Nanostructured Lipid Carriers of Donepezil Hydrochloride for the Treatment of Alzheimer's Disease

BACKGROUND

Alzheimer's Disease (AD) is a long-term brain disorder that worsens over time. A cholinesterase inhibitor called Donepezil HCl (DNZ) is used to treat and control AD. Due to its failure to reach the appropriate concentration in the brain cells, its efficacy upon oral administration is limited, and thus investigation of alternative administration route is necessary.

OBJECTIVE

The objective of this study was to develop donepezil HCl-loaded Nanostructured Lipid Carriers (NLCs) that can bypass the blood-brain barrier and thus be directly delivered to the brain through the nasal route. This method improves availability at the site of action, reduces the negative effects of oral medication, and ensures an expedited commencement of action.

METHOD

High-pressure homogenization and ultrasonication were used to formulate NLCs. Glyceryl Monostearate (GMS) as a solid lipid, Tween 80 as a surfactant, and Poloxamer 407 as a co-- surfactant were used. In this study, argan oil was employed as a liquid lipid as well as a penetration enhancer.

RESULTS

The chosen NLCs displayed a particle size of 137.34 ± 0.79 nm, a PDI of 0.365 ± 0.03, and a zeta potential of -10.4 mV. The selected formulation showed an entrapment efficiency of 84.05 ± 1.30% and a drug content of 77.02 ± 0.23%. The concentration of the drug in the brain after intravenous and intranasal administration of DNZ NLCs at 1 h was found to be 0.490 ± 0.007 and 4.287 ± 0.115, respectively. Thus, the concentration of DNZ achieved in the brain after intranasal administration of DNZ NLCs was approximately 9 times more than the concentration when administered by intravenous route.

CONCLUSION

The DNZ-loaded NLCs, when administered via nasal route, showed markedly improved drug availability in the brain, suggesting an efficient drug delivery strategy to treat Alzheimer's disease.

Comparative assessment of immunogenicity of recombinant insulin Aspart from BioGenomics and its originator NovoRapid® in adult patients with type 2 diabetes mellitus

OBJECTIVES

To assess and compare the immunogenicity of recombinant Insulin Aspart [manufactured by BioGenomics Limited (BGL-ASP)] with its originator NovoRapid® (manufactured by Novo Nordisk) in adult patients with type 2 diabetes mellitus.

RESEARCH DESIGN AND METHODS

BGL-IA-CTP301 study was a randomized, open label, parallel group, multicenter phase-III clinical study to compare the efficacy and safety of recombinant Insulin Aspart 100 U/mL [manufactured by BioGenomics Limited (BGL-ASP)] with its reference medicinal product (RMP); NovoRapid® [manufactured by Novo Nordisk], in adult patients with Type 2 diabetes mellitus (T2DM). The primary objective of the study was to compare the immunogenicity of BGL-ASP and RMP; NovoRapid® in patient serum samples collected from phase-III clinical study. Immunogenicity was studied as the incidence of patients positive for anti-insulin Aspart (AIA) antibodies, developed against BGL-ASP/RMP at baseline, end of 12 week and end of 24 week of the treatment period. The changes in incidence of patients positive for AIA antibodies post-baseline were also studied to assess and compare the treatment-emergent antibody response (TEAR) between the treatment groups (BGL-ASP and RMP). Statistical evaluation was done by Fisher's exact test to compare the overall incidence of patients positive for AIA antibodies and the TEAR positives observed post-baseline in both the treated groups. An in-vitro neutralizing antibody assay (Nab assay) was also performed to study the effect of AIA antibodies in neutralizing the biological activity/metabolic function of the insulin. The neutralizing potential of AIA was studied by its effect on %glucose uptake. We also evaluated the association between AIA antibody levels and its impact on biological activity by studying the correlation between them.

RESULTS

Analysis of immunogenicity data suggested that the percentage of patients positive for AIA antibodies until week 24 was similar and comparable in both the treatment groups, BGL-ASP and RMP; NovoRapid®. The changes in incidence of patients positive for AIA post-baseline in terms of TEAR positives were also similar and comparable between the treatment groups. The results of the Nab assay with confirmed positive AIA samples from BGL-ASP- and RMP-treated groups did not have any negative impact on %glucose uptake by the cells in Nab assay, confirming the absence of neutralizing antibodies in both the treatment groups. The correlation studies also showed absence of association between AIA antibody levels and percentage glucose uptake in both BGL-ASP and RMP-NovoRapid® treatment groups. CONCLUSIONS: The immunogenicity assessment based on the overall incidence of patients positive for AIA, changes in incidence of patients positive for AIA post-baseline, TEAR rates and absence of neutralizing antibodies, were found to be apparently similar and comparable in both the treatment groups (BGL-ASP and RMP). We conclude from our studies that the immunogenicity of BGL-ASP is similar and comparable to RMP and the observed immunogenicity in terms of anti-insulin Aspart antibody levels had no impact on the biological activity of insulin.

Resin Composite Versus Amalgam Restorations Placed in United States Dental Schools

OBJECTIVES

To investigate the latest teaching policies for posterior resin composite placement versus amalgam and to determine the actual numbers of posterior resin composites versus amalgam restorations placed in American dental schools from 2008 to 2018.

METHODS

Emails were sent to the deans of all 66 dental schools in the United States to collect data in the forms of: 1) Questionnaire on current teaching policies of posterior composite and amalgam restorations; and 2) Data entry form to collect the actual numbers of posterior composite and amalgam restorations placed in their clinics. Descriptive statistics were used to summarize ratios of posterior restorations. Inferential analysis (chi-square test and z-test) was employed to compare posterior restoration proportions over time and within each year. Level of significance was set at 0.05.

RESULTS

For the teaching questionnaire, the response rate was 52% (n=34). Seventy-six per cent of the responding schools reported that they assign 50% or more of their preclinical restorative teaching time towards posterior resin composite placement, while 50% of the responding schools devoted 25% or less towards amalgam teaching. Data entry response rate was 26% (n=17). In 2008, amalgam and resin composite restorations were placed almost equally. However, resin composite restorations were placed significantly more frequently from 2009 onwards in all responding schools. The results revealed a significant ongoing increasing trend in placing posterior resin composites in all responding schools over time (p<0.05).

CONCLUSIONS

Data analysis revealed a clear trend towards an increase in posterior resin composite restoration placement and a decrease in the number of amalgam restorations. However, the time assigned for posterior resin composite teaching is not aligned with quantity of restorations placed. Review and adjustment of the time allocated for teaching and training of each material are suggested.

P-153 COMPARING MESH RELATED SENSATION IN PATIENTS UNDERGOING AWR USING SYNTHETIC VERSUS BIOSYNTHETIC MESH USING STANDARDIZED PROMS

Aim

To compare QualityOfLife (QoL) outcomes amongst patients undergoing elective Open abdominal wall reconstruction (AWR) with Synthetic Mesh versus Biosynthetic mesh, using Carolinas Comfort scale and EuraHS QOL questionnaires.

Material and Methods

This is a retrospective study with longitudinal prospective extension for serial administration of questionnaires at specific intervals, focusing on patients having undergone AWR within last 4 years by a two-operator team of same AWR surgeon and Plastic surgeon. 4 groups of patients compared based on less than / more than six months from time of surgery using either biosynthetic or synthetic mesh.

The rationale behind it is based on characteristics of the biosynthetic mesh data showing complete disappearance by 6 months time and replacement by a scaffolding tissue as a ingrown matrix and collagen. Decision of type of mesh was governed by patient characteristics.

Results

15 patients in each group (total 60 patients) included by consecutive retrospective enrollment. We excluded those who had further abdominal surgery since. Preliminary data showing reduced mesh related sensation in favour of patients with biosynthetic mesh repair more than six months ago. Since few of those patients have still not completed their six months post operative period yet, formal statistics are not included in abstract. They shall be available in time for EHS meeting, analysed to recognise differences if any regarding mesh related questions using variance, correlation and descriptive statistics.

Conclusions

This outcomes will provide a review of current surgical practises and meshes, helping surgeons & patients make better informed decisions.

246 A Case Report on Bilateral Spontaneous Carotico-Cavernous Fistula with Literature Review

Background

CCF is an abnormal vascular communication that allows blood to either directly or indirectly flow from the carotid arteries to the cavernous sinus. We present a rare case of spontaneous bilateral direct CCF. Coil embolization is a very effective treatment for CCF.

Case report

86-year-old lady presented in ED with two weeks history of progressive painful, swollen right eye & drooping of eyelid with double vison in left eye. Patient also had a history of intermittent headache and had pulsatile tinnitus in right ear. There was no history of head or eye trauma. On examination, the lady had proptosis, chemosis and restricted movement in right eye, 3rd nerve palsy in left eye. Corrected vision +0.3 in right eye, +0.1 in left eye. Pupils were bilaterally sluggish, there was no relative afferent pupillary defect.

CTA showed bilateral direct CCF along with dilated superior ophthalmic veins on both sides (L&gt;R). No other associated or underlying pathologies were seen.

She was started on oral Acetazolamide, Travoprost and Brimonidine topically. Patient was urgently referred to neurosurgery department and Coil embolization of her CCF was done successfully the following day.

Eye casualty review was done day after her coil embolization. IOP pressure was decreased to normal limits -12 RE and 8 LE. Although her VA was slightly down compared to her preoperative visit, her other symptoms were improving.

Six months later her vision has returned to normal.

Conclusions

Bilateral spontaneous CCF is a rare entity.

Early diagnosis and treatment lead to successful outcomes.

Neuro-radiological intervention is an effective treatment in acute setting.

Antidepressant effects of ketamine and ECT: A pilot comparison

BACKGROUND

To compare the antidepressant effects and cognitive adverse effects of intravenous ketamine infusion and Electro-convulsive therapy (ECT) in persons with severe depressive episodes.

METHODS

This assessor-blinded randomized control trial included 25 patients (either sex; 18-65 years) meeting ICD-10 criteria for severe depression (bipolar or unipolar). Patients received either ECT (n = 13) or intravenous infusions of ketamine hydrochloride (0.5 mg/kg over 45 min; n = 12) for six alternate day sessions over a period of two weeks. Severity of depression was assessed at baseline and on every alternate day of intervention using the Hamilton Depression Rating Scale (HDRS) and self-reported Beck Depression Inventory (BDI).

RESULTS

Baseline socio-demographic and clinical variables including HDRS (ECT: 25.15±6.58; Ketamine: 23.33±4.05, p = 0.418) and BDI (ECT: 37.07±6.58; Ketamine: 33.33±9.29; p = 0.254) were comparable. Repeated-measures analysis of variance revealed that ECT patients showed significantly greater reduction in HDRS (group*time interaction effect; F = 4.79; p<0.001) and BDI scores (group*time interaction effect; F = 3.83; p<0.01). ECT patients had higher response rate than ketamine patients [HDRS: ECT- 13/13(100%) vs ketamine- 8/12 (66.70%); p = 0.04]. This was true for remission as well [ECT- 12/13(92.30%) vs ketamine- 6/12(50%), p = 0.030; both HDRS and BDI]. Performance on Digit Symbol Substitution Test (as part of the Battery for ECT-Related Cognitive Deficits scale) significantly improved in ketamine patients (p = 0.02) while that in ECT patients worsened non significantly (p = 0.30).

LIMITATIONS

Relatively small sample size; higher proportion of dropouts in the Ketamine arm.

CONCLUSION

This study favoured ECT over ketamine for a better efficacy over six treatment sessions in severe depression. The results need to be replicated in larger studies.

TRIAL REGISTRATION

CTRI/2019/09/021184.

Vital Autotransplantation and Orthodontic Treatment of Ectopic Maxillary Canines

The purpose of this article was to present the case of a 13-year-old patient with impacted, ectopic, permanent maxillary canines that were repositioned into their natural positions via autotransplantation without endodontic treatment and aligned into ideal occlusion via orthodontic treatment. The autotransplanted canines demonstrated normal masticatory function, physiologic mobility, and long-term tooth vitality. Clinical considerations, clinical procedures, and the rationale behind this alternative approach in managing this common growth and developmental dental anomaly are also discussed.

Conservative Management of Fused and Geminated Permanent Anterior Teeth

The purpose of this case report is to present an eight-year-old patient with a permanent right central incisor that was fused with a supernumerary tooth as well as a geminated permanent left central incisor, and to describe the surgical-orthodontic-restorative management of the resultant malocclusion in the developing dentition. The fused teeth were split, mesiodistal widths of both central incisors were reduced, and the incisors were orthodontically aligned into an ideal occlusion. Both maxillary central incisors maintained vitality and normal masticatory function. We also discuss the physiological basis of the treatment plan, the clinical considerations, and how problems associated with double teeth can be managed conservatively with minimally invasive treatments for an esthetically pleasing result. (J Dent Child 2019;86(3):164-8).

The Prostate Cancer Rehabilitation Clinic: a biopsychosocial clinic for sexual dysfunction after radical prostatectomy

Purpose

The most prevalent intervention for localized prostate cancer (pca) is radical prostatectomy (rp), which has a 10-year relative survival rate of more than 90%. The improved survival rate has led to a focus on reducing the burden of treatment-related morbidity and improving the patient and partner survivorship experience. Post-rp sexual dysfunction (sdf) has received significant attention, given its substantial effect on patient and partner health-related quality of life. Accordingly, there is a need for sdf treatment to be a fundamental component of pca survivorship programming.

Methods

Most research about the treatment of post-rp sdf involves biomedical interventions for erectile dysfunction (ed). Although findings support the effectiveness of pro-erectile agents and devices, most patients discontinue use of such aids within 1 year after their rp. Because side effects of pro-erectile treatment have proved to be inadequate in explaining the gap between efficacy and ongoing use, current research focuses on a biopsychosocial perspective of ed. Unfortunately, there is a dearth of literature describing the components of a biopsychosocial program designed for the post-rp population and their partners.

Results

In this paper, we detail the development of the Prostate Cancer Rehabilitation Clinic (pcrc), which emphasizes multidisciplinary intervention teams, active participation by the partner, and a broad-spectrum medical, psychological, and interpersonal approach.

Conclusions

The goal of the pcrc is to help patients and their partners achieve optimal sexual health and couple intimacy after rp, and to help design cost-effective and beneficial rehabilitation programs.

Electron Acceptors Based on Cyclopentannulated Tetracenes

New cyclopenta-fused polycyclic aromatic hydrocarbons (CP-PAHs) based on tetracene have been prepared by a palladium-catalyzed cyclopentannulation reaction. The new compounds have low-energy lowest unoccupied molecular orbitals (LUMOs) and relatively small band gaps. The photooxidative stability was intermediate to previously prepared CP-PAHs based on anthracene and pentacene as found in traditional acene stabilities. Scholl cyclodehydrogenation of pendant aryl groups led to materials that quickly formed endoperoxide products.

Hopanoids play a role in stress tolerance and nutrient storage in the cyanobacterium Nostoc punctiforme

Hopanes are abundant in ancient sedimentary rocks at discrete intervals in Earth history, yet interpreting their significance in the geologic record is complicated by our incomplete knowledge of what their progenitors, hopanoids, do in modern cells. To date, few studies have addressed the breadth of diversity of physiological functions of these lipids and whether those functions are conserved across the hopanoid-producing bacterial phyla. Here, we generated mutants in the filamentous cyanobacterium, Nostoc punctiforme, that are unable to make all hopanoids (shc) or 2-methylhopanoids (hpnP). While the absence of hopanoids impedes growth of vegetative cells at high temperature, the shc mutant grows faster at low temperature. This finding is consistent with hopanoids acting as membrane rigidifiers, a function shared by other hopanoid-producing phyla. Apart from impacting fitness under temperature stress, hopanoids are dispensable for vegetative cells under other stress conditions. However, hopanoids are required for stress tolerance in akinetes, a resting survival cell type. While 2-methylated hopanoids do not appear to contribute to any stress phenotype, total hopanoids and to a lesser extent 2-methylhopanoids were found to promote the formation of cyanophycin granules in akinetes. Finally, although hopanoids support symbiotic interactions between Alphaproteobacteria and plants, they do not appear to facilitate symbiosis between N. punctiforme and the hornwort Anthoceros punctatus. Collectively, these findings support interpreting hopanes as general environmental stress biomarkers. If hopanoid-mediated enhancement of nitrogen-rich storage products turns out to be a conserved phenomenon in other organisms, a better understanding of this relationship may help us parse the enrichment of 2-methylhopanes in the rock record during episodes of disrupted nutrient cycling.

Clinical Performance of Pedo Jacket Crowns in Maxillary Anterior Primary Teeth

PURPOSES

To assess the clinical performance of Pedo Jacket crowns for restoration of carious primary anterior teeth.

METHODS

A total of 129 carious primary incisors and canines of 48 children younger than 71 months of age- were restored with Pedo Jacket crowns and resin-modified glass ionomer cementation. They were assessed for: ease of use; presence of recurrent decay; wear; partial or complete loss of the crown; color stability; gingival health; and overall clinical success over a 12-month follow-up. The patient's behavior at the restorative appointment during crown placement was also assessed.

RESULTS

An overall clinical success of 89.5 percent of the teeth in 87.3 percent of the children was seen one year later. The crowns were easy to use, even in uncooperative children. The color stability, wear, plaque accumulation, and gingival health were acceptable. Discoloration, wear, or complete loss of the crown were found in 13.1 percent, 5.4 percent, and 7.6 percent of children, respectively. Although not statistically significant, failures were associated with poor patient cooperation at the time of crown placement, poor oral hygiene, or operator error.

CONCLUSION

Pedo Jacket crowns are a viable treatment alternative for carious maxillary primary anterior teeth.

Vital Autotransplantation and Orthodontic Treatment of a Transmigrant Mandibular Canine

The purpose of this study was to present the case of a 14-year-old patient with an apically closed, transmigrated permanent canine that was autotransplanted into its natural position without endodontic treatment and orthodontically aligned into ideal occlusion. The transplanted canine maintained long-term tooth vitality, physiologic mobility, and normal masticatory function. Also discussed are the clinical considerations and rationale behind this treatment, the clinical procedure, and factors for successully implementing this alternative approach in managing this relatively common developmental dental anomaly.

Quantitative hopanoid analysis enables robust pattern detection and comparison between laboratories

Hopanoids are steroid-like lipids from the isoprenoid family that are produced primarily by bacteria. Hopanes, molecular fossils of hopanoids, offer the potential to provide insight into environmental transitions on the early Earth, if their sources and biological functions can be constrained. Semiquantitative methods for mass spectrometric analysis of hopanoids from cultures and environmental samples have been developed in the last two decades. However, the structural diversity of hopanoids, and possible variability in their ionization efficiencies on different instruments, have thus far precluded robust quantification and hindered comparison of results between laboratories. These ionization inconsistencies give rise to the need to calibrate individual instruments with purified hopanoids to reliably quantify hopanoids. Here, we present new approaches to obtain both purified and synthetic quantification standards. We optimized 2-methylhopanoid production in Rhodopseudomonas palustris TIE-1 and purified 2Me-diplopterol, 2Me-bacteriohopanetetrol (2Me-BHT), and their unmethylated species (diplopterol and BHT). We found that 2-methylation decreases the signal intensity of diplopterol between 2 and 34% depending on the instrument used to detect it, but decreases the BHT signal less than 5%. In addition, 2Me-diplopterol produces 10× higher ion counts than equivalent quantities of 2Me-BHT. Similar deviations were also observed using a flame ionization detector for signal quantification in GC. In LC-MS, however, 2Me-BHT produces 11× higher ion counts than 2Me-diplopterol but only 1.2× higher ion counts than the sterol standard pregnane acetate. To further improve quantification, we synthesized tetradeuterated (D4) diplopterol, a precursor for a variety of hopanoids. LC-MS analysis on a mixture of (D4)-diplopterol and phospholipids showed that under the influence of co-eluted phospholipids, the D4-diplopterol internal standard quantifies diplopterol more accurately than external diplopterol standards. These new quantitative approaches permit meaningful comparisons between studies, allowing more accurate hopanoid pattern detection in both laboratory and environmental samples.

Evaluation of normal abdominal aortic diameters in the Indian population using computed tomography

OBJECTIVES

The aim of this study was to establish normal diameters for the suprarenal and infrarenal abdominal aorta measured at T12 and L3 vertebral levels in the Indian population and to study the variation in aortic diameters with age, sex, height, weight, body mass index (BMI), and body surface area (BSA).

MATERIALS AND METHODS

One hundred and forty-two patients who underwent helical contrast-enhanced computed tomography (CT) scans of the abdomen for non-cardiovascular reasons were recruited.. The mean internal diameters of the suprarenal and infrarenal abdominal aorta (maximum anteroposterior and transverse diameter) were measured at T12 and L3 vertebral levels and tabulated according to various age groups for both men and women. Pearson correlation coefficient was used to evaluate the correlation between aortic diameters, height, weight, BSA, and BMI.

RESULTS

The mean diameters of the suprarenal and infrarenal abdominal aorta measured at T12 and L3 vertebral levels, in men were 19.0 ± 2.3 and 13.8 ± 1.9 mm and in women 17.1 ± 2.3 and 12.0 ± 1.6 mm, respectively. The aortic diameter progressively increased in caliber with increasing age of the patients and was smaller in women than men. A significant positive correlation was found in men between the suprarenal and infrarenal aortic diameters and weight, BSA, and BMI. In women, this correlation was significant in the infrarenal aorta but not in the suprarenal aorta.

CONCLUSION

We obtained a set of normal values for the abdominal aorta in the Indian population. The aortic diameters correlated with age, gender, and body size of the patients as seen with previously published data in the Western population. A brief comparison of data between Indian and Western population showed that the values obtained were less than published elsewhere and hence, this should be considered while formulating intervention protocols.

Olanzapine induced de-novo obsessive compulsive disorder in a patient with schizophrenia

There are reports of de novo development or exacerbation of obsessive-compulsive symptoms in patients with schizophrenia treated with atypical antipsychotics, although this is widely debated. We report one such case where a patient with a primary diagnosis of schizophrenia, treated with olanzapine, developed de novo obsessive-compulsive disorder, with convincing evidence for its causality due to the drug.

Gingival microleakage of class V composite restorations with fiber inserts

AIM

This study investigated the effect of different fiber inserts (glass and polyethylene), bonding agents, and resin composites on the gingival margin microleakage of class V composite restorations.

MATERIALS AND METHODS

Sixty premolars were sterilized and mounted in acrylic resin bases. Class V cavities were prepared buccally and lingually, 1 mm below the cementoenamel junction, comprising 12 groups (n = 10). In the experimental groups fiber inserts were cut and placed at the gingival seat, while the control groups had no inserts. Combinations of two composite materials, Filtek-Z250 and Filtek-LS (3M-ESPE), and four bonding agents, Clearfil SE bond (Kuraray) (C), Scotch Bond Multipurpose (3M-ESPE) (SB), Prime and Bond NT (Dentsply) (PB), and Filtek-LS (3M-ESPE) (LS) were used. Restorations were incrementally inserted and polymerized for 40s. Specimens were then stored in distilled water for 7 days and thermocycled for 500 cycles. Teeth surfaces were sealed with nail polish except for 1 mm around restoration margins and immersed in 2% red procion dye. Teeth were then sectioned buccolingually and dye penetration was assessed with five-point scale. Data were statistically-analyzed by Kruskal-Wallis, ANOVA and Tukey's tests (α = 5%).

RESULTS

Mean microleakage scores varied from 0.40 (Groups C, C with polyethylene, LS, LS with polyethylene) to 1.50 (SB).

CONCLUSION

Different bonding agents led to differences in microleakage scores where C and LS showed significantly lower microleakage than PB. SB had highest mean microleakage score, however, incorporation of fibers resulted in significant reduction in microleakage.

CLINICAL SIGNIFICANCE

Class V resin composite restorations bonded with a total-etch adhesive had a significant reduction in mean microleakage scores when glass or polyethylene fibers were placed at the gingival cavo-surface margin. In contrast, for two self-etch adhesive systems, the incorporation of fibers had no significant effect on mean microleakage scores.

Should follow-up biopsies for men on active surveillance for prostate cancer be restricted to limited templates?

OBJECTIVE

To investigate if prostate biopsy templates with fewer cores can be used during active surveillance (AS) for prostate cancer.

METHODS

At present, we use an AS protocol template (ASPT) consisting of 13-17 cores. We hypothesize in the setting of known cancer, sextant (6 cores) or standard extended (10-12 cores) templates, could be used with similar effect. We identified patients in our referral institution database (1997-2009) with entry prostate-specific antigen <10 ng/mL, stage ≤cT2, Gleason sum ≤6, ≤3 cores positive for cancer, <50% of single core involved, and age ≤75 years (N = 272). Patients fulfilling standard criteria for pathologic reclassification (N = 94) at any follow-up biopsy were selected for evaluation. By mapping tumor location on the pathologic reclassification determining biopsy, hypothetical scenarios of sextant or standard extended templates (SET) were compared with our ASPT and examined for frequency of cancer detection and pathologic reclassification.

RESULTS

For the 94 patients analyzed, the median number of cores taken was 9.7 (6-22) at baseline and 15 (14-17) for the reclassification biopsy. The median time between baseline and the pathologic reclassification determining biopsy was 15.4 months. Analysis of subgroupings showed that sextant template would identify 84% of cancers and 47.9% of the reclassification events, whereas SET detected 99% of cancers and 81.9% of patients who pathologically reclassified. When only considering Gleason sum ≥7 related progression events, SET found 16.2% less (n = 57) compared with ASPT (n = 68).

CONCLUSION

When monitoring patients on AS, a 13-17 core template detects more pathologic reclassification than standard sextant (18.1%) or extended (52.1%) biopsy templates.

Synthesis of graphene films by rapid heating and quenching at ambient pressures and their electrochemical characterization

We study the process of graphene growth on Cu and Ni substrates subjected to rapid heating (approximately 8 °C/s) and cooling cycles (approximately 10 °C/s) in a modified atmospheric pressure chemical vapor deposition furnace. Electron microscopy followed by Raman spectroscopy demonstrated successful synthesis of large-area few-layer graphene (FLG) films on both Cu and Ni substrates. The overall synthesis time was less than 30 min. Further, the as-synthesized films were directly utilized as anode material and their electrochemical behavior was studied in a lithium half-cell configuration. FLG on Cu (Cu-G) showed reduced lithium-intercalation capacity when compared with SLG, BLG and Bare-Cu suggesting its substrate protective nature (barrier to Li-ions). Although graphene films on Ni (Ni-G) showed better Li-cycling ability similar to that of other carbons suggesting that the presence of graphene edge planes (typical of Ni-G) is important in effective uptake and release of Li-ions in these materials.

Fixed orthodontic appliances in the management of severe dental trauma in mixed dentition: a case report

We describe a case of complex trauma to the early mixed dentition in which tooth avulsion, intrusion, extrusion and lateral luxation were managed effectively using a fixed, non-rigid orthodontic splint after treatment with a traditional wire-composite splint had failed. The use of orthodontic brackets and flexible wires provided several advantages, such as the ability to splint severely malpositioned teeth; easy assessment without removing the splint; slow, gentle repositioning of traumatized teeth; and gradual reestablishment of the arch form allowing for ease of future prosthodontic rehabilitation. Therefore, orthodontic appliances should be considered as a viable option for managing complex dental trauma.

An in vitro comparison of short and long term shear bond strengths of polyacid modified composite resins to primary human and bovine enamel and dentine

AIM

This in vitro study compared the shear bond strengths and fracture patterns over 7 and 180 day periods of two PMCRs bonded to both human and bovine primary tooth enamel and dentine to determine if the bovine tooth model is a suitable substitute for the human tooth model.

METHODS

Flattened enamel and dentine surfaces were produced using water irrigated #600 grit SiC paper and the teeth randomly placed in groups of N=10. Cylinders of Dyrat AP (Dentsply/DeTrey) or F2000 (3M/ESPE) were bonded to the surfaces that were either etched with 37% H(3)PO(4) (etch, E groups) or treated with their respective conditioners, primers and adhesives (no etch, NE groups). The teeth were stored in distilled water at 37(o)C and shear bond strength (SBS) tested to failure at either 7 (human and bovine) or 180 days (bovine). The modes of failure were assessed under a dissecting microscope at x30.

RESULTS

In general the results showed comparable mean SBS for both human and bovine enamel with Dyract AP, E and NE and also for F2000, E. Lower enamel SBS were recorded for F2000 NE but there was no significant differences in mean SBS for bovine enamel after long term storage. For dentine, significantly larger SBS were recorded for human versus bovine teeth for all of the four bonding protocols. There were also significant species differences, the mean SBS for Dyract AP, E and F2000, E for human dentine were higher than bovine but the mean SBS for the respective NE groups showed no significant differences between species. It was concluded that 37% H(3)PO(4) has a detrimental effect on SBS for bovine dentine. Over long term storage SBS of bovine dentine bonds decreased. The modes of failure were related to SBS with varying degrees of significance.

CONCLUSION

Bovine primary incisor enamel and dentine, provided the latter is not conditioned with 37% H(3)PO(4), are suitable alternative test SBS substrates for human enamel and dentine.

Molecular phylogenetic study of Culex quinquefasciatus mosquito from different geographical regions of India using 16S rRNA gene sequences

Culex quinquefasciatus is a major vector of filariasis and various encephalitis in India and worldwide. Vector control remains the most successful strategy for the suppression of mosquito borne diseases. The genetic structure of vector populations in terms of insecticide resistance and susceptibility or refractoriness to infection may possibly vary. To exploit the genetic variability in vector population could pave the path for the alternative strategies in vector management. The sequences of ribosomal RNA molecules have been widely used for such studies. Here, we examined the molecular phylogenetic relationship among the Cx. quinquefasciatus collected from different geographical regions of India, using 16S ribosomal RNA (16S rRNA) gene nucleotide sequences. The distances among the species were measured using Pearson correlation; the Neighbor-Joining (NJ) method was used for the clustering with appropriate bootstrap values using Data Analysis in Molecular Biology and Evolution (DAMBE) software. The results revealed that the populations are genetically diverse. Based on the distance values and the tree topology on the basis of 16S rRNA sequences reflected the clear biogeographical and geoclimatic pattern among the different geographical populations from India.

Giant Axonal Neuropathy: A Pictorial Essay and Review of Literature

Giant axonal neuropathy (GAN) is a neurodegenerative disorder classified within the hereditary motor and sensory neuropathies, affecting both the peripheral and central nervous systems. GAN typically presents in early childhood before the age of five years and progresses to death usually by early adulthood. Various imaging findings in giant axonal neuropathy have been described and documented in literature in the form multiple case reports. We here present a pictorial essay of all the major imaging GAN findings described in the literature. In addition, involvement of the dentate nucleus hitherto not described in the literature was noted in the present case.

Development and testing of fiber-reinforced composite space maintainers

PURPOSE

The purpose of this study was to develop a clinically acceptable, cheaper, and more expedient alternative to standard stainless steel band and loop space maintainers.

METHODS

Loops of fiber-reinforced composites were constructed using polyethylene fiber (Ribbond) and glass fiber (Sticktech). The loops were bonded on extracted third molars and tested for flexural strength before and after thermocycling and following repair of the appliances after initial stress failure. Bacterial colonization on the appliances was also compared. Conventional stainless steel band and loop space maintainers cemented with Ketac were controls.

RESULTS

Ribbond samples demonstrated higher flexural strength than Sticktech and the control (P<.05). No differences were noted among the other samples and the control. The repaired Ribbond samples were statistically comparable in flexural strength to the initial samples. Thermocycling resulted in decreased flexural strength of both Ribbond and Sticktech (P<.05). Thermocycled Ribbond samples were comparable to the control, but a lower flexural strength was noted for Sticktech samples (P<.05). While all space maintainers allowed some bacterial adhesion, Sticktech showed higher Streptococcus mutans counts than Ribbond (P=.06).

CONCLUSIONS

Ribbond space-maintainers are comparable to the stainless steel in terms of physical strength and biofilm formation. The fiber-reinforced composite space maintainers may be a clinically acceptable and expedient alternative to the conventional band-loop appliance.

Cervical intra-/extramedullary solitary fibrous tumour

A 53-year-old man presented with a 9-month history of symptoms of right-sided weakness, tingling and hypersentivity to clothes on both sides of the body. MRI revealed a large intraspinal intradural tumour at the level of C3-C4 in the cervical cord. The final histology was a solitary fibrous tumour (SFT) of the cervical spinal cord. The radiological diagnosis, surgical management and histology are reviewed.

Lack of oral care policies in Toronto daycares

OBJECTIVES

Currently, there is a deficit of information on policies regarding oral hygiene practices in Toronto daycares. It is unknown if any tooth-brushing programs are in existence and if children are permitted to follow professional advice on oral hygiene. The main objectives of this investigation were to a) determine the prevalence of oral care policies in daycares and b) examine the availability of resources.

METHODS

Telephone interviews were conducted with daycare supervisors using a pretested questionnaire. Summary statistics and the chi-square test were used to analyze the results.

RESULTS

Two hundred forty-nine questionnaires were completed (response rate of 99.6 percent), representing 38 percent of the total daycare population (650) in Toronto. Eighty-three percent did not have a policy on oral care and 11 percent would not cede to requests from parents or medical professionals to brush teeth. However, 50 daycares indicated that their centers used to have a tooth-brushing program, and most (79 percent) were open to establishing an oral care policy. Fifteen percent reported not having proper sinks for tooth brushing.

CONCLUSIONS

Many daycares do not have a policy regarding oral hygiene. A policy that encourages and provides guidance on safe tooth-brushing procedures is needed and may improve the oral health of preschool children.

Detection of interproximal demineralized lesions on human teeth in vitro using frequency-domain infrared photothermal radiometry and modulated luminescence

Frequency-domain photothermal radiometry (FD-PTR or PTR) is used to detect mechanical holes and demineralized enamel in the interproximal contact area of extracted human teeth. Thirty-four teeth are used in a series of experiments. Preliminary tests to detect mechanical holes created by dental burs and 37% phosphoric acid etching for 20 s on the interproximal contact points show distinct differences in the signal. Interproximal contact areas are demineralized by using a partially saturated acidic buffer system. Each sample pair is examined with PTR before and after micromachining or treating at sequential treatment periods spanning 6 h to 30 days. Dental bitewing radiographs showed no sign of demineralized lesion even for samples treated for 30 days. Microcomputer tomography (micro-CT), transverse microradiography (TMR), and scanning electron microscopy (SEM) analyses are performed. Although micro-CT and TMR measured mineral losses and lesion depths, only SEM surface images showed visible signs of treatment because of the minimal extent of the demineralization. However, the PTR amplitude increased by more than 300% after 80 h of treatment. Therefore, PTR is shown to have sufficient contrast for the detection of very early interproximal demineralized lesions. The technique further exhibits excellent signal reproducibility and consistent signal changes in the presence of interproximal demineralized lesions, attributes that could lead to PTR as a reliable probe to detect early interproximal demineralization lesions. Modulated luminescence is also measured simultaneously, but it shows a lower ability than PTR to detect these interproximal demineralized lesions.

Prevalence of oral diseases in Shwachman-Diamond syndrome

The aim of this study was to determine the prevalence and severity of oral diseases in patients with ShwachmanDiamond syndrome (SDS). Thirty-five persons with SDS were compared to 20 healthy controls. A cross-sectional survey was carried out using self-reporting questionnaires and dental radiographs collected from the subjects and their dentists. Overall, oral diseases were more prevalent among subjects with SDS when compared to controls (p < 0.001). Persons with SDS also had more caries in both primary (p < 0.03) and permanent dentitions (p < 0.01), and also had delayed dental development (p < 0.04). Oral soft tissue pathoses, such as recurrent oral ulcerations (p < 0.00) and gingival bleeding upon brushing (p < 0.00), were significantly more prevalent in subjects with SDS. Pain on eating was also more frequent amongst persons with SDS (p < 0.008) and was often associated with oral ulcerations (p < 0.002). In conclusion, based on self-completed subject and dentist questionnaires, diseases of oral hard and soft tissues were more prevalent and severe in persons with SDS when compared with healthy controls.

Short-Term Cytotoxicity Assessment of Components of the Epiphany Resin-Percha Obturating System by Indirect and Direct Contact Millipore Filter Assays

The Epiphany Resin-Percha Obturating System was assessed for cytotoxicity, compared with gutta-percha and AH-Plus sealer. Specimen disks (Resilon, gutta-percha), filled glass rings (sealers), or imbibed cellulose disks (primer, thinning resin) were placed over Millipore filters in direct or indirect contact with HeLa cell monolayer, incubated for 2 hours, and stained with tetrazolium blue. Cytotoxicity was rated by the surrounding unstained zone: none (0 mm), mild (</=7 mm), moderate (7-12 mm), or marked (>12 mm). Data were analyzed with one-way ANOVA and post hoc pairwise t tests. Unstained zones indicating moderate cytotoxicity were significantly larger (p < 0.05) for Epiphany primer than for thinning resin and for freshly mixed AH-Plus than for Epiphany sealer. Set sealers (24 and 48 hours), gutta-percha, and Resilon elicited noncytotoxic responses. In conclusion, cytotoxicity of set Epiphany sealer and Resilon was comparable with that of set AH-Plus and gutta-percha. Cytotoxicity of freshly mixed Epiphany sealer, primer, and thinning resin did not exceed that of freshly mixed AH-Plus.

eEF1A2 activates Akt and stimulates Akt-dependent actin remodeling, invasion and migration

eEF1A2 (eukaryotic protein elongation factor 1 alpha 2) is a protein translation factor that is likely a human oncogene by virtue of its capacity to transform mammalian cells and its high expression in tumors of the ovary, breast and lung. Here, we show that expression of eEF1A2 is sufficient to stimulate the formation of filopodia in BT549 human breast cancer cells and non-transformed Rat2 cells. Filopodia formation in eEF1A2-expressing cells is dependent on the activity of phosphatidylinositol-3 kinase (PI3K), and the ROCK and Akt kinases. Furthermore, eEF1A2 expression is sufficient to activate Akt in a PI3K-dependent fashion and inactivation of eEF1A2 by short interfering RNA reduces Akt activity. Using breast cancer cell line BT 549, we show that eEF1A2 expression stimulates cell migration and invasion in a largely PI3K- and Akt-dependent manner. These results suggest that eEF1A2 regulates oncogenesis through Akt and PI3K-dependent cytoskeletal remodeling.

An effective method for improving the fertility of glycerol-exposed poultry semen

Semen cryopreservation is necessary for banking germplasm from critical poultry stocks. To date, glycerol is the most effective cryoprotectant for poultry sperm; however, the contraceptive effects of glycerol require a significant reduction of the cryoprotectant from thawed semen before artificial insemination (AI). The effectiveness of glycerol reduction by dialysis, Percoll density gradient centrifugation, or washing through 12% (wt/vol) Accudenz was evaluated by fertility trials with highly inbred chicken research lines and commercial turkey lines. Semen was extended 1:1 and then diluted with glycerolized extender to yield a final 11% (vol/vol) glycerol concentration. Glycerolized rooster semen was aliquoted for control, Accudenz centrifugation, and dialysis treatments. A total of 90 pure line and 85 F1 hybrid chicken hens were each inseminated with 100 x 10(6) sperm at 7-d intervals for 4 to 6 wk. All eggs from the glycerolized control semen treatments were infertile, and fertility rates from dialyzed semen decreased steadily from 26.4 to 0% within the first 4 wk for the pure lines. In contrast, fertility rates for Accudenz-processed semen increased from 17.9 to 37.17% during the first 4 wk. Similar fertility rates occurred with the F1 hybrid cross lines. For turkey fertility trials, the dialysis treatment was not used; glycerolized turkey semen was processed by Accudenz or Percoll centrifugation to reduce glycerol. A total of 36 hens were inseminated with 150 x 10(6) sperm at 7-d intervals for 6 wk. Similar to the chicken trials, fertility rates of Accudenz-processed semen steadily increased to 49.4% by the sixth week of insemination. The average fertility of Percoll-processed semen was only 19.1%. These data demonstrate that Accudenz centrifugation is an acceptable glycerol reduction method for nonfrozen poultry semen.

Utility of Urichrom II - a chromogenic medium for uropathogens

PURPOSE

Chromogenic media are increasingly being used as versatile tools in early differentiation and identification of bacterial isolates from clinical specimens. We have evaluated the Urichrome II, a newly introduced chromogenic medium, for its utility as a primary isolation and identification medium for urinary microbial isolates.

MATERIALS

This study included 5497 consecutively collected midstream and/or catheter catch urine samples obtained from patients attending several clinical services. They were inoculated on blood, MacConkey, cystine lactose electrolyte deficient, and Urichrom II agar plates for isolation of uropathogens.

RESULTS

The Urichrom II medium allowed the growth, and primary identification, of the predominant uropathogens like E.coli, Klebsiella spp. and Enterobacter spp. (KES group). The different coloured colonies produced by the breakdown of the chromogenic substrates by the specific enzymes of the bacteria were very useful in the presumptive identification of these organisms even from mixed cultures by the colour differences of the colonies. The medium also supported growth and differentiation of gram positive organisms like Staphylococcus aureus and enterococci.

CONCLUSIONS

Urichrom II can be used as a primary culture medium for predominant uropathogens like E.coli, KES group and enterococci. It is an easy to use primary screening medium that considerably reduces the daily workload and thus minimizes or limits the use of identification tests.

Factors that affect the shear bond strength of multiple component and single bottle adhesives to dentin

PURPOSE

To examine the effects of thermocycling and the long-term integrity of the bonds between adhesive and resin composite to bovine dentin using multi-step and single bottle adhesive systems.

MATERIALS AND METHODS

Dentin bonding sites were prepared using water irrigated #600 grit SiC paper on bovine incisor crowns mounted in acrylic resin. A 4 mm diameter area of dentin was etched, rinsed, left visibly moist and adhesives applied according to the manufacturers' instructions. The adhesives were: Scotchbond Multipurpose, Single Bond, All Bond 2, One Step, and Prime & Bond 2.1. Cylinders of Z100 resin composite 4 mm in diameter were positioned over the adhesive and visible light-cured. Bonded specimens were divided into five groups each containing 12 samples and: (1) stored in water for 24 hours; (2) stored in water for 7 days; (3) stored in water for 270 days; (4) thermocycled after 24 hours and stored for a total lapsed time of 7 days; (5) stored in water for 6.5 days, and thermocycled for a total lapsed time of 7 days. All storage temperatures were 37 degrees C. All specimens were shear (SBS) tested to failure at the end of each storage period, the results converted to MPa and the mode of fracture failure recorded.

RESULTS

The SBS for all five adhesives deteriorated over time; the effects of thermocycling were shown to be variable and dependant upon the adhesive; the modes of fracture failure were shown to be adhesive/cohesive or mixed; after long-term (270 days) storage there was an increased tendency for adhesive/cohesive fracture failure.