Biomechanical analysis and comparison between 'Zeta' miniplate design and conventional miniplate system for fixation of fracture segments in transition zone of parasymphysis body region of mandible - an in vitro study.

The parasymphysis area of the mandible is highly dynamic because it is subjected to both occlusal and muscular forces. As a result, the fractures in this transition zone have a special pattern, posing a challenge for surgeons whether to use one miniplate versus two miniplates, as per Champy's recommendations. The commonest complication resulting to treat this area is mental nerve paraesthesia due to the dissection and stretching of the nerve. Hence, an in vitro research study of a newly designed 'Zeta' miniplate is performed, to evaluate the biomechanical behaviour using finite element (FE) analysis and biomechanical analysis along with a comparison study with the conventional miniplate configurations. The results showed that the Zeta miniplate produces the lowest stresses 17.511 MPa and the least total structural deformation of 0.0011 mm after applying the maximum occlusal bite force. On application of torsional load, total structural deformation was 0.0004 mm and von Mises (VM) stress value was 0.24 MPa which was lowest when compared with the two miniplate system. Hence, the newly developed Zeta miniplate is superior in terms of stability. Another benefit of its design is that it helps in preventing mental nerve paraesthesia and tooth root damage while fixing and stabilising the fractured bony segments.

A comparative analysis between intra articular injections of injectable platelet rich fibrin versus platelet rich plasma in the management of temporomandibular disorders: A randomized control trial.

Background: Platelet concentrate has become an increasingly popular alternative source of growth factors for several types of dental and surgical procedures. It improves healing and stimulates cell proliferation, matrix remodeling, and angiogenesis. The injectable platelet-rich fibrin (i-PRF) has various advantages over platelet-rich plasma (PRP). The aim of our study was to evaluate the efficacy of intra-articular injections of i-PRF versus PRP in the management of temporomandibular disorders (TDMs). Method: The prospective randomized study involved 14 patients (N = 28 joints) of internal derangement between the age groups of 20 to 50 years divided randomly into two groups with seven patients (N = 14 joints) in each group. For all the patients, arthrocentesis was carried out in the first sitting followed by intra-articular injections of PRP and i-PRF in group I and group II, respectively, at 1-month interval for 6 months. A single surgeon has performed the procedure. All patients were assessed clinically for pain, maximal mouth opening (MMO), lateral movement, protrusive movement, and joint sounds and radiographically for disc position and joint effusion (JE). Results: Pain reduction, MMO, lateral movement, protrusive movement, and joint sounds were significant in both groups with more significance in group II. Disc position had improved toward normal in both groups and showed significant changes in both groups at the 9-month follow-up with better results in group II. Conclusion: PRP and i-PRF injections are regarded as simple and safe methods with potential beneficial effects and are cost-effective. In this preliminary study, i-PRF has been found to be scoring better in terms of efficacy over PRP across all set parameters.

Differentiable Preisach Modeling for Characterization and Optimization of Particle Accelerator Systems with Hysteresis.

Future improvements in particle accelerator performance are predicated on increasingly accurate online modeling of accelerators. Hysteresis effects in magnetic, mechanical, and material components of accelerators are often neglected in online accelerator models used to inform control algorithms, even though reproducibility errors from systems exhibiting hysteresis are not negligible in high precision accelerators. In this Letter, we combine the classical Preisach model of hysteresis with machine learning techniques to efficiently create nonparametric, high-fidelity models of arbitrary systems exhibiting hysteresis. We experimentally demonstrate how these methods can be used in situ, where a hysteresis model of an accelerator magnet is combined with a Bayesian statistical model of the beam response, allowing characterization of magnetic hysteresis solely from beam-based measurements. Finally, we explore how using these joint hysteresis-Bayesian statistical models allows us to overcome optimization performance limitations that arise when hysteresis effects are ignored.

Association of Serum Ferritin Levels with Microalbuminuria, Glycemic Control and Dyslipidemia.

As diabetes is on the rise worldwide, early screening and detection of its complications is crucial. The first clinical sign of renal dysfunction in diabetes is microalbuminuria. Ferritin may have a possible role in the development and prediction of microalbuminuria and other complications of diabetes by 3 possible mechanisms- 1) it is a marker of elevated body iron stores. 2) acts as acute-phase reactant and elevation reflects inflammation 3) Delayed clearance of glycosylated ferritin in patients with diabetes causes raised ferritin levels. In this premise, we studied the association between serum ferritin levels and microalbuminuria, glycemic control and dyslipidemia in type 2 diabetic patients. MATERIAL: A cross-sectional study was carried out at a tertiary hospital in northern India involving 152 patients of type 2 diabetes mellitus. Anthropometric measurements (weight, height), sample collection for basic laboratory parameters including complete blood count, kidney function tests, liver function tests, HbA1c, lipid profile, serum iron and ferritin levels, urinary albumin- creatinine ratio was done. A fundus examination was performed. Results were analyzed using descriptive statistics and making comparisons among various groups. Categorical data were summarized as proportions or percentages while discrete as mean. Chi-square test was used for testing associations. OBSERVATION: Mean serum ferritin levels were significantly higher in patients having microalbuminuria as against patients having normal urinary albumin- creatinine ratio (539 vs 292, p-value- 0.04). Patients having poor glycemic control (HbA1c > 7) had higher ferritin levels (p-value- 0.024). There was a near-significant association (p-value-0.06) between serum ferritin and triglyceride levels. More cases with raised serum ferritin had higher triglyceride levels. Patients having microalbuminuria had a higher prevalence of diabetic retinopathy (p-value- 0.003) and higher triglyceride levels (p-value- 0.041). CONCLUSION: Ferritin can act as a marker of diabetic nephropathy, poor glycemic control and dyslipidemia in type 2 diabetic patients. Our study, therefore, indicates that programs to prevent complications of diabetes would be more effective by placing greater emphasis on patients having higher ferritin levels.

A comparative evaluation of bone regeneration using mesenchymal stem cells versus blood coagulum in sinus augmentation procedures.

OBJECTIVE: The present study evaluated the quality and quantity of new bone formation in the maxillary sinus lift procedures and stability of implants in posterior atrophic maxilla. MATERIALS AND METHODS: This prospective randomized controlled split-mouth study included 20 patients (16 males and 4 females having a mean age of 36.7 years) having atrophic maxilla. They were divided randomly into two groups: Group A using mesenchymal stem cells and Group B into blood coagulum. They were radiographically evaluated using cone-beam computed tomography (CBCT) for residual bone height preoperatively and availability of new bone formation around implants, density, and stability of implants 6 months postoperatively. RESULTS: The placement of dental implants in posterior maxilla is challenging due to rapid resorption of alveolar bone after extraction of teeth due to pneumatization of maxillary sinuses. In both the groups, more pain and swelling were observed in the 2nd postoperative day which gradually decreased over a period of 7 days. Membrane perforation occurs in only four cases (20%). A significant gain in alveolar bone height was observed in Group A (7.69 mm ± 2.5 mm) and Group B (9.32 mm ± 2 mm) after 6 months. On comparing both the groups, there is a similar significant increase in bone density in Hounsfield units postoperatively at various levels buccally and palatally. Total 40 sinuses were lifted and 42 implants were placed, respectively. All implants showed primary stability. CONCLUSIONS: Such findings provide a significant contribution in future perspective studies that the use of stem cells had the same success rate as blood coagulum.

Predicted concentrations of anticancer drugs in the aquatic environment: What should we monitor and where should we treat?

Anticancer drugs have been detected in the aquatic environment, they have a potent mechanism of action and their consumption is expected to drastically increase in the future. Consequently, it is crucial to routinely monitor the occurrence of anticancer drugs and to develop effective treatment options to avoid their release into the environment. Prior to implementing a monitoring program, it is important to define which anticancer drugs are more prone to be found in the surface waters. In this study the consumption of anticancer drugs in the Lisbon region (Portugal), Belgium and Haryana state (India) were used to estimate the concentrations that can be expected in surface waters. Moreover, one important aspect is to define the major entry route of anticancer drugs in the aquatic environment: is it hospital or household effluents? The results disclosed in this study showed that in Belgium and Lisbon, 94 % of the total amount of anticancer drugs were delivered to outpatients, indicating that household effluents are the primary input source of these drugs and thus, upgrading the treatment in the domestic wastewater facilities should be the focus.

Emergent airway management in blunt tracheal trauma: A novel use of the mini-tracheostomy kit.

AIM: To report and discuss a novel way of managing the airway in a difficult case of anterior tracheal wall disruption caused by blunt trauma to the neck. BACKGROUND: Tracheal injury resulting in laceration of the windpipe may present with either one or many of the multitude of problems such as respiratory distress, hoarseness of voice and subcutaneous emphysema. Most often it requires surgical intervention. CASE DESCRIPTION: We hereby present the novel use of a mini-tracheostomy kit as an aid in the cannot-intubate-cannot-ventilate situation of a 30-year-old patient presenting with severe features of blunt tracheal injury. The airway was established critically with the use of the mini-tracheostomy kit in a "cannot-intubate-cannot-ventilate" situation during surgical tracheostomy and a potentially disastrous cardiorespiratory arrest situation was averted. CONCLUSION: Timely presence of airway equipment, adequate preparation, a willingness to innovate and a team approach are of paramount importance in dealing with difficult airway situations that are presented in myriad and complex ways. CLINICAL SIGNIFICANCE: The stylet of mini-tracheostomy kit can be used in emergent airway management especially in clinical situations mimicking ours specifically as a guide for insertion of the standard tracheostomy tube.

Bleomycin Sclerotherapy in Lymphangiomas of Head and Neck: Prospective Study of 8 Cases.

The aim of this study is to evaluate the role of bleomycin as a primary mode of nonsurgical treatment in lymphangiomas of head and neck and study their complications. This is a prospective study of 8 patients diagnosed with lymphangioma of head and neck presenting to ENT department of Tata main Hospital from December 2014 to January 2017. They were clinically and radiologically evaluated and treated with intralesional injection of bleomycin diluted in normal saline. Complete resolution was seen in 62.5% (5/8) of patients, 25% (2/8) had good response while 12.5% (1/8) had a poor response. No major complications were noted apart from fever and inflammation. Intralesional bleomycin can be used as a primary modality of treatment.

Melt-compounded composites of ethylene vinyl acetate with magnesium sulfate as flexible EPR dosimeters: Mechanical properties, manufacturing process feasibility and dosimetric characteristics.

Novel polymeric composites for radiation dosimetry were developed. The composites were prepared by solvent-free melt compounding of ethylene vinyl acetate (EVA) (40% vinyl) and magnesium sulfate (MgSO4). Mechanical properties, melt flow characteristics and dosimetric properties were investigated. The composites with up to 50% (wt) of MgSO4 were flexible and capable of flow. The dose response of the EPR signal of the composites was studied in the dose range 3Gy-4kGy and found to be linear between 18Gy and 4kGy. The reproducibility of dose measurements was good. The signal fading rate and the energy dependence of the dose response were found to be acceptable.

Comparison of three types of intervention to enhance placental redistribution in term newborns: randomized control trial.

OBJECTIVE: To compare the effect of combined delayed cord clamping and umbilical cord milking to either of them had done alone, on hematological parameters at 6 weeks of age in term neonates. STUDY DESIGN: It was a randomized controlled trial, conducted during January to December 2014. Three hundred eligible neonates were randomly allocated to three parallel groups. Primary outcome was hemoglobin and serum ferritin at 6 weeks of age. Data were analyzed using analysis of variance and Kruskal-Wallis test. RESULTS: Baseline characteristics and hemodynamic parameters were comparable in all the three groups. The median serum ferritin level at 6 weeks was significantly higher in the group receiving both delayed cord clamping and milking the cut cord group (295.49 (233.5 to 346.54) ng ml(-1)) as compared with the group that received only milking of the cut cord (184.55 (131.22 to 256.5) ng ml(-1)) or only delayed cord clamping (268.8 (189.4 to 315.44) ng ml(-1)). CONCLUSION: Delayed cord clamping with milking the cut cord improved iron stores at 6 weeks of age in term infants, then either of the two interventions alone.

Synthesis of a flexible poly(chloroprene)/methyl red film dosimeter using an environment-benign shear compounding method.

The paper reports synthesis of a new film dosimeter based on a solvent-free route. Methyl red (MR) dye was introduced into poly(chloroprene) (PC) in various concentrations. The films were intensely red with λmax ~515nm. The absorbance decreased linearly with absorbed radiation dose up to 30kGy without a significant change in λmax. Color coordinates of the films were also analyzed. Optical micrographs of the films showed no signs of inhomogeneous distribution of MR in the PC matrix, which was attributed to the polarity of PC. Radiation sensitivity, dose response linearity, effects of irradiation temperature and humidity, as well as the rate of fading, were also investigated.

Fracture of the styloid process associated with the mandible fracture.

Fracture of the styloid process (SP) of temporal bone is an uncommon injuries. Fracture of the SP can be associated with the facial injuries including mandible fracture. However, injury to the SP may be concealed and missed diagnosis may lead to the improper or various unnecessary treatments. A rare case of SP fracture associated with the ipsilateral mandibular fracture and also the diagnostic and management considerations of the SP fracture are discussed.

Solid state white light emitting systems based on CeF3: RE3+ nanoparticles and their composites with polymers.

A series of doped CeF(3): RE(3+) (RE(3+): Tb(3+), Eu(3+) and Dy(3+)) nanoparticles were synthesized, with the aim of obtaining a white light emitting composition, by a simple polyol route at 160°C and characterized by X-ray diffraction (XRD), high resolution transmission electron microscopy (HR-TEM), Fourier transform infrared spectroscopy (FT-IR) and photoluminescence. Uniformly distributed and highly water-dispersible rectangular nanoparticles (length ~15-20 nm, breadth ~5-10 nm) were obtained. The steady state and time resolved luminescence studies confirmed efficient energy transfer from the host to activator ions. Lifetime studies revealed that optimum luminescence is observed for 2.5 mol% Dy(3+) and 7.5 mol% Tb(3+). The energy transfer efficiencies (Ce(3+) to activators) were found to be 89% for CeF(3): Tb(3+) (7.5 mol%) nanoparticles and 60% for CeF(3): Dy(3+) (2.5 mol%) nanoparticles. Different concentrations of Tb(3+), Eu(3+) and Dy(3+) were doped to achieve a white light emitting phosphor for UV-based LEDs (light emitting diodes). Finally CeF(3), triply doped with 2.0 mol%Tb(3+), 4.5 mol% Eu(3+) and 3.5 mol% Dy(3+), was found to have impressive chromaticity co-ordinates, close to broad day light. The colloidal solutions of doped CeF(3) nanoparticles emitted bright green (Tb(3+)), blue (Dy(3+)) and white (triply doped) luminescence upon host excitation. Composites of poly methyl methacrylate (PMMA) and poly vinyl alcohol (PVA) were made with CeF(3): 5.0 mol%Tb(3+), CeF(3): 5.0 mol% Dy(3+) and triply doped white light emitting composition. The CeF(3)/PMMA (PVA) nanocomposite films, so obtained, are highly transparent (in the visible spectral range) and exhibit strong photoluminescence upon UV excitation.

Diagnosis and osseous healing of a lateral periodontal cyst mimicking a deep unusual interdental pocket in a young patient.

A 17-year-old male patient presented for the evaluation of his nonhealing interdental deep pocket in relation to the mandibular second premolar and mandibular first molar. He denied any history of pain. Excessive food lodgment, salty taste, and smell related to the specific region were his chief complaints. The periapical radiograph exhibited well-defined interradicular unilocular radiolucency with sclerotic margins between the vital mandibular second premolar and mandibular first molar. The lesion was completely enucleated with deep curettage and root planning. Histopathologic reports showed a heavy inflammatory infiltrate. Successive radiographs showed excellent bone healing. Teeth were endodontically treated for severe sensitivity to cold. Step-by-step radiographic follow-up showed osseous repair with no evidence of disease till 25 months.

Effects of estradiol metabolites on cAMP production and degradation.

(Full text is available at http://www.manu.edu.mk/prilozi). 17beta-Estradiol is metabolized to 2-hydroxyestradiol, and 2-hydroxyestradiol is converted to 2-methoxyestradiol. These steroids reduce proliferation of, migration of and collagen production by vascular smooth muscle cells with an order of potency of 2-methoxyestradiol > 2-hydroxyestradiol > 17beta-estradiol, i.e. the converse of their estrogenic potency. Since cAMP also inhibits cell growth, it is conceivable that these steroids alter cAMP synthesis or degradation, and this hypothesis was addressed in this study. In cultured preglomerular vascular smooth muscle cells pretreated with a high concentration of a broad spectrum phosphodiesterase inhibitor (3-isobutyl-1-methylxanthine, 1 mM) to eliminate phosphodiesterase activity as a confounding variable, high (100 microM), but not low (10 microM), concentrations of 17beta-estradiol, 2-hydroxyestradiol and 2-methoxyestradiol attenuated isoproterenol-induced cAMP by 15%, 19% and 55%, respectively. 2-Hydroxyestradiol (100 microM) also attenuated forskolin-induced cAMP by 31% in cells treated with 3-isobutyl-1-methylxanthine. In cells not pretreated with 3-isobutyl-1-methylxanthine and using concentrations of steroids (10 microM) that did not interfere with adenylyl cyclase, 17beta-estradiol decreased by 34%, 2-hydroxyestradiol did not alter and 2-methoxyestradiol increased by 60% isoproterenol-induced cAMP. These results indicate that in preglomerular vascular smooth muscle cells, high concentrations of 2-hydrxoyestradiol markedly inhibit adenylyl cyclase whereas 17beta-estradiol and 2-methoxestradiol only modestly inhibit adenylyl cyclase even at high concentrations. Our results also indicate that lower concentrations of 17beta-estradiol, 2-hydroxyestradiol and 2-methoxyestradiol activate, have no effect on and inhibit, respectively, phosphordiesterase activity. The effects of these compounds on phosphodiesterase activity may account in part for the greater potency of 2-methoxyestradiol as an anti-growth compound compared with 17beta-estradiol and 2-hydroxyestradiol. Key words: Estradiol, Estradiol metabolites, 2-Methoxyestradiol, Cyclic adenosine monophosphate.

Swelling response of radiation synthesized 2-hydroxyethylmethacrylate-co-[2-(methacryloyloxy)ethyl] trimethylammonium chloride hydrogels under various in vitro conditions.

High-energy (60)Co gamma radiation has been used to synthesize 2-hydroxyethylmethacrylate-co-[2-(methacryloyloxy)ethyl]trimethylammonium chloride (HEMA-co-MAETC) polyelectrolyte hydrogels. HEMA-co-MAETC co-polymer gels were characterized and investigated for swelling behaviour in different swelling conditions. Fourier transformed infrared spectroscopy (FT-IR) and scanning electron microscopy (SEM) techniques were used to characterize the co-polymer gels. Swelling extent of the gels was found to be a linear function of MAETC content in the gels. The effect of ionic strength, temperature, pH, some solutes of biological importance like glucose, urea, and surfactants such as Triton-X and deoxycholic acid on swelling behavior have been reported. The swelling of gels at higher temperature enhanced the swelling rates but not the swelling extent. HEMA-co-MAETC hydrogel exhibited an excellent responsive characteristic to the ionic strength of the swelling medium. It was found that the swelling of the co-polymer gel at 60 degrees C reduced the swelling-deswelling cycle time by approx. 30% without altering the swelling extent. The gels were also investigated for their swelling in aqueous solutions of anionic dyes, acid blue 25 (AB25), acid blue (AB74) and acid yellow 99 (AY99), and were found to be suitable for dye uptake applications.

The extracellular cyclic AMP-adenosine pathway in renal physiology.

Many cell types in the kidney express adenosine receptors, and adenosine has multiple effects on renal function. Although adenosine is produced within the kidney by several biochemical reactions, recent studies support a novel mechanism for renal adenosine production, the extracellular cAMP-adenosine pathway. This extracellular cAMP-adenosine pathway is initiated by efflux of cAMP from cells following activation of adenylyl cyclase. Extracellular cAMP is then converted to adenosine by the serial actions of ecto-phosphodiesterase and ecto-5'-nucleotidase. When extracellular cAMP is converted to adenosine near the biophase of cAMP production and efflux, this local extracellular cAMP-adenosine pathway permits tight coupling of the site of adenosine production to the site of adenosine receptors. cAMP in renal compartments may also be formed by tissues/organs remote from the kidney. For example, stimulation of hepatic adenylyl cyclase by the pancreatic hormone glucagon increases circulating cAMP, which is filtered at the glomerulus and concentrated in the tubular lumen as water is extracted from the ultrafiltrate. Conversion of hepatic-derived cAMP to adenosine in the kidney completes a pancreatohepatorenal cAMP-adenosine pathway that may serve as an endocrine link between the pancreas, liver, and kidney.

Sinonasal inverted schneiderian papilloma.

Inverted papilloma of paranasal sinuses are rare disorders of fifth & sixth decade of life, have been characterised by their usually benign histologic features, their ability to grow rapidly with bone destruction, und their tendency to recur if not adequately treated. We hereby report such an uncommon case of Schneiderian papilloma in a young patient and its management with a brief review of literature.

Potential adverse interaction between aspirin and lisinopril in hypertensive rats.

The potential clinical effect of aspirin (ASA) in patients treated with angiotensin converting enzyme (ACE) inhibitors is debatable. Several studies have suggested that ASA attenuates the beneficial effects of ACE inhibitors in hypertension, congestive heart failure (CHF) or coronary artery disease (CAD) and have questioned the safety of using ASA concomitantly with these agents. The present study aims to investigate the possible interaction between ASA and ACE inhibitor in hypertensive rats. Hypertension was induced in adult male Wistar rats using Methylprednisolone (MP) 20 mg/kg per week s.c. for 2 weeks. The systolic blood pressure (SBP) was measured by noninvasive BP technique. The effect of Lisinopril (LS) 15 mg/kg per day and that of combination of LS and ASA; 100 and 25 mg/kg per day p.o. was studied on hypertension induced by glucocorticoid. Concurrent ASA treatment with LS did not hinder the hypotensive effect of LS at either dose. However ASA 100 mg/kg per day caused mortality in animals and produced massive cardiac necrosis and renal damage as evident from histopathology. Treatment with ASA 25 mg/kg per day caused lower mortality with variable effects on cardiac and renal tissues. These results indicate that ASA attenuates the beneficial effects of ACE inhibitor on survival in hypertensive rats and this effect was more pronounced at higher dose of ASA.

Sexual behavior of drug-users: is it different?

BACKGROUND: Across the world, drug-users (DU) have been shown to be at greater risk of contracting and transmitting sexually transmitted diseases and HIV infection. However, in the metropolitan cities of India, where drug-use patterns may uniquely vary between injection and noninjection, depending on drug availability, little is known about the risk behavior of drug-users. OBJECTIVE: The objective of the study was to find out whether drug-users are more likely to practice high-risk sexual behavior compared to non-drug users. METHODS: The sexual behavior of 70 drug-users, selected by snowball sampling, was compared with 128 age- and economic status-matched controls (non-drug-users), randomly selected from the same community. RESULTS: Seventy-eight percent sexually active drug-users and 43% sexually active non-drug-users had multiple sex partners (P < 0.02). The average number of sex partners was significantly higher among the drug-users (P = 0.05). Anal intercourse was practiced by 25.7% drug-users and 8.6% non-drug-users (OR = 3.7; P < 0.01). The drug-users were 6.7 times more likely to visit commercial sex workers (P < 0.0001). Sexually transmitted disease prevalence was higher among the drug-users (P < 0.003). CONCLUSIONS: Notwithstanding the small sample size, this study shows that drug-users practice high-risk sexual behavior more frequently. Interventions, in the form of awareness generation and prevention education programs, are required in order to reduce risk of sexually transmitted diseases and HIV transmission among drug-users.