.9%; POX: 51- 145%) reduced the MDA accumulation (5.61-9.11 µM cm-1) in tolerant lines. The overexpression of Fe transporters IRT1, ZIP5, YSL3 was recorded to the tune of 2.3-9.54; 1.45-3.7; 2.20-2.32- folds respectively in PBS 22040 and 29,192, over NRCG 7472. PBS 22040 recorded the maximum pod yield (282 ± 4.6 g/row), hundred kernel weight (55 ± 0.7 g) and number of pods per three plants (54 ± 1.7). The study thus reports new insights into the roles of resveratrol, ferulic acid and differential antioxidant enzyme activities in imparting IDC tolerance. PBS 22040, being the best performing line, can be the potent source of IDC tolerance for introgression in high yielding but susceptible genotypes under similar edaphic conditions. Supplementary Information: The online version contains supplementary material available at 10.1007/s12298-023-01321-9.

Modeling electronic health record data using an end-to-end knowledge-graph-informed topic model.

The rapid growth of electronic health record (EHR) datasets opens up promising opportunities to understand human diseases in a systematic way. However, effective extraction of clinical knowledge from EHR data has been hindered by the sparse and noisy information. We present Graph ATtention-Embedded Topic Model (GAT-ETM), an end-to-end taxonomy-knowledge-graph-based multimodal embedded topic model. GAT-ETM distills latent disease topics from EHR data by learning the embedding from a constructed medical knowledge graph. We applied GAT-ETM to a large-scale EHR dataset consisting of over 1 million patients. We evaluated its performance based on topic quality, drug imputation, and disease diagnosis prediction. GAT-ETM demonstrated superior performance over the alternative methods on all tasks. Moreover, GAT-ETM learned clinically meaningful graph-informed embedding of the EHR codes and discovered interpretable and accurate patient representations for patient stratification and drug recommendations. GAT-ETM code is available at https://github.com/li-lab-mcgill/GAT-ETM .

An expedient ion chromatography based method for high-throughput analysis of phytic acid in groundnut kernels.

A study was made to expedite ion chromatography method using IonPac analytical column and self-regenerating anion suppressor for phytic acid determination in groundnut seeds and compared with a widely adopted spectrophotometric method based on enzymatic hydrolysis. The Ion Chromatography method equipped with AG11 guard and AS11 analytical columns in isocratic mode using 65 mM NaOH mobile phase at 1 mL min-1 flow rate showed a sharp peak for phytic acid with a retention time of 2.42 ± 0.2 min. The peak area was plotted v/s concentration showed linearity with an R2 value of 0.997, detection limit of 0.028 mg L-1 and recovery of 98% as against R2 value of 0.988 and detection limit of 0.065 mg L-1 in the spectrophotometric method. The study demonstrates that Ion Chromatography method was more accurate with a better detection limit than spectrophotometry. Also, this method provides robust handling with lesser reagent requirements due to combined eluent generation and self-regenerating suppression. Supplementary Information: The online version contains supplementary material available at 10.1007/s13197-022-05527-9.

MixEHR-Guided: A guided multi-modal topic modeling approach for large-scale automatic phenotyping using the electronic health record.

Electronic Health Records (EHRs) contain rich clinical data collected at the point of the care, and their increasing adoption offers exciting opportunities for clinical informatics, disease risk prediction, and personalized treatment recommendation. However, effective use of EHR data for research and clinical decision support is often hampered by a lack of reliable disease labels. To compile gold-standard labels, researchers often rely on clinical experts to develop rule-based phenotyping algorithms from billing codes and other surrogate features. This process is tedious and error-prone due to recall and observer biases in how codes and measures are selected, and some phenotypes are incompletely captured by a handful of surrogate features. To address this challenge, we present a novel automatic phenotyping model called MixEHR-Guided (MixEHR-G), a multimodal hierarchical Bayesian topic model that efficiently models the EHR generative process by identifying latent phenotype structure in the data. Unlike existing topic modeling algorithms wherein the inferred topics are not identifiable, MixEHR-G uses prior information from informative surrogate features to align topics with known phenotypes. We applied MixEHR-G to an openly-available EHR dataset of 38,597 intensive care patients (MIMIC-III) in Boston, USA and to administrative claims data for a population-based cohort (PopHR) of 1.3 million people in Quebec, Canada. Qualitatively, we demonstrate that MixEHR-G learns interpretable phenotypes and yields meaningful insights about phenotype similarities, comorbidities, and epidemiological associations. Quantitatively, MixEHR-G outperforms existing unsupervised phenotyping methods on a phenotype label annotation task, and it can accurately estimate relative phenotype prevalence functions without gold-standard phenotype information. Altogether, MixEHR-G is an important step towards building an interpretable and automated phenotyping system using EHR data.

Mortality trends and length of stays among hospitalized patients with COVID-19 in Ontario and Québec (Canada): a population-based cohort study of the first three epidemic waves.

BACKGROUND: Epidemics of COVID-19 strained hospital resources. We describe temporal trends in mortality risk and length of stays in hospital and intensive care units (ICUs) among patients with COVID-19 hospitalized through the first three epidemic waves in Canada. METHODS: We used population-based provincial hospitalization data from the epicenters of Canada's epidemics (Ontario and Québec). Adjusted estimates were obtained using marginal standardization of logistic regression models, accounting for patient-level and hospital-level determinants. RESULTS: Using all hospitalizations from Ontario (N = 26,538) and Québec (N = 23,857), we found that unadjusted in-hospital mortality risks peaked at 31% in the first wave and was lowest at the end of the third wave at 6-7%. This general trend remained after adjustments. The odds of in-hospital mortality in the highest patient load quintile were 1.2-fold (95% CI: 1.0-1.4; Ontario) and 1.6-fold (95% CI: 1.3-1.9; Québec) that of the lowest quintile. Mean hospital and ICU length of stays decreased over time but ICU stays were consistently higher in Ontario than Québec. CONCLUSIONS: In-hospital mortality risks and length of ICU stays declined over time despite changing patient demographics. Continuous population-based monitoring of patient outcomes in an evolving epidemic is necessary for health system preparedness and response.

Effects of Confounding Bias in Coronavirus Disease 2019 (COVID-19) and Influenza Vaccine Effectiveness Test-Negative Designs Due to Correlated Influenza and COVID-19 Vaccination Behaviors.

BACKGROUND: The test-negative design is commonly used to estimate influenza and coronavirus disease 2019 (COVID-19) vaccine effectiveness (VE). In these studies, correlated COVID-19 and influenza vaccine behaviors may introduce a confounding bias where controls are included with the other vaccine-preventable acute respiratory illness (ARI). We quantified the impact of this bias on VE estimates in studies where this bias is not addressed. METHODS: We simulated study populations under varying vaccination probabilities, COVID-19 VE, influenza VE, and proportions of controls included with the other vaccine-preventable ARI. Mean bias was calculated as the difference between estimated and true VE. Absolute mean bias in VE estimates was classified as low (<10%), moderate (10% to <20%), and high (≥20%). RESULTS: Where vaccination probabilities are positively correlated, COVID-19 and influenza VE test-negative studies with influenza and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ARI controls, respectively, underestimate VE. For COVID-19 VE studies, mean bias was low for all scenarios where influenza represented ≤25% of controls. For influenza VE studies, mean bias was low for all scenarios where SARS-CoV-2 represented ≤10% of controls. Although bias was driven by the conditional probability of vaccination, low VE of the vaccine of interest and high VE of the confounding vaccine increase its magnitude. CONCLUSIONS: Where a low percentage of controls is included with the other vaccine-preventable ARI, bias in COVID-19 and influenza VE estimates is low. However, influenza VE estimates are likely more susceptible to bias. Researchers should consider potential bias and its implications in their respective study settings to make informed methodological decisions in test-negative VE studies.

Rapid Response Preparedness for Management of Post-Covid Invasive Rhino-Orbito-Cerebral Fungal Infections: Experience from a Tertiary Care Government Institute in India.

Sudden surge of Post Covid-19 Rhino-orbito-mucormycosis cases has left entire ENT fraternity in the center of a war room. We present a quick administrative preparedness for this situation in a tertiary care Government Institute in India. This model may serve as a reference for other centers.

Infection and utilization rates of bone allografts in a hospital-based musculoskeletal tissue bank in north India.

BACKGROUND: The bone bank unit of interest in this article was established in January 2018, in a tertiary care teaching institute of north India. Aim of this article is to describe the sources of allografts obtained, discard rates of allografts and infection rates in the recipients after use. MATERIAL AND METHODS: All the relevant details of donors and recipients were maintained, and donors were screened for standard inclusion and exclusion criteria before obtaining the grafts. Aerobic culture was performed before storage and just prior to use. Samples with incomplete documentation, incomplete donor screening or positive cultures were discarded. Data on surgical site infection in recipients was collected from hospital records retrospectively. Initially ELISA based serological tests were used for screening. Donor has to undergo these tests again after 6 months to account for the window period of proliferation of viruses. Nucleic acid amplification tests (NAAT) for these viral agents were introduced in the hospital in May 2018. RESULTS: Allografts from a total of 196 donors were obtained in the bone bank over 2 years. Major source of bone was femoral heads harvested during total hip arthroplasty or hemi-arthroplasty. 44(22.4%) grafts had to be discarded. 95 allografts were used in 88 patients during this time. Most common indication for use was surgery for bone tumors (40%), followed by complex primary or revision arthroplasty (30.5%). Three (3.4%) recipients developed deep infection postoperatively. CONCLUSION: Frozen allograft bone from hospital based bone banks is a reliable source of allografts. When meticulous precautions for sterility are followed, risk of infection is low. Monitoring of such bone banks should fall within a framework of the local legislature. Incomplete documentation is the major reason for wastage of the samples obtained. NAAT may be useful in screening of donors, as it reduces the wastage and the holding time of the allografts.

Outcome of Neglected Talus Neck Fracture and it's Management: A Case Report.

INTRODUCTION: Talus fracture is an uncommon fracture that can be encountered on day- to- day basis. However, it is the 2nd most common tarsal bone to get fractured after calcaneum and accounts for approximately 1% of all fractures around foot and ankle. The anastomotic ring around the talar neck is highly likely to get damaged at the time of the fracture, which, in turn, hampers the blood supply to the body of talus. As a result, the bone healing is delayed and the integrity of the healed fracture is poor which leads to poor functional outcome. Almost 39% cases are missed during the initial evaluation, and talus fracture accounts for almost 50% of all the missed injuries (6-8). A high level of clinical suspicion is required to avoid missing such injuries. CASE REPORT: A 26-year-old male presented to the outpatient department with chief complaint of pain over the left foot while walking for past 6 months. There was a history of significant trauma to the foot 6 months back (fall from 12 feet) for which he sought medical advice and was managed with analgesics and rest for a couple of weeks. He presented to us 6 months later with chronic, dull aching, and continuous pain which aggravates while walking and standing. The diagnosis of the non-union fracture neck of talus was made after radiology and was managed by open reduction and internal fixation with cannulated cancellous screws along with contralateral iliac crest cancellous bone grafting. CONCLUSION: Delay in diagnosing such injuries accelerates the vascular compromise, delays timely intervention, and ultimately leads to increased morbidity.

Metabolic profiling for dissection of late leaf spot disease resistance mechanism in groundnut.

Late leaf spot (LLS) caused by fungi Passalora personata is generally more destructive and difficult to control than early leaf spot. The aim of this study was to decipher biochemical defense mechanism in groundnut genotypes against P. personata by identifying resistance specific biomarkers and metabolic pathways induced during host-pathogen interaction. Metabolomics of non-infected and infected leaves of moderately resistant (GPBD4 and ICGV86590), resistant (KDG128 and RHRG06083) and susceptible (GG20, JL24 and TMV2) genotypes was carried out at 5 days after infection (65 days after sowing). Non-targeted metabolite analysis using GC-MS revealed total 77 metabolites including carbohydrates, sugar alcohols, amino acids, fatty acids, polyamines, phenolics, terpenes and sterols. Variable importance in projection (VIP) measure of partial least squares-discriminant analysis (PLS-DA) showed that resistant and moderately resistant genotypes possessed higher intensities of ribonic acid, cinnamic acid, malic acid, squalene, xylulose, galactose, fructose, glucose, ß-amyrin and hydroquinone while susceptible genotypes had higher amount of gluconic acid 2-methoxime, ribo-hexose-3-ulose and gluconic acid. Heat map analysis showed that resistant genotypes had higher intensities of ß-amyrin, hydroquinone in non-infected and malic acid, squalene, putrescine and 2,3,4-trihydroxybutyric acid in infected leaves. Dendrogram analysis further separated resistant genotypes in the same cluster along with infected moderately resistant genotypes. The most significant pathways identified are: linoleic acid metabolism, flavone and flavonol biosynthesis, cutin, suberin and wax biosynthesis, pentose and glucuronate interconversions, starch and sucrose metabolism, stilbenoid biosynthesis and ascorbate and aldarate metabolism. Targeted metabolite analysis further confirmed that resistant genotypes possessed higher content of primary metabolites sucrose, glucose, fructose, malic acid and citric acid. Moreover, resistant genotypes possessed higher content of salicylic, coumaric, ferulic, cinnamic, gallic acid (phenolic acids) and kaempferol, quercetin and catechin (flavonols). Thus metabolites having higher accumulation in resistant genotypes can be used as biomarkers for screening of LSS resistant germplasm. These results unravel that higher amount of primary metabolites leads to stimulate the accumulation of more amounts of secondary metabolites such as phenolic acid, flavanols, stilbenes and terpenoids (squalene and ß-amyrin) biosynthesis which are ultimately involved in defense mechanism against LLS pathogen. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12298-021-00985-5.