UNASSIGNED: Fluoroscopy is considered to be the gold standard and an essential requirement for catheter insertion. However, there is a paucity of data regarding the outcomes in ultrasound (USG)-guided insertion with and without fluoroscopy. We compared the complications of USG-guided tunneled dialysis catheter (TDC) insertion with and without fluoroscopy assistance.
UNASSIGNED: This was a single-center randomized controlled trial (RCT) done in a tertiary hospital in North India. After screening 153 patients, 149 were enrolled: 87 were randomized into USG-guided insertion without fluoroscopy (group A) and 62 were randomized into USG-guided insertion with fluoroscopy (group B). All insertions were done in a dedicated procedure room by trained nephrologists. Outcomes were analyzed at baseline and at 1-month follow-up. Mechanical complications as well as infective and thrombotic complications were compared between both the groups.
UNASSIGNED: TDC insertion was successful (100%) in all the study participants (N = 149). One hundred twenty-nine catheters (86.5%) were inserted in the first attempt, 19 (12.5%) in the second attempt, and one catheter insertion required three attempts for insertion. The mean age of study participants was 43 years (±16.5), and males constituted 63% of the study cohort. Baseline laboratory characteristics of the two groups were comparable. The mean time of catheter insertion was 41.26 min (standard deviation [SD] 11.8) in group A and 47.74 min (SD 17.2) in group B (P = 0.007). The mean score of ease of catheter insertion, exit site bleed, infective and mechanical complications were not different between the two groups.
UNASSIGNED: Our study concluded that fluoroscopy has no additional advantage in reducing mechanical, infective, or thrombotic complications. In experienced hands, USG-guided TDC insertion without fluoroscopy assistance is as good as the insertion done with fluoroscopy assistance, with a shorter procedure time.

BACKGROUND: To compare the surgical outcomes of the inverted internal limiting membrane (ILM) flap technique and ILM insertion for macular hole (MH) without retinal detachment in eyes with extremely high myopia.
METHODS: In this retrospective study, we analyzed 22 eyes with an axial length ≥ 30.0 mm that had underwent MH surgery between April 2015 and August 2021. The surgical procedures involved either an inverted ILM flap or ILM insertion. The outcomes were compared between the two techniques. Closure of the MH was confirmed by optical coherence tomography (OCT). The best-corrected visual acuity (BCVA) was measured before and after surgery. Associated complications were documented.
RESULTS: The median of axial length was 30.64 mm (range, 30.0-34.42). The MH closed in 100% (22/22) eyes and did not recur with a median follow-up of 12.5 months. For the inverted ILM flap technique, the median BCVA improved significantly from 0.80 logarithm of the minimum angle of resolution (logMAR) (range, 0.40-2.00) before surgery to 0.70 logMAR (range, 0.09-1.52) after surgery (p = 0.002). In addition, the median of final BCVA was better for the inverted ILM flap than ILM insertion (0.7 logMAR V.S. 1.00 logMAR; p = 0.016).
CONCLUSIONS: In eyes with extremely high myopia, despite comparable effects on MH closure for both ILM insertion and the inverted ILM flap, the later technique achieved significantly better visual outcomes.

Objectives: Histological differences in cartilage layer growth in Achilles tendon (AT), quadriceps tendon (QT), patellar tendon (PT), and anterior cruciate ligament (ACL) insertion are unclear. Therefore, this study aimed to investigate the differences in cartilage layer growth in AT, QT, PT, and ACL insertions. Materials and Methods: Forty-eight male Japanese white rabbits were used. Six animals were euthanized at different stages (day 1 and 1, 2, 4, 6, 8, 12, and 24 weeks). Safranin O-stained glycosaminoglycan (GAG) production area, chondrocyte count, and insertion width were investigated. Results: A two-way analysis of variance (ANOVA) revealed a significant difference in the main effects of time and insertion for all parameters. In addition, the time × insertion interaction was significant. Multiple comparisons showed a significant difference between the ACL insertion and all other variables; however, the GAG production area was not significantly different for the QT, PT, and AT insertions. AT insertions were significantly different from all other groups; however, the number of chondrocytes and insertion width were not significantly different for ACL, QT, and PT insertions. Conclusion: Cartilage layer growth differed between the AT, QT, PT, and ACL insertions. The differences between the insertions may also be due to the differences in their structures, locations, and mechanical environments.

UNASSIGNED: We aimed at determining the distribution of the ACE insertion/deletion gene polymorphisms among type 2 diabetic patients and their association with the nephropathy biomarkers and the metabolic indicators.
UNASSIGNED: Data were collected from 237 adult type 2 diabetes mellitus patients receiving healthcare at the diabetic clinic of Mbarara Regional Referral Hospital. Peripheral blood genomic DNA was amplified using a conventional PCR technique and analyzed for the ACE homozygous forms of the insertion (II), deletion (DD) and heterozygous insertion deletion (ID) genotypes as well as their respective allele counts. Biomarkers of nephropathy were analyzed on a Beckman coulter AU480 chemistry analyzer using system compatible reagents.
UNASSIGNED: Majority of the participants were older persons (Median = 57, IQR = 49-64) and female 171 (72.2%). Most of them had the Deletion allele 198 (83.5%) and DD genotype 116 (48.9%). At multivariate logistic regression, the nephropathy biomarkers that is microalbuminuria, serum creatinine, urea, eGFR and electrolytes had no association with the ACE I/D alleles or genotypes (p > 0.05). On the other hand, selected metabolic indicators had a positive relationship. The insertion allele was associated with increasing glycated hemoglobin (OR = 1.082, p = 0.019) and decreasing serum glucose levels (OR = 0.891, p = 0.001). Deletion allele was associated with decreasing glycated hemoglobin (OR = 0.924, p = 0.047) and increasing serum glucose levels (OR = 1.208, p = 0.001). ACE II genotype was associated with decreasing serum glucose levels (OR = 0.873, p = 0.029). ACE DD genotype was associated with decreasing glycated hemoglobin (OR = 0.917, p = 0.010) and increasing serum glucose levels (OR = 1.132, p = 0.001). ACE ID genotype was associated with increasing glycated hemoglobin (OR = 1.077, p = 0.022), triglyceride levels (OR = 1.316, p = 0.031) and decreasing serum glucose levels (OR = 0.933, p = 0.038).
UNASSIGNED: The presence or absence of the ACE I/D alleles and genotypes affects the ultimate increase or decrease in the serum glucose, glycated hemoglobin and triglyceride levels. Although there was no significant association between the biomarkers of nephropathy and the ACE I/D alleles or genotypes, the above implicated metabolic indicators should be included in healthcare guidelines used when attending to type 2 diabetic patients.

BACKGROUND: Hypohidrotic ectodermal dysplasia (HED) is a genetic disorder that results in the abnormal development of structures derived from ectodermal tissue. This rare condition predominantly affects the hair, nails, eccrine glands, and teeth. While HED can be caused by various genes, the EDA, EDAR, EDARADD, and WNT10A genes account for approximately 90% of cases. Notably, HED forms associated with variants in the EDA, EDAR, or EDARADD genes may exhibit similar phenotypes due to defects in a common signaling pathway. Proper interaction among the products of these genes is crucial for the activation of the nuclear factor (NF-κB) signaling pathway, which subsequently regulates the transcription of targeted genes. The EDARADD gene, in particular, harbors one of the rarest reported variants associated with HED.
METHODS: Five-and two-years-old brothers born into consanguineous parents were examined at our outpatient medical genetics clinic at Sanliurfa Training and Research Hospital, Turkey. Both displayed the same classical phenotypic features of HED. The elder had a very sparse dark and brittle hair, sparse eyebrows and eyelashes, conical upper and lower premolar teeth with hypodontia, widely spaced teeth, very dry skin, mildly prominent forehead, and periorbital wrinkles. The younger one showed the same, but less severe, clinical features. After thorough examination and patient history evaluation, targeted next-generation sequencing analysis yielded the novel homozygous insertion variant c.322_323insCGGGC p.(Arg108ProfsTer7) in EDARADD. The mutation has not been reported to date in the literature.
CONCLUSIONS: In this report, we present two siblings exhibiting classical HED symptoms and a novel insertion variant of the EDARADD gene, which leads to a frameshift introducing a stop codon. Both brothers inherited such mutation from their parents, who were heterozygous carriers of the same variant. The present study may shed light about the pathogenic mechanisms underlying HED, and expand the spectrum of EDARADD gene variants associated with this condition.

UNASSIGNED: Nasogastric tube (NGT) insertion is one of the most commonly performed procedures for critically ill patients through the nostril or mouth into the stomach, which is indicated for multiple reasons.
UNASSIGNED: This study is, therefore, aimed to enhance the NGT insertion skill performance of third-year nursing students using the updated checklist, 2021.
UNASSIGNED: A facility-based pre-post intervention study was conducted among third-year nursing students of the School of Nursing, Jimma University. An updated checklist and intervention package were used among 26 randomly selected nursing students. The collected data was entered into EpiData version 3.1, EpiData Association, Denmark and exported to SPSS version 23, IBM Corp, Armonk, NewYork for analysis. Descriptive statistics were made for each item and Paired T-test analysis was conducted to summarize the findings.
UNASSIGNED: The highest NGT skill insertion performance score from 40% before the intervention was 35; however, after the intervention, the score increased to 40.3. Their mean score in NGT skill performance was increased by 11 after the intervention of implementing the intervention package using the updated checklist from 26.5 ±5 0.3 the pre-intervention to 37.8 ±5 1.7 post-intervention. The finding indicated that the improvement was statistically significant at p < 0.001.
UNASSIGNED: Implementing an intervention package and employing an updated NGT insertion checklist improved the performance of third-year nursing students\' NGT insertion skills by an average of 11 points compared to their pre-test scores. A large-scale control randomized trial study was recommended to control for the effects of confounding factors on the implementation of intervention packages.

A fundamental goal in evolutionary biology and population genetics is to understand how selection shapes the fate of new mutations. Here, we test the null hypothesis that insertion-deletion (indel) events in protein-coding regions occur randomly with respect to secondary structures. We identified indels across 11,444 sequence alignments in mouse, rat, human, chimp, and dog genomes and then quantified their overlap with four different types of secondary structure-alpha helices, beta strands, protein bends, and protein turns-predicted by deep-learning methods of AlphaFold2. Indels overlapped secondary structures 54% as much as expected and were especially underrepresented over beta strands, which tend to form internal, stable regions of proteins. In contrast, indels were enriched by 155% over regions without any predicted secondary structures. These skews were stronger in the rodent lineages compared to the primate lineages, consistent with population genetic theory predicting that natural selection will be more efficient in species with larger effective population sizes. Nonsynonymous substitutions were also less common in regions of protein secondary structure, although not as strongly reduced as in indels. In a complementary analysis of thousands of human genomes, we showed that indels overlapping secondary structure segregated at significantly lower frequency than indels outside of secondary structure. Taken together, our study shows that indels are selected against if they overlap secondary structure, presumably because they disrupt the tertiary structure and function of a protein.

UNASSIGNED: The deltoid is a trisegmented muscle with anterior, middle, and posterior components. While the clinical relevance of the presence of anatomic variations of the deltoid origin and insertion continues to be debated, the architecture of the deltoid muscle is more complex than initially believed. This study aimed to evaluate the gross anatomy of the deltoid muscle insertion by qualitatively and quantitatively characterizing the insertion and location of the deltoid muscle\'s anterior, middle, and posterior components. This information is valuable to surgeons as it raises awareness of potential variants that could be encountered during surgery, promotes mindfulness of neurovascular proximities, and reduces the likelihood of confusion between adjacent muscle fibers.
UNASSIGNED: Eight nonpaired, fresh-frozen clavicle-to-fingertip cadaveric shoulders were acquired for the study (6 left, 2 right). The average age of the cadavers was 79.5 years (range: 64-92). The standard deltopectoral approach was carried out on all specimens. The planes dividing the anterior, middle, and posterior deltoid were identified and marked. Once complete exposure had been achieved, digital calipers were used to record the size of the deltoid insertion. The specimens were qualitatively assessed to characterize the style of insertion they demonstrated.
UNASSIGNED: The average length of the deltoid insertion was 39.45 ± 9.33 mm (n = 8). Six of the eight shoulders demonstrated an insertion style previously characterized in the literature. The remaining two shoulders highlighted an insertion pattern not previously described.
UNASSIGNED: The current study demonstrates a novel insertion pattern for the deltoid muscle that has not been previously characterized. This \"step-off\" insertion pattern shows that the anterior, middle, and posterior tendons are inserted superior-medial, directly on, and inferior-lateral to the deltoid tuberosity and was found in 2/8 of our cadaveric specimens.

The present study aimed to evaluate the effect of denture wearing on the occurrence of fungal isolates in the oral cavity before and after complete denture insertion. Fifty completely edentulous patients were selected. Swab samples were collected intraorally before the fabrication of complete dentures from the palatal mucosal surface and after complete denture fabrication (1 and 7 days after denture insertion). Further, these samples were inoculated and incubated. Results showed that in 48 patients, no isolate of fungus before denture insertion was found. In two subjects, results were false positive (contamination from the environment), and in six patients, there was an increase in growth, but not much significant increase of growth was seen (mild growth of fungus only after denture insertion). One of the major findings of this study was that the overall occurrence of fungal isolates (before and after denture insertion) in the oral cavity was not significant.

UNASSIGNED: The ideal position of the femoral bone tunnel in the anterior cruciate ligament (ACL) is controversial. The functional importance of the ACL fiber varies depending on where it is attached to the femur. Functionally important fibers can cause high mechanical stress on the bone, and the Wolff law predicts that bone mineral density will increase at high mechanical stress sites.
UNASSIGNED: The purpose of this study was to use computed tomography imaging to determine the distribution pattern of bone density in the lateral intercondylar wall. It was hypothesized that the high-density area (HDA) of the lateral intercondylar wall would reflect the functional insertion of the ACL as reported in previous anatomic studies.
UNASSIGNED: Descriptive epidemiology study.
UNASSIGNED: Data from 39 knees without ACL injuries were retrospectively collected. The HDA of the lateral intercondylar wall was defined as the region containing the top 10% of the radiodensity values. The shape of the HDA was approximated as an ellipse, and the quadrant method was used to determine the center of the ellipse. The association between the ratio of the minor axis to the major axis of the ellipse and background characteristics was investigated.
UNASSIGNED: According to the quadrant method, the center of the HDA ellipse was 33.6% in the deep-shallow direction and 23.4% in the high-low direction. The center of the ellipse was comparable to the anatomic center of the ACL footprint, as previously reported. The ratio of the minor axis to the major axis of the ellipse was 0.58 (95% CI, 0.54-0.62). There was a significant negative correlation between the ratio of the minor axis to the major axis of the HDA ellipse and the posterior tibial slope (r = -0.38, P = .02).
UNASSIGNED: The center of the HDA ellipse was found to be similar to the anatomic center of the ACL footprint. Considering the mechanical stress responses in bone, the HDA of the lateral intercondylar wall has the potential to represent the ACL insertion, especially functional insertion.