Alterations in amygdala-prefrontal circuits in infants exposed to prenatal maternal depression

Prenatal exposure to maternal depression is common and puts offspring at risk for developing a range of neuropsychiatric disorders. Despite its prevalence and adverse associations, neurobiological processes by which prenatal maternal depression (PMD) confers risk remain poorly understood. Maternal mood and fetal behavior were assessed between 34 and 37 gestational weeks. Using resting-state functional magnetic resonance imaging (fMRI) and diffusion MRI, we examined functional and structural connectivity within amygdala-prefrontal circuits in 64 infants (mean age=5.8±1.7 weeks) with (n=20) and without (n=44) in utero exposure to PMD. Resting fMRI and diffusion MRI both indicated atypical amygdala-prefrontal connectivity in PMD-exposed infants: Resting fMRI indicated increased inverse, or negative, functional connectivity between the amygdala and the dorsal prefrontal cortex (PFC), bilaterally, and diffusion MRI indicated decreased structural connectivity between the right amygdala and the right ventral PFC. Spectral dynamic causal modeling supported these findings suggesting altered amygdala-PFC effective (or directed) connectivity in PMD-exposed infants. Last, path analyses supported a mechanistic account relating PMD to a third-trimester fetal behavior: PMD alters amygdala-PFC connectivity, which in turn, is associated with an increase in fetal heart rate reactivity to in utero perturbation. These data suggest that the maturation and coordination of central and peripheral physiology are altered by prenatal exposure to maternal depression. To the best of our knowledge, this is the first study to directly associate infant MRI measures with a behavior-fetal heart rate response, and supports hypotheses that PMD-associated variations in the development of amygdala-PFC circuits are relevant for future neurobehavioral maturation.

Diverticulitis in the Young Population : Reconsidering Conventional Recommendations

BACKGROUND

In the past diverticulitis was believed to be uncommon in the young population. However, there is growing concern suggesting that these patients develop more severe clinical symptoms and may require more frequent intervention.

METHOD

We performed a retrospective chart review of patients with diverticulitis in individuals with age less than 40 years over an 8 year period (2007-2015). Diagnosis was confirmed with a CT scan. In addition to age we took into consideration race, gender, anemia (hematocrit< 41), leukocytosis (WBC > 12), BMI and whether it was an initial episode or recurrence. Our outcome variables were complications (abscess, fistula, and perforation, results of colonoscopy (polyps or colon cancer)) and whether the patient required surgery.

RESULTS

We identified 123 patients who were less than 40 years old with the diagnosis of diverticulitis. There was greater than a 3:1 ratio of males to females (77% males and 23% females) with an average age of 32.6 year. The race of the patients was nearly entirely Hispanic (88.6%). With regards to the outcome variables, 18.7% had abscesses as a complication. Perforations were observed in 26% of the patients, of which one was complicated by a fistula. A total of 25 (20%) patients went to surgery. Of these, 21 had an abscess, perforation, or tubular adenomatous polyps (TAP). Follow-up colonoscopy post-diverticulitis results were available for 42 patients. Of those patients, 9 had hyperplastic polyps and 3 had TAP. The remaining 30 patients had no polyps. No colon cancer or villous polyps were found in the entire cohort.

CONCLUSION

Our study highlights that young patients who have an index case of uncomplicated diverticulitis with no other risk factors or complications may not gain further benefit from routine colonoscopy as once traditionally thought. (Acta gastroenterol. belg., 2016, 79, 435-439).

ID: 35: ASSOCIATION BETWEEN HELICOBACTER PYLORI INFECTION WITH CORONARY ARTERY DISEASE AND ACUTE MYOCARDIAL INFARCTION: A RETROSPECTIVE CHART ANALYSIS

Introduction

Helicobacter pylori (HP) infection is known to target the gastrointestinal system and is associated with extra gastrointestinal manifestations, but there is limited literature on cardiac associations. The most supported pathogenesis uses chronic inflammation as a risk factor causing atherosclerosis resulting in cardiovascular disease. Our aim is to evaluate whether there is an association between HP infection and acute myocardial infarction (AMI) and coronary artery disease (CAD).

Method

We performed a retrospective single center study at our medical center from 2005 to 2014 consisting of 1,671 patients who underwent Coronary Angiography (CA). We divided these patients into two groups based on CA reports. Patients with CAD defined as left main stenosis of ≥50% or any stenosis of ≥70% versus normal coronaries. We reviewed each patient chart to determine the prevalence of positive serum HP IgG antibody. Smoking, hypertension, dyslipidemia and obesity were also considered in each group.

Results

Of 1,671 patients, 1,237 had evidence of CAD vs 434 with normal coronary arteries. Twelve percent of CAD patients were found to have seropositive HP (SPHP) versus 1% in the control group (OR: 7.3, 95% CI: 3.5–15, p<0.0001) as depicted in figure 1. When we looked at the CAD group and compared SPHP patients to seronegative HP (SNHP) patients we found a greater amount of multiple coronary vessels disease in the SPHP group (OR: 1.4, 95% CI: 1.1–2, P=0.04). With regards to AMI, 30% of the SPHP group presented with AMI versus 10% seen in the SNHP group (OR: 4.3, 95% CI: 3–6.5, p<0.0001). In the CAD group with SPHP there was more hyperlipidemia and a higher BMI than in the CAD SNHP group (p<0.0001 and <0.0001, respectively), but there was no statistical difference between the two groups for the risk factors of smoking, hypertension and diabetes.

Conclusion

According to this study, the results showed a correlation with SPHP patients and CAD. Patients with HP seropositivity also tend to have multiple coronary artery vessel disease. In addition, our results also confirmed that there is an association between with HP infection and AMI. We hypothesize that the associated maybe secondary to inflammatory reaction associated with HP. Additional studies with larger sample groups are needed to investigate the possible role of this pathogen as a risk factor for heart disease.

Abstract ID: 35 Figure 1

Twelve percent of CAD patients were found to have seropositive HP (SPHP) versus 1% in the control group (OR: 7.3, 95% CI: 3.5–15, p<0.0001).

Aggregation Kinetics for IgG1-Based Monoclonal Antibody Therapeutics

Monoclonal antibodies (mAbs) as a class of therapeutic molecules are finding an increasing demand in the biotechnology industry for the treatment of diseases like cancer and multiple sclerosis. A key challenge associated to successful commercialization of mAbs is that from the various physical and chemical instabilities that are inherent to these molecules. Out of all probable instabilities, aggregation of mAbs has been a major problem that has been associated with a change in the protein structure and is a hurdle in various upstream and downstream processes. It can stimulate immune response causing protein misfolding having deleterious and harmful effects inside a cell. Also, the extra cost incurred to remove aggregated mAbs from the rest of the batch is huge. Size exclusion chromatography (SEC) is a major technique for characterizing aggregation in mAbs where change in the aggregates' size over time is estimated. The current project is an attempt to understand the rate and mechanism of formation of higher order oligomers when subjected to different environmental conditions such as buffer type, temperature, pH, and salt concentration. The results will be useful in avoiding the product exposure to conditions that can induce aggregation during upstream, downstream, and storage process. Extended Lumry-Eyring model (ELE), Lumry-Eyring Native Polymerization model (LENP), and Finke-Watzky model (F-W) have been employed in this work to fit the aggregation experimental data and results are compared to find the best fit model for mAb aggregation to connect the theoretical dots with the reality.

Optic nerve involvement in childhood onset systemic lupus erythematosus: Three cases and a review of the literature

The ocular system can be affected in systemic lupus erythematosus (SLE) in one third of patients. However, optic nerve involvement is relatively uncommon, but is more so in pediatric SLE patients, where it can occur in 1% of cases. We report three children with SLE who presented with optic nerve involvement. Two children had optic neuritis, with optic neuritis being the first manifestation in one child. The third child had ischaemic optic neuropathy secondary to antiphospholipid syndrome. A careful work up for SLE should be performed in every child with optic nerve disease. Prompt diagnosis and early treatment results in a better prognosis.

Hematuria without chyluria: It could still be due to filarial etiology

There are few reports of “microfilaria in the urine.” We report an elderly woman with gross hematuria who was being investigated for urinary tract tuberculosis. Three consecutive urine samples showed microfilaria of Wuchereria bancrofti. However, she did not have chyluria. Treatment with diethylcarbamazine cleared up the hematuria within 3 days. Chyluria, hematuria, and hematochyluria are problems of Bancroftian filariasis reported worldwide. The literature review was made to present a simplified way for management.

Severe periodontal disease manifested in chronic disseminated type of langerhans cell histiocytosis in a 3-year old child

Langerhans cell histiocytosis (LCH), previously known as histio-cytosis X, is a rare idiopathic disorder of reticulo-endothelial system with abnormal proliferation of bone marrow derived Langerhans cells along with a variable number of leukocytes, such as eosinophils, neutrophils, lymphocytes and plasma cells. Three years old male child presented with multifocal osteolytic lesions and papulosquamous skin lesions. Clinical and radio-graphic features, such as severe alveolar bone loss, mobility of teeth, precocious eruption of teeth, foating appearance of teeth in orthopantomogram (OPG), osteolytic lesion in skull and cutaneous lesions were highly suggestive of LCH disease. Skin biopsy confirmed a diagnosis of LCH. Induction chemotherapy with oral prednisolone and intravenous vinblastine was started. Child responded well to chemotherapy. The clinical significance of the presented case is to diagnose the case of LCH on the basis of the manifestation of severe periodontal disease as this can be first or only manifestation of LCH. A dentist plays a major role in the multidisciplinary treatment of LCH through routine examination and periodic follow-up.

How to cite this article: Bansal M, Srivastava VK, Bansal R, Gupta V, Bansal M, Patne S. Severe Periodontal Disease Manifested in Chronic Disseminated Type of Langerhans Cell Histiocytosis in a 3-Year Old Child. Int J Clin Pediatr Dent 2014;7(3):217-219.

Whole genome sequencing reveals novel non-synonymous mutation in ectodysplasin A (EDA) associated with non-syndromic X-linked dominant congenital tooth agenesis

Congenital tooth agenesis in human is characterized by failure of tooth development during tooth organogenesis. 300 genes in mouse and 30 genes in human so far have been known to regulate tooth development. However, candidature of only 5 genes viz. PAX9, MSX1, AXIN2, WNT10A and EDA have been experimentally established for congenitally missing teeth like hypodontia and oligodontia. In this study an Indian family with multiple congenital tooth agenesis was identified. Pattern of inheritance was apparently autosomal dominant type with a rare possibility to be X-linked. Whole genome sequencing of two affected individuals was carried out which revealed 119 novel non-synonymous single nucleotide variations (SNVs) distributed among 117 genes. Out of these only one variation (c.956G>T) located at exon 9 of X-linked EDA gene was considered as pathogenic and validated among all the affected and unaffected family members and unrelated controls. This variation leads to p.Ser319Ile change in the TNF homology domain of EDA (transcript variant 1) protein. In silico analysis predicts that this Ser319 is well conserved across different vertebrate species and a part of putative receptor binding site. Structure based homology modeling predicts that this amino acid residue along with four other amino acid residues nearby, those when mutated known to cause selective tooth agenesis, form a cluster that may have functional significance. Taken together these results suggest that c.956G>T (p.Ser319Ile) mutation plausibly reduces the receptor binding activity of EDA leading to distinct tooth agenesis in this family.

CBCT: a revolutionary diagnostic aid for endodontic dilemmas

Successful management of endodontic problems is reliant on diagnostic imaging techniques to provide critical information about the teeth under investigation, and their surrounding anatomy. Until recently, most of this core information was obtained from conventional radiographs. The introduction of cone-beam computed tomography (CBCT) specifically dedicated to imaging the maxillofacial region heralds a true paradigm shift from a two dimensional (2D) to a three dimensional (3D) approach to data acquisition and image reconstruction. CBCT systems provide small field of view images at low dose with sufficient spatial resolution for applications in endodontic diagnosis, treatment guidance, and post treatment evaluation. CBCT has been the subject of unparalleled levels of independent research in dental imaging in the area of endodontics. It gives the edge of 3D imaging at lower radiation level in comparison to conventional CT and has helped to treat endodontic cases with external resoption, root canal variations and apical periodontitis providing the size, site and extent accurately. This paper reviews the fundamentals of CBCT and presents the applications of this imaging system in contemporary endodontic practice.

Enhanced Osteoblast Proliferation and Corrosion Resistance of Commercially Pure Titanium Through Surface Nanostructuring by Ultrasonic Shot Peening and Stress Relieving

This investigation was carried out to study the effect of a novel process of surface modification, surface nanostructuring by ultrasonic shot peening, on osteoblast proliferation and corrosion behavior of commercially pure titanium (c p-Ti) in simulated body fluid. A mechanically polished disc of c p-Ti was subjected to ultrasonic shot peening with stainless steel balls to create nanostructure at the surface. A nanostructure (&lt;20 nm) with inhomogeneous distribution was revealed by atomic force and scanning electron microscopy. There was an increase of approximately 10% in cell proliferation, but there was drastic fall in corrosion resistance. Corrosion rate was increased by 327% in the shot peened condition. In order to examine the role of residual stresses associated with the shot peened surface on these aspects, a part of the shot peened specimen was annealed at 400°C for 1 hour. A marked influence of annealing treatment was observed on surface structure, cell proliferation, and corrosion resistance. Surface nanostructure was much more prominent, with increased number density and sharper grain boundaries; cell proliferation was enhanced to approximately 50% and corrosion rate was reduced by 86.2% and 41% as compared with that of the shot peened and the as received conditions, respectively. The highly significant improvement in cell proliferation, resulting from annealing of the shot peened specimen, was attributed to increased volume fraction of stabilized nanostructure, stress recovery, and crystallization of the oxide film. Increase in corrosion resistance from annealing of shot peened material was related to more effective passivation. Thus, the surface of c p-Ti, modified by this novel process, possessed a unique quality of enhancing cell proliferation as well as the corrosion resistance and could be highly effective in reducing treatment time of patients adopting dental and orthopedic implants of titanium and its alloys.

Oral rehabilitation of segmental mandibulectomy patient with osseointegrated dental implant

Surgical management of oral cancer lesions results in explicit aesthetic and functional disfigurement, including facial deformity, loss of hard and soft tissue, impaired speech, swallowing and mastication, which modify the patient's self-image and quality-of-life. Recent advances in head and neck reconstruction techniques and dental implant based prosthetic rehabilitation may significantly improve the quality-of-life and self-esteem for such post-surgery patients. This clinical report describes rehabilitation of oral cancer patient having segmental mandibulectomy with implant-supported fixed partial denture.

Effect of dentin powder on setting time of mineral trioxide aggregate: an in vitro study

AIM

Mineral trioxide aggregate (MTA) is a biomaterial with numerous clinical applications in the field of endodontics. The properties of this material come closest to the requirements of an ideal endodontic repair material. Delayed setting time though may limit the use of MTA in endodontic procedures. Many chemical based additives have influenced the setting time of MTA. The aim of this paper was to evaluate the effect of a natural additive in the form of human dentin powder on setting properties of ProRoot MTA (Dentsply/Tulsa Dental, Tulsa, OK).

METHODS

Thirty extracted human teeth were taken to obtain fine dentin powder. The methodology used to obtain dentin powder for the present study was same as performed by Haapsalo et al. The specimens were divided into two groups. The samples were placed in standardized stainless steel ring moulds. The setting time of MTA alone and in equal proportions with dentin powder as an additive was evaluated using Vicats apparatus.

RESULTS

MTA mixed with dentin powder showed faster setting time (70 minutes) in comparison to MTA without dentin powder (120 minutes) (P<0.5).

CONCLUSION

Although MTA is an ideal retrograde material with increased efficacy due to reduced setting on addition of dentin powder. A combination of MTA with dentin powder might be a viable option in procedures where fast setting of the MTA is critical.

Profile of lung cancer in predominantly Bidi smoking rural population of northern Himachal Pradesh

BACKGROUND

Lung cancer is a leading cause of morbidity and mortality among both genders. The histopathological patterns of lung cancer in different parts of India appear to be variable.

OBJECTIVE

To study the profile of lung cancer in northern Himachal Pradesh.

METHODS

Patients of all age groups and either gender with history and complaints suggestive of lung cancer were subjected to further investigations to study the histopathological types of lung cancer over a period of 14 months.

RESULTS

Out of 105 histopathologically confirmed patients with lung cancer (mean age 62.7 +/- 11.6 years; 96 males), 89.5% were "ever smokers" and 82.9% were "current smokers"; 92% of current smokers were bidi smokers. Most common presenting complaints were chest pain (46.7%) and cough (35.2%). Mean duration of longest presenting complaint was 64 days. The histopathological types included squamous cell carcinoma (37.1%), adenocarcinoma (36.2%), small cell carcinoma (8.6%), un-classifiable (16.2%), and other types (1.9%).

CONCLUSIONS

Majority of the lung cancer patients in northern Himachal Pradesh were bidi smoking males from rural areas and the incidence of adenocarcinoma and squamous cell carcinoma is almost equal.