Temporal and institutional trends in robotic surgery.

Robotic surgery has become increasingly prevalent in general surgery practice. While previous studies have shown the safety and efficacy of robotic assistance in laparoscopic general surgery procedures, few studies have evaluated the temporal and regional trends in implementation. In our retrospective population-based study, we aim to evaluate the national trends in robotic surgery. National Inpatient Database (NIS 2009-2014) was used to identify adults who underwent robotic assisted surgery (ICD 9 codes 17.41 to 17.49). Robotic procedures related to seven abdominal organ systems were compared against the trends of Urology, Gynaecologic, and Orthopedic robotic procedures. Discharge weights were applied to calculate National temporal trends separated by hospital size, teaching status and US geographic region. 894,163 patients received a robotic assisted procedure between 2009 and 2014 with 64% increase in utilization. The largest percent change was witnessed in biliary robotic procedures with 2984% change in utilization, followed by hernia (1376%). Lowest percent change was witnessed in esophageal procedures with 114% increase. Medium sized hospitals had the largest change in robotic utilization (41%), with large institutions seeing 18% decrease. Gastric procedures were the most common robotic procedure performed at small institutions (7917 total cases; 316%). Large institutions saw an overall decrease in gastric (- 47%), esophageal (- 17%), small and large intestinal (-16%), and hepatic (- 7%) robotic procedures. Rural non-teaching hospitals saw the largest increase in robotic surgery (274%). Urban non-teaching hospitals saw a decrease of 29%. While urban teaching institutions saw a 20% and 6% increase in gynecological and urological procedures, an overall decrease was seen in esophageal (- 10%), gastric (- 12%), intestinal (- 11%), hepatic (- 17%), biliary (- 10%), pancreatic (- 11%) and hernia procedures (- 14%). Biliary procedures saw the largest increase in rural institutions (740 cases; 392%), followed by hernia (144% increase). South region of the nation had the largest increase in robotic procedures (23%). No change was seen in the use of robotic surgery in the northeast region with the midwest and west seeing an overall decrease (- 4% and - 22%, respectively). Our study highlights the increase in use of robotics for both general and specialty surgery, with an increase in utilization over time. Increased incidence of robotic surgery in smaller, rural institutions with overall decrease in larger, urban teaching hospitals suggests increasing comfort in robotic surgery in the community setting. Further studies are necessary to evaluate the factors associated with increased utilization in smaller institutions.

Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India.

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.

Comparison of bacterial colonization on absorbable non-coated suture with Triclosan- or Chlorhexidine-coated sutures: a randomized controlled study.

OBJECTIVE: The oral cavity is a colossal reservoir for the bacteria. The healing of tissues is compromised after flap surgery, particularly in the presence of sutures, as they can act as repositories for bacteria, ultimately leading to surgical site infections. Hence, antibacterial-coated sutures have been considered as an alternative to reduce the risk of these infections and further improve the wound healing of the tissues after flap surgery. Since minimal information is available on the effect of antibacterial-coated sutures on periodontal tissues, this study aims to clinically and microbiologically assess the antibacterial efficacy of Triclosan (TCS) and Chlorhexidine-coated sutures (CCS) on periodontal tissues compared to non-coated sutures (NCS). PATIENTS AND METHODS: A total of 75 subjects with moderate to severe periodontitis were included in the study and randomly allocated to one of the three groups, (TCS, CCS, and NCS groups) equally. Suture removal was performed on postoperative day 8, and parameters such as wound healing and post-operative pain were evaluated. The retrieved suture samples were subjected to microbiological analysis and the bacteria were identified quantitatively and qualitatively. RESULTS: Intragroup analysis of the wound healing index and post-operative pain for all the groups showed a significant improvement (p<0.01), from day 8 to day 30. Intergroup analysis of the wound healing index revealed significant wound healing (p<0.05) on day 15 and day 30. For post-operative pain, intergroup analyses showed significantly low pain scores (p<0.01) for the TCS group. Microbiologic analysis of aerobic colony counts in both anterior and posterior regions revealed significantly (p<0.01) least colony counts in TCS and highest colony counts in NCS groups, respectively. Although anaerobic colony counts were not statistically significant, relatively fewer colony counts were identified in the TCS group. Whereas, relatively higher anaerobic colony counts were seen in the CCS group in the anterior region and in the NCS group in the posterior region. Qualitative assessment revealed higher amounts of Streptococcus and Staphylococcus species in all the three groups (TCS, CCS, and NCS groups). CONCLUSIONS: Antibacterial-coated sutures, particularly Triclosan-coated sutures, are effective in reducing bacterial accumulation compared to non-coated sutures. Therefore, these sutures can be effectively utilized in periodontal flap surgery.

In Vitro Evaluation of marginal adaptation of polyether ether ketone and zirconia copings.

Background: Polyether ether ketone (PEEK) has emerged as a new thermoplastic material with potential applications as a restorative material. Aim: This study aimed to evaluate the marginal adaptation of PEEK copings compared to zirconia copings using field emission scanning electron microscopy. Materials and Methods: A freshly extracted maxillary central incisor was prepared for a full-coverage restoration following standard principles of tooth preparation. The tooth was sent to a laboratory for fabrication of samples using computer-aided design and manufacturing (CAD/CAM). Twenty samples of polyether ether ketone (PEEK) copings (group A) and 20 of zirconia copings were fabricated (group B). The copings were scanned under a field emission scanning electron microscope and measurements were taken at four distinct points. The marginal adaptation over the buccal, lingual, mesial, and distal margins for both groups was evaluated. One-way analysis of variance (ANOVA) and independent t test were applied. Results: Our findings indicate that PEEK showed better marginal adaptation than zirconia at all measurement points. The mean marginal gap value of the PEEK group was 33.99 ± 8.81 µm and of the zirconia group was 56.21 ± 15.07 µm. On comparing marginal adaptation among the mesial, distal, buccal, and lingual aspects, PEEK showed better adaptation on all four margins, with the best adaptation on the buccal margin that had the lowest mean gap value of 29.27 ± 6.07 µm. The zirconia group adapted best at the distal margin, with a lowest mean gap value of 53.58 ± 15.25 µm (P ≤ 0.05). Conclusion: PEEK copings had better marginal adaptation and fit compared to zirconia copings. It may have applications as a restorative material in fixed prostheses.

Antimicrobial Efficacy of Blended Essential Oil and Chlorhexidine against Periodontal Pathogen (P.gingivalis)-An In Vitro Study.

Background: Essential oils (EOs) have a considerable amount of therapeutic and preventive effect in treating dental diseases due to their wider potential as antibacterial and anti-inflammatory agents. EOs like virgin coconut oil, eucalyptus oil, peppermint oil thyme oil, and clove oil, when used in combination, may further have enhanced antimicrobial effects. However, limited information exists on the synergistic effect of these oils when used in combination, especially on the primary periodontal pathogen Porphyromonas gingivalis. Aim: The current study aims to compare the antimicrobial efficacy of commercially available EO on the periodontal pathogen, P. gingivalis, in comparison to chlorhexidine (CHX). Materials and Methods: Antimicrobial efficacy of EO and CHX was assessed at various concentrations against the periodontal pathogen P. gingivalis, by evaluating the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). Results: P. gingivalis was seen to be sensitive at a MIC of 100 µg/ml and 50 µg/ml concentration of the EO, which is regarded as the MIC of EO against P. gingivalis and CHX effectively inhibited microbial growth at 0.4 µg/ml. Conclusion: A combination of EOs possesses a potent antibacterial activity against P. gingivalis, and the antibacterial efficacy increases with increasing concentration of EOs.

Cerebrospinal fluid inflammatory cytokine profiles of patients with neurotropic parasitic infections.

The pathogenesis of chronic parasitic central nervous system (CNS) infections, including granulomatous amoebic meningoencephalitis (GAE), cerebral toxoplasmosis (CT), and neurocysticercosis (NCC), is primarily due to an inflammatory host reaction to the parasite. Inflammatory cytokines produced by invading T cells, monocytes, and CNS resident cells lead to neuroinflammation which underlie the immunopathology of these infections. Immune molecules, especially cytokines, can therefore emerge as potential biomarker(s) of CNS parasitic infections. In this study, cerebral spinal fluid (CSF) samples from suspected patients with parasitic infections were screened for pathogenic free-living amoebae by culture (n=2506) and PCR (n=275). Six proinflammatory cytokines in smear and culture-negative CSF samples from patients with GAE (n = 2), NCC (n = 7), and CT (n = 23) as well as control (n = 7) patients were measured using the Multiplex Suspension assay. None of the CSF samples tested was positive for neurotropic free-living amoebae by culture and only two samples showed Acanthamoeba 18S rRNA by PCR. Of the six cytokines measured, only IL-6 and IL-8 were significantly increased in all three infection groups compared to the control group. In addition, TNFa levels were higher in the GAE and NCC groups and IL-17 in the GAE group compared to controls. The levels of IL-1b and IFNg were very low in all the infection groups and the control group. There was a correlation between CSF cellularity and increased levels of IL-6, IL-8, and TNFa in 11 patients. Thus, quantifying inflammatory cytokine levels in CSF might help with understanding the level of neuroinflammation in patients with neurotropic parasitic diseases. Further studies with clinico-microbiological correlation in the form of reduction of cytokine levels with treatment and the correlation with neurological deficits are needed.

Diode laser targeting red-complex bacteria in periodontitis: a systematic review.

OBJECTIVE: This systematic review examines the effectiveness of diode laser irradiation in reducing the levels of red complex bacteria as well as periodontal parameters of pocket depth and clinical attachment level. MATERIALS AND METHODS: We conducted electronic searches across databases such as Scopus, Embase, Medline, and Web of Science databases in July 2022. Randomized controlled trials that evaluated the reduction of red-complex bacteria in patients with periodontitis using diode lasers were included. The primary focus was the reduction in the microbial count of red complex bacteria, whereas probing depth and attachment level were considered secondary outcomes. Articles in languages other than English were excluded. Study quality was assessed based on the Cochrane Handbook for Systematic Reviews of Interventions and the ROB2 tool. RESULTS: After searching the databases, eight independent studies were included, with a sample size of 210 subjects. The average age group of the study population was 30-60 years, and there was a lack of consensus on the antimicrobial effect of diode lasers. Out of the eight studies, four studies reported no significant difference in the levels of red complex bacteria before and after laser application. Three studies reported significantly lower levels of red complex bacteria in the intergroup comparison. One study reported that laser had no significant effect on intergroup bacterial levels. The combination of diode laser irradiation with scaling reduced the count of red complex bacteria and improved the clinical parameters, although not significantly. CONCLUSIONS: Based on the limited evidence available, the adjunctive use of diode laser for scaling and root planning may provide some additional benefit in terms of reduction of red complex bacterial count and clinical parameters. Further well-designed trials and the use of objective measures are necessary before outlining universal guidelines for best practice. The adjunctive use of diode laser in non-surgical periodontal therapy may provide a reduction in the red complex microbial count and improvement in clinical parameters, decreasing the need for periodontal surgery.

Biosynthesis, Characterization, Evaluation, and Shelf-Life Study of Silver Nanoparticles against Cotton Bollworm, Helicoverpa armigera (Hubner) (Noctuidae: Lepidoptera).

Nanoparticles provide a promising and alternative platform of eco-friendly technologies that encompasses better cost-resilient remedies against one of the most economically harnessing insect pests of cotton. The main goal of this research was to provide a better management strategy through biologically synthesizing (sunlight exposure method) green nanoparticles from leaf extracts of Azadirachta indica and Pongamia pinnata and proving their bioefficacy on H. armigera (2nd instar). Characterization of bio-synthesized silver nanoparticles was carried out using UV-Visible spectroscopy for confirming the formation of nanoparticles, a Particle Size Analyzer (PSA) for determining the size/distribution of particles, and a Scanning Electron Microscope (SEM) for analyzing the surface topology of nanoparticles. The results obtained from PSA analysis showed that A. indica and P. pinnata-based silver nanoparticles had an average diameter of 61.70 nm and 68.80, respectively. Topographical images obtained from SEM proved that most of the green synthesized silver nanoparticles were spherical in shape. A. indica-based silver nanoparticles were found to be comparatively more efficient and have higher insecticidal activity compared to P. pinnata-based nanoparticles. A. indica-based AgNPs recorded larval mortality of 60.00 to 93.33 percent at the concentrations of 500 to 2000 ppm, followed by P. pinnata-based nanoparticles, with 60.00 to 90.00 percent larval mortality. Shelf-life studies revealed that A. indica-based AgNPs had the maximum negative zeta potential of -58.96 mV and could be stored for three months without losing bioefficacy and up to six months with negligible reduction in bioefficacy. Symptoms caused by silver nanoparticles were leakage of body fluids, sluggishness, inactiveness, brittleness, etc.

Prevalence of electronic cigarette usage among medical students in Saudi Arabia - A systematic review.

The systematic review aimed to report the prevalence of electronic cigarette (e-cigarette) usage among medical students in Saudi Arabia. Electronic databases were searched for scientific research articles published from January 2010 until December 2020. The data search was performed in electronic search engines such as PubMed, Google Scholar, Scopus, Web of Science, Medline, Embase, Cochrane, and Saudi Digital Library. A total of five research articles that qualified the eligibility criteria were analyzed for qualitative data. The sample size in the included studies ranged from 229 to 1007 participants. The prevalence of e-cigarette usage ranged from 10.6% to 27.7% among medical students in Saudi Arabia. Studies have also reported that the prevalence of e-cigarette usage is higher among the male population in comparison with the female population. The prevalence of e-cigarette usage among medical students in Saudi Arabia is high. Similar to tobacco smoking, e-cigarette usage is a major public health issue and concern among the younger population because they have potential benefits in some and are harmful to some and also it is still unclear whether they are effective for quitting smoking. Regulatory bodies must focus and initiate strict laws and policies to minimize the sales of these products to the younger population. Health promotion strategies need to be developed to reduce the usage of e-cigarettes.

Micromolar Metabolite Measurement in an Electronically Multiplexed Format.

OBJECTIVE: The detection of metabolites such as choline in blood are important in clinical care for patients with cancer and cardiovascular disease. Choline is only present in human blood at low concentrations hence accurate measurement in an affordable point-of-care format is extremely challenging. Although complementary metal-oxide semiconductor (CMOS) and microfluidics are individually mature technologies, their integration has presented challenges that we overcome in a novel, cost-effective, single-step process. METHODS: To demonstrate the process, we present the microfluidic integration of a metabolomics-on-CMOS point-of-care platform with four capillary microfluidic channels on top of a CMOS optical sensor array. RESULTS: The fabricated device was characterised to verify the required structural profile, mechanical strength, optical spectra, and fluid flow. As a proof of concept, we used the device for the in-vitro quantification of choline in human blood plasma with a limit of detection of 3.2 µM and a resolution of 1.6 µM. SIGNIFICANCE: Integration of microfluidics on to CMOS technology has the potential to enable advanced sensing technologies with extremely low limit of detection that are well suited to multiple clinical metabolite measurements.

The involvement of caregivers of patients with dementia during mastoid surgery under local anaesthesia.

BACKGROUND: With a growing ageing population, there is a higher prevalence of dementia in patients with conditions that can be managed surgically. Patients with dementia undergoing surgery under general anaesthesia often have poorer outcomes than those without. Therefore, local anaesthesia can be an option. METHODS: Two patients with severe dementia and advanced cholesteatoma were identified for operative management. They were deemed too high risk to proceed with general anaesthesia. This article describes our experience of performing mastoid surgery under local anaesthesia in the presence of a primary carer in the operating theatre. RESULTS: The complete extirpation of cholesteatoma was achieved in both cases. The carers reported that local anaesthesia helped to facilitate communication and aid patient co-operation. CONCLUSION: Our experience, albeit limited to two cases, illustrates an alternative individualised peri-operative strategy in the surgical management of patients with dementia and concurrent advanced cholesteatoma.

Prevalence and Pattern of Self-medication with Alternative Medicine: Treatment-switch Analysis in Oral Submucous Fibrosis Patients.

AIM: The aim of this study was to investigate prevalence and pattern of self-medication with alternative medicine (ALM) among oral submucous fibrosis (OSF) patients with emphasis on treatment-switch analysis. METHODS: A total of 115 OSF patients were recruited and subjected to scientifically validated questionnaire. Two groups were identified: S-ALM: patients who have previously received modern medicinal treatment but switched to ALM; and DN-ALM: patients who started ALM from De Novo. RESULTS: A total of 37 (32.18%) patients reported use of the ALM at some point of time. Twenty-five (67.56%) switched to ALM, whereas 12 (32.43%) patients used ALM from De Novo. The pattern of switching to ALM in short period was significantly prevalent in patients with advanced stages (stage III and IV) as compared to early stages (stage I and II) of OSF. Clarified butter, glycerin, and honey were the most commonly used ALM in both the groups. The most common reasons for switching to ALM were the cost of treatment (32.00%), longer duration of medicinal treatment (24.00%) and ineffectiveness of the medications (24.00%). CONCLUSIONS: ALM usage is common in OSMF patients with significant percentage of patient switched from modern medicine to ALM. Therapeutic efficacy of ALM in OSF needs exploration in future.

Recurrent endometrial carcinoma metastasis to the temporal bone and skull base.

A 62-year old woman presented with a 1-month history of left otalgia, facial palsy and hearing loss. She had a background of non-insulin-dependent diabetes mellitus and stage 2 endometrial adenocarcinoma, treated 18 months ago. Computed tomography scan showed erosion of the skull base and temporal bone. She was referred to the otolaryngology team with a diagnosis of necrotising otitis externa. On clinical examination, there was an exophytic, necrotic lesion in the ear canal arising from the posterior canal wall. A subsequent magnetic resonance imaging scan showed a lesion located in the left jugular foramen extending into the middle ear, with characteristics consistent with a glomus jugulo-tympanicum. Interestingly, histology of the lesion showed malignant cells with immunohistochemical staining suggestive of an adenocarcinoma. This is the first reported case of metastatic endometrial carcinoma involving the jugular foramen and temporal bone. Although a diagnosis is rare, it is important to consider it when other differential diagnoses are not fitting. Imaging should always be interpreted with caution, correlating to the clinical findings.

Triple-negative breast cancers with expression of glucocorticoid receptor in immune cells show better prognosis.

Background: Glucocorticoid receptor (GR) is shown to have variable frequency of expression in invasive tumors of the breast. Investigation of additional nuclear receptors like GR in receptor negative tumors like triple negative breast cancer (TNBC) may have prognostic and therapeutic significance. Methods: Expression of GR was evaluated by immunohistochemistry in 175 tumors of invasive breast cancer with long term follow up. GR Expression was separately evaluated in invasive tumor cells, stromal cells and tumor infiltrating lymphocytes (TIL's). Staining pattern was categorised as positive when more than 1% of the cells stained in each subpopulation of cells. Disease free survival was analysed between GR positive and negative status by Kaplan Meier analysis. Results: Of the 175 tumors, 121 (70%) were ER positive, 53 (30%) were ER negative and 29% (51) were triple negative. 74% (130/175) tumors showed expression of GR in invasive tumor cells while (84%) 147/175 had expression in TIL's. No significant difference in distribution of GR was noted between ER positive and ER negative tumors (78% vs 66%, p-0.1). Of the TNBC's 54% (28/51) and 70% (36/51) showed expression of GR in invasive tumor and TIL's respectively. Overall, GR positive tumors had significant better survival than GR negative tumors (mean survival time of 85 vs 59 months respectively, p-0.04) Contrary to the reports that GR expression in TIL's are associated with immunosuppressive activity in model systems, TNBC's with increased expression of GR in immune cells were associated with better survival (Mean survival time 74 vs 41 months, log rank test- p-0.03). TNBC tumors which were GR negative had higher lymph node metastases (p-0.04) and none of the other clinical features like age, menopausal state, tumor size and grade were different between GR positive and negative tumors within TNBC. Conclusions: Glucocorticoids (GC) are often used to alleviate the adverse symptoms during chemotherapy. Determining the GR status is of importance due to the pro cell survival effect of the glucocorticoids mediated through GR during chemotherapy. Though GC mediated effects on chemotherapy are controversial, our results indicate favourable effects in TNBC.

How do we improve adolescent diet and physical activity in India and sub-Saharan Africa? Findings from the Transforming Adolescent Lives through Nutrition (TALENT) consortium.

OBJECTIVE: Adolescent diet, physical activity and nutritional status are generally known to be sub-optimal. This is an introduction to a special issue of papers devoted to exploring factors affecting diet and physical activity in adolescents, including food insecure and vulnerable groups. SETTING: Eight settings including urban, peri-urban and rural across sites from five different low- and middle-income countries. DESIGN: Focus groups with adolescents and caregivers carried out by trained researchers. RESULTS: Our results show that adolescents, even in poor settings, know about healthy diet and lifestyles. They want to have energy, feel happy, look good and live longer, but their desire for autonomy, a need to 'belong' in their peer group, plus vulnerability to marketing exploiting their aspirations, leads them to make unhealthy choices. They describe significant gender, culture and context-specific barriers. For example, urban adolescents had easy access to energy dense, unhealthy foods bought outside the home, whereas junk foods were only beginning to permeate rural sites. Among adolescents in Indian sites, pressure to excel in exams meant that academic studies were squeezing out physical activity time. CONCLUSIONS: Interventions to improve adolescents' diets and physical activity levels must therefore address structural and environmental issues and influences in their homes and schools, since it is clear that their food and activity choices are the product of an interacting complex of factors. In the next phase of work, the Transforming Adolescent Lives through Nutrition consortium will employ groups of adolescents, caregivers and local stakeholders in each site to develop interventions to improve adolescent nutritional status.

Facile manufacturing of fused-deposition modeled composite scaffolds for tissue engineering-an embedding model with plasticity for incorporation of additives.

The fused-deposition modeling (FDM) process is carried out at an elevated temperature, preventing the addition of biological factors, drugs, bioactive compounds, etc, during fabrication. To overcome this disadvantage, a 3D interlinked porous polylactic acid (PLA) scaffold was fabricated by FDM, followed by the embedding of a polycaprolactone (PCL) scaffold into the pores of the PLA at room temperature, yielding a PLA-PCL scaffold. In addition, PLA-PCL scaffolds with nanohydroxyapatite (PLA-PCL-nHAP) and multiwalled carbon nanotubes (PLA-PCL-MWCNT) were also fabricated. Here, the FDM-fabricated PLA scaffold functions as the structural component, whereas the embedded PCL scaffold acts as the functional component, which provides a the ability to functionalize the scaffolds with the desired chemical or biological materials. The embedding process is straightforward, cost effective, and does not require sophistication. A mechanical characterization of the scaffolds suggests that the Young's modulus of the PLA-PCL scaffold (16.02 MPa) was higher than that of the FDM-fabricated PLA (9.98 MPa) scaffold, by virtue of embedded PCL matrix. In addition, finite element analysis showed that the von Mises stress on a mandible with scaffolds was 4.04 MPa, whereas for a mandible with a defect, it was 6.7 MPa, confirming the stress distribution efficiency and mechanical stability of these scaffolds. Furthermore, field emission-scanning electron microscope analysis implied the presence of interlinked porous structures with pore diameters of 50 µm to 300 µm. X-ray diffraction results revealed an increased crystallinity (%) in the embedded models (PLA-PCL, PLA-PCL-nHAP and PLA-PCL-MWCNT), compared to a PLA printed scaffold. Additionally, Raman analysis revealed that the embedding process did not cause chemical alterations in the polymeric chains. In vitro analysis with human osteoblasts demonstrated the osteoconductive nature of the scaffold, which supported mineralization. In brief, the advantage of our model is that it helps to overcome the difficulties of manufacturing a filament with the desired additives for FDM, and offers the ability to incorporate the desired concentrations of heat-labile bioactive molecules during the embedding process at ambient temperatures.

Fabrication of tri-layered electrospun polycaprolactone mats with improved sustained drug release profile.

Modulation of initial burst and long term release from electrospun fibrous mats can be achieved by sandwiching the drug loaded mats between hydrophobic layers of fibrous polycaprolactone (PCL). Ibuprofen (IBU) loaded PCL fibrous mats (12% PCL-IBU) were sandwiched between fibrous polycaprolactone layers during the process of electrospinning, by varying the polymer concentrations (10% (w/v), 12% (w/v)) and volume of coat (1 ml, 2 ml) in flanking layers. Consequently, 12% PCL-IBU (without sandwich layer) showed burst release of 66.43% on day 1 and cumulative release (%) of 86.08% at the end of 62 days. Whereas, sandwich groups, especially 12% PCLSW-1 & 2 (sandwich layers-1 ml and 2 ml of 12% PCL) showed controlled initial burst and cumulative (%) release compared to 12% PCL-IBU. Moreover, crystallinity (%) and hydrophobicity of the sandwich models imparted control on ibuprofen release from fibrous mats. Further, assay for cytotoxicity and scanning electron microscopic images of cell seeded mats after 5 days showed the mats were not cytotoxic. Nuclear Magnetic Resonance spectroscopic analysis revealed weak interaction between ibuprofen and PCL in nanofibers which favors the release of ibuprofen. These data imply that concentration and volume of coat in flanking layer imparts tighter control on initial burst and long term release of ibuprofen.

Comparison of biochemical markers of bone metabolism between conventional labial and lingual fixed orthodontic appliances.

OBJECTIVES: The applied orthodontic force causes remodeling of the periodontium through the selective release of cytokines causing resorption of bone, enabling controlled movement of the tooth. This study compared the cytokine profile between patients treated with conventional labial and lingual fixed orthodontic appliances. PATIENTS AND METHODS: The study included 80 patients in need of orthodontic treatment, out of which 40 patients were treated by the labial fixed appliance and 40 by the lingual fixed appliance. Gingival crevicular fluid (GCF) specimens were gathered from both the groups using a microcapillary pipette. The samples were collected at the beginning of the treatment and after 21 days. Enzyme-linked immunosorbent assay was performed to evaluate the cytokine levels. RESULTS: Interleukin (IL)-1α, 1ß, 2, 8, and tumor necrosis factor-alpha (TNF-α) levels were significantly high (P < 0.001) in GCF of participants treated with conventional labial fixed appliance. IL-1α, 1ß, 2, 6, 8, and TNF-α levels were significantly high (P < 0.001) in GCF of participants treated by the lingual fixed appliance. The concentrations of TNF-α and IL-1ß were increased higher than other cytokines in both the treatment groups. CONCLUSION: Overall, the lingual fixed appliance had higher cytokine levels than a labial fixed appliance. Analyzing the GCF cytokine levels during orthodontic treatment could provide an ideal platform for monitoring the progress of the treatment.

MRI Guided Magneto-chemotherapy with High-Magnetic-Moment Iron Oxide Nanoparticles for Cancer Theranostics.

Elevating and monitoring the temperature of tumors using magnetic nanoparticles (MNPs) still presents a challenge in magnetic hyperthermia therapy. The efficient heating of tumor volume can be achieved by preparing MNPs with high magnetization values. The next-generation approach to magnetic resonance image (MRI)-guided magneto-chemotherapy of cancer based on high-magnetic-moment iron oxide nanoparticles is proposed. The proof of concept is validated by cellular MRI experiments on breast cancer cells. To explore magneto-chemotherapy, we developed high-magnetic-moment iron oxide (Fe3O4) nanoparticles (NPs) using base diisopropylamine (DIPA), which plays a dual role as reducing agent and surface stabilizer. Spherical NPs with ∼12 nm size and a high magnetization value of about 92 emu g-1 at room temperature are obtained by this unique method. A high specific absorption rate value of ∼717 wg-1 was obtained for Fe3O4 NPs in water at an alternating magnetic field of 20 kAm-1 and frequency of 267 kHz, which is attributed to the high magnetization value. The magneto-polymeric micelle structure is formed by using Pluronic F127, and anticancer drug doxorubicin is conjugated in the micelle by electrostatic interactions for magneto-chemotherapy. Finally, the magnetic resonance imaging (MRI)-guided magneto-chemotherapy was achieved on breast cancer (MCF7) cells with an overall ∼96% killing of cancer cells attained in 30 min of magneto-chmeotherapy.