Electrophysiological Analyses of Human Dorsal Root Ganglia and Human Induced Pluripotent Stem Cell-derived Sensory Neurons From Male and Female Donors.

Human induced pluripotent stem cell-derived sensory neurons (hiPSC-SNs) and human dorsal root ganglia neurons (hDRG-N) are popular tools in the field of pain research; however, few groups make use of both approaches. For screening and analgesic validation purposes, important characterizations can be determined of the similarities and differences between hDRG-N and hiPSC-SNs. This study focuses specifically on the electrophysiology properties of hDRG-N in comparison to hiPSC-SNs. We also compared hDRG-N and hiPSC-SNs from both male and female donors to evaluate potential sex differences. We recorded neuronal size, rheobase, resting membrane potential, input resistance, and action potential waveform properties from 83 hiPSCs-SNs (2 donors) and 108 hDRG-N neurons (8 donors). We observed several statistically significant electrophysiological differences between hDRG-N and hiPSC-SNs, such as size, rheobase, input resistance, and several action potential waveform properties. Correlation analysis also revealed many properties that were positively or negatively correlated, some of which were differentially correlated between hDRG-N and hiPSC-SNs. This study shows several differences between hDRG-N and hiPSC-SNs and allows a better understanding of the advantages and disadvantages of both for use in pain research. We hope this study will be a valuable resource for pain researchers considering the use of these human in vitro systems for mechanistic studies and/or drug development projects. PERSPECTIVE: hiPSC-SNs and hDRG-N are popular tools in the field of pain research. This study allows for a better functional understanding of the pros and cons of both tools.

Electrophysiological analyses of human dorsal root ganglia and human induced pluripotent stem cell-derived sensory neurons from male and female donors.

Human induced pluripotent stem cell-derived sensory neurons (hiPSC-SNs) and human dorsal root ganglia (hDRG) neurons are popular tools in the field of pain research; however, few groups make use of both approaches. For screening and analgesic validation purposes, important characterizations can be determined of the similarities and differences between hDRG and hiPSC-SNs. This study focuses specifically on electrophysiology properties of hDRG in comparison to hiPSC-SNs. We also compared hDRG and hiPSC-SNs from both male and female donors to evaluate potential sex differences. We recorded neuronal size, rheobase, resting membrane potential, input resistance, and action potential waveform properties from 83 hiPSCs-SNs (2 donors) and 108 hDRG neurons (9 donors). We observed several statistically significant electrophysiological differences between hDRG and hiPSC-SNs, such as size, rheobase, input resistance, and several actional potential (AP) waveform properties. Correlation analysis also revealed many properties that were positively or negatively correlated, some of which were differentially correlated between hDRG and hiPSC-SNs. This study shows several differences between hDRG and hiPSC-SNs and allows better understanding of the advantages and disadvantages of both for use in pain research. We hope this study will be a valuable resource for pain researchers considering the use of these human in vitro systems for mechanistic studies and/or drug development projects.

Rapid Generation and Molecular Docking Analysis of Single-Chain Fragment Variable (scFv) Antibody Selected by Ribosome Display Targeting Cholecystokinin B Receptor (CCK-BR) for Reduction of Chronic Neuropathic Pain.

A robust cell-free platform technology, ribosome display in combination with cloning, expression, and purification was utilized to develop single chain Fragment variable (scFv) antibody variants as pain therapy directed at the mouse cholecystokinin B (CCK-B) receptor. Three effective CCK-B peptide-specific scFvs were generated through ribosomal display technology. Soluble expression and ELISA analysis showed that one antibody, scFv77-2 had the highest binding and could be purified from bacterial cells in large quantities. Octet measurements further revealed that the CCK-B scFv77-2 antibody had binding kinetics of KD = 1.794 × 10-8 M. Molecular modeling and docking analyses suggested that the scFv77-2 antibody shaped a proper cavity to embed the whole CCK-B peptide molecule and that a steady-state complex was formed relying on intermolecular forces, including hydrogen bonding, electrostatic force, and hydrophobic interactions. Thus, the scFv antibody can be applied for mechanistic intermolecular interactions and functional in vivo studies of CCK-BR. The high affinity scFv77-2 antibody showed good efficacy with binding to CCK-BR tested in a chronic pain model. In vivo studies validated the efficacy of the CCK-B receptor (CCK-BR) scFv77-2 antibody as a potential therapy for chronic trigeminal nerve injury-induced pain. Mice were given a single dose of the CCK-B receptor (CCK-BR) scFv antibody 3 weeks after induction of a chronic trigeminal neuropathic pain model, during the transition from acute to chronic pain. The long-term effectiveness for the reduction of mechanical hypersensitivity was evident, persisting for months. The anxiety- and depression-related behaviors typically accompanying persisting hypersensitivity subsequently never developed in the mice given CCK-BR scFv. The effectiveness of the antibody is the basis for further development of the lead CCK-BR scFv as a promising non-opioid therapeutic for chronic pain and the long-term reduction of chronic pain- and anxiety-related behaviors.

A review on blockchain for DNA sequence: security issues, application in DNA classification, challenges and future trends.

In biological science, the study of DNA sequences is considered an important factor because it carries the genomic details that can be used by researchers and doctors for the early prediction of disease using DNA classification. The NCBI has the world's largest database of genetic sequences, but the security of this massive amount of data is currently the greatest issue. One of the options is to encrypt these genetic sequences using blockchain technology. As a result, this paper presents a survey on healthcare data breaches, the necessity for blockchain in healthcare, and the number of research studies done in this area. In addition, the report suggests DNA sequence classification for earlier disease identification and evaluates previous work in the field.

Plant-derived natural products targeting ion channels for pain.

Chronic pain affects approximately one-fifth of people worldwide and reduces quality of life and in some cases, working ability. Ion channels expressed along nociceptive pathways affect neuronal excitability and as a result modulate pain experience. Several ion channels have been identified and investigated as potential targets for new medicines for the treatment of a variety of human diseases, including chronic pain. Voltage-gated channels Na+ and Ca2+ channels, K+ channels, transient receptor potential channels (TRP), purinergic (P2X) channels and acid-sensing ion channels (ASICs) are some examples of ion channels exhibiting altered function or expression in different chronic pain states. Pharmacological approaches are being developed to mitigate dysregulation of these channels as potential treatment options. Since natural compounds of plant origin exert promising biological and pharmacological properties and are believed to possess less adverse effects compared to synthetic drugs, they have been widely studied as treatments for chronic pain for their ability to alter the functional activity of ion channels. A literature review was conducted using Medline, Google Scholar and PubMed, resulted in listing 79 natural compounds/extracts that are reported to interact with ion channels as part of their analgesic mechanism of action. Most in vitro studies utilized electrophysiological techniques to study the effect of natural compounds on ion channels using primary cultures of dorsal root ganglia (DRG) neurons. In vivo studies concentrated on different pain models and were conducted mainly in mice and rats. Proceeding into clinical trials will require further study to develop new, potent and specific ion channel modulators of plant origin.

Rare Case of Remitting Seronegative Symmetrical Synovitis with Pitting Edema Syndrome with Monoclonal Gammopathy of Undetermined Significance.

BACKGROUND Remitting seronegative symmetrical synovitis with pitting edema (RS3PE) is a rare condition with underlying polyarthritis, pitting edema, and negative rheumatoid factor. It can be associated with an underlying rheumatological condition or can present as a paraneoplastic syndrome with malignancy. We present a rare case of RS3PE associated with monoclonal gammopathy of undermined significance (MGUS). CASE REPORT A 62-year-old man presented in ambulatory medicine clinic with 3-month swelling of distal lower extremities that progressed to distal upper extremities. He had pain and morning stiffness in hands, left elbow, and left shoulder. Examination revealed 3+ pitting edema in bilateral hands, feet, legs, and thighs. Laboratory studies revealed normal blood counts and renal and liver functions. Erythrocyte sedimentation rate was normal; C-reactive protein was mildly elevated (0.7 mg/dL). Echocardiogram and computed tomography of chest, abdomen, and pelvis revealed mild splenomegaly (14.5 cm). Serum protein electrophoresis revealed IgG kappa monoclonal peak of 0.1 g/dL. Beta-2 microglobulin was elevated (7.4 mg/L); LDH was elevated (264 U/L). No lytic lesions were present in bones. RS3PE was diagnosed based on established diagnostic criteria. Prednisone produced significant improvement in swelling within 72 h of start; however, he required a longer duration of steroid treatment due to relapse and continued periodic MGUS surveillance. CONCLUSIONS Our case highlights the importance of awareness of this condition in general practice to help with timely diagnosis and intervention, as this condition is steroid responsive. Also, it is important to screen for underlying autoimmune condition, hematological, and solid organ malignancies with appropriate workup.

Use of recombinant calflagin protein as a potential candidate for diagnosis of Trypanosoma evansi infection.

Serodiagnosis of surra, caused by Trypanosoma evansi, is still based on native antigens purified from bloodstream form of T. evansi grown in rodents. In order to investigate prospective diagnostic possibilities as an alternative for native antigens, we cloned, expressed 26 kDa calflagin protein containing 218 amino acids from T. evansi (Indian Strain) in Escherichia coli. The potential of recombinant calflagin (rCLF) protein as diagnostic antigen was evaluated in immunoblot and indirect ELISA using experimentally infected equine serum samples from 0 to 84 days post infection. The antibodies against T. evansi were detected with rCLF antigen in serum samples of experimentally infected equines as early as 10 days and 14 days post infection, using immunoblot and ELISA respectively. No cross-reactivity was observed with rCLF antigen in ELISA with different serum samples of equines positive for Equine herpesvirus 1, Burkholderia mallei, and Theileria equi infections. Several immunoreactive regions ranging from 10 to 28 kDa were detected using distinct T. evansi isolates (pony, cattle, donkey and camel origin) indicating presence of multiple calflagin family members in a single trypanosome. Indirect immunofluorescence antibody test with anti-CLF rabbit hyperimmune serum showed localisation of native immunogenic protein near attachment of flagellum. The rCLF protein was found to be a potential diagnostic candidate for distinguishing T. evansi positive and negative equine serum sample, suggesting that it could be used for serological surveys in animals for surra. In addition, it could be used with other potential diagnostic candidates to improve the diagnostic efficiency.

A comprehensive tool for rapid and accurate prediction of disease using DNA sequence classifier.

In the current pandemic situation where the coronavirus is spreading very fast that can jump from one human to another. Along with this, there are millions of viruses for example Ebola, SARS, etc. that can spread as fast as the coronavirus due to the mobilization and globalization of the population and are equally deadly. Earlier identification of these viruses can prevent the outbreaks that we are facing currently as well as can help in the earlier designing of drugs. Identification of disease at a prior stage can be achieved through DNA sequence classification as DNA carries most of the genetic information about organisms. This is the reason why the classification of DNA sequences plays an important role in computational biology. This paper has presented a solution in which samples collected from NCBI are used for the classification of DNA sequences. DNA sequence classification will in turn gives the pattern of various diseases; these patterns are then compared with the samples of a newly infected person and can help in the earlier identification of disease. However, feature extraction always remains a big issue. In this paper, a machine learning-based classifier and a new technique for extracting features from DNA sequences based on a hot vector matrix have been proposed. In the hot vector representation of the DNA sequence, each pair of the word is represented using a binary matrix which represents the position of each nucleotide in the DNA sequence. The resultant matrix is then given as an input to the traditional CNN for feature extraction. The results of the proposed method have been compared with 5 well-known classifiers namely Convolution neural network (CNN), Support Vector Machines (SVM), K-Nearest Neighbor (KNN) algorithm, Decision Trees, Recurrent Neural Networks (RNN) on several parameters including precision rate and accuracy and the result shows that the proposed method gives an accuracy of 93.9%, which is highest compared to other classifiers.

Antiviral activity of molnupiravir against COVID-19: a schematic review of evidences.

Background: The study was aimed at encapsulating the evidence of in vitro and in vivo antiviral activities of molnupiravir and its active form against highly pathogenic SARS-CoV-2, the pathogen responsible for COVID-19, and finding out the efficacy and safety of molnupiravir in clinical trials. Main body: Information on publications was explored on several databases, gray literature was reviewed, and the outcomes were discussed narratively. Molnupiravir's antiviral efficacy and associated mechanism of action have been verified in vitro against both non-COVID and multiple coronaviruses. Molnupiravir has been tried in preclinical investigations in numerous animal models against non-coronaviruses. Clinical studies in several countries are now being conducted to evaluate its antiviral efficacy in persons infected with COVID-19. The medication displays antiviral effect via generation of copying mistakes during viral RNA replication. Conclusions: Molnupiravir is the first oral antiviral medicine to show considerable and convincing antiviral activity in vitro and in animal models. Molnupiravir stops the spread of SARS-CoV-2 in animals that have been infected and in cells grown in a lab. In a clinical research, early molnupiravir treatment reduced hospitalization and death risk in unvaccinated individuals with COVID-19. In the battle against SARS-CoV-2, it could be a potent weapon. However, its role in COVID-19 in moderate to severe cases is still up in the air, and more research is needed.

Post-acute COVID-19 functional movement disorder.

Movement disorders are rare compared to other neurological manifestations of COVID-19. Patients who have recovered from acute severe acute respiratory syndrome coronavirus-2 infection continue to have multiple debilitating symptoms months later. We report a case of 54-year-old man who presented with repetitive flexion movement of head which started 2 months after severe acute respiratory syndrome coronavirus-2 infection. Extensive work-up including neurological examination, neuroimaging, cerebrospinal fluid analysis, and electroencephalogram were normal. The self-reported questionnaires for depression and anxiety were suggestive of severe anxiety and depression. The patient continued to have the jerky movements besides cognitive impairment, frequent headaches, intermittent shortness of breath, sleeping difficulties, fatigue, and dizziness at 1-year follow-up. This case highlights the presentation of functional movement disorder as one of the manifestations of underlying neuropsychiatric condition. Our patient had significant effect on quality of life with high symptom burden which further highlights the struggle and unmet needs of the patients with multiple symptoms after severe acute respiratory syndrome coronavirus-2 infection.

Three-dimensional nonlinear dynamics of prestressed active filaments: Flapping, swirling, and flipping.

Initially straight slender elastic filaments or rods with constrained ends buckle and form stable two-dimensional shapes when prestressed by bringing the ends together. Beyond a critical value of this prestress, rods can also deform off plane and form twisted three-dimensional equilibrium shapes. Here, we analyze the three-dimensional instabilities and dynamics of such deformed filaments subject to nonconservative active follower forces and fluid drag. We find that softly constrained filaments that are clamped at one end and pinned at the other exhibit stable two-dimensional planar flapping oscillations when active forces are directed toward the clamped end. Reversing the directionality of the forces quenches the instability. For strongly constrained filaments with both ends clamped, computations reveal an instability arising from the twist-bend-activity coupling. Planar oscillations are destabilized by off-planar perturbations resulting in twisted three-dimensional swirling patterns interspersed with periodic flipping or reversal of the swirling direction. These striking swirl-flip transitions are characterized by two distinct timescales: the time period for a swirl (rotation) and the time between flipping events. We interpret these reversals as relaxation oscillation events driven by accumulation of torsional energy. Each cycle is initiated by a fast jump in torsional deformation with a subsequent slow decrease in net torsion until the next cycle. Our work reveals the rich tapestry of spatiotemporal patterns when weakly inertial strongly damped rods are deformed by nonconservative active forces. Taken together, our results suggest avenues by which prestress, elasticity, and activity may be used to design synthetic macroscale pumps or mixers.

Implementation of Telemedicine in a Tertiary Hospital-Based Ambulatory Practice in Detroit During the COVID-19 Pandemic: Observational Study.

BACKGROUND: The COVID-19 pandemic, caused by SARS-CoV-2, has forced the health care delivery structure to change rapidly. The pandemic has further widened the disparities in health care and exposed vulnerable populations. Health care services caring for such populations must not only continue to operate but create innovative methods of care delivery without compromising safety. We present our experience of incorporating telemedicine in our university hospital-based outpatient clinic in one of the worst-hit areas in the world. OBJECTIVE: Our goal is to assess the adoption of a telemedicine service in the first month of its implementation in outpatient practice during the COVID-19 pandemic. We also want to assess the need for transitioning to telemedicine, the benefits and challenges in doing so, and ongoing solutions during the initial phase of the implementation of telemedicine services for our patients. METHODS: We conducted a prospective review of clinic operations data from the first month of a telemedicine rollout in the outpatient adult ambulatory clinic from April 1, 2020, to April 30, 2020. A telemedicine visit was defined as synchronous audio-video communication between the provider and patient for clinical care longer than 5 minutes or if the video visit converted to a telephone visit after 5 minutes due to technical problems. We recorded the number of telemedicine visits scheduled, visits completed, and the time for each visit. We also noted the most frequent billing codes used based on the time spent in the patient care and the number of clinical tasks (eg, activity suggested through diagnosis or procedural code) that were addressed remotely by the physicians. RESULTS: During the study period, we had 110 telemedicine visits scheduled, of which 94 (85.4%) visits were completed. The average duration of the video visit was 35 minutes, with the most prolonged visit lasting 120 minutes. Of 94 patients, 24 (25.54%) patients were recently discharged from the hospital, and 70 (74.46%) patients were seen for urgent care needs. There was a 50% increase from the baseline in the number of clinical tasks that were addressed by the physicians during the pandemic. CONCLUSIONS: There was a high acceptance of telemedicine services by the patients, which was evident by a high show rate during the COVID-19 pandemic in Detroit. With limited staffing, restricted outpatient work hours, a shortage of providers, and increased outpatient needs, telemedicine was successfully implemented in our practice.

A Case of COVID-19 With Memory Impairment and Delayed Presentation as Stroke.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a respiratory pathogen with remarkable properties of multisystem involvement and numerous complications. The coronavirus disease of 2019 (COVID-19) presenting as stroke is becoming more common. Herein, we describe an unusual case of COVID-19 in a patient who initially presented with myalgia, fatigue, loss of taste and smell, and non-specific memory impairment. Two months after infection with SARS-CoV-2, the patient presented with acute onset of right-sided weakness, sensory loss, and worsening cognitive impairment. Reverse transcription-polymerase chain reaction was performed to detect the SARS-CoV-2 virus, and the results were positive at the time of initial infection as well as during the current admission. Neuroimaging suggested a subacute ischemic infarct in the middle cerebral artery. The patient was re-tested for SARS-CoV-2 and found to be positive, but the cycle threshold was high (40.4) along with a positive test for immunoglobulin-G (IgG) for SARS-CoV-2. This report highlights a unique case of stroke-related to COVID-19 infection in a middle-aged woman with otherwise mild symptomatic illness. The patient had a chronic ischemic stroke with delayed presentation two months after the initial symptomatic viral infection. This case underscores the importance of neurological assessment as well as timely evaluation of patients presenting with COVID-19 and any neurological concerns to recognize stroke as a complication of COVID-19 promptly.

Linearized Bayesian inference for Young's modulus parameter field in an elastic model of slender structures.

The deformations of several slender structures at nano-scale are conceivably sensitive to their non-homogenous elasticity. Owing to their small scale, it is not feasible to discern their elasticity parameter fields accurately using observations from physical experiments. Molecular dynamics simulations can provide an alternative or additional source of data. However, the challenges still lie in developing computationally efficient and robust methods to solve inverse problems to infer the elasticity parameter field from the deformations. In this paper, we formulate an inverse problem governed by a linear elastic model in a Bayesian inference framework. To make the problem tractable, we use a Gaussian approximation of the posterior probability distribution that results from the Bayesian solution of the inverse problem of inferring Young's modulus parameter fields from available data. The performance of the computational framework is demonstrated using two representative loading scenarios, one involving cantilever bending and the other involving stretching of a helical rod (an intrinsically curved structure). The results show that smoothly varying parameter fields can be reconstructed satisfactorily from noisy data. We also quantify the uncertainty in the inferred parameters and discuss the effect of the quality of the data on the reconstructions.

A Rare Presentation of Non-Hodgkin's Lymphoma Presenting With Bleeding Esophageal Varices Secondary to a Malignant Portal Vein Tumor Thrombosis.

A 60-year-old woman presented with six months of abdominal pain, weight loss and diarrhea for which she underwent bidirectional endoscopies that were unremarkable. Over the next two weeks, she developed non-cirrhotic portal hypertension and presented with esophageal variceal bleeding. A diffuse large B-cell lymphoma encircling her celiac axis with a tumor thrombosis of the superior mesenteric, splenic and portal veins was found to be the cause of her portal hypertension. An esophagogastroduodenoscopy (EGD) was performed to control her variceal bleeding. She was started on R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone) chemotherapy and after three cycles her symptoms have subsided, and a CT scan has shown shrinking mesenteric lymphadenopathy.

A Case of COVID-19 Infection With Delayed Thromboembolic Complication on Warfarin.

Novel coronavirus disease 2019 (COVID-19) pandemic has posed an unprecedented threat to humanity with more than eight million infections and 450,000 deaths reported worldwide so far. The spectrum of the disease varies from mild asymptomatic infection to severe disease with rapid progression to acute respiratory distress syndrome and multiorgan failure. It is associated with a prothrombotic state and hence there is a risk of thromboembolic complications in critically ill patients, even after recovery. However, the duration of prothrombotic risk after recovery is yet to be determined. We present the case of a 78-year-old man with a history of atrial fibrillation on warfarin who had been recently discharged to a nursing home after recovering from COVID-19 pneumonia and presented to the emergency department a month later with worsening shortness of breath and cough. He was found to have worsening respiratory failure with multiple segmental pulmonary emboli, despite being on warfarin, and supratherapeutic international normalized ratio (INR). He required mechanical ventilation and was started on steroids and therapeutic enoxaparin anticoagulation. This case highlights the risk of delayed thromboembolic complications in patients with COVID-19 infection and the need to identify the subgroup of patients with a higher risk of thromboembolism, such as discharges to nursing homes and those in need of oxygen requirement; and those with underlying comorbid conditions that may require anticoagulation for a longer duration. The role of heparin is being increasingly investigated in patients with COVID-19 infection; however, the role of other anticoagulants such as warfarin is yet to be defined.

Secondary angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease: Results from the nationwide inpatient sample.

BACKGROUND: Chronic kidney disease is associated with angiodysplasia of gastrointestinal tract leading to increased risk of gastrointestinal bleeding. AIM: To determine the nationwide prevalence, trends, predictors and resource utilization of angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalizations. METHODS: The Nationwide Inpatient Sample database from 2009 to 2014, was utilized to conduct a retrospective study on patients with angiodysplasia associated- gastrointestinal bleeding and end-stage renal disease. Hospitalizations with end-stage renal disease were included in the Nationwide Inpatient Sample database and a subset of hospitalizations with end-stage renal disease and angiodysplasia-associated gastrointestinal bleeding were identified with International Classification of Diseases, 9th revision, Clinical Modification codes for both end-stage renal disease (585.6) and Angiodysplasia (569.85, 537.83). RESULTS: The prevalence of angiodysplasia-associated gastrointestinal bleeding was 0.45% (n = 24709) among all end-stage renal disease patients (n = 5505252) that were hospitalized. Multivariate analysis indicated that the following were significant factors associated with higher odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients: an increasing trend from 2009-2014 (P < 0.01), increasing age (P < 0.0001); African American race (P = 0.0206); increasing Charlson-Deyo Comorbidity Index (P < 0.01); hypertension (P < 0.0001); and tobacco use (P < 0.0001). Diabetes mellitus (P < 0.0001) was associated with lower odds of angiodysplasia associated-gastrointestinal bleeding in end-stage renal disease patients. In comparison with urban teaching hospitals, rural and urban nonteaching hospitals were associated with decreased odds of angiodysplasia associated-gastrointestinal hemorrhage. CONCLUSION: Angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease patients showed an increasing trend from 2009-2014. Advanced age, African American race, overall high comorbidities, hypertension and smoking were significant factors for angiodysplasia-associated gastrointestinal bleeding in end-stage renal disease hospitalized patients.

Celiac Artery Portal Vein Fistula After Transjugular Intrahepatic Portosystemic Shunt Presenting as Heart Failure.

Transjugular intrahepatic portosystemic shunt (TIPS) is an important therapeutic tool available to decrease portal vein pressure in patients with cirrhosis and portal hypertension. TIPS is associated with various complications, and fistula formation is an important one to be noted. We present an unusual and interesting case of a patient who developed right-sided heart failure 5 months after TIPS placement. Diagnostic workup revealed an uncommon fistula between the celiac artery trunk and portal vein that was successfully treated with angiography-guided embolization, resulting in clinical improvement.

Hepatic Sinusoidal Obstruction Syndrome in a Patient With Multiple Myeloma Treated With CyBorD.

Hepatic sinusoidal obstruction syndrome (SOS) is a life-threatening state generally occurring as a complication of conditioning regimens used for hematopoietic stem cell transplant. Hepatic SOS after a standard dose of chemotherapy in malignancies is rare, and there are only a few cases in pediatric literature. We report a 56-year-old man with multiple myeloma who experienced SOS after being initiated on chemotherapy including cyclophosphamide, dexamethasone, and bortezomib and who experienced a delay in treatment with defibrotide, because it is currently approved by the Food and Drug Administration for only patients who develop SOS after hematopoietic stem cell transplant.

Effect of laser application in the healing of intrabony defects treated with bioactive glass.

AIMS: Presence of bacteria within the environment of infrabony pockets affects healing during their treatment. Present investigation utilized a diode laser for pocket sanitization before the placement of bone biomaterial with the aim of enhancing the healing. MATERIALS AND METHODS: Twelve patients with bilateral intrabony defects participated in a split-mouth study design. Control group received biomaterial application only after surgical debridement. Infrabony pockets in the test group were irradiated with 810-nm diode laser at 0.8 W, continuous wave for 20 s before surgical debridement and biomaterial application. Healing was assessed using clinical and radiologic parameters. RESULTS: Control group showed mean probing depth (PD) reduction of 3.25 ± 0.62 at 3, 4.08 ± 0.90 mm at 6 months. 3.00 ± 0.73 at 3, 3.91 ± 0.66 mm at 6 months reduction in mean PD was seen in the test group (P < 0.001). No statistically significant differences between the groups were observed. A gain of 2.50 ± 0.67 at 3, 3.25 ± 0.62 mm at 6 months in relative clinical attachment level was seen in the control and of 2.33 ± 0.77 at 3, 3.16 ± 0.57 mm at 6 months in the test group (P < 0.001) without significant differences between groups. 1.33 ± 0.57 and 0.95 ± 0.68 mm hard-tissue fill (difference in the radiographic distance between cementoenamel junction and base of the intrabony defect pre- and post-operative) at 6 months was observed in the control and test groups, respectively (P < 0.001). Between groups differences (0.22 ± 0.24 mm) were not significant. CONCLUSIONS: Similar reduction in soft- and hard-tissue parameters in both groups indicates that adjunctive pocket sanitization with diode laser did not improve the healing of intrabony defects treated with bioactive glass.