Computed Tomographic Analysis of Position of Mandibular Canal and Mandibular Foramen in Patients with Mandibular Asymmetry

Introduction

Mandibular osteotomies in facial asymmetry are complicated by the abnormal position and course of inferior alveolar nerve. This manuscript aims to evaluate the possible variations in the preoperative positions of mandibular canal and mandibular foramen in patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia.

Materials & Methods

This study included 15 patients with mandibular asymmetry due to condylar hyperplasia or condylar hypoplasia for which bilateral sagittal split osteotomy (BSSO) was performed as a corrective procedure. The presence/absence and extent of postoperative neurosensory deficiency was recorded subjectively and objectively. The measurements were done using multiplanar reconstruction (MPR) of three-dimensional radiographic imaging and were compared to normal subjects.

Discussion

The results revealed that the mandibular canal was closer to the buccal cortex on the affected side and the inferior border on both sides in the region of second molar in condylar hyperplasia. In condylar hypoplasia, the canal was nearer to the inferior border and the alveolar crest in relation to second and third molars respectively on the affected and contralateral sides.The mandibular foramen was also more superior to the occlusal plane on both sides in both condylar hyperplasia and hypoplasia.

Conclusion

Based on the study outcomes, the authors propose that assessment of the positions of mandibular canal and mandibular foramen is crucial to avoid postoperative neurosensory deficiencies.

Influence of CoFeB layer thickness on elastic parameters in CoFeB/MgO heterostructures

The surface acoustic waves, i.e., surface phonons may have huge potential for future spintronic devices, if coupled to other waves (e.g., spin waves) or quasiparticles. In order to understand the coupling of acoustic phonons with the spin degree of freedom, especially in magnetic thin film-based heterostructures, one needs to investigate the properties of phonons in those heterostructures. This also allows us to determine the elastic properties of individual magnetic layers and the effective elastic parameters of the whole stacks. Here, we study frequency versus wavevector dispersion of thermally excited SAWs in CoFeB/MgO heterostructures with varying CoFeB thickness by employing Brillouin light spectroscopy. The experimental results are corroborated by finite element method-based simulations. From the best agreement of simulation results with the experiments, we find out the elastic tensor parameters for CoFeB layer. Additionally, we estimate the effective elastic parameters (elastic tensors, Young's modulus, Poisson's ratio) of the whole stacks for varying CoFeB thickness. Interestingly, the simulation results, either considering elastic parameters of individual layers or considering effective elastic parameters of whole stacks, show good agreement with the experimental results. These extracted elastic parameters will be very useful to understand the interaction of phonons with other quasiparticles.

Phosphonomethyl iminodiacetic acid functionalized metal organic framework supported PAN composite beads for selective removal of La(III) from wastewater: Adsorptive performance and column separation studies

The rare earth elements being toxic in nature are being accumulated in water bodies as their industrial usage is growing exponentially, thus their efficient separation holds an immense significance. Herein, ligand functionalized metal organic framework (MOF), Phosphonomethyl iminodiacetic acid coordinated at Fe-BTC, was synthesized post-synthetically and incorporated subsequently in polyacrylonitrile polymer to prepare the composite beads via nonsolvent induced-phase-inversion technique for selective adsorption of La(III) from the wastewater in batch and dynamic column mode. XPS NMR, and FTIR were used to establish the interaction between functionalized ligand and unsaturated metal nodes of MOF. The adsorption capacity was 232.5 mg/g and 77.51 mg/g at 298 K of the functionalized MOF and composite beads respectively. Adsorption kinetics followed a pseudo-second order rate equation, and isotherm indicated the best fitting with Langmuir model. The dynamic behavior of the adsorption column packed with MOF/Polymer beads was fairly described by the Thomas model. The breakthrough time of 23.2 h could be attained with 12 cm of bed height and 10 ml/min of flow rate. These MOF/Polymer beads shown the selectivity of La over transitional metals were recycled over 5 times with about 15% loss of adsorption capacity. The findings provide suggestive insights of the potential use of functionalized MOF towards the separation of the rare earth element.

Evidence in crisis: a closer look into the quality of published systematic reviews in the cardiology literature

Background

Systematic reviews are usually considered as the highest level of evidence and are increasingly used in shaping cardiology policies and guidelines. However, as the rate of publishing systematic reviews increases annually, there are rising concerns regarding their quality and reporting standards.

Purpose

The current analysis provides an insight into the quality of published systematic reviews in cardiology and provides recommendations for researchers, clinicians, and stakeholders in this regard.

Methods

Using a comprehensive Medline/PubMed search, we retrieved all systematic reviews, published between 2009 and 2019 in five general cardiology journals with the highest impact factor as per the Clarivate Analytics 2019 Journal Impact Factor List (Circulation, European Heart Journal, Journal of the American College of Cardiology, Circulation Research, and JAMA Cardiology). We assessed the methodological characteristics, eligibility criteria, reporting standards, as well as review quality scores according to the AMSTAR tool.

Results

Among 352 retrieved reviews, 275 (75.3%) performed direct head-to-head analysis and 164 (46.6%) included only clinical trials. The median numbers of searched databases and included studies were 3 (IQR: 2, 3) and 13 (IQR: 7, 30). The primary outcomes were often hard clinical endpoints as mortality (39.2%) and stroke (11.9%). 64 (18.2%) registered their protocol, 208 (58.4%) used validated tools for risk of bias assessment, 177 (52.3%) assessed for publication bias, and 221 (62.8%) adhered to the PRISMA checklist. Thirty-five reviews detected significant publication bias, which was significantly associated with heterogeneity of the primary outcome. The AMSTAR quality scores were low or critically low in 71% of evaluated reviews. Further, 87 (24.7%) did not report on whether they received funding or not, 33 (9.4%) reported receiving no funding, and 232 adequately reported on their funding sources [70 (19.9%) from governmental/academic sources, 120 (34.1%) from pharmaceutical companies, and 42 (11.9%) from both sources]. analysis showed that reviews with advanced statistical analysis, those that included RCTs, adhered to the PRISMA checklist, or had higher AMSTAR quality scores had significantly higher citation metrics (p<0.05).

Conclusion

Due to the widespread low quality and poor reporting in cardiovascular systematic reviews, clinicians should be educated on the value of methodological quality in interpreting systematic review findings. In addition, academic societies and guideline writing groups should implement rigorous critical appraisal and peer review policies to improve the synthesis and utilization of systematic reviews in evidence-based cardiovascular medicine.

Funding Acknowledgement

Type of funding sources: None.

Outcomes of transfemoral-transcatheter aortic valve replacement with Sapien-3 valve in liver cirrhosis patients

Background

Little is known about the outcomes of liver cirrhosis patients with severe aortic stenosis (AS) who undergo transcatheter aortic valve replacement (TAVR).

Methods

We undertook a retrospective analysis of consecutive patients with severe symptomatic AS who underwent transfemoral-TAVR with Sapien-3 valve at our Clinic between April 2015 and December 2018, yielding 32 patients with liver cirrhosis on imaging including ultrasound and/or computed tomography. Their baseline characteristics, procedural and long-term outcomes after TAVR with the non-cirrhotic group were compared, along with their management strategies as per the hepatology team.

Results

Among 1028 patients, 32 were assigned to the cirrhosis, and 996 were assigned to the non-cirrhosis (control) group. Compared with the control group cirrhotic patients were slightly younger in age (74.5 vs 81.2 years), had a slightly higher BMI (31.3 vs 29.3), and had a higher incidence of prior history of myocardial infarction (38% vs 33%). Baseline variables including the history of smoking, hypertension, diabetes, and atrial fibrillation were comparable in both groups. Among cirrhotic patients (n=32), the most common etiologies were non-alcoholic steatohepatitis (NASH) (37.5%), Alcoholism (18.75%), and Hepatitis C (12.5%). The mean MELD-NA score was 11.8 and 67% of patients were Child PUGH Class A and 33% were Child PUGH Class B and all patients had a Child PUGH score of ≥5. 53% of patients (n=17) in the cirrhosis group were evaluated by Hepatology and 12.5% (n=4) were evaluated for a liver transplant but only 1 patient had a liver transplant post-TAVR. Compared with the control group cirrhotic patients had similar 1-year mortality (12% vs 12%, p=1), had a lower rate of 30-day new pacemaker post tavr (6% vs 9% p=0.85), had a higher rate of 1-year readmission for heart failure (12% vs 5% p=0.12) and similar 1-year major adverse cardiac and cerebrovascular event (MACCE) rate (15% vs 14% p=0.98)

Conclusion

Patients with severe AS undergoing TAVR with concomitant liver cirrhosis demonstrate comparable outcomes compared with their non- cirrhotic counterparts. NASH followed by alcoholic cirrhosis was found to be most common etiology.

Funding Acknowledgement

Type of funding sources: None. Figure 1Figure 2

Valorisation of waste galvanizing dross: Emphasis on recovery of zinc with zero effluent strategy

Galvanizing dross-a waste product from steel industries but it can be a potential secondary resource for zinc through urban mining and recycling. In this concern, a novel and scalable recycling route with zero effluent strategy is developed for the recovery of zinc from galvanizing dross as high grade zinc salts along with value-added products through hydrometallurgical processing. In particular, as-such dross block was leached in 9% (v/v) sulphuric acid medium, wherein strong hydrogen gas effervescence results in alleviating the pulverization and stirring requirements; which are material and energy intensive. Leached zinc is purified and recovered as high purity ZnSO₄.(H₂O/7H₂O) and Zn₃(PO₄)₂.4H₂O through controlled crystallization and phosphate precipitation respectively; which find application in fertilizers and anti-corrosive paints. Temperature difference method was opted for the crystallization of zinc sulfate salts, wherein 70 °C and 30 °C were found to be stability range of crystallization of ZnSO₄.H₂O and ZnSO₄.7H₂O respectively. ZnSO₄-H₂O phase diagram is developed using Factsage calculations to corroborate crystallization study. Moreover, exhaustive thermodynamic analysis of Zn²⁺-PO₄^3--H₂O system at 303 K on precipitation of zinc phosphate using di-ammonium hydrogen phosphate (80-240 g/L) is conducted and the results reveal that with increasing pH (3-6), intermediate hydrogen phosphate species (H₃PO₄, H₂PO₄^- and H₂PO₄^2-) decompose to produce stable PO₄^3- ions leading to zinc phosphate precipitation. Impurity like Iron and supernatant solution left after crystallization are recovered as hydrated iron-calcium sulfate mixture and ammonium sulfate salt respectively. This explored route is economical and easily adaptable with zero effluents, therefore, transcends serious challenges in terms of energy requirement, scale-up and effluent generation.

Monitoring and automatic tuning and stabilization of a 2×2 MZI optical switch for large-scale WDM switch networks

Large-scale optical switch networks employ wavelength division multiplexing to expand and facilitate multiple input and outputs. Such networks can be implemented with the Mach-Zehnder interferometer (MZI) as the building block. A fully-loaded MZI switch, meaning one with two optical signals at its two inputs and one that is capable of simultaneously switching those inputs to its two outputs, reduces the number building blocks within the network, and as a result makes them more power and area efficient. However, for practical operation, such MZI switches need to be automatically controlled for overcoming fabrication and thermal variations. We present an interference-based monitoring method that enables automatically switching, tuning, and stabilizing of a fully-loaded 2×2 MZI optical switch and demonstrate a prototype on an SOI platform. Using the proposed device and off-the-shelf electronics, we demonstrate automatic tuning and stabilization of an MZI switch with 12.5 Gb/s and 25 Gb/s data rates and channel spacing as small as 1 nm.

Analysing malaria incidence at the small area level for developing a spatial decision support system: A case study in Kalaburagi, Karnataka, India

Spatial decision support systems have already proved their value in helping to reduce infectious diseases but to be effective they need to be designed to reflect local circumstances and local data availability. We report the first stage of a project to develop a spatial decision support system for infectious diseases for Karnataka State in India. The focus of this paper is on malaria incidence and we draw on small area data on new cases of malaria analysed in two-monthly time intervals over the period February 2012 to January 2016 for Kalaburagi taluk, a small area in Karnataka. We report the results of data mapping and cluster detection (identifying areas of excess risk) including evaluating the temporal persistence of excess risk and the local conditions with which high counts are statistically associated. We comment on how this work might feed into a practical spatial decision support system.

Factors Influencing Drivers' Left Turn Decisions

An experiment is reported which examined drivers' responses in turning left across a line of traffic as presented in a closed-loop, interactive, fixed-base driving simulator. Drivers were located near an intersection and instructed to turn left across a stream of on-coming traffic when they felt that it was safe for them to do so. The on-coming stream of traffic was varied in terms of the physical parameters of approach velocity, inter-vehicle time interval, and vehicle type. Specifically, seven velocities (10–70 mph) were crossed with seven gap sizes (3–9 sec) to yield forty-nine within-subject conditions for each of four, between-subject, vehicle types; motorcycle, compact car, large car, and delivery truck. There were ten subjects per vehicle type, giving forty total participants in the experiment. Results indicated differential acceptance of gap and velocity combinations depending upon the type of approaching vehicle. Collisions tended to occur along the boundaries where driver's decisions to reject or accept turns were ambivalent. They also occurred with greater frequency at higher velocity approach rates. Turn decisions were not dependent upon a single physical parameter such as vehicle velocity or inter-vehicle distance, although gap-size generated an arguable influence. Rather, left turn decisions appeared to result from the complex interplay of rate-of-change perceptual variables such as “time-to-contact” and the perceived characteristics of the vehicles themselves. Implications of the results are discussed with respect to the perception of vehicles and turn safety at roadway intersections.

Oral nifedipine versus intravenous labetalol for severe hypertension during pregnancy: a systematic review and meta-analysis

BACKGROUND

Oral nifedipine is recommended along with labetalol and hydralazine for treatment of severe hypertension during pregnancy by most authorities. Although nifedipine is cheap and easily administered, the usage pattern among health care providers suggests a strong preference for labetalol despite lack of evidence for the same.

OBJECTIVES

To determine the efficacy and safety of oral nifedipine for treatment of severe hypertension of pregnancy compared with intravenous labetalol.

SEARCH STRATEGY

We systematically searched for articles comparing oral nifedipine with intravenous labetalol for the treatment of severe hypertension during pregnancy in any language, over Medline, Cochrane Central Register of Clinical Trials and Google Scholar from inception till February 2014.

SELECTION CRITERIA

We included all RCTs that compared intravenous labetalol with oral nifedipine for treatment of severe hypertension during pregnancy, addressing relevant efficacy and safety outcomes.

DATA COLLECTION AND ANALYSIS

Eligible studies were reviewed, and data were extracted onto a standard form. We used Cochrane review manager software for quantitative analysis. Data were analysed using a fixed effect model.

MAIN RESULTS

The pooled analysis of seven trials (four from developing countries) consisting of 363 woman-infant pairs showed that oral nifedipine was associated with less risk of persistent hypertension (RR 0.42, 95% CI 0.18-0.96) and reported maternal side effects (RR 0.57, 95% CI 0.35-0.94). However, on sensitivity analysis the outcome 'persistent hypertension' was no longer significant. Other outcomes did not reach statistical significance.

CONCLUSION

Oral nifedipine is as efficacious and safe as intravenous labetalol and may have an edge in low resource settings.

TWEETABLE ABSTRACT

Although studies to date are few in number and small, nifedipine shows promise for severe hypertension in pregnancy.

Multiple cysts in kidneys: a case report

Von Hippel-Lindau (VHL) disease, which is an autosomal dominant inherited disease, is characterized by highly vascularized tumors in different organs. We report a 42-year-old male who presented to our hospital with diarrhea and weight loss of six months' duration. Ultrasonography of the abdomen revealed bilateral polycystic kidneys with multiple cystic and solid components as well as polycystic pancreas. A computerized tomography scan of the abdomen revealed bilateral multiple simple and complex renal cysts, cystic lesions in the head and body of the pancreas and a non-enhancing lesion in the left adrenal gland. The features raised the possibility of VHL syndrome and a biopsy of the kidney revealed atypical cells with a suspicion of malignancy. He underwent bilateral nephrectomy and is on maintenance dialysis since then.

Emphysematous pyelonephritis: A single center study

We present our experience of 22 cases of emphysematous pyelonephritis (EPN) treated from 1996 to 2012. Medical records were analyzed retrospectively for demographic profile, presence and duration of diabetes mellitus, and mode of clinical presentation. EPN was diagnosed based on demonstration of intra-renal gas by plain X-ray, ultrasound, and/or computed tomography (CT) scan. Details of medical treatment, reason for surgical intervention, and final outcome were recorded. Univariate analysis was performed to identify risk factors for mortality and P value of less than 0.05 was taken as significant. Twenty-two cases (6 males, 16 females) of EPN were diagnosed. Seven cases presented with acute pyelonephritis, seven cases with urosepsis, and the remaining eight patients with multi-organ dysfunction. CT grading of EPN was class IV in three, class III in four, class II in 14, and class I in one. All were initially managed medically with parenteral antibiotics. Ten patients needed additional surgical intervention. The overall survival rate was 86.3% (19/22). Among the risk factors analyzed higher CT grade, altered sensorium and thrombocytopenia were significantly associated with mortality. We conclude that a more conservative approach in managing EPN has become the standard of care. Patients having high CT grade of lesions (III and IV) with altered sensorium and thrombocytopenia at presentation are more likely to die due to the disease and may be better managed by an aggressive surgical plan.

A method for spatially resolved local intracellular mechanochemical sensing and organelle manipulation

Because both the chemical and mechanical properties of living cells play crucial functional roles, there is a strong need for biophysical methods to address these properties simultaneously. Here we present a novel (to our knowledge) approach to measure local intracellular micromechanical and chemical properties using a hybrid magnetic chemical biosensor. We coupled a fluorescent dye, which serves as a chemical sensor, to a magnetic particle that is used for measurement of the viscoelastic environment by studying the response of the particle to magnetic force pulses. As a demonstration of the potential of this approach, we applied the method to study the process of phagocytosis, wherein cytoskeletal reorganization occurs in parallel with acidification of the phagosome. During this process, we measured the shear modulus and viscosity of the phagosomal environment concurrently with the phagosomal pH. We found that it is possible to manipulate phagocytosis by stalling the centripetal movement of the phagosome using magnetic force. Our results suggest that preventing centripetal phagosomal transport delays the onset of acidification. To our knowledge, this is the first report of manipulation of intracellular phagosomal transport without interfering with the underlying motor proteins or cytoskeletal network through biochemical methods.

Abolition of endocrine dimorphism in hyperthyroid males? An argument for the positive feedback effect of hyperoestrogenaemia on LH secretion

Our aim was (i) to investigate the hypothalamo-hypophyseal-gonadal axis in hyperthyroid Indian males, (ii) to rule out the modulatory role of adrenal steroids on it and (iii) to determine if the simultaneous rise in oestradiol and luteinising hormone (LH) in hyperthyroid males is due to a positive feedback action of oestradiol on pituitary LH release. Age- and BMI-matched men were divided into two groups, I, euthyroid subjects (n = 17) and II, hyperthyroid patients (n = 12) on the basis of their thyroid hormone levels. Serum levels of thyroid-stimulating hormone, triiodothyronine, thyroxine, LH, follicle-stimulating hormone (FSH), prolactin, E(2), T, P(4), sex hormone binding globulin and dehydroepiandrosterone sulphate (DHEAS) were assayed. Mean levels of T and E(2) were approximately two times higher in group II in comparison with group I. DHEAS levels were similar in both groups ruling out any adrenal involvement. Mean serum LH level was 2.6 folds higher in group II in comparison with group I. Mean serum levels of FSH were higher in group II, it was marginally nonsignificant. On the basis of these and previous observations, we hypothesise that endocrinological dimorphism in human male and female is not rigid; a sustained rise in serum oestradiol probably induces a positive feedback action on pituitary leading to elevated gonadotrophin levels.

A prospective study of the long-term efficacy of local methyl prednisolone acetate injection in the management of mild carpal tunnel syndrome

OBJECTIVE

Local glucocorticoid injections are used to treat carpal tunnel syndrome (CTS). However, this treatment is associated with frequent relapses. An important limitation of studies with higher relapse rates is that no attempt has been made to identify patients with mild or severe disease. We evaluated the efficacy of local glucocorticoid injection in patients with mild CTS.

METHOD

Mild CTS was defined as intermittent symptoms without absence of sensations, muscle atrophy or weakness of the thenar muscles. Forty-eight patients with idiopathic mild CTS were evaluated before and 3 and 12 months after a single local injection of 40 mg methyl prednisolone acetate. Outcome was assessed by overall satisfaction on a 100 mm visual analogue scale, the Boston self-administered questionnaire for symptom severity and functional scores and improvement in the electrophysiological parameters.

RESULTS

At 3 months, 93.7% of the patients reported marked improvement in their symptoms, with significant improvement in the mean values of the nerve conduction parameters distal motor latency at the wrist (DML) (P = 0.00001), distal sensory latency at mid-palm (DSL MP) (P = 0.014) and distal sensory latency at the wrist (DSL W) (P = 0.0003), and symptom severity (P = 4.96 x 10(-8)) and the functional scores (P = 3.56 x 10(-5)). Significant improvement was still present for DML (P = 1.39 x 10(-5)) at 12 months. Almost 50% of the patients achieved normalization in the electrophysiological study. At a median follow-up of 16 months, 79% patients continued to have improvement in their symptoms. Eight patients (16.6%) relapsed following the initial response.

CONCLUSIONS

Local glucocorticoid injection results in long-term improvement in nerve conduction parameters, symptom severity and functional scores in patients with mild CTS.