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The Sars coronavirus 2019 (COVID-19) pandemic has resulted in increased morbidity and mortality; however, there is limited understanding of how excess mortality is distributed among different racial and ethnic subgroups and vascular diseases., Methods: We conducted a retrospective, cross-sectional study design using data from the United States (US) Center for Disease Control (CDC) Wide Ranging Online Data for Epidemiologic Research (Wonder) database. The database contains death certificate information for all US residents by cause of death as ascertained by the treating physician. We examined the trends of excess death by vascular disease specific mortality among different racial and ethnicity subgroups. Excess deaths were defined as the difference between observed numbers of deaths in specific time periods and the expected numbers of deaths in the same time periods. We compared mortality rates during the reference period of 2018-2019 (pre-pandemic) with the study period of 2020-2021 (pandemic years). We also compared excess mortality rates among racial and ethnic subgroups (Non-Hispanic white, Non-Hispanic Black, and Hispanic individuals). Vascular disease was categorized by administrative diagnostic codes (ICD10): Vascular disease (I26, I82, I70-73, I74) and its subtypes Arterial thrombosis (I74), venous thromboembolism (I26, I82) and atherosclerotic disease (I70-73)., Results: Compared to 2018-2019, there was a 1.3 % excess mortality associated with vascular disease, a 12.2 % excess mortality due to arterial thrombosis mortality, and an 8.0 % excess mortality due to thromboembolism in 2020-2021. Black individuals demonstrated higher excess vascular mortality (6.9 %) compared to white individuals (-0.3 %) P < .001, higher excess venous thromboembolism mortality (14.1 % vs 5.1 % P = 0.002) and higher atherosclerosis mortality (2.1 % vs -2.6 % P = 0.002). Hispanics compared to white individuals had higher excess vascular mortality (5.1 % vs -0.3 % P = 0.03) and excess venous thromboembolism mortality (24.2 % vs 5.1 % P < 0.001)., Conclusion: The COVID-19 pandemic has led to a significant and persistent increase in vascular mortality. Excess mortality has disproportionately affected Black and Hispanic individuals compared to white individuals, highlighting the need for further studies to address and eliminate these health care disparities., Competing Interests: Declaration of competing interest The authors have no disclosures pertinent to this manuscript., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background Saliva has a powerful antioxidant activity proposing that it might have a protective role in the oral cavity. It is yet unclear, how circadian rhythm might affect this activity. Objective The main goal of this study was to compare the antioxidant status of saliva in patients with periodontal diseases (PD) to that of healthy people on a diurnal basis. Material and methods A total of 18 periodontal healthy individuals and 18 patients with chronic periodontitis were chosen. Samples of saliva were collected in the morning between 6:00 and 8:00 and in the evening between 6:00 and 8:00 (both stimulated and non-stimulated). The amount of glutathione (GSH), malondialdehyde (MDA), and total antioxidant status (TAS) in the salivary samples were analyzed, and its flow was also assessed. In addition, the scavenging capacity of saliva was tested in three systems generating oxygen free radicals. Results Results showed that GSH and TAS concentrations in the evening saliva of healthy subjects were significantly higher than those in the morning saliva, while MDA levels decreased (p<0.05). Conversely, there was no significant increase in GSH and TAS levels in the evening saliva of subjects with PD, and lipid peroxidation remained constant. On the other hand, the evening saliva of healthy subjects but not of subjects with PD was significantly more potent in scavenging free radicals in vitro than the morning saliva, especially for the superoxide (O2.-) radical (p<0.05). Moreover, scavenging activity was higher in stimulated than non-stimulated saliva. This activity was higher in evening saliva compared to the morning one and greater in healthy subjects compared to patients with PD (p<0.05). Conclusion A balance exists between oxidative stress and antioxidant mechanisms to maintain homeostasis in the oral cavity. This balance is deregulated in patients with PD as their saliva is unable to properly scavenge free radicals that might potentially increase over the day. Antioxidant supplements may be used in accordance with the circadian rhythm to minimize oxidative damage., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Diab et al.)

Percutaneous balloon mitral valvuloplasty (PBMV) is primarily performed for rheumatic mitral stenosis (MS). Therefore, limited data exist on PBMV in countries with a low incidence of rheumatic disease. Using the Nationwide Readmission Database, we examined trends in in-hospital mortality and 30-day readmission among patients who received PBMV for rheumatic and non-rheumatic MS. We also examined the change in 90-day hospitalization rate before vs after PBMV. Between 2016 and 2019, there were 1109 hospitalizations in which patients received PBMV for rheumatic (n = 955, 86.1%) vs non-rheumatic MS (n = 154, 13.9%). The all-cause in-hospital mortality for rheumatic and non-rheumatic MS did not change over time (0.9% → 2.0%, P = 0.94, and 5.9% → 9.5%, P = 0.09 respectively). Similarly, the 30-day readmission for patients with rheumatic and non-rheumatic MS did not change over time (12.4% → 9.9%, P = 0.26, and 4.4% → 10.5%, P = 0.30, respectively). The 90-day all-cause hospitalization rate remained the same before vs after PBMV for rheumatic and non-rheumatic MS (25.5% → 21.8%; P = 0.14, and 24.0% → 33.7%; P = 0.19, respectively). Although no statistically significant change was noted over time for trends in in-hospital mortality, 30-day readmission, or even in the change in 90-day all-cause hospitalizations before and after PBMV for both types of MS, among those with non-rheumatic MS, there was a signal of an increase in the in-hospital mortality, and 30-day readmission, even more, there was 29% relative increase in 90-day hospitalizations after PBMV. Future studies are needed to examine the role of PBMV in patients with non-rheumatic MS., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To investigate the patterns and demographic features of cardiovascular disease (CVD) death and subtypes myocardial infarction (MI), stroke, and heart failure in the pre-COVID-19 era (2018-2019) vs during the COVID-19 pandemic (2020-2021) in the United States., Methods: In this cross-sectional study, we used the US Multiple Cause of Death files for 2018 to 2021 to examine the trend of excess cause-specific deaths using International Classification of Diseases, Tenth Revision codes for CVD (I00 to I99), MI (I21 and I22), stroke (I60 to I69), and heart failure (I42 and I50). Our primary outcome was excess mortality from CVD and its 3 subtypes (MI, stroke, and heart failure) between prepandemic (2018-2019) and pandemic (2020-2021) years. We performed a subgroup analysis on race and month-to-month and year-to-year variation using χ 2 analysis to test statistical significance., Results: Overall, 3,598,352 CVD deaths were analyzed during the study period. There was a 6.7% excess CVD mortality, 2.5% MI mortality, and 8.5% stroke mortality during the COVID-19 pandemic (2020-2021) compared with the prepandemic era (2018-2019). Black individuals had higher excess CVD mortality (13.8%) than White individuals (5.1%; P<.001). This remained consistent across subtypes of CVD, including MI (9.6% vs 1.0%; P<.001), stroke (14.5% vs 6.9%; P<.001), and heart failure (5.1% vs -1.2%; P<.001)., Conclusion: There has been a significant rise in CVD and subtype-specific mortality during the COVID-19 pandemic that has been persistent despite 2 years since the onset of the pandemic. Excess CVD mortality has disproportionately affected Black compared with White individuals. Further studies targeting and eliminating health care disparities are necessary., (Copyright © 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.)

Acute myelogenous leukemia (AML) is one of the most common leukemias experienced in adults and conveys significant morbidity and mortality. While the traditional anthracycline based treatments of AML involves cytarabine, developments in alternatives (liposomal cytarabine, fludarabine, cladribine, azacitidine, decitabine), and targeted agents (midostaurin, gilteritinib, enasidenib, ivosidenib, gemtuzumab ozogamicin, and venetoclax) exist. Multiple cardiovascular adverse events, notably pericardial toxicity, have been observed in small studies; however, to date little is known about the comparative pericardial toxicity among these newer regimens. Due to the paucity of data, we sought to investigate the reported pericardial events and mortality associated with treatments for AML. Utilizing the Food and Drug Administration (FDA) Adverse Events Reporting System (FAERS), we identified all adverse events associated with FDA approved treatments for AML (2002-2022). Pericardial events were defined as pericarditis, pericardial effusion and tamponade. We excluded any individuals with age <18 years old. Logistic regression was utilized to identify factors associated with pericardial events. Out of 94,262 reported adverse events, 675 pericardial toxicities were included (243 pericarditis, 479 tamponade). Pericardial events occurred less often in Cladribine (0.3%, P < 0.001), fludarabine (0.4%, P < 0.001), Venetoclax (0.3%, P < 0.001), enasidenib (0.3%, P value < 0.001), and ivosidenib (0.3%, P < 0.001) compared to Cytarabine (0.9%). Tamponade events occurred significantly less often in cladribine (0.1%, P < 0.001), fludarabine (0.4%, P = 0.001), enasidenib (0.1%, P = 0.006), ivosidenib (0.1%, P = 0.01), and venetoclax (0.1%, P < 0.001) compared to cytarabine 0.7%. After adjusting for age and sex, Cladribine (reporting odds ratio [ROR] 0.35 [95% CI 0.18-0.68], P = 0.008) and Fludarabine (ROR 0.65 [0.45-0.92], P = 0.03), venetoclax (ROR 0.57 [0.41-0.79], P < 0.001) remained significantly associated with lower incidence of reported pericardial events. While cytarabine has been the routinely used and/or drug of choice for induction chemotherapy for AML, alternatives like cladribine may have a greater safety profile regarding pericardial toxicities. Future studies should be directed at further investigating cardiovascular safety profiles of AML induction therapy., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Background: Diabetes mellitus is characterized by hyperglycemia ensuing from deficiencies in insulin action, secretion, or both. Hyperglycemia has wide-ranging molecular and cellular effects, leading to oxidative stress, up-regulation of pro-inflammatory responses, and vascular changes., Objectives: The aim of this study was to evaluate the expressions of inflammatory markers involved in periodontal destructive process occurring in diabetes, periodontitis (PD), and both coexisting conditions., Methods: A rat model was carried out using streptozotocin (STZ) to induce diabetes and Lipopolysaccharides (LPS) with teeth ligature to mimic periodontitis. The animals were distributed randomly into seven groups (n=12) and treated for 10 weeks with alternation between diabetes and PD. The relative quantification analysis of inflammatory markers expression: CRP, MMP-2-14, TIMP-2, IL-4, IFN-γ, was performed at the end of the experiments using western blot after protein isolation from periodontal tissue surrounding the ligation., Results: The data showed that CRP, MMP-2, MMP-14, TIMP-2, and IFN-γ are involved in the process of periodontal inflammation associated with diabetes. A significant increase (p<0.05) in the expression of inflammatory markers was detected when PD is associated with preexisting diabetes in comparison with diabetes superimposed on preexisting PD., Conclusion: This study demonstrated that already established diabetes worsens periodontitis more than diabetes upcoming on existing periodontitis., (© 2021 Charbel Choubaya, Nathalie Chahine, Georges Aoun, Sukumaran Anil, Pierre Zalloua, Ziad Salameh.)

At the start of 2020, a new coronavirus (COVID-19) invaded the world leading to the death of 3.92 million people. Sadly, to date, no remedy has been discovered for this virus. Preventive vaccines have been under investigation, but were unavailable until December 2020. Clinical deficiencies of nutrients may increase susceptibility to infections. This knowledge may have provided an incentive for some dietary supplement (DS) manufacturers to advertise their products as COVID-19 preventatives or cures without any substantiation, targeting mainly social media fans. The objective of this research was to assess the usage, knowledge and attitudes towards dietary supplementation before and during the COVID-19 pandemic among Lebanese people. A cross-sectional study was conducted based on a convenience sample (N = 2966) and information from participants aged 18 years and above was collected about periods before and during the pandemic. Our findings showed that attitudes towards DSs changed when the pandemic emerged and people believed that DSs can improve their health and strengthen their immunity. Despite the rise in DS prescription by healthcare professionals, the prevalence of DS use decreased from 73.3% before the pandemic to 69.9% during the pandemic ( p < 0.001). Study results declared that the weekly or the daily estimated intake had increased during the pandemic as compared to before the pandemic, from 14% to 15.6% for antioxidants ( p = 0.014), from 35.3% to 42.1% for vitamin C ( p < 0.001), from 35.5% to 41% for vitamin D ( p < 0.001), from 15.2% to 17.5% for vitamin E ( p = 0.002), and from 18.8% to 29.3% for zinc ( p < 0.001) and other vitamins and minerals (from 9% to 10.9%, p < 0.001). Binary logistic regression indicated that the use of DSs during the pandemic was 4 times higher among those infected with COVID-19, 30 times higher among those who used to take DSs before pandemic, and 1.5 times higher among those who worked in the medical sector. To conclude, there is a crucial need to increase awareness among Lebanese people regarding the use of DSs.

Despite the beneficial health properties shown by Lebanese saffron, its qualitative and quantitative composition has never been investigated before. In the present study, NMR spectroscopy, together with antioxidant activity assays, were applied to evaluate the chemical composition of saffron samples of different geographical origins (Lebanon, Italy, Iran, and India) and to categorize the Lebanese saffron for the first time. The distinction between Lebanese saffron and that produced in other countries was attributed to its higher linolenic and linoleic fatty acids, glucose and picrocrocin contents. Moreover, spices produced in three different regions of the Lebanese territory have been clearly differentiated. Saffron cultivated in the Qaa region displayed a high glucose, fatty acids and polyphenols content, whereas Hermel saffron exhibited the largest rate of picrocrocin and glycosylated carotenoids. Finally, samples from Baalbeck showed lower rates for the majority of metabolites. Moreover, Lebanese saffron showed a high antioxidant activity in ABTS and DPPH assays. A low dose of saffron extract (10 µg/mL) inhibited the growth of human lung adenocarcinoma cells, probably due to the high polyphenolic content. This study highlights the quality and peculiarity of Lebanese saffron cultivated in Northern Beqaa district and allows for a good discrimination between spices produced in relatively close territory.

Intervertebral disc (IVD) degeneration is associated with elevated levels of inflammatory cytokines implicated in disease aetiology and matrix degradation. Toll-like receptor-4 (TLR4) has been shown to participate in the inflammatory responses of the nucleus pulposus (NP) and its levels are upregulated in disc degeneration. Activation of TLR4 in NP cells leads to significant, persistent changes in cell biophysical properties, including hydraulic permeability and osmotically active water content, as well as alterations to the actin cytoskeleton. The study hypothesis was that inflammation-induced changes to cellular biomechanical properties and actin cytoskeleton of NP cells could be prevented by inhibiting TLR4 signalling. Isolated NP cells from bovine discs were treated with lipopolysaccharide (LPS), the best studied TLR4 agonist, with or without treatment with the TLR4 inhibitor TAK-242. Cellular volume regulation responses to step osmotic loading were measured and the transient volume-response was captured by time-lapse microscopy. Volume-responses were analysed using mixture theory framework to investigate hydraulic permeability and osmotically active intracellular water content. Hydraulic permeability and cell radius were significantly increased with LPS treatment and these changes were blocked in cells treated with TAK-242. LPS-induced remodelling of cortical actin and IL-6 upregulation were also mitigated by TAK-242 treatment. These findings indicated that TLR4 signalling participated in NP cell biophysical regulation and may be an important target for mitigating altered cell responses observed in IVD inflammation and degeneration.

Objective: The contributions of intervertebral disc disease and subject-specific covariates to systemic inflammation in low back pain are unknown. We examined the effects of symptomatic disc herniation (DH) and MRI herniation severity on serum cytokine levels in clinical subjects., Design: Cytokine levels from lumbar DH subjects (N = 78) were compared to control subjects (N = 57) accounting for effects of DH, age, body mass index (BMI) and gender. Effect of DH severity on cytokine levels was analyzed on subsets of subjects with acute or chronic pain. Serum cytokines were also analyzed in a subset of patients between pre- and 3 months post-surgery., Results: Cytokine levels were elevated in the serum of patients with symptomatic DH, and the covariates age, BMI and gender significantly contributed to levels of some cytokines. Severity of herniation was a significant contributor to pain intensity (VAS), serum levels of HMGB1, PDGFbb, and IL-9. The relationship between DH severity and cytokine levels was confirmed in subjects with chronic, but not acute symptoms. Serum levels of macrophage migration inhibitory factor (MIF) decreased, whereas levels of CCL3, CCL11, CXCL1, and CXCL10 were significantly elevated post surgery., Conclusions: This study is the first to show that DH severity is coordinately associated with changes in serum levels of inflammatory cytokines in chronic pain subjects. HMGB1, PDGFbb and IL-9 are novel mediators of increasing DH severity, indicative of cellular damage, neuro-inflammation and angiogenesis. Resolution of inflammation was observed with decrease in MIF post surgery. However, elevated chemokine levels indicate ongoing remodeling and wound healing at 3-month time point., (Copyright © 2020 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.)

Modern digital interfaces display typeface in ways new to the 500 year old art of typography, driving a shift in reading from primarily long-form to increasingly short-form. In safety-critical settings, such at-a-glance reading competes with the need to understand the environment. To keep both type and the environment legible, a variety of 'middle layer' approaches are employed. But what is the best approach to presenting type over complex backgrounds so as to preserve legibility? This work tests and ranks middle layers in three studies. In the first study, Gaussian blur and semi-transparent 'scrim' middle layer techniques best maximise legibility. In the second, an optimal combination of the two is identified. In the third, letter-localised middle layers are tested, with results favouring drop-shadows. These results, discussed in mixed reality (MR) including overlays, virtual reality (VR), and augmented reality (AR), considers a future in which glanceable reading amidst complex backgrounds is common. Practitioner summary: Typography over complex backgrounds, meant to be read and understood at a glance, was once niche but today is a growing design challenge for graphical user interface HCI. We provide a technique, evidence-based strategies, and illuminating results for maximising legibility of glanceable typography over complex backgrounds. Abbreviations: AR: augmented reality; VR: virtual reality; HUD: head-up display; OLED: organic light-emitting diode; UX: user experience; MS: millisecond; CM: centimeter.

This study aimed to determine the prevalence of oral mucosal lesions and risk factors among the institutionalized elderly Lebanese population. A representative sample of 526 individuals (49% males and 61% females) aged 65 years and above was examined. A questionnaire and clinical examination were administered. Bivariate and multivariate regressions were carried out. The frequency of oral mucosal lesions was 22.8% and it was associated to the use, integrity ( p < .002), and hygiene level ( p < .047) of removable mandibular and maxillary prosthesis. Multiple regression analysis also predicted the relationship between the mandibular prosthesis hygiene level and the occurrence of mucosal lesions. The factors controlling the occurrence of oral mucosal lesion were mainly related to the level of oral care given to the individuals. Therefore, a proper oral health care system should be implemented in the Lebanese residential homes to ensure the well-being of the residing population., Competing Interests: Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2020.)

Typography plays an increasingly important role in today's dynamic digital interfaces. Graphic designers and interface engineers have more typographic options than ever before. Sorting through this maze of design choices can be a daunting task. Here we present the results of an experiment comparing differences in glance-based legibility between eight popular sans-serif typefaces. The results show typography to be more than a matter of taste, especially in safety critical contexts such as in-vehicle interfaces. Our work provides both a method and rationale for using glanceable typefaces, as well as actionable information to guide design decisions for optimised usability in the fast-paced mobile world in which information is increasingly consumed in a few short glances. Practitioner summary: There is presently no accepted scientific method for comparing font legibility under time-pressure, in 'glanceable' interfaces such as automotive displays and smartphone notifications. A 'bake-off' method is demonstrated with eight popular sans-serif typefaces. The results produce actionable information to guide design decisions when information must be consumed at-a-glance. Abbreviations: DOT: department of transportation; FAA: Federal Aviation Administration; GHz: gigahertz; Hz: hertz; IEC: International Electrotechnical Commission; ISO: International Organization for Standardization; LCD: liquid crystal display; MIT: Massachusetts Institute of Technology; ms: milliseconds; OS: operating system.

Introduction Recent studies on the use of transforaminal epidural steroid injection (TFESI) to treat lumbar radicular pain have highlighted controversies pertaining to the choice of corticosteroid agent utilized in lumbosacral TFESI, in terms of both safety and efficacy. The primary objective was to characterize the radicular pain response after a first transforaminal injection with dexamethasone. The secondary objective was to document the response of those who failed to respond to a dexamethasone injection when particulate steroid was utilized for a second injection. Methods It was a retrospective study of 94 consecutive patients undergoing transforaminal injection for lumbosacral radicular pain. At two-week follow-up, patients rated their pain response on a clinically oriented five-point survey. First injection non-responders were given a second injection with particulate steroid and again completed the survey. Results Approximately one-third (N = 31/94) of patients received no meaningful relief from a single injection with dexamethasone. No patients achieved lasting and complete pain relief after a single injection. Of initial non-particulate steroid non-responders, approximately two-thirds (N = 19/28) demonstrated a notable or complete response to a second injection with particulate steroid. Conclusions We are now able to better inform patients with regard to their anticipated pain response to an initial dexamethasone injection. Only one-third of patients realized more significant and lasting relief after a single injection. Of those who did not demonstrate a more meaningful response, a second injection with particulate steroid resulted in more pronounced pain relief in two-thirds of patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2020, Lipetz et al.)

Multiple sclerosis (MS) is the most frequent demyelinating disease of the central nervous system (CNS) associated with inflammatory plaques of white matter demyelination, oligodendrocyte destruction, reactive gliosis and axonal degeneration. In this chapter, we first review the pathological process of axonal degeneration in MS and discuss how these changes cause clinical symptoms of MS. We then discuss the pharmacological treatment to improve the clinical symptoms. Finally, we highlight how the autologous hematopoietic stem cell transplantation (AHSCT) can be effective for aggressive MS patients, who fail to respond to drug therapies, and also propose the future challenges of AHSCT.

Reading at a glance, once a relatively infrequent mode of reading, is becoming common. Mobile interaction paradigms increasingly dominate the way in which users obtain information about the world, which often requires reading at a glance, whether from a smartphone, wearable device, or in-vehicle interface. Recent research in these areas has shown that a number of factors can affect text legibility when words are briefly presented in isolation. Here we expand upon this work by examining how legibility is affected by more crowded presentations. Word arrays were combined with a lexical decision task, in which the size of the text elements and the inter-line spacing (leading) between individual items were manipulated to gauge their relative impacts on text legibility. In addition, a single-word presentation condition that randomized the location of presentation was compared with previous work that held position constant. Results show that larger text was more legible than smaller text. Wider leading significantly enhanced legibility as well, but contrary to expectations, wider leading did not fully counteract decrements in legibility at smaller text sizes. Single-word stimuli presented with random positioning were more difficult to read than stationary counterparts from earlier studies. Finally, crowded displays required much greater processing time compared to single-word displays. These results have implications for modern interface design, which often present interactions in the form of scrollable and/or selectable lists. The present findings are of practical interest to the wide community of graphic designers and interface engineers responsible for developing our interfaces of daily use., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background: Malpositioning of an anterior cruciate ligament graft during reconstruction can occur during screw fixation. The purpose of this study is to compare the fixation biomechanics of a conventional interference screw with a novel Twist Lock Screw, a rectangular shaped locking screw that is designed to address limitations of graft positioning and tensioning., Methods: Synthetic bone (10, 15, 20lb per cubic foot) were used simulating soft, moderate, and dense cancellous bone. Screw push-out and graft push-out tests were performed using conventional and twist lock screws. Maximum load and torque of insertion were measured., Findings: Max load measured in screw push out with twist lock screw was 64%, 60%, 57% of that measured with conventional screw in soft, moderate and dense material, respectively. Twist lock max load was 78% and 82% of that with conventional screw in soft and moderate densities. In the highest bone density, max loads were comparable in the two systems. Torque of insertion with twist lock was significantly lower than with conventional interference screw., Interpretation: Based on geometric consideration, the twist lock screw is expected to have 35% the holding power of a cylindrical screw. Yet, results indicate that holding power was greater than theoretical consideration, possibly due to lower friction and lower preloaded force. During graft push out in the densest material, comparable max loads were achieved with both systems, suggesting that fixation of higher density bone, which is observed in young athletes that require reconstruction, can be achieved with the twist lock screw., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Cells within cartilaginous tissues are mechanosensitive and thus require mechanical loading for regulation of tissue homeostasis and metabolism. Mechanical loading plays critical roles in cell differentiation, proliferation, biosynthesis, and homeostasis. Inflammation is an important event occurring during multiple processes, such as aging, injury, and disease. Inflammation has significant effects on biological processes as well as mechanical function of cells and tissues. These effects are highly dependent on cell/tissue type, timing, and magnitude. In this review, we summarize key findings pertaining to effects of inflammation on multiscale mechanical properties at subcellular, cellular, and tissue level in cartilaginous tissues, including alterations in mechanotransduction and mechanosensitivity. The emphasis is on articular cartilage and the intervertebral disc, which are impacted by inflammatory insults during degenerative conditions such as osteoarthritis, joint pain, and back pain. To recapitulate the pro-inflammatory cascades that occur in vivo, different inflammatory stimuli have been used for in vitro and in situ studies, including tumor necrosis factor (TNF), various interleukins (IL), and lipopolysaccharide (LPS). Therefore, this review will focus on the effects of these stimuli because they are the best studied pro-inflammatory cytokines in cartilaginous tissues. Understanding the current state of the field of inflammation and cell/tissue biomechanics may potentially identify future directions for novel and translational therapeutics with multiscale biomechanical considerations.

Background: Chronic Achilles injury is often treated with flexor hallucis longus (FHL) tendon transfer to the calcaneus using 1 or 2 incisions. A single incision avoids the risks of extended dissections yet yields smaller grafts, which may limit fixation options. We investigated the required length of FHL autograft and biomechanical profiles for suture anchor and biotenodesis screw fixation., Methods: Single-incision FHL transfer with suture anchor or biotenodesis screw fixation to the calcaneus was performed on 20 fresh cadaveric specimens. Specimens were cyclically loaded until maximal load to failure. Length of FHL tendon harvest, ultimate load, stiffness, and mode of failure were recorded., Results: Tendon harvest length needed for suture anchor fixation was 16.8 ± 2.1 mm vs 29.6 ± 2.4 mm for biotenodesis screw ( P = .002). Ultimate load to failure was not significantly different between groups. A significant inverse correlation existed between failure load and donor age when all specimens were pooled (ρ = -0.49, P < .05). Screws in younger specimens (fewer than 70) resulted in significantly greater failure loads ( P < .03). No difference in stiffness was found between groups. Modes of failure for screw fixation were either tunnel pullout (n = 6) or tendon rupture (n = 4). Anchor failure occurred mostly by suture breakage (n = 8)., Conclusion: Adequate FHL tendon length could be harvested through a single posterior incision for fixation to the calcaneus with either fixation option, but suture anchor required significantly less graft length. Stiffness, fixation strength, and load to failure were comparable between groups. An inverse correlation existed between failure load and donor age. Younger specimens with screw fixation demonstrated significantly greater failure loads., Clinical Relevance: Adequate harvest length for FHL transfer could be achieved with a single posterior incision. There was no difference in strength of fixation between suture anchor and biotenodesis screw.

Recent research on the legibility of digital displays has demonstrated a "positive polarity advantage", in which black-on-white text configurations are more legible than their negative polarity, white-on-black counterparts. Existing research in this area suggests that the positive polarity advantage stems from the brighter illumination emitted by positive polarity displays, as opposed to the darker backgrounds of negative polarity displays. In the present study, legibility thresholds were measured under glance-like reading conditions using a lexical decision paradigm, testing two type sizes, display polarities, and ambient illuminations (near-dark and daylight-like). Results indicate that legibility thresholds, quantified as the amount of time needed to read a word accurately, were highest for the negative polarity configurations under dark ambient illumination, indicated worse performance. Conversely, the positive polarity conditions under dark ambient illumination and all conditions under bright illumination demonstrated significantly reduced thresholds, indicating greater legibility. These results are consistent with the hypothesis that the "positive polarity advantage" arises because brighter illumination produces pupillary contraction that reduces optical aberrations as light enters the eye. These results have implications for the design of automotive interfaces and other scenarios in which an interface must be optimized for glance-like reading under variations in ambient lighting conditions., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Restoration of blood flow to the ischemic myocardium is imperative to avoid demise of cardiomyocytes, but is paradoxically associated with irreversible damage to cardiac tissues due to the excessive generation of reactive oxygen species (ROS). We have previously reported that saffron, a natural antioxidant, attenuated ischemia-reperfusion (IR) injuries in vitro; however, its role in a meaningful cardiac recovery remains unknown. Here, we show that saffron supplement (oral administration for 6 weeks) reduced myocardial damage and restored cardiac function in an IR model of rabbit hearts. This was evidenced by improved left ventricle pressure, heart rate and coronary flow, and left ventricle end diastolic pressure (LVEDP) in IR hearts (isolated from rabbits pre-exposed to saffron (S/IR)). Electrophysiological recordings revealed a significant decline in both premature ventricle contraction and ventricle tachycardia/fibrillation in S/IR compared to IR hearts. This was paralleled by increased expression of the contractile proteins α-actinin and Troponin C in the myocardium of S/IR hearts. Histological examination combined to biochemical analysis indicated that hearts pre-exposed to saffron exhibited reduced infarct size, lower lipid peroxidation, with increased glutathione peroxidase activity, and oxidation of nitro blue tetrazolium (by reactive oxygen species). Furthermore, in contrast with IR hearts, saffron pretreatment induced restoration of the phosphorylation level of the survival proteins Akt and 4EBP1 and reduced activity of p38. Collectively, our data demonstrate that the natural antioxidant saffron plays a pivotal role in halting IR-associated cardiac injuries and emerges as a novel preventive tool for ischemic heart disease.

Stem cell therapy, an evolving, progressive field of therapeutics has shown several successes in areas where classic treatments failed to prevent or stop disability. Starting in 2009, twenty two sequential patients with progressive Multiple Sclerosis (MS) courses were treated with Autologous Bone Marrow Mononuclear stem cells (BM-MNSCs). The cells were given both intravenously and intrathecally. Using the Expanded Disability Status Scale (EDSS) score for evaluation, our data indicates that the majority of the patients benefited on the average one point on the scale. This paper adds to the body of evidence suggesting the safety and efficacy of autologous BM-MNSCs in the treatment of MS and awaits validation through larger, randomized studies.

Psychophysical research on text legibility has historically investigated factors such as size, colour and contrast, but there has been relatively little direct empirical evaluation of typographic design itself, particularly in the emerging context of glance reading. In the present study, participants performed a lexical decision task controlled by an adaptive staircase method. Two typefaces, a 'humanist' and 'square grotesque' style, were tested. Study I examined positive and negative polarities, while Study II examined two text sizes. Stimulus duration thresholds were sensitive to differences between typefaces, polarities and sizes. Typeface also interacted significantly with age, particularly for conditions with higher legibility thresholds. These results are consistent with previous research assessing the impact of the same typefaces on interface demand in a simulated driving environment. This simplified methodology of assessing legibility differences can be adapted to investigate a wide array of questions relevant to typographic and interface designs. Practitioner Summary: A method is described for rapidly investigating relative legibility of different typographical features. Results indicate that during glance-like reading induced by the psychophysical technique and under the lighting conditions considered, humanist-style type is significantly more legible than a square grotesque style, and that black-on-white text is significantly more legible than white-on-black.

We treated 2 patients with progressive, refractory scleroderma with a combined immunotherapy approach using plasmapheresis followed by rituximab and then intravenous umbilical-cord-derived allogeneic mesenchymal stem cells (MSCs). Both patients improved subjectively and objectively for over a year. Upon recurrence of their symptoms, the patients were treated again with allogeneic MSCs alone with a very good response. The combination was well tolerated and effective suggesting a large scale study may be warranted in progressive, refractory Scleroderma., Competing Interests: The authors have no conflicts of interest to declare.

Context: Several plant-derived natural products have been used in clinical phase for applications in neurological, cardiovascular, and inflammatory diseases. Arbutus andrachne L. (Ericacea) is an evergreen shrub native to the Mediterranean region. Traditionally, the fruits and leaves of Arbutus tree are well known and used as antiseptics, diuretics, blood tonic, and laxatives., Objective: Data regarding the biological effects of compounds derived from the Lebanese Arbutus andrachne are not available. In the present work, we studied the antioxidant activity of methanol extracts of leaves, fruits, and roots of the plant against electrolysis; together with their effects on the cardiodynamics of isolated perfused rabbit hearts., Materials and Methods: In vitro electrolysis of the different root, leaves, and fruits methanol extracts was evaluated by the amount of free radicals that has been reduced by increasing the concentration of root extracts ranging from 0.5 to 2 mg after 1, 2, 3, and 4 min. Left ventricular pressure (LVP), heart rate (HR), and coronary flow (CR) were investigated in isolated rabbit heart after administration of 0.5, 1, 2, and 2 mg of each methanol extracts plotted against time (0, 0.5, 1.5, 5, and 10 min), according to the Langendorff method. Lipid peroxidation study was performed by the colorimetric method on myocard tissue after incubation with 500 μl of the different methanol extracts. The amount of MDA was determined at 500 nm absorbance after 5 min incubation., Results: Among the different methanol extracts, the roots showed the highest in vitro antioxidant activity, particularly observed at concentration of 2 mg which completely inhibits free radical generation after 4 min. LVP decreases by 32% at the dose of 2 mg of root extracts after 5 min. No significant effect was observed by the three tested extracts on the heart rate. The three methanol extracts did not show any significant effect on the coronary flow. Moreover, the roots show an increase in the coronary flow at a concentration of 1 and 2 mg/ml during 1 min. Electrolysis on heart tissue treated with the roots extracts shows a decrease in the MDA level from 70.51 ± 6.71 to 48.58 ± 4.15 nmole/g of tissue., Discussion and Conclusion: Methanol extracts of the roots possess antihypertensive effect that may result from its ability to decrease the LVP together with its protective role by inhibiting free radical generation and significantly decreasing the MDA level of heart tissue.

Doxorubicin (DOX), a highly active chemotherapeutic drug, faces limitations in clinical application due to severe cardiotoxic effects (mainly through increased oxidative stress). Therefore, its effect is exacerbated in subjects with ischemic heart disease. We have recently reported that saffron extract (SAF), a natural compound mainly consisting of safranal and corcins, exerts a protective effect against DOX oxidative cytotoxicity in isolated rabbit hearts. Here, we aimed to investigate whether SAF exerts cardioprotection against combined ischemia-reperfusion (I/R) and DOX toxicity in H9c2 cardiomyocytes. H9c2 were subjected to simulated I/R, with or without DOX treatment at reperfusion, in the presence or absence of SAF prior to ischemia or at reperfusion. We evaluated the effects of these treatments by MTT, LDH and western blot analysis. Apoptosis was assessed by Hoechst 33258 staining, tetramethyl rhodamine methyl ester fluorescence and caspase activity. The results showed that I/R and DOX significantly decreased cardiomyocytes viability, inhibited reperfusion injury salvage kinase cardioprotective pathway, reduced contractile proteins (α-Actinine, Troponine C and MLC), increased caspase-3 expression and induced loss of mitochondrial membrane potential. These effects were remarkably inhibited by treatment with SAF (10 μg/mL) at reperfusion. SAF activated AKT/P70S6K and ERK1/2, restored contractile proteins expression, inhibited mitochondrial permeability transition pore and decreased caspase-3 activity. In conclusion, our findings indicate that SAF treatment exerted cardioprotection against I/R and DOX toxicity by reducing oxidative stress (LDH assay). Thereby, SAF offers a potential novel antioxidant therapeutic strategy to counteract I/R and DOX cardiotoxicity, paving the way for future clinical trials.

Doxorubicin (DOX) is an anthracycline antibiotic routinely used as a chemotherapeutic agent for the treatment of solid tumours. However, DOX possesses an acute and cumulative cardiotoxicity due to free radical production. The present study was designed to investigate the possible protective effects of saffron (Crocus sativus) extracts against DOX-induced acute cardiotoxicity in isolated rabbit hearts submitted to 30 min global ischemia followed by 40 min reperfusion. DOX was delivered during reperfusion, without or with saffron given 5 min before ischemia or at reperfusion. Cardiodynamic, biochemical, and histopathological parameters were determined. In addition, to determine the expression of the AKT/mTOR/4EBP1 pathway, the levels of p38 MAPK and cardiac troponin T in heart homogenates were visualized by Western blotting. DOX administration during 40 min of reperfusion increased ischemic tissue damage, but did not act synergistically. Administration of saffron extracts during the first minutes of reperfusion significantly reduced oxidative myocardial damage, but was less effective when given before ischemia. Subsequent Western blot analysis revealed that saffron administration preserved cardiac troponin T proteins, inhibited the p38 MAPK pathway, and activated the AKT/mTOR/4EBP1 pathway in reperfusion- and DOX-treated rabbit hearts. In conclusion, saffron extracts, acting through antioxidant and antiapoptotic mechanisms, exhibited a protective effect against DOX-induced cardiotoxicity under ischemic condition.

Text-rich driver-vehicle interfaces are increasingly common in new vehicles, yet the effects of different typeface characteristics on task performance in this brief off-road based glance context remains sparsely examined. Subjects completed menu selection tasks while in a driving simulator. Menu text was set either in a 'humanist' or 'square grotesque' typeface. Among men, use of the humanist typeface resulted in a 10.6% reduction in total glance time as compared to the square grotesque typeface. Total response time and number of glances showed similar reductions. The impact of typeface was either more modest or not apparent for women. Error rates for both males and females were 3.1% lower for the humanist typeface. This research suggests that optimised typefaces may mitigate some interface demands. Future work will need to assess whether other typeface characteristics can be optimised to further reduce demand, improve legibility, increase usability and help meet new governmental distraction guidelines. Practitioner Summary: Text-rich in-vehicle interfaces are increasingly common, but the effects of typeface on task performance remain sparsely studied. We show that among male drivers, menu selection tasks are completed with 10.6% less visual glance time when text is displayed in a 'humanist' typeface, as compared to a 'square grotesque'.

Context: Anticancer treatments such as anthracyclines are effective; however, they induce cardiotoxicity by releasing radical oxygen species (ROS). Saffron (Crocus sativus; Iridaceae) is a widely used spice with antioxidant properties and numerous health benefits that may provide cardioprotection., Objective: To assess the effect of saffron against acute myocardium damage by anthracyclines compared with electrolysis as a free radical generating system., Materials and Methods: According to the Langendorff method, we used the model of an isolated rabbit heart perfused in retrograde. In one set of experiments, ROS was generated by electrolysis of the perfused heart solution (3 mA for 30 min) in the presence and absence of saffron extracts at the optimal dose (10 μg/ml). In another set, we perfused the heart with anthracycline, i.e. 30 μM doxorubicin (Doxo) in the presence and absence of 10 μg/ml saffron extracts. We evaluated cardiodynamics, as well as biochemical and pathological parameters, to emphasize the effectiveness of the treatment with saffron extract using the optimal dose of catalase (150 IU) as a positive control., Results: ROS generated, respectively, by electrolysis and by Doxo significantly (p < 0.05) affects cardiovascular function; it decreased ventricular pressure (45.02 and 40.41%), heart rate (36.31 and 22.39%) and coronary flow (50.98 and 36.67%). Increased lipid peroxidation of the myocardium was also observed (118.22 and 56.58%), while superoxide dismutase activity decreased (48.33 and 38.70%). The myocardial architecture was altered and the intercellular spaces increased., Conclusion: Saffron perfused during electrolysis helps trap ROS and significantly improves myocardial function; however, saffron was less effective against Doxo, thus suggesting that mechanisms other than oxidative stress underlie Doxo cardiotoxicity.

Although several imaging modalities have been utilized to observe tendons, assessing injured tendons by tracking the healing response over time with ultrasound is a desirable method which is yet to be realized. This study examines the use of ultrasound for non-invasive monitoring of the healing process of Achilles tendons after surgical transection. The overall extracellular matrix content of the transection site is monitored and quantified as a function of time. B-mode images (built from successive A-scan signatures) of the injury site were obtained and compared to biomechanical properties. A quantitative measure of tendon healing using the extracellular matrix (ECM) content of the injury site was analyzed using linear regression with all biomechanical measures. Contralateral tendons were used as controls. The trend in the degree of ECM regrowth in the 4 weeks following complete transection of excised tendons was found to be most closely paralleled with that of linear stiffness (R(2) = 0.987, p < .05) obtained with post-ultrasound biomechanical tests. Results suggest that ultrasound can be an effective imaging technique in assessing the degree of tendon healing, and can be used to correlate structural properties of Achilles tendons.

A novel first-generation Clark-type biosensor platform that can eliminate the oxygen dependence has been presented. Sufficient oxygen to drive the enzymatic reaction under hypoxic conditions was produced by encapsulated oxygen generating biomaterial, calcium peroxide. The catalase immobilized in chitosan matrix was coated on top of the groove to decompose residual hydrogen peroxide to oxygen. A glucose biosensor was developed on the proposed platform as proof of concept. Under hypoxic conditions, developed glucose biosensors maintained their sensitivity response around 84% of their response at oxygen tension of 151 mmHg. The sensitivity deviation was less than 5.3% with the oxygen tension traversed from 0 to 57 mmHg. Under oxygen tension of 8.3 mmHg, the sensitivity of 37.130 nA/mM and the linear coefficient of R(2)=0.9968 were obtained with the glucose concentration varying from 0.05 to 10mM. This new platform is particularly attractive for injured brain monitoring.

Translational or implementation research that assesses the effectiveness of strategies to promote health behaviours among children that have been previously tested under 'ideal' conditions is rarely reported. Switch-2-Activity aimed to examine the effectiveness of an abbreviated programme delivered by teachers targeting children's television viewing, computer use, physical activity and potential mediators of behaviour change. Fifteen schools from disadvantaged areas in Melbourne, Australia agreed to participate in the study (43% school-level response rate). Out of the 1566 Grades 5 and 6 (9-12 year old) children invited to take part in the study, 1048 (67% response rate) provided informed consent. Schools were randomized to either an intervention or wait-list control condition. Teachers delivered six lessons, which included strategies such as self-monitoring, behavioural contracting and budgeting of screen time. Children completed a self-report survey at baseline and post-intervention examining screen-based behaviours, physical activity, self-efficacy and behavioural capability. Teachers reported implementation of and attitudes to the programme. Seventy-one per cent of teachers delivered at least four of the six lessons. Most teachers reported that the materials were easy to follow and deliver; however, many teachers reported modifying the materials in some way. Among boys, there were favourable small intervention effects on weekend screen time [(coefficient = -0.62, 95% 95% confidence interval: -1.15, -0.10, p = 0.020)]. The intervention also had significant positive effects on children's self-efficacy for reducing television viewing and on behavioural capability (television viewing styles). Future studies that assess the translation of efficacious programmes and that test whether such programmes are equally effective in different settings (e.g. in the family setting) are urgently required.

Polymers confined to small dimensions and that undergo high strains can show remarkable nonlinear mechanics, which must be understood to accurately predict the functioning of nanoscale polymer devices. In this paper we describe the determination of the mechanical properties of ultrathin polydimethylsiloxane (PDMS) films undergoing large strains, using atomic force microscope (AFM) indentation with a spherical tip. The PDMS was molded into extremely thin films of variable thickness and adhered to a hard substrate. We found that for films below 1 μm in thickness the Young's modulus increased with decreasing sample thickness with a power law exponent of 1.35. Furthermore, as the soft PDMS film was indented, significant strain hardening was observed as the indentation depth approached 45% of the sample thickness. To properly quantify the nonlinear mechanical measurements, we utilized a pointwise Hertzian model which assumes only piecewise linearity on the part of the probed material. This analysis revealed three regions within the material. A linear region with a constant Young's modulus was seen for compression up to 45% strain. At strains higher than 45%, a marked increase in Young's modulus was measured. The onset of strain induced stiffening is well modeled by finite element modeling and occurs as stress contours expanding from the probe and the substrate overlap. A third region of mechanical variation occurred at small indentations of less than 10 nm. The pointwise Young's modulus at small indentations was several orders of magnitude higher than that in the linear elasticity region; we studied and ruled out causes responsible for this phenomenon. In total, these effects can cause thin elastomer films to become extremely stiff such that the measured Young's modulus is over a 100-fold higher than the bulk PDMS. Therefore, the mechanics of a polymer can be changed by adjusting the geometry of a material, in addition to changing the material itself. In addition to understanding the mechanics of thin polymer films, this work provides an excellent test of experimental techniques to measure the mechanics of other nonlinear and heterogeneous materials such as biological cells., (© 2011 American Chemical Society)

Three Victorian local governments cooperated in a pilot study of physical activity promotion as part of home and community care (HACC) service delivery. Thirty-one people receiving HACC volunteered to participate, including completing the Transtheoretical Stages of Change Exercise Questionnaire and the short-form Stanford Health Assessment Questionnaire (HAQ) just before and at 3 months and 6 months after starting regular self-selected physical activity. Twenty-one participants returned questionnaires at 3 months, and 17 participants returned questionnaires at 6 months. Data were analysed using paired t tests and effect sizes were calculated as mean differences. At 3 months, mean improvements were identified on 6 of the 8 HAQ-DI (disability index) subscales, and in the overall HAQ-DI score. Improvement in dressing and grooming was preserved at 6 months. At either 3 or 6 months, improvements in dressing and grooming, reach, hygiene, and daily activities, and overall HAQ-DI score exceeded the minimum clinically important difference. No improvements were statistically significant, as is likely in a pilot study with a small sample, however, these results suggest that even very small increases in physical activity may afford clinically meaningful improvements in some areas of physical function required for independent living. Australian Clinical Trials Registry registration number: ACTRN012606000242527.

Recent studies have reported that certain regimes of compressive loading of articular cartilage result in increased cell death in the superficial tangential zone (STZ). The objectives of this study were (1) to test the prevalent hypothesis that preferential cell death in the STZ results from excessive compressive strain in that zone, relative to the middle and deep zones, by determining whether cell death correlates with the magnitude of compressive strain and (2) to test the corollary hypothesis that the viability response of cells is uniform through the thickness of the articular layer when exposed to the same loading environment. Live cartilage explants were statically compressed by approximately 65% of their original thickness, either normal to the articular surface (axial loading) or parallel to it (transverse loading). Cell viability after 12 h was compared to the local strain distribution measured by digital image correlation. Results showed that the strain distribution in the axially loaded samples was highest in the STZ (77%) and lowest in the deep zone (55%), whereas the strain was uniformly distributed in the transversely loaded samples (64%). In contrast, axially and transversely loaded samples exhibited very similar profiles of cell death through the depth, with a preferential distribution in the STZ. Unloaded control samples showed negligible cell death. Thus, under prolonged static loading, depth-dependent variations in chondrocyte death did not correlate with the local depth-dependent compressive strain, and the prevalent hypothesis must be rejected. An alternative hypothesis, suggested by these results, is that superficial zone chondrocytes are more vulnerable to prolonged static loading than chondrocytes in the middle and deep zones.

Introduction: In Lebanon, clinical pharmacy is not professionally applied, despite being taught and required by the accreditation system of hospitals established by the Ministry of Health. The objective of our study is to evaluate the knowledge and attitude of medical professionals regarding the concept of clinical pharmacy., Methods: It is a descriptive cross-sectional study, conducted in hospitals with doctors, nurses and administrators. Standardized self-filling questionnaires were distributed., Results: The majority of physicians and of nurses found a clinical pharmacist intervention beneficial. All administrators were ready to accept a clinical pharmacist in their institution, since his/her presence would contribute to the reduction of hospitalization costs, mortality and morbidity., Discussion: Medical professionals have a clear and positive idea regarding clinical pharmacy., Conclusion: Different steps are necessary in order to integrate clinical pharmacy in the Lebanese health care system.

Acute epiglottitis is a dangerous disease which is not often seen in adults. Early diagnosis and medical attention is required. Relief of airway obstruction by intubation or tracheostomy is necessary in most cases. Ampicillin plus Chloramphenicol or only Cefotaxime is administered, pending a report on sensitivities. 3 cases of acute epiglottitis in adults are presented. The management is discussed in view to avoid this disease's possible fatal outcome.

Two techniques of salpingotomy have been compared in two series of rabbit experiments with the aim of finding out whether, when carrying out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate g out conservative surgery in extra-uterine pregnancy with rupture of the tube, it is better to suture the salpingotomy or to leave it open without suture. The two series show that there is no difference as far as the frequency of large adhesions, as far as ovulation and the strength of the scar and the pregnancy rate following the two methods. On the other hand, implantation is less good when the tube is left open than when the salpingotomy is sewn up. In the first series there was a significant difference between the side that was operated on and the control side, whereas the second series there was very little difference. In spite of the fact that the scar seemed to be apparently of the same type, the eggs were able to descend more easily in the oviduct when it had been sutured.