Abstract Study question Does the supplementation of vitamin B12 protect the spermatozoa against damage caused by the freeze-thaw process further improving the overall post-thaw survival and DNA integrity? Summary answer The antioxidant property of vitamin B12 protects the spermatozoa and improves the post thaw motility, vitality, and reduces DNA damage caused by freeze-thaw process. What is known already Cryopreservation of spermatozoa is an effective way of fertility preservation in humans, often used in Assisted Reproductive Technology(ART). Despite the refinement in cryopreservation, the salvage of post-thaw sperms remains poor. The reactive oxygen species(ROS), that is formed as a result of freeze-thaw process is known to decrease the motility, plasma membrane integrity and increase the DNA fragmentation. Most vitamins have antioxidant properties, that protect the mammalian cells from oxidative stress one such vitamin is cyanocobalamin(vitamin B12). Vitamin B12 modulates oxidative stress through methionine synthase activity and also acts as a scavenger of ROS. Thus protecting the DNA against free radicals. Study design, size, duration This prospective observational study was performed for a period of 6 months in 111 men, who attended the fertility clinic. The study population included all semen samples except men with azoospermia, surgically retrieved samples and men on vitamin supplements. The study population contained men ageing between 21-40 years. Participants/materials, setting, methods Semen samples were analysed according to WHO 5th edition and were assessed for DNA fragmentation index (DFI) using sperm chromatin dispersion assay (SCD). The ejaculates were split into two as group A: semen samples with equal amount of cryoprotectant and group B: semen samples with equal amount of cryoprotectant supplemented with Vitamin B12 (2mg/ml). They were frozen for a minimum of 24 hrs. Post-thaw motility, vitality and DFI were assessed and compared. Main results and the role of chance The mean age of patients in our study was 34.26±4.7yrs. 58.5% of the study population had primary infertility. 37.8% of the study population had male factor infertility, 32.4% had oligoasthenoteratozoospermia(OAT), 31.1% had normozoospermia 16.2% had asthenoteratozoospermia, 13.5% had teratozoospermia, 3.6% had oligozoospermia and rest 2.7% had asthenozoospermia. There was an overall increase in post thaw motility (41.59±18.09 vs 32.3±18.8,p=0.0005), progressive motility (21.54±13.02 vs 15.91±11.80,p=0.0005), vitality (57.14±15.09 vs 46.76±16.45,p=0.0005) and a significant decrease in DFI (26.69±10.03 vs 32.09±10.00,p=0.0005) in group B compared to group A. Our study also demonstrated that, Normozoospermia patients had a significant increase in vitality (67.17±13.8 vs 58.51±12.0, p = 0.007) and lower DFI (22.68±9.3 vs 27.6±8.9, p = 0.02) in group B than in group A. OAT patients had a significant increase in total motility (26.25±12.15 vs 15.7±11.4,p=0.0003), progressive motility (11.69±8.8 vs 6.14±5.8,p=0.0028), vitality (46.06±11.34 vs 34.31±12.99,p=0.0001) and significantly lower DFI (30.22±9.87 vs 36.08±9.7,p=0.012) in group B. Teratozoospermia patients showed significant increase in progressive motility in group B (27.87±8.81 vs 19.33±10.69,p=0.02) and Asthenoteratozoospermia patients showed significant increase in total motility (40.72± 13.14 vs 30.89±13.06,p=0.02) and vitality (54.39±12.28 vs 43.78±14.14,p=0.02) in group B. However, in asthenozoospermic patients the parameters were comparable in both the groups. Limitations, reasons for caution Due to ethical reasons the samples were not used for in vitro procedures such as intrauterine insemination(IUI), in vitro fertilization (IVF) and intracytoplasmic sperm injection(ICSI). Hence, no inference was obtained regarding the fertilization rates/ pregnancy rates. Wider implications of the findings Our study demonstrated that with supplementation of vitamin B12 the recovery rate significantly increased and also preserved the DNA content. Among the various categories, supplementation of vitamin B12 to OAT samples was more beneficial as it improved the overall viability of the sperms. Trial registration number CSP/21/JUL/96/389

Angioedema is fortunately rare, but can be fatal, almost always due to airway compromise.Common causes include allergic reactions and angiotensin-convertingenzyme inhibitors (ACEI).The reported incidence is 1-5%, in patients receiving thrombolysis with concomitant use of ACEI.African Americans (AA) have higher risk than Caucasians.We present a rare case of hemi-orolingual angioedema in a patient without current or prior history of ACEI.A 37 year old AA female with history of uncontrolled hypertension (non-compliant with amlodipine), presented with transient blurry vision.Neurological exam was unremarkable.National Institutes of Health Stroke Scale (NIHSS) was zero.MRI brain demonstrated punctate DWI/FLAIR focus of abnormal signal along bilateral posterior parietal regions.The next morning, a 'code stroke' was activated for new symptoms of aphasia, dysarthria, right facial droop, and right arm weakness.NIHSS was 5. CT brain ruled out intracranial bleeding.She was treated with tissue plasminogen activator (tPA) per standard infusion protocol.During the infusion, her neurological symptoms improved.15 minutes after completion of tPA, she complained of hoarseness of voice.Exam was significant for urticaria of right upper extremity, right facial swelling and swelling of dorsal and ventral right tongue abruptly ending in midline (Figure 1-1).The posterior pharynx, soft palate and uvula was found to have no swelling.She was given methylprednisolone, famotidine, diphenhydramine, and epinephrine.Initially thought to have low threshold for intubation, however, the swelling improved in 6 hours and later resolved (Figure 12).Repeat MRI brain demonstrated a small left parietal acute infarct and she was initiated on aspirin and statin.tPA is the gold standard treatment of acute ischemic stroke.It activates fibrin-bound plasminogen into plasmin, the major enzyme for clot break-down.The most common adverse effect is bleeding.Orolingual angioedema is rare and associated with use of ACEI.Increased production of bradykinin by tPA, coupled with reduced breakdown by ACEI has been suggested as the mechanism for increased likelihood.Repeated tPA exposure also increases the risk.Our patient is rare as she had demarcated swelling sharply ending in midline after tPA, without prior exposure to tPA or ACEI.The tissue swelling, lateralized contralateral to the ischemic hemisphere is thought to be due to autonomic dysfunction.In conclusion, ACEI should be avoided in patients receiving tPA.Early recognition of angioedema and cessation of tPA is crucial.Immediate medical management followed by airway assessment to guide timing of intubation is life saving.

Let D . n/ be a non-decreasing sequence of positive real numbers tending to1with nC1 nC1; 1D 1: In the present paper, we introduce the notion of -statistical convergence of order ̨, -statistical Cauchy sequences of order ̨ in random 2-normed spaces and obtain some results. We display examples which show that our method of convergence is more general in random 2-normed space. 2010 Mathematics Subject Classification: 40A05; 46A70; 46A99; 60B99

Use of high-fidelity patient simulators for resident education is growing rapidly. There are few qualitative data pertaining to the learner's perception of high-fidelity simulation as a teaching modality. Knowing what residents find valuable in simulation training would aid in simulation curriculum development.

Study ObjectivesDermal glues are commonly used for laceration repairs of the face but are rarely used in the US for scalp lacerations. Liquiband is a cyanoacrylate fast polymerizing wound glue used in the United Kingdom for scalp lacerations. To our knowledge, this is the first US study addressing dermal glue on scalp lacerations. The study purpose was to determine effectiveness of LiquiBand™ Flow Control skin adhesive for closure of scalp wounds. Emergency physicians measured ease of use, closure time, wound appearance, and complications. Patients assessed wound appearance post closure and pain level during application.MethodsThis was an institutional review board approved prospective, follow-up pilot study of a convenience sample. Patients aged >24 months seen in an emergency department (ED) with a scalp laceration were evaluated. Inclusion criteria were simple scalp lacerations < 5cm and < 6 hours old with easily approximated wound edges. Exclusions were multiple trauma, blood clotting disorders or blood thinning medications, animal or human bites, pregnancy, inadequate wound hemostasis or allergy to cyanoacrylate or formaldehyde. Consented patients had wounds cleaned and irrigated and a photo taken of the scalp wound prior to applying LiquiBand and post application. Data collected included: demographics, length of wound, anesthetic use, ease of application and satisfaction of closure. Patients rated wound closure pain on a Visual Analogue Scale. Patients were followed-up in ED 8-12 days post repair where physicians and patients rated satisfaction of closure. Physicians evaluated wounds for apposition, edema, inflammation, and infection and utilized a modified Hollander scale to further evaluate cosmesis. A follow-up photo was taken at the second visit. Four physician investigators were trained on LiquiBand use prior to the study and patients only recruited and seen for follow-up by study physicians.ResultsTwenty-eight patients were screened for inclusion between January and April 2011. Eight were excluded due to prisoner status (4), wound too deep (3) or too small (1). At time of abstract, 15 patients met inclusion criteria and were consented with 14 completing follow-up. Thirteen were male, 53% White and 47% African American; age range 4-72 years. All scalp wounds achieved ≥ 90% apposition (14), with 57% (n=8) achieving 100% apposition. There were no reports of dehiscence, infection, edema, or inflammation at follow-up and all patients (14) rated wound appearance as acceptable versus unacceptable. All but 1 reported their wound looked better (7) or much better (6) than expected. Additionally, all patients reported they would use LiquiBand again and reported very low pain scores during the procedure (M1.3; +/-2.05). All physicians rated the wound as good or excellent with a mean Hollander score of 4.6; +-.51. Mean application and closure time was 72 seconds (+/- 36.35). When asked to compare to other closure methods, physicians were highly satisfied (4.67; +/-.62) on a scale of 1-5 and all would use LiquiBand again over staples or sutures.ConclusionThis small pilot study demonstrates that Liquiband can be used safely for rapid closure of simple scalp lacerations with minimal pain and good to excellent cosmesis. There was a high level of physician and patient satisfaction. A larger prospective study is warranted. Skin adhesives should be considered for simple scalp laceration repair. Study ObjectivesDermal glues are commonly used for laceration repairs of the face but are rarely used in the US for scalp lacerations. Liquiband is a cyanoacrylate fast polymerizing wound glue used in the United Kingdom for scalp lacerations. To our knowledge, this is the first US study addressing dermal glue on scalp lacerations. The study purpose was to determine effectiveness of LiquiBand™ Flow Control skin adhesive for closure of scalp wounds. Emergency physicians measured ease of use, closure time, wound appearance, and complications. Patients assessed wound appearance post closure and pain level during application. Dermal glues are commonly used for laceration repairs of the face but are rarely used in the US for scalp lacerations. Liquiband is a cyanoacrylate fast polymerizing wound glue used in the United Kingdom for scalp lacerations. To our knowledge, this is the first US study addressing dermal glue on scalp lacerations. The study purpose was to determine effectiveness of LiquiBand™ Flow Control skin adhesive for closure of scalp wounds. Emergency physicians measured ease of use, closure time, wound appearance, and complications. Patients assessed wound appearance post closure and pain level during application. MethodsThis was an institutional review board approved prospective, follow-up pilot study of a convenience sample. Patients aged >24 months seen in an emergency department (ED) with a scalp laceration were evaluated. Inclusion criteria were simple scalp lacerations < 5cm and < 6 hours old with easily approximated wound edges. Exclusions were multiple trauma, blood clotting disorders or blood thinning medications, animal or human bites, pregnancy, inadequate wound hemostasis or allergy to cyanoacrylate or formaldehyde. Consented patients had wounds cleaned and irrigated and a photo taken of the scalp wound prior to applying LiquiBand and post application. Data collected included: demographics, length of wound, anesthetic use, ease of application and satisfaction of closure. Patients rated wound closure pain on a Visual Analogue Scale. Patients were followed-up in ED 8-12 days post repair where physicians and patients rated satisfaction of closure. Physicians evaluated wounds for apposition, edema, inflammation, and infection and utilized a modified Hollander scale to further evaluate cosmesis. A follow-up photo was taken at the second visit. Four physician investigators were trained on LiquiBand use prior to the study and patients only recruited and seen for follow-up by study physicians. This was an institutional review board approved prospective, follow-up pilot study of a convenience sample. Patients aged >24 months seen in an emergency department (ED) with a scalp laceration were evaluated. Inclusion criteria were simple scalp lacerations < 5cm and < 6 hours old with easily approximated wound edges. Exclusions were multiple trauma, blood clotting disorders or blood thinning medications, animal or human bites, pregnancy, inadequate wound hemostasis or allergy to cyanoacrylate or formaldehyde. Consented patients had wounds cleaned and irrigated and a photo taken of the scalp wound prior to applying LiquiBand and post application. Data collected included: demographics, length of wound, anesthetic use, ease of application and satisfaction of closure. Patients rated wound closure pain on a Visual Analogue Scale. Patients were followed-up in ED 8-12 days post repair where physicians and patients rated satisfaction of closure. Physicians evaluated wounds for apposition, edema, inflammation, and infection and utilized a modified Hollander scale to further evaluate cosmesis. A follow-up photo was taken at the second visit. Four physician investigators were trained on LiquiBand use prior to the study and patients only recruited and seen for follow-up by study physicians. ResultsTwenty-eight patients were screened for inclusion between January and April 2011. Eight were excluded due to prisoner status (4), wound too deep (3) or too small (1). At time of abstract, 15 patients met inclusion criteria and were consented with 14 completing follow-up. Thirteen were male, 53% White and 47% African American; age range 4-72 years. All scalp wounds achieved ≥ 90% apposition (14), with 57% (n=8) achieving 100% apposition. There were no reports of dehiscence, infection, edema, or inflammation at follow-up and all patients (14) rated wound appearance as acceptable versus unacceptable. All but 1 reported their wound looked better (7) or much better (6) than expected. Additionally, all patients reported they would use LiquiBand again and reported very low pain scores during the procedure (M1.3; +/-2.05). All physicians rated the wound as good or excellent with a mean Hollander score of 4.6; +-.51. Mean application and closure time was 72 seconds (+/- 36.35). When asked to compare to other closure methods, physicians were highly satisfied (4.67; +/-.62) on a scale of 1-5 and all would use LiquiBand again over staples or sutures. Twenty-eight patients were screened for inclusion between January and April 2011. Eight were excluded due to prisoner status (4), wound too deep (3) or too small (1). At time of abstract, 15 patients met inclusion criteria and were consented with 14 completing follow-up. Thirteen were male, 53% White and 47% African American; age range 4-72 years. All scalp wounds achieved ≥ 90% apposition (14), with 57% (n=8) achieving 100% apposition. There were no reports of dehiscence, infection, edema, or inflammation at follow-up and all patients (14) rated wound appearance as acceptable versus unacceptable. All but 1 reported their wound looked better (7) or much better (6) than expected. Additionally, all patients reported they would use LiquiBand again and reported very low pain scores during the procedure (M1.3; +/-2.05). All physicians rated the wound as good or excellent with a mean Hollander score of 4.6; +-.51. Mean application and closure time was 72 seconds (+/- 36.35). When asked to compare to other closure methods, physicians were highly satisfied (4.67; +/-.62) on a scale of 1-5 and all would use LiquiBand again over staples or sutures. ConclusionThis small pilot study demonstrates that Liquiband can be used safely for rapid closure of simple scalp lacerations with minimal pain and good to excellent cosmesis. There was a high level of physician and patient satisfaction. A larger prospective study is warranted. Skin adhesives should be considered for simple scalp laceration repair. This small pilot study demonstrates that Liquiband can be used safely for rapid closure of simple scalp lacerations with minimal pain and good to excellent cosmesis. There was a high level of physician and patient satisfaction. A larger prospective study is warranted. Skin adhesives should be considered for simple scalp laceration repair.