Various surgical methods of impacted maxillary canine exposure: A case series.

Impacted tooth is often a common problem in dentistry. Maxillary canines are seen impacted most commonly in patients undergoing orthodontic treatment without reaching the line of occlusion. These impactions are commonly due to physical obstructions and the difference in the direction of movement of the tooth. Canines are the cornerstones for esthetic smile and functional occlusion. Hence, surgical exposure of these impacted canines, guiding them toward the line of occlusion, plays a very important role in the maintenance of the health of periodontium. A series of cases are discussed on various techniques that can be used in guiding the direction or altering the direction of impacted canines to bring them into a proper occlusion without disturbing the health of periodontium.

In vitro and in silico studies of silver nanoparticles (AgNPs) from Allium sativum against diabetes.

In the present study, the silver nanoparticles (AgNPs) were synthesized from the bulbs of Allium sativum, characterized by UV-visible spectroscopy, FT-IR, SEM, HR-TEM, EDAX analysis and investigated its action on the inhibition of starch digestion. The results proved that the biosynthesized nanoparticles were uniformly dispersed, spherical shaped with the size ranging from 10 to 30 nm. The phytochemical and FT-IR analysis showed the presence of phenols, terpenoids, and amino acids in the synthesized AgNPs. The cytotoxicity analysis revealed that the synthesized AgNPs were non-toxic to the normal cells. The synthesized AgNPs exhibited significant free radical scavenging activity. The in vitro antidiabetic activity showed that the synthesized AgNPs increased glucose utilization, decreased hepatic glucose production, inhibited the activity of starch digestive enzymes such as α-amylase and α-glucosidase, and were not involved in the stimulation of pancreatic cells for the secretion of insulin. The in silico antidiabetic activity analysis (molecular docking) also revealed that the silver atoms of the AgNPs interacted with the amino acid residues of α-amylase, α-glucosidase, and insulin. The present study proved that the AgNPs synthesized from A. sativum have prominent antidiabetic activity in terms of reducing the hyperglycemia through the increased glucose utilization, decreased hepatic glucose production, and the inhibition of α-amylase and α-glucosidase enzymes. So it can be used as a promising nanomedicine for the treatment of diabetes.

Bone Loss Evaluation by Cone Beam Computed Tomography Postdental Implant Placement: An Original Research.

Introduction: The success of the prosthetic rehabilitation is a factor of the periodontal reactions. Hence, in the current study, we aim to assess bone loss in the osseointegrated implants posttreatment by the cone beam computed tomography (CBCT) imaging. Materials and Methods: We conducted a prospective clinical observational study among 50 subjects who received mandibular dental implants for the replacement of the single lost anterior tooth. The follow-up was done at 1 week, 2 weeks, and after 6 weeks. The bone loss around the implant was noted by imaging with CBCT. The values were compared and analyzed statistically. Results: We observed a significant variation among the genders and the age groups. The mean bone loss around the implants was statistically significant for the different time intervals (P = 0.001). Conclusion: Significant bone loss was noted in the first few weeks after implantation. Care should be focused in the initial posttreatment phase to eliminate the factors aggravating the periodontitis.

Classification of Myopathy and Amyotrophic Lateral Sclerosis Electromyograms Using Bat Algorithm and Deep Neural Networks.

Electromyograms (EMG) are a recorded galvanic action of nerves and muscles which assists in diagnosing the disorders associated with muscles and nerves. The efficient discrimination of abnormal EMG signals, myopathy and amyotrophic lateral sclerosis, engage crucial role in automatic diagnostic assistance tools, since EMG signals are nonstationary signals. Hence, for computer-aided identification of abnormalities, extraction of features, selection of superlative feature subset, and developing an efficient classifier are indispensable. Initially, time domain and Wigner-Ville transformed time-frequency features were extracted from abnormal EMG signals for experiments. The selection of substantial characteristics from time and time-frequency features was performed using bat algorithm. Extensively, deep neural network classifier is modelled for selected feature subset using bat algorithm from extracted time and time-frequency features. The performance of deep neural network exerting selected features from bat algorithm was compared with conventional artificial neural network. Results demonstrate that the deep neural network modelled with layers 2 and 3 (neurons = 2 and 4) using time domain features is efficient in classifying the abnormalities of EMG signals with an accuracy, sensitivity, and specificity of 100% and also exhibited finer performance. Correspondingly, the developed conventional single layer artificial neural network (neurons = 7) with time domain features has shown an accuracy of 83.3%, sensitivity of 100%, and specificity of 71.42%. The work materializes the significance of conventional and deep neural network using time and time-frequency features in diagnosing the abnormal signals exists in neuromuscular system using efficient classification.

EHMO-Based Deep ResNet for Survival Timeline Prediction of Adenocarcinoma Cancer.

Lung cancer is due to the growth of uncontrolled cells in the lungs, and the death rate is high compared with all types of cancer. It is recognized and treated using images of computed tomography (CT). This paper develops the elephant herding magnetic optimization-based deep residual network (EHMO-based Deep ResNet) for survival timeline prediction in adenocarcinoma. Here, preprocessing is performed using a Gaussian filter for the lung CT image. The preprocessed image is subjected to lung lobe segmentation, which is performed by the active contour model. Nodule identification locates nodules in the segmented image, where the process is carried out using a grid-based scheme. After that, feature extraction is carried out to extract intensity, wavelet, tetrolet transform, local optimal oriented pattern (LOOP), and clinical features. Finally, the extracted features are fed to the prediction module, which is based on the Deep ResNet classifier, which is trained by the proposed EHMO optimization algorithm. Here, the developed EHMO combines elephant herding optimization (EHO) and the magnetic optimization algorithm (MOA). The developed adenocarcinoma survival timeline prediction technique exhibits efficient performance in terms of accuracy, 0.955; maximal sensitivity, 0.962; and high specificity, 0.958.

Nanofibrous yarn reinforced HA-gelatin composite scaffolds promote bone formation in critical sized alveolar defects in rabbit model.

Alveolar ridge resorption and crestal bone loss necessitate the use of bone graft substitutes for dental rehabilitation. The aim of this study was to compare the bone regenerative property of nanofibre incorporated two composite matrices (nanofibrous sheet layered matrix (CS-S) and nanofibrous yarn reinforced matrix (CS-Y)) in critical sized mandibular defect in a rabbit model (under load bearing scenario). Histological evaluation revealed continuous bone formation in the defect implanted with fibre reinforced scaffolds than those without fibres as well as commercial nanoHA-collagen graft. Interestingly, the mineralisation and the mineral density were significantly higher with nanoyarn reinforced scaffolds. Moreover, the compressive strength of new bone formed from CS-Y scaffolds was almost similar to that of native rabbit mandible. It can be concluded that the mechanical strength provided by three-dimensionally reinforced nanoyarns in the matrix could promote bone formation in load bearing mandibular region, and these can be proposed as a scaffold of choice for alveolar bone augmentation and dental rehabilitation.

Effectiveness of Peripheral Intravenous Skill Continuing Education Using Low-Fidelity Simulation Among Nurses in India.

BACKGROUND: Many nurses have limited opportunities to practice peripheral intravenous (IV) skill access until they begin their nursing career, particularly in limited resource settings. Continuing nursing education is needed for practicing nurses to build nurse capacity and skill accuracy in IV access globally. METHOD: A pretest-posttest design was used to measure effectiveness of peripheral IV continuing education among 180 nurses in India. A skills checklist was used to observe for skill accuracy using low-fidelity simulation. RESULTS: A statistically significant improvement in knowledge regarding peripheral IV skill access and care was found (p < .001), and 95% of nurse participants successfully simulated IV access accuracy after the continuing education intervention. CONCLUSION: Findings support the need for continuing nursing education to improve peripheral IV access and care knowledge and skill among nurses, particularly in low- and middle-income countries or other settings where hands-on experience is limited during undergraduate nursing education programs. J Contin Educ Nurs. 2018;49(6):255-261.

BMP2 expressing genetically engineered mesenchymal stem cells on composite fibrous scaffolds for enhanced bone regeneration in segmental defects.

The treatment of critical sized bone defect remains a significant challenge in orthopedics. The objective of the study is to evaluate the effect of the combination of bone morphogenetic protein 2 (BMP2) expressing genetically engineered mesenchymal stem cells (MSCs) [MSCs engineered using a multimam vector, pAceMam1, an emerging gene delivery vector] and an osteoconductive scaffold [silica coated nanohydroxyapatite-gelatin reinforced with fibers] in enhancing bone regeneration in critical sized segmental defects. The scaffold with transfected MSCs showed significantly higher viability, proliferation and osteogenic differentiation in vitro. Further, this group augmented union and new bone formation in critical sized rat femoral segmental defect at 12 weeks when compared to control groups (scaffold with MSCs and scaffold alone). These data demonstrated that the MSCs engineered for transient expression of BMP2 can improve the repair of segmental defects, which paves an avenue for using pAceMam1 as a vector for bone tissue regeneration.

Poly(L-lactic acid) nanofibers containing Cissus quadrangularis induced osteogenic differentiation in vitro.

Cissus quadrangularis (CQ) is known as "bone setter" in Ayurvedic Medicine because of its ability to promote fracture healing. Polymers incorporated with CQ at lower concentration have shown to enhance osteogenic differentiation of mesenchymal stem cells (MSCs) in vitro. However, for the healing of clinically relevant critical sized bone defects, large amount of CQ would be required. Based on this perception, a herbal fibrous sheet containing high weight percentage of CQ [20,40 and 60wt/wt% in poly (L-lactic acid) (PLLA)] was fabricated through electrospinning. The solution concentration, flow rate, voltage and tip-target distance was optimized to obtain nanofibers. The hydrophobicity of PLLA fibers was reduced through CQ incorporation. There was considerable increase in the adhesion, proliferation and osteogenic differentiation of MSCs on herbal fibers than normal fibers, mainly on P-Q20 and P-CQ40. MSCs were differentiated into osteoblasts without providing any osteogenic supplements in the medium, indicating its osteoinductive capability. The herbal sheet also could promote mineralization when immersed in simulated body fluid for 14days. These studies specify that PLLA nanofibers loaded with 20 and 40wt% of CQ could serve as a potential candidate for bone tissue engineering applications.

Electrospun Yarn Reinforced NanoHA Composite Matrix as a Potential Bone Substitute for Enhanced Regeneration of Segmental Defects.

Nanohydroxyapatite (nanoHA) is a well-established synthetic bone substitute with excellent osteoconduction and osteointegration. However, brittleness coupled with slow degradation curtails its load-bearing and bone regeneration potential, respectively. To address these limitations, nanoHA composite matrix reinforced with electrospun fibrous yarns was fabricated and tested in vitro and in vivo. Different weight percentages (5, 10, 15 wt%) and varying lengths (short and continuous) of poly(l-lactic acid) yarns were randomly dispersed in a gelatinous matrix containing nanoHA. This significantly improved the compressive strength as well as work of fracture, especially for continuous yarns at high weight percentages (10 and 15 wt%). Incorporation of yarns did not adversely affect the pore size (50-350 µm) or porosity of the scaffolds as well as the in vitro cellular response. Finally, when tested in a critical-sized femoral segmental defect in rat, the nanocomposite scaffolds induced osteoblast cell infiltration at 2 months that subsequently underwent increased mature lamellar bone formation at 4 months, in both the mid and peripheral defect regions. Histomorphometric analysis demonstrated that new bone formation and biomaterial degradation were significantly enhanced in the composite scaffold when compared to commercially available HA. Overall, the composite matrix reinforced with electrospun yarns proved to be a potential bone substitute having an appropriate balance between mechanical strength, porosity, biodegradation, and bone regeneration ability.

Combinatorial Effects of Aromatic 1,3-Disubstituted Ureas and Fluoride on In vitro Inhibition of Streptococcus mutans Biofilm Formation.

Dental caries occur as a result of disequilibrium between acid producing pathogenic bacteria and alkali generating commensal bacteria within a dental biofilm (dental plaque). Streptococcus mutans has been reported as a primary cariogenic pathogen associated with dental caries. Emergence of multidrug resistant as well as fluoride resistant strains of S. mutans due to over use of various antibiotics are a rising problem and prompted the researchers worldwide to search for alternative therapies. In this perspective, the present study was aimed to screen selective inhibitors against ComA, a bacteriocin associated ABC transporter, involved in the quorum sensing of S. mutans. In light of our present in silico findings, 1,3-disubstituted urea derivatives which had better affinity to ComA were chemically synthesized in the present study for in vitro evaluation of S. mutans biofilm inhibition. The results revealed that 1,3-disubstituted urea derivatives showed good biofilm inhibition. In addition, synthesized compounds exhibited potent synergy with a very low concentration of fluoride (31.25-62.5 ppm) in inhibiting the biofilm formation of S. mutans without affecting the bacterial growth. Further, the results were supported by confocal laser scanning microscopy. On the whole, from our experimental results we conclude that the combinatorial application of fluoride and disubstituted ureas has a potential synergistic effect which has a promising approach in combating multidrug resistant and fluoride resistant S. mutans in dental caries management.

Type III collagen disorders: A case report and review of literature.

Collagen type III is a normal component of interstitium and blood vessels. Collagenofibrotic glomerulopathy (CG) and nail patella syndrome (NPS) are the diseases of abnormal type III collagen deposition. In spite of these curved frayed structures with a periodicity of 45-60 nm are deposited in subendothelium and mesangium in CG, they are found only in the basement membrane in NPS. The clinical features of CG are confined to the kidney, NPS has associated extra-renal manifestations. Electron microscopy is essential to make the renal diagnosis in both these rare diseases. Both the entities considered to be systemic diseases evidence to suggest similar deposition in other organs, understanding etiopathogenesis and disease progression await research.

Combinatorial nanomedicines for colon cancer therapy.

Colon cancer is one of the major causes of cancer deaths worldwide. Even after surgical resection and aggressive chemotherapy, 50% of colorectal carcinoma patients develop recurrent disease. Thus, the rationale of developing new therapeutic approaches to improve the current chemotherapeutic regimen would be highly recommended. There are reports on the effectiveness of combination chemotherapy in colon cancer and it has been practiced in clinics for long time. These approaches are associated with toxic side effects. Later, the drug delivery research had shown the potential of nanoencapsulation techniques and active targeting as an effective method to improve the effectiveness of chemotherapy with less toxicity. This current focus article provides a brief analysis of the ongoing research in the colon cancer area using the combinatorial nanomedicines and its outcome.