Arrhythmic Risk in Biventricular Pacing Compared With Left Bundle Branch Area Pacing: Results From the I-CLAS Study.

BACKGROUND: Left bundle branch area pacing (LBBAP) may be associated with greater improvement in left ventricular ejection fraction and reduction in death or heart failure hospitalization compared with biventricular pacing (BVP) in patients requiring cardiac resynchronization therapy. We sought to compare the occurrence of sustained ventricular tachycardia (VT) or ventricular fibrillation (VF) and new-onset atrial fibrillation (AF) in patients undergoing BVP and LBBAP. METHODS: The I-CLAS study (International Collaborative LBBAP Study) included patients with left ventricular ejection fraction ≤35% who underwent BVP or LBBAP for cardiac resynchronization therapy between January 2018 and June 2022 at 15 centers. We performed propensity score-matched analysis of LBBAP and BVP in a 1:1 ratio. We assessed the incidence of VT/VF and new-onset AF among patients with no history of AF. Time to sustained VT/VF and time to new-onset AF was analyzed using the Cox proportional hazards survival model. RESULTS: Among 1778 patients undergoing cardiac resynchronization therapy (BVP, 981; LBBAP, 797), there were 1414 propensity score-matched patients (propensity score-matched BVP, 707; propensity score-matched LBBAP, 707). The occurrence of VT/VF was significantly lower with LBBAP compared with BVP (4.2% versus 9.3%; hazard ratio, 0.46 [95% CI, 0.29-0.74]; P<0.001). The incidence of VT storm (>3 episodes in 24 hours) was also significantly lower with LBBAP compared with BVP (0.8% versus 2.5%; P=0.013). Among 299 patients with cardiac resynchronization therapy pacemakers (BVP, 111; LBBAP, 188), VT/VF occurred in 8 patients in the BVP group versus none in the LBBAP group (7.2% versus 0%; P<0.001). In 1194 patients with no history of VT/VF or antiarrhythmic therapy (BVP, 591; LBBAP, 603), the occurrence of VT/VF was significantly lower with LBBAP than with BVP (3.2% versus 7.3%; hazard ratio, 0.46 [95% CI, 0.26-0.81]; P=0.007). Among patients with no history of AF (n=890), the occurrence of new-onset AF >30 s was significantly lower with LBBAP than with BVP (2.8% versus 6.6%; hazard ratio, 0.34 [95% CI, 0.16-0.73]; P=0.008). The incidence of AF lasting >24 hours was also significantly lower with LBBAP than with BVP (0.7% versus 2.9%; P=0.015). CONCLUSIONS: LBBAP was associated with a lower incidence of sustained VT/VF and new-onset AF compared with BVP. This difference remained significant after adjustment for differences in baseline characteristics between patients with BVP and LBBAP. Physiological resynchronization by LBBAP may be associated with lower risk of arrhythmias compared with BVP.

The effects of metyrosine on ischemia-reperfusion-induced oxidative ovarian injury in rats: Biochemical and histopathological assessment.

The aim of this study is to investigate the effect of metyrosine on ischemia-reperfusion (I/R) induced ovarian injury in rats in terms of biochemistry and histopathology. Rats were divided into: ovarian I/R (OIR), ovarian I/R+50 mg/kg metyrosine (OIRM) and sham (SG) operations. OIRM group received 50 mg/kg metyrosine one hour before the application of the anesthetic agent, OIR and SG group rats received equal amount of distilled water to be used as a solvent orally through cannula. Following the application of the anesthetic agent, ovaries of OIRM and OIR group rats were subjected to ischemia and reperfusion, each of which took two hours. This biochemical experiment findings revealed high levels of malondialdehyde (MDA) and cyclo-oxygenase-2 (COX-2) and low levels of total glutathione (tGSH), superoxide dismutase (SOD) and cyclo-oxygenase-1 (COX-1) in the ovarian tissue of OIR group, with significant histopathological injury. In metyrosine group, MDA and COX-2 levels were lower than the OIR group whereas tGSH, SOD and COX-1 levels were higher, with slighter histopathological injury. Our experimental findings indicate that metyrosine inhibits oxidative and pro-inflammatory damage associated with ovarian I/R in rats. These findings suggest that metyrosine could be useful in the treatment of ovarian injury associated with I/R.

Addressing Unmet Surgical Needs in an Underserved Nigerian Community: Report of a 'Town and Gown' Initiative.

BACKGROUND: Access to quality and timely care prevents unnecessary deaths and morbidity from potentially curable surgical diseases. This study describes the magnitude of unmet surgical needs in a Nigerian community and describes the experiences garnered during a surgical outreach organized by a tertiary institution in an underserved community. METHODS: This is a descriptive study highlighting details of a surgical outreach to a community in south-Western part of Nigeria. The project was based on a collaboration between a University Teaching Hospital (gown) and the community (town). Details of the patients' demographic and disease characteristics as well as barriers to seeking medical care were obtained. The operational workflow, treatment offered, and outcomes are highlighted. Results are presented as descriptive statistics. RESULTS: Over a two-day period, 83 out of 3,056 patients who were screened had surgically treatable conditions (2.7%), predominantly hernias (37, 46.6%), goitres (13, 15.7%) and soft tissue swellings (9, 10.8%). The majority were adults (56, 67.5%) while 27 (32.5%) were in the paediatric age group. The mean duration of symptoms was 8.64 months ± 9.5 months. About half of the patients (46.9%) had never visited a medical facility on account of their index illnesses. Lack of funds was cited by many patients as the main reason for having not presented at a hospital. Sixty-three surgical operations were performed with no peri-operative adverse events. CONCLUSION: Lack of financial access was the major barrier to surgical care in the sampled community. Moving from 'gown to town' helped address a significant proportion of the unmet needs over a relatively short period. Tertiary hospitals can provide surgical oversight to communities within their jurisdiction using this approach.

CONTEXTE: L'accès à des soins de qualité et en temps opportun permet d'éiter les décès et la morbidité inutiles dus à des maladies chirurgicales potentiellement curables. Cette étude décrit l'ampleur des besoins chirurgicaux non satisfaits dans une communauté nigériane et décrit les expériences recueillies au cours d'une action chirurgicale organisée par une institution tertiaire dans une communauté mal desservie. MÉTHODES: Il s'agit d'une étude descriptive mettant en évidence les détails d'une action chirurgicale dans une communauté du sud-ouest du Nigeria. Le projet était basé sur une collaboration entre un hôpital universitaire (ville) et la communauté (ville). Les détails des caractéristiques démographiques et pathologiques des patients ainsi que les obstacles à la recherche de soins médicaux ont été obtenus. Le déroulement des opérations, le traitement proposé et les résultats sont mis en évidence. Les résultats sont présentés sous forme de statistiques descriptives. RÉSULTATS: Sur une période de deux jours, 83 des 3056 patients examinés présentaient des affections pouvant être traitées chirurgicalement (2,7 %), principalement des hernies (37, 46,6 %), des goitres (13, 15,7 %) et des tuméfactions des tissus mous (9, 10,8 %). La majorité des patients étaient des adultes (56, 67,5 %), tandis que 27 (32,5 %) appartenaient au groupe d'âge pédiatrique. La durée moyenne des symptômes était de 8,64 mois ±9,5 mois. Environ la moitié des patients (46,9 %) ne s'étaient jamais rendus dans un établissement médical en raison de leurs maladies index. Le manque de moyens financiers a été cité par de nombreux patients comme la principale raison pour laquelle ils ne s'étaient pas présentés à l'hôpital. Soixante-trois opérations chirurgicales ont été réalisées sans aucun événement indésirable périopératoire. CONCLUSION: Le manque d'accès financier était le principal obstacle aux soins chirurgicaux dans la communauté échantillonnée. Le passage de la ville à l'hôpital a permis de répondre à une proportion importante des besoins non satisfaits sur une période relativement courte. Les hôpitaux tertiaires peuvent fournir une supervision chirurgicale aux communautés de leur juridiction en utilisant cette approche. Mots clés: Chirurgie, Besoins non satisfaits, Nigeria, Communauté mal desservie.

Comparison of full-night and ambulatory polysomnography with ApneaGraph in the subjects with obstructive sleep apnea syndrome.

The localization of the obstruction is crucial in determining the appropriate surgical treatment for obstructive sleep apnea syndrome (OSAS); ApneaGraph has been introduced for diagnosis of OSAS and localization of airway obstruction level. This study aims to evaluate the diagnostic value of ApneaGraph for both clinical staging and site of obstruction. Thirty male OSAS patients were prospectively enrolled in this clinical trial. The following parameter were included to the study: Body mass indexes and neck circumferences of the subjects, Epworth sleepiness scale, site of obstruction detected by flexible endoscopy and ApneaGraph, apnea hypopnea index (AHI), apnea index, hypopnea index, maximal oxygen desaturation and average oxygen saturation which were detected by both polysomnography (PSG) and ApneaGraph devices. Our data presented that, although AHI measured by ApneaGraph and PSG were significantly correlated; severity stages of the subjects were different in 44 % of the subjects when based on AHI of ApneaGraph, compared to PSG. Majority of the changes were from severe OSAS to mild or moderate levels. Similar dominant collapse levels were detected in 64 % of the subjects by both devices. It was seen that transpalatal obstruction was better correlated between ApneaGraph and flexible endoscopy. As a conclusion, we might assume that ApneaGraph can be used as a screener for OSAS and it appears to be a more reliable device to confirm dominancy of palatal level obstruction.

Lack of a synergistic effect of arginine-glutamic acid on the physical stability of spray-dried bovine serum albumin.

Improving the physical stability of spray-dried proteins is essential for enabling pulmonary delivery of biotherapeutics as a noninvasive alternative to injections. Recently, a novel combination of two amino acids - l-arginine (l-Arg) and l-glutamic acid (l-Glu), has been reported to have synergistic protein-stabilizing effects on various protein solutions. Using spray-dried bovine serum albumin (BSA) reconstituted in solution as a model protein, we investigated the synergistic effect of these amino acids on the physical stability of proteins. Five BSA solutions were prepared: (1) BSA with no amino acids (control); (2) with 50 mM l-Arg; (3) with 200 mM l-Arg, (4) with 50 mM l-Glu and (5) with 25:25 mM of Arg:Glu. All solutions were spray-dried and accelerated studies at high temperatures were performed. Following accelerated studies, monomer BSA loss was measured using SE-HPLC. We found that l-Arg significantly improved the physical stability of spray-dried BSA even at low concentrations, however, when combined with l-Glu, was ineffective at reducing monomer BSA loss. Our findings demonstrate the limitations in using Arg-Glu for the stabilization of spray-dried BSA. Furthermore, we found that a low concentration of l-Glu enhanced monomer BSA loss. These findings may have significant implications on the design of future biotherapeutic formulations.

Reliability of SleepStrip as a screening test in obstructive sleep apnea patients.

Obstructive sleep apnea syndrome (OSAS) is a common sleep disorder and related to multiple conditions that cause mortality in adults. In the present study, reliability of SleepStrip, a disposable screening device for detection of OSAS, is tested. In this prospective, nonrandomized double-blinded single cohort study at an academic health center, the performance of the SleepStrip in detecting respiratory events and establishing an SleepStrip score (Sscore) in domestic use were compared to the apnea-hypopnea index (AHI) obtained by the standard polysomnography (PSG) recordings in the sleep laboratory. Forty-one patients who have the PSG results participated the study and wore the SleepStrips at home. Test efficiency rate was 75% and there was a positive correlation between PSG-AHI scores and Sscores (r = 0.71, p < 0.001). However, diagnostic accuracy analysis showed that the correlation between Sscores and PSG-AHI scores were significant only at AHI > 30 levels. The SleepStrip has 100% specificity and positive predictive values, but it also has low negative predictive and sensitivity values. The SleepStrip is not a reliable screening test in differential diagnosis among simple snorers, mild, moderate and severe OSAS patients. However, high Sscores highly indicate the presence of moderate-severe OSAS. We can safely send these patients to split-night PSG and continuous, automatic, bi-level positive airway pressure (CPAP/BPAP/APAP) titration at the same night. The SleepStrip may increase the effective use of the sleep laboratories.

A study of the diffusion characteristics of normal, delipidized and relipidized articular cartilage using magnetic resonance imaging.

This paper assesses the capacity to provide semipermeability of the synthetic layer of surface-active phospholipids created to replace the depleted surface amorphous layer of articular cartilage. The surfaces of articular cartilage specimens in normal, delipidized, and relipidized conditions following incubation in dipalmitoyl-phosphatidylcholine and palmitoyl-oleoyl-phosphatidylcholine components of the joint lipid mixture were characterized nanoscopically with the atomic force microscope and also imaged as deuterium oxide (D2O) diffused transiently through these surfaces in a magnetic resonance imaging enclosure. The MR images were then used to determine the apparent diffusion coefficients in a purpose-built MATLAB(®)-based algorithm. Our results revealed that all surfaces were permeable to D2O, but that there was a significant difference in the semipermeability of the surfaces under the different conditions, relative to the apparent diffusion coefficients. Based on the results and observations, it can be concluded that the synthetic lipid that is deposited to replace the depleted SAL of articular cartilage is capable of inducing some level of semipermeability.

Evaluation of Clinical and Laboratory Findings in the Differential Diagnosis of Central Precocious Puberty and Premature Thelarche.

Aim: In this study, it was aimed to examine the clinical and laboratory findings that can be used to predict central precocious puberty (CPP) in cases whose breast development started before the age of 8. Materials and Methods: The chronological age, anthropometric measurements, bone age (BA), hormone test results and pelvic ultrasonography findings of the cases were recorded. Those with a peak luteinizing hormone (LH) level of ≥5 IU/L in the gonadotropin-releasing hormone (GnRH) stimulation test were classified as CPP and those with a peak LH level of <5 IU/L were classified as prepubertal cases. A receiver operating characteristic (ROC) analysis was performed to determine the diagnostic accuracy of laboratory variables. Findings: A total of 297 female cases were included in the study. The age at the time of admission, height-standard deviation score (SDS), BA, the long axis of the uterus and the volumes of the right and left ovaries of the cases diagnosed with CPP were found to be significantly higher than those of the prepubertal group. The cut-off value providing the best sensitivity (99%) and specificity (99%) for the peak LH was found to be 4.55; the cut-off value providing the best sensitivity (94%) and specificity (85%) for the peak LH/follicle-stimulating hormone (FSH) ratio was found to be 0.32 and the cut-off value providing the best sensitivity (47%) and specificity (93%) for the basal LH was found to be 0.13. Conclusion: We believe that in female cases with early breast development, a peak LH level of ≥4.55 may possibly indicate CPP and a basal LH level of <0.13 can significantly rule out CPP.

Ultraviolet-Ozone Treatment: An Effective Method for Fine-Tuning Optical and Electrical Properties of Suspended and Substrate-Supported MoS2.

Ultraviolet-ozone (UV-O3) treatment is a simple but effective technique for surface cleaning, surface sterilization, doping, and oxidation, and is applicable to a wide range of materials. In this study, we investigated how UV-O3 treatment affects the optical and electrical properties of molybdenum disulfide (MoS2), with and without the presence of a dielectric substrate. We performed detailed photoluminescence (PL) measurements on 1-7 layers of MoS2 with up to 8 min of UV-O3 exposure. Density functional theory (DFT) calculations were carried out to provide insight into oxygen-MoS2 interaction mechanisms. Our results showed that the influence of UV-O3 treatment on PL depends on whether the substrate is present, as well as the number of layers. Additionally, 4 min of UV-O3 treatment was found to be optimal to produce p-type MoS2, while maintaining above 80% of the PL intensity and the emission wavelength, compared to pristine flakes (intrinsically n-type). UV-O3 treatment for more than 6 min not only caused a reduction in the electron density but also deteriorated the hole-dominated transport. It is revealed that the substrate plays a critical role in the manipulation of the electrical and optical properties of MoS2, which should be considered in future device fabrication and applications.

Hemolysis and cardiopulmonary bypass: meta-analysis and systematic review of contributing factors.

BACKGROUND: The use of cardiopulmonary bypass (CPB) is almost inevitable in cardiac surgery. However, it can cause complications, including hemolysis. Until now, there have not been any standards for reducing hemolysis from CPB. Therefore, this systematic review was conducted to determine the factors that increase or reduce hemolysis in the use of CPB. METHODS: Keywords Earches (cardiac surgery AND cardiopulmonary bypass AND hemolysis) were done on PubMed databases and Cochrane CENTRAL from 1990-2021 for published randomized controlled trials (RCTs) that studied interventions on CPB, in cardiac surgery patients, and measured hemolysis as one of the outcomes. Studies involving patients with preoperative hematological disorders, prosthetic valves, preoperative use of intra-aortic balloon pumps and extracorporeal circulation, emergency and minimally invasive surgery are excluded RESULTS: The search yielded 64 studies that met the inclusion criteria, which involved a total of 3,434 patients. The most common surgery was coronary revascularization (75%). Out of 64 studies, 33 divided into 7 analyses. Remaining 31 studies were synthesized qualitatively. Significant decreases were found in centrifugal vs roller pumps for PFHb (p = 0.0006) and Hp (p < 0.0001) outcomes, separated vs combined suctioned blood (p = 0.003), CPB alternatives vs conventional CPB (p < 0.0001), and mini extracorporeal circulation (MiniECC) vs conventional CPB for LDH (p = 0.0008). Significant increases were found in pulsatility (p = 0.03) and vacuum-assisted venous drainage (VAVD) vs gravity-assisted venous drainage (GAVD) (p = 0.002). CONCLUSION: The review shows that hemolysis could be caused by several factors and efforts have been made to reduce it, combining significant efforts could be beneficial. However, this review has limitations, such as heterogeneity due to no standards available for conducting CPB. Therefore, further research with standardized guidelines for CPB is needed to yield more comparable studies. Meta-analyses with more specific parameters should be done to minimize heterogeneity.

Comparison of Left Bundle Branch Area Pacing and Biventricular Pacing in Candidates for Resynchronization Therapy.

BACKGROUND: Cardiac resynchronization therapy (CRT) with biventricular pacing (BVP) is a well established therapy in patients with reduced left ventricular ejection fraction (LVEF), heart failure, and wide QRS or expected frequent ventricular pacing. Left bundle branch area pacing (LBBAP) has recently been shown to be a safe alternative to BVP. OBJECTIVES: The aim of this study was to compare the clinical outcomes between BVP and LBBAP among patients undergoing CRT. METHODS: This observational study included patients with LVEF ≤35% who underwent BVP or LBBAP for the first time for Class I or II indications for CRT from January 2018 to June 2022 at 15 international centers. The primary outcome was the composite endpoint of time to death or heart failure hospitalization (HFH). Secondary outcomes included endpoints of death, HFH, and echocardiographic changes. RESULTS: A total of 1,778 patients met inclusion criteria: 981 BVP, 797 LBBAP. The mean age was 69 ± 12 years, 32% were female, 48% had coronary artery disease, and mean LVEF was 27% ± 6%. Paced QRS duration in LBBAP was significantly narrower than baseline (128 ± 19 ms vs 161 ± 28 ms; P < 0.001) and significantly narrower compared to BVP (144 ± 23 ms; P < 0.001). Following CRT, LVEF improved from 27% ± 6% to 41% ± 13% (P < 0.001) with LBBAP compared with an increase from 27% ± 7% to 37% ± 12% (P < 0.001) with BVP, with significantly greater change from baseline with LBBAP (13% ± 12% vs 10% ± 12%; P < 0.001). On multivariable regression analysis, the primary outcome was significantly reduced with LBBAP compared with BVP (20.8% vs 28%; HR: 1.495; 95% CI: 1.213-1.842; P < 0.001). CONCLUSIONS: LBBAP improved clinical outcomes compared with BVP in patients with CRT indications and may be a reasonable alternative to BVP.

Clinical evaluation of caries removal in primary teeth using conventional, chemomechanical and laser technique: an in vivo study.

AIM: To evaluate four different techniques of caries excavation in primary teeth in terms of efficacy, efficiency and pain experienced during the procedure. MATERIALS AND METHODS: Sample of 120 teeth from children aged 5 to 9 years were equally divided into 4 groups - Air rotor (group A), Carisolv (group B), Papacarie (group C) and Er:YAG laser (group D). Visual and tactile criteria along with DIAGNOdent pen value was used to evaluate efficacy. Time was recorded to determine efficiency and FLACC scale was used to assess the pain experienced. RESULTS: Air rotor and laser were more effective and efficient method whereas laser and CMCR methods were more comfortable methods. CONCLUSION: Laser irradiation and CMCR methods are comparable to conventional methods in terms of effectiveness and are less painful methods. CLINICAL SIGNIFICANCE: Newer techniques of CMCR and laser irradiation of dentinal caries are minimally invasive methods and are less painful and thus should be more frequently employed in pediatric dentistry.

Management of internal and external root resorption in primary teeth of a 3-year-old with myelomeningocele: A case report.

BACKGROUND: Myelomeningocele (MMC) is a severe manifestation of spina bifida. Children with MMC have motor disability, hydrocephalus, skeletal abnormalities, and mental retardation. These individuals are more susceptible to caries due to poor oral hygiene, carbohydrate-rich diet, prolonged use of sugar-containing medications and limited motor abilities. Latex allergy is an important factor to be considered during the dental rehabilitation of such patients. CASE REPORT: A 3-year-old girl visited the dental clinic with the chief complaint of multiple carious teeth and H/o neural tube defect (NTD) which had been operated on at the age of 6 weeks. On dental examination, multiple dental abscesses and severe early childhood caries were noted. Radiographic evaluation revealed internal root resorption of tooth "K" and external root resorption of tooth "T." The two teeth were treated with ledermix paste followed by obturation with Vitapex® (Diadent Group International Inc., Burnaby, BC, Canada) along with triple antibiotic paste and placement of stainless steel crown (SSC). A latex-free environment was maintained during the entire treatment to prevent allergic reaction. A follow up after 42 months indicated clinical and radiographical success. CONCLUSION: The paper reports succesfull management of internal and external root resorption as well as latex allergy in a dental operatory. The dental perspective while dealing with patients having NTD is limited. Explaining the particulars of the treatment plan will aid in management of such cases .

Vaccination With Oral Polio Vaccine Reduces COVID-19 Incidence.

Background: Effective response to emerging pandemic threats is complicated by the need to develop specific vaccines and other medical products. The availability of broadly specific countermeasures that could be deployed early in the pandemic could significantly alter its course and save countless lives. Live attenuated vaccines (LAVs) were shown to induce non-specific protection against a broad spectrum of off-target pathogens by stimulating innate immune responses. The purpose of this study was to evaluate the effect of immunization with bivalent Oral Poliovirus Vaccine (bOPV) on the incidence of COVID-19 and other acute respiratory infections (ARIs). Methods and Findings: A randomized parallel-group comparative study was conducted in Kirov Medical University. 1115 healthy volunteers aged 18 to 65 were randomized into two equal groups, one of which was immunized orally with a single dose of bOPV "BiVac Polio" and another with placebo. The study participants were monitored for three months for respiratory illnesses including COVID-19. The endpoint was the incidence of acute respiratory infections and laboratory confirmed COVID-19 in both groups during 3 months after immunization. The number of laboratory-confirmed cases of COVID-19 was significantly lower in the vaccinated group than in placebo (25 cases vs. 44, p=0.036). The difference between the overall number of clinically diagnosed respiratory illnesses in the two groups was not statistically significant. Conclusions: Immunization with bOPV reduced the number of laboratory-confirmed COVID-19 cases, consistent with the original hypothesis that LAVs induce non-specific protection against off-target infections. The findings are in line with previous observations of the protective effects of OPV against seasonal influenza and other viral and bacterial pathogens. The absence of a statistically significant effect on the total number of ARIs may be due to the insufficient number of participants and heterogeneous etiology of ARIs. OPV could be used to complement specific coronavirus vaccines, especially in regions of the world where the vaccines are unavailable, and as a stopgap measure for urgent response to future emerging infections. Clinical trial registration number NCT05083039 at clinicaltrals.gov https://clinicaltrials.gov/ct2/show/NCT05083039?term=NCT05083039&draw=2&rank=1.

Design, optimization and characterisation of polymeric microneedle arrays prepared by a novel laser-based micromoulding technique.

PURPOSE: Design and evaluation of a novel laser-based method for micromoulding of microneedle arrays from polymeric materials under ambient conditions. The aim of this study was to optimise polymeric composition and assess the performance of microneedle devices that possess different geometries. METHODS: A range of microneedle geometries was engineered into silicone micromoulds, and their physicochemical features were subsequently characterised. RESULTS: Microneedles micromoulded from 20% w/w aqueous blends of the mucoadhesive copolymer Gantrez® AN-139 were surprisingly found to possess superior physical strength than those produced from commonly used pharma polymers. Gantrez® AN-139 microneedles, 600 µm and 900 µm in height, penetrated neonatal porcine skin with low application forces (>0.03 N per microneedle). When theophylline was loaded into 600 µm microneedles, 83% of the incorporated drug was delivered across neonatal porcine skin over 24 h. Optical coherence tomography (OCT) showed that drug-free 600 µm Gantrez® AN-139 microneedles punctured the stratum corneum barrier of human skin in vivo and extended approximately 460 µm into the skin. However, the entirety of the microneedle lengths was not inserted. CONCLUSION: In this study, we have shown that a novel laser engineering method can be used in micromoulding of polymeric microneedle arrays. We are currently carrying out an extensive OCT-informed study investigating the influence of microneedle array geometry on skin penetration depth, with a view to enhanced transdermal drug delivery from optimised laser-engineered Gantrez® AN-139 microneedles.

Response to treatment with intravitreal anti-vascular endothelial growth factors in bilateral exudative cuticular drusen.

PURPOSE: To present the response to treatment with anti-vascular endothelial growth factor (VEGF) agents of exudative cuticular drusen (CD) in a patient who developed temporary suspended scattering particles in motion (SSPiM) after injection in the symptomatic eye and full recovery of subretinal hyperreflective exudation (SHE) in the fellow eye by multimodal imaging modalities. OBSERVATIONS: A 46-year-old patient was diagnosed with exudative CD associated with type I and II (mixed type) macular neovascularization (MNV) in the right eye, and quiescent type I MNV was detected in the left eye by en face optical coherence tomography angiography (OCTA). Bilateral flat irregular pigment epithelial detachments were found in both eyes by optical coherence tomography (OCT). A week after injection of intravitreal aflibercept (IVA), oval shaped hypersignals developed at Henle's fiber layer with a petaloid appearance and at the subfoveal space as detected by en face OCTA in the right eye. These oval hypersignals were considered as SSPiM. They disappeared 4 weeks later and did not recur. During follow-up of the patient, juxtafoveal SHE and disruption of the ellipsoid zone (EZ) were noticed in her left asymptomatic eye by OCT. Fluorescein angiography disclosed leakage at the location of the SHE. Choriocapillaris flow analyzed by cross-sectional OCTA disclosed time-dependent local alterations before and after the development of SHE. SHE recurred twice, and juxtafoveal type I MNV subsequently developed at the same location. Intravitreal ranibizumab (IVR) treatment was initiated because of distorted vision accompanied by the development of SHE and persistent subfoveal fluid accumulation, as documented by OCT during IVA treatment. Complete recovery of the EZ took place consistently in both eyes with stable vision over three years of follow-up. CONCLUSIONS AND IMPORTANCE: Temporary SSPiM could be seen in the early period after IVA injection once but has not recurred up to three years' follow-up in the right eye of our patient with exudative CD. Prompt and appropriate treatment of SHE by intravitreal anti-VEGF agents (IVA and IVR) prevented the permanent deterioration of visual acuity in the left eye with type I MNV at her thirty-months follow-up.

Frontal QRS-T angle as a predictive marker for myocardial damage in acute carbon monoxide poisoning.

INTRODUCTION: The present study was undertaken to investigate the prognostic value of the frontal QRS-T angle associated with adverse cardiac outcomes in patients with carbon monoxide (CO) poisoning in early stages in the emergency department. MATERIALS AND METHODS: The data of 212 patients with CO poisoning who were admitted to the ED between January 2010 and May 2020 were retrospectively analyzed. The frontal QRS-T angle was obtained from the automatic reports of the EKG device. RESULTS: Compared to patients without myocardial damage, among patients with myocardial damage, statistically high creatinine, creatine kinase MB, cardiac troponin I, and frontal QRS-T angle values were found (p < 0.001 for all parameters), while the saturation of arterial blood pH and arterial oxygen values were found to be lower (p = 0.002 and p < 0.001, respectively). The frontal QRS-T angle values were correlated with creatine kinase, creatine kinase-MB, cardiac troponin I, and oxygen saturation (SpO2) in arterial blood (r = 0. 232, p = 0.001; r = 0. 253, p = < 0.001; r = 0. 389, p = < 0.001; r = -0. 198, p = 0.004, respectively). The optimum cut-off value of the frontal QRS-T angle was found to be 44.5 (area under the curve: 0.901, 95% confidence interval: 0.814-0.988, sensitivity: 87%, specificity: 84%). CONCLUSIONS: The frontal QRS-T angle, a simple and inexpensive parameter that can be easily obtained from 12-lead surface electrocardiography, can be used as an early indicator in the detection of myocardial damage in patients with CO poisoning.

Is cranial imaging necessary in girls between 6-8 years diagnosed with central precocious puberty?

AIM: There is no clear consensus on whether a cranial MRI should be performed in all cases of central precocious puberty(CPP). In this study, we aimed at evaluating the incidence of intracranial lesions and analyzing cranial imaging results in females with CPP. METHODS: In the retrospective study medical records of the case, the age at the time of admission, anthropometric measurements, bone age, Tanner stages, serum follicle-stimulating hormone (FSH), serum luteinizing hormone(LH), serum estradiol (E2) levels, the peak LH level during the gonadotropin-releasing hormone (GnRH) stimulation test and the cranial MRI findings at the time of the diagnosis of CPP were collected. RESULTS: The mean age diagnosis of the 154 girls included in the study was 6.9 ±1.08. Nine (5.8%) of 154 patients were diagnosed with organic-caused CPP. Four of the nine cases diagnosed with organic CPP had a previously known CNS pathology. The other five cases did not have any neurological findings at the time of diagnosis. Incidental lesions were detected at cranial MRI of nine of the 145 cases diagnosed with idiopathic CPP. The basal E2, basal LH, basal FSH, peak LH and peak LH/FSH levels of the cases with organic CPP were higher than those with idiopathic CPP. CONCLUSIONS: In our study, approximately 90% of organic CPP due to intracranial lesions were between 6-8 years. Therefore, we believe that cranial imaging should be performed in all females with CPP.

An 18-Month Prospective Randomized Clinical Trial Comparing Zirconia Crowns with Glass-reinforced Fiber Composite Crowns in Primary Molar Teeth.

Purpose: The purpose of this clinical trial was to assess the clinical performance of primary molar zirconia crowns with a glass fiber-reinforced composite crown (GFRC) in primary molar teeth. Methods: This trial was designed as a prospective, randomized, bilateral split-mouth study. A total of 66 crowns were placed in 30 children, ages four to nine years, from October 2018 until January 2019. Assessment of the clinical performance was done at one week and at three, six, 12, and 18 months. Several criteria, such as color match, time taken for the clinical procedure, resistance to dislodgement prior to cementation, crown retention, occlusal wear, staining, gingival health, plaque retention, and parental satisfaction, were evaluated. Result: At 18 months, 58 crowns were analyzed: 30 ZR crowns and 28 GFRC crowns. There was a statistically significant difference (P<0.05) between staining, occlusal wear, gingival health, plaque retention, and parental satisfaction between groups at 18 months, with the zirconia crowns outperforming the GFRC crowns in all those categories. The only areas where GFRC crowns performed better than ZR crowns were the time required to place them and the resistance to dislodgement before cementation. Conclusion: This study demonstrated that primary molar zirconia crowns had highly acceptable and significantly better clinical performance than glass fiber-reinforced composite crowns after 18 months.

Turkish Validity and Reliability Study of the Speech, Spatial and Qualities of Hearing Scale.

OBJECTIVE: The Speech, Spatial and Qualities of Hearing Scale (SSQ) is a self-report scale that evaluates hearing in complex daily life situations in the areas of hearing quality, speech perception, and spatial perception. It is also frequently used in the follow-up of hearing-impaired people, hearing aid and cochlear implant users. It is aimed to translate and adapt SSQ into Turkish, and to investigate its test-retest reliability, and construct validity and reliability, and further to present associations of SSQ scores with the pure tone averages (PTA). METHODS: The Turkish SSQ (Tr-SSQ) scale was administered on 114 adults including those with and without hearing loss. Cronbach's alpha was used to assess its reliability. The reliability coefficient of the scale was calculated by test-retest method. Associations of SSQ scores with PTAs in better and worse hearing ears (BHE and WHE) were evaluated. RESULTS: Tr-SSQ presented high internal consistency (Cronbach's alpha = 0.984) and test-retest reliability (r=0.994). Tr-SSQ scores were lower in the subjects with hearing loss and correlated with PTAs. Age was found to be correlated with PTAs; regression analysis demonstrated that only WHE-PTA was extracted as explanatory variable for average Tr-SSQ, speech perception and spatial perception scores while both BHE-PTA and WHE-PTA were found to be predictors of hearing quality, but not age for any of Tr-SSQ scores. CONCLUSION: Tr-SSQ is a convenient tool for assessing the hearing abilities of individuals with hearing impaired.