Effects of simulated long-term exposure to bottled, neutral pH electrolyzed oxidizing water on the properties of denture base resins.

STATEMENT OF PROBLEM: Denture stomatitis can pose serious health risks, especially to older people. Chemical denture cleaning agents must be effective, yet not adversely affect the longevity of removable dentures. Ready-to-use (RTU) neutral pH electrolyzed oxidizing water (EOW) is an effective biocide against Candida albicans biofilms on denture resins, but the effects of daily disinfection with EOW on the physical and mechanical properties of resins have not been established. PURPOSE: The purpose of this in vitro study was to investigate the effects of simulated long-term exposure to RTU EOW on the color, surface characteristics, and flexural strength of denture base resins. MATERIAL AND METHODS: Heat-polymerized (HP), 3D printed (3D) and computer-aided design and computer-aided manufacture (CAD-CAM)-milled (CC) denture resin specimens (square: 20×20×3.3 mm; beam: 64×10×3.3 mm) were immersed in tap water (TW), RTU EOW (Neutral Anolyte ANK; Envirolyte; EOW), or a commercial denture cleaning tablet solution (Polident 3-Minute; Glaxo SmithKline; PD), mimicking a 5-minute once daily disinfection routine performed up to 3.0 years. Color and surface roughness were recorded (n=3, squares), and changes in color (∆E00) and surface roughness (∆Ra) were calculated. Flexural strength (n=12, beams) and surface hardness (n=18, beams) were measured with a universal testing machine. The fractured surfaces of specimens were examined by scanning electron microscopy and energy dispersive spectroscopy. Data were assessed by performing the Shapiro-Wilk or D'Agostino and Pearson normality tests. Two-way ANOVA or the Kruskal-Wallis test with a post hoc Tukey HSD or Dunn multiple comparisons (α=.05) was used for statistical analyses. RESULTS: No significant changes were found in either color or surface roughness for HP, 3D, and CC resins after 1.5-year and 3.0-year immersion in any of the agents (P>.05). The surface hardness of 3D resins reduced by 14% with TW and by 23% with EOW and PD at 3.0 years. The flexural strengths of all 3 resins were unaffected by 3.0-year immersion (P>.05). CONCLUSIONS: Simulated long-term immersion disinfection with RTU neutral pH EOW did not adversely affect the physical and mechanical properties of HP or CC denture resins.

Electrolysed oxidising water as a multi-purpose biocide in dental healthcare-A scoping review.

OBJECTIVES: The objective of this scoping review was to map evidence of electrolysed oxidising water (EOW) as a biocide for dental applications of relevance to older people and identify research gaps. BACKGROUND: EOW is an emerging, "green," and cost-effective biocide. There are no reviews on the landscape of EOW research as either an antiseptic or disinfectant in dental healthcare or its suitability for the oral healthcare of older people. MATERIALS AND METHODS: The review follows the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. Database searches (Google Scholar, PubMed, Web of Science, Ovid, Scopus and Science Direct) were undertaken using MESH terms and Boolean operators with no date restrictions, to identify full-text, original reports published in English-language peer-reviewed journals. RESULTS: The search yielded 114 papers that met the inclusion/exclusion criteria. Dental applications of EOW include its use as an endodontic irrigant (39%); mouth rinse/surgical irrigant (21%); disinfectant for dental unit water lines (19%) and dental biomaterials (17%); and for antimicrobial efficacy, effects on oral tissues and on dental material properties. Most studies (83%) evaluated a single EOW formulation (acidic, moderately acidic or neutral) that was either generated at 'point-of-use' (POU; 72%), bottled ('ready-to-use', RTU; 24%) or from unspecified (3%) sources. Six reports evaluated storage-related parameters and 25 evaluated clinical applications; 89 were in vitro studies and one investigated the cost-effectiveness of POU EOW. CONCLUSIONS: Neutral-pH, EOW is effective as an antimicrobial agent without deleterious effects on oral tissues. However, research on the impact of storage conditions, anti-Candida biofilm efficacy and mechanism of action against yeasts, long-term effects on denture materials and cost-effectiveness is required to establish the suitability of EOW as a multipurpose biocide for dental healthcare, including infection-control requirements relating to older people.

Influence of Cortical Layer and Surgical Techniques on the Primary Implant Stability in Low-density Bone: An In Vitro Study.

AIM: This study aimed at evaluating the influence of cortical layer and surgical techniques on the primary stability of implants in low-density bone. MATERIALS AND METHODS: Two solid rigid polyurethane blocks with a density equivalent to 0.32 g/cm3 simulating cancellous bone were used. A short fiber-filled epoxy resin sheet of 2 mm was layered to one block to simulate cortico cancellous bone. A total of 40 implants were used in this study (n = 40). Twenty implants each (n = 20) were inserted in cancellous (Group 1) and cortico-cancellous bone (Group 2), of which 10 implants each (n = 10) were placed using undersized preparation technique with surgical drills-A and osteotomes-B, in both the groups. Insertion torque (IT) and implant stability quotient (ISQ) for each implant placed were assessed to determine the primary stability of each implant using a digital torque meter and resonance frequency analyzer, respectively. The values were statistically analyzed using an independent t-test (p < 0.05). Pearson's correlation analysis was performed to correlate between IT and ISQ. RESULTS: Technique B resulted in significantly higher IT and ISQ values in Group 1 (27.69 ± 1.2 N cm; 52.5 ± 1.05 ISQ) and Group 2 (38.8 ± 0.87 N cm; 70.1 ± 1.04 ISQ) compared to those with technique A (22.40 ± 1.62 N cm; 41.75 ± 1.20 ISQ and 33.24 ± 0.67 N cm; 63.72 ± 1.33 ISQ), respectively. Group 2 exhibited significantly higher IT and ISQ values as compared to Group 1 irrespective of the surgical technique employed (p < 0.05). CONCLUSION: The presence of the cortical layer significantly influenced the primary stability and preparing low-density bone with an undersized preparation technique using osteotomes that significantly increased the IT and ISQ. CLINICAL SIGNIFICANCE: Undersizing the preparation site considerably will help achieve a significant increase in primary stability in the poor quality bone as in the posterior maxilla, thereby contributing to the success of the implant.

Compatibility of Nonoriginal Abutments With Implants: Evaluation of Microgap at the Implant-Abutment Interface, With Original and Nonoriginal Abutments.

PURPOSE: The purpose of this study was to evaluate the fit of nonoriginal abutments to implants at the implant abutment junction. MATERIALS AND METHODS: Twenty titanium implants from a single manufacturer were randomly divided into 2 groups of ten each. Ten titanium premachined original abutments (group I) and ten titanium premachined nonoriginal abutments (from different manufacturer-group II) were connected to the implants with the recommended manufacturer torque level and then embedded into autopolymerizing clear acrylic resin blocks. After overnight curing, these blocks were vertically sectioned using water jet sectioning machine and evaluated under scanning electron microscope following the sequential cleaning procedures. The microgap at the implant-abutment interface for all the samples was measured using pixel counting software and subjected to statistical analysis using nonparametric Mann-Whitney U test. RESULTS: The mean microgap at the implant-abutment interface at the external, middle, and internal points was 1.597, 1.399, and 1.831 µm, respectively, for group I and 2.395, 2.488, and 3.339 µm, respectively, for group II samples. Nonparametric Mann-Whitney U test showed statistically significant difference between 2 groups at the midpoint for the nonoriginal abutments compared with the original ones. CONCLUSION: Within the limitations of the study, the mean microgap at the implant-abutment interface at the platform level at the external, middle, and internal points for both original abutments and nonoriginal abutments was found to be within clinically acceptable limits.

Comparative evaluation of the effect of electrolyzed oxidizing water on surface detail reproduction, dimensional stability and Surface texture of poly vinyl siloxane impressions.

AIM: The aim of this in vitro study was to comparatively evaluate the effect of chemical disinfectants on the surface detail reproduction, dimensional stability and surface texture of polyvinyl siloxane (PVS) impressions. MATERIALS AND METHODS: The impressions were then divided into five groups (fifteen samples per group) and subjected to a ten minutes immersion with 2% glutaraldehyde (Group I), 1% sodium hypochlorite (Group II), freshly prepared electrolyzed oxidizing water (EOW) with different pH values - acidic (Group III), alkali (Group IV) and neutral (Group V). The samples were examined pre and post-immersion under visual observation for surface detail reproduction, travelling microscope for measurement of dimensional stability and surface profilometer (3D) for evaluation of surface texture. A standardized master die was fabricated and seventy-five PVS test samples were made. The samples were subjected to immersion disinfection and studied for surface detail reproduction, dimensional stability and surface texture. Post-hoc test, paired t test and ANOVA were used to analyze dimensional stability statistically both within and between the test groups. RESULTS: The surface detail reproduction was satisfactory with both pre and post-immersion test samples. A statistically significant dimensional change was observed post-immersion in Groups II, III and V test samples and a statistically insignificant dimensional change was observed in Groups I and IV test samples. There was a negligible change in surface texture post-immersion in Groups I, III, IV and V test samples with a slight increase in surface roughness post-immersion in Group II samples. CONCLUSION: In this study, all the test disinfectants produced satisfactory surface detail reproduction on Polyvinyl siloxane impressions. 2% glutaraldehyde and electrolyzed oxidizing water (alkali) have resulted in statistically insignificant dimensional change, while 1% sodium hypochlorite, electrolyzed oxidizing water (acidic) and electrolyzed oxidizing water (neutral) have resulted in statistically significant dimensional changes. All the test disinfectants except 1% sodium hypochlorite showed a reduction in surface roughness (Ra) values.

Comparative Evaluation of the Antimicrobial Efficacy of Three Immersion Chemical Disinfectants on Clinically Derived Poly(Vinyl Siloxane) Impressions.

PURPOSE: To comparatively evaluate the antimicrobial efficacy of freshly prepared electrolyzed oxidizing water (EOW) with that of 2.4% glutaraldehyde (GA) and 1% sodium hypochlorite (SH) on clinically derived poly vinyl siloxane (PVS) impressions. MATERIALS AND METHODS: Four clinically derived PVS impressions each were obtained from 10 subjects. One impression from each subject was randomly kept as control (group I), without disinfection. The remaining three impressions were randomly disinfected by immersion in either 2.4% GA (group II), 1% SH (group III), or freshly prepared EOW (group IV). The samples were subjected to microbial culture individually on brain heart infusion (BHI) agar medium. The organisms isolated were confirmed by visual examination and gram staining. Mean colony forming units (CFU) were counted, log10 reduction obtained and compared. Data were statistically analyzed using one-way ANOVA, followed by multiple comparisons using Tukey-HSD post hoc tests (p < 0.05). RESULTS: Streptococci, Staphylococci, Pseudomonas, Candida, Proteus, Klebsiella, and E. coli were isolated from all impressions including the controls, except those disinfected by EOW. All three disinfectants showed significant reduction in CFU and log10 reduction values as compared to the controls. EOW showed significantly higher reduction in log10 values compared to GA and SH, whereas GA and SH showed similar reductions. EOW, GA, and SH showed kill rates of 100%, 99.60%, and 99.82%, respectively. CONCLUSION: EOW showed significant antimicrobial efficacy as evidenced by reduction in log10 values when used as an immersion disinfectant for PVS impressions when compared with the results obtained using GA and SH. These results need further investigation. CLINICAL IMPLICATIONS: EOW shows high antimicrobial efficacy when used as an immersion disinfectant as compared to GA and SH for clinically derived PVS impressions.

Effect of work from home and employee mental health through mediating role of workaholism and work-family balance.

BACKGROUND: The current global outbreak caused by COVID-19 has produced a unique situation with severe health and financial consequences. The fast and quick global impact called for an immediate response. A key public health action was the decision to amend the law to allow employees to work from home (WFH) whenever it was possible. In response to public health restrictions to stop the spread of COVID-19, organizations quickly switched to WFH without fully comprehending the effects of continued WFH on mental and physical health. Working from anywhere and at any time has made the separation between business and personal life more difficult. These modifications may cause employees' workdays to be longer and to experience greater work-life conflict. Overwork and work addiction provide a greater risk to the public's health and can harm various facets of mental and physical health, such as depression, anxiety, and sleep difficulties. There hasn't been much research on the underlying processes that link workaholism to poor mental health, especially among Indian academics. PURPOSE: There is a rise in the number of people who are worried about their mental health in academic settings. The primary purpose of this study is to determine whether academicians in India can potentially have a healthy work-family balance, which may mitigate the negative impacts of workaholism and poor mental health especially due to the Work from Home system. METHODOLOGY: A population-based study was conducted on academicians (n = 456) at private and public universities in Delhi NCR, India. Workaholism, work-family balance, and mental health difficulties were all measured using self-reported scales in the study. By using path analysis, the proposed mediation model was evaluated. The survey responses had an accuracy rate of 80%. Based on the conceptual research framework, PLS-SEM path modeling is used to find the causal connection between the indicators and latent components. FINDINGS: The findings indicated that workaholism has been associated with mental health in two different ways: directly and through work-family balance. The path analysis found a statistically significant relationship between work from home and mental health through workaholism and work-family balance. Increased levels of anxiety, depression, stress, headaches, exhaustion, and reduced job satisfaction were some of the mental health consequences of Work from Home. PRACTICAL IMPLICATION: This study provides real-world guidance to human resource managers on how to prioritize composite-level interventions at all levels of the university to create highly satisfied employees, provide a good working environment, and improve employees' mental health. ORIGINALITY/VALUE: Many researches have been done on the relationship between work-from-home and employee mental health, but relatively few have looked at how work-life balance and workaholism play a role in how work-from-home affects employees' mental health. This study fills a need in the academic and practitioner literature by investigating the relationship between work-from-home from home and employee mental health as well as the mediating function of work-family balance and workaholism with regard to Indian higher education institutions.

A quasi-experimental study on health insurance coverage and health services in Nigeria.

BACKGROUND: Nigeria has the highest maternal mortality rate among sub-Saharan African countries. Recently, universal health insurance coverage has been embraced as a means to enhance population health in low- and middle-income countries. Hitherto, the effect of health insurance coverage on the utilisation of facility-level delivery is largely unknown in the face of the earnest need to lower maternal mortality rates in developing countries. AIM: To empirically investigate the association of health insurance coverage on health services utilisation of facility-level delivery and the extent to which public- and private-sector facility delivery in Nigeria had a disproportionate associational effect with health insurance coverage, in the universal health coverage era. SETTING: A cross-sectional study conducted for Nigeria. METHODS: This study employed a quasi-experimental method using propensity scores along with different matching methods that were applied to the most recent wave of Nigeria's Demographic and Health Survey (2020) data. RESULTS: Evidence suggests that childbearing mothers from insured households had an average of 25% probability of utilising facility-level delivery relative to mothers from uninsured households in the year that preceded the survey. Moreover, private-sector facility delivery had a 31% higher associational effect with health insurance coverage than public-sector facility delivery, which had an estimated probability of 21%. CONCLUSION: Expansion of health insurance coverage in Nigeria will be a desirable way to stimulate the utilisation of facility-level delivery by women of childbearing age. Consequently, coverage expansion has the potential to save many maternal and newborn lives in Nigeria.Contribution: This study has contributed to the urgent attention of the federal government of Nigeria to monitor and revamp the health insurance coverage policies of the country for better facilitation of health services to the Nigerian population.

Pharmacological evaluation of embelin - chitosan nanoparticles as an antidiabetic agent.

Embelin has been reported to possess variety of pharmacological activities such as androgenic antagonists, antiangiogenic, antibacterial, anticancer, anticonvulsant, antidiabetic, antidepressant, antihelmintic, antifertility, antihyperlipidemic, anti-inflammatory, antimalarial, antimitotic, antiobesity and antioxidant properties. The current research work aimed to study the hypoglycemic effect of embelin-chitosan nanoparticles (ECNPs) diabetic rats provoked by streptozotocin (STZ). Embelin nanoparticles (ENPs) were created by combining chitosan, a natural biopolymer, and glutaric acid, a new cross-linker. STZ 50 mg/kg was given intravenously into Sprague-Dawley rats weighing 250-300 g (75-90 days) to induce experimental diabetes. The antidiabetic efficacy of orally administered ECNPs in diabetic rats developed by STZ was investigated, as well as histological examination. When compared to diabetic control rats, ECNPs (25 mg/kg body weight and 50 mg kg body weight) and standard glibenclamide (10 mg/kg body weight) treated rodents exhibited a remarkable drop in glucose contents. Furthermore, histological research showed that ECNPs-treated rats were harmless up to amount of 25 mg/kg bwt. Thus current investigation reveals that ECNPs have antidiabetic potential and may be beneficial in treating hyperglycemia in people.

Acute flaccid myelitis: long-term outcomes recorded in the CAPTURE study compared with paediatric transverse myelitis.

BACKGROUND: Since 2014, the USA has documented three outbreaks of acute flaccid myelitis (AFM). Unique features and treatment responses of this myelitis variant have not been prospectively studied. This study prospectively measured outcomes in paediatric myelitis patients relative to treatments. METHODS: This was a prospective, multicentre, non-randomised, observational cohort study. The study duration was 5 years and the length of follow-up was 1 year. This study collected data from children and families in North America. Patients were enrolled at academic centres with expertise in myelitis or online via a web portal. Paediatric patients diagnosed with myelitis were eligible for enrolment in the study within 6 months of onset of symptoms. Patients were characterised as transverse myelitis (TM) or the AFM variant based on clinical and radiographic findings. RESULTS: The cohort of 90 patients included patients with AFM and TM. Of the 51 patients with AFM there was evidence of two clinically relevant patterns. This included a grey matter restricted form of AFM and a cohort with concomitant white matter that could explain lower extremity motor deficits in patients with lesions restricted to the cervical spine. The improvement in deficits with the use of corticosteroids was similar to what was observed in the TM cohort (p=0.97). CONCLUSIONS: Clinicians should consider on a case by case basis the approach to therapy for AFM patients. Prospective controlled studies of long-term outcomes would be useful in this growing patient population.

Design and Synthesis of Novel 1-substituted-3-(3-(3-nitrophenyl)-4-oxo-3,4-dihydrobenzopyrimidin-2-yl amino) Isothioureas for their Anti-HIV, Antibacterial Activities, Graph Theoretical Analysis, Insilico Modeling, Prediction of Toxicity and Metabolic Studies.

In the present study, we have placed the substituted thiosemicarbazide moiety at the C-2 position and 3-nitrophenyl group at N-3 position of benzopyrimidines and studied their antitubercular, anti-HIV and antibacterial activities against selected gram positive and negative bacteria. The target compounds 1-substituted-3-(3-(3-nitrophenyl)-4-oxo-3,4-dihydrobenzopyrimidin-2-ylamino) isothioureas (PTS1 - PTS15: ) were obtained by the reaction of 2-hydrazino-3-(3-nitrophenyl) benzopyrimidin-4(3 H)-one (5: ) with different alkyl/aryl isothiocyanates followed by methylation with dimethyl sulphate. All synthesized compounds were screened for their antitubercular, anti-HIV and antibacterial activity against selective gram positive and gram negative bacteria by agar dilution method. Among the series, compound 2-methyl-3-(3-(3-nitrophenyl)-4-oxo-3,4-dihydrobenzopyrimidin-2-ylamino)-1-(3-chlorophenyl)isothiourea (PTS14): shown most potent activity against Klebsiella pneumoniae, Proteus vulgaris and Staphylococcus aureus; PTS14: exhibited the antitubercular activity at the minimum microgram of 1.56 µg/mL and anti-HIV activity at 0.96 µg/mL against HIV1 and HIV2 and offers potential for further optimization and development to new antitubercular and anti-HIV agents. The results obtained from this study confirm that the synthesized and biologically evaluated benzopyrimidines showed promising antimicrobial, antitubercular and anti-HIV activities and are new scaffolds for antimicrobial activity.

Surface Characteristics and Bioactivity of Zirconia (Y-TZP) with Different Surface Treatments.

BACKGROUND: Zirconia being a bio-inert material needs to be surface treated to render it more bioactive and enhance its osseointegration potential. However, bioactivity studies focusing on the ability of sandblasting and ultraviolet photofunctionalization (UVP) surface treatments in inducing apatite precipitation using simulated body fluid (SBF) are lacking. AIM: The aim of the study was to comparatively evaluate the effect of two different surface treatments-sandblasting with 50 µm alumina and UVP with ultraviolet C (UVC) light on the bioactivity of zirconia. MATERIALS AND METHODS: A total of 33 discs with dimensions 10 mm × 2 mm were obtained from zirconia blanks (Amann Girrbach, Koblach, Austria) and randomly divided into three groups (n = 11), namely Group I (untreated), Group II (sandblasted), and Group III (UVP). Surface characteristics of representative test samples were analyzed using X-ray diffraction (XRD), atomic force microscopy (AFM), contact angle goniometry, scanning electron microscopy (SEM), and energy dispersive X-ray spectroscopy (EDX), to assess type of crystal phase of zirconia, surface roughness, wettability, surface topography, and elemental composition, respectively. SBF was prepared and calcium content in SBF (Ca-SBF) was determined using inductively coupled plasma mass spectrometry (ICP-MS). RESULTS: Data were analyzed by one-way analysis of variance (ANOVA), post hoc Tukey honestly significant difference (HSD), and Student's t test for statistical significance (P < 0.05, significant; P < 0.01, highly significant). Surface characteristics analyses revealed that XRD showed predominant tetragonal (t) zirconia crystal phase for all test groups. Mean surface roughness (Sa) of Group I was 41.83 nm, and it was significantly lesser than that of Group II (115.65 nm) and Group III (102.43 nm). Mean contact angles were 98.26°, 86.77°, and 68.03° for Groups I, II, and III, respectively, and these differences were highly significant. Mean pre-immersion Ca content in SBF was found to be 159 mg/L. Mean post-immersion Ca content was 70.10, 60.80, and 56.20 mg/L for Groups I, II, and III, respectively. Significant differences were found between Group I as compared to both Groups II and III. Bioactivity of Group III was marginally, but insignificantly higher with respect to Group II. Groups II and III were insignificant with respect to each other. Post-immersion XRD revealed predominant "t" phase, and SEM-EDX revealed well-formed, abundant calcium apatite layer on the treated samples as compared to that on untreated sample and an increasing Ca/P ratio from 1.15, 1.79 to 2.08, respectively from Group I to Group III. CONCLUSION: Within the limitations of this study, both sandblasting and UVP significantly and similarly improved bioactivity of zirconia as compared to the untreated samples, which was corroborated by the SEM-EDX results.

New onset transverse myelitis diagnostic accuracy and patient experiences.

IMPORTANCE: Patients afflicted with rare diseases often have a delay in diagnosis and treatment. Understanding the prevalence and impact of delayed diagnosis in transverse myelitis could trigger directed educational initiatives to increase clinician awareness and improve care. OBJECTIVE: To determine if symptoms at onset or care provider initially approached was associated with time to diagnosis, treatment or outcome in patients with transverse myelitis. DESIGN: This was an online patient and caregiver standardized survey to collect data about the initial medical experience. Patients were recruited through social media to complete a survey about initial symptoms, care provider approached for diagnosis, first events (hospital admission, testing, sent home, etc.), first diagnosis, time to treatment and outcomes. The data was collected by an independent, non-profit patient advocacy organization (The Transverse Myelitis Association) and provided to researchers for analysis. SETTING: This was an online survey of a prevalent cohort of individuals diagnosis with transverse myelitis. PARTICIPANTS: Patients with various autoimmune disorders responded to the survey. These included patients with multiple sclerosis, neuromyelitis optica, acute disseminated encephalomyelitis and idiopathic transverse myelitis. Only data about patients, greater than a year of age, with a diagnosis of transverse myelitis were included in the study.

Comparative Evaluation of the Masking Ability of Lithium Disilicate Ceramic with Different Core Thickness on the Shade Match of Indirect Restorations over Metallic Substrate: An In vitro Study.

PURPOSE: The purpose of this in vitro study was to comparatively evaluate the masking ability of lithium disilicate ceramic with different core thickness on the shade match of indirect restorations over metallic substrate. MATERIALS AND METHODS: A total of 30 heat pressed lithium disilicate ceramic discs of low translucency were fabricated with diameter 10mm and thickness of 1 mm, 1.3 mm and 1.6mm with each thickness consisting of 10 samples to be used in the study. Thirty Ni-Cr metal discs of diameter 10mm were used to simulate metallic substrates .The colour difference of the lithium disilicate ceramic disc before and after cementation were measured using CIE LAB system. RESULTS: The mean colour difference (ΔE) of Group I,Group II, Group III before cementation with the Ni-Cr metal discs was 17.32,13.01 and 11.73 respectively. The mean colour difference (ΔE) of Group I,Group II, Group III after cementation with the Ni-Cr metal discs was 16.32,12.10, 11.05 respectively. CONCLUSION: The mean colour difference of the three groups were found to be more than the clinically acceptable perceptibility threshold (ΔE < 3.3) indicative of reduced masking ability of all the three groups of ceramic discs over metallic substrate used in this study.

IL-6 induces regionally selective spinal cord injury in patients with the neuroinflammatory disorder transverse myelitis.

Transverse myelitis (TM) is an immune-mediated spinal cord disorder associated with inflammation, demyelination, and axonal damage. We investigated the soluble immune derangements present in TM patients and found that IL-6 levels were selectively and dramatically elevated in the cerebrospinal fluid and directly correlated with markers of tissue injury and sustained clinical disability. IL-6 was necessary and sufficient to mediate cellular injury in spinal cord organotypic tissue culture sections through activation of the JAK/STAT pathway, resulting in increased activity of iNOS and poly(ADP-ribose) polymerase (PARP). Rats intrathecally infused with IL-6 developed progressive weakness and spinal cord inflammation, demyelination, and axonal damage, which were blocked by PARP inhibition. Addition of IL-6 to brain organotypic cultures or into the cerebral ventricles of adult rats did not activate the JAK/STAT pathway, which is potentially due to increased expression of soluble IL-6 receptor in the brain relative to the spinal cord that may antagonize IL-6 signaling in this context. The spatially distinct responses to IL-6 may underlie regional vulnerability of different parts of the CNS to inflammatory injury. The elucidation of this pathway identifies specific therapeutic targets in the management of CNS autoimmune conditions.

Interleukin-17 in transverse myelitis and multiple sclerosis.

CSF IL-6 is elevated in transverse myelitis (TM) and predicts disability. Since IL-17 regulates cytokines (TNFalpha, IL-1beta and IL-6) known to stimulate IL-6 production by astrocytes, we sought to determine whether IL-17 was increased in TM and MS compared to healthy controls (HC) and other neurologic diseases (OND). IL-17 and IL-6 levels were measured in stimulated peripheral blood mononuclear cell (PBMC) supernatants from HC, MS, TM and OND. IL-17 was increased in TM compared to HC, MS, and OND (mean pg/ml+/-standard error; HC: 36.1+/-11.7, MS: 89.4+/-23.3, TM: 302.6+/-152.5, OND: 41.2+/-13.0, p=0.01). IL-6 was increased in TM relative to MS and HC (HC: 2624 pg/ml+/-641, MS: 6129+/-982, TM: 12,536+/-2657, OND: 6920+/-1801, p<0.002). MS patients with early disease (<2 years) also had increased levels of IL-17 (p<0.04) and IL-6 (p<0.05). Cytokine neutralization experiments demonstrated that IL-6 was the main inducer of astrocyte IL-6 production. We conclude that IL-17 and IL-6 production from PBMC in TM and early MS are increased and induce astrocyte IL-6 production through IL-6.

Viral-induced spinal motor neuron death is non-cell-autonomous and involves glutamate excitotoxicity.

Neuroadapted Sindbis virus (NSV) is a neurotropic virus capable of inducing the death of spinal motor neurons in mice and rats. In this study we investigated the mechanisms that underlie NSV-induced motor neuron death. We found that many degenerating spinal motor neurons were not infected directly with NSV, suggesting that bystander cell death occurs. An excitotoxic mechanism was confirmed when blockade of calcium-permeable AMPA receptors attenuated motor neuron death both in vitro and in vivo. Blockade of astroglial glutamate reuptake potentiated NSV-induced motor neuron loss in vivo, suggesting that astrocyte-mediated removal of perisynaptic glutamate is important in limiting NSV-induced excitotoxic injury. Astroglial glutamate transport was reduced markedly in the spinal cord during NSV infection, in advance of motor neuron injury in susceptible mice. In contrast, we found 5.6-fold elevated glutamate uptake in the spinal cords of mice resistant to NSV-induced paralysis. Likewise, minocycline markedly increased spinal cord glutamate transport and protected mice from NSV-induced motor neuron death. These studies suggest that NSV infection triggers a cascade of events in the spinal cord resulting in impaired astrocytic glutamate transport and excitotoxic injury of motor neurons mediated via calcium-permeable AMPA receptors. Similar changes may occur in other motor neuron disorders such as amyotrophic lateral sclerosis or West Nile Virus-induced poliomyelitis, suggesting a common tissue injury pathway.

Human embryonic germ cell derivatives facilitate motor recovery of rats with diffuse motor neuron injury.

We have investigated the potential of human pluripotent cells to restore function in rats paralyzed with a virus-induced motor neuronopathy. Cells derived from embryonic germ cells, termed embryoid body-derived (EBD) cells, introduced into the CSF were distributed extensively over the rostrocaudal length of the spinal cord and migrated into the spinal cord parenchyma in paralyzed, but not uninjured, animals. Some of the transplanted human cells expressed the neuroglial progenitor marker nestin, whereas others expressed immunohistochemical markers characteristic of astrocytes or mature neurons. Rare transplanted cells developed immunoreactivity to choline acetyltransferase (ChAT) and sent axons into the sciatic nerve as detected by retrograde labeling. Paralyzed animals transplanted with EBD cells partially recovered motor function 12 and 24 weeks after transplantation, whereas control animals remained paralyzed. Semi-quantitative analysis revealed that the efficiency of neuronal differentiation and extension of neurites could not account for the functional recovery. Rather, transplanted EBD cells protected host neurons from death and facilitated reafferentation of motor neuron cell bodies. In vitro, EBD cells secrete transforming growth factor-alpha (TGF-alpha) and brain-derived neurotrophic factor (BDNF). Neutralizing antibodies to TGF-alpha and to BDNF abrogated the ability of EBD-conditioned media to sustain motor neuron survival in culture, whereas neutralizing antibodies to BDNF eliminated the axonal outgrowth from spinal organotypics observed with direct coculture of EBD cells. We conclude that cells derived from human pluripotent stem cells have the capacity to restore neurologic function in animals with diffuse motor neuron disease via enhancement of host neuron survival and function.

Diagnosis and management of acute myelopathies.

BACKGROUND: Acute myelopathies represent a heterogeneous group of disorders with distinct etiologies, clinical and radiologic features, and prognoses. Transverse myelitis (TM) is a prototype member of this group in which an immune-mediated process causes neural injury to the spinal cord, resulting in varying degrees of weakness, sensory alterations, and autonomic dysfunction. TM may exist as part of a multifocal CNS disease (eg, MS), multisystemic disease (eg, systemic lupus erythematosus), or as an isolated, idiopathic entity. REVIEW SUMMARY: In this article, we summarize recent classification and diagnostic schemes, which provide a framework for the diagnosis and management of patients with acute myelopathy. Additionally, we review the state of current knowledge about the epidemiology, natural history, immunopathogenesis, and treatment strategies for patients with TM. CONCLUSIONS: Our understanding of the classification, diagnosis, pathogenesis, and treatment of TM has recently begun to expand dramatically. With more rigorous criteria applied to distinguish acute myelopathies and with an emerging understanding of immunopathogenic events that underlie TM, it may now be possible to effectively initiate treatments in many of these disorders. Through the investigation of TM, we are also gaining a broader appreciation of the mechanisms that lead to autoimmune neurologic diseases in general.

Partial Edentulism and its Correlation to Age, Gender, Socio-economic Status and Incidence of Various Kennedy's Classes- A Literature Review.

Partial edentulism, one or more teeth missing is an indication of healthy behaviour of dental practices in the society and attitude towards dental and oral care. The pattern of partial edentulism has been evaluated in many selected populations in different countries by different methods. Most of the studies have evaluated partial edentulism by surveying of Removable Partial Dentures (RPDs), patients visiting clinics, clinical records and population in particular locality. The objective of the study is to review the prevalence of partial edentulousness and its correlation to age,gender, arch predominance, socio economic factors and incidence of various Kennedy's Classes. Key observations drawn from the review are as below. There is no gender correlation for partial edentulism.Prevalence of partial edentulism is more common in mandibular arch than maxillary arch.Younger adults have more Class III and IV RPDs. Elders have more distal extension RPDs Class I and II.