Traumatic Dental Injuries and their Association with Demographics and Other Predisposing Risk Factors in School Children Aged between 8-13 Years: A Descriptive, Cross-Sectional Study.

Background: Traumatic dental injuries are most commonly seen in school age children. This not only affects physical, but, also, the psychological and social well-being of a child. The aim of the present study was to assess the prevalence of traumatic dental injuries in school children aged between 8 and 13 years and their association with the demographics and other predisposing risk factors. Materials and Methods: The present study was conducted as a cross-sectional study design on 1500 school children aged between 8 and 13 years. Apart from clinical examination, all the participants were asked to complete a questionnaire related to the injuries sustained. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) version 21.0 (IBM, Chicago). Pearson's Chi-square (Χ²) test was used for categorical data analysis and distribution to determine the association between categorical variables, while P < 0.05 was considered statistically significant. Results: The prevalence of traumatic dental injuries in the present study was calculated at 9.7%. Also, the occurrence of such injuries was found to be higher in the age group of 8-11 years with 10 years being the peak age of incidence for sustaining such injuries. Again, crown fracture involving enamel was found to be the most common type of injury sustained, while proclination observed in relation to upper anterior teeth, and incompetent lips were found to be the independent, significant risk predictors associated with the frequency and severity of such injuries. Conclusions: The results obtained in the present study suggested a high prevalence of traumatic dental injuries in school children aged between 8 and 13 years highlighting the need for conducting educational programs, for increasing knowledge and awareness of parents, school children and school faculty in this regard to save the affected child patients from the more dreaded sequelae including complete loss of tooth structure, and social and emotional trauma.

Performance optimization for an optimal operating condition for a shell and heat exchanger using a multi-objective genetic algorithm approach.

In this study, shell and heat exchangers are optimized using an integrated optimization framework. In this research, A structured Design of Experiments (DOE) comprising 16 trials was first conducted to systematically determine the essential parameters, including mass flow rates (mh, mc), temperatures (T1, t1, T2, t2), and heat transfer coefficients (€, TR, U). By identifying the first four principal components, PCA was able to determine 87.7% of the variance, thereby reducing the dimensionality of the problem. Performance-related aspects of the system are the focus of this approach. Key outcomes (€, TR, U) were predicted by 99% R-squared using the RSM models. Multiple factors, such as the mass flow rate and inlet temperature, were considered during the design process. The maximizing efficiency, thermal resistance, and utility were achieved by considering these factors. By using genetic algorithms, Pareto front solutions that meet the requirements of decision-makers can be found. The combination of the shell and tube heat exchangers produced better results than expected. Engineering and designers can gain practical insight into the mass flow rate, temperature, and key responses (€, TR, U) if they quantify improvements in these factors. Despite the importance of this study, it has several potential limitations, including specific experimental conditions and the need to validate it in other situations as well. Future research could investigate other factors that influence system performance. A holistic optimization framework can improve the design and engineering of heat exchangers in the future. As a result of the study, a foundation for innovative advancements in the field has been laid with tangible improvements. The study exceeded expectations by optimizing shell and heat exchanger systems using an integrated approach, thereby contributing significantly to the advancement of the field.

Loss of SAV1 in Kidney Proximal Tubule Induces Maladaptive Repair after Ischemia and Reperfusion Injury.

Kidney ischemia and reperfusion injury (IRI) is a significant contributor to acute kidney injury (AKI), characterized by tubular injury and kidney dysfunction. Salvador family WW domain containing protein 1 (SAV1) is a key component of the Hippo pathway and plays a crucial role in the regulation of organ size and tissue regeneration. However, whether SAV1 plays a role in kidney IRI is not investigated. In this study, we investigated the role of SAV1 in kidney injury and regeneration following IRI. A proximal tubule-specific knockout of SAV1 in kidneys (SAV1ptKO) was generated, and wild-type and SAV1ptKO mice underwent kidney IRI or sham operation. Plasma creatinine and blood urea nitrogen were measured to assess kidney function. Histological studies, including periodic acid-Schiff staining and immunohistochemistry, were conducted to assess tubular injury, SAV1 expression, and cell proliferation. Western blot analysis was employed to assess the Hippo pathway-related and proliferation-related proteins. SAV1 exhibited faint expression in the proximal tubules and was predominantly expressed in the connecting tubule to the collecting duct. At 48 h after IRI, SAV1ptKO mice continued to exhibit severe kidney dysfunction, compared to attenuated kidney dysfunction in wild-type mice. Consistent with the functional data, severe tubular damage induced by kidney IRI in the cortex was significantly decreased in wild-type mice at 48 h after IRI but not in SAV1ptKO mice. Furthermore, 48 h after IRI, the number of Ki67-positive cells in the cortex was significantly higher in wild-type mice than SAV1ptKO mice. After IRI, activation and expression of Hippo pathway-related proteins were enhanced, with no significant differences observed between wild-type and SAV1ptKO mice. Notably, at 48 h after IRI, protein kinase B activation (AKT) was significantly enhanced in SAV1ptKO mice compared to wild-type mice. This study demonstrates that SAV1 deficiency in the kidney proximal tubule worsens the injury and delays kidney regeneration after IRI, potentially through the overactivation of AKT.

ISSLS prize in clinical/bioengineering science 2024: How standing and supine positions influence nutrient transport in human lumbar discs?-A serial post-contrast MRI study evaluating interplay between convection and diffusion.

PURPOSE: The intervertebral disc being avascular depends on diffusion and load-based convection for essential nutrient supply and waste removal. There are no reliable methods to simultaneously investigate them in humans under natural loads. For the first time, present study aims to investigate this by strategically employing positional MRI and post-contrast studies in three physiological positions: supine, standing and post-standing recovery. METHODS: A total of 100 healthy intervertebral discs from 20 volunteers were subjected to a serial post-contrast MR study after injecting 0.3 mmol/kg gadodiamide and T1-weighted MR images were obtained at 0, 2, 6, 12 and 24 h. At each time interval, images were obtained in three positions, i.e. supine, standing and post-standing recovery supine. The signal intensity values at endplate zone and nucleus pulposus were measured. Enhancement percentages were calculated and analysed comparing three positions. RESULTS: During unloaded supine position, there was slow gradual increase in enhancement reaching peak at 6 h. When the subjects assumed standing position, there was immediate loss of enhancement at nucleus pulposus which resulted in reciprocal increase in enhancement at endplate zone (washout phenomenon). Interestingly, when subjects assumed the post-standing recovery position, the nucleus pulposus regained the enhancement and endplate zone showed reciprocal loss (pumping-in phenomenon). CONCLUSIONS: For the first time, present study documented acute effects of physiological loading and unloading on nutrition of human discs in vivo. While during rest, solutes diffused gradually into disc, the diurnal short loading and unloading redistribute small solutes by convection. Standing caused rapid solute depletion but promptly regained by assuming resting supine position.

Cell death induced by acute renal injury: a perspective on the contributions of accidental and programmed cell death.

The involvement of cell death in acute kidney injury (AKI) is linked to multiple factors including energy depletion, electrolyte imbalance, reactive oxygen species, inflammation, mitochondrial dysfunction, and activation of several cell death pathway components. Since our review in 2003, discussing the relative contributions of apoptosis and necrosis, several other forms of cell death have been identified and are shown to contribute to AKI. Currently, these various forms of cell death can be fundamentally divided into accidental cell death and regulated or programmed cell death based on functional aspects. Several death initiator and effector molecules switch molecules that may act as signaling components triggering either death or protective mechanisms or alternate cell death pathways have been identified as part of the machinery. Intriguingly, several of these cell death pathways share components and signaling pathways suggesting complementary or compensatory functions. Thus, defining the cross talk between distinct cell death pathways and identifying the unique molecular effectors for each type of cell death may be required to develop novel strategies to prevent cell death. Furthermore, depending on the multiple forms of cell death simultaneously induced in different AKI settings, strategies for combination therapies that block multiple cell death pathways need to be developed to completely prevent injury, cell death, and renal function. This review highlights the various cell death pathways, cross talk, and interactions between different cell death modalities in AKI.

Hybrid optimization algorithm for enhanced performance and security of counter-flow shell and tube heat exchangers.

A shell and tube heat exchanger (STHE) for heat recovery applications was studied to discover the intricacies of its optimization. To optimize performance, a hybrid optimization methodology was developed by combining the Neural Fitting Tool (NFTool), Particle Swarm Optimization (PSO), and Grey Relational Analysis (GRE). STHE heat exchangers were analyzed systematically using the Taguchi method to analyze the critical elements related to a particular response. To clarify the complex relationship between the heat exchanger efficiency and operational parameters, grey relational grades (GRGs) are first computed. A forecast of the grey relation coefficients was then conducted using NFTool to provide more insight into the complex dynamics. An optimized parameter with a grey coefficient was created after applying PSO analysis, resulting in a higher grey coefficient and improved performance of the heat exchanger. A major and far-reaching application of this study was based on heat recovery. A detailed comparison was conducted between the estimated values and the experimental results as a result of the hybrid optimization algorithm. In the current study, the results demonstrate that the proposed counter-flow shell and tube strategy is effective for optimizing performance.

An automatic diagnostic model for the detection and classification of cardiovascular diseases based on swarm intelligence technique.

Globally, cardiovascular diseases (CVDs) rank among the leading causes of mortality. One out of every three deaths is attributed to cardiovascular disease, according to new World Heart Federation research. Cardiovascular disease can be caused by a number of factors, including stress, alcohol, smoking, a poor diet, inactivity, and other medical disorders like high blood pressure or diabetes. In contrast, for the vast majority of heart disorders, early diagnosis of associated ailments results in permanent recovery. Using newly developed data analysis technology, examining a patient's medical record could aid in the early detection of cardiovascular disease. Recent work has employed machine learning algorithms to predict cardiovascular illness on clinical datasets. However, because of their enormous dimension and class imbalance, clinical datasets present serious issues. An inventive model is offered in this work for addressing these problems. An efficient decision support system, also known as an assistive system, is proposed in this paper for the diagnosis and classification of cardiovascular disorders. It makes use of an optimisation technique and a deep learning classifier. The efficacy of traditional techniques for predicting cardiovascular disease using medical data is anticipated to advance with the combination of the two methodologies. Deep learning systems can reduce mortality rates by predicting cardiovascular illness based on clinical data and the patient's severity level. For an adequate sample size of synthesized samples, the optimisation process chooses the right parameters to yield the best prediction from an enhanced classifier. The 99.58% accuracy was obtained by the proposed method. Also, PSNR, sensitivity, specificity, and other metrics were calculated in this work and compared with systems that are currently in use.

Health Recommendation System using Deep Learning-based Collaborative Filtering.

The crucial aspect of the medical sector is healthcare in today's modern society. To analyze a massive quantity of medical information, a medical system is necessary to gain additional perspectives and facilitate prediction and diagnosis. This device should be intelligent enough to analyze a patient's state of health through social activities, individual health information, and behavior analysis. The Health Recommendation System (HRS) has become an essential mechanism for medical care. In this sense, efficient healthcare networks are critical for medical decision-making processes. The fundamental purpose is to maintain that sensitive information can be shared only at the right moment while guaranteeing the effectiveness of data, authenticity, security, and legal concerns. As some people use social media to recognize their medical problems, healthcare recommendation systems need to generate findings like diagnosis recommendations, medical insurance, medical passageway-based care strategies, and homeopathic remedies associated with a patient's health status. New studies aimed at the use of vast numbers of health information by integrating multidisciplinary data from various sources are addressed, which also decreases the burden and health care costs. This article presents a recommended intelligent HRS using the deep learning system of the Restricted Boltzmann Machine (RBM)-Coevolutionary Neural Network (CNN) that provides insights on how data mining techniques could be used to introduce an efficient and effective health recommendation systems engine and highlights the pharmaceutical industry's ability to translate from either a conventional scenario towards a more personalized. We developed our proposed system using TensorFlow and Python. We evaluate the suggested method's performance using distinct error quantities compared to alternative methods using the health care dataset. Furthermore, the suggested approach's accuracy, precision, recall, and F-measure were compared with the current methods.

Reduced and oxidized rice straw biochar for hexavalent chromium adsorption: Revisiting the mechanism of adsorption.

Surface oxygen functional groups of biochar were tuned by oxidation and reduction of biochar for establishing Cr(VI) adsorption mechanism. Oxygen functional groups (OFGs) on the surface of leached rice straw biochar (LBC4-6) obtained from pyrolysis at 400, 500 and 600 °C, were oxidized to furnish OBC4-6 using modified Hummer's method. Reduced biochar RBC4-6 were obtained by esterification and NaBH4/I2 reduction of oxidized biochar (OBC4-6). The modified biochar were characterized by increase in O/C and H/C ratio, respectively, in case of OBC4-6 and RBC4-6. The Cr(VI) adsorption by modified biochar LBC4-6, OBC4-6, and RBC4-6 showed optimum conditions of pH 3 and dose 0.1 g/L with a good non-linear fit for Langmuir & Freundlich isotherm. The maximum adsorption (Qm) followed the trend: OBC4 (17.47 mg/g) > RBC4 (15.23) > OBC5 (13.23) > LBC4 (10.23) > RBC5 (9.83) > OBC6 (9.60) > RBC6 (7.24) > LBC5 (6.32) > LBC6 (5.98). The adsorption kinetics for adsorption of Cr(VI) on to modified biochar fits pseudo second order (PSO), Elovich and intraparticle diffusion kinetics, showing a chemisorptions in case of biochar L/O/RBC4-6. The lower temperature modified biochar O/RBC4 show better Cr(VI) adsorption. X-ray Photoelectron Spectroscopy (XPS) studies establish optimum OFGs for reduction of Cr(VI) and chelation of the reduced Cr(III). Adsorption and stripping cycles show the oxidized and reduced biochar as better adsorbents with excellent stripping of Cr up to >98 % upon desorption with 1 M NaOH.

Multi-region minutiae depth value-based efficient forged finger print analysis.

The application of biometrics has expanded the wings to many domains of application. However, various biometric features are being used in different security systems; the fingerprints have their own merits as it is more distinct. A different algorithm has been discussed earlier to improve the security and analysis of fingerprints to find forged ones, but it has a deficiency in expected performance. A multi-region minutiae depth value (MRMDV) based finger analysis algorithm has been presented to solve this issue. The image that is considered as input has been can be converted into noisy free with the help of median and Gabor filters. Further, the quality of the image is improved by sharpening the image. Second, the preprocessed image has been divided into many tiny images representing various regions. From the regional images, the features of ridge ends, ridge bifurcation, ridge enclosure, ridge dot, and ridge island. The multi-region minutiae depth value (MRMDV) has been computed based on the features which are extracted. The test image which has a similarity to the test image is estimated around MRMDV value towards forgery detection. The MRMDV approach produced noticeable results on forged fingerprint detection accuracy up to 98% with the least time complexity of 12 seconds.

A critical review of inverse fluidized bed reactors-start-up optimization strategies and wastewater treatment.

A critical evaluation of strategies used for reducing start-up time and biological wastewater treatment using an inverse fluidized bed reactor (IFBR) was done. The start-up of an IFBR is one of the most important, time-consuming, and limiting steps in wastewater treatment using biofilm reactors. Evaluation of different strategies used by various researchers is helpful in future research works with this reactor. Different types of treated wastewater, the effect of wastewater characteristics, carriers used, and reactor hydrodynamics on the reactor performance were reviewed in detail in the first part. The second part of this review covers the use of an IFBR in the biological treatment of different wastewaters through multiple biochemical pathways and how it helped improve performance compared to other reactors. This will enable the researchers to understand the novelty of an IFBR for wastewater treatment and allow them to use it as a potential reactor.

Edge detection using fast pixel based matching and contours mapping algorithms.

Current methods of edge identification were constrained by issues like lighting changes, position disparity, colour changes, and gesture variability, among others. The aforementioned modifications have a significant impact, especially on scaled factors like temporal delay, gradient data, effectiveness in noise, translation, and qualifying edge outlines. It is obvious that an image's borders hold the majority of the shape data. Reducing the amount of time it takes for image identification, increase gradient knowledge of the image, improving efficiency in high noise environments, and pinpointing the precise location of an image are some potential obstacles in recognizing edges. the boundaries of an image stronger and more apparent locate those borders in the image initially, sharpening it by removing any extraneous detail with the use of the proper filters, followed by enhancing the edge-containing areas. The processes involved in recognizing edges are filtering, boosting, recognizing, and localizing. Numerous approaches have been suggested for the previously outlined identification of edges procedures. Edge detection using Fast pixel-based matching and contours mappingmethods are used to overcome the aforementioned restrictions for better picture recognition. In this article, we are introducing the Fast Pixel based matching and contours mapping algorithms to compare the edges in reference and targeted frames using mask-propagation and non-local techniques. Our system resists significant item visual fluctuation as well as copes with obstructions because we incorporate input from both the first and prior frames Improvement in performance in proposed system is discussed in result section, evidences are tabulated and sketched. Mainly detection probabilities and detection time is remarkably reinforced Effective identification of such things were widely useful in fingerprint comparison, medical diagnostics, Smart Cities, production, Cyber Physical Systems, incorporating Artificial Intelligence, and license plate recognition are conceivable applications of this suggested work.

Knowledge, attitudes, and practices of dentists after the COVID-19 pandemic: A cross-sectional study.

Background: Dentists are at an increased risk of encountering cross-infections because of working in close proximity with oral mucosa and saliva making use of high-speed rotary instruments during treatment generating large amount of aerosols and splatter which in turn increases the probability of nosocomial spread of infections. The present study aimed to evaluate the knowledge, attitudes, and practices of dentists after the COVID-19 pandemic. Materials and Methods: The present cross-sectional study was conducted using Google Forms wherein a well-structured questionnaire composed of a total of 25 closed-ended questions was distributed among practicing dentists through online mode. Step-wise linear regression analysis was done to determine the influence of independent variables on the knowledge, attitude, and practice scores of the participants. P < 0.05 was considered statistically significant. Results: On analyzing the results, multiple linear regression analysis revealed no significant difference in the knowledge scores among the participants, while good attitude and practice scores were significantly associated with higher qualification of the participants. Another noteworthy finding in the study was the significant correlation observed between the various components of the knowledge, attitude, and practice scores among the participants (P < 0.05). Conclusion: It could be concluded from the findings of the present survey that dentists were found to have good knowledge scores about the COVID-19 pandemic. They should, however, pay more emphasis on practicing tele-triaging and proper screening and should follow various guidelines and advisories issued from time to time by the competent authorities.

Strategic implants and bone morphogenic changes: Survival and clinical success in long-term.

Dental implants are one of the established treatment protocols to replace/restore lost tooth/teeth structures. Ihde and Ihde redefined concept of strategic implantology based on immediate loading. The aim of present case series was to evaluate efficacy of strategic implants regarding primary stability, quality of bone, survival, and clinical success in long-term. The present case series included a total of 26 patients aged 40 to 70 years restored with strategic implants after an immediate loading protocol. On follow-up visits, clinical assessment of implant stability was done by absence of implant mobility and absence of pain and dysesthesia while radiographically, immediate postoperative crestal bone level was compared with that observed on follow-up visits. Also, integration of apical and/or crestal threads of implants were assessed radiographically for any signs of radiolucency along with healing of sockets and crestal bone levels in relation to abutment margins.

Perception of dental students regarding possible career challenges and associated factors towards working in rural areas: A questionnaire based survey.

OBJECTIVE: The shortage of health care professionals in rural areas contributes toward discriminatory health care delivery. The present study was planned with a similar intent and aimed to evaluate the perception of dental students regarding their future in rural areas. MATERIALS AND METHODS: The present study was designed as a cross-sectional study comprising of a 30-item questionnaire survey instrument distributed among a total of 550 dental students while the results obtained were subjected to statistical analysis. Statistical analysis was done using SPSS version 12.0 (SPSS Inc., Chicago, IL, USA). Independent student's t-test and one-way analysis of variance (ANOVA) were used for comparison among the variables while the Chi-square test was used to determine the association between the variables. P < 0.05 was considered statistically significant. RESULTS: No significant difference was observed in the attitude based on gender (P = 0.43), although, a statistically significant difference was observed in the attitude of students based on the year of their education with a positive attitude toward rural dental practice generally noted in the first year Bachelor of Dental Surgery (BDS) students which significantly declined with the increasing level of education (P = 0.01). CONCLUSIONS: Dental students were more influenced by the negative aspects of rural dental practice though they had, in their mind, a positive approach for the same at the beginning of their education, but this significantly declined with the increasing level of their education.

Facial Plates in Phalanx Fracture-Non-Union of Great Toe - A Case Report.

Introduction: Phalanx fractures of the lower limb have high rates of union when manage conservatively. Case Report: A 26-year-old male with fracture of great toe proximal phalanx fracture which was initially managed conservatively with buddy strapping, who missed follow-up and presented late to outpatient department at 6 months with persistence of pain and difficulty in weight bearing. Here, we treated the patient with L-facial plate (2.0 system). Conclusion: Fracture non-union of proximal phalanx can be managed surgically with L- facial plates and screw and bone grafting which will provide full weight bearing and walk normally without any pain and with adequate range of movements.

The Presence of Testis Determines Aristolochic Acid-Induced Nephrotoxicity in Mice.

Aristolochic acid (AA) is notorious for inducing nephrotoxicity, but the influence of sex on AA-induced kidney injury was not clear. This study sought to investigate sex differences in kidney dysfunction and tubular injury induced by AA. Male and female mice were bilaterally orchiectomized and ovariectomized, respectively. Fourteen days after gonadectomy, the mice were intraperitoneally injected with AA (10 mg/kg body weight/day) daily for 2 days and sacrificed 7 days after the first injection. Body weight, kidney function, and tubular structure were assessed. When compared between male and female non-gonadectomized mice, AA-induced body weight loss was greater in male mice than in female mice. Functional and structural damages in male kidneys were markedly induced by AA injection, but kidneys in AA-injected female mice showed no or mild damages. Ovariectomy had no effect on AA-induced nephrotoxic acute kidney injury in female mice. However, orchiectomy significantly reduced body weight loss, kidney dysfunction, and tubular injury in AA-induced nephrotoxicity in male mice. This study has demonstrated that testis causes AA-induced nephrotoxic acute kidney injury.

Scheimpflug imaging for evaluation of intraocular lens position in modified flanged scleral fixated intraocular lens.

Background: Scleral fixation of intraocular lens (IOLs) is the most preferred technique for the management of aphakia and the techniques have evolved over the years. These methods have their advantages and disadvantages, however, the major concern being the position of the intraocular lens, its stability and complications. The final IOL position is the major determinant of the final visual acuity, and various imaging modalities have been used to quantify the IOL tilt. Objectives: Use of Scheimpflug imaging to evaluate the IOL tilt in modified flanged scleral-fixated intraocular lens (MFSIOL). Design: Retrospective chart review of 41 consecutive patients who underwent MFIOL. Methods: We conducted a retrospective chart review of 41 consecutive patients who underwent MFIOL. The baseline and final best-corrected visual acuity (BCVA), refractive error, and clinical examination findings were recorded. The vertical and horizontal tilts of the IOLs were calculated using the Scheimpflug image. The IOL tilt (in degrees) in the vertical and horizontal axes was the primary outcome and the BCVA, residual refractive error, intraocular pressure, and surgical complications were secondary outcome measures. Results: The mean baseline BCVA was logMAR 0.49, which improved to logMAR 0.356 (p < .005) after the surgery. The mean IOL tilt in the vertical axis was 3.40° (range of 0.0°-8.5°, interquartile range: 1.21-5.66) and in the horizontal axis was 1.35° (range of 0.60°-4.620°, interquartile range: 0.44-1.86), respectively. There was no correlation between angle of IOL tilt and UCVA (r = 0.089, p = 0.580), BCVA (r = 0.109, p = 0.498), final spherical error (r = 0.081, p = 0.615), cylindrical error (r = 0.207, p = 0.195), axial length (r = 0.105, p = 0.514), and IOL power (r = -0.139, p = 0.388). Conclusion: Modified flanged IOL (MFIOL) is an alternative technique for intrascleral fixation of IOL resulting in good lens stability. The IOL tilt achieved by this technique is minimal and did not influence the final visual outcome or spectacle correction. Scheimpflug imaging is simple and non-invasive method to measure the IOL tilt. Plain Language Summary Scheimpflug imaging for modified flanged scleral fixated lens position: This study on 41 eyes was aimed to analyze the lens tilt using Scheimpflug imaging in cases of modified flanged scleral fixation of intraocular lens (MFSFIOL), which is a novel technique to minimize the complications and simplify the procedure. The intraocular lens (IOL) remained stable with an acceptable range of vertical and horizontal tilt. There was no significant effect of IOL tilt on the final best-corrected visual acuity (BCVA) or spectacle correction. Scheimpflug imaging is an accurate and non-invasive technique for assessment of lens position in the patients with intrascleral fixation of IOL.

AO Spine Adult Spinal Deformity Patient Profile: A Paradigm Shift in Comprehensive Patient Evaluation in Order to Optimize Treatment and Improve Patient Care.

STUDY DESIGN: Modified Delphi study. OBJECTIVE: Adult spinal deformity (ASD) is an increasingly recognized condition, comprising a spectrum of pathologies considerably impacting patients' health and functional status. Patients present with a combination of pain, disability, comorbidities and radiological deformity. The study aims to propose a systematic approach of gathering information on the factors that drive decision-making by developing a patient profile. METHODS: The present study comprises of 3 parts. Part 1: Development of prototype of patient profile: The data from the Core Outcome Study on SCOlisis (COSSCO) by Scoliosis Research Society (SRS) was categorized into a conceptual framework. Part 2: Modified Delphi study: Items reaching >70% agreement were included in a 4 round iterative process with 51 panellists across the globe. Part 3: Pilot testing-feasibility: Content validity and usability were evaluated quantitatively. RESULTS: The profile consisted of 4 domains. 1. General health with demographics and comorbidities, 2.Spine-specific health with spine related health and neurological status, 3. Imaging with radiographic and MRI parameters and 4. Deformity type. Each domain consisted of 1 or 2 components with various factors and their measuring instruments. Profile was found to have an excellent content validity (I-CVIr 0.78-1.00; Ave-CVI 0.92) appropriateness, relevance and usefulness. CONCLUSIONS: The present study, is first to provide a universally applicable multimodal ASD patient profile to methodically describe patients. Physicians are encouraged to assess ASD patients holistically using this profile and not just based on radiographic findings.

Epoxyeicosatrienoic acid administration or soluble epoxide hydrolase inhibition attenuates renal fibrogenesis in obstructive nephropathy.

Epoxyeicosatrienoic acids (EETs) are arachidonic acid metabolites with biological effects, including antiapoptotic, anti-inflammatory, and antifibrotic functions. Soluble epoxide hydrolase (sEH)-mediated hydrolysis of EETs to dihydroxyeicosatrienoic acids (DHETs) attenuates these effects. Recent studies have demonstrated that inhibition of sEH prevents renal tubulointerstitial fibrosis and inflammation in the chronic kidney disease model. Given the pathophysiological role of the EET pathway in chronic kidney disease, we investigated if administration of EET regioisomers and/or sEH inhibition will promote antifibrotic and renoprotective effects in renal fibrosis following unilateral ureteral obstruction (UUO). EETs administration abolished tubulointerstitial fibrogenesis, as demonstrated by reduced fibroblast activation and collagen deposition after UUO. The inflammatory response was prevented as demonstrated by decreased neutrophil and macrophage infiltration and expression of cytokines in EET-administered UUO kidneys. EET administration and/or sEH inhibition significantly reduced M1 macrophage markers, whereas M2 macrophage markers were highly upregulated. Furthermore, UUO-induced oxidative stress, tubular injury, and apoptosis were all downregulated following EET administration. Combined EET administration and sEH inhibition, however, had no additive effect in attenuating inflammation and renal interstitial fibrogenesis after UUO. Taken together, our findings provide a mechanistic understanding of how EETs prevent kidney fibrogenesis during obstructive nephropathy and suggest EET treatment as a potential therapeutic strategy to treat fibrotic diseases.NEW & NOTEWORTHY Epoxyeicosatrienoic acids (EETs) are cytochrome P-450-dependent antihypertensive and anti-inflammatory derivatives of arachidonic acid, which are highly abundant in the kidney and considered renoprotective. We found that EET administration and/or soluble epoxide hydrolase inhibition significantly attenuates oxidative stress, renal cell death, inflammation, macrophage differentiation, and fibrogenesis following unilateral ureteral obstruction. Our findings provide a mechanistic understanding of how EETs prevent kidney fibrogenesis during obstructive nephropathy and suggest that EET treatment may be a potential therapeutic strategy to treat fibrotic diseases.