Nail changes are visible in a variety of inflammatory dermatoses. The commonest dermatological condition with nail manifestations is chronic plaque psoriasis. This two-part article reviews the nail signs in psoriasis in Part 1, and the nail changes in cutaneous lichen planus and alopecia areata in Part 2. It provides a brief summary of the salient points in the clinical features, management and prognosis of these entities, with practical recommendations that may be beneficial to all dermatologists.The impact of global warming on the life of the earth is increasingly concerned. Previous studies indicated that temperature changes have a serious impact on insect sleep. Sleep is critical for animals as it has many important physiological functions. It is of great significance to study the regulation mechanism of temperature-induced sleep changes for understanding the impact of global warming on insects. More importantly, understanding how these pressures regulate sleep can provide insights into improving sleep. In this study, we found that extra sex combs (ESC) are a regulatory factor in this process. Our data showed that ESC was an upstream negative regulatory factor of Heat shock proteins (Hsps), and it could regulate sleep in mushroom and ellipsoid of Drosophila. ESC mutation exaggerates the sleep change caused by temperature, while buffering the shortening of life caused by sleep deprivation. These phenotypes can be rescued by Hsps mutants. Therefore, we concluded that the ESC buffers sleep-related stresses through regulating Hsps.Chronic limb-threatening ischemia (CLTI), with characteristic ischemic rest pain, non-healing ulcers, or gangrene attributable to arterial occlusive disease, requires successful revascularization to minimize tissue loss. End-stage CLTI in particular, with occlusion of the pedal arteries, results in a lack of suitable targets for bypass and can result in failure of endovascular revascularization procedures, leaving no option for treatment other than amputation. With limb salvage as the primary goal, nontraditional revascularization techniques such as percutaneous deep vein arterialization (pDVA) may help minimize incidence of amputation. We present a case of a patient with no-option CLTI, at high risk of amputation who failed conventional endovascular revascularization attempts facing imminent major amputation. The limb was salvaged with a successful pDVA procedure.This vitro study aimed to evaluate the effects of 45S5 bioactive glass (BAG) and ErYAG laser as desensitization treatments on the microtensile bond strength (MTBS) of fluorosed teeth. The 120 noncarious fluorosis were to obtain superficial dentin, being classified into four groups according to the Thylstrup and Fejerskov Index (TFI). https://www.selleckchem.com/products/qnz-evp4593.html from each group were randomly divided into five subgroups. After fluorosed teeth hypersensitivity models were established, the following pretreatments were applied on dentine surface Subgroup 1 deionized water (Control); Subgroup 2 BAG; Subgroup 3 ErYAG laser; Subgroup 4 BAG + ErYAG laser, and Subgroup 5 ErYAG laser + BAG. #link# One sample was randomly selected from each subgroup for scanning electron microscope (SEM). The remaining samples were bonded with composite resin by Adper Single Bond 2 adhesive. Then water bath at 37°C for 24 hr. After 5,000 thermocycling, MTBS was tested and fracture mode was analyzed. The difference of MTBS between BAG group and Control group was found statistically significant (p  less then  .05) in fluorosis. The ErYAG laser + BAG group showed lowest MTBS values in fluorosis. In conclusion, the pretreatment of BAG might be beneficial to the adhesive of fluorosed teeth. ErYAG laser desensitization alone or using BAG first and then ErYAG laser desensitization might not affect the adhesive of fluorosed teeth, while ErYAG laser desensitization followed by the pretreatment of BAG would be not conducive to the adhesive of fluorosed teeth.
Applying the principles of misdirected nerve regeneration to the larynx, Roger Crumley in 1989 coined the term laryngeal synkinesis (LS) which he later (2000) classified into 4 types (type I - good voice, type II - involuntary twitches and poor voice, type III - adduction during inspiration, type IV - abduction during phonation). link2 Neurophysiological data were not available for all LS patients at that time. The current study was undertaken to utilize and test the Crumley classification for a clinical interrater comparison and, secondly, compare predicted with actual laryngeal electromyography (LEMG) results.

Descriptive study.

Laryngoscopic and LEMG data of patients with unilateral vocal fold paralysis (VFP) of 6 months duration or longer were combined for retrospective evaluation. Forty-five data sets were available for laryngoscopic classification by two local laryngologists and by Roger Crumley. Twenty-three data sets with complete thyroarytenoid (TA) and posterior cricoarytenoid (PCA) - EMG data were used to compare predicted with actual LEMG results.

Local laryngologists were able to classify 24 of 45, Crumley 30 of 45 cases into one of the 4 synkinesis types. There was substantial agreement between examiners (Cohens Kappa 0.66 [P < .001]). Comparison of predicted and actual LEMG data showed only moderate agreement. EMG sykinesis rates were lower in TA than in PCA and highest in Crumley type I cases.

The Crumley classification is helpful in describing and understanding synkinesis. It does not always correlate predictably with actual LEMG data. A complete LEMG mapping of all intrinsic muscles may improve understanding of chronic VFP.

4. Laryngoscope, 131E1605-E1610, 2021.
4. Laryngoscope, 131E1605-E1610, 2021.
What is the central question of this study? What are the determinants of muscle belly gearing, and how does it affect the torque rise? What is the main finding and its importance? Change in muscle thickness of the gastrocnemius medialis is related to variations in belly gearing. Belly gearing has a key role in the rise of muscle torque and rate of torque development (RTD). Besides, the increase of tendinous tissue stiffness could increase the torque rise as well, and in turn, the RTD. However, changes in the tendinous tissue stiffness showed no effects on muscle fascicle behaviour, suggesting a possible uncoupling between muscle and tendon mechanical properties.

During fixed-end contractions, muscles bulge in thickness and/or width to maintain a constant volume, whereas tendons lengthen over the entire contraction period. These dynamic changes play a key functional role in modulating the generated torque. However, the literature has revealed a limited understanding of in vivo dynamic muscle-tendon changes.
Fluoroscopy has been an essential part of every electrophysiological procedure since its inception. However, till now no clear standards regarding acceptable x-ray exposure nor recommendation how to achieve them have been proposed.

Current norms and quality markers required for optimal clinical routine can be identified.

Centers participating in this Europe-wide multicenter, prospective registry were requested to provide characteristics of the center, operators, technical equipment as well as procedural settings of consecutive cases.

Twenty-five centers (72% university clinics, with a mean volume of 526 ± 348 procedures yearly) from 14 European countries provided data on 1788 cases [9% diagnostic procedures (DP), 38% atrial fibrillation (AF) ablations, 44% other supraventricular (SVT) ablations, and 9% ventricular ablations (VT)] conducted by 95 operators (89% male, 41 ± 7 years old). Mean dose area product (DAP) and time was 304 ± 608 cGy*cm
, 3.6 ± 4.8 minutes, 1937 ± 608 cGy*cm
, 15.3 ± 15.5 minutes, 805 ± 1442 cGy*cm
, 10.6 ± 10.7 minutes, and 1277 ± 1931 cGy*cm
, 10.4 ± 12.3 minutes for DP, AF, SVT, and VT ablations, respectively. Seven percent of all procedures were conducted without any use of fluoroscopy. Procedures in the lower quartile of DAP were performed more frequently by female operators (OR 1.707, 95%CI 1.257-2.318, P = .001), in higher-volume center (OR 1.001 per one additional procedure, 95%CI 1.000-1.001, P = .002), with the use of 3D-mapping system (OR 2.622, 95%CI 2.053-3.347, P < .001) and monoplane x-ray system (OR 2.945, 95%CI 2.149-4.037, P < .001).

Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.
Exposure to ionizing radiation varies widely in daily practice for all procedure. Significant opportunities for harmonization of exposure toward the lower range has been identified.Limited capacity to deliver comprehensive safe abortion care and shortages in trained healthcare providers contribute to a lack of access to safe services. link3 The World Health Organization published guidelines and recommendations on expanding health worker roles through task-sharing as one way to address disparities. A multicountry case study was conducted in six diverse contexts (Bangladesh, Colombia, Ghana, Mexico City in Mexico, Sweden, and Tunisia) to determine the cross-cutting strategies that enabled inclusion of a broader range of healthcare workers in comprehensive safe abortion care. Five strategies emerged leveraging of favorable contexts, policies, and guidelines; use of evidence for advocacy; building upon existing task-sharing; mitigation of negative responses to abortion and task-sharing; and collaboration across sectors. The findings suggest that there are potential opportunities for stakeholders to employ these strategies in many contexts to broaden health worker roles in comprehensive safe abortion care.Ghana has made progress in expanding providers in abortion care but access to the service is still a challenge. We explored stakeholder perspectives on task-sharing in abortion care and the opportunities that exist to optimize this strategy in Ghana. We purposively sampled 12 representatives of agencies that played a key role in expanding abortion care to include midwives for key informant interviews. All interviews were audio recorded, transcribed verbatim, and then coded for thematic analysis. Stakeholders indicated that Ghana was motivated to practice task-sharing in abortion care because unsafe abortion was contributing significantly to maternal mortality. They noted that the Ghana Health Service utilized the high maternal mortality in the country at the time, advancements in medicine, and the lack of clarity in the definition of the term "health practitioner" to work with partner nongovernmental organizations to successfully task-share abortion care to include midwives. Access, however, is still poor and provider stigma continues to contribute significantly to conscientious objection. This calls for further task-sharing in abortion care to include medical or physician assistants, community health officers, and pharmacists to ensure that more women have access to abortion care.
To explore the strategies undertaken to decentralize menstrual regulation services and implement task-sharing, including barriers and facilitators, with nonphysician providers in Bangladesh.

We conducted a desk review of relevant policies and health service information from grey and published literature on task-sharing in menstrual regulation services, plus stakeholder interviews with 19 representatives of relevant health organizations to investigate facilitators for and barriers to the implementation of task-sharing of these services.

Task-sharing in menstrual regulation began in 1979 as part of the national family planning program. The Ministry of Health and Family Welfare has guidelines for menstrual regulation services provided by a wide range of healthcare workers using manual vacuum aspiration and the medications misoprostol and mifepristone. Despite government approval, implementation of task-sharing is challenging owing to lack of skilled providers, lack of facility readiness, and unmet need for family planning.