PURPOSE: . This prospective clinical study aimed to evaluate the accuracy of intraoral scanning (IOS) as an alternative to the conventional window technique impression (WTI) for recording maxillary flabby ridges in edentulous patients. MATERIALS AND METHODS: . Twelve edentulous participants with maxillary flabby ridges underwent both IOS (TRIOS 5, 3Shape, Denmark) and WTI. WTI impressions were made using zinc oxide-eugenol paste and plaster of Paris as the reference. All scans were exported in STL format. Accuracy was assessed via trueness and precision, using RMS, average negative, and average positive deviations, calculated with Medit Compare software. RESULTS: . IOS showed significantly higher trueness than WTI in RMS (mean difference (MD) = -0.11, 95% CI: -0.15 to -0.06, P = .0001) and average negative deviation (MD = 0.13, 95% CI: 0.07 to 0.19, P = .0001). The average positive deviation had no significant difference (MD = 0.02, 95% CI: -0.01 to 0.05, P = .11). In terms of precision, IOS had significantly higher precision across all parameters: RMS (MD = 0.23, 95% CI: 0.21 to 0.26, P = .0001), average positive deviation (MD = 0.14, 95% CI: 0.11to 0.17, P = .0001), and average negative deviation (MD = -0.15, 95% CI: -0.17to -0.13, P = .0001). CONCLUSION . This study suggests that IOS may provide improved accuracy compared to the conventional window impression technique for capturing maxillary flabby ridges in edentulous patients. Further research with larger sample size and clinical outcome assessments is needed to confirm its efficacy.

Purpose: The aim of this study was to explore the correlations of cone-beam computed tomographic findings with the apnea-hypopnea index in patients with obstructive sleep apnea. Materials and Methods: Forty patients with obstructive sleep apnea were selected from the ear-nose-throat (ENT) outpatient clinic, Faculty of Medicine, Mansoura University. Cone-beam computed tomography was performed for each patient at the end of both inspiration and expiration. Polysomnography was carried out, and the apneahypopnea index was obtained. Linear measurements, including cross-sectional area and the SNA and SNB angles, were obtained. Four oral and maxillofacial radiologists categorized pharyngeal and retropalatal airway morphology and calculated the airway length and volume. Continuous data were tested for normality using the KolmogorovSmirnov test and reported as the mean and standard deviation or as the median and range. Categorical data were presented as numbers and percentages, and the significance level was set at P<0.05. Results: The minimal value of the cross-sectional area, SNB angle, and airway morphology at the end of inspiration demonstrated a statistically significant association (P<0.05) with the apnea-hypopnea index, with excellent agreement. No statistically significant difference was found in the airway volume, other linear measurements, or retropalatal airway morphology. Conclusion Cone-beam computed tomographic measurements in obstructive sleep apnea patients may be used as a supplement to a novel radiographic classification corresponding to the established clinical apnea-hypopnea index classification.

PURPOSE: The aim of this prospective clinical study was to compare the influence of palatal vault forms on accuracy and speed of intraoral (IO) scans in completely edentulous cases. MATERIALS AND METHODS: Based on the palatal vault form, participants were divided into three equal groups (n = 10 each); Class I: moderate;Class II: deep; Class III: flat palatal vault. A reference model was created for each patient using polyvinylsiloxane impression material. The poured models were digitized using an extraoral scanner. The resultant data were imported as a solid CAD file into 3D analysis software (GOM Inspect 2018; Gom GmbH, Braunschweig, Germany) and aligned using the software’s coordinate system to determine its X, Y, and Z axes. Five digital impressions (DIs) of maxilla were captured for each patient using an intraoral scanner (TRIOS; 3Shape A/S, Copenhagen, Denmark) and the resultant Standard Tessellation Language (STL) scan files served as test models. Trueness was evaluated by calculating arithmetic mean deviation (AMD) of the vault area between reference and test files while precision was evaluated by calculating AMD between captured scans to measure repeatability of scan acquisition. The scan time taken for each participant was also recorded. RESULTS: There was no significant difference in trueness and precision among the groups (P = .806 and .950, respectively). Average scan time for Class I and III palatal vaults was 1 min 13 seconds and 1 min 37 seconds, respectively, while class II deep palatal vaults showed the highest scan time of 5 mins. CONCLUSION Palatal vault form in edentulous cases has an influence on scan time. However, it does not have a substantial impact on the accuracy of the acquired scans.

Purpose: The development and study of hepatitis C virus (HCV) vaccine candidates’ individualized responses are of great importance. Here we report on an HCV DNA vaccine candidate based on selected envelope (E1/E2) epitopes. Besides, we assessed its expression and processing in human peripheral blood mononuclear cells (PBMCs) and in vivo cellular response in mice. Materials and Methods: HCV E1/E2 DNA construct (EC) was designed. The antigen expression of EC was assayed in PBMCs of five HCV-uninfected donors via a real-time quantitative polymerase chain reaction. Serum samples from 20 HCV antibody-positive patients were used to detect each individual PBMCs expressed antigens via enzyme-linked immunosorbent assay. Two groups, five Swiss albino mice each, were immunized with the EC or a control construct. The absolute count of lymph nodes’ CD4+ and CD8+ T-lymphocytes was assessed. Results: Donors’ PBMCs showed different levels of EC expression, ranging between 0.83–2.61-fold in four donors, while donor-3 showed 34.53-fold expression. The antigens expressed in PBMCs were significantly reactive to the 20 HCV antibody repertoire (all p=0.0001). All showed comparable reactivity except for donor-3 showing the lowest reactivity level. The absolute count % of the CD4+ T-cell significantly increased in four of the five EC-immunized mice compared to the control group (p=0.03). No significant difference in CD8+ T-cells % was observed (p=0.89). Conclusion The inter-individual variation in antigen expression and processing dominance was evident, showing independence in individuals’ antigen expression and reactivity levels to antibodies. The described vaccine candidate might result in a promising natural immune response with a possibility of CD4+ T-cell early priming.

The apnea-hypopnea index is widely regarded as a measure of the severity of obstructive sleep apnea (OSA), a condition characterized by recurrent episodes of apnea or hypopnea during sleep that induce airway collapse. OSA is a catastrophic problem due to the wide range of health issues it can cause, including cardiovascular disease and memory loss. This review was conducted to clarify the roles of various imaging modalities, particularly conebeam computed tomography (CBCT), in the diagnosis of and preoperative planning for OSA. Unfortunately, 2-dimensional imaging techniques yield insufficient data for a comprehensive diagnosis, given the complex anatomy of the airway. Three-dimensional (3D) imaging is favored as it more accurately represents the patient’s airway structure. Although computed tomography and magnetic resonance imaging can depict the actual 3D airway architecture, their use is limited by factors such as high radiation dose and noise associated with the scans. This review indicates that CBCT is a low-radiation imaging technique that can be used to incidentally identify patients with OSA, thereby facilitating early referral and ultimately enhancing the accuracy of surgical outcome predictions.

Background: Overweight and obesity are growing public health concerns worldwide. Bariatric surgery is a modality of weight reduction; however, postoperative pain can increase the length of hospital stay, with all the associated consequences. While regional anesthesia is an available option, the feasibility of performing abdominal wall blocks on patients with obesity is questionable. Methods: Sixty adult patients with a body mass index of 40–50 kg/m2 undergoing laparoscopic bariatric surgery were randomly assigned to receive either an ultrasound-guided transversus abdominis plane (TAP) or erector spinae plane (ESP) block. The primary outcome was the analgesic effect in the first 24 h postoperatively, assessed using the mean visual analog scale (VAS) score. Secondary outcomes were the time required for a successful block, incidence of complications, time to first rescue analgesia, time to flatus or stool passage, and total opioid consumption. Results: The mean VAS score during the first 24 h was higher with the TAP block than with the ESP block (2.78 ± 0.34 vs. 2.32 ± 0.12, P < 0.001). Additionally, the time to first rescue analgesia was greater with the ESP block (P = 0.001) and the time required for a successful block was higher with the TAP block (P = 0.001). However, the incidence of complications, total opioid consumption, and other secondary outcomes was similar between the groups. Conclusions Compared with the TAP block, the bilateral ESP block is a more feasible and effective method for intra- and postoperative analgesia in patients undergoing laparoscopic bariatric surgery.

BACKGROUND: Lung fibrosis is considered as an end stage for many lung diseases including lung inflammatory disease, autoimmune diseases and malignancy. There are limited therapeutic options with bad prognostic outcome. The aim of this study was to explore the effect of mesenchymal stem cells (MSCs) derived from bone marrow on Bleomycin (BLM) induced lung fibrosis in albino rats. METHODS: 30 adult female albino rats were distributed randomly into 4 groups; negative control group, Bleomycin induced lung fibrosis group, lung fibrosis treated with bone marrow-MSCs (BM-MSCs) and lung fibrosis treated with cell free media. Lung fibrosis was induced with a single dose of intratracheal instillation of BLM. BM-MSCs or cell free media were injected intravenously 28 days after induction and rats were sacrificed after another 28 days for assessment. Minute respiratory volume (MRV), forced vital capacity (FVC) and forced expiratory volume 1 (FEV1) were recorded using spirometer (Power lab data acquisition system). Histological assessment was performed by light microscopic examination of H&E, and Masson’s trichrome stained sections and was further supported by morphometric studies. In addition, electron microscopic examination to assess ultra-structural changes was done. Confocal Laser microscopy and PCR were used as tools to ensure MSCs homing in the lung. RESULTS: Induction of lung fibrosis was confirmed by histological examination, which revealed disorganized lung architecture, thickened inter-alveolar septa due excessive collagen deposition together with inflammatory cellular infiltration. Moreover, pneumocytes depicted variable degenerative changes. Reduction in MRV, FVC and FEV1 were recorded. BM-MSCs treatment showed marked structural improvement with minimal cellular infiltration and collagen deposition and hence restored lung architecture, together with lung functions. CONCLUSION MSCs are promising potential therapy for lung fibrosis that could restore the normal structure and function of BLM induced lung fibrosis.

Objective: To investigate the combined effect of extracorporeal shockwave therapy (ESWT) and integrated neuromuscular inhibition (INI) on myofascial trigger points in the upper trapezius. Methods: Sixty subjects aged 18–24 years old with active myofascial trigger points in the upper trapezius were studied. Participants were assigned randomly to either group A who received ESWT one session/week, group B who received INI three sessions/week, or group C who received ESWT in addition to INI. All groups completed 4 weeks of intervention. The following main outcome measures were evaluated at baseline and after 4 weeks of intervention: pain intensity, functional disability, pressure pain threshold (PPT), sympathetic skin response (SSR), and neuromuscular junction response (NMJR). Results: Within-group analysis revealed a significant decline in visual analog scale (VAS), Arabic neck disability index (ANDI), and NMJR and incline in PPT and SSR latency post-intervention (p<0.001). Multiple comparison analysis showed a substantial difference between the groups, while the major changes favored group C (p<0.05). Conclusion Combined treatment with ESWT and INI for treating myofascial trigger points in the upper trapezius is more effective than using only one of the two approaches in terms of clinical, functional, and neurophysiological aspects.

BACKGROUND: Lung fibrosis is considered as an end stage for many lung diseases including lung inflammatory disease, autoimmune diseases and malignancy. There are limited therapeutic options with bad prognostic outcome. The aim of this study was to explore the effect of mesenchymal stem cells (MSCs) derived from bone marrow on Bleomycin (BLM) induced lung fibrosis in albino rats. METHODS: 30 adult female albino rats were distributed randomly into 4 groups; negative control group, Bleomycin induced lung fibrosis group, lung fibrosis treated with bone marrow-MSCs (BM-MSCs) and lung fibrosis treated with cell free media. Lung fibrosis was induced with a single dose of intratracheal instillation of BLM. BM-MSCs or cell free media were injected intravenously 28 days after induction and rats were sacrificed after another 28 days for assessment. Minute respiratory volume (MRV), forced vital capacity (FVC) and forced expiratory volume 1 (FEV1) were recorded using spirometer (Power lab data acquisition system). Histological assessment was performed by light microscopic examination of H&E, and Masson’s trichrome stained sections and was further supported by morphometric studies. In addition, electron microscopic examination to assess ultra-structural changes was done. Confocal Laser microscopy and PCR were used as tools to ensure MSCs homing in the lung. RESULTS: Induction of lung fibrosis was confirmed by histological examination, which revealed disorganized lung architecture, thickened inter-alveolar septa due excessive collagen deposition together with inflammatory cellular infiltration. Moreover, pneumocytes depicted variable degenerative changes. Reduction in MRV, FVC and FEV1 were recorded. BM-MSCs treatment showed marked structural improvement with minimal cellular infiltration and collagen deposition and hence restored lung architecture, together with lung functions. CONCLUSION MSCs are promising potential therapy for lung fibrosis that could restore the normal structure and function of BLM induced lung fibrosis.

Background: Glioblastoma is the most aggressive primary malignant brain tumor in adults and is characterized by poor prognosis. Immune evasion occurs via programmed death-ligand 1 (PD-L1)/programmed death receptor 1 (PD-1) interaction. Some malignant tumors have responded to PD-L1/PD-1 blockade treatment strategies, and PD-L1 has been described as a potential predictive biomarker. This study discussed the expression of PD-L1 and CD8 in glioblastomas. Methods: Thirty cases of glioblastoma were stained immunohistochemically for PD-L1 and CD8, where PD-L1 expression in glioblastoma tumor tissue above 1% is considered positive and CD-8 is expressed in tumor infiltrating lymphocytes. The expression of each marker was correlated with clinicopathologic parameters. Survival analysis was conducted to correlate progression-free survival (PFS) and overall survival (OS) with PD-L1 and CD8 expression. Results: Diffuse/fibrillary PD-L1 was expressed in all cases (mean expression, 57.6%), whereas membranous PD-L1 was expressed in six of 30 cases. CD8-positive tumor-infiltrating lymphocytes (CD8+ TILs) had a median expression of 10%. PD-L1 and CD8 were positively correlated (p = .001). High PD-L1 expression was associated with worse PFS and OS (p = .026 and p = .001, respectively). Correlation of CD8+ TILs percentage with age, sex, tumor site, laterality, and outcomes were statistically insignificant. Multivariate analysis revealed that PD-L1 was the only independent factor that affected prognosis. Conclusions PD-L1 expression in patients with glioblastoma is robust; higher PD-L1 expression is associated with lower CD8+ TIL expression and worse prognosis.