New accessory palatine canals and foramina in cone beam computed tomography

Background: Palatal surgeries are associated with many complications. Accessory foramina may be a cause of concern.  The present study was conducted to assess the presence of and to evaluate the anatomical characteristics of accessory palatine foramina and related bony canals in cone beam CT scans. Materials and methods: The incidence, location, and types of foramina on the palate were evaluated in 170 CBCT scans.  Readings from coronal, sagittal, and axial planes were recorded using a computer program and evaluated. Results: Other than nasopalatine, greater and lesser palatine foramina, 278 foramina were seen in the palate in different locations. New accessory palatine foramina were found posteriorly in 14.71% of the studied scans with wide anatomical variations. Unusual foraminal canals were seen crossing the antral floor laterally. The anterior accessory palatine foramina were seen in 73.53% of scans while bilateral accessory palatine foramina were found in 43.53% of cases. Conclusions: Accessory palatine foramina and related canals are frequently seen in CBCT with many anatomical variations. New unusual connecting canals are found passing through the antral floor from palatine foramina to the lateral antral wall. These anatomical structures should be considered in preoperative planning for local analgesia and surgical interventions in the palate

The partially alternating ternary sum in an associative dialgebra

The alternating ternary sum in an associative algebra, $abc - acb - bac + bca + cab - cba$, gives rise to the partially alternating ternary sum in an associative dialgebra with products $\dashv$ and $\vdash$ by making the argument $a$ the center of each term: $a \dashv b \dashv c - a \dashv c \dashv b - b \vdash a \dashv c + c \vdash a \dashv b + b \vdash c \vdash a - c \vdash b \vdash a$. We use computer algebra to determine the polynomial identities in degree $\le 9$ satisfied by this new trilinear operation. In degrees 3 and 5 we obtain $[a,b,c] + [a,c,b] \equiv 0$ and $[a,[b,c,d],e] + [a,[c,b,d],e] \equiv 0$; these identities define a new variety of partially alternating ternary algebras. We show that there is a 49-dimensional space of multilinear identities in degree 7, and we find equivalent nonlinear identities. We use the representation theory of the symmetric group to show that there are no new identities in degree 9.Comment: 14 page

Sex Differences in Trends and In-Hospital Outcomes among Patients with Critical Limb Ischemia: A Nationwide Analysis

Background Critical limb ischemia (CLI) represents the most severe form of peripheral artery disease and is associated with significant mortality and morbidity. Contemporary data comparing the sex differences in trends, revascularization strategies, and in-hospital outcomes among patients with CLI are scarce. Methods and Results Using the National Inpatient Sample database years 2002 to 2015, we identified hospitalizations for CLI. Temporal trends for hospitalizations for CLI were evaluated. The differences in demographics, revascularization, and in‐hospital outcomes between both sexes were compared. Among 2 400 778 CLI hospitalizations, 43.6% were women. Women were older and had a higher prevalence of obesity, hypertension, heart failure, and prior stroke. Women were also less likely to receive any revascularization (34.7% versus 35.4%, P\u3c 0.001), but the trends of revascularization have been increasing among both sexes. Revascularization was associated with lower in‐hospital mortality among women (adjusted odds ratio [OR], 0.76; 95% CI, 0.71–0.81) and men (adjusted OR, 0.69; 95% CI, 0.65–0.73). On multivariable analysis adjusting for patient‐ and hospital‐related characteristics as well as revascularization, women had a higher incidence of in‐hospital mortality, postoperative hemorrhage, need for blood transfusion, postoperative infection, ischemic stroke, and discharge to facilities compared with men. Conclusions In this nationwide contemporary analysis of CLI hospitalizations, women were older and less likely to undergo revascularization. Women had a higher incidence of in‐hospital mortality and bleeding complications compared with men. Sex‐specific studies and interventions are needed to minimize these gaps among this high‐risk population

Structural basis of synthetic agonist activation of the nuclear receptor REV-ERB

The nuclear receptor REV-ERB plays an important role in a range of physiological processes. REV-ERB behaves as a ligand-dependent transcriptional repressor and heme has been identified as a physiological agonist. Our current understanding of how ligands bind to and regulate transcriptional repression by REV-ERB is based on the structure of heme bound to REV-ERB. However, porphyrin (heme) analogues have been avoided as a source of synthetic agonists due to the wide range of heme binding proteins and potential pleotropic effects. How non-porphyrin synthetic agonists bind to and regulate REV-ERB has not yet been defined. Here, we characterize a high affinity synthetic REV-ERB agonist, STL1267, and describe its mechanism of binding to REV-ERB as well as the method by which it recruits transcriptional corepressor both of which are unique and distinct from that of heme-bound REV-ERB

Efficacy and safety of Elagolix in the treatment of endometriosis associated pain: a systematic review and network meta-analysis

Background: Endometriosis commonly presents with dysmenorrhea, non-menstrual pelvic pain, and infertility. Elagolix is an oral, short-acting, gonadotropin-releasing hormone antagonist acting through complete estrogen suppression. Objective: To evaluate the evidence from published randomized controlled trials (RCTs) about the efficacy and safety of Elagolix in the treatment of endometriosis associated pain. Search strategy: Electronic databases containing articles published between January 2000 and February 2020 were searched using the MeSH terms (Elagolix OR gonadotropin-releasing hormone antagonist OR GnRH antagonist OR antigonadotropin) AND (endometriosis) AND (pelvic pain). Selection criteria: All RCTs assessing the efficacy of Elagolix in the treatment of pain associated with endometriosis were considered for this network meta-analysis, where five studies were deemed eligible for this review. Data collection and analysis: The mean difference (MD) and confidence intervals (95% CI) for continuous outcomes including analgesic use, dysmenorrhea, non-menstrual pelvic pain, and quality of life were calculated. Main results: Elagolix 250 mg reduced dysmenorrhea significantly, as compared to placebo, (MD = -0.41, 95% CI [-0.7, -0.13]) at 12 weeks, while Elagolix 200 mg reduced dysmenorrhea significantly (MD= -1.2, 95% CI [-1.9, -0.57]) compared to placebo after 24 weeks of treatment. Conclusions: Elagolix 200 mg seems to be an effective drug with fewer side effects when used to reduce dysmenorrhea and non-menstrual pelvic pain after 24 weeks of treatment in patients with endometriosis