Platelet Rich Fibrin Graft in Myringoplasty: Pitfalls and Challenges.

Autologous Platelet-rich fibrin (PRF) is an amalgam of fibrin mesh, platelets and growth factors that favour wound healing. It can be easily used as a graft material in myringoplasty, making it a promising, easy to harvest and cost effective alternative compared to cartilage or fascia graft used in conventional myringoplasty. 50 patients of small to medium, dry central perforation underwent myringoplasty using PRF graft (Group 1). Results were compared to 50 patients with similar small to medium perforations who underwent conventional transcanal myringoplasty using temporalis fascia graft (Group 2): Outcome of surgery was measured by closure of perforation and improvement in hearing at 3 months. In group 1, overall closure rate was 70% while in group 2 it was 96%. For both small and medium perforations healing was significantly higher in group 2 compared to group 1, (100% vs 87.5%) for small perforations and (95.45% vs 66.67%) for medium perforations. Hearing gain was comparable in both groups in patients in whom healing of perforation occurred. PRF stands as a suitable graft material for closure of small perforations, but, lack of rigidity and early disintegration of the graft makes it less suitable for larger perforations compared to other conventional grafts such as temporalis fascia.

Surgical Correction of Ankyloglossia Using Diode Laser-Assisted Frenectomy in a Pediatric Patient: A Case Report.

Tongue-tie is a continuation of the lingual frenum that is attached to the tip of the tongue. It is a congenital oral anomaly that could restrict tongue movements, caused by a lingual frenum a membrane that originates from the floor of the mouth to the bottom of the tongue that is too thick and short, which limits the natural ability of the tongue to move and function. The tongue is an auxiliary organ that facilitates speaking, mastication, and deglutition. This condition may result in several difficulties including chewing, breastfeeding, speech, and pronunciation of particular words, as well as possessing social and mechanical consequences. Ankyloglossia can be seen in young age groups. The use of lasers has increased in dentistry in recent years. However, in oral and maxillofacial surgery, the use of lasers has been largely restricted to soft tissues, and less focus is placed on the use of hard tissues. Carbon dioxide (CO2) lasers, erbium-doped yttrium aluminum garnet (Er: YAG) lasers, and Er, the erbium, chromium: yttrium: scandium gallium-garnet (Cr: YSGG) lasers are among the several types of lasers that have been utilized in dentistry for correction of soft tissues as well as for hard tissues.

Comparative Assessment of Modified Self-Reported Periodontal Risk Assessment Model and Periodontal Risk Assessment Model among the Adult Population.

Introduction: A high burden of periodontal diseases is seen in the adult population. Hence, it is important to monitor the risk and progression of periodontal diseases. Instead of using complex clinical periodontal risk assessment models, self-reported measures would be favorable for obtaining data in order to conduct research and surveillance of population over time on the progression of periodontitis. Our aim was to compare two tools for periodontal risk assessment, the originally described periodontal risk assessment (PRA) model given by Lang and Tonetti and the modified self-reported periodontal risk assessment model, in patients, depending upon can be changed to after. Materials and Methods: All the participants completed a questionnaire used for modified self-reported periodontal risk assessment model. Periodontal status of the participants was recorded using the periodontal risk assessment (PRA) model given by Lang and Tonetti. Results: Among 50 patients examined 28, 14, and eight were in low-, moderate-, high-risk groups, respectively, identified by self-reported periodontal risk assessment, whereas 34, 10, and six were in low-, moderate-, high-risk groups, respectively, when identified by the PRA model given by Lang and Tonetti. Receiver operating characteristic curve (ROC curve) showed an area under the curve (AUC) of 0.835, and it represents good predictability of self-reported periodontal risk assessment model. Conclusion: This is feasible method with self-reported measures; it is easier, of low cost, and requires less equipment for obtaining data for research and surveillance of the periodontal status of a population.

Evaluation of right ventricular performance in patients with postoperative congenital heart disease using Doppler tissue imaging and cardiopulmonary bypass indices: A prospective cohort study.

Background and Aims: Postoperative cardiac outcomes after intracardiac repair (ICR) are determined by numerous factors whereas right ventricle (RV) dysfunction is considered essential for them, as only few studies attempted to evaluate it postsurgically. RV's function is supposed to be the strong prognostic factor for patients diagnosed with congenital heart defects; therefore, assessing it is the main objective of the study. Methods: This is a prospective single-centered cohort study performed on 50 pediatric patients with congenital heart disease (CHD) who underwent ICR between January 2019 and January 2022. All patients underwent echocardiographic assessment of RV function via tricuspid annular plane systolic excursion (TAPSE) and fractional area change (FAC) at 1, 24, and 48 h. After surgery, where pre- and postoperative RV pressure, cardiopulmonary bypass (CPB), and aortic cross-clamp (ACC) time were assessed. Similarly ventilation intensive care unit (ICU) and hospital stay times and mediastinal drainage were also monitored. Results: The mean ± standard deviation for pre- and postoperative RV pressure was 49.1 ± 16.12 and 42.7 ± 2.9 mmHg, respectively, whereas that for pre- and postoperative pulmonary artery pressure was 30.4 ± 2.6 and 24.2 ± 12.9 mmHg, with p value of <0.002 and <0.001, respectively. The mean ± standard deviation of CPB and ACC times was 120.92 ± 74.17 and 78.44 ± 50.5 min accordingly, while those for mean ± standard deviation of ventilation time, mediastinum chest drainage, ICU and hospital stays were 30.36 ± 54.04, 43.78 ± 46.7 min, 5.9 ± 4.01 h, were 30.36 ± 54.0, 43.78 ± 46.7 min, 5.9 ± 4.01 and 10.3 ± 4.83 h, respectively. Conclusions: RV dysfunction plays the important role in longer recovery and intraoperative time, while its effect is mostly transient. The use of TAPSE and FAC methods is valuable in the evaluation of postoperative outcomes, and the former proved to be more effective.

Systems Analysis Reveals Contraceptive-Induced Alteration of Cervicovaginal Gene Expression in a Randomized Trial.

Hormonal contraceptives (HCs) are vital in managing the reproductive health of women. However, HC usage has been linked to perturbations in cervicovaginal immunity and increased risk of sexually transmitted infections. Here, we evaluated the impact of three HCs on the cervicovaginal environment using high-throughput transcriptomics. From 2015 to 2017, 130 adolescent females aged 15-19 years were enrolled into a substudy of UChoose, a single-site, open-label randomized, crossover trial (NCT02404038) and randomized to injectable norethisterone-enanthate (Net-En), combined oral contraceptives (COC), or etonorgesterol/ethinyl-estradiol-combined contraceptive vaginal ring (CCVR). Cervicovaginal samples were collected after 16 weeks of randomized HC use and analyzed by RNA-Seq, 16S rRNA gene sequencing, and Luminex analysis. Participants in the CCVR arm had a significant elevation of transcriptional networks driven by IL-6, IL-1, and NFKB, and lower expression of genes supporting epithelial barrier integrity. An integrated multivariate analysis demonstrated that networks of microbial dysbiosis and inflammation best discriminated the CCVR arm from the other contraceptive groups, while genes involved in epithelial cell differentiation were predictive of the Net-En and COC arms. Collectively, these data from a randomized trial represent the most comprehensive "omics" analyses of the cervicovaginal response to HCs and provide important mechanistic guidelines for the provision of HCs in sub-Saharan Africa.

Variability of particulate organic carbon and assessment of satellite retrieval algorithms over the eastern Arabian Sea.

Particulate organic carbon (POC) and its variability were studied to assess the accuracy of ocean colour retrieval algorithms over the eastern Arabian Sea (EAS) as it controls the carbon sequestration, oxygen minimum zone and biogeochemical (C, N and P) cycles. The seasonality in the physical and biological processes strongly influenced the distribution of POC along the EAS. Higher POC and chlorophyll a (chl a) during the spring inter monsoon (SIM) in the north EAS were due to detrainment bloom. The lower POC:chl a ratios during the winter monsoon (WM) (299.8 ± 190.8) than the SIM (482.1 ± 438.3) were due to the influence of freshly derived organic matter with high nutrient levels. The moderate coefficient of regression values of POC with chl a (R2 = 0.49, N = 59) suggests the importance of dead organic materials in controlling the POC distribution in the EAS. Validation between satellite and in situ POC using the four ocean colour retrieval algorithms showed that the algorithm based on the ratio of remote sensing reflectance (Rrs) performed better (R2 = 0.6, N = 17). It also showed a linear trend of POC with absorption coefficients suggesting it as an optical proxy for the POC retrieval.

Mannich Bases: Centrality in Cytotoxic Drug Design.

Mannich bases identified by Professor Carl Mannich have been the most extensively explored scaffolds for more than 100 years now. The versatile biological roles that they play have promoted their applications in many clinical conditions. The present review highlights the application of Mannich bases as cytotoxic agents, categorizing them into synthetic, semisynthetic, and prodrugs classes, and gives an exhaustive account of the work reported in the last two decades. The methods of synthesis of these cytotoxic agents, their anti-cancer potential in various cell lines, and promising leads for future drug development have also been discussed. Structure-activity relationships, along with the targets on which these cytotoxic Mannich bases act, have been included as well.

Epiblepharon in a Case of Anterior Megalophthalmos: A Diagnostic Red Herring.

Epiblepharon is a condition characterized by the presence of a congenital horizontal fold of skin near the upper or lower eyelid margin and rarely requires intervention. In this communication, we present the case of a five-month-old child who had enlarged eyes, tearing, and intense photophobia; and was referred to as a case of congenital glaucoma. Congenital or infantile glaucoma can, indeed present with enlarged eyes, watering, and photophobia. However, in the absence of optic disc cupping and elevated intraocular pressures, a diagnosis of anterior megalophthalmos should be considered, especially in the presence of a very deep anterior chamber. Subsequent evaluation in our case established the diagnosis of anterior megalophthalmos along with concomitant bilateral epiblepharon. The child underwent surgery to correct the epiblepharon, following which, the tearing and photophobia resolved. The clinical characteristics of anterior megalophthalmos and the causality between an enlarged globe and epiblepharon are discussed in this article.

Spinal and paraspinal inflammatory reactions after epidural steroid injection in a patient taking disease-modifying antirheumatic drugs.

BackgroundDisease-modifying anti-rheumatic drugs (DMARDs) are used in the management of rheumatoid arthritis (RA) and are classified as conventional DMARDs and biologic agents. A concern with DMARDs is the increased risk of infection after surgery. A practice advisory from the American Society of Anesthesiologists recommend alternatives to neuraxial injections in patients who are immunocompromized. We describe a patient who was on several DMARDs and developed inflammatory reactions in her bilateral paraspinal muscles and lumbar spine after an epidural steroid injection (ESI). CASE PRESENTATION: The patient was a 79-year-old woman; she was taking methotrexate, adalimumab and prednisone for her RA. She had a left L5-S1 paramedian ESI for her L5 radiculitis. After relief of her back and radicular pain for 5 weeks, she had an acute exacerbation of her back pain. MRI showed bilateral paraspinal fluid accumulations and enhancement in her ligamentum flavum. Cultures of the aspirated fluid and biopsy specimens were negative for fungal, aerobic and anaerobic organisms. A repeat MRI 2 months later showed diminution of the fluid collection but with a new fluid accumulation near the left L4-5 facet and left L4 pedicle. Repeat cultures and gram stain of the specimens taken from the pedicle and the paraspinal muscles were negative. The patient was followed by her rheumatologist and in the pain clinic until resolution of her symptoms. CONCLUSIONS: Several society guidelines recommend the continuation of methotrexate but stoppage of the biologic DMARDS before surgery. The occurrence of an intense inflammatory reaction after an ESI in our patient calls for additional research on the subject and shared decision-making between the pain physician, patient and rheumatologist especially in patients on several DMARDs.

Lymphatic filariasis presenting as retroperitoneal cyst.

Filariasis is endemic in the tropical and subtropical regions of the world. Lymphatic filariasis presents commonly as hydrocele, lymphocele, lymphadenopathy, pitting edema, elephantiasis, or subclinical microfilaremia. Here, we present a case of filariasis presenting as a retroperitoneal cyst, which was diagnosed on identification of microfilaria in the cyst fluid and cyst wall.

Women Physicians and the Suffrage Movement.

Women physicians have a long history of advocacy, dating to the 19th century women's suffrage movement. As history recounts the work of the suffragists, many women physicians bear mention. Some were leaders on the national scene, and others led suffrage efforts in their own state. In this article, we provide a snapshot of 7 prominent suffragists who were also physicians: Mary Edwards Walker, Mary Putnam Jacobi, Esther Pohl Lovejoy, Marie Equi, Mattie E. Coleman, Cora Smith Eaton, and Caroline E. Spencer. In sharing their stories, we hope to better understand some of the challenges and struggles of the suffrage movement and how their advocacy paved the way not only for women's voting rights but also the role of women physicians as advocates for change.

The neutrophil to albumin ratio as a predictor of pathological complete response in rectal cancer patients following neoadjuvant chemoradiation.

Pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT) and total mesorectal excision (TME), in patients with locally advanced rectal cancer, occurs in 15-27% of patients. Because blood cell counts and albumin are a direct indicator of the host environment, a response to nCRT might be predicted by these markers. This study was carried out to determine whether the neutrophil to albumin ratio (NAR) was predictive of pCR in veteran patients. Ninety-eight patients with rectal cancer who underwent standard nCRT, followed by TME were analyzed. Pre-nCRT and post-nCRT hematologic data were collected. Univariate and multivariate analyses were carried out. Kaplan-Meier curves were constructed with our primary endpoint of pCR. Male patients (99%), age 62.4±9.1 years, BMI=27.4±5.9 kg/m, rectal cancer distance from anal verge=7.1±4.5 cm (SD), interval between nCRT and TME=8 weeks, 55% patients=low anterior resection, 95% received 5-fluorouracil, and all patients received radiation, with 15% achieving a pCR. Univariate analysis showed that pre-nCRT carcinoembryonic antigen (15.8±45.1 vs. 3.5±5.3 ng/dl; P=0.002) and the pre-nCRT NAR (16.4±4.8 vs. 14.2±1.6; P=0.002) were associated with pCR. On multivariate analysis, pre-nCRT carcinoembryonic antigen (odds ratio=0.41, 95% confidence interval 0.22-0.77) and pre-nCRT NAR (odds ratio=0.76, 95% confidence interval 0.60-0.97) remained independent predictors of pCR. Overall survival between nonresponders and pCR patients at 1, 5, and 10 years was 96, 62, and 44% versus 93, 85, and 61%, P=0.13, and disease-free survival was 95, 60, and 47% versus 93, 85, and 61%, P=0.17; respectively. Our study shows that the pre-nCRT NAR is an independent predictor of pCR. These findings should be applied to other cohorts to determine its validity and reliability for use as a potential predictor of pCR.

Predictors of inguinodynia, recurrence, and metachronous hernias after inguinal herniorrhaphy in veteran patients.

BACKGROUND: The present single-institution, single-surgeon experience interrogated morbidity as well as predictors of inguinodynia, recurrence, and metachronous hernias in 953 consecutive inguinal herniorrhaphies between 2005 and 2015. METHODS: Data were prospectively collected and retrospectively analyzed from patient medical records at the VA North Texas Health Care System. RESULTS: Ninety-nine percent of our patients were male, 73% Caucasian, 60.4 ± 1.4 years old, body mass index = 26.7 ± 4.2 kg/m(2). Overall morbidity was 11.9%. The most common complication was urinary retention (2.3%). Inguinodynia and recurrence occurred at a rate of 1.5% and .8%, respectively. If a patient had a hernia repair, he had a 12% chance of needing a contralateral repair within 7.6 years. Younger age (odds ratio [OR], .96; 95% confidence interval [CI], .91 to 1.0), current history of smoking (OR, 5.3; 95% CI, 1.3 to 22.3), and a previous contralateral hernia repair (OR, 5.5; 95% CI, 1.2 to 25.0) were independent predictors of inguinodynia. A direct hernia was associated with recurrence (45% vs 100%; P = .02). Current smoking was an independent predictor of recurrence (OR, 5.4; 95% CI 1.0 to 29.3). Age (55- to 75-year old; OR, 2.0; 95% CI, 1.1 to 3.9), age (>75-year old; OR, 2.6; 95% CI, 1.1 to 6.1), an indirect hernia repair (OR, 1.9; 95% CI, 1.2 to 3.1), a pantaloon hernia repair (OR, 2.0; 95% CI, 1.0 to 3.8), and current consumption of alcohol (OR, 1.6; 95% CI, 1.0 to 2.5) were independent predictors of a metachronous hernia. CONCLUSIONS: The following study presents several factors predictive of outcomes in patients with inguinal hernias that might be useful in preventing complications and providing informed consent to this patient population.

Biological Mesh Implants for Abdominal Hernia Repair: US Food and Drug Administration Approval Process and Systematic Review of Its Efficacy.

IMPORTANCE: Expensive biological mesh materials are increasingly used to reinforce abdominal wall hernia repairs. The clinical and cost benefit of these materials are unknown. OBJECTIVES: To review the published evidence on the use of biological mesh materials and to examine the US Food and Drug Administration (FDA) approval history for these devices. EVIDENCE ACQUISITION: Search of multiple electronic databases (Ovid, MEDLINE, EMBASE, Cochrane Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Cochrane National Health Service Economic Evaluation Database) to identify articles published between 1948 and June 30, 2015, on the use of biological mesh materials used to reinforce abdominal wall hernia repair. Keywords searched included surgical mesh, abdominal hernia, recurrence, infection, fistula, bioprosthesis, biocompatible materials, absorbable implants, dermis, and collagen. The FDA online database for 510(k) clearances was reviewed for all commercially available biological mesh materials. The median national price for mesh materials was established by a benchmarking query through several Integrated Delivery Network and Group Purchasing Organization tools. EVIDENCE SYNTHESIS: Of 274 screened articles, 20 met the search criteria. Most were case series that reported results of convenience samples of patients at single institutions with a variety of clinical problems. Only 3 of the 20 were comparative studies. There were no randomized clinical trials. In total, outcomes for 1033 patients were described. Studies varied widely in follow-up time, operative technique, meshes used, and patient selection criteria. Reported outcomes and clinical outcomes, such as fistula formation and infection, were inconsistently reported across studies. Conflicts of interest were not reported in 16 of the 20 studies. Recurrence rates ranged from 0% to 80%. All biological mesh devices were approved by the FDA based on substantial equivalence to a group of nonbiological predicate devices that, on average, were one-third less costly. CONCLUSIONS AND RELEVANCE: There is insufficient evidence to determine the extra costs associated with or the clinical efficacy of biological mesh materials for the repair of abdominal wall hernia.

Phosphorylation of psyllium seed polysaccharide and its characterization.

Psyllium is widely used as a medicinally active natural polysaccharide for treating conditions like constipation, diarrhea, and irritable bowel syndrome, inflammatory bowel disease, ulcerative colitis and colon cancer. Studies have been performed to characterize and modify the polysaccharide obtained from psyllium seed husk and to evaluate its use as a pharmaceutical excipient, but no studies have been performed to evaluate the properties of the polysaccharide present in psyllium seeds. The present study focuses on phosphorylation of psyllium seed polysaccharide (PPS) using sodium tri-meta phosphate as the cross-linking agent. The modified phosphorylated psyllium seed polysaccharide was then evaluated for physicochemical properties, rheological properties, spectral analysis, thermal analysis, crosslinking density and acute oral toxicity studies. The modified polysaccharide (PhPPS) has a high swelling index due to which it can be categorized as a hydrogel. The percent increase in swelling of PhPPS as compared to PPS was found to be 90.26%. The PPS & PhPPS mucilages of all strengths were found to have shear thinning properties. These findings are suggestive of the potential use of PhPPS as gelling & suspending agent. PhPPS was found to have a mucoadhesive property which was comparable with carbopol.

Clinical and molecular diagnosis of pathologic complete response in rectal cancer.

The current standard approach to locally advanced rectal cancer involves pre-operative chemoradiotherapy followed by total mesorectal excision. This practice is supported by several studies that have demonstrated superior local control with this approach. This strategy, leads to a pathologic complete response (pCR) in a substantial proportion of patients treated with neoadjuvant therapy. Furthermore, pCR has been shown to be a reliable predictor of improved oncologic outcomes. This observation has led to an increased interest in the pursuit of identifying clinical, radiographic, pathologic and biochemical predictors of pCR. This review discusses the promising approaches to and most recent advancements in predicting pCR in rectal cancer.

Development of microencapsulation delivery system for long-term preservation of probiotics as biotherapeutics agent.

The administration of probiotic bacteria for health benefit has rapidly expanded in recent years, with a global market worth $32.6 billion predicted by 2014. The oral administration of most of the probiotics results in the lack of ability to survive in a high proportion of the harsh conditions of acidity and bile concentration commonly encountered in the gastrointestinal tract of humans. Providing probiotic living cells with a physical barrier against adverse environmental conditions is therefore an approach currently receiving considerable interest. Probiotic encapsulation technology has the potential to protect microorganisms and to deliver them into the gut. However, there are still many challenges to overcome with respect to the microencapsulation process and the conditions prevailing in the gut. This review focuses mainly on the methodological approach of probiotic encapsulation including biomaterials selection and choice of appropriate technology in detailed manner.

In vivo studies to elucidate the role of extracellular polymeric substances from Azotobacter in immobilization of heavy metals.

The role of extracellular polymeric substances (EPS) produced by the heavy metal-resistant strain of Azotobacter spp. in restricting the uptake of cadmium (Cd) and chromium (Cr) by wheat plants cultivated in soils contaminated with the respective heavy metals has been demonstrated. A heavy metal-resistant strain of Azotobacter spp. was isolated and identified. Minimum inhibitory concentrations (MIC) of Cd2+ and CrO4(2-) were determined to be 20 and 10 mg L(-1), respectively. Under in vitro conditions, the EPS produced by the strain could bind 15.17 +/- 0.58 mg g(-1) of Cd2+ and 21.9 +/- 0.08 mg g(-1) of CrO4(2-). Fourier transform infrared spectra of the EPS revealed the presence of functional groups like carboxyl (-COOH) and hydroxyl (-OH), primarily involved in metal ion binding. Under pot culture experiments, the isolated strain of Azotobacter was added to the metal-contaminated soils in the form of free cells and immobilized cells. The total Azotobacter count and plant metal concentrations under different treatments showed a negative coefficient between the Azotobacter population and plant Cd (-0.496) and Cr (-0.455). Thus it could be inferred that Azotobacter spp. is involved in metal ion complexation either through EPS or through cell wall lipopolysaccharides (LPS).