Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p =0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1–C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability.

Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p =0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1–C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability.

Traumatic posterior atlantoaxial dislocation (TPAD) without an associated fracture is a rare and challenging spinal injury. This PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-compliant case-based systematic review and meta-analysis aimed to comprehensively explore TPAD, covering clinical presentation, diagnosis, treatment, and clinical and radiological outcomes. Following the presentation of a case of TPAD without an associated fracture, we conducted a systematic search of electronic databases, including Scopus, PubMed, and Web of Science, from inception through October 2023, without language restrictions. Cases involving dislocations due to congenital anomalies or inflammatory processes were excluded. The search yielded 31 eligible cases of TPAD without an associated fracture. The majority (81%) of the cases were males, with traffic accidents being the leading cause (87%). Notably, 52% of the cases presented without any neurological deficits. Regarding treatment approaches, 23% of the cases were managed through closed reduction alone, 32% required fusion following closed reduction, and 45% underwent open reduction and fusion. A time delay exceeding 7.5 days was associated with a significantly higher risk of closed reduction failure (odds ratio, 56.463; p =0.011). This review identified key management strategies for TRAD without fracture, informed by the available evidence. Optimal management entails prompt closed reduction under C-arm while monitoring neurological status once hemodynamic stability is achieved. Surgical fusion is indicated for cases with magnetic resonance imaging-confirmed transverse ligament rupture or residual instability. If closed reduction fails, open reduction and fusion should be carried out. Posterior C1–C2 screws fixation is the preferred fusion technique, providing high levels of safety and biomechanical stability.

Purpose: A wide range of cytokines has been demonstrated to be involved in the etiology of type 1 diabetes mellitus (T1DM). Gene polymorphisms may potentially contribute to a hereditary predisposition toward circulating cytokine levels as (high, intermediate, or low) since they can affect cytokine production or function. The aim of this study was to investigate the roles of cytokine levels and the association of single-nucleotide polymorphisms (SNPs) within cytokine genes with T1DM in Saudi children. Methods: Totals of 91 well-characterized T1DM patients and 91 T1DM-free control subjects were enrolled in this study. Results: The levels of 3 circulating cytokines (transforming growth factor [TGF]-β1, interleukin [IL]-10, and IL-6) and 6 SNPs in 3 cytokine genes (TGF-β1 [rs1800470 and rs1800471], IL-10 [rs1800896, rs1800871, and rs1800872], and IL-6 [rs1800795]) that contribute to genetic susceptibility were measured by enzyme-linked immunosorbent assay and polymerase chain reaction with sequence-specific primers. Our fn dings show that TGF-β1 serum levels were signifcantly lower in the children with T1DM than in the control participants. The TGF-β1 genotypes with a high-production phenotype were signifcantly less frequent and those with a lowproduction phenotype were signifcantly more frequent in the children with T1DM compared to the control participants. respectively. Furthermore, the IL-6 genotype frequency with low level of IL-6 production were signifcantly increased in the T1DM group compared to the control group. Moreover, our data demonstrated no appreciable diferences in circulating serum level or genotype and phenotype of IL- 10 between the patients and controls. Conclusion This kind of measurement, which considers the prediction of T1DM, may be useful in assessing the severity of T1DM and susceptibility to T1DM among Saudi children.

Background: The introduction of presurgical nasoalveolar molding represented a significant departure from traditional molding methods. Developed by Grayson and colleagues in 1993, this technique combines an intraoral molding device with a nasal molding stent. This study aimed to compare the Grayson nasoalveolar molding appliance versus DynaCleft appliance as two methods of presurgical nasoalveolar molding. Methods: A single-blinded, randomized, parallel-arm clinical trial was conducted. Sixteen infants with complete unilateral cleft lip and palate were enrolled and divided into two groups of eight. Group 1 was treated with a modified Grayson nasoalveolar molding appliance that included a nasal stent, while group 2 was treated with DynaCleft elastic adhesive tape and an external nasal elevator. Standardized digital photographs of each infant were taken at baseline and post-treatment using a professional camera. Nine extraoral anthropometric measurements were obtained from each image using image measurement software. Results: The modified Grayson nasoalveolar appliance demonstrated a more significant improvement compared to DynaCleft in terms of alar length projection (on both sides), columella angle, and nasal tip projection. Symmetry ratios also showed enhancement, with significant improvements observed in nasal width, nasal basal width, and alar length projection (p< 0.05). Conclusion Both the modified Grayson nasoalveolar appliance and DynaCleft appear to be effective presurgical infant orthopedics treatment options, demonstrating improvements in nasolabial aesthetics. The modified Grayson appliance, equipped with a nasal stent, improved nasal symmetry more effectively than DynaCleft, resulting in a straighter columella and a more medially positioned nasal tip.

Background: and Purpose Repetitive transcranial magnetic stimulation (rTMS) of the cerebellar hemisphere represents a new option in treating essential tremor (ET) patients. We aimed to determine the efficacy of cerebellar rTMS in treating ET using different protocols regarding the number of sessions, exposure duration, and follow-up duration. Methods: A randomized sham-controlled trial was conducted, in which 45 recruit patients were randomly allocated to 2 groups. The first (active group) comprised 23 patients who were exposed to 12 sessions of active rTMS with 900 pulses of 1-Hz rTMS at 90% of the resting motor threshold daily on each side of the cerebellar hemispheres over 4 weeks. The second group (sham group) comprised 22 patients who were exposed to 12 sessions of sham rTMS. Both groups were reassessed at baseline and after 1 day, 1 month, 2 months, and 3 months using the Fahn-Tolosa-Marin tremor-rating scale (FTM). Results: Demographic characteristics did no differ between the two groups. There were significant reductions both in FTM subscores A and B and in the FTM total score in the active-rTMS group during the period of assessment and after 3 months (p=0.031 and 0.011, respectively).However, subscore C did not change significantly from baseline when assessed at 2 and 3 months (p=0.073 and 0.236, respectively). Furthermore, the global assessment score was significantly higher in the active-rTMS group (p>0.001). Conclusions Low-frequency rTMS over the cerebellar cortex for 1 month showed relative safety and long-lasting efficacy in patients with ET. Further large-sample clinical trials are needed that include different sites of stimulation and longer follow-ups.

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.

Worldwide, cardiovascular disease is the main cause of death, which accordingly increased by hyperlipidemia. Hyperlipidemia therapy can include lifestyle changes and medications to control cholesterol levels. Statins are the medications of the first choice for dealing with lipid abnormalities. Rosuvastatin founds to control high lipid levels by hindering liver production of cholesterol and to achieve the targeted levels of low-density lipoprotein cholesterol, another lipid lowering agents named ezetimibe may be used as an added therapy. Both rosuvastatin and ezetimibe have low bioavailability which will stand as barrier to decrease cholesterol levels, because of such depictions, formulations of this combined therapy in nanotechnology will be of a great assistance. Our study demonstrated preparations of nanoparticles of this combined therapy, showing their physical characterizations, and examined their behavior in laboratory conditions and vivo habitation. The mean particle size was uniform, polydispersity index and zeta potential of formulations were found to be in the ranges of (0.181–0.72) and (–13.4 to –6.24), respectively. Acceptable limits of entrapment efficiency were affirmed with appearance of spherical and uniform nanoparticles. In vitro testing showed a sustained release of drug exceeded 90% over 24 h. In vivo study revealed an enhanced dissolution and bioavailability from loaded nanoparticles, which was evidenced by calculated pharmacokinetic parameters using triton for hyperlipidemia induction. Stability studies were performed and assured that the formulations are kept the same up to one month. Therefore, nano formulations is a suitable transporter for combined therapy of rosuvastatin and ezetimibe with improvement in their dissolution and bioavailability.

Background: Tumor-infiltrating neutrophils and lymphocytes play essential roles in promoting or combating various neoplasms. This study aimed to investigate the association between tumor-infiltrating neutrophils and lymphocytes and the neutrophil-to-lymphocyte ratio in the progression of urothelial carcinoma. Methods: A total of 106 patients diagnosed with urothelial carcinoma were was. Pathological examination for tumor grade and stage and for tumor-infiltrating neutrophils, both CD4 and CD8+ T lymphocytes, as well as the neutrophil- to-lymphocyte ratio were evaluated. Results: The presence of neutrophils and the neutrophil-to-lymphocyte ratio correlated with high-grade urothelial neoplasms. In both low- and high-grade tumors, the lymphocytes increased during progression from a non-invasive neoplasm to an early-invasive neoplasm. CD8+ T lymphocytes increased in low-grade non–muscle-invasive tumors compared to non-invasive tumors. Additionally, there was a significant decrease in CD8+ T lymphocytes during progression to muscle-invasive tumors. Conclusions Our results suggest that tumor-infiltrating neutrophils and CD8+ T lymphocytes have a significant effect on tumor grade and progression.