Comparative evaluation of pinhole surgical technique with and without A-PRF in the treatment of multiple adjacent recession defects: A clinico radiographic study.

BACKGROUND: To evaluate and compare efficacy of pinhole surgical technique (PST) alone and with advanced platelet rich fibrin (A-PRF) in the management of bilateral multiple adjacent gingival recession defects (MAGRD). METHODS: One hundred and sixty five MAGRD were randomly assigned to control group (treated with PST) and test group (PST with A-PRF). Clinical parameters of gingival recession depth (GRD), gingival recession width (GRW), width of keratinised gingiva (WKG), complete root coverage (CRC) and gingival thickness (GT) on ST-CBCT was measured at 2, 4 and 6 mm apically from the gingival margin. Also, root coverage aesthetic score and patient satisfaction ratings were recorded at baseline, 6 and 12 months postoperatively. RESULTS: Substantial reduction in GRD (Test: 1.29 ± 0.69 mm and Control 0.98 ± 0.30 mm) (p < 0.001) and GRW (Test: 2.03 ± 0.90 mm and control 1.73 ± 0.99 mm) (p < 0.05) with associated gain in WKG and GT was observed (p < 0.001). Mean GT values were increased in both the groups at 2, 4 and 6 mm from the crest. Comparison of Test and Control groups yielded significant reductions in GRD (-0.17 ± 0.56 mm) and WKG (0.73 ± 1.07 mm) favoring the Test group (p < 0.05). Similar increase in GT was observed with better results in Test than control group. (p < 0.001). CONCLUSION: Both groups exhibited sound clinical outcomes with test group offering better resolution of MAGRD in comparison to control group. Also, it enhances clinical and therapeutic end results in terms of attaining reduction in GRD and GRW along with greater gain in KTW and GT. CLINICAL SIGNIFICANCE: PST as a minimally invasive approach has numerous benefits, some of which include the absence of scarring and improved aesthetics linked to faster wound healing. The addition of A-PRF enhances the intended therapy outcomes, which is beneficial for both patients and professionals in the field of periodontics.

Simulation-based learning in nursing curriculum- time to prepare quality nurses: A systematic review and meta-analysis.

Background: Simulation-based learning (SBL) emerged as an imperative pedagogical approach adaptable to situations involving widely varying clinical content without exposing patients to the risks inherent in trainee learning. The purpose of the present review was to assess the outcome of SBL on the domains of learning i.e cognitive, affective, and psychomotor. Methods: We searched PubMed, Embase, Cochrane library, Clinical Trial database, and other sources to evaluate the effectiveness of SBL versus traditional teaching methods among nursing students till March 2021. Two authors individually extracted the data and identified the risk of bias and analyzed the data. Results: The selected studies with a total of 364 nursing students were included for analysis. Overall, it was found that learning via simulation has beneficial effects. In combined subgroup analysis, use of simulation showed significant effects on students' understanding (SMD = 1.31, 95% CI [0.80, 1.82], P < 0.00001), Self-confidence (SMD = 1.93, 95% CI [1.01,2.84], P < 0.0001), (SMD = 1.83, 95% CI [0.91,2.74], P < 0.0001), Learning satisfaction [E:17.94, C-17.60] and Skill (SMD = 1.62, 95% CI [0.62,2.62], P = 0.002) and psychological care (SMD = 1.60, 95%CI [0.61,2.58], P = 0.001). Heterogeneity ranging from I2 = 54%-86% was found during the analysis. Conclusion: The findings of the present study considered simulation as an effective teaching method to enhance cognitive, affective, and psychomotor skills.

Assessing clinical and molecular outcomes of prophylactic thermal pulsation therapy on ocular surface health following refractive surgery.

Purpose: To study ocular surface signs, symptoms, and tear film composition following prophylactic thermal pulsation therapy (TPT) prior to refractive surgery, and to compare these outcomes with those who underwent TPT after refractive surgery. Methods: Patients with mild-to-moderate evaporative dry eye disease (DED) and/or meibomian gland dysfunction (MGD) undergoing refractive surgery were included. Group 1 patients received TPT (LipiFlow) prior to laser-assisted in situ keratomileusis (LASIK; n = 32, 64 eyes), and Group 2 patients received TPT three months after LASIK (n = 27, 52 eyes). Ocular Surface Disease Index (OSDI) score, Schirmer's test (ST1, ST2), Tear Breakup Time (TBUT), meibography, and tear fluid were obtained preoperatively and at three months postoperatively in Groups 1 and 2. Additional postoperative evaluation was performed three months after TPT in Group 2. Tear soluble factor profile was measured by multiplex enzyme-linked immunosorbent assay (ELISA) using flow cytometry. Results: Postoperative OSDI score was significantly lower and TBUT was significantly higher when compared with matched preoperative values of Group 1 participants. On the other hand, the postoperative OSDI score was significantly higher and TBUT significantly lower when compared with matched preoperative values of Group 2 participants. TPT significantly reduced the postoperative elevation in OSDI and significantly reduced the postoperative reduction in TBUT in Group 2 participants. Tear Matrix metalloproteinase-9/ Tissue inhibitor matrix metalloproteinase 1 (MMP-9/TIMP1) ratio was significantly higher, postoperatively, when compared with matched preoperative levels in Group 2. However, MMP9/TIMP1 ratio remained unaltered in Group 1 participants. Conclusion: TPT prior to refractive surgery improved postsurgical ocular surface signs and symptoms and reduced tear inflammatory factors, thereby suggesting the plausibility of reduced post-refractive surgery DED in patients.

Association of gingival exhibit with lip dimensions, intercommissural width, and gingival and interdental smile lines - a gender-based evaluation.

OBJECTIVE: The present study aimed to evaluate the gender-based association of gingival exhibit with lip dimensions, intercommissural width (ICW), interdental smile line (ISL), and gingival smile line (GSL) in periodontally healthy patients. MATERIALS AND METHODS: 120 patients aged between 20 and 40 years were divided equally into two groups based on gender. The parameters of lip length (LL) at rest and on smiling, ICW, and the intraoral parameters of gingival exhibit in ISL and GSL were measured on digitized photographs in the maxillary anterior teeth. RESULTS: The LL positions at rest and on smiling differed significantly: 23.50 ± 3.31 mm and 19.89 ± 1.91 mm, and 16.53 ± 2.94 mm and 13.91 ± 1.93 mm for males and females, respectively. The gingival exhibit of the interdental papillae in ISL was 3.01 ± 1.85 mm for males and 4.26 ± 1.85 mm for females, while the midfacial exhibit in GSL was 0.62 ± 1.01 mm for males and 1.24 ± 1.44 mm for females; both the differences were statistically significant. CONCLUSION: The gender variability in LL, the interdental papillae exhibit in ISL, and the midfacial exhibit in GSL can provide constructive guidelines that can be implemented in the esthetic zone.

Controlling neural territory patterning from pluripotency using a systems developmental biology approach.

Successful manufacture of specialized human cells requires process understanding of directed differentiation. Here, we apply high-dimensional Design of Experiments (HD-DoE) methodology to identify critical process parameters (CPPs) that govern neural territory patterning from pluripotency-the first stage toward specification of central nervous system (CNS) cell fates. Using computerized experimental design, 7 developmental signaling pathways were simultaneously perturbed in human pluripotent stem cell culture. Regionally specific genes spanning the anterior-posterior and dorsal-ventral axes of the developing embryo were measured after 3 days and mathematical models describing pathway control were developed using regression analysis. High-dimensional models revealed particular combinations of signaling inputs that induce expression profiles consistent with emerging CNS territories and defined CPPs for anterior and posterior neuroectoderm patterning. The results demonstrate the importance of combinatorial control during neural induction and challenge the use of generic neural induction strategies such as dual-SMAD inhibition, when seeking to specify particular lineages from pluripotency.

Repeatability and Agreement of a New Scheimpflug Device and a Hartmann-Shack Aberrometer With a Ray-Tracing Aberrometer in Normal, Keratoconus, and CXL Groups.

PURPOSE: To assess repeatability and agreement of a Scheimpflug topographer and a Hartmann-Shack aberrometer with a ray-tracing aberrometer in normal, keratoconus, and corneal cross-linking (CXL) groups. METHODS: In this cross-sectional, observational study, normal, keratoconus, and CXL groups with 125 eyes in each of the three groups were included. All eyes underwent three sets of measurements, at a single visit, using the Pentacam AXL Wave (Oculus Optikgeräte GmbH) and iTrace (Tracey Technologies). Keratometry, pachymetry, objective refraction, and total ocular aberrations including root mean square (RMS) lower order aberrations (LOAs), RMS higher order aberrations (HOAs), RMS coma, and spherical aberrations (SA) were analyzed. Objective assessment of haze after CXL was done using the Pentacam AXL Wave. Repeatability was assessed using within-subject standard deviation (Sw), test-retest variability, within-subject coefficient of variation (COV), and intraclass correlation coefficient (ICC). Bland-Altman analysis assessed 95% limits of agreement and correlation coefficient (r) determined the strength of the relationship between measurements. RESULTS: The Pentacam AXL Wave had Sw for keratometry of 0.12 in the normal group and 0.15 in the keratoconus group and lower (poorer) Sw of 0.17 in the CXL group. For pachymetry, Sw was 9.18, 9.53, and 10.11 in the normal, keratoconus, and CXL groups, respectively. Total aberrations had ICCs ranging from 0.88 for RMS HOAs to 0.95 for SA in the normal group, 0.86 for RMS HOAs to 0.92 for SA in the keratoconus group, and 0.72 for RMS HOAs to 0.82 for SA (poorer) in the CXL group. In the normal group, mean differences between the two devices were nonsignificant for all parameters except SA (0.011 ± 0.038 µm, P < .01; limits of agreement = -0.09 to 0.07; r = 0.87). In the keratoconus group, mean differences were significant in all aberrations except RMS LOAs (-0.27 ± 0.85 µm, P = .10; limits of agreement = -3.3 to 3.8; r = 0.92). In the CXL group, all parameters varied significantly (P < .006). CONCLUSIONS: The Pentacam AXL Wave showed comparable repeatability in the normal and keratoconus groups, but was poorer in the CXL group, more so with increasing corneal haze. Both devices can be used interchangeably in normal eyes, except for SA, but not in eyes with keratoconus or CXL for aberration measurements. [J Refract Surg. 2022;38(3):201-208.].

Repeatability and agreement of wavefront aberrations of a new hybrid topographer and aberrometer in healthy eyes.

PURPOSE: To assess repeatability and agreement of the Pentacam AXL Wave with that of the iTrace aberrometer. SETTING: Narayana Nethralaya, Bangalore, India. DESIGN: Prospective, cross-sectional study. METHODS: All eyes of patients underwent 3 sets of measurements at a single visit, using Pentacam AXL Wave and iTrace. Lower-order aberrations (LOAs), higher-order aberrations (HOAs), and coma and spherical aberrations (SAs) were analyzed. Repeatability was assessed using within-subject (Sw) SD, test-retest variability (TRT), Sw coefficient of variation (CoV), and intraclass correlation coefficient (ICC). The Bland-Altman analysis was used to assess 95% limits of agreement (LoA) and the correlation coefficient (r) to determine strength of relationship between measurements. RESULTS: 100 eyes of 100 patients underwent measurements. Pentacam AXL Wave had repeatability with an ICC for total ocular aberrations ranging from 0.84 for HOAs to 0.92 for LOAs and for corneal from 0.76 for HOAs to 0.86 for LOAs. The Sw, TRT, and CoV of all aberrations were significantly lower (better) than those of iTrace (P < .001). The mean differences between 2 devices were insignificant for the comparison of all parameters, except for spherical aberration (0.011 [0.002571 to 0.02008]; P = .01). Both devices showed excellent correlations for ocular aberrations (total HOAs [P = .12, LoA = -0.52 to 0.025; r = 0.89]; LOAs [P = .14, LoA = -2.71 to 2.61; r = 0.96]; coma [P = .27, LoA = -0.11 to 0.12; r = 0.89]; and SA [P = .01, LoA = -0.09 to 0.07; r = 0.97]). CONCLUSIONS: The repeatability estimates for wavefront aberrations using Pentacam AXL Wave were significantly better than those using iTrace. Both devices showed excellent correlations for total ocular aberrations.

High-Dimensional Design-Of-Experiments Extracts Small-Molecule-Only Induction Conditions for Dorsal Pancreatic Endoderm from Pluripotency.

The derivation of endoderm and descendant organs, such as pancreas, liver, and intestine, impacts disease modeling and regenerative medicine. Use of TGF-ß signaling agonism is a common method for induction of definitive endoderm from pluripotency. By using a data-driven, High-Dimensional Design of Experiments (HD-DoE)-based methodology to address multifactorial problems in directed differentiation, we found instead that optimal conditions demanded BMP antagonism and retinoid input leading to induction of dorsal foregut endoderm (DFE). We demonstrate that pancreatic identity can be rapidly, and robustly, induced from DFE and that such cells are of dorsal pancreatic identity. The DFE population was highly competent to differentiate into both stomach organoids and pancreatic tissue types and able to generate fetal-type ß cells through two subsequent differentiation steps using only small molecules. This alternative, rapid, and low-cost basis for generating pancreatic insulin-producing cells may have impact for the development of cell-based therapies for diabetes.

Patients' Awareness About Their Rights: A Study from Coastal South India.

Respecting patients' rights is a fundamental aspect of providing quality healthcare. The present investigation attempts to explore the awareness among patients about their rights in a coastal township in India. A questionnaire-based cross-sectional study was carried out among 215 patients admitted to the wards of a tertiary care teaching hospital in Mangalore. Awareness among patients regarding their rights varied for various issues and ranged between 48.4 and 87.4 %. Awareness about patients' rights was independent of gender, socio-economic and educational status. Doctors were found to be the most common source of information for patient's about their rights in the study. Doctors must conform to the relevant legislations and involve patients in all aspects of healthcare. There is a need to increase awareness among patients about their rights to ensure informed decisions and better health care services.