bluuebunny/crossref_metadata_2025_split huggingface dataset:
DNA Fragmentation and mRNA Expression of Bcl-2, Bcl-xL, p53, p21 and HSP70 Genes in Nondysplastic and Dysplastic Oral Lichen Planus
Authors: Jana Abhishek , Thomas Jincy , Ghosh Pratiti 
Published: December 2022

Background:
Oral lichen planus (OLP) is a chronic inflammatory disease. Apoptosis of the basal keratinocytes is a causative factor for OLP pathogenesis but the detailed mechanism of apoptosis among nondysplastic and dysplastic OLP lesions is yet unraveled.

Aims:
This study aims to evaluate the involvement of cellular DNA fragmentation and alteration in the expression of Bcl-2 and B-cell lymphoma extra-large (Bcl-xL), p53, p21 and heat shock protein 70 (HSP70) in nondysplastic and dysplastic OLP lesions.

Materials and Methods:
Untreated, fifteen OLP patients each with nondysplastic and dysplastic lesions were enrolled for this study. Their DNA fragmentation was analyzed by the agarose gel electrophoresis method. The mRNA expression of Bcl-2, Bcl-xL, p53, p21 and HSP70 were measured using semi-quantitative reverse transcription-polymerase chain reaction.

Results:
Elevated DNA fragmentations were found in dysplastic lesions compared to nondysplastic type. Significantly higher expression of Bcl-2, Bcl-xL, p53 and p21 were found in both types of OLP lesion compared to the control. Expression of Bcl-2 and Bcl-xL were significantly elevated in nondysplastic lesions, whereas significantly overexpression of p53 and p21 were found in dysplastic lesions. Anti-stress protein HSP70 was overtly expressed in dysplastic lesions compared to other groups.

Conclusion:
Reduced expression of Bcl-2 and Bcl-xL, with elevated DNA fragmentation, may be associated with increased apoptosis in dysplastic lesions which aid in the resolution of the chronic inflammatory process. Higher expression of p53 and p21 in dysplastic lesions reflect its malignant potentiality. Overexpression of HSP70 in dysplastic lesions is a useful marker for higher cellular stress.
Shaping Ability and Buckling Resistance of TruNatomy, WaveOne gold, and XP-Endo Shaper Single-File Systems
Authors: Shaheen Neveen Ali , Elhelbawy Nahla Gamal Eldin 
Published: December 2022

Objectives:
The target of the current study was to evaluate and compare the shaping ability and buckling resistance of various single-file systems (TruNatomy [TRN], WaveOne gold [WOG], and XP-Endo Shaper [XPS]).

Materials and Methods:
Thirty recently extracted human first mandibular molars were chosen with severely curved mesiobuccal (MB) canals. Following access cavity preparation and determination of working length, teeth were randomly divided into three groups (n = 10) according to the instrumentation technique used, Group 1 (TRN), Group 2 (WOG), and Group 3 (XPS). Preinstrumentation and postinstrumentation, cone-beam computed tomography images were recorded at 3, 5, and 8 mm from the apex representing apical, middle, and coronal levels under the same circumstances, superimposed, and then canal transportation was determined using a particular equation. For buckling resistance calculation, files were loaded in the axial direction of the shaft and the maximum load was determined during the deflection of the file. One-way analysis of variance and Tukey test at 5% significance level were used to analyze data. Pearson's correlation between shaping ability and buckling resistance was performed.

Results:
XPS and TRN displayed significantly less canal transportation than WOG at the coronal and middle levels. While WOG recorded the highest value of buckling resistance, XPS recorded the least.

Conclusions:
XPS and TRN preserved the original curvature slightly better than WOG, while WOG reported the highest buckling resistance. There was a positive correlation between canal transportation and instrument resistance to buckle.

Clinical Relevance:
Preservation of the original shape of the canal after instrumentation is beneficial.
Soft Tissue Augmentation Using De-Epithelialized Free Gingival Graft Compared to Single-line Incision Subepithelial Connective Tissue Graft in the Management of Miller Class I and II Gingival Recession
Authors: Mashaly Mohamed , Ghallab Noha A. , Elbattawy Weam , Elarab Azza Ezz 
Published: December 2022

Aims:
The purpose of this randomized controlled clinical trial was to clinically assess soft tissue augmentation and compare patients’ morbidity and root coverage outcomes of coronally advanced flap (CAF) with subepithelial connective tissue graft (SCTG) versus de-epithelialized free gingival graft (DFGG) in the management of Miller Class I and II gingival recession.

Materials and Methods:
Twenty-eight patients with Miller's Class I or II gingival recession (GR) defects were randomly assigned into two equal parallel groups treated with either CAF + SCTG, harvested using single-line incision technique (control), or CAF + DFGG (test). Gingival thickness (GT), recession depth, recession width, percentage of root coverage, keratinized tissue width, pocket depth, and clinical attachment level were measured at baseline and 3 and 6 months postoperatively. Patient-reported outcomes were assessed postoperatively, including pain, stress, bleeding, and inability to chew. Patients’ overall satisfaction and root coverage esthetic scores were recorded at 6 months.

Results:
Both groups demonstrated a statistically significant improvement in all clinical outcomes after 3 and 6 months compared to baseline. DFGG showed a statistically significant increase in GT after 6 months. No statistically significant difference was detected in other clinical outcomes between both groups at different time intervals. Both treatments achieved 92.9% complete root coverage. Patients treated with CAF + DFGG reported significantly higher stress and inability to chew scores after 2 weeks than those treated with SCTG. There were no significant differences in patient satisfaction between both groups.

Conclusions:
CAF + SCTG and CAF + DFGG were both effective and can be applied safely in treating Miller Class I and II GRs.
Accuracy of Patient-specific Soft-tissue Prediction Algorithms for Maxillomandibular Surgery in Class III Patients
Authors: Mehta Shivam Y. , Han Michael D. , Tsay T. Peter , Kusnoto Budi 
Published: December 2022

Context:
Improved esthetics is an important factor for most patients undergoing orthognathic surgery. Thus, a treatment simulation that can provide patients with a realistic view of the esthetic outcome after surgery is important in clinical practice.

Aims:
To evaluate the accuracy of simulations generated using algorithms specific for patient's type of malocclusion and surgical procedure compared to nonspecific algorithms.

Settings and Design:
A total of 36 patients (average age 18.41 years) who had undergone maxillary advancement and mandibular setback for Class III malocclusion were included.

Subjects and Methods:
The presurgical and postsurgical cone-beam computed tomography scans were used to generate the lateral cephalograms and the surgical simulations were created with the patient-specific algorithm (specific for Class III patients) and the nonspecific algorithm (default algorithm not specific for any particular malocclusion or type of surgery) using the treatment simulation feature in Dolphin Imaging software. The accuracy of the simulations was examined by comparing the soft-tissue changes in the surgical simulations with the postsurgical result.

Statistical Analysis Used:
Statistical analyses were performed with SPSS-software at 0.05 significance level. For the mean difference between the postsurgical and surgical-simulation landmarks, a paired sample t-test (Student's t-test) was performed.

Results:
Patient-specific algorithms were accurate in vertical prediction of lower lip, B’, tip of nose, upper lip, and horizontal prediction of pogonion’. Whereas the nonspecific algorithm was accurate in the horizontal prediction of the lower lip, pogonion’, and menton’.

Conclusions:
Patient-specific and nonspecific algorithms for generating surgical simulations showed different accuracy for vertical and horizontal predictions of the parameters.
Health care utilization among geriatric patients with respiratory diseases – An Indian perspective
Authors: Gupta Sonisha , Asthana Smita , Gupta Atul Kumar 
Published: December 2022

Background:
The elderly population is continuously growing and respiratory diseases account for 20% of chronic diseases among ageing people; these diseases are often treated imprecisely. Thus, the health-care system should adapt to the growing health needs of the elderly population.

Aims:
To study health care utilisation by geriatric patients with respiratory diseases.
Material and Methods: A cross-sectional study of the elderly aged 60 years and over was conducted in the urban and rural areas of the National Capital Region and the Ghaziabad district of Uttar Pradesh. The first part of the study included socio-demographic characteristics and self-reported co-morbidities. In this first part, suspected respiratory cases were screened out, and a questionnaire regarding health-care utilisation was administered. The effect of socio-demographic factors on health-care utilisation was analysed.

Results:
In urban areas, 282/1522 (18.5%) and in rural areas, 298/1503 (19.8%) were found to suffer from respiratory illnesses. Health-care utilisation among elderly patients was significantly higher in urban areas compared to rural areas. In both areas, a large number of elderly people (70.5% rural and 61.7% urban) were insufficiently utilising health-care services. The socio-economic status (P = 0.034) and the source of income (P = 0.002) of urban residents were found to be significant factors. Among rural residents, health security (P = 0.05) and source of income (P = 0.002) were found to be statistically significant. Among the combined population (580), socio-economic status (P = 0.020) and source of income (P = 0.002) were found to be statistically significant.

Conclusion:
Health-care utilisation was better in urban residents than in rural elderly. However, majority of the elderly were utilising health-care services insufficiently in both areas. Socio-economic status and source of income had a significant effect on health-care utilisation.
Awareness and practices about menstruation among adolescent girls
Authors: Parmar Priyanka R. , Deshpande Shrikalp S. 
Published: December 2022

Introduction:
Menstruation is still a taboo in India and it is common for people across society to feel uncomfortable about the subject. It is a normal physiological process.

Objectives:
The objective of this study was to assess awareness and hygiene practices amongst adolescent girls and to study the menarche age of respondents in comparison to their mother's age at menarche.

Materials and Methods:
A cross-sectional, observational and prospective study was carried out in two private high schools of Mehsana city, Gujarat. Data were collected in a form of a structured questionnaire. Adolescent girls from 10 to 19 years were enrolled in the study. Ethical approval was obtained before initiating data collection. IBM SPSS version 2.0 was used for the analysis of the data.

Results:
Out of a total of 454 screened, 398 adolescents were enrolled in the study with an 87.76% response rate. The mean menarche age of adolescent girls was 13.33 ± 1.18 years. Mothers 316 (78.4%) were the first source of information. Majority of study respondents (68.5%) rated menstruation as a part of the physiologic process caused by hormonal changes. About 18.6% knew the uterus as a source of bleeding. About 59.8% of adolescent girls were scared and discomforted at their menarche. Most (93.5%) were using sanitary pads as absorbent material. Half of the respondents were using water to clean their genitals. Nearly half of the respondents felt hesitation for discussing their menstrual-related problems with others. The mean menarche age of the participants was 13.33 ± 1.18 years with a minimum of 10 years and a maximum of 18 years, while their mother's age at menarche was 14.58 ± 1.27 years.

Conclusion:
Menstrual hygiene education must be provided to adolescent girls. Need to solve taboos and misconception amongst adolescent girls of India.
Predictive Value of Beclin1 in the Pathogenesis of Rheumatoid Arthritis in the Indian Population
Authors: Varshney Tanu , Singh Praveen Kumar , Saha Sarama , Manna Sukdev , Pai Venkatesh S. , Naithani Manisha , Mirza Anissa Atif 
Published: December 2022

Background:
Rheumatoid arthritis (RA) is a systemic autoimmune disease leading to the destruction of articular cartilage and deformity of joints if not detected early. There is an unmet need to find out a highly sensitive and specific biomarker for RA. This was the first study designed in Indian setting to assess whether it can be used as a biomarker in the diagnosis of RA in the Indian population.

Aim:
To correlate serum Beclin1 in the pathogenesis of rheumatoid arthritis in the Indian population.

Patients and Methods:
Observational analytical study was conducted for 18 months at AIIMS Rishikesh, Department of Biochemistry in collaboration with the Department of Rheumatology. Beclin1 serum expression levels were estimated by the enzyme-linked immunosorbent assay and beclin1 mRNA expression was assessed by a real-time polymerase chain reaction from peripheral blood mononuclear cells (PBMCs). Beclin1 expression was compared by Mann–Whitney U-test using SPSS 22 version. Cut-off values of Beclin1 for screening of cases were analysed by receiver operating characteristic test.

Results:
Age- and sex-matched 38 RA patients (5 males and 33 females) and 39 controls (8 males and 31 females) were recruited in the study. Patients with the American College of Rheumatology

/
European League Against Rheumatism score ≥6 were recruited in this study. Serum level of beclin1 was significantly (P ≤ 0.001) lower in cases (6.30 [2.82]) compared to healthy controls (11.43 [4.62]) which were corroborated with mRNA expression. The optimal cut-off value for detecting RA cases was 7.25 with 89.7% sensitivity and 79.8% specificity.

Conclusion:
Beclin1 may be involved in the pathogenesis of RA and may be considered a diagnostic marker for RA cases.
Influence of blood pressure on internal carotid artery blood flow during combined propofol-remifentanil and thoracic epidural anesthesia
Authors: Olesen Niels D. , Egesborg Astrid H. , Frederiksen Hans-Jørgen , Kitchen Carl-Christian , Svendsen Lars B. , Olsen Niels V. , Secher Niels H. 
Published: December 2022

Background and Aims:
Anesthesia often reduces mean arterial pressure (MAP) to a level that may compromise cerebral blood flow. We evaluated whether phenylephrine treatment of anesthesia-induced hypotension affects internal carotid artery (ICA) blood flow and whether anesthesia affects ICA flow and CO2 reactivity.

Material and Methods:
The study included twenty-seven patients (65 ± 11 years; mean ± SD) undergoing esophageal resection (n = 14), stomach resection (n = 12), or a gastroentero anastomosis (n = 1) during combined propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound evaluated ICA blood flow. Evaluations were before and after induction of anesthesia, before and after the administration of phenylephrine as part of standard care to treat anesthesia-induced hypotension at a MAP below 60 mmHg, and the hypocapnic reactivity of ICA flow was determined before and during anesthesia.

Results:
Induction of anesthesia reduced MAP from 108 ± 12 to 66 ± 16 mmHg (P < 0.0001) and ICA flow from 340 ± 92 to 196 ± 52 mL/min (P < 0.0001). Phenylephrine was administered to 24 patients (0.1–0.2 mg) and elevated MAP from 53 ± 8 to 73 ± 8 mmHg (P = 0.0001) and ICA flow from 191 ± 43 to 218 ± 50 mL/min (P = 0.0276). Furthermore, anesthesia reduced the hypocapnic reactivity of ICA flow from 23 (18–33) to 14%/kPa (10–22; P = 0.0068).

Conclusion:
Combined propofol–remifentanil and thoracic epidural anesthesia affect ICA flow and CO2 reactivity. Phenylephrine partly restored ICA flow indicating that anesthesia-induced hypotension contributes to the reduction in ICA flow.
Intraoperative administration of systemic/epidural/intrathecal morphine on the quality of recovery following substitutional urethroplasty with buccal mucosal graft: A randomized control trial
Authors: Johnson Juliya Pearl Joseph , Arumugam Rajasekar , Karuppusami Reka , Mariappan Ramamani 
Published: December 2022

Background and Aims:
Substitutional urethroplasty with buccal mucosal grafting for urethral stricture is associated with significant pain, and thus inappropriate perioperative pain management could delay postoperative recovery. The objective of our research was to determine the effects of analgesia with systemic or epidural or intrathecal morphine on quality of recovery (QoR) in patients undergoing substitutional urethroplasty with buccal mucosal grafting.

Material and Methods:
This prospective, double-blinded, randomized control trial was conducted over 2 years in ASA I and II patients who underwent substitutional urethroplasty with buccal mucosal graft. Patients were randomized into three groups, and Group A received systemic morphine (0.1 mg/kg), Group B received epidural morphine (3 mg), and Group C received intrathecal morphine (150 μg). The QoR between the groups were compared postoperatively using the 40-item QoR questionnaire, and the hemodynamic variations, time taken for ambulation, resumption of oral intake, and incidence of complications were also compared.

Results:
Out of the recruited 93 patients, 88 patients were analyzed. The QoR score for each domain was comparable between the three groups. The total QoR score for systemic, epidural, and intrathecal morphine groups were 189 (185–191), 189 (187–191), and 185 (183–189), respectively. Additionally, the hemodynamic variations, time taken for ambulation, and resumption of oral intake were comparable between all three groups except the incidence of postoperative nausea and vomiting (PONV) and pruritis, which were higher in the intrathecal group.

Conclusion:
All three modalities, namely systemic morphine (0.1 mg/kg), epidural morphine (3 mg), and intrathecal morphine (150 μg), offer similar QoR after substitutional urethroplasty. However, the incidence of PONV and pruritis was higher with the administration of intrathecal morphine.
Relationship between pulse pressure variation and stroke volume variation with changes in cardiac index during hypotension in patients undergoing major spine surgeries in prone position - A prospective observational study
Authors: Arumugam Rajasekar , Thomas Susan , Jacob Nisha Sara M , Nadaraj Ambily , George Sajan P. , Singh Georgene 
Published: December 2022

Background and Aims:
Dynamic indices such as pulse pressure variation (PPV) and stroke volume variation (SVV) are better predictors of fluid responsiveness than static indices. There is a strong correlation between PPV and SVV in the prone position when assessed with the fluid challenge. However, this correlation has not been established during intraoperative hypotension. Our study aimed to assess the correlation between PPV and SVV during hypotension in the prone position and its relationship with cardiac index (CI).

Material and Methods:
Thirty patients aged 18–70 years of ASA class I–III, undergoing spine procedures in the prone position were recruited for this prospective observational study. Hemodynamic variables such as heart rate (HR), mean arterial pressure (MAP), PPV, SVV, and CI were measured at baseline (after induction of anesthesia and positioning in the prone position). This set of variables were collected at the time of hypotension (T-before) and after correction (T-after) with either fluids or vasopressors. HR and MAP are presented as median with inter quartile range and compared by Mann-Whitney U test. Reliability was measured by intraclass correlation coefficients (ICC). Generalized estimating equations were performed to assess the change of CI with changes in PPV and SVV.

Results:
A statistically significant linear relationship between PPV and SVV was observed. The ICC between change in PPV and SVV during hypotension was 0.9143, and after the intervention was 0.9091 (P < 0.001). Regression of changes in PPV and SVV on changes in CI depicted the reciprocal change in CI which was not statistically significant.

Conclusion:
PPV is a reliable surrogate of SVV during intraoperative hypotension in the prone position.
Correlation between depth of subarachnoid space in the lumbar region estimated by Stocker’s formula, ultrasound, and depth of needle insertion: A prospective observational study
Authors: Nair Nayantara , Gnanasekar Rajiv , Joshi Reesha , Lakshmi R 
Published: December 2022

Background and Aims:
The main challenge in administration of spinal anesthesia in patients is the unpredictability of the exact skin to subarachnoid space depth (SSD). Approximation of SSD and needle length comes at the expense of patient comfort and multiple attempts increases complications. Our study aimed to evaluate the validity of Stocker’s formula to estimate SSD in comparison to ultrasonography and depth of needle insertion. We also aimed to determine an equation to describe the relationship between patient weight and SSD in an Indian population.

Material and Methods:
This was a prospective observational study. A total of 234 adults of American Society of Anesthesiologists (ASA) category 1 and 2 were selected for the study. The patients underwent spinal anaesthesia and SSD data were determined using weight-based Stocker’s formula (DS), ultrasonography (DU), and actual depth of needle insertion (DA). Correlation analysis was performed to determine variables that can predict the SSD. A linear regression was calculated to describe the relationship between patient weight and SSD. SSD data were determined using weight-based Stocker’s formula ultrasonography, and actual depth of needle insertion.

Results:
Mean SSD using Stocker’s formula, ultrasonography, and actual depth of needle insertion was 4.92 ± 0.6 cm, 4.47 ± 0.6 cm, and 4.81 ± 0.6 cm. Our study showed a significant correlation between Stocker’s formula and SSD measured by actual depth of needle insertion (R
2 = 0.376). This was described by the derived formula: SSD (cm) =2.522+ [0.031 × weight (kg)].

Conclusion:
SSD correlates well with the weight of adult patients. Measurement with Stocker’s formula and actual depth showed better correlation than Stocker’s formula and ultrasonography. This is valuable in resource-poor areas with a lack of ultrasound machines or expertise in training.
Ultrasound-guided single needle tip placement below axillary artery in the infraclavicular area: A cadaveric study
Authors: Diwan Sandeep , Feigl Georg , Nair Abhijit 
Published: December 2022

Background and Aims:
The parasagittal ultrasound-guided infraclavicular block (ICB) aims to cover all the elements of brachial plexus for the surgeries at and below the elbow. Our aim was to demonstrate the spread of 20 ml latex in vicinity of brachial plexus cords after injecting posterior to the axillary artery in Thiel embalmed cadavers.

Material and Methods:
A blunt insulated needle was inserted posterior to the axillary artery in a traditional parasagittal infraclavicular in 2 Thiel embalmed cadavers, on both the sides (four specimens). A day later cadaver 1 was dissected and cadaver 2 was frozen at ‒20ºC for 2 weeks and sectioned. Both cadavers were photographed.

Results:
In cadaver 1, dissection revealed a spread of red latex on the lateral cord extending onto the musculocutaneous nerve, the posterior cord engulfing the radial and axillary nerves distally. In cadaver 2, a cross-section revealed latex engulfed all three cords.

Conclusion:
Single injection of 20 ml latex aimed posterior to the axillary artery in the parasagittal infraclavicular approach engulfed the posterior, medial and lateral cord in Thiel embalmed cadavers. This needs to be investigated in patients who receive ICB clinically and using contrast studies.