CHARACTERISATION OF RESORBABLE AND NON- RESORBABLE SUTURES COATED WITH Punica granatum SEED EXTRACT: AN in vitro PILOT STUDY.

BACKGROUND: In order to achieve uneventful and rapid healing of the tissues, a suture material should be biocompatible, easy to handle, sterile, and have good and uniform tensile strength. Hence, in the present study, characterization of the suture materials was done through a novel green chemistry approach using Punica granatum seed extract. MATERIALS AND METHODS: Ethanolic extract of P. granatum seed was prepared by dissolving 25 g of P. granatum seed powder with 100 mL of ethanol. The obtained extract was coated in silk and Vicryl suture material and was tested for its surface morphology (SEM), tensile strength, anti-microbial activity, biocompatibility, and wound healing potential. RESULTS: Silk and Vicryl sutures coated with P. granatum seed extract showed the uniform coating and deposition of extract with sustaining integrity. Vicryl suture coated with the extract had good tensile strength and antimicrobial activity. The in vitro scratch assay and biocompatibility test showed that the P. granatum seed extract had excellent wound healing potential and can be used without any effect on the viability of the normal cells. CONCLUSION: Within the limitations of the study it can be concluded that P. granatum seed extract coated Vicryl sutures had good tensile strength and anti-microbial activity. P. granatum seed extract also showed excellent biocompatibility and wound healing potential.

Surgical Management of Mandibular Subcondylar Fractures Under Local Anesthesia: A Proposed Protocol.

PURPOSE: The optimal treatment for adult mandibular condylar fractures (MCFs) has largely shifted in favor of open reduction and rigid internal fixation. However, a sizeable portion of these injuries are still being treated in a closed manner based on old literature, convenience, results deemed acceptable, and lesser associated morbidity. Most MCFs with multiple associated facial traumas are appropriately treated under general anesthesia (GA). However, some selected isolated MCFs or those with minimal associated mandibular or low midfacial fractures can be treated optimally with patients under local anesthesia following a protocol presented in this article, thus expediting and simplifying their management. The purpose of this study was to develop a safe, sound, effective protocol for routine surgical management of mandibular subcondylar fractures under local anesthesia. PATIENTS AND METHODS: We carried out a prospective clinical study to assess the feasibility of operating on MCFs with patients under local anesthesia. Seven patients with MCFs and other associated facial fractures underwent surgery after careful case selection following our proposed protocol. The outcome variables were 1) duration of the procedure, 2) intraoperative pain assessed by a visual analog scale, 3) fracture reduction assessed by measuring the preoperative and postoperative average fracture gap, 4) presence of malocclusion preoperatively and postoperatively, 5) deviation on mouth opening, and 6) maximal mouth opening. RESULTS: The mean duration of the procedure was 35.14 minutes, and the mean rating of intraoperative pain or discomfort was 0.57 as reported on the visual analog scale by the patients. Mean mouth opening improved from 17.1 to 40.5 mm, whereas deviation on opening improved from 4.4 to 0.28 mm. The average fracture gap was reduced from 6.32 to 0.97 mm. CONCLUSIONS: The presented protocol is a straightforward, efficient, safe, cost-effective tool for operating on MCFs, avoiding GA with its attendant risks and complications, that can be used routinely, as well as in patients for whom GA is deemed unsuitable.

Second primary uterine malignancies after radiation therapy for cervical cancer.

PURPOSE: Radiation exposure has long been established as a risk factor for cancer development. The purpose of this study is to assess the risk of uterine malignancy in patients previously treated for cervical cancer with radiation therapy. METHODS: A population-based cohort of 9092 patients diagnosed with cervical cancer who did not undergo surgery and received radiation therapy between 1973 and 2008 was identified from the Surveillance, Epidemiology and End Results Program database (SEER 9). Patients in this cohort who developed endometrial cancer after treatment of cervical cancer were identified. 55,140 patients with endometrial cancer were also identified. The distribution of the different histologic types of endometrial cancer was determined for each of these cohorts. RESULTS: 54 patients (0.6%) were diagnosed with an endometrial cancer more than 12 months after diagnosis of cervical cancer. The average latency to endometrial cancer diagnosis was 160 months, with a range of 14-374 months. The average age of cervical cancer diagnosis was 52 years and the average age at subsequent endometrial cancer diagnosis was 66 years. Only 40% of the endometrial cancers diagnosed following treatment of cervical cancer were endometrioid. The majority were clear-cell adenocarcinomas (42%), 9% were carcinosarcomas and 5.5% were leiomyosarcomas. Of the 55,140 endometrial cancer patients in the database, a vast majority were endometrioid adenocarcinomas (91%), and only 2.3% clear-cell adenocarcinoma, 2.3% carcinosarcoma and 0.5% leiomyosarcoma. The difference in histologic type distribution between these two cohorts is highly significant (p < 0.01). CONCLUSION: A small proportion of women who receive radiation for cervical cancer go on to develop endometrial cancer. These are predominantly of the more aggressive histologic types when compared to primary endometrial cancers. The latency from cervical cancer diagnosis to endometrial cancer diagnosis is over a decade. In a patient who still has a uterus after receiving pelvic radiation, vaginal bleeding should be investigated.

Induced-Charge Capacitive Deionization: The Electrokinetic Response of a Porous Particle to an External Electric Field.

We demonstrate the phenomenon of induced-charge capacitive deionization that occurs around a porous and conducting particle immersed in an electrolyte, under the action of an external electric field. The external electric field induces an electric dipole in the porous particle, leading to its capacitive charging by both cations and anions at opposite poles. This regime is characterized by a long charging time, which results in significant changes in salt concentration in the electrically neutral bulk, on the scale of the particle. We qualitatively demonstrate the effect of advection on the spatiotemporal concentration field, which, through diffusiophoresis, may introduce corrections to the electrophoretic mobility of such particles.

Non-invasive assessment of endothelial function in children with obesity and lipid disorders.

BACKGROUND: Digital tonometry is designed to non-invasively screen for endothelial dysfunction by the detection of impaired flow-induced reactive hyperaemia in the fingertip. We determined whether digital reactive hyperaemia correlated with risk factors for atherosclerosis in two groups of children at increased risk for endothelial dysfunction. METHODS: A total of 15 obese children and 23 non-obese, dyslipidaemic children, 8-21 years of age, were enrolled, and their medical histories, anthropometric measurements, carotid wall thickness by means of ultrasonography, and fasting blood samples for cardiovascular risk factors were obtained. The standard endoPAT index of digital reactive hyperaemia was modified to reflect the true peak response or the integrated response of the entire post-occlusion period. In each group, age, sex, pubertal status, carotid wall thickness, and multiple cardiovascular risk factors were tested as predictors of endothelial dysfunction. RESULTS: In the non-obese, dyslipidaemic group, but not in the obese group, both indices strongly correlated with height (r=0.55, p=0.007, by peak response) followed by weight, waist circumference, and age. In both groups, neither index of reactive hyperaemia significantly correlated with any other cardiovascular risk factor. CONCLUSIONS: Contrary to the known age-related increase in atherosclerosis, digital reactive hyperaemia increased with age and its correlates in non-obese, dyslipidaemic children and was not related to other cardiovascular risk factors in either group. The reason for the lack of this relationship with age in obese children is unknown. The age-dependent physiology of digital microvascular reactivity and the endothelium-independent factors controlling the peak hyperaemic response need further study in children with a wide age range.

Alternate-day dosing of itraconazole in healthy adult cats.

The current available formulations of itraconazole are not ideal for dosing in cats. The capsular preparation often does not allow for accurate dosing, the oral solution is difficult to administer and poorly tolerated, and the bioavailability of compounded formulations has been shown to be poor in other species. The aim of this study was to evaluate every other day dosing of 100 mg itraconazole capsule in healthy adult cats. Ten healthy adult cats received a 100 mg capsule of itraconazole orally every 48 h for 8 weeks. Peak and trough serum concentrations of itraconazole were measured weekly using high-performance liquid chromatography (HPLC). Physical examination, complete blood count (CBC), and chemistry profiles were performed weekly. The dosage regimen achieved average therapeutic trough concentrations (>0.5 µg/mL) within 3 weeks. The protocol yielded no adverse effects in 8 of the 10 study cats, with affected cats recovering fully with discontinuation of the drug and supportive care. At 8 weeks, an average peak concentration of 1.79 ± 0.952 µg/mL (95% CI: 0.996-2.588) and an average trough concentration of 0.761 ± 0.540 µg/mL (95% CI: 0.314-1.216) were achieved. Overall, a 100 mg every other day oral dosage regimen for itraconazole in cats yielded serum concentrations with minimal fluctuation and with careful monitoring may be considered for treatment of cats with systemic fungal disease.

ABCG2pos lung mesenchymal stem cells are a novel pericyte subpopulation that contributes to fibrotic remodeling.

Genesis of myofibroblasts is obligatory for the development of pathology in many adult lung diseases. Adult lung tissue contains a population of perivascular ABCG2(pos) mesenchymal stem cells (MSC) that are precursors of myofibroblasts and distinct from NG2 pericytes. We hypothesized that these MSC participate in deleterious remodeling associated with pulmonary fibrosis (PF) and associated hypertension (PH). To test this hypothesis, resident lung MSC were quantified in lung samples from control subjects and PF patients. ABCG2(pos) cell numbers were decreased in human PF and interstitial lung disease compared with control samples. Genetic labeling of lung MSC in mice enabled determination of terminal lineage and localization of ABCG2 cells following intratracheal administration of bleomycin to elicit fibrotic lung injury. Fourteen days following bleomycin injury enhanced green fluorescent protein (eGFP)-labeled lung MSC-derived cells were increased in number and localized to interstitial areas of fibrotic and microvessel remodeling. Finally, gene expression analysis was evaluated to define the response of MSC to bleomycin injury in vivo using ABCG2(pos) MSC isolated during the inflammatory phase postinjury and in vitro bleomycin or transforming growth factor-ß1 (TGF-ß1)-treated cells. MSC responded to bleomycin treatment in vivo with a profibrotic gene program that was not recapitulated in vitro with bleomycin treatment. However, TGF-ß1 treatment induced the appearance of a profibrotic myofibroblast phenotype in vitro. Additionally, when exposed to the profibrotic stimulus, TGF-ß1, ABCG2, and NG2 pericytes demonstrated distinct responses. Our data highlight ABCG2(pos) lung MSC as a novel cell population that contributes to detrimental myofibroblast-mediated remodeling during PF.

What should men living with haemophilia need to know? The perspectives of Canadian men with haemophilia.

Haemophilia is an inherited bleeding disorder affecting approximately 3000 Canadian men (Walker 2012). To manage their disease effectively individuals must be knowledgeable about the disease, bleed prevention strategies, treatment approaches, and complications. Data on individuals' knowledge levels are scarce. The availability of such data could lead to better educational strategies for disease management. The aim of this study was to determine current knowledge levels, needs and gaps among Canadian individuals with haemophilia to facilitate optimal disease management. A survey was disseminated to adult males with haemophilia at three Haemophilia Treatment Centres (HTCs) in Canada. Self-reported current knowledge levels and knowledge seeking were measured. Survey respondents reported highest levels of knowledge in the following areas: identifying and treating a bleed, haemophilia and physical activity, travel, career issues and genetics. Lower levels of knowledge were reported in the areas of sexual activity, product safety, information about factor, haemophilia and ageing, advocacy, timing of prophylactic infusions, and new or alternative therapies. Treating a bleed was the most commonly sought information, followed by information about factor, product safety, identifying a bleed and other health care issues. There was a positive correlation between knowledge seeking and severity of disease. HTC attendance was associated with knowledge seeking, and HTCs were the most frequented knowledge source, followed by the Canadian Haemophilia Society website. Canadian men were well informed; the HTC's role in knowledge sharing was recognized. Timing of infusions, sexual activity and ageing are areas which should be targeted in knowledge sharing.

Efficacy of Tranexamic Acid in Preventing Alveolar Osteitis in Post-extraction Sockets of First Premolars.

OBJECTIVES: The present study is a randomized trial for comparing the effectiveness of tranexamic acid as an antifibrinolytic agent in preventing alveolar osteitis in the post-extraction period in patients receiving orthodontic therapy that requires extraction. METHODOLOGY: This research was carried out in the Department of Oral and Maxillofacial Surgery, Saveetha Dental College and Hospitals, Chennai, India. A total of 40 patients were considered subjects for the research. Patients undergoing orthodontic treatment referred to the Department of Oral and Maxillofacial Surgery for the therapeutic extractions of the first premolars were considered for this study. Randomization was done to split the population into study and control. After the atraumatic extraction of the first premolars under local anesthesia using 2% lignocaine with 1:80000 adrenaline, a tranexamic acid solution of 500 mg soaked gauze over the extraction sockets was used as the intervention in the study group, and plain gauze was used on the control group. Patients were asked to hold the gauze in place for one hour. Participants were reviewed after three days for the incidence of alveolar osteitis and pain severity and healing of the extraction sockets.  Results: The prevalence of Alveolitis sicca dolorosa was found to be 5% in the research group and 15% in the control group. Patients in the control group showed more pain than the patients in the research group. The period taken for healing ranged from 7 days to 10 days in the control group and 10 days to 12 days in the study group.  Conclusion: This study gives an edge that tranexamic acid can be used as a local hemostatic agent in preventing fibrinolysis of clots and preventing alveolar osteitis.

Comparison of the Efficacy of Two Different Local Anesthesia Techniques for Mesotherapy in Temporal Region Alopecia.

Introduction Mesotherapy is a wide range of minimally invasive injections. In mesotherapy, a mixture of various tonics is injected into the skin. These include plant extracts, various medications, vitamins, enzymes, hormones, growth factors, and other factors that will help treat alopecia. Most commonly, a mixture of platelet-rich plasma (PRP) and vitamins is used. In mesotherapy treatment for hair regrowth in the temporal region, zygomaticotemporal nerve blocks, supratrochlear nerve blocks, and supraorbital nerve blocks are given. The zygomaticotemporal nerve, supraorbital nerve, and supratrochlear nerve are the branches of the trigeminal nerve. They provide sensation on the lateral side of the forehead, which is the temple region.  Methods A sample size of 100 people was taken for the study who were undergoing mesotherapy in the bilateral temporal region for alopecia. Each group had 50 subjects: group I was given supratrochlear, supraorbital, and zygomaticotemporal nerve blocks as local anesthesia techniques, and group II was given supratrochlear and supraorbital nerve blocks. PRP was injected using an insulin syringe. Pain was assessed using a visual analog scale (VAS). Results During the procedure, a mean VAS of 1 and 3 was observed in groups I and II, respectively, during the procedure (p-value 0.023). A mean VAS of 3 and 5 was observed in groups I and II, respectively, after three hours (p-value 0.000). This shows a significant difference in the pain experienced by the subjects between the groups.  Conclusion This study proves that the zygomaticotemporal nerve, used along with supratrochlear and supraorbital nerve blocks, is better at producing analgesia and reducing pain.

Comparison of Efficacy of Platelet-Rich Plasma With and Without Topical Minoxidil for Hair Growth in Patients With Androgenetic Alopecia: A Prospective Study.

Introduction Androgenetic pattern of alopecia is a common problem occurring in men, which mostly arises from their younger age. There are many therapies advocated in the literature for hair loss reduction, and one of them is platelet-rich plasma (PRP) therapy. This study aimed to assess the efficacy of combined PRP therapy with topical minoxidil over PRP as monotherapy in hair loss reduction and regeneration of new hair. Materials and methods The study was conducted at our institute in the Department of Oral and Maxillofacial Surgery at Saveetha Dental College and Hospital. The study consisted of 40 participants, 20 of whom had only PRP therapy as part of their treatment, while the other 20 participants received PRP combined with topical minoxidil as treatment. Both group participants were evaluated for postoperative hair shaft diameter and hair follicle density. Parameters were measured preoperatively and postoperatively after one month, two months, and three months. Data analysis was done with the help of SPSS, with P-values less than 0.05 considered statistically significant. The Mann-Whitney U test was used to compare the two groups for measurement of hair shaft diameter, and for comparison between hair follicle density, an unpaired t-test was used. Results It was found that the mean hair shaft diameter in the PRP with minoxidil group was higher than that of the PRP group for one month (P = 0.023), two months (P = 0.001), and three months (P = 0.001) postoperative periods, and the results were statistically significant. Hair follicle density (mean hair quantity) was higher in the PRP group than in the PRP with the minoxidil group in the first postoperative month. However, this difference was not statistically significant (P = 0.08). While the mean hair quantity in the PRP with minoxidil group was higher than that in the PRP group for two months (P = 0.45) and three months (P = 0.001) postoperative periods, the results were statistically significant only at the three-month postoperative period. Conclusion It can be concluded that injectable autologous PRP with minoxidil as a topical agent is a better treatment option for the improvement of both hair quality (hair shaft diameter) and hair quantity (hair follicle density) compared to plain autologous injectable PRP monotherapy.

Comparison of the Efficacy Between Regional Nerve Block and Ring Block as Local Anesthetic Techniques for Platelet-Rich Plasma Treatment.

Introduction Platelet-rich plasma (PRP), a solution of concentrated platelets, has been widely used to promote wound repair and tissue regeneration. In the treatment of pattern hair loss, platelets in PRP secrete an abundance of growth factors, including platelet-derived growth factor (PDGF), fibroblast growth factor(FGF), and many more, which stimulate and increase signaling molecules and accelerate cell proliferation. In the PRP treatment for hair regrowth, the supratrochlear nerve (STN) block and supraorbital nerve (SON) block are given to anesthetize the scalp up to the vertex except for the temporal region. The ring block is the common local anesthetic technique used by infiltrating local anesthetic agents around the target area. The primary objectives were to compare the pain and anesthetic success rates produced by regional nerve blocks and ring blocks. Materials and methods A sample size of 100 patients undergoing PRP treatment for hair regrowth were taken as the subjects for the study. Patients were allotted into two groups by randomization. Group 1 was given regional nerve blocks as the anesthetic technique used for local anesthesia, and group 2 was given ring blocks. In the study group, STN and SON blocks as the regional nerve blocks were given 2% lignocaine with 1:80000 adrenaline to anesthetize the area, and the PRP was injected from the anterior hairline up to the vertex of the scalp, not involving the occipital and temporal regions. In the control group, a ring block was given for the same procedure. Participants from both groups were assessed for the pain and analgesia caused by ring block and regional nerve blocks using the visual analog scale (VAS). Results A mean rank of 30.28 was observed for the regional nerve block technique, and a mean rank of 70.72 was observed for the ring block technique. A p-value of 0.00 that is <0.05 was observed, which shows there is a significant difference in the pain and the analgesia experienced by the subjects between the two groups, during and three hours after the procedure. Conclusion PRP is one of the most commonly used treatments for hair regrowth. The ring block is the common local anesthetic technique used for producing anesthesia, while regional nerve blocks are more effective in producing local anesthesia. This study proves that STN and SON blocks are better anesthetic techniques than the ring block technique for PRP treatment in hair growth.

Association of hypomagnesemia with inferior survival in a phase III, randomized study of cetuximab plus best supportive care versus best supportive care alone: NCIC CTG/AGITG CO.17.

BACKGROUND: Cetuximab-induced hypomagnesemia has been associated with improved clinical outcomes in advanced colorectal cancer (CRC). We explored this relationship from a randomized clinical trial of cetuximab plus best supportive care (BSC) versus BSC alone in patients with pretreated advanced CRC. PATIENTS AND METHODS: Day 28 hypomagnesemia grade (0 versus ≥1) and percent reduction (<20% versus ≥20%) of Mg from baseline was correlated with outcome. RESULTS: The median percentage Mg reduction at day 28 was 10% (-42.4% to 63.0%) for cetuximab (N = 260) versus 0% (-21.1% to 25%) for BSC (N = 251) [P < 0.0001]. Grade ≥1 hypomagnesemia and ≥20% reduction from baseline at day 28 were associated with worse overall survival (OS) [hazard ratio, HR 1.61 (95% CI 1.12-2.33), P = 0.01 and 2.08 (95% CI 1.32-3.29), P = 0.002, respectively] in multivariate analysis including grade of rash (0-1 versus 2+). Dyspnea (grade ≥3) was more common in patients with ≥20% versus < 20% Mg reduction (68% versus 45%; P = 0.02) and grade 3/4 anorexia were higher in patients with grade ≥1 hypomagnesemia (81% versus 63%; P = 0.02). CONCLUSIONS: In contrast to prior reports, cetuximab-induced hypomagnesemia was associated with poor OS, even after adjustment for grade of rash.

High tracking of apolipoprotein B levels from the prepubertal age to adolescence in Spanish children.

AIM: To assess tracking of lipid and apolipoproteins from the prepubertal age (baseline, 6-8 years old) to adolescence (follow-up, 13-16 years old) in Spanish children. METHODS: The sample population included 385 healthy children (179 boys and 206 girls). Tracking was estimated by correlations between baseline and follow-up levels, multiple regression models in which the follow-up lipid was the dependent variable and analysing the percentage of individuals who remained in the same lipid levels status from prepubertal age to adolescence. RESULTS: Correlations between baseline and follow-up levels for low density lipoprotein (LDL)-cholesterol and apolipoprotein B (apo B) were stronger in boys and for high density lipoprotein-cholesterol and apo A-I stronger in girls. Regression analyses showed that, after adjusting by body mass index (BMI), baseline LDL-cholesterol and apo B levels explain 23% and 39% of the variation of follow-up LDL-cholesterol and apo B levels, respectively, in boys and 13% and 22%, respectively, in girls. The strength of tracking for LDL-cholesterol and apo B was 79% and 89%, respectively, in boys and 72% and 82%, respectively, in girls. CONCLUSION: Apolipoprotein B showed the strongest tracking in both sexes, stronger than for LDL-cholesterol, which supports the importance of determining apo B levels as a marker of dyslipidaemia in children.

An Extremely Rare Case of Synchronous Low-Grade Polymorphous Adenocarcinoma With Canalicular Adenoma of the Minor Salivary Gland of the Palate.

Tumors of the salivary gland are a group of complex, heterogeneous lesions that are located either in the parotid gland, submandibular gland, sublingual gland, or minor salivary glands. These tumors have a wide range of etiology, pathophysiology, treatment, and prognosis. Multiple salivary gland tumors are extremely rare and usually occur more commonly in major salivary glands than in minor glands. A 61-year-old man with a chief complaint of swelling in the upper jaw for the past eight years reported to the department of oral and maxillofacial surgery. Incisional biopsy revealed a canalicular adenoma (CA) of the minor salivary gland of the palate. Wide local excision was done with closure using a buccal pad of fat and a collagen sheet. Surprisingly, the excisional biopsy was suggestive of synchronous low-grade polymorphous adenocarcinoma (PAC) with CA of the minor salivary gland of the palate. This appears to be the first reported case of PAC with CA found in the palate.

Botulinum Toxin Injection for Masseteric Hypertrophy Using 6 Point Injection Technique - A Case Report. Proposal of a Clinical Technique to Quantify Prognosis.

Introduction: Masseter hypertrophy presents as unilateral or bilateral swellings over the ramus and angle of the mandible. It is caused by malocclusion, clenching, TMJ disorders, etc and alters facial symmetry, leading to discomfort and negative cosmetic impact in many patients, making this a popular request for aesthetic and functional correction. Materials and Methods: This case report involves injecting Botulinum toxin into 6 equidistant bulging points on the masseter. Standardized photography and clinical parameters were used to assess facial contour and masseter muscle thickness at baseline and successive follow ups. Results and Discussion: Significant masseteric bulk reduction was observed in subsequent follow ups. Conclusion: The 6-point technique was found to be an effective treatment modality for Botox injection in masseteric hypertrophy. The clinical method to quantify prognosis was easy and economical.

Psychiatric disorders in youth with medically unexplained chest pain versus innocent heart murmur.

OBJECTIVE: To examine the prevalence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychiatric disorders in youth with chest pain compared with a control sample with innocent heart murmur. STUDY DESIGN: We assessed youth ages 8 to 17 years who were examined in cardiology settings for medically unexplained chest pain (n=100) or innocent heart murmur (n=80). We conducted semi-structured interviews and assessed medical history, quality of life, and disability. RESULTS: Youth with chest pain had a higher prevalence of psychiatric disorders compared with youth with murmur (74% versus 47%, χ(2)=13.3; P<.001). Anxiety disorders predominated, although major depression was also more common in the chest pain group (9% versus 0%; Fisher exact tests; P<.01). Onset of psychiatric disorders generally preceded chest pain. Patterns were similar for boys and girls and for children and adolescents. Chest pain was associated with poorer quality of life and with pain-related disability for youth with co-morbid psychiatric disorder. CONCLUSIONS: In childhood and adolescence, medically unexplained chest pain is associated with a high prevalence of psychiatric disorders. Systematic mental health screening may improve detection and enhance treatment of these patients.

Oxygen-mediated enhancement of primary hepatocyte metabolism, functional polarization, gene expression, and drug clearance.

The liver is a major site for the metabolism of xenobiotic compounds due to its abundant level of phase I/II metabolic enzymes. With the cost of drug development escalating to over $400 million/drug there is an urgent need for the development of rigorous models of hepatic metabolism for preclinical screening of drug clearance and hepatotoxicity. Here, we present a microenvironment in which primary human and rat hepatocytes maintain a high level of metabolic competence without a long adaptation period. We demonstrate that co-cultures of hepatocytes and endothelial cells in serum-free media seeded under 95% oxygen maintain functional apical and basal polarity, high levels of cytochrome P450 activity, and gene expression profiles on par with freshly isolated hepatocytes. These oxygenated co-cultures demonstrate a remarkable ability to predict in vivo drug clearance rates of both rapid and slow clearing drugs with an R(2) of 0.92. Moreover, as the metabolic function of oxygenated co-cultures stabilizes overnight, preclinical testing can be carried out days or even weeks before other culture methods, significantly reducing associated labor and cost. These results are readily extendable to other culture configurations including three-dimensional culture, bioreactor studies, as well as microfabricated co-cultures.

mRNA Expression of Ezrin in Gingival Crevicular Fluid and Whole Blood of Gingivitis and Chronic Periodontitis Patients - A Polymerase Chain Reaction Study.

Background: A comparative analysis of protein expression of gingival crevicular fluid (GCF) obtained from healthy individuals and individuals with periodontal diseases would help to identify proteins involved in periodontal disease progression. Among the identified proteins, Moesin which is a disease-associated protein belongs to the ezrin-radixin-moesin protein family and was proved to play an important role in the recognition of oral bacteria contributing to the consequent development of inflammatory immune responses involved in periodontal disease development. Aim: The aim of the study is to quantify and compare mRNA expression levels of ezrin in GCF and whole blood of gingivitis and chronic periodontitis patients. Materials and Methods: A total of 60 patients were selected for the study and were divided into three groups as follows: Group 1 (20 participants with healthy gingiva), Group 2 (20 participants with gingivitis), and Group 3 (20 participants with chronic periodontitis). Clinical parameters such as gingival index, periodontal index, probing pocket depth, and clinical attachment level were assessed. GCF and blood samples were taken from these patients and assessed for the mRNA expression of ezrin using real-time polymerase chain reaction. Results: The expression and mean relative quantification of mRNA expression of ezrin in GCF and blood were higher for periodontitis (18.32 ± 8.398, 19.34 ± 9.487) when compared to that of gingivitis (5.34 ± 3.609, 5.48 ± 4.428) and healthy individuals (2.33 ± 0.643, 3.47 ± 1.923) and they positively correlated with the clinical parameters. Conclusion: The increased expression of ezrin can be considered as a good indicator to assess the inflammatory activity in periodontitis and gingivitis.

Surgical management of maxillary trauma in pediatric special needs patient using modified cap splint.

Pediatric maxillofacial trauma is a rare entity, which is primarily the reason for an individual surgeon's inexperience in managing such injuries. More so, maxillary injuries are infrequent. Pediatric maxillofacial injuries are usually a result of blunt force trauma such as falls, motor vehicle accidents, bicycle injuries, sports-related injuries, assault, and child abuse. The atypical pattern of facial injuries in the pediatric population necessitates each surgeon to approach individual cases with a unique and innovative technique of management, while still following the basic principles of surgical management of maxillofacial injuries. Since facial trauma and surgical interventions both have the potential to lead to disturbance in growth and development, management should be as conservative as possible. The foundation of any surgical intervention must be developed keeping in perspective, the future growth, and development of dentofacial structures. Pediatric facial trauma management is in itself a disconcerting situation for a maxillofacial surgeon, but when a special needs child is involved it becomes an even more perplex decision. We present a case of maxillary trauma in a pediatric patient with global developmental delay, the treatment dilemma, and a review of current literature.