Assessment of Platelet-Rich Plasma Alone and Platelet-Rich Plasma Combined with Bioactive Glass in the Management of Intrabony Defect

Objectives

To assess the function of platelet-rich plasma (PRP) both only and in combination with bioactive glass in intrabony defects.

Materials and Method

Twenty patients were split into two groups with 10 samples each: group I with PRP alone, whereas group II was done with PRP in addition to bioactive glass. Following local anesthesia, full-thickness mucoperiosteal flaps were elevated in the afflicted site, the defect was debrided, and root planning with curettes was performed. Irrigation was then used while in group II- PRP along with bone graft (BG) preservationwas done. Suturing in group I was contained. At day 0 (baseline) and 6 months after surgery, the clinical parameters for probing depth, clinical attachment stage, and radiographic assessment were noted for both groups.

Result

When comparing both groups, there was no statistically considerable variation. However, the intragroup comparison for pocket depth and clinical attachment level between baseline and 6 months was significant. Radiographic bone level was not considerably dissimilar across groups; however, it was significantly different between groups.

Conclusion

Reduced probing depth, higher clinical attachment level, and radiographic evidence of bone fill are clinical outcome measures that are associated with effective regenerative therapy.

Application of short-wave pocket-sized near-infrared spectrophotometer to predict milk quality traits

Portable-hand-held devices based on near-infrared (NIR) technology have improved and are gaining popularity, even if their implementation in milk has been barely evaluated. Thus, the aim of the present study was to assess short-wave pocket-sized NIR devices' feasibility to predict milk quality. A total of 331 individual milk samples from different cow breeds and herds were collected in 2 consecutive days for chemical determination and spectral collection by using 2 pocket-sized NIR spectrophotometers working in the range of 740-1070 nm. The reference data was matched with the corresponding spectrum and modified-partial least-squares regression models were developed. A 5-fold cross-validation was applied to evaluate individual devices' performance and an external-validation with 25% of the data set as the validation set was applied for the final models. Results revealed that both devices' absorbance was highly correlated but greater for instrument A than B. Thus, the final models were built by averaging the spectra from both devices for each sample. The fat content prediction model was adequate for quality control with a coefficient of determination (R2ExV) and a residual predictive deviation (RPDExV) in external validation of 0.93 and 3.73, respectively. Protein and casein content as well as fat-to-protein ratio prediction models might be used for a rough screening (R2ExV > 0.70; RPDExV > 1.73). However, poor prediction models were obtained for all the other traits with an R2ExV between 0.43 (urea) and 0.03 (somatic cell count), and a RPDExV between 1.18 (urea) and 0.22 (somatic cell count). In conclusion, short-wave portable-hand-held NIR devices accurately predicted milk fat content, and protein, casein, and fat-to-protein ratio might be applied for rough screening. It seems that there is not enough information in this NIR region to develop adequate prediction models for lactose, somatic cell count, urea, and freezing point.

Clinical and radiographic assessment of periodontal status among patients with post-COVID mucormycosis: A cross-sectional study

Background

An escalation in cases of rhinomaxillary mucormycosis among post-COVID patients is being reported. However, there is limited information about periodontal features in mucormycosis cases. This study explored the periodontal signs and symptoms among post-COVID mucormycosis individuals.

Materials and Methods

This cross-sectional study was carried out with a total of 25 post-COVID mucormycosis patients attending tertiary care public teaching hospital. Clinical and radiographic assessments were done.

Results

An elevation in mean probing pocket depth (PPD) up to 6.21 ± 2.7 mm was noted. Nearly 16%-40% of patients had Miller's Grade III mobility in the affected site. Forty-four per cent had localized single or multiple abscess, 40% had palatal swelling, 32% had necrosis of soft tissue and bone exposure, and 52% had maxillary dentoalveolar segmental mobility in the affected site. Radiographic examination revealed varying stages of interdental bone loss.

Conclusion

The present study observed an increase in mobility and mean PPD which did not commiserate with interdental bone loss in the affected maxillary region.

Novel SiGe/Si Heterojunction Double-Gate Tunneling FETs with a Heterogate Dielectric for High Performance

In this paper, a new SiGe/Si heterojunction double-gate heterogate dielectric tunneling field-effect transistor with an auxiliary tunneling barrier layer (HJ-HD-P-DGTFET) is proposed and investigated using TCAD tools. SiGe material has a smaller band gap than Si, so a heterojunction with SiGe(source)/Si(channel) can result in a smaller tunneling distance, which is very helpful in boosting the tunneling rate. The gate dielectric near the drain region consists of low-k SiO₂ to weaken the gate control of the channel-drain tunneling junction and reduce the ambipolar current (I_amb). In contrast, the gate dielectric near the source region consists of high-k HfO₂ to increase the on-state current (I_on) through the method of gate control. To further increase I_on, an n⁺-doped auxiliary tunneling barrier layer (pocket)is used to reduce the tunneling distance. Therefore, the proposed HJ-HD-P-DGTFET can obtain a higher on-state current and suppressed ambipolar effect. The simulation results show that a large I_on of 7.79 × 10^-5 A/μm, a suppressed I_off of 8.16 × 10^-18 A/μm, minimum subthreshold swing (SS_min) of 19 mV/dec, a cutoff frequency (f_T) of 19.95 GHz, and gain bandwidth product (GBW) of 2.07 GHz can be achieved. The data indicate that HJ-HD-P-DGTFET is a promising device for low-power-consumption radio frequency applications.

Device infections related to cardiac resynchronization therapy in clinical practice-An analysis of its prevalence, risk factors and routine surveillance at a single center university hospital

Background

The implantation rates of cardiac implantable electronic devices have steadily increased, accompanied by a steeper rise of device related infections (DRI).

Hypothesis

The prevalence of DRI for cardiac resynchronization therapy (CRT) is higher in clinical practice than reported previously, even at a university hospital, and likely higher than reported to the national device registry.

Methods

Electronic medical records of consecutive patients undergoing a CRT procedure between January 2016 and December 2017 were analyzed. Clinical history, procedure related variables and complications were reviewed by specialists in cardiology and infectious diseases.

Results

A total of 171 patients, mean aged 74 years, 138 males (80.7%) were included. Twelve DRI occurred in 10 patients during mean 2.5 years follow‐up, giving a prevalence of 7% (incidence of 29/1000 person‐years). Reoperation, pocket haematoma, ≥3 procedures, previous device infection and indwelling central venous line were the strongest predictive factors according to univariate analysis. Out of 63/171 (36.8%) major complications, 31(49.2%) were lead‐related. There were 49/171 (28.7%) reoperations and 15/171 (8.8%) minor complications. The number major complications and DRI reported to the national device registry were 7/171 (4.1%) and 2/171 (0.6%), respectively, reflecting a 5‐fold underreporting.

Conclusions

The high rate of CRT device infections is in sharp contrast to those reported by others and to the national device registry. Although a center specific explanation cannot be excluded, the high rates highlight a major issue with registries, reinforcing the need for better surveillance and automatic reporting of device related complications.

Blockage of Store-Operated Ca2+ Influx by Synta66 is Mediated by Direct Inhibition of the Ca2+ Selective Orai1 Pore

The Ca2+ sensor STIM1 and the Ca2+ channel Orai1 that form the store-operated Ca2+ (SOC) channel complex are key targets for drug development. Selective SOC inhibitors are currently undergoing clinical evaluation for the treatment of auto-immune and inflammatory responses and are also deemed promising anti-neoplastic agents since SOC channels are linked with enhanced cancer cell progression. Here, we describe an investigation of the site of binding of the selective inhibitor Synta66 to the SOC channel Orai1 using docking and molecular dynamics simulations, and live cell recordings. Synta66 binding was localized to the extracellular site close to the transmembrane (TM)1 and TM3 helices and the extracellular loop segments, which, importantly, are adjacent to the Orai1-selectivity filter. Synta66-sensitivity of the Orai1 pore was, in fact, diminished by both Orai1 mutations affecting Ca2+ selectivity and permeation of Na+ in the absence of Ca2+. Synta66 also efficiently blocked SOC in three glioblastoma cell lines but failed to interfere with cell viability, division and migration. These experiments provide new structural and functional insights into selective drug inhibition of the Orai1 Ca2+ channel by a high-affinity pore blocker.

Characterization of Self-Processing Activities and Substrate Specificities of Porcine Torovirus 3C-Like Protease

The 3C-like protease (3CL^pro) of nidovirus plays an important role in viral replication and manipulation of host antiviral innate immunity, which makes it an ideal antiviral target. Here, we characterized that porcine torovirus (PToV; family Tobaniviridae, order Nidovirales) 3CL^pro autocatalytically releases itself from the viral precursor protein by self-cleavage. Site-directed mutagenesis suggested that PToV 3CL^pro, as a serine protease, employed His53 and Ser160 as the active-site residues. Interestingly, unlike most nidovirus 3CL^pro, the P1 residue plays a less essential role in N-terminal self-cleavage of PToV 3CL^pro Substituting either P1 or P4 residue of substrate alone has little discernible effect on N-terminal cleavage. Notably, replacement of the two residues together completely blocks N-terminal cleavage, suggesting that N-terminal self-cleavage of PToV 3CL^pro is synergistically affected by both P1 and P4 residues. Using a cyclized luciferase-based biosensor, we systematically scanned the polyproteins for cleavage sites and identified (FXXQ↓A/S) as the main consensus sequences. Subsequent homology modeling and biochemical experiments suggested that the protease formed putative pockets S1 and S4 between the substrate. Indeed, mutants of both predicted S1 (D159A, H174A) and S4 (P62G/L185G) pockets completely lost the ability of cleavage activity of PToV 3CL^pro In conclusion, the characterization of self-processing activities and substrate specificities of PToV 3CL^pro will offer helpful information for the mechanism of nidovirus 3C-like proteinase's substrate specificities and the rational development of the antinidovirus drugs.IMPORTANCE Currently, the active-site residues and substrate specificities of 3C-like protease (3CL^pro) differ among nidoviruses, and the detailed catalytic mechanism remains largely unknown. Here, porcine torovirus (PToV) 3CL^pro cleaves 12 sites in the polyproteins, including its N- and C-terminal self-processing sites. Unlike coronaviruses and arteriviruses, PToV 3CL^pro employed His53 and Ser160 as the active-site residues that recognize a glutamine (Gln) at the P1 position. Surprisingly, mutations of P1-Gln impaired the C-terminal self-processing but did not affect N-terminal self-processing. The "noncanonical" substrate specificity for its N-terminal self-processing was attributed to the phenylalanine (Phe) residue at the P4 position in the N-terminal site. Furthermore, a double glycine (neutral) substitution at the putative P4-Phe-binding residues (P62G/L185G) abolished the cleavage activity of PToV 3CL^pro suggested the potential hydrophobic force between the PToV 3CL^pro and P4-Phe side chains.

Detection of cave pockets in large molecules: Spaces into which internal probes can enter, but external probes from outside cannot

Geometric features of macromolecular shapes are important for binding with other molecules. Kawabata, T. and Go, N. (2007) defined a pocket as a space into which a small probe can enter, but a large probe cannot. In 2010, mathematical morphology (MM) was introduced to provide a more rigorous definition, and the program GHECOM was developed using the grid-based representation of molecules. This method was simple, but effective in finding the binding sites of small compounds on protein surfaces. Recently, many 3D structures of large macromolecules have been determined to contain large internal hollow spaces. Identification and size estimation of these spaces is important for characterizing their function and stability. Therefore, we employ the MM definition of pocket proposed by Manak, M. (2019)—a space into which an internal probe can enter, but an external probe cannot enter from outside of the macromolecules. This type of space is called a “cave pocket”, and is identified through molecular grid-representation. We define a “cavity” as a space into which a probe can enter, but cannot escape to the outside. Three types of spaces: cavity, pocket, and cave pocket were compared both theoretically and numerically. We proved that a cave pocket includes a pocket, and it is equal to a pocket if no cavity is found. We compared the three types of spaces for a variety of molecules with different-sized spherical probes; cave pockets were more sensitive than pockets for finding almost closed internal holes, allowing for more detailed representations of internal surfaces than cavities provide.

Voronoi-based detection of pockets in proteins defined by large and small probes

The function of enzymatic proteins is given by their ability to bind specific small molecules into their active sites. These sites can often be found in pockets on a hypothetical boundary between the protein and its environment. Detection, analysis, and visualization of pockets find its use in protein engineering and drug discovery. Many definitions of pockets and algorithms for their computation have been proposed. Kawabata and Go defined them as the regions of empty space into which a small spherical probe can enter but a large probe cannot and developed programs that can compute their approximate shape. In this article, this definition was slightly modified in order to capture the existence of large internal holes, and a Voronoi-based method for the computation of the exact shape of these modified regions is introduced. The method first puts a finite number of large probes on the protein exterior surface and then, considering both large probes and atomic balls as obstacles for the small probe, the method computes the exact shape of the regions for the small probe. This is all achieved with Voronoi diagrams, which help with the safe navigation of spherical probes among spherical obstacles. Detected regions are internally represented as graphs of vertices and edges describing possible movements of the center of the small probe on Voronoi edges. The surface bounding each region is obtained from this representation and used for visualization, volume estimation, and comparison with other approaches. © 2019 Wiley Periodicals, Inc.

A simple technique for relocating chronic CIED leads to a subpectoral position for relief of erosion and pain

BACKGROUND

Methodology specific for moving superficial chronically implanted transvenous pacing leads to a subpectoral pocket is not described in the literature. Relocation of prepectoral leads and generator to a submuscular pocket for relief of erosion and pain with minimal pectoral trauma is possible by applying a variant of a previously described submammary tunneling technique.

METHODS

All patients presenting for device follow-up, elective battery replacement, or system upgrade over an 8-month period were considered for relocation if experiencing significant thinning or pain over their prepectoral implant. Those selected for relocation then had their system moved subpectorally via the tunneling technique. Patients were followed for 6 months postoperatively for procedurally related complications and resolution of preprocedure symptoms.

RESULTS

Thirty-two leads in 14 patients were all successfully relocated. Of the relocated leads, five (16%) were a three-pin connector implantable cardioverter defibrillator lead. Three patients (21%) in the group required short-term prescription analgesia in the immediate postdischarge period. Pain and erosion concerns abated in the study group by the 3-month follow-up.

CONCLUSIONS

Relocation of superficial pacing leads with CIED generator to a subpectoral pocket facilitated by this tunneling method is successful, safe, and can accommodate single and multipin leads with minimal pectoral trauma and no nerve damage.

Smartphone App-Based Assessment of Gait During Normal and Dual-Task Walking: Demonstration of Validity and Reliability

BACKGROUND

Walking is a complex cognitive motor task that is commonly completed while performing another task such as talking or making decisions. Gait assessments performed under normal and "dual-task" walking conditions thus provide important insights into health. Such assessments, however, are limited primarily to laboratory-based settings.

OBJECTIVE

The objective of our study was to create and test a smartphone-based assessment of normal and dual-task walking for use in nonlaboratory settings.

METHODS

We created an iPhone app that used the phone's motion sensors to record movements during walking under normal conditions and while performing a serial-subtraction dual task, with the phone placed in the user's pants pocket. The app provided the user with multimedia instructions before and during the assessment. Acquired data were automatically uploaded to a cloud-based server for offline analyses. A total of 14 healthy adults completed 2 laboratory visits separated by 1 week. On each visit, they used the app to complete three 45-second trials each of normal and dual-task walking. Kinematic data were collected with the app and a gold-standard-instrumented GAITRite mat. Participants also used the app to complete normal and dual-task walking trials within their homes on 3 separate days. Within laboratory-based trials, GAITRite-derived heel strikes and toe-offs of the phone-side leg aligned with smartphone acceleration extrema, following filtering and rotation to the earth coordinate system. We derived stride times-a clinically meaningful metric of locomotor control-from GAITRite and app data, for all strides occurring over the GAITRite mat. We calculated stride times and the dual-task cost to the average stride time (ie, percentage change from normal to dual-task conditions) from both measurement devices. We calculated similar metrics from home-based app data. For these trials, periods of potential turning were identified via custom-developed algorithms and omitted from stride-time analyses.

RESULTS

Across all detected strides in the laboratory, stride times derived from the app and GAITRite mat were highly correlated (P<.001, r²=.98). These correlations were independent of walking condition and pocket tightness. App- and GAITRite-derived stride-time dual-task costs were also highly correlated (P<.001, r²=.95). The error of app-derived stride times (mean 16.9, SD 9.0 ms) was unaffected by the magnitude of stride time, walking condition, or pocket tightness. For both normal and dual-task trials, average stride times derived from app walking trials demonstrated excellent test-retest reliability within and between both laboratory and home-based assessments (intraclass correlation coefficient range .82-.94).

CONCLUSIONS

The iPhone app we created enabled valid and reliable assessment of stride timing-with the smartphone in the pocket-during both normal and dual-task walking and within both laboratory and nonlaboratory environments. Additional work is warranted to expand the functionality of this tool to older adults and other patient populations.

Landmark-Based Drift Compensation Algorithm for Inertial Pedestrian Navigation

The navigation of pedestrians based on inertial sensors, i.e., accelerometers and gyroscopes, has experienced a great growth over the last years. However, the noise of medium- and low-cost sensors causes a high error in the orientation estimation, particularly in the yaw angle. This error, called drift, is due to the bias of the z-axis gyroscope and other slow changing errors, such as temperature variations. We propose a seamless landmark-based drift compensation algorithm that only uses inertial measurements. The proposed algorithm adds a great value to the state of the art, because the vast majority of the drift elimination algorithms apply corrections to the estimated position, but not to the yaw angle estimation. Instead, the presented algorithm computes the drift value and uses it to prevent yaw errors and therefore position errors. In order to achieve this goal, a detector of landmarks, i.e., corners and stairs, and an association algorithm have been developed. The results of the experiments show that it is possible to reliably detect corners and stairs using only inertial measurements eliminating the need that the user takes any action, e.g., pressing a button. Associations between re-visited landmarks are successfully made taking into account the uncertainty of the position. After that, the drift is computed out of all associations and used during a post-processing stage to obtain a low-drifted yaw angle estimation, that leads to successfully drift compensated trajectories. The proposed algorithm has been tested with quasi-error-free turn rate measurements introducing known biases and with medium-cost gyroscopes in 3D indoor and outdoor scenarios.

Microbiological Characteristics and Clinical Features of Cardiac Implantable Electronic Device Infections at a Tertiary Hospital in China

The incidence of cardiac implantable electronic device (CIED) infections is rapidly increasing worldwide. However, the microbiological characteristics and clinical features of symptomatic CIED infections are not well described. The present study included patients with CIED infections in China, and their pocket tissues were collected for clinical microbiological determination. A total of 219 patients with CIED infections were investigated; of these patients, 145 (66.2%) were positive for CIED infection in pocket tissue cultures and 24 (11.0%) were positive in both blood and pocket tissue cultures. Patients with recurrent infections and patients with systemic infections tended to have higher rates of positive cultures from pocket tissue. In addition, patients with lung diseases were more likely to have early CIED infections than late CIED infections, while patients with liver diseases were more susceptible to systemic infections than local infections. Staphylococcus species were the most common cause of CIED infections; coagulase-negative staphylococci was the predominant type (accounting for 45.2% in all cases and 68.3% in culture-positive cases). None of the Staphylococcus isolates were resistant to gentamicin, linezolid or vancomycin. Gram-negative bacilli accounted for 9.1% of all cases and 13.8% of culture-positive cases. Significant differences in the distribution of different pathogens were identified between primary infections and recurrent infections, between local infections and systemic infections, and between early infections and late infections. Our data describe the microbiological characteristics and clinical features of CIED infections, and provide evidence for advisory guidelines on the management of CIED infections in China.

Endodontic and periodontal management of a severely affected maxillary lateral incisor having combined mucosal fenestration and palatogingival groove

Mucosal fenestrations, wherein the tooth root apices are clinically discernible in the oral cavity subsequent to loss of overlying alveolar bone and mucosa, are rare pathologic entities. Palato gingival grooves- anatomic aberrations are also infrequent occurrences that notoriously predispose to periodontal pathologies of varying extent. Both conditions independently are known to popularly affect maxillary lateral incisors. Coexistent fenestration defect and palato gingival groove in the same tooth is extremely rare and undoubtedly is a perfect combination to precipitate severe endodontic-periodontal consequences. In this report, a 34-year-old patient presented to the dental department with complaint of esthetics in relation to exposed root of right maxillary lateral incisor. On closer inspection, a palato gingival groove in addition to fenestration defect was evident on the root surface along with a periodontal pocket of >5 mm. An interdisciplinary treatment was instituted which included endodontic treatment followed by root end resection, osseous bone graft placement and guided tissue regeneration procedures for repair of mucosal fenestration defect. Debridement of the palatal pocket, with saucerization of the groove and restoration with glass ionomer cement were simultaneously employed to correct the palatal defect.

Thermal capsulorrhaphy: a modified technique for breast pocket revision

BACKGROUND

Scant attention has been paid to breast capsule revision after augmentation mammaplasty. Dissatisfaction with traditional techniques prompted the senior authors to develop a thermal capsulorrhaphy (TC) technique to obliterate excess breast pocket space using ball cautery followed by barbed suture closure.

OBJECTIVES

The authors propose a new periprosthetic technique for pocket closure, present a corresponding guide for surgical and postoperative management, and provide results of their retrospective review.

METHODS

Medical records were reviewed for all patients who underwent TC after cosmetic augmentation mammaplasty during a 5-year period, for whom clinical photographs were available from at least 1 year postoperatively. Operating details and complications were documented. Outcomes were rated a success, partial success, or failure, based on analysis of the photographs.

RESULTS

Of the 157 TC cases (41 unilateral, 58 bilateral) with a mean follow-up of 2 years, 141 (90%) outcomes were successful, 4 (2%) were partially successful, and 12 (8%) had failed. There were 16 complications: 10 over- or undercorrections and 1 episode each of hematoma, capsular contracture, slight deformity, nipple sensitivity, exposed suture knot, and suture abscess.

CONCLUSIONS

The efficacy of TC derives from the symbiosis of stitches and heat: capsulorrhaphy reinforces apposition of the damaged walls, and cautery contracts and thickens the capsule, thus reducing dead space and improving suture purchase. Initially popularized in shoulder surgery, TC is even better suited for breast pocket closure due to superior visibility and maneuverability, more aggressive practices, and the lack of similar complications. Postoperative stabilization and guideline compliance are essential to successful revision.

LEVEL OF EVIDENCE

4.

Chapter 4. Predicting and characterizing protein functions through matching geometric and evolutionary patterns of binding surfaces

Predicting protein functions from structures is an important and challenging task. Although proteins are often thought to be packed as tightly as solids, closer examination based on geometric computation reveals that they contain numerous voids and pockets. Most of them are of random nature, but some are binding sites providing surfaces to interact with other molecules. A promising approach for function prediction is to infer functions through discovery of similarity in local binding pockets, as proteins binding to similar substrates/ligands and carrying out similar functions have similar physical constraints for binding and reactions. In this chapter, we describe computational methods to distinguish those surface pockets that are likely to be involved in important biological functions, and methods to identify key residues in these pockets. We further describe how to predict protein functions at large scale from structures by detecting binding surfaces similar in residue make-ups, shape, and orientation. We also describe a Bayesian Monte Carlo method that can separate selection pressure due to biological function from pressure due to protein folding. We show how this method can be used to reconstruct the evolutionary history of binding surfaces for detecting similar binding surfaces. In addition, we briefly discuss how the negative image of a binding pocket can be casted, and how such information can be used to facilitate drug discovery.