Ultrasound can identify important characteristics in primary hypothyroidism and diffuse hyperthyroidism (Graves\' disease). Therefore, sonologists are actively investigating ultrasound criteria to differentiate between these two conditions. Nevertheless, practice shows the absence of such ultrasonic landmarks. For the first time in the literature, three cases of primary hypothyroidism have demonstrated an ultrasound pattern identical to that of Graves\' disease. This pattern includes the presence of goiter, marked total hypoechogenicity of the parenchyma, significantly or moderately increased blood flow intensity (\'thyroid inferno\'), and elevated peak systolic velocity of the superior thyroid arteries. These signs are less common in hypothyroidism compared to hyperthyroidism. Diagnostic data suggest that the pathogeneses of primary hypothyroidism and Graves\' disease share the same mechanisms, leading to similar thyroid ultrasound patterns. One of these shared mechanisms is presumably thyroid overstimulation by the autonomic nervous system, which is adequate to the body\'s hormonal requirements in hypothyroidism but excessive in hyperthyroidism.

Systematic toxicological analysis (STA) is the process of using an adequate analytical methodology to detect and identify as many potentially toxicologically relevant compounds as possible in biological samples. STA is an important part of everyday routine work within forensic toxicology, and several methods for STA have frequently been published and reviewed independently. However, the many drugs and other substances involved, as well as the constant emergence of new ones, may pose a major challenge in STA, which often demands a strategy involving multiple analytical methods in parallel. Such strategies have been published and evaluated less frequently despite their relevance in forensic toxicology. This mini-review briefly summarizes commonly applied methods for STA in forensic toxicology, including gas chromatography-mass spectrometry (GC-MS) and liquid chromatography-MS (LC-MS) methods, and highlights some of their potential pitfalls. Second, it provides an overview of previously reported strategies to conduct STA, including a presentation of the STA strategy applied in the authors\' laboratory. This involves broad drug screening by LC-high-resolution MS, supported by targeted screening and quantification using LC-tandem MS, headspace (HS)-GC-MS, HS-GC-flame ionization detector and other complementary methods. The STA strategy aims to cover as many potentially relevant drugs as possible and seeks to reduce potential pitfalls arising in forensic casework. The review underlines that not every substance can be identified in all circumstances even with a comprehensive STA strategy.

Drug-facilitated sexual assault (DFSA) is characterized by victim incapacitation due to intoxicating substances. Detection of single drug exposure from DFSA requires a systematic toxicological analysis strategy including sensitive methods covering a broad spectrum of substances. The aim of this study was to develop and validate an UHPLC-MS/MS screening method for analysis of samples from DFSA cases and incorporate an automated enzymatic pre-treatment of urine samples into a robotic sample preparation for an efficient laboratory workflow. The screening method included 144 drugs of abuse, pharmaceuticals, and metabolites relevant to DFSA. The use of a recombinant enzyme showed an efficient glucuronide hydrolysis with an average parent drug recovery of 97%. Investigation of matrix effect showed no pronounced ion enhancement or suppression for most analytes (96%), and extraction recovery was above 80% for 97% of analytes. Process efficiency ranged from 50% to 138% for most analytes. The LODs ranged from 0.0001 mg/L to 2 mg/L depending on analyte, and most analytes met the SOFT recommended minimum performance limits. The validated method was applied to authentic suspected DFSA cases (n = 38). Results showed that drugs of abuse, benzodiazepines, and antidepressants were most commonly found in suspected DFSA cases. Incorporation of an automated enzymatic hydrolysis step during sample preparation enables a fast and simple workflow for simultaneous analysis of blood and urine samples for an improved systematic toxicological analysis strategy for DFSA cases.

Aim This study aimed to evaluate the prevalence of developmental disturbances in permanent second premolars in which their tooth buds were exposed to mandibular intraligamental anesthesia (ILA) using a computer-controlled local anesthetic delivery system (CCLAD). Materials and methods This was a longitudinal follow-up study conducted in a previous randomized clinical trial (RCT). In the previous RCT, a total of 91 children were included (61 control and 30 cases). A structured form was created that contained details about the date of birth, age, and sex at which the participants received local anesthesia and the type of local anesthesia administered (ILA using CCLADS, traditional inferior alveolar nerve block [IANB], and IANB using CCLADS). A history of post-treatment abscess, retreatment, and post-treatment extraction was documented in both groups. Descriptive statistics, including frequency and percentage, and additionally, the chi-square test and Fisher\'s exact test were used to compare ILA and IANB. Results Forty of the 91 children attended follow-up visits. Only two children had developmental defects: one child who received traditional IANB had a demarcated white opacity (this patient had a history of dental abscess), and another who received ILA using CCLADS showed hypoplasia on his permanent premolar. No significant association was found between the type of anesthesia and the presence of developmental defects. Conclusion The slow administration of ILA delivered by CCLADS in the primary teeth does not increase the chances of developmental disturbances or damage to the corresponding permanent tooth bud.

Sagittal split ramus osteotomy (SSRO) is a widely performed orthognathic surgery; however, among the various reported complications of SSRO, pseudoaneurysms are rarely reported. Pseudoaneurysms are rare vascular lesions formed by damage to the arterial wall that can occur after trauma or postoperatively, causing uncontrolled bleeding. The present report describes a case of a pseudoaneurysm that occurred after SSRO in a 22-year-old female patient. Le Fort I osteotomy and bilateral SSRO were performed under general anesthesia to improve the gummy smile and mandibular asymmetry of the patient. While osteotomizing the medial side of the left SSRO, major bleeding occurred from the soft tissue of the posterior margin of the mandibular branch. Direct compression with gauze and a local hemostatic agent stopped the bleeding. Immediately after returning to the ward, bleeding was observed from the left wound site and marked swelling of the left buccal area occurred. Contrast-enhanced computed tomography revealed a pseudoaneurysm of the left superficial temporal artery (STA). Subsequently, arterial embolization for the pseudoaneurysm was performed. Overall, the present report describes a rare case of pseudoaneurysm of the STA as a postoperative complication of SSRO.

The purpose of this study was to evaluate relation between superior thyroid vessels, external branch of superior laryngeal nerve and superior pole of thyroid based on Cernea classification in Jammu population. The present study was conducted on 50 patients in Department of ENT & Head and Neck Surgery, SMGS Hospital, Government Medical College Jammu during a time period of January 2018 to March 2020. Patients undergoing selective thyroid surgeries for various pathologies were included in the study. Patients with preoperative vocal cord palsy and patients with malignant thyroid neoplasms were excluded from the study. All patients were operated under general anaesthesia, with supine neck extended position. The bifurcation and the branches of STA were meticulously dissected preserving all the branches and any anastomoses if present. Once visualization of the nerve was attained, various measurements were taken to assess Cernea classification type. Depending on extent of lesion appropriate surgical procedure was done so as remove all the diseased tissue. Out of total 62 lobes, Cernea\'s Type 1 pattern was seen in 33 (53.2%) of patients, Cernea\'s Type 2a was seen in 11 patients (17.7%) and Cernea\'s Type 2b was seen in 14 patients (22.5%). No specific pattern was seen in 4 (6.4%) of patients. Cernea classification system is a simple and reliable guide to identify and preserve the nerve.

Asphalt binder is a complex mixture of dark brown polymers composed of hydrocarbons with generally poor fire resistance. To improve its flame retardancy when used in tunnel asphalt pavements, a new inorganic flame-retardant filler (FR) containing magnesium hydroxide, aluminum hydroxide, inorganic phosphate, and melamine salt was explored. Thereafter, limiting oxygen index (LOI) and smoke suppression tests for the flame-retarded asphalt binder (FRA) mastics mixed with FR and styrene-butadiene-styrene (SBS) copolymer asphalt binder were conducted. Thermogravimetric (TG) and differential scanning calorimetry (DSC) curves for the FRA were correspondingly generated. Based on the TG data, the reaction function g(α), apparent activation energy Ea, and pre-exponential factor A were quantitatively evaluated using kinetic analysis. In addition, a Fourier transform infrared spectrometry (FTIR) test was utilized to assess the effects of the presence of FR on the chemical composition of the asphalt binder. Dynamic shear rheometer (DSR) tests were also performed to evaluate the rheological behavior of FRA. Results show that the presence of the FR significantly reduced the LOI and improved the smoke suppression during combustion of the asphalt binder mastics. The presence of FR was found to increase the Ea and the complexity of the combustion reaction, thereby improving the flame retardancy of the asphalt binder. FTIR analysis indicated that the presence of FR did not induce any strong chemical reactions to significantly impact or alter the functional groups of the asphalt binder. Furthermore, it was also observed that the rutting parameter and critical failure temperature of FRA increased with the addition of FR due to the stiffening effect of the solid FR particles.

UNASSIGNED: The thyroid gland displays numerous variations in its anatomy. Understanding the variations that occur can benefit diagnosis of thyroid disorders and improve management. The aim of this study was to investigate how factors such as age and sex may influence variations in the thyroid.
UNASSIGNED: Twenty cadavers (10 males & 10 females) with a mean age of 78 were dissected. Variations in anatomy and vasculature were examined. Correlation between age and thyroid size was tested for significance using GraphPad prism 7.
UNASSIGNED: Most cadavers, 65%, had the superior thyroid artery originating from the external carotid artery, while 25% were from the bifurcation and 10% from the common carotid. The average weight for thyroids was 19.9 g in males and 13.9 g in females. A significant negative correlation was found between age and thyroid size.
UNASSIGNED: Thyroid gland variations, such as pyramidal lobes which affected 30% of cadavers, could impact medical interventions. Evidence from this study has confirmed the high incidence of such variations emphasising the requirement for preoperative imaging.

In the absence of a framework designed to evaluate medicines for rare diseases in the UK, most orphan medicines are appraised by the National Institute for Health and Care Excellence (NICE) through the Single Technology Appraisal (STA) process.
An analysis of STA appraisals of orphan and non-orphan medicines revealed that orphan medicines were subject to a significantly longer mean time in the NICE process than non-orphan medicines [370 days (n = 44) vs. 277 days (n = 118), p =  < 0.0001]. A higher proportion of orphan STAs required more than one Appraisal Committee Meeting (ACM) versus non-orphan STAs, and orphan STAs were disadvantaged by worse outcomes with respect to positive recommendations than those orphan medicines assessed by Highly Specialised Technology evaluation (HST).
The uncertainties inherent to developing orphan medicines may contribute to these disadvantages. Improved understanding of the challenges in drug development for orphan medicines and clearer guidance for decision makers on navigating uncertainty in the HTA process may promote greater equity in access to medicines across rare and common conditions.

User studies are typically difficult, recruiting enough users is often problematic and each experiment takes a considerable amount of time to be completed. In these studies, eye tracking is increasingly used which often increases time, therefore, the lower the number of users required for these studies the better for making these kinds of studies more practical in terms of economics and time expended. The possibility of achieving almost the same results with fewer users has already been raised. Specifically, the possibility of achieving 75% similarity to the results of 65 users with 27 users for searching tasks and 34 users for browsing tasks has been observed in scanpath trend analysis which discovers the most commonly followed path on a particular web page in terms of its visual elements or areas of interest (AOIs). Different approaches are available to segment or divide web pages into their visual elements or AOIs. In this paper, we investigate whether the possibility raised by the previous work is restricted to a particular page segmentation approach by replicating the experiments with two other segmentation approaches. The results are consistent with ~5% difference for the searching tasks and ~10% difference for the browsing tasks.