Bony bridge resorption after secondary alveolar grafting and correlation with success of orthodontic treatment: A prospective volumetric cone beam computed tomography (CBCT) study.

BACKGROUND: Cleft lip/palate is the second most observed congenital defect which constitutes a serious dental-medical-social problem. Successful uptake and stability of alveolar graft is required to achieve closure of the oro-nasal fistula and continuity of the dental arches. Resorption of bone graft may compromise the results achieved. This study determined the bony bridge volume required for successful repair of alveolar cleft, evaluated the resorption after 3 months of grafting and correlated the success of orthodontic treatment. METHODS: 30 patients with unilateral cleft lip and palate requiring secondary alveolar bone grafting and orthodontic correction were included in the study. After arch expansion and before alveolar grafting using cone beam computed tomography (CBCT) of maxilla was recorded and was repeated after 3 months of alveolar bone grafting to estimate the volume of grafted bone in the cleft. RESULTS: The bridge bone volume resorption after 3 months post-operative ranged from 14% to 100% with a mean of 36.46%. The percentage of resorption of alveolar bone graft after 3 months of surgery was statistically significant. Success of orthodontic treatment was statistically significant when correlated with percentage of resorption. CONCLUSION: The accurate localization and estimation of the size and extent of alveolar cleft area is important for treatment planning. Post-operative it is important to analyze the outcome of transplanted bone as early as possible. Early evaluation can help to predict the outcome of transplanted bone and may guide to re-grafting of the site immediate or to restart any interrupted orthodontic procedure, if necessary.

Spread and exchange of bla NDM-1 in hospitalized neonates: role of mobilizable genetic elements.

To investigate the mobilizable elements associated with bla NDM-1 in Enterobacteriaceae isolated from septicaemic neonates at a NICU in India, during December, 2008-2011. An attempt was also made to understand whether there was a pattern in the temporal acquisition of bla NDM-1 within the unit. Transferability of carbapenem resistance was tested by conjugation and transformation. Plasmid types and addiction systems were analysed. The genetic background of bla NDM-1 and association with class 1 integron were evaluated by PCR mapping. RFLP was carried out to discriminate plasmids of same incompatibility group. Transfer of carbapenem resistance was successful in 13/15 cases. bla NDM-1 was associated with different plasmid scaffolds (IncFII, IncL/M, IncN, IncR, IncHIB-M/FIB-M), IncF type being the prevalent one. Addiction systems ccdAB and hok/sok were associated with transferable plasmids. Genetic structures surrounding bla NDM-1 showed its association with at least a remnant of ISAba125 at its 5'-end. The spread of NDM-1 was not related to class 1 integron which possessed resistance determinants against trimethoprim (dfrA12, dfrA1, dfrA5), streptomycin (aadA2, aacA4), and rifampicin (arr-3). RFLP showed that three isolates possessed the same FII/FIIs plasmid; two of these three isolates were from a single neonate, implying interspecies transfer of bla NDM-1. The predominance of FII plasmids and ISAba125 along with bla NDM-1 was noted, but no specific pattern in the temporal acquisition of mobile genetic elements could be identified. To the best of our knowledge, this report is the first to inform the in-vivo interspecies plasmid transfer event of bla NDM-1 in a neonate.

The impact of HLA class I and EBV latency-II antigen-specific CD8(+) T cells on the pathogenesis of EBV(+) Hodgkin lymphoma.

In 40% of cases of classical Hodgkin lymphoma (cHL), Epstein-Barr virus (EBV) latency-II antigens [EBV nuclear antigen 1 (EBNA1)/latent membrane protein (LMP)1/LMP2A] are present (EBV(+) cHL) in the malignant cells and antigen presentation is intact. Previous studies have shown consistently that HLA-A*02 is protective in EBV(+) cHL, yet its role in disease pathogenesis is unknown. To explore the basis for this observation, gene expression was assessed in 33 cHL nodes. Interestingly, CD8 and LMP2A expression were correlated strongly and, for a given LMP2A level, CD8 was elevated markedly in HLA-A*02(-) versus HLA-A*02(+) EBV(+) cHL patients, suggesting that LMP2A-specific CD8(+) T cell anti-tumoral immunity may be relatively ineffective in HLA-A*02(-) EBV(+) cHL. To ascertain the impact of HLA class I on EBV latency antigen-specific immunodominance, we used a stepwise functional T cell approach. In newly diagnosed EBV(+) cHL, the magnitude of ex-vivo LMP1/2A-specific CD8(+) T cell responses was elevated in HLA-A*02(+) patients. Furthermore, in a controlled in-vitro assay, LMP2A-specific CD8(+) T cells from healthy HLA-A*02 heterozygotes expanded to a greater extent with HLA-A*02-restricted compared to non-HLA-A*02-restricted cell lines. In an extensive analysis of HLA class I-restricted immunity, immunodominant EBNA3A/3B/3C-specific CD8(+) T cell responses were stimulated by numerous HLA class I molecules, whereas the subdominant LMP1/2A-specific responses were confined largely to HLA-A*02. Our results demonstrate that HLA-A*02 mediates a modest, but none the less stronger, EBV-specific CD8(+) T cell response than non-HLA-A*02 alleles, an effect confined to EBV latency-II antigens. Thus, the protective effect of HLA-A*02 against EBV(+) cHL is not a surrogate association, but reflects the impact of HLA class I on EBV latency-II antigen-specific CD8(+) T cell hierarchies.

Hybrid 3D structures of ZnO nanoflowers and PdO nanoparticles as a highly selective methanol sensor.

The present study concerns the enhancement of methanol selectivity of three dimensional (3D) nanoflowers (NFs) of ZnO by dispersing nickel oxide (NiO) and palladium oxide (PdO) nanoparticles on the surface of the nanoflowers to form localized hybrid nano-junctions. The nanoflowers were fabricated through a liquid phase deposition technique and the modification was achieved by addition of NiCl and PdCl2 solutions. In addition to the detailed structural (like X-ray diffraction (XRD), electron dispersive spectroscopy (EDS), X-ray mapping, XPS) and morphological characterization (by field emission scanning electron microscopy (FESEM)), the existence of different defect states (viz. oxygen vacancy) was also confirmed by photoluminescence (PL) spectroscopy. The sensing properties of the pristine and metal oxide nanoparticle (NiO/PdO)-ZnO NF hybrid sensor structures, towards different alcohol vapors (methanol, ethanol, 2-propanol) were investigated in the concentration range of 0.5-700 ppm at 100-350 °C. Methanol selectivity study against other interfering species, viz. ethanol, 2-propanol, acetone, benzene, xylene and toluene was also investigated. It was found that the PdO-ZnO NF hybrid system offered enhanced selectivity towards methanol at low temperature (150 °C) compared to the NiO-ZnO NF and pristine ZnO NF counterparts. The underlying mechanism for such improvement has been discussed with respective energy band diagram and preferential dissociation of target species on such 3D hybrid structures. The corresponding improvement in transient characteristics has also been co-related with the proposed model.

A mine is a terrible thing to waste: high content, single cell technologies for comprehensive immune analysis.

In recent years, an incredible variety of single cell technologies have become available to analyze immune responses. These technologies include polychromatic flow cytometry, mass cytometry, highly multiplexed single cell qPCR, RNA sequencing, microtools, and high-resolution imaging. In this article, we review these platforms, describing their power and limitations for comprehensive analysis of the immune system. We relate the properties of these technologies to the various cellular states relevant to an immune response, in order to address which technologies are most appropriate for which settings.

Alteration in regulatory T cells and programmed cell death 1-expressing regulatory T cells in active generalized vitiligo and their clinical correlation.

BACKGROUND: Vitiligo is an autoimmune depigmentation disease, and defects in regulatory T cells (Tregs) have been proposed in the pathogenesis of generalized vitiligo (GV). However, the role of programmed cell death (PD)1(+) Tregs has not been studied. OBJECTIVES: To investigate the status of Tregs, PD1(+) Tregs and associated parameters in active GV (aGV) during the first episode of disease attack and to establish the clinical correlation. METHODS: The percentages of circulating Tregs, PD1(+) Tregs and CD3(+) CD4(+) PD1(+) T cells were evaluated in 50 patients with aGV and 51 controls. Expression levels of FOXP3, TGFB1, CTLA4 and genes for chemokine receptors (CCR4, CCR7) and their ligands (CCL21, CCL22) were quantified in peripheral blood and in lesional, perilesional, nonlesional and normal skin sections. The corresponding proteins were immunolocalized in tissue of aGV. RESULTS: The percentage of Tregs was decreased (P = 0·001) and that of PD1(+) Tregs increased (P = 0·001) in peripheral blood of patients with aGV compared with controls. The abundance of TGFB1 and CCL21 mRNA was significantly decreased in the peripheral blood of patients with aGV. Significant differences in forkhead box P3, transforming growth factor-ß and CCL21 protein expression were found in skin sections. CONCLUSIONS: Deficiency in Treg frequency and decreased expression of Treg-associated parameters (TGFB and CCL21) suggested a possible defect in Tregs that may alter their suppression function and skin homing in aGV. The increased PD1(+) Tregs suggests that the PD1/PD ligand pathway may be involved in aGV and may have a role in Treg exhaustion. Further study is required to delineate the effect of PD1 in regulating Treg function in aGV.

Isolation and Characterization of Antidermatophytic Bioactive Molecules from Piper longum L. Leaves.

Piper longum L. (Piperaceae) commonly known as "long pepper" is a well known medicinal plant in ayurveda. Different parts of this plant, such as root, seed, fruit, whole plant etc. are used traditionally in various ailments. Here we have investigated the antidermatophytic activity of sequentially extracted petroleum ether, chloroform, methanol and water extracts from P. longum leaf against Trichophyton mentagrophytes, T. rubrum, T. tonsurans, Microsporum fulvum and M. gypseum. Better activity of chloroform and methanol extracts was observed. The chloroform extract was selected for further study and the MIC value was recorded as 5.0 mg ml(-1) against the test organisms. In the chloroform extract, tannins and phenolic compounds were detected. Further activity-guided fractionation of chloroform extract by silica gel column chromatography yielded nine major fractions. Among these, fraction-1, 4, 5 and 7 showed higher antidermatophytic activity. Fraction-4 on further purification by repeated column chromatography yielded a potential antidermatophytic fraction showing MIC value of 0.625 mg ml(-1) against T. mentagrophytes and T. rubrum as determined by broth microdilution method. The major compounds were identified as 1,2-benzenedicarboxylic acid, bis(2-ethylhexyl) ester (C24H38O4] (41.45 %), 2,2-dimethoxybutane (C6H14O2] (13.6 %) and ß-myrcene (C10H16) (6.75 %) based on GC-MS data.

Optimization of HTST process parameters for production of ready-to-eat potato-soy snack.

Ready-to-eat (RTE) potato-soy snacks were developed using high temperature short time (HTST) air puffing process and the process was found to be very useful for production of highly porous and light texture snack. The process parameters considered viz. puffing temperature (185-255 °C) and puffing time (20-60 s) with constant initial moisture content of 36.74% and air velocity of 3.99 m.s(-1) for potato-soy blend with varying soy flour content from 5% to 25% were investigated using response surface methodology following central composite rotatable design (CCRD). The optimum product in terms of minimum moisture content (11.03% db), maximum expansion ratio (3.71), minimum hardness (2,749.4 g), minimum ascorbic acid loss (9.24% db) and maximum overall acceptability (7.35) were obtained with 10.0% soy flour blend in potato flour at the process conditions of puffing temperature (231.0 °C) and puffing time (25.0 s).

Bisphosphonate Osteonecrosis in a Case of Langerhans Cell Histiocytosis: Report of a Case and Review of Literature.

Langerhans Cell histiocytosis is a rare multisystem disease originating from dendritic cell lines primarily characterized by osteolytic lesion of the skeleton. Chemotherapy along with bisphosphonates have been used to control the progression of the disease and prevent the osteolysis associated with the disease. Bisphosphonate osteonecrosis of the jaws is a common finding following treatment with bisphosphonates for osteoporosis, metastatic tumors to the bone or the osteolytic lesions of multiple myeloma. The article highlights a rare case of bisphosphonate osteonecrosis of the mandible in a case of long-standing Langerhans cell histiocytosis.

Validity of IL-6 and Arthrocentesis in the Cause and Management of Internal Derangement of TMJ.

Purpose: The aim of this clinical study was to evaluate the level of Interleukine-6 (IL-6), pre and post arthrocentesis to validate it as a biomarker in the Internal Derangement (ID) of TMJ. Material and Methods: This study included 30 patients (20 females and 10 males) of Temporo-Mandibular Dysfunction (TMD) with Disc displacement without reduction (DDwoR) Wilkes stage III, who were refractory to conservative management. Arthrocentesis was performed as a therapeutic modality. Synovial fluid aspirates were obtained prior to arthrocentesis and post arthrocentesis with 300 ml of Ringer Lactate solution into the superior joint compartment for the assessment of level of IL-6. The clinical parameters used for correlating the level of IL-6 were degree of pain (VAS I), chewing ability (VAS II), Maximal Mouth Opening (MMO) in both pre and post op phase with the follow-up period of 01 day, 01 week, 01 month, 03 month and 06 month and the results were compared. ELISA was performed to analyze the levels of IL-6 in the aspirates. The clinical parameters and the level of IL-6 were recorded and analyzed statistically. Results: The study showed ID of TMJ (Wilkes stage III) s are more prevalent in females especially in the fourth decades of life with the mean age of 38.4 years. The post operative assessment in terms of pain, maximum mouth opening, lateral movements of the mandible and the levels of IL-6 were found to be statistically significant with a P value <0.01. Conclusion: This study validates the role of IL-6 as a definitive biomarker for the pathogenesis of ID of TMJ Wilkes stage III and arthrocentesis proved to be a minimally invasive therapeutic modality for its management.

Reversible diffuse neurological deficits in systemic lupus erythematosus: report of a case.

We report a case of lupus presenting with focal as well as diffuse neurological deficits with intracranial and subarachnoid haemorrhages and diffuse hyperintense lesions in T2-weighted and fluid-attenuated inversion recovery images of brain magnetic resonance imaging proved by further investigation as demyelination, which completely recovered with intravenous methylprednisolone therapy. During the patient's hospital stay there was one episode of transient hypertensive episode lasting a few hours, promptly reverting to normal with low-dose ramipril therapy. Complete neurological and radiological recovery of such diffuse leucoencephalopathy-like central nervous system lesions has been rarely reported before.

Acute cerebellar ataxia in lupus.

Acute cerebellar ataxia in patients with lupus is rare and occurs early in the course of disease. We report a case of acute cerebellar ataxia in a young adult female who recovered completely with intravenous high-dose steroid therapy.

Systemic lupus erythematosus presenting as ischaemic proctitis.

Ischaemic colitis is relatively uncommon in systemic lupus erythematosus (SLE), with only very few case reports or case series in world literature. Ischaemic colitis occurs when SLE activity is high and is inarguably due to small vessel vasculitis affecting the large or small intestine. Ischaemic proctitis with rectal ulceration, as a presenting feature in SLE, is even rarer with only two case reports in the world to date. We present the case of a 38-year-old woman, who presented with haematochezia which subsequently proved to be due to ischaemic proctitis with a large rectal ulcer in a case that was subsequently diagnosed as SLE. The clinical course in this patient greatly improved with aggressive management with systemic steroids.

Low-temperature particulate calcium phosphates for bone regeneration.

BACKGROUND: Low-temperature synthesized calcium phosphates are produced by mixing calcium phosphate powders in an aqueous solution resulting in a precipitated phase. These compounds can be formulated in several forms (e.g. injectable cements and implantable blocks), and are commonly used as bone substitutes and drug delivery systems for the treatment of bone defects. As bone substitutes, calcium phosphates in general offer the advantages of being biocompatible and osteoconductive. AIMS: The present work employed a machine-based process to derive a reproducible preparation method for low-temperature calcium phosphate particulate (LTCP). The in vivo outcomes of LTCP were compared with those of three commercially available bone substitutes by histomorphometric measurements of bone formation and material degradation in a rat femur implantation model. MATERIALS & METHODS: Specifically, LTCP, anorganic bovine bone (AB), bioactive glass (BG), and demineralized bone matrix (DBM) were implanted in defects created in the distal aspect of rat femora. Reparative bone and particulate volumes of these biomaterials were evaluated post-operatively using micro-computed tomography and histological analyses at 3, 6, 12, and 16 weeks. RESULTS & DISCUSSION: Results showed that, despite invoking bone formation, AB, BG, and DBM were found un-resorbed in situ at 16 weeks. Conversely, LTCP showed an early increase in bone formation as well as clear evidence of complete degradation and reparative bone remodelling, resulting in the total reconstitution of the marrow cavity and marrow tissue. CONCLUSION: LTCP promoted increased early bone formation, associated with an improved degradation rate, compared with the other three bone-substitute biomaterials tested.

Fractures in the Maxillofacial Region: A Four Year Retrospective Study.

INTRODUCTION: The incidence of maxillofacial injuries is on the rise due to motor vehicle accidents and increased incidence of violence in recent times. The aim of this retrospective study was to determine the incidence, aetiology, the pattern of fractures, their management with open reduction and internal fixation (ORIF) and complications, if any. METHODS: A retrospective analysis of 621 fractures in 361 patients managed by ORIF over a four year period was carried out. RESULT: The average age of patients was 24.3 years with a male to female ratio of 21.2:1. Panfacial fractures comprised 4.7%, frontal bone fractures 8.9%, orbital fractures 0.7%, naso-orbito-ethmoid complex (NOE) fractures 0.7%, zygomatic complex fractures 23.5%, fracture maxilla 11.5% and mandibular fractures 52.2% of all facial fractures. All the cases were successfully managed by ORIF under general anaesthesia (GA). Complications were noticed in 6.8% of cases in the form of reactive implants in 3.6%, deranged occlusion in 1% and infection at operated site in 1% cases which were managed satisfactorily. CONCLUSION: The findings of this study reveal sharp annual increase in the number of cases of maxillofacial trauma. Road traffic accidents (RTA) were the commonest cause and the age group most affected was between 20-25 years. ORIF of these fractures was chosen for its obvious advantages of direct anatomical reduction, early return to function and minimal complications.

Management of Zygomatic Complex Fracture in Armed Forces.

INTRODUCTION: The Armed Forces personnel are exposed to various kinds of injuries due to the nature of their duties. Increase in motorized population without taking protective measures and rise in violence has contributed towards maxillofacial injuries. The aim of this study was to determine the incidence, aetiology and management of injuries resulting in fracture of the Zygomatic complex in Armed Forces personnel and their families. METHODS: This study was conducted at Command Military Dental Centre (EC). Out of 90 maxillofacial injuries, 40 individuals (44.4%) were treated for Zygomatic complex fractures, majority were in their third decade of life and RTA was the leading cause. RESULT: Thirty seven individuals (92.5%) recovered uneventfully, while three (7.5%) patients had post operative complications such as enophthalmos, paraesthesia, diplopia, facial asymmetry, palpability of implants and facial nerve paresis. These complications were subsequently treated successfully. CONCLUSION: The midface is composed of fragile bones which get fractured easily. It is imperative to educate people regarding the use of protective headgears/seat belts while travelling in motorized transport.

Retromandibular transparotid approach compared with transmasseteric anterior parotid approach for the management of fractures of the mandibular condylar process: a prospective randomised study.

Fractures of the mandibular condyle lead to displacement of the condyle and loss of the height of the ramus. A retromandibular approach is the most commonly used for open reduction and internal fixation (ORIF) of such fractures. We aimed to compare the complications associated with a retromandibular transparotid approach with a retromandibular transmasseteric anterior parotid (TMAP) approach for their management. Thirty patients were randomly selected into two groups (15 in each): Group A comprised the retromandibular transparotid approach and Group B the retromandibular TMAP. The variables evaluated were: operating time, facial nerve injury, occurrence of Frey syndrome, and sialocoele at one week, four weeks, three months, and six months. The mean (SD) age in group A and B was 33.93 (17.97) years and 33.53 (16.15) years, respectively, and there were 28 men and two women. Mean (SD) exposure time in the transparotid approach was 26.93 (5.19) minutes and 25.4 (8.35) minutes in the TMAP approach. The incidence of facial nerve injury was 2/15 patients in the transparotid group and 3/15 in the TMAP group, all of which resolved within six months. The incidence of sialocoele was 2/15 in the transparotid group. The results did not show any significant difference in complications between the two approaches, but the retromandibular transparotid approach provided straight-line access in fractures of the condylar neck, with fewer incidences of nerve injury. The anterior parotid approach, on the other hand, provided easier access for fractures that were medially dislocated or of the condylar base but had an increased incidence of facial nerve injuries.

Does methylprednisolone improve postoperative outcomes after mandibular third molar surgery? A systematic review and meta-analysis.

This systematic review and meta-analysis was performed to investigate whether methylprednisolone (MP) administered via any route improves postoperative outcomes (pain, trismus, and oedema) following mandibular third molar surgery. An electronic search of the PubMed, Scopus, Cochrane CENTRAL, and Google Scholar databases was performed to identify studies published in English up until January 2018. A total of 28 studies were included in the review: 25 randomized clinical trials (RCTs) and three controlled clinical trials. Studies were grouped according to the route of administration of MP for qualitative and quantitative analysis. Three studies were of 'high' quality and 22 were of 'medium' quality; three studies had a high risk of bias. Within the purview of the limitations of this review, the results showed that MP administered via any route significantly improves oedema in the early postoperative period, but has no effect on late postoperative oedema. Oral and intra-masseteric MP also seems to reduce pain and trismus in the early postoperative period. The results also indicate that oral MP may reduce late postoperative pain, while intra-masseteric MP may improve the late trismus outcome. More high quality RCTs are required to provide stronger evidence on the use of MP in third molar surgery.

A new multi-line cusp magnetic field plasma device (MPD) with variable magnetic field.

A new multi-line cusp magnetic field plasma device consisting of electromagnets with core material has been constructed with a capability to experimentally control the relative volume fractions of magnetized to unmagnetized plasma volume as well as accurate control on the gradient length scales of mean density and temperature profiles. Argon plasma has been produced using a hot tungsten cathode over a wide range of pressures 5 × 10-5 -1 × 10-3 mbar, achieving plasma densities ranging from 109 to 1011 cm-3 and the electron temperature in the range 1-8 eV. The radial profiles of plasma parameters measured along the non-cusp region (in between two consecutive magnets) show a finite region with uniform and quiescent plasma, where the magnetic field is very low such that the ions are unmagnetized. Beyond that region, both plasma species are magnetized and the profiles show gradients both in temperature and density. The electrostatic fluctuation measured using a Langmuir probe radially along the non-cusp region shows less than 1% (δIisat/Iisat < 1%). The plasma thus produced will be used to study new and hitherto unexplored physics parameter space relevant to both laboratory multi-scale plasmas and astrophysical plasmas.