Disease-specific wearable sensor algorithms for profiling activity, gait, and balance in individuals with Charcot-Marie-Tooth disease type 1A

BACKGROUND/AIMS

Charcot-Marie-Tooth Disease type 1A (CMT1A), the most common inherited peripheral neuropathy, is characterized by progressive sensory loss and weakness, which results in impaired mobility. Increased understanding of the genetics and pathophysiology of CMT1A has led to development of potential therapeutic agents, necessitating clinical trial readiness. Wearable sensors may provide useful outcome measures for future trials.

METHODS

Individuals with CMT1A and unaffected controls were recruited for this 12-month study. Participants wore sensors for in-clinic assessments and at-home, from which activity, gait, and balance metrics were derived. Mann-Whitney U tests were used to analyze group differences for activity, gait, and balance parameters. Test-retest reliability of gait and balance parameters and correlations of these parameters with clinical outcome assessments (COAs) were examined.

RESULTS

Thirty individuals, 15 CMT1A, and 15 controls, participated. Gait and balance metrics demonstrated moderate to excellent reliability. CMT1A participants had longer step durations (p < .001), shorter step lengths (p = .03), slower gait speeds (p < .001), and greater postural sway (p < .001) than healthy controls. Moderate correlations were found between CMT-Functional Outcome Measure and step length (r = -0.59; p = .02), and gait speed (r = 0.64; p = .01); 11 out of 15 CMT1A participants demonstrated significant increases in stride duration between the first and last quarter of the 6-min walk test, suggesting fatigue.

INTERPRETATION

In this initial study, gait and balance metrics derived from wearable sensors were reliable and associated with COAs in individuals with CMT1A. Larger longitudinal studies are needed to confirm our findings and evaluate sensitivity and utility of these disease-specific algorithms for clinical trial use.

Functional traits and phylogenetic analysis of top-soil inhabiting rhizobacteria associated with tea rhizospheres in North Bengal, India

Rhizobacteria associated with cultivated crops are known to stimulate plant growth through various indirect or direct mechanisms. In recent years, the host list of plant growth promotion/promoting rhizobacteria has expanded to include bean, barley, cotton, maize, rice, vegetables, peanut, rice, wheat, and several plantation crops. However, interaction of rhizobacteria with tea plants of organic and conventional tea gardens is poorly understood. In the present study, rhizobacterial species associated with tea rhizosphere were isolated from 14 tea gardens located in North Bengal, India. In total, 16 rhizobacterial isolates isolated from collected soil samples were assessed for antagonistic and plant growth promotion/promoting activity under laboratory conditions. Molecular characterization based on sequencing of 16S rRNA gene revealed dominance of Bacillus with five species followed by Pseudomonas with two species. Interestingly, only one isolate was affiliated with actinobacteria, i.e., Microbacterium barkeri. Out of 16 isolates, isolates Bacillus subtilis OKAKP01, B. subtilis BNLG01, B. paramycoides BOK01, M. barkeri BPATH02, and Stenotrophomonas maltophilia BSEY01 showed highest growth inhibition against Fusarium solani (68.2 to 72.8%), Pseudopestalotiopsis theae (71.1 to 85.6%), and Exobasidium vexans (67.4 to 78.3%) causing respective Fusarium dieback, gray blight, and blister blight diseases in tea crop. Further, these five isolates also possessed significantly greater antifungal (siderophore producer, protease, chitinase, and cellulase activity) and plant growth promotion/promoting (indole-3-acetic acid production, ACC deaminase, ammonia, and phosphate solubilization) traits over other eleven rhizobacterial isolates. Therefore, these five isolates of rhizobacteria were chosen for their plant growth promotion/promoting activity on tea plants in nursery conditions. Results from nursery experiments revealed that these five rhizobacteria significantly improved growth rates of tea plants compared with the control. Therefore, this study suggests that these rhizobacteria could be used to formulate biopesticides and biofertilizers, which could be applied to sustainable tea cultivation to improve crop health and reduce disease attack.

Evaluation of the effect of remineralization with strontium-doped nanohydroxyapatite with noncollagenous protein analog: Chitosan on the shear bond strength of resin composite to dentin - An in vitro study

Context

The resin-dentin interface is less durable, which reduces the longevity of tooth-colored restorations. To encounter this shortcoming, the use of nanotechnology to mimic biomineralization proves beneficial.

Aims

This study was conducted to evaluate the effect of remineralization with strontium-doped nanohydroxyapatite (Sr-nHAp) with chitosan on shear bond strength of resin composite to dentin.

Materials and Methods

Sixty five extracted human premolars were divided into five groups (n = 13) based on remineralization protocol as: Group A - 20% (Sr-nHAp) with chitosan, Group B - 10% (Sr-nHAp) with chitosan, Group C - 20% (Sr-nHAp) with simulated body fluid, Group D - 10% (Sr-nHAp) with simulated body fluid, and Group E - control. Following bonding, resin composite of specified dimension was built and was subjected to shear bond strength test after 24 h and 1 week using Universal Testing Machine, and mode of failure was assessed. ANOVA and paired sample t-test were used for analyzing the data, and the level of significance was set at 5%.

Results

The highest value of shear bond strength was obtained from Group A after aging for a week, and there is a significant increase in the value of all the groups as compared to the control group after 1 week of storage than 24 h.

Conclusions

Remineralization with Sr-nHAp and chitosan has positively improved the bond strength of resin to dentin at the end of 1 week.

Comparative evaluation of decalcifying agents for dissolution of pulp stones: An in vitro study

Background:

Despite constant advances in science, obscurity remains in the efficient removal of pulp stones to aid in successful root canal treatment. In this context, chemical means of dissolving pulp stones were explored.

Aim:

The aim of this study is to evaluate and to compare the efficacy of decalcifying agents on the dissolution of pulp stones.

Materials and Methods:

The study was divided into two groups for pulp stone analysis (21 samples) and dentin analysis (54 samples). Twenty-one pulp stones from patients aged 18–70 who underwent root canal treatment were collected and divided into three subgroups (n = 7) randomly. They were subjected to chemical treatment in a labeled glass container with 5 ml of the respective chemical agents, such as 17% ethylenediaminetetraacetic acid solution (positive control), no treatment (negative control), and newly developed Physiological Simulated Decalcifying Agent (PSDA). At the end of the study period (24 h), the samples were removed, rinsed with deionized water, and subjected to physical analysis, scanning electron microscopy (SEM), and Energy –dispersive X-ray spectroscopy (EDS) analysis. Under dentin analysis, 54 maxillary premolars scheduled for orthodontic extraction without caries or extensive restorations were selected, following which 2-mm thick transverse dentinal sections at the cementoenamel junction level were obtained and randomly divided into two groups for SEM (n = 21) and microhardness analysis (n = 33). The samples were subjected to respective chemical treatment groups similar to pulp stones for 24 h and analyzed using SEM, EDS, and microhardness analysis.

Results:

Postchemical treatment with the newly developed decalcifying solution, the pulp stones showed the absence of nodular crystallites and surface softening under SEM and a decrease in the calcium level under EDS analysis. Concerning the microhardness of dentin, no significant changes could be observed.

Conclusion:

The newly explored PSDA was found to be efficacious in the decalcification of pulp stones at a clinically relevant time of 24 h, without significantly affecting the structural integrity and the hardness values of dentin.

The efficacy of transdermal and oral diclofenac for post-endodontic pain control: A randomised controlled trial

Objective

The aim of the present study was to compare the effect of transdermal diclofenac patch against oral diclofenac for post-endodontic pain control.

Materials and Methods

Thirty-two patients with symptomatic irreversible pulpitis in single-rooted premolar teeth of either arch were treated endodontically in a single visit by a single endodontist. Oral diclofenac (50 mg twice daily) for group I and transdermal diclofenac patch (100 mg once daily) for group II were administered as post-endodontic analgesics for two days. Visual analogue scale (VAS) chart was used to record pain intensity scores preoperatively and at intervals of 4, 8, 12 and 24 h postoperatively for 2 days. Paracetamol 650 mg tablets were provided as rescue medication.

Results

There was a significant decrease in the postoperative pain intensity scores for both groups. The postoperative scores gradually decreased from day 1 to day 2 in both groups. Twelve out of sixteen patients who had received diclofenac tablets complained of gastric discomfort.

Conclusion

Transdermal diclofenac patch was as effective as an oral diclofenac tablet and can be used as an alternative and effective analgesic for post-endodontic pain management, especially in patients with gastric discomfort.

Cone-beam computed tomographic evaluation of remaining dentin thickness in bifurcated roots of maxillary first premolars after rotary instrumentation and post space preparation: An in vitro study

BACKGROUND

Intraradicular procedures remove radicular dentin and jeopardizing longevity of a tooth. Traditional in vitro methods used to determine the remaining dentin thickness (RDT) have limitations.

AIM

The aim is to evaluate, using cone-beam computed tomography (CBCT), RDT following rotary instrumentation and post space preparation in buccal and palatal roots of maxillary first premolars.

MATERIALS AND METHODS

Twenty-three maxillary first premolars with two roots were selected. CBCT images were taken preoperatively, after instrumentation and Parapost 3 and 4 preparation (CBCT 1, 2, 3, and 4). RDT was measured 5 mm above apex, 1 mm below furcation, and 1 mm above furcation (Levels 1, 2, and 3). Data were analyzed using ANOVA and post hoc Tukey's test (P = 0.05).

RESULTS

Rotary instrumentation and post space preparation reduced RDT in all walls of buccal and palatal roots. Post space preparation with Parapost 3 and 4 reduced RDT in the palatal wall of buccal root to <1 mm and Parapost 4 reduced all walls to 1 mm of dentin.

CONCLUSION

Post space preparation in maxillary first premolars should be performed cautiously. It is safer to place a post in the palatal root of this tooth and limit preparation to Parapost 3.

Clinical evaluation of mineral trioxide aggregate and biodentine as direct pulp capping agents in carious teeth

Background:

Root canal treatment has been a routine treatment option for carious exposure of the dental pulp. In the context of minimally invasive dentistry, direct pulp capping (DPC) procedure with a reliable biomaterial may be considered as an alternative provided the pulp status is favorable. Mineral trioxide aggregate (MTA), a bioactive cement with excellent sealing ability and biocompatibility is capable of regenerating relatively damaged pulp and formation of dentin bridge when used as DPC agent. Biodentine is comparatively a new biomaterial claimed to possess properties similar to MTA and is currently explored for vital pulp therapy procedures.

Aim:

The aim of the present study was to evaluate the clinical response of pulp-dentin complex after DPC with MTA and biodentine in carious teeth.

Subjects and Methods:

Twenty-four permanent molars with carious exposure having no signs and symptoms of irreversible pulpitis were selected and assigned to one of the two groups, Group I - MTA and Group II - biodentine. Patients were recalled at 3 weeks, 3 months, and 6 months for clinical and radiographic evaluation. Fisher's exact test was used along with Chi-square test for statistical analysis.

Results:

Over a period of 6 months, MTA and biodentine showed 91.7% and 83.3% success rate, respectively, based on the subjective symptoms, pulp sensibility tests, and radiographic appearance.

Conclusion:

MTA and biodentine may be used as DPC agents when the pulpal diagnosis is not more than reversible pulpitis.

Effect of Desensitization Using Bioactive Glass, Hydroxyapatite, and Diode Laser on the Shear Bond Strength of Resin Composites Measured at Different Time Intervals: An In vitro Study

BACKGROUND

Dentin desensitizers may change the properties of smear layer and have adverse effects on the bonding performance of adhesive systems.

AIM

The aim of this study was to compare the effect of bioactive glass (BG), hydroxyapatite, and diode laser desensitization on shear bond strength of resin composites to dentin at different time intervals.

MATERIALS AND METHODS

Seventy-two caries-free maxillary premolars were selected. Buccal surfaces were flattened to expose dentin. Teeth were divided into four groups (Groups 1, 2, 3, and 4) according to treatment modality (control with no pretreatment, Sensodyne Repair and Protect, Teethmate Desensitizer, diode laser). Bonding was performed using self-etch adhesive followed by composite buildup. Universal testing machine was used to determine shear bond strengths immediately after bonding, after 3 months, and 5 months storage in artificial saliva.

RESULTS

Pretreatment with BG and hydroxyapatite desensitizers increased, whereas diode laser decreased mean shear bond strength of composite to dentin as compared to control group. No statistical significant difference in shear bond strength values was seen in groups after storage.

CONCLUSION

Desensitizing toothpastes incorporating remineralizing agents not only occluded open dentinal tubules but also increased shear bond strength of composite to dentin.

Comparative Evaluation of Two Final Irrigation Techniques for the Removal of Precipitate Formed by the Interaction between Sodium Hypochlorite and Chlorhexidine

AIM

To evaluate the effectiveness of two final irrigation techniques for the removal of precipitate formed by the interaction between sodium hypochlorite (NaOCl) and chlorhexidine (CHX).

MATERIALS AND METHODS

Sixty freshly extracted human maxillary incisor teeth were taken and randomly divided into three groups, containing 20 teeth each. Group 1 (control group), were irrigated with 5 ml of 2.5% NaOCl and a final flush with 5 ml of 2% chlorhexidine. Group 2 were irrigated with 5 ml of 2.5% NaOCl and 5 ml of 2% chlorhexidine followed by 5 ml of saline and agitated with F-files. Group 3 were irrigated with 5 ml of 2.5% NaOCl and 5 ml of 2% chlorhexidine followed by 5 ml of 15% citric acid and passively agitated with ultrasonics. A thin longitudinal groove was made along the buccal and lingual aspect of the root using diamond disks and split with chisel and mallet. Both halves of the split tooth will be examined under stereomicroscope. Results were tabulated and analyzed statistically using analysis of variance (ANOVA) and Mann-Whitney U test.

RESULT

There was a significant difference between the mean values (p < 0.05) in groups 2 and 3 compared to group 1 at each level.

CONCLUSION

Passive ultrasonic irrigation is more effective than the F-file agitation technique to remove the precipitate at all three levels measured.

CLINICAL SIGNIFICANCE

Combination of sodium hypochlorite and chlorhexidine irrigation protocol has been practiced since from many years to achieve good results. However, it has adverse effect in the form of precipitate and which is considered to be a carcinogenic in nature, hence this precipitate should be removed.

The effect of 2% chlorhexidine on the bond strength of two different obturating materials

The bond strength of ActiV GP and gutta-percha/AH Plus after using 2% CHX as final rinse was evaluated in this study. According to the final irrigation regimen forty roots were divided into two groups (n = 20) randomly: Group 1-5 ml of 17% EDTA; Group 2-5 ml of 17% EDTA followed by 5 ml of 2% chlorhexidine gluconate (CHX). Based on the obturation system the two groups were further subdivided into two subgroups (n = 10). The roots were horizontally sectioned from the coronal and midthird sections for measuring the push-out bond strength. CHX/AH Plus (2.795 ± 0.42 MPa) and EDTA/ActiV GP (1.489 ± 0.117 MPa) recorded the highest and lowest mean bond strength values respectively. It was concluded that when 2% CHX was used as a final irrigation rinse the bond strength of both gutta-percha/AH Plus and ActiV GP obturation system improved significantly.

Comparison of injection lignocaine (preservative free) 1.5 mg/kg i.v with oral pregabalin 150 mg for attenuation haemodynamic response to laryngoscopy and tracheal intubation

Endotracheal intubation is sine quo non for safe conduct of general anaesthesia. Pregabalin, an anticonvulsant drug is being studied for control of haemodynamic response to laryngoscopy and intubation. Some authors have found that pregabalin 150 mg orally attenuates the haemodynamic response to laryngoscopy. The purpose of the present study was to compare injection lignocaine (preservative free) i.v. and oral pregabalin for attenuation of haemodynamic response to laryngoscopy and intubation. The study consisted of 60 patients of ASA class I, divided into two groups of 30 each. Group I received injection lignocaine (preservative free) 1.5 mg/kg i.v., 3 minutes prior to laryngoscopy. Group II received oral pregabalin 150 mg capsule 1 hour prior to induction. The parameters recorded were heart rate, systolic BP, diastolic BP, mean BP and rate pressure product was calculated at baseline before induction and at 1, 3 and 5 minutes following laryngoscopy. The data obtained was analysed using unpaired "t" test. Lignocaine was more effective than pregabalin in controlling the heart rate at one minute following laryngoscopy. Pregabalin was more effective than lignocaine in controlling diastolic blood pressure at 1, 3 and 5 minutes following laryngoscopy, and mean arterial pressure at land 3 minutes following laryngoscopy. There was no difference between two groups when systolic BP and rate pressure product were compared. Lignocaine (preservative free) thus, exerts better control over heart rate and pregabalin exerts better control over diastolic and mean blood pressure following laryngoscopy.

Similarities in lindane induced alteration in cytochrome P450s and associated signaling events in peripheral blood lymphocytes and brain

Studies were initiated to investigate the similarities in alterations in cytochrome P450s (CYPs) and associated signaling events in brain and peripheral blood lymphocytes (PBL) induced by lindane, an organochlorine pesticide. Adult male albino wistar rats were treated orally with different doses (2.5- or 5.0- or 10- or 15 mg/kg/body weight) of lindane daily for 4 days. In another experiment, the treatment of low dose (2.5mg/kg) of lindane was continued for 15- and 21 days. A dose- and time-dependent increase was observed in the activity of CYP dependent enzymes in brain microsomes and PBL isolated from the treated rats. However, the magnitude of induction was several folds less in PBL. As observed in brain, RT-PCR and Western immunoblotting demonstrated that increase in CYP enzymes in PBL is due to the increase in the mRNA expression of specific CYP isoenzymes. Similarities were also observed in activation of ERK and JNK MAP kinases and c-jun in PBL or brain isolated from rats treated with lindane. Similarities in the induction of CYPs and activation of MAP kinases in PBL and brain suggest that CYP expression profiles in PBL could be used for monitoring the exposure and toxicity of environmental chemicals.

A novel computer-assisted technique for pedicle screw insertion

BACKGROUND

Commercially available systems for computer-assisted pedicle screw placement are prohibitively expensive, even in advanced countries. The advantage of the great accuracy of computer-assisted systems for pedicle screw insertion makes them highly desirable and essential for current spinal surgeries.

METHODS

We have tried to develop a new software for pedicle screw placement, based on paired point matching.

RESULTS

The newly developed software is much less expensive and is an excellent educational tool. Its accuracy has been established by a cadaveric study, described in this paper.

CONCLUSIONS

The cadaveric study supports the view that computer-assisted pedicle screw fixation using the newly developed software is superior to the conventional fluoroscopic method, especially with regard to the thoracic spine, where a higher degree of accuracy is needed. Further clinical studies are planned and the software needs further refinement for complex clinical situations.

Variations in the pattern of mental spines and spinous mental foramina in dry adult human mandibles

The frequency and morphology of mental spines and spinous mental foramina was studied in 1200 adult human mandibles of Indian origin. The mental spines were present in 1178 mandibles (98.2%). The usual textbook description of four spines, arranged in two pairs one above the other was found only in 231 mandibles (19.6%). Mandibles with only two superior mental spines were seen in 842 cases (71.4%) which were associated with either a median vertical ridge below them (47.7%) or with a rough impression in place of the median ridge (23.7%). Spinous mental foramina (one to three) close to the midline and in between the spines were found in 1165 mandibles (97.57%). The presence of these foramina has not been mentioned in most textbooks of anatomy.

Vertical rectus abdominis myocutaneous flap cover for lower abdomen, chest wall, groin and thigh defects following resection of malignant tumours

Vertical rectus abdominis mycutaneous (VRAM) flap provides a reliable flap cover for large soft tissue defects of chest wall, torso, groin, perineum and thigh. It has been mainly used in trauma and benign conditions. Between January 1994 through January 1999, eight patients with locally advanced malignant tumors underwent radical resection and reconstruction using pedicled VRAM flap. Inferiorly based VRAM flap was used in five patients and superiorly based VRAM flap in three patients. Defect size ranged from 144 to 900 CM2. (mean 386 cm2). Average blood loss for combined resection and reconstruction was 600ml. (range 400-800 ml.) Primary closure of both donor and recipient sites achieved in all patients. There was no wound infection, flap necrosis or abdominal hernia. There patients received postoperative radiotherapy and chemotherapy and two patients received radiotherapy only. All the the patients are alive and free of local recurrence at mean follow up 32 months. Results of our study shows that VRAM flap is versatile and sturdy flap with a wide are of rotation and it can reach diverse anatomical sites like torso, chestwall, thigh and perineum to cover large defects following radical resection for tumors.