Patient-reported outcomes after oral cancer reconstructions with radial and ulnar forearm-free flaps.

OBJECTIVES: This study aimed to evaluate patient-reported quality of life and incidence of decision regret in patients undergoing radial (RFFF) and ulnar forearm-free flaps (UFFF) reconstruction. MATERIALS AND METHODS: Patients undergoing either RFFF or UFFF were assessed with the University of Washington Quality of Life (UW-QOL) and Oral Health Impact Profile (OHIP-14) questionnaires, and the Decision Regret Scale (DRS), both before and at least 12 months post-reconstruction. RESULTS: In total, 40 RFFF and 40 UFFF were included. Harvesting time was longer in RFFF (p = 0.043), and the donor-site defect was significantly larger in RFFF than in UFFF (p = 0.044). Patients with UFFF scored better UW-QOL in the appearance, pain, activity, mood, and social functioning domains (p < 0.05). However, the RFFF group excelled in swallowing and chewing domains. The DRS score revealed a significant difference between RFFF and UFFF, with scores of 36.26 versus 27.36, respectively. Moreover, the mean DRS score reduced at 12 months compared with 6 months, significantly superior for UFFF. CONCLUSION: Oral cancer patients reconstructed with UFFF exhibited a better appearance, social domain, and mild decision regret compared with RFFF, indicating that the UFFF may contribute to improving postoperative quality of life in oral cancer patients.

Medial sural artery perforator free flap versus radial forearm free flap in oral cavity reconstruction and donor site morbidity.

OBJECTIVE: Radial Forearm Free flap (RFFF) is widely used in head and neck reconstruction, yet its donor site defect remains a significant drawback. The Medial Sural Artery Perforator Free Flap (MSAPFF) is considered an alternative flap to RFFF. This study aims to comprehensively analyze their characteristics, outcomes, and their impact on patient quality of life. METHODS: All patients who underwent oral cavity reconstruction using RFFF and MSAPFF between February 2017 and April 2023 were included in this study. Flap characteristics, outcomes and post-operative complications were recorded and compared. Subjective donor site morbidity, aesthetic and functional results, and quality of life were also analyzed. RESULTS: The study included 76 patients: 37 underwent reconstruction with RFFF, and 39 with MSAPFF. There was no significance difference between the RFFF and MSAPFF regarding the success rate (97.2% vs 97.4%), flap size (4.8 × 8.8 cm2 vs 5 × 9.8 cm2), hospital of stay (15.5 days vs 13.5 days) and recipient site complications (P > 0.05). However, MSAPFF showed larger flap thickness (P = 0.001), smaller arterial caliber (P = 0.008), shorter pedicle length (P = 0.001), and longer harvesting time (P < 0.001). No significant difference was observed between the pre-and postoperative ranges of wrist and ankle movements or in recipient site complications. MSAPFF showed a significant difference in donor site morbidity (P < 0.05). CONCLUSION: The MSAPFF is an excellent alternative to the RFFF for repairing oral cavity defects, with additional advantage of a well-hidden scar on the posterior calf, a larger flap thickness, accepted pedicle length and arterial caliber. However, one should consider the harvesting time and surgical skills required in comparison to the RFFF. CLINICAL RELEVANCE: The study highlights the importance of the MSAPFF as an alternative option for RFFF with less donor site morbidity and high success rate in oral cavity reconstruction and improved patient Quality of life after ablative surgery.

Carbon footprint of synthetic nitrogen under staple crops: A first cradle-to-grave analysis.

More than half of the world's population is nourished by crops fertilized with synthetic nitrogen (N) fertilizers. However, N fertilization is a major source of anthropogenic emissions, augmenting the carbon footprint (CF). To date, no global quantification of the CF induced by N fertilization of the main grain crops has been performed, and quantifications at the national scale have neglected the CO2 assimilated by plants. A first cradle-to-grave life cycle assessment was performed to quantify the CF of the N fertilizers' production, transportation, and application to the field and the uses of the produced biomass in livestock feed and human food, as well as biofuel production. We quantified the direct and indirect inventories emitted or sequestered by N fertilization of main grain crops: wheat, maize, and rice. Grain food produced with N fertilization had a net CF of 7.4 Gt CO2eq. in 2019 after excluding the assimilated C in plant biomass, which accounted for a quarter of the total CF. The cradle (fertilizer production and transportation), gate (fertilizer application, and soil and plant systems), and grave (feed, food, biofuel, and losses) stages contributed to the CF by 2%, 11%, and 87%, respectively. Although Asia was the top grain producer, North America contributed 38% of the CF due to the greatest CF of the grave stage (2.5 Gt CO2eq.). The CF of grain crops will increase to 21.2 Gt CO2eq. in 2100, driven by the rise in N fertilization to meet the growing food demand without actions to stop the decline in N use efficiency. To meet the targets of climate change, we introduced an ambitious mitigation strategy, including the improvement of N agronomic efficiency (6% average target for the three crops) and manufacturing technology, reducing food losses, and global conversion to healthy diets, whereby the CF can be reduced to 5.6 Gt CO2eq. in 2100.

Perioperative risk factors impact on intensive care unit length of stay (ICU length of stay) in oral squamous cell carcinoma.

BACKGROUND: The trend in postoperative care for free flap patients is to deescalate from routine ICU admission into a specialty recovery unit. This study aims to investigate the predictive parameters in a routine perioperative clinical assessment that are expected to be directly correlated with prolonged ICU length of stay in at-risk patients who received oral reconstructive surgery for squamous cell carcinoma (OSCC). METHODS: All patients who underwent ablative surgery for OSCC with free flap reconstruction and were managed in the ICU were included in this study. The primary outcome was ICU-length of stay. Perioperative, operative and postoperative parameters were analyzed using single test ( t-test, ANOVA analysis, correlation coefficients, effect size) and multivariate regression test. The P-value was set as < 0.005 to be considered statically significant. RESULTS: The study included 136 homogeneous patients, with a mean ICU length of stay of 4.5 (± 4.43 day). Patients with pre-operative positive renal dysfunction (P = 0.004), peripheral vascular disease (P < 0.001), postoperative complications (P = 0.028) or positive heart failure class III (P < 0.001 ) were recognized as at-risk patients for a significantly longer ICU length of stay. CONCLUSION: Patients with perioperative severe renal dysfunction, peripheral vascular disease, postoperative complication or high NYHA class are prone to have a significantly longer ICU length of stay. Several factors were considered as confounders contributing to increased ICU management time in combination with other variables. Additionally, in highly risk patient, the presence of the highly trained medical support, including the appropriate nursing care, is more critical than those patients without these risk factors.

Extraction of foreign body from the urinary bladder using nephroscope: A case report of endoscopy treatment.

Transurethral foreign bodies (FBs) in the urinary tract are rare findings in a clinical setting. The most common cases are reported for FBs in the urinary bladder. The present report similarly aimed to examine a whole pen as a FB with a discussion about symptoms and complexities. Here, we significantly reported the management of pen extraction from the bladder of a female patient using nephroscope and proposed success with possible recommendations for treatment in future operations.

Three dimensional condylar positional and morphological changes following mandibular reconstruction based on CBCT analysis: a prospective study.

OBJECTIVE: This study aimed to evaluate the condylar positional changes following mandibular reconstruction with preservation of the condylar head using Cone-Beam Computed Tomography (CBCT). Also, to assess joint space changes and the overall volumetric space compared to the preoperative status. METHODOLOGY: This prospective study included 30 patients (60 joints) subjected to unilateral mandibular resection and reconstruction with preservation of the condylar head. The Helkimo index and preoperative (T1), two weeks postoperative (T2), and follow-up CBCTs (T3) after at least six months were gathered and processed to evaluate the condylar position and TMJ joint space using Anatomage Invivo 6. A student's t-test and repeated-measures ANOVA statistics were used. A P value of less than 0.05 was considered statistically significant. RESULTS: Thirty patients (14 males, 16 females) with a mean age of 40.01 ± 12.7 years (a range of 18.1-62.9 years) were included. On the tumor side, there were significant variances in the vertical and mediolateral condylar positions between the three-time points (T1, T2, T3). Immediately after the operation, the condyles were significantly displaced in a downward direction at T2, which became larger after the last follow-up period (T3) (p = 0.007). The condylar positions at the anteroposterior direction were relatively stable without significant differences between the three times points (p = 0.915). On the non-tumor side, the condylar positions were relatively stable in the mediolateral and anteroposterior positions. In the tumor side, all of the TMJ spaces were significantly increased in size following the mandibular reconstructions (T2 and T3). However, on the non-tumor side, the anterior, posterior, and medial joint spaces were significantly changed postoperatively. CONCLUSION: After mandibular reconstruction with condylar preservation, the condylar position and volumetric measurement immediately changed noticeably and continued to be a permanent change over time compared to relatively stable condyles on the non-tumor side. According to Helkimo index, patients become adapted to the postoperative changes without significant differences between the two sides.

The Sommerlad-Furlow Modified Palatoplasty Technique: Postoperative Complications and Implicating Factors.

OBJECTIVE: To explore the incidence of postoperative complications and investigate the impact of preselected factors on functional and quality of life outcomes following the Sommerlad-Furlow modified palatoplasty technique. STUDY DESIGN: Retrospective cohort. METHODS: A total of 429 patients with cleft palate, who received Sommerlad-Furlow modified technique between 2011-2017 were enrolled. The postoperative complications including oronasal fistula (ONF), velopharyngeal insufficiency (VPI), and inadequate quality of life (QOL) were collected. Data of preselected factors including gender, age at palatoplasty, cleft type, cleft width, palatal width, pharyngeal cavity depth, and operation duration were also collected. RESULTS: Among 429 patients, 40.1% were males whereas 59.9% were females. The mean age at palatoplasty was 1.23 ± 0.69 (0.42-4) years, and the average cleft width was 10.15 ± 2.95 (4-27) mm. The cleft types had recorded rates of about 6.8%, 69.5%, 17.7%, and 6.1% of Veau I, II, III, and IV, respectively. The overall incidence rates of ONF, VPI, and inadequate QOL were 2.3%, 19.4%, and 31.3%, respectively. In both the univariate and multivariate analyses, the cleft type was significantly implicated in ONF formation (p = 0.023 and 0.032, respectively) whereas the velopharyngeal function was impacted by the palatoplasty age (p Ë‚ 0.001). The receiver operating characteristic curve indicated that age of palatoplasty ≥1.3 years (area under the curve = 0.611, p = 0.002) was the cutoff value for predicting the incidence of VPI. CONCLUSIONS: The Sommerlad-Furlow modified technique appears to have appropriate postoperative outcomes, even in the wide cleft palate. The older age at palatoplasty has a major impact on the overall postoperative outcomes. LEVEL OF EVIDENCE: 4 Laryngoscope, 133:822-829, 2023.

Is the retromandibular approach a suitable approach to anatomical reduction of unilateral subcondylar fracture? A non-randomized clinical trial.

The aim of this study was to evaluate the efficacy of the retromandibular approach (RMA) to produce three-dimensional (3-D) reduction of the unilateral subcondylar fracture and Temporomandibular Joint (TMJ) functional implication. METHODS:  A prospective cohort study was designed. Twenty-nine patients with unilateral subcondylar fracture underwent consecutively Open Reduction, and Internal Fixation. The cohorts were divided into two groups; RMA group (n = 16, 55.17%) and submandibular approach SMA group (n = 13, 44.82%). The primary outcome was the anatomical 3-D reduction of the condyle. The secondary outcome was to compare the condyle position and inclination finding with TMJ outcomes. Helkimo Index score was used to evaluate the TMJ outcome at six months postoperatively. RESULT:  There was a significant difference between the mediolateral condylar inclination, condylar medial and vertical positions when RMA compared with SMA groups (P < 0.05). The medial joint space was correlated with the medial condylar position in both groups (P < 0.05). The Helkimo Ai and Di was associated with mediolateral condylar inclination in SMG; however, Helkimo Ai was found to be correlated with the RMA group. CONCLUSION:  The current study demonstrates that the RMA could re-establish the anatomical position of the unilateral subcondylar fracture in patients undergoing ORIF. The clinical outcome of the TMJ with RMA was better than SMA.

Optimizing maize yields using growth stimulants under the strategy of replacing chemicals with biological fertilizers.

Partial replacement of chemicals with biological fertilizers is a recommended strategy to reduce the adverse environmental effects of chemical fertilizer losses. Enhancing the reduced mineral with biological fertilizers strategy by foliar application of humic acid (HA) and amino acids (AA) can reduce environmental hazards, while improving maize (Zea mays L.) production under semiarid conditions. The recommended doses of N, P and K (e.g., 286 kg N ha-1, 75 kg P2O5 ha-1 and 67 kg K2O ha-1) were applied as the first fertilization level (100% NPK) and were replaced with biofertilizers by 100%, 75%, 50% and 25% as levels of reducing mineral fertilization. These treatments were applied under four foliar applications of tap water (TW), HA, AA and a mixture of HA and AA. Our results reported significant reductions in all parameters, including maize ear yield attributes and grain nutrient uptake, when replacing the mineral NPK with biofertilizers by 25-100% replacement. However, these reductions were mitigated significantly under the application of growth stimulants in the descending order: HA and AA mixture>AA>HA>TA. Applying a mixture of HA and AA with 75% NPK + biofertilizers increased ear length, grain yield, grain uptake of N and K, and crude protein yield by 37, 3, 4, 11 and 7%, respectively as compared with 100% mineral fertilizer only. Moreover, all investigated parameters were maximized under the application of 75% NPK + biofertilizers combined with AA or the mixture of HA and AA, which reveals the importance of growth stimulants in enhancing the reduced chemical NPK strategy. It could be concluded that the mineral NPK rate can be reduced by 25% with biofertilization without any yield losses when combined with HA and AA under arid and semi-arid conditions. That achieves the dual goals of sustainable agriculture by improving yield, while reducing environmental adverse effects.

Maintaining higher grain production with less reactive nitrogen losses in China: A meta-analysis study.

Managing reactive nitrogen (Nr) in agricultural production is crucial for addressing the triple challenges of food security, climate change and environmental degradation. Intensive work has been conducted to investigate the effects of mitigation strategies on reducing Nr losses by ammonia emission (Nr-NH3), nitrous oxide emission (Nr-N2O) and nitrate leaching (Nr-NO3-) separately. This meta-analysis evaluated the efficiency of each strategy in mitigating Nr losses coupled with grain yield responses. The results indicate that producing one Megagram (Mg) of wheat grains caused higher Nr losses, twice that of rice and 17% that of maize. The Nr-NH3 and Nr-NO3- were the dominant sources of Nr losses of the three crops (96%), while Nr-NH3 only presented 86% of the total Nr losses for rice. Reducing the N rate strategy decreased the yield by 33% and the Nr losses by 62% compared with the conventional rate (150-250 kg N ha-1) as an average of the three crops. In contrast, increasing the N rate higher than 250 kg N ha-1 amplified the yield by 15% but also caused a 71% increase in Nr losses compared with the conventional rate. Although subsurface application decreased Nr losses by 5%, this study rejected this approach as an effective strategy due to a 4% yield decline on average of the grain crops. Slow-release fertilizers decreased Nr-NH3 and Nr-N2O losses by 41-58% and 54-89%, respectively, of the highest losses under urea in the three crops, but also led to yield reductions. Organic amendments achieved the highest drop in Nr-NO3- loss by 66% in maize coupled with yield declines. Biochar increased wheat and maize yields by 0.3 and 0.1 Mg, respectively, coupled with 1 kg reduction in Nr losses. On average, inhibitors augmented the grain yields by 0.2 Mg ha-1 for each 1 kg decline in Nr losses. In conclusion, for sustainable agricultural intensification, biochar (for wheat only) and inhibitors (for the three crops) are strongly recommended as mitigation strategies for Nr losses from grain crop production systems in China.

Coupling the environmental impacts of reactive nitrogen losses and yield responses of staple crops in China.

Cropland reactive nitrogen losses (Nr) are of the greatest challenges facing sustainable agricultural intensification to meet the increases in food demand. The environmental impacts of Nr losses and their yield responses to the mitigation strategies were not completely evaluated. We assessed the environmental impacts of Nr losses in China and coupled the efficiency of mitigation actions with yield responses. Datasets about Nr losses in China were collected, converted into potentials of acidification (AP), global warming (GWP), and aquatic eutrophication (AEP), and analyzed by a meta-analysis program. Results showed that producing 1 Mg of rice grains had the highest AP (153 kg acid equiv.), while wheat had the highest GWP and AEP (74 kg CO2 equiv. and 0.37 kg PO4 equiv., respectively). Using the conventional rates (averagely, 200, 230, and 215 kg N ha-1) of urea as a surface application to produce 131.4, 257.2, and 212.1 Tg of wheat, maize, and rice resulted in 17-33 Tg, 7-10 Tg, and 6-87 Gg of AP, GWP, and AEP, respectively. For their balanced effect on reducing AP, GWP, and AEP while maximizing yields, inhibitors, and subsurface application could be set as the best mitigation strategies in wheat production. Inhibitors usage and biochar are strongly recommended strategies for sustainable production of maize. None of the investigated strategies had a balanced effect on rice yield and the environment, thus new mitigation technologies should be developed.

Analysis of Environmental Exposures for Nonsyndromic Cleft Lip and/or Palate: A Case-Control Study.

Background: Orofacial cleft is among the most common developmental malformations in humans. This study aimed to identify the relationship between environmental factors and nonsyndromic cleft lip and/or palate (NSCL/P) in Northwest China. Methods: This case-control study was conducted in Gansu Province, China over two years (Jan. 1, 2017-Jan. 1, 2019). Overall, 600 NSCL/P cases and 660 normal control cases were finally enrolled in the current study. Data were collected by conducting face-to-face interviews with both parents of each case. Results: Univariate (χ2) analysis revealed 22 factors as being significantly associated with NSCL/P. Multivariate (stepwise logistic regression) analysis identified that 14 factors had statistically significant association with NSCL/P. Male gender (OR=0.789), paternal age at childbirth of 25-29 yr (OR=0.690), and folic acid supplement (OR=0.197) were found to be protective factors against NSCL/P. On the other hand, blood A-type, multiple births, positive family history of NSCLP (OR=6.660), parental consanguinity (OR=6.107), positive abortion history, high or low maternal childbearing age, and maternal passive smoking (OR=4.349), malnutrition (OR=4.431), infections, and drug use (OR=2.188) during early gestation were significant risk factors for NSCL/P. Conclusion: Parental age at childbirth of 25-29 yr, and folic acid supplement can reduce the risk of NSCL/P. By contrast, maternal passive smoking, infections, and drug use during early gestation period, and multiple births, parental consanguinity, positive family history, and maternal abortion history can increase the risk of NSCL/P. Identification of risk factors is essential in minimizing the incidence of NSCL/P in a particular population.

Correlation of the Chinese velopharyngeal insufficiency-related quality of life instrument and speech in subjects with cleft palate.

OBJECTIVE: Assessment of the hypothesized correlation between the Chinese Velopharyngeal Insufficiency (VPI) Effects on Life Outcomes (VELO) instrument and measured speech parameters. METHODS: A cross-sectional study was conducted in the Oral Clefts Center of West China Hospital of Stomatology between January 2019 and December 2019. Speech parameters including speech intelligibility deficit, VPI severity, VP gap, and need for speech therapy were evaluated by speech-language pathologists. All patients and their parents completed the VELO instrument. The correlation between aforementioned speech parameters and VELO scores was examined utilizing Spearman correlation coefficients. The reliability of VELO test-retest and parent proxy assessment was estimated utilizing intraclass correlation coefficients (ICC). A receiver operating characteristic curve was used to calculate the cutoff VELO score. RESULTS: One hundred and forty patients with their parents were enrolled. The mean age was 12.58 ± 3.72 years. Both parent and youth VELO total and domain scores recorded moderate to strong correlations with all speech parameters (r > -.40, P ˂ .001) except the swallowing domain. Most VELO domain items have shown significant correlations with at least one speech parameter. Moreover, the scales of all speech parameters showed different VELO scores (P Ë‚ .001). The ICC reported test-retest correlation >.73 in all domains, and parent proxy correlation >.63 in most domains except the emotional and perception domains. The cutoff VELO score was 79.04 in parent version and 85.77 in youth version. CONCLUSIONS: The correlations between VELO scores and measured speech parameters have provided evidence for test-retest and parent proxy reliability and criterion and construct validity of the Chinese version of the VELO instrument. A VELO score ≥79.04 (in parent version) or ≥85.77 (in youth version) mostly reflects proper speech-related quality of life. Hence, this instrument could serve as a simple tool to help clinicians understand the social, emotional, and physical influences of VPI.

Three-dimensional assessment of accuracy for open reduction and internal fixation of the subcondylar fracture and its implications on the TMJ function.

This study used three-dimensional cone beam computed tomography (CBCT) to assist the accuracy of open reduction and internal fixation (ORIF) for the unilateral subcondylar fracture and the long-term temporomandibular joint (TMJ) function impairment. Bilateral TMJs were analyzed postoperatively on CBCT images, involving the following three-dimensional (3D) parameters: condylar position and inclination; circumferential joint space, ramus, and mandible length; and the volumetric joint space. The inclusion criteria for adult patients included having a displaced fracture >5°, a shortening in ramus length >2 mm, and mouth opening limitation. The non-fracture side was used as the comparison group. The Helkimo index was employed for the clinical assessment of the outcomes, while the paired student t-test and Pearson coefficient test were used to compare both sides. The study included 60 joints in 30 consecutive patients. The condylar inclination to the horizontal plane on the fracture and non-fracture sides was 9.29 ± 3.9°, 12.46 ± 4.2°, (p < 0.001) and was positively related to the subjective (Helkimo Hi) and objective (Helkimo Di) clinical outcomes. In contrast, the condylar position to the midsagittal plane in the fracture and non-fracture sides was 51.95 ± 3.5 mm, 50.17 ± 3.6 mm (P = 0.038), and was positively related to the objective outcomes. Additionally, the objective outcome was negatively related to the change of the posterior joint space. CONCLUSION: The three-dimensional assessments seem to demonstrate that the ORIF is an accurate approach for obtaining a three-dimensional reduction to the displaced subcondylar fracture.

Application of neural network and time series modeling to study the suitability of drain water quality for irrigation: a case study from Egypt.

Limited water resources are one of the major challenges facing Egypt during the current stage. The agricultural drainage water is an important water resource which can be reused for agriculture. Thus, the current study aims to assess the quality of drainage water for irrigation purpose through monitoring and predicting its suitability for irrigation. The chemical composition of Bahr El-Baqr water drain, especially salinity, as well as ions are mainly involved in calculating indicators of water suitability for irrigation, i.e., Ca2+, Mg2+, Na+, K+, HCO-3, Cl-, and SO42-. Further analysis was carried out to evaluate the irrigation water quality index (IWQI) through integrated approaches and artificial neural network (ANN) model. Further, ARIMA models were developed to forecast IWQI of Bahr El-Baqr drain in Egypt. The results indicated that the computed IWQI values ranged between 46 and 81. Around 11% of the samples were classified as excellent water, while 89% of the samples were categorized as good water. The results of IWQI showed a standard deviation of 8.59 with a mean of 62.25, indicating that IWQI varied by 13.79% from the average. ANN model showed much higher prediction accuracy in IWQI modeling with R2 value greater than 0.98 during training, testing and validation. A relatively good correlation was obtained, between the actual and forecasted IWQI based on the Akaike information criterion (AIC); the best fit models were ARIMA (1,0) (0,0) without seasonality. The determination coefficient (R2) of ARIMA models was 0.23. Accordingly, 23% of IWQI variability could be explained by different model parameters. These findings will support the water resources managers and decision-makers to manage the irrigation water resources that can be implemented in the future.

Public Awareness of and Action towards Heart Attack Symptoms: An Exploratory Study.

BACKGROUND: Cardiovascular disease (CVD) is still the leading cause of mortality worldwide, and Malaysia is not an exception in this regard. The current research is an attempt to explore symptom awareness of and necessary actions in response to heart attack (HA) among lay public. METHODS: This is a cross-sectional study design, and a survey was conducted from May to July 2018 among general public in Kuantan, Pahang state, Malaysia. RESULTS: A total of 393 respondents recruited. Slightly more than one-fourth of the respondents (26.35%) were aware of HA symptoms like pain and/or discomfort in the jaw, neck, or back, while 71.65% showed awareness only of chest pain or discomfort as symptoms. Only 35.6% reported to call an ambulance if they experience someone suffering from HA symptoms, while 82% recognized ≥1 symptom, and only 11.5% recognized all five HA symptoms. Very few respondents, i.e., 1.3% reported awareness about correct recognition of all five HA symptoms. Respondents who had diabetes and hypercholesteremia were more likely to recognize all five HA symptoms. For those who had excellent awareness of all five HA symptoms, the odds ratio (OR) were significantly higher among single respondents (OR 0.023; 95% CI 0.001-0.594), Malay (OR 0.376; 95% CI 0.193-0.733), and those who received information associated with HA (OR 7.540; 95% CI 2.037-27.914). However, those who were aware that HA requires quick treatment had significantly low odds ratio (OR 0.176; 95% CI 0.044-0.710). CONCLUSIONS: The awareness of and action towards the signs and symptoms of HA among the public were poor.

Effect of two bleaching regimens on enamel bonding performance.

This study evaluated the post-bleaching bonding performance of a one-step and two-step self-etch adhesive (SEA) to bleached enamel using in-office or at-home bleaching. Bovine enamel surfaces were treated with an in-office or at-home bleaching agent and divided into four post-bleach time periods: immediate, one day (1d), one week (1w) and one month (1m) before application of SEA systems. Enamel was bonded using the following procedures: Group 1: one-step SEA application (BeautiBond Multi, BBM), Group 2: two-step SEA application (FL-Bond II, FLBII). Microshear bond strengths (µSBS) were measured 24-h after bonding for each of the post-bleaching time periods. Acid-base resistant zones (ABRZs) were observed under SEM. Data were analyzed using three-way ANOVA. Bleaching caused a significant decrease of the immediate µSBSs for both adhesives (p≤0.005) then increased. Thick ABRZs were observed in BBM and FLBII after bleaching. Enamel µSBSs were adversely affected by bleaching. Thick ABRZ was created with bleaching.

Food-drug interactions: Knowledge among pharmacists in Jordan.

BACKGROUND: Pharmacists have crucial role in providing drug information and medication counseling to patients. This survey aimed to benchmark the current knowledge of the pharmacists concerning food-drug interactions (FDIs) in Jordan. METHODS: A cross-sectional study was conducted in Amman, the capital and largest city of Jordan, using a validated questionnaire. It was distributed to pharmacists working in community and hospital pharmacies using a convenience sampling technique. Descriptive and inferential statistics were performed in this study. RESULTS: A total of 340 questionnaires distributed, 300 (88%) pharmacists responded. Over 50% of pharmacists claimed that they have sufficient knowledge regarding FDI. Virtually, the overall median (interquartile range) knowledge score was 18 (15-21), approximately 60%. The highest knowledge scores were for alcohol-drug interactions section (66.6%) followed by both common food-drug interactions and the timing of drug intake to food consumption sections with a score of (58.3%) for each, reflecting a suboptimal knowledge of FDIs among the pharmacists. CONCLUSION: Pharmacists had unsatisfactory knowledge about common FDIs, with no significant difference between hospital and community pharmacists. Therefore, more attention and efforts should be played to improve awareness about potential food-drug interactions.

Integrative application of licorice root extract or lipoic acid with fulvic acid improves wheat production and defenses under salt stress conditions.

Although different plant extracts and plant growth regulators are used as biostimulants to support plants grown under salt stress conditions, little information is available regarding the use of licorice root extract (LRE) or lipoic acid (LA) as biostimulants. Studies on the application of LRE or LA in combination with fulvic acid (FA) as natural biostimulants have not been performed. Therefore, in this study, two pot experiments were conducted to evaluate the potential effects of LRE (5 g L-1) or LA (0.1 mM) supplemented as a foliar spray in combination with FA (0.2 mg kg-1 soil) on osmoprotectants and antioxidants, growth characteristics, photosynthetic pigments, nutrient uptake, and yield as well as on the anatomical features of the stems and leaves of wheat plants irrigated with three levels of saline water (0.70, 7.8, and 14.6 dSm-1). Moderate (7.8 dSm-1) and high (14.6 dSm-1) levels of salinity caused a significant (p ≤ 0.05) increase in the activities of SOD, APX CAT, POX, and GR as well as in electrolyte leakage, malondialdehyde level, and reactive oxygen species (O2‒ and H2O2) levels compared to those in controls (plants irrigated with tap water). However, the leaf relative water content, membrane stability index, NPK uptake, leaf area, plant height, spike length, straw yield, grain yield, and protein content of wheat grains significantly (p ≤ 0.05) decreased. Addition of LRE or LA and/or HA to wheat plants under saline stress significantly (p ≤ 0.05) enhanced their morphological and physio-biochemical characteristics in parallel with increases in the activities of enzymatic antioxidants. Salinity stress altered (p ≤ 0.05) wheat stem and leaf structures; however, treatment with LRE + FA significantly improved these negative effects. These findings indicate that FA + LRE treatment significantly improved the antioxidant defense system of the plants, thereby reducing ROS levels and increasing wheat growth and production under saline conditions.

Tissue-engineered bone using mesenchymal stem cells versus conventional bone grafts in the regeneration of maxillary alveolar bone: A systematic review and meta-analysis.

PURPOSE: The aim of this study was to compare tissue-engineered bone using mesenchymal stem cells (MSCs) and conventional bone grafts in terms of histomorphometric outcome, bone gained, and implant failure in the atrophic maxilla. MATERIALS AND METHODS: A systematic review and meta-analysis of randomized clinical trials (RCTs) was conducted. An electronic search of several databases was performed. RCTs comparing tissue-engineered bone using MSCs to bone graft alone in rehabilitation of the atrophic maxilla were included. Outcome variables were a mean percentage of new bone formation, residual graft particles, and connective tissue. Bone gained and implant failure rate were also assessed. Risk ratio (RR) or standardized mean differences (SMD) were statistically analyzed. RESULTS: A total of 190 augmented sites enrolled in 12 RCTs were included in this study. Nine of the 12 RCTs included 153 maxillary sinuses that underwent sinus elevation, and three RCTs included 28 patients with bone grafting only. There was no significant increase in new bone formation between the two groups at 3 to 4 months (SMD = -0.232, CI, -0.659 to 0.195, low-quality evidence). However, at 6 months postgrafting, a statistically significant increase in new bone formation was found in favor of the tissue-engineered bone using the MSC group (SMD = 0.869%, CI, -1.98 to 9.310, moderate-quality evidence). No substantial difference was found between the two groups with respect to residual graft particles, connective tissue, bone gained, and implant failure rate (RR = 2.8, CI: 0.517 to 16.6, P = .226, very low-quality evidence). CONCLUSION: There is moderate- to very low-quality evidence supporting the use of tissue-engineered bone using MSC therapy in maxillary alveolar bone regeneration compared with conventional bone grafting without MSCs.