Postoperative Pain After The Use Of A Dexamethasone Rinse As An Irrigant Prior To Obturation

Purpose: The purpose of this randomized, double-blind pilot study was to determine the effect of dexamethasone on post-operative pain when used as an intracanal rinse prior to obturation. Materials and Methods: Nine adult volunteers consented to enroll. They presented to the Marquette University School of Dentistry Endodontic Department with a diagnosis of irreversible pulpitis. Patients recorded their baseline pain levels on the numering rating scale (NRS). Patients were randomly assigned to either experimental or control group. Patients in the experimental group received 4 mg/mL dexamethasone solution as a final rinse prior to obturation were as patients in the control group received saline as a final rinse. Patients recorded their pain levels at 3, 6, 12, 24, and 48 hours post-operatively. Means and standard deviations were calculated. Treatment effects were analyzed using repeated measures ANOVA. Statistical significance was set at p\u3c.05. Results: Eight patients returned the participation forms. Pain reduction after endodontic treatment was statistically significant (p=0.039). There was no significant difference in post-operative pain between the control and experimental groups (p-0.789). Conclusion: The patient sample size was not large enough to state any conclusions with confidence. However, endodontic treatment remains an effective means of reducing post-operative pain

Suture-related keratitis following cataract surgery caused by methicillin-resistant Staphylococcus aureus

A 54-year old-man presented with a two-day history of severe pain and decreased vision. Examination revealed a corneal ulcer associated with a loose suture from cataract surgery done approximately two years ago. The suture was removed and the patient was started on topic antibiotic treatment with cefazolin and gentamycin. Cultures revealed methicillin-resistant Staphylococcus aureus (MRSA). The antibiotic regimen was changed to include vancomycin but the ulcer continued to progress. Three days later, the ulcer had perforated and an emergent corneal patch graft was performed. To our knowledge, this is the first reported case of suture-related MRSA keratitis after uncomplicated clear corneal cataract surgery

Deep learning surrogate models for spatial and visual connectivity

Spatial and visual connectivity are important metrics when developing workplace layouts. Calculating those metrics in real time can be difficult, depending on the size of the floor plan being analysed and the resolution of the analyses. This article investigates the possibility of considerably speeding up the outcomes of such computationally intensive simulations by using machine learning to create models capable of identifying the spatial and visual connectivity potential of a space. To that end, we present the entire process of investigating different machine learning models and a pipeline for training them on such task, from the incorporation of a bespoke spatial and visual connectivity analysis engine through a distributed computation pipeline, to the process of synthesizing training data and evaluating the performance of different neural networks

A New Paradigm: Entrepreneurial Leadership

Lloyd W. Fernald, Jr., D.B.A, is professor of management, Management Department, College of Business, Administration, University of Central FLorida, Orlando, FL 32817. George T. Solomon, D.B.A, is associate professor of entrepreneurship, The George Washington University, Washington, DC, 20052. Ayman Tarabishy, is a doctoral student, The George Washington University, Washington, DC 20052

Eustachian Tube Foreign Body with Endoscopic-Assisted Surgical Removal

Abstract Objectives. Foreign bodies of the external and middle ear are not uncommon; however, foreign bodies in the eustachian tube are rare. Here we describe the presentation, imaging, and endoscopic-assisted surgical management of a case of eustachian tube foreign body. Methods. A 34-year-old male was seen for evaluation of foreign body of the left eustachian tube while working with metal at a machine shop. Imaging and surgical management are highlighted and review of available literature regarding foreign bodies of the eustachian tube is presented. Results. A CT scan revealed a foreign body present approximately 1 cm into the bony eustachian tube. The patient underwent middle ear exploration which required endoscopic assistance to adequately visualize the foreign body. The foreign body was unable to be removed and required the creation of a bony tunnel lateral to the eustachian tube for visualization and access to the foreign body. Conclusions. This report presents a rare case of eustachian tube foreign body. Use of the endoscope during the surgical removal greatly enhanced the ease and safety of removal. This report also highlights the importance of ear protection with any machining and welding work

MR-guided focused ultrasound thalamotomy for lithium-induced tremor: a case report and literature review

Drug-induced tremor is a common side effect of lithium with an occurrence of approximately 25% of patients. Cessation of the offending drug can be difficult, and many medical treatments for drug-induced tremor are ineffective. Deep brain stimulation (DBS) has been shown in a limited number of case reports to effectively reduce drug-induced tremor, however, which remains an invasive therapeutic option. MR-guided focused ultrasound (MRgFUS) thalamotomy is an FDA-approved non-invasive treatment for essential tremor (ET). To the best of our knowledge, MRgFUS thalamotomy has never been reported to treat drug-induced tremor. Here, we present a case of a left-handed 55-year-old man with a progressive, medically refractory lithium-induced tremor of the bilateral upper extremities. The patient underwent MRgFUS thalamotomy targeting the right ventral intermediate nucleus (VIM) of the thalamus to treat the left hand. There was almost complete resolution of his left-hand tremor immediately following MRgFUS. There were no side effects. The patient continues to show excellent tremor control at 90-day follow-up and remains free from side effects. This case demonstrates MRgFUS thalamotomy as a possible novel treatment option to treat drug-induced tremor

Monocyte-lymphocyte cross-communication via soluble CD163 directly links innate immune system activation and adaptive immune system suppression following ischemic stroke

CD163 is a scavenger receptor expressed on innate immune cell populations which can be shed from the plasma membrane via the metalloprotease ADAM17 to generate a soluble peptide with lympho-inhibitory properties. The purpose of this study was to investigate CD163 as a possible effector of stroke-induced adaptive immune system suppression. Liquid biopsies were collected from ischemic stroke patients (n = 39), neurologically asymptomatic controls (n = 20), and stroke mimics (n = 20) within 24 hours of symptom onset. Peripheral blood ADAM17 activity and soluble CD163 levels were elevated in stroke patients relative to non-stroke control groups, and negatively associated with post-stroke lymphocyte counts. Subsequent in vitro experiments suggested that this stroke-induced elevation in circulating soluble CD163 likely originates from activated monocytic cells, as serum from stroke patients stimulated ADAM17-dependant CD163 shedding from healthy donor-derived monocytes. Additional in vitro experiments demonstrated that stroke-induced elevations in circulating soluble CD163 can elicit direct suppressive effects on the adaptive immune system, as serum from stroke patients inhibited the proliferation of healthy donor-derived lymphocytes, an effect which was attenuated following serum CD163 depletion. Collectively, these observations provide novel evidence that the innate immune system employs protective mechanisms aimed at mitigating the risk of post-stroke autoimmune complications driven by adaptive immune system overactivation, and that CD163 is key mediator of this phenomenon