Serum Creatinine and Creatine Kinase as an Indicator for Gingival Wound Healing in Rabbits by Supplementation of Pomegranate Seed Extract

Background: Pomegranate (Punica granatum) is an edible fruit that has been described as a medical and therapeutic functional food in the Middle East and the Mediterranean. Objective: To investigate the use of serum creatinine (Cr) level and creatine kinase (CK) activity as indicators for gingival wound healing process rate in rabbits, supplemented on pomegranate seed extract (PSE). Patients and Methods: A total of 45 rabbit males were used. They were divided into 3 groups; 5 rabbits as a baseline group that left without a buccal gingival wound. 20 rabbits (5 rabbits per each time interval) as a study group with buccal gingival wound with PSE supplementation, and another 20 rabbits (5 rabbits per each time interval) as a control group with gingival wound without PSE supplementation. A buccal gingival wound was created on the lower right central incisor, and the suture was removed after (7) days. Blood samples were collected for the baseline group and at time intervals; 3 hour, 1, 3, 7 days after creating the wound for both control and study groups to determine serum Cr and serum CK. Results: Serum Cr and CK significantly increased in all time intervals after gingival wounds, in the control group compared with baseline values. Whereas the levels significantly increased in rabbits receiving PSE at intervals of 3 hours, 1 and 3 days after gingival wound, they returned to the baseline values, seven days after gingival wound incision. Conclusion: Serum Cr and CK increase in the buccal gingival wound, while oral supplementation of PSE can decline them to the baseline value after a period of time, therefore these parameters can be used as indicators for gingival wound healing rate. Keywords: Punicagranatum seed extract, gingival wound healing, creatinine, creatine kinase.

Thiol/disulfide homeostasis and oxidant status in children with congenital heart disease

Objectives This article aims to explain the altered oxidative status and thiol/disulfide homeostasis before and after surgery in children with congenital heart disease (CHD). Methods Blood samples were taken from the patients (n=50) before the operation (baseline), at the 1st hour, and at the 24th hour after the operation. Thiol-disulfide levels, total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), myeloperoxidase (MPO), ceruloplasmin, albumin, ischemia-modified albumin (IMA), and prolidase activities of all samples were measured. Pre-operative oxygen saturation (SaO2) values and neutrophil/lymphocyte ratios (NLR) were also measured. Results Before the operation, TOS, OSI, MPO, ceruloplasmin, IMA, NRL, and disulfide levels were higher in the cyanotic group than in the acyanotic group. When the indicated three different time points were compared, the TOS, OSI levels, and MPO activities of the 24th hour were significantly lower than the baseline and 1st hour. In comparison, ceruloplasmin levels of 1st hour were significantly higher than of the baseline and 24th hour. Native thiol and total thiol levels in the baseline group were significantly lower than in the 1st and 24th hours. Disulfide levels of the 24th hour were significantly lower than of the baseline. Conclusions The operation leads to changes in the thiol-disulfide balance and oxidant status in CHD.

The Compatibility between the Takeover Process in Conditional Automated Driving and the Current Geometric Design of the Deceleration Lane in Highway

In recent years, the takeover process of conditional automated driving has attached a great deal of attention. However, most of the existing research has focused on the effects of human-machine interactions or driver-related features (e.g., non-driving-related tasks), while there is little knowledge about the compatibility between the takeover process and existing road geometric design. As there is a high possibility that drivers must take over the vehicle before they diverge from the mainline of the highway, this explanatory study aimed to examine the compatibility between the takeover process and the current deceleration lane geometric design. The distribution range of existing deceleration lanes’ lengths were obtained through a geo-based survey. Nine scenarios were recreated in the driving simulator which were designed with various deceleration lane lengths and driving modes (different takeover time budgets and manual driving as the baseline group). A total of 31 participants were recruited to take part in the experiment, their gaze behaviors were recorded simultaneously. Results showed that, compared with manual driving, both drivers’ horizontal and vertical gaze dispersion increased, while drivers adopted higher deceleration in the mainline and merged into the deceleration lane later under takeover conditions. Moreover, a longer deceleration lane could benefit vehicle control. However, its marginal effect was reduced with the increase of deceleration lane length. These findings can help automated vehicle manufacturers design dedicated takeover schemes for different deceleration lane lengths.

Surface-Based Amplitude of Low-Frequency Fluctuation Alterations in Patients With Tinnitus Before and After Sound Therapy: A Resting-State Functional Magnetic Resonance Imaging Study

This study aimed to investigate abnormal tinnitus activity by evaluating brain surface-based amplitude of low-frequency fluctuation (ALFF) changes detected by resting-state functional magnetic resonance imaging (RS-fMRI) in patients with idiopathic tinnitus before and after 24 weeks of sound therapy. We hypothesized that sound therapy could gradually return cortical local brain function to a relatively normal range. In this prospective observational study, we recruited thirty-three tinnitus patients who had undergone 24 weeks of sound therapy and 26 matched healthy controls (HCs). For the two groups of subjects, we analyzed the spontaneous neural activity of tinnitus patients by cortical ALFF and detected its correlation with clinical indicators of tinnitus. Patients’ Tinnitus Handicap Inventory (THI) scores were assessed to determine the severity of their tinnitus before and after treatment. Two-way mixed model analysis of variance and Pearson’s correlation analysis were used in the statistical analysis. Student–Newman–Keuls tests were used in the post hoc analysis. Interaction effects between the two groups and between the two scans revealing local neural activity as assessed by ALFF were observed in the bilateral dorsal stream visual cortex (DSVC), bilateral posterior cingulate cortex (PCC), bilateral anterior cingulate and medial prefrontal cortex (ACC and MPC), left temporo-parieto-occipital junction (TPOJ), left orbital and polar frontal cortex (OPFC), left paracentral lobular and mid cingulate cortex (PCL and MCC), right insular and frontal opercular cortex (IFOC), and left early visual cortex (EVC). Importantly, local functional activity in the left TPOJ and right PCC in the patient group was significantly lower than that in the HCs at baseline and was increased to relatively normal levels after treatment. The 24-week sound therapy tinnitus group demonstrated significantly higher ALFF in the left TPOJ and right PCC than in the tinnitus baseline group. Also, compared with the HC baseline group and the 24-week HC group, the 24-week sound therapy tinnitus group demonstrated slightly lower or higher ALFF in the left TPOJ and right PCC, and there were no differences between the 24-week sound therapy tinnitus and HC groups. Decreased THI scores and ALFF changes in the abovementioned brain regions were not correlated. Taken together, surface-based RS-fMRI can provide more subtle local functional activity to explain the mechanism of tinnitus treatment, and long-term sound therapy had a normalizing effect on tinnitus patients.

Tocilizumab in Systemic Juvenile Idiopathic Arthritis: Response Differs by Disease Duration at Medication Initiation and by Phenotype of Disease

Objective: We performed a single-center retrospective study to determine the different efficacy of tocilizumab (TCZ) in the early and late stages and in three phenotypic subgroups (monocyclic, polycyclic, and persistent) of systemic juvenile idiopathic arthritis (sJIA).Methods: Clinical and serological parameters of 77 sJIA patients treated by TCZ were collected from November 1, 2013 to May 1, 2019. Patients were grouped based on the duration group A < 6 months (n = 41) and group B > 6 months (n = 36) and divided into three phenotypes: monocyclic (n = 12), polycyclic (n = 14), and persistent (n = 51) course.Results: At baseline, group A had pronounced ESR, fever less active arthritis than group B (p < 0.05). After 12 weeks of therapy, TCZ alleviated fever, ESR, CRP, and systemic-onset juvenile arthritis disease activity score-27 (sJADAS27) in both group A and group B (p>0.05), while the efficacy of TCZ in relieving active arthritis in group A was better than that in group B (p<0.05). After 1 year of TCZ therapy, it showed that patients with monocyclic phenotype had the highest clinical response rate (91.7%, odds ratio = 0, 95% CI: 24–24, p = 0.00), followed by the polycyclic (28.6%, odds ratio = 2.1, 95% CI: 10.5–18.8, p = 0.00) and the persistent course (9.8%, odds ratio = 1.2, 95% CI: 9.5–13.8, p = 0.00).Conclusion: TCZ can quickly relieve fever and inflammation, especially when patients have less active arthritis with shorter disease duration. The long-term efficacy of TCZ is related to the phenotypes, among which the monocyclic is the best, and the persistent is the worst.

1144. Evaluation of Procalcitnonin Usage in Neonates Presenting with Fever or Suspected Sepsis

Background Clinical evaluation alone is not effective in identifying serious bacterial infections (SBI) in neonates presenting with suspected sepsis and fever. A clinical decision making tool to aide in evaluating neonates presenting to the pediatric emergency department (PED) uses urinalysis, absolute neutrophil count (ANC), and procalcitonin (PCT) and together has high negative predictive value (NPV) for SBI. Use may decrease invasive testing, antibiotic exposure, and rates of admission. The tool was incorporated into hospital guidelines in October 2020. The purpose is to assess implementation and prediction of SBIs. Methods This is a single-center quality improvement study at an academic medical center. Neonates less than 60 days presenting with fever or suspected sepsis were included in the baseline group from October 2019- March 2020 or the post-implementation group from October 2020- March 2021. Exclusion criteria were receiving antibiotics 48 hours before PED visit, pre-existing medical conditions, indwelling devices, soft-tissue infections, and ≤ 36 weeks gestation. Implementation and guideline compliance was assessed in neonates aged 29-60 days as the primary outcome. Secondary endpoints include initiation of empiric antibiotics, rates of admission, rates of re-presentation within 30 days, and rates of lumbar punctures in all included patients. Results The baseline group had 29 patients and the post-implementation group had 35 patients who met inclusion/exclusion criteria. Baseline characteristics were similar with higher SBI rates in the post-implementation group having 8 SBIs while the baseline group had 4. There were 16 patients aged 29-60 days in the baseline (55%) and 17 in the post-implementation groups (49%). Complete labs were available for 9 patients (53%) and guideline compliance was 89%. NPV in neonates aged 0-60 days with negative urinalysis, ANC, and PCT was 100%. Rates of secondary endpoints were slightly higher in the post-implementation group along with higher rates of infections. Conclusion High NPV in this small cohort is an indication for continued use of this tool in neonates presenting to the PED with suspected sepsis or fever. Further education to increase use and expansion to all neonates should be considered based on overall NPV and previous studies. Disclosures All Authors: No reported disclosures

783. Impact of Universal Decolonization on Intensive Care Unit Bloodstream Infections

Background Interventions used to reduce the incidence of hospital-acquired infections (HAIs) include hand hygiene, isolation, and decolonization. The routine use of chlorhexidine gluconate (CHG) and nasal mupirocin ointment has been shown to be an effective universal decolonization option to reduce bacterial transmission and prevent HAIs. The objective of this study is to compare the pre- and post-intervention of universal decolonization among ICU patients at Desert Regional Medical Center, an acute care Level II trauma center. Methods The first part of this study is a retrospective chart review of all ICU patients from June 2020 to August 2020. The second part of this research is a prospective study from December 2020 to March 2021. The prospective study will include all patients admitted to the ICU who completed the decolonization regimen of mupirocin for 5 days and daily CHG baths. In the intervention phase, all ICUs patients will be decolonized with nasal mupirocin twice daily for 5 days and CHG baths daily for the entire ICU stay. The primary outcome is the number of ICU bloodstream infections (BSIs). Secondary outcomes include the number of ICU-related central line associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), and ventilator associated pneumonia (VAP). An infection attributed to ICU stay is defined as an infection onset occurring more than 48 hours after ICU admission. Fisher’s exact and chi square test was used for the statistical analysis. Results A total of 130 patients were included in this study. Universal decolonization resulted in a reduction in overall ICU infections in the baseline group vs intervention group using a p-value of 0.05 (ICU-BSI 5 vs 4, p=0.73; CLABSI 2 vs 1, p=0.56; CAUTI 4 vs 2, p=0.41; VAP 23 vs 17, p=0.25). Conclusion Patients in the intervention group had a lower incidence of ICU infections compared to the baseline group. These findings suggest that universal decolonization may be an effective strategy in reducing ICU incidence rates of BSI, CLABSI, CAUTI, and VAP. Further studies need to be conducted to validate this finding with a greater population enrolled to achieve adequate power. Disclosures All Authors: No reported disclosures

Coronal subluxation of the tibiofemoral joint before and after anterior cruciate ligament reconstruction

Background Studies have shown that medial subluxation of the tibia occurs after anterior cruciate ligament (ACL) rupture. However, it is unclear whether anterior cruciate ligament reconstruction (ACLR) can correct tibial coronal subluxation. Purpose To determine whether the tibia is medially subluxated after ACL rupture, and whether ACLR can correct medial subluxation of the tibia. Study design Case series; Level of evidence, 4, Retrospective clinical study. Methods The distance of tibial coronal subluxation before and after ACLR surgery was measured in 48 patients with ACL rupture and meniscus injury. Tibiofemoral subluxation was defined as the perpendicular distance between the long axis of the tibia and a second parallel line originating at the most proximal aspect of the femoral intercondylar notch. To determine the long axis of the tibia, two circles separated by 5 cm were centered on the proximal tibia. The proximal circle is 5 cm from the tibial plateau, and the distal circle is 5 cm from the proximal circle. The line passing through the center of the two circles was considered the long axis of the proximal tibia. Care was taken to ensure that each patient lied on the back with their patellae facing upward, to minimize rotational variation among the radiographs. At the same time, 30 patients with simple meniscus injury who underwent arthroscopy during the same period were selected to determine the degree of tibiofemoral coronal subluxation as the baseline value. The changes before and after operation were compared, as well as the differences with the baseline data. Result The average follow-up period was 21.2 ± 5.8 months. The average distance of tibial coronal subluxation before ACLR was 5.5 ± 2.1 mm, which was significantly different from that of baseline group (7.3 ± 2.1 mm) (P < 0.001). The tibial subluxation after ACLR was 7.7 ± 2.6 mm, which was significantly different from that before operation (P < 0.001). There was no significant difference in the distance between postoperative tibial subluxation and baseline group (P = 0.472). Conclusion The tibia was coronally medially subluxated after ACL rupture. ACLR can correct the medial subluxation of tibia. This finding is helpful in the diagnosis of ACL rupture, and can be used to assess the imaging status of the tibiofemoral joint on the coronal plane during or after ACLR.

Evaluation of Some Serum Antioxidants in Mandibular Bone Defect Healing in Rabbits Orally Supplemented with Pomegranate Peel Extract

Background: Pomegranate (PG) fruit (punicagranatum L, Punicaceae contains many bioactive substances that play important role in the treatment of a variety of medical problems. Among PG parts, it was observed that the peel had the most potent antioxidant activity. Objective: To evaluate some serum antioxidants levels in mandibular bone injury healing in rabbits orally supplemented with pomegranate peel extract (PPE). Patients and Methods: Forty-five male rabbits (1-1.2 kg) were used and they were divided into 3 groups; the baseline group consisted of 5 rabbits without creating mandibular bone defects. 20 rabbits were used as a study group with creating mandibular bone defects and they received orally 1ml/day of PPE. Another 20 rabbits were used as a control group with creating mandibular bone defects without receiving PPE. For each rabbit of both study and control groups, a circular defect of 3 mm in diameter was made in the mid labial area of the alveolar bone of the lower right central incisor. Blood samples were taken from the baseline group and both the study and control groups at time intervals; 3hrs, 1, 3, and 7days after bone defect creation, for estimation of serum albumin (Alb), bilirubin (Bili), zinc (Zn), and magnesium (Mg) levels. Results: Serum Bili levels significantly increased 1and 3 days after bone defect creation in both study and control groups, while the levels returned back to baseline in a study group, 7 days after the operation. Serum Alb, Zn, and Mg levels showed a significant decrease in study and control groups, 1 day and 3 days after the operation, while the levels of these parameters returned back to baseline, in a study group, 7 days after bone defect. Conclusion: Supplementation of PPE can affect serum antioxidants and this was accompanied by the increase in the bone healing rate process. Keywords: Pomegranate peel, mandibular bone defect, albumin, bilirubin, divalent cations, antioxidant

USE OF NON-DRUG METHODS IN THE TREATMENT OF PATIENTS WITH ARTERIAL HYPERTENSION

The aim of the study is to optimize the comprehensive treatment of patients with severe arterial hypertension, through the use of multicomponent rational antihypertensive pharmacotherapy, followed by the use of unloading therapeutic exercises. 32 men with severe arterial hypertension were examined. Initially, a clinical, instrumental and laboratory examination, registration of blood pressure and its 24-hour monitoring were carried out. The average daily systolic (ADBPsyst.) and average daily diastolic (ADBPdiast.) blood pressure were determined. A multicomponent rational antihypertensive pharmacotherapy, according to the clinical recommendations for the treatment of arterial hypertension was selected for all the patients. In at least 3 months after the selection of pharmacotherapy, the patients were divided into two groups, comparable in gender, age, severity of the condition, features of the disease course and medicamentous therapy. Patients of the 1st group (active treatment group) against the background of pharmacotherapy were prescribed unloading therapeutic exercises according to a patented technique. The 2nd group of patients continued to take pharmacotherapy and it was used as a baseline group. The average age in the 1st and 2nd groups was 46,3±6,8 and 43,6±7,2 years, respectively. Patients of the 1st group were prescribed unloading therapeutic exercises and in 3 months in both groups the ADBPsyst. and ADBPdiast. were compared. Initially, there was a significant increase in ADBPsyst. and ADBPdiast. compared to the normal range in both groups. These indicators in both groups differed insignificantly. In 3 months after pharmacotherapy, there was a significant decrease in ADsyst. and ADdiast. in both groups, but these indicators remained elevated and did not reach the target level. Then, in the 1st group, unloading therapeutic exercises were included in the comprehensive treatment. Patients of the 2nd group continued to receive pharmacotherapy. In 3 months after including unloading therapeutic exercises in the 1st group, there was a significant decrease in ADBP (syst. and diast.) not only in comparison with the initial data, but also with the data in 3 months after pharmacotherapy. In the 2nd group, these indicators did not change significantly compared to the three-month data. In 6 months, ADBPsyst. and ADBPdiast. in the 1st group were significantly lower compared to similar indicators in the 2nd group, which proves significant clinical effectiveness of unloading therapeutic exercises in patients of the 1st group. The results obtained confirm that patients with severe arterial hypertension have such types of disorders at the cellular-tissue and microcirculatory level that are not eliminated only by drug therapy. For their high-grade correction, along with multicomponent pharmacotherapy, it is necessary to include unloading therapeutic exercises. To optimize the treatment of severe arterial hypertension against the background of receiving multicomponent antihypertensive pharmacotherapy, it is recommended to include unloading therapeutic exercises in the therapeutic complex.