Impression tray designs and techniques for complete dentures in cases of microstomia--a review

ObjectivesThe present paper aims to review the literature on various approaches in the tray designs and different techniques used to overcome difficulties in making impressions of patients with severely limited mouth opening published from 1984 to 2009.Study designA search in the National Library of Medicine's Pub Med database, Google search and Science Direct was performed to include all case reports and reviews on prosthodontic rehabilitation of patients with microstomia. A total of 17 articles were included for discussion in the review out of the 22 articles found to be giving new tray designs.ConclusionsDifferent tray designs and impression techniques which can be useful in management of difficult cases causing little discomfort to the patient and help in getting back such patients to a comfortable social living.     

Optimizing the management of neuromyelitis optica and spectrum disorders in resource poor settings: Experience from the Mangalore demyelinating disease registry

Background:

In resource-poor settings, the management of neuromyelitis optica (NMO) and NMO spectrum (NMOS) disorders is limited because of delayed diagnosis and financial constraints.

Aim:

To device a cost-effective strategy for the management of NMO and related disorders in India.

Materials and Methods:

A cost-effective and disease-specific protocol was used for evaluating the course and treatment outcome of 70 consecutive patients.

Results:

Forty-five patients (65%) had a relapse from the onset and included NMO (n = 20), recurrent transverse myelitis (RTM; n = 10), and recurrent optic neuritis (ROPN; n = 15). In 38 (84.4%) patients presenting after multiple attacks, the diagnosis was made clinically. Only 7 patients with a relapsing course were seen at the onset and included ROPN (n = 5), NMO (n = 1), and RTM (n = 1). They had a second attack after a median interval of 1 ± 0.9 years, which was captured through our dedicated review process. Twenty-five patients had isolated longitudinally extensive transverse myelitis (LETM), of which 20 (80%) remained ambulant at follow-up of 3 ± 1.9 years. Twelve patients (17%) with median expanded disability status scale (EDSS) of 8.5 at entry had a fatal outcome. Serum NMO-IgG testing was done in selected patients, and it was positive in 7 of 18 patients (39%). Irrespective of the NMO-IgG status, the treatment compliant patients (44.4%) showed significant improvement in EDSS (P ≤ 0.001).

Conclusions:

Early clinical diagnosis and treatment compliance were important for good outcome. Isolated LETM was most likely a post-infectious demyelinating disorder in our set-up. NMO and NMOS disorders contributed to 14.9% (45/303) of all demyelinating disorders in our registry.Key Words: Demyelinating disease registry, immunosuppression, India, neuromyelitis optica, neuromyleitis optica spectrum disorders     

STAN: spatio-temporal attention network for pandemic prediction using real-world evidence

ObjectiveWe aim to develop a hybrid model for earlier and more accurate predictions for the number of infected cases in pandemics by (1) using patients’ claims data from different counties and states that capture local disease status and medical resource utilization; (2) utilizing demographic similarity and geographical proximity between locations; and (3) integrating pandemic transmission dynamics into a deep learning model.Materials and MethodsWe proposed a spatio-temporal attention network (STAN) for pandemic prediction. It uses a graph attention network to capture spatio-temporal trends of disease dynamics and to predict the number of cases for a fixed number of days into the future. We also designed a dynamics-based loss term for enhancing long-term predictions. STAN was tested using both real-world patient claims data and COVID-19 statistics over time across US counties.ResultsSTAN outperforms traditional epidemiological models such as susceptible-infectious-recovered (SIR), susceptible-exposed-infectious-recovered (SEIR), and deep learning models on both long-term and short-term predictions, achieving up to 87% reduction in mean squared error compared to the best baseline prediction model.ConclusionsBy combining information from real-world claims data and disease case counts data, STAN can better predict disease status and medical resource utilization.     

Association of E-selectin Gene Polymorphism (S128R) with Ischemic Stroke and Stroke Subtypes

E-selectin is an important inflammatory cytokine involved in the pathogenesis of various diseases such as atherosclerosis and stroke. We investigated the association of E-selectin gene polymorphism (S128R) with ischemic stroke and its subtypes. We studied 610 patients with ischemic stroke and 610 age- and sex-matched healthy controls. The ischemic stroke was classified according to Trial of Org10172 in Acute Stroke Treatment (TOAST). E-selectin gene polymorphism (S128R) was determined by polymerase chain reaction–restriction fragment length polymorphism technique. We found statistically significant difference in the genotypic distribution between patients and controls (for AC vs. AA, χ ²?=?49.5; p?<?0.001, odds ratio?=?5.47(95 % CI, 3.25–9.21). A significant difference was observed in the frequency of C and A alleles in patients and controls (for C vs. A, χ ²?=?47.4; p?<?0.001, odds ratio?=?5.13 (95 % CI, 3.06–8.57). Multiple logistic regression analysis revealed that the most predictive risk factor for stroke was AC genotype (adjusted odds ratio?=?1.450 (95 % CI, 1.23–2.75) and p?=?0.001), hypertension, smoking, and diabetes (p?=?0.001 in each case). We also found a significant association of AC genotype with intracranial large artery atherosclerosis (p?<?0.01, odds ratio?=?9.37, (95 % CI, 5.31–16.5) and small artery occlusion (p?<?0.0001, odds ratio?=?9.81 (95 % CI, 4.94–19.4). Our results indicate that the individuals bearing AC genotype of E-selectin gene polymorphism (S128R) are more prone to stroke than AA genotype.     

Microsurgical anatomy of the posterior circulation

CONTEXT: The microsurgical anatomy of the posterior circulation is very complex and variable. Surgical approaches to this area are considered risky due to the presence of the various important blood vessels and neural structures. AIMS: To document the microsurgical anatomy of the posterior circulation along with variations in the Indian population. MATERIALS AND METHODS: The authors studied 25 cadaveric brain specimens. Microsurgical dissection was carried out from the vertebral arteries to the basilar artery and its branches, the basilar artery bifurcation, posterior cerebral artery and its various branches. Measurements of the outer diameters of the vertebral artery, basilar artery and posterior cerebral artery and their lengths were taken. RESULTS: The mean diameter of the vertebral artery was 3.4 mm on the left and 2.9 mm on the right. The diameter of the basilar artery varied from 3-7 mm (mean of 4.3 mm). The length varied from 24-35 mm (mean of 24.9 mm). The basilar artery gave off paramedian and circumferential perforating arteries. The origin of the anterior inferior cerebellar artery (AICA) varied from 0-21 mm (mean 10.0 mm) from the vertebrobasilar junction. The diameter of the AICA varied from being hypoplastic i.e., CONCLUSIONS: The authors have documented the various anomalies as well as the differences of the anatomy in this area in the Indian population as compared to the Western literature.     

Real-Time Sensing of Output Polymer Flow Temperature and Volumetric Flowrate in Fused Filament Fabrication Process

In this paper we addressed key challenges in engineering an instrumentation system for sensing and signal processing for real-time estimation of two main process variables in the Fused-Filament-Fabrication process: (i) temperature of the polymer melt exiting the nozzle using a thermocouple; and (ii) polymer flowrate using extrusion width measurements in real-time, in-situ, using a microscope camera. We used a design of experiments approach to develop response surface models for two materials that enable accurate estimation of the polymer exit temperature as a function of polymer flowrate and liquefier temperature with a fit of R2=99.96% and 99.39%. The live video stream of the deposition process was used to compute the flowrate based on a road geometry model. Specifically, a robust extrusion width recognizer REXR algorithm was developed to identify edges of the deposited road and for real-time computation of extrusion width, which was found to be robust to filament colors and materials. The extrusion width measurement was found to be within 0.08 mm of caliper measurements with an R2 value of 99.91% and was found to closely track the requested flowrate from the slicer. This opens new avenues for advancing the engineering science for process monitoring and control of FFF.     

A review on assessment and treatment of the trunk in stroke A need or luxury

Trunk function has been identified as an important early predictor of functional outcome after stroke and the same deteriorates on both contralateral and ipsilateral sides of the body following stroke.The primary contribution of the trunk muscles is to allow the body to remain upright,adjust weight shifts,and control movements against constant pull of gravity and is considered central key point of the body.Proximal stability of the trunk is a pre-requisite for distal limb mobility,balance,gait and functional activities and its positive correlation in hemiplegia has been demonstrated in a cross-sectional study.Both isokinetic and handheld dynamometer muscle strength testing demonstrated the weakness of bilateral trunk flexors,extensors and rotator muscles in both acute and chronic hemiplegic patients.This was confirmed by electromyography analysis which identified poor bilateral trunk muscles activity in patients with stroke.Trunk impairment scale is sensitive to evaluate the selective muscle control of upper and lower trunk,and it has been reported that lateral flexion of the trunk is easier than rotation of the trunk and the clinical observation concurs to the difficulty in lower trunk rotation of stroke patients.However,trunk exercises given early after stroke could produce enhanced balance performance post-stroke.This review attempts to report the evidence supporting the involvement of the trunk and its influence on balance and functional performance in post-stroke hemiplegia.