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ObjectivesTo present a case of foreign body granuloma (FBG) development after injection of calcium hydroxylapatite as a urethral bulking agent and to review all documented cases of this phenomenon in the literature.MethodsWe analyzed a new case of calcium hydroxylapatite-induced FBG. We also conducted a literature review of the PubMed, Embase, CINAHL, and Web of Science databases through March 2022. Reports were included if they contained stress urinary incontinence patients that developed an FBG after calcium hydroxylapatite injection. The cases were reviewed for presenting symptoms, patient demographics, granuloma details, and surgical treatment.ResultsWe screened 250 articles and included six articles between 2006 and 2015 in addition to the present case. The median age of the patients was 65.5 years (range 45-93), and all patients were female. The most common presenting symptoms and the proportion of patients affected were difficulty voiding (4/8), recurrent urinary incontinence (3/8), and dyspareunia (2/8). The median time between the first CaHA injection and discovery of the FBG was 5 months (range 1-50). The median longest dimension of the FBGs was 1.85 cm (range 1.0-3.0). The 8 masses observed were evenly distributed throughout the urethra, with 3 in the bladder neck, 2 in the midurethra, and 3 in the distal urethra. Surgical excision was the predominant management choice, with some variation in technique.ConclusionsSevere, persistent lower urinary tract symptoms after calcium hydroxylapatite injection may indicate an FBG, which has been successfully managed with surgical excision.

Background: Blue light imaging (BLI) has been shown to improve the characterization of colorectal polyps among the endoscopy experts. We aimed to determine if this technology could be taught to endoscopy trainees while maintaining high accuracy and interobserver agreement. Methods: Twenty‐one gastroenterology trainees (fellows) from two academic institutions participated in this prospective study. Each trainee completed a web‐based learning comprising four modules: pre‐test, didactic videos explaining the BLI Adenoma Serrated International Classification (BASIC), interactive examples, and post‐test assessment. The pre‐ and post‐test modules consisted of reviewing video images of colon polyps in high definition white light imaging and BLI and then applying the BASIC classification to determine if the polyps were likely to be adenomatous. Confidence in adenoma identification (rated '1' to '5'), accuracy in polyp (adenoma vs. non‐adenoma) identification, and agreement in characterization per BASIC criteria were derived. Results: Trainee accuracy in the adenoma diagnosis improved from 74.7% (pre‐test) to 85.4% (post‐test) (P < 0.01). There was a trend towards higher accuracy in polyp characterization with subsequent years of training (1st year fellows 77.4%, 2nd year 88.5%, and final year 94.0%) with consistent improvements after the e‐learning across years of trainees. Overall, trainees were able to identify adenoma with a high sensitivity of 86.9%, specificity 83.9%, positive predictive value of 84.4%, and negative predictive value of 86.5%. However, their interobserver agreement in adenoma diagnosis was moderate (k = 0.52). Conclusion: The novel BLI classification can be easily taught to gastroenterology trainees using an online module and accuracy improves with years of training reaching >90% for colorectal polyp characterization. [ABSTRACT FROM AUTHOR]

Pain in the orofacial region or within the tooth is one of the most common complaints patients report to a dental office. An efficient practitioner must have adequate knowledge and tools to address and remedy the problem. Pain control in dentistry has a rich history and learning about it gives an insight into how the current modalities being used came into existence. As dentistry keeps evolving, newer and more efficient modalities have been developed for pain control. Dental pain is primarily remedied by dental practitioners and clinicians involved in emergency medicine; it may result due to various causes, mainly insulting the tooth or complications involved in and after oral surgery. Several modalities have been developed to reduce and eliminate this, including pharmacological and non-pharmacological treatment modalities. Pharmacological modalities include using drugs. Many medications are used for pain management, such as non-steroidal anti-inflammatory drugs, corticosteroids, and muscle relaxants. Non-pharmacological modalities include behavior control methods based on several theories of pain. These modalities are used mainly for children, but some can also be used for adult patients. Several advances in delivery systems for local anesthesia involve using newer technologies to deliver a sustained dose of anesthetic agent. This review aims to enlist both modalities of pain control management in dental practices along with the newer advancements in this field., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Pahade et al.)

The aim of this literature review was to compile and present information on the use of mobile dental vans (MDVs) in India and to figure out if the use of these vans can be used to eliminate the barriers that prevent Indian people from getting access to quality and affordable dental care. Since the working of an MDV is quite complex, this article also serves to summarize the information available in the existing literature in a much simpler yet elaborate manner. An electronic database search was done using relevant keywords such as MDVs, mobile health units, dental vans, mobile dentistry, and portable dentistry on search engines PubMed, Scopus, and Medline. After removing the irrelevant and duplicate articles, 30 were shortlisted and reviewed. It is a difficult task to provide access to affordable dental care to every person in a country like India, which has such a large population and a large number of people living in rural areas. People who live in rural areas and/or belong to a lower socioeconomic class are more susceptible to oral diseases. Lower economic status, geographical location, motivational barriers, lack of public transportation, etc., deter people from receiving adequate dental care. MDVs are vehicles that can work as independent, efficient operatories to provide dental care and act as an adjunct as well as an alternative to conventional methods of improving the oral health of the community. The global impact of MDVs, coupled with efficient and organized implementation, can make them an instrumental tool for the good. The various barriers to providing dental care to the underserved groups of the population can be easily overcome through this powerful tool., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, John et al.)

This article reviews and critically analyzes the literature on mini-implants (temporary anchorage devices) for anterior en masse retraction in orthodontics. The search methods used were an E-database search, a secondary computerized search of orthodontics journals, and a reference list of selected studies. Eligibility criteria included individuals who underwent orthodontic treatment for correction of malocclusion with premolar extraction. Data were taken from PubMed and Scopus as well as the Cochrane Central Register of Controlled Trials and the Cochrane Database of Systematic Reviews. Keywords used for searching the article were temporary anchorage devices, premolar extraction, orthodontics, and anterior en masse retraction, Anterior en masse retraction with sliding mechanics in pre-adjusted edgewise appliances was considered for the study. Data collection and analysis involved three different researchers performing three steps of selection. All titles were initially filtered for irrelevant review articles. In the first step, all summaries from the selected studies were reviewed, and in the second, the entire content of the papers was read. The study was then discarded based on qualifying standards. A chart was created using the data from the final chosen research as well as the findings. The following information was evaluated for the final table: author, publication year, research structure, study group, sample size, methods/measures, study findings, and conclusion about frictionless mechanics. Results showed that a meta-analysis was not feasible due to clinical and statistical variability, as well as variations in study design, sample selection, and sample size. Thus, it was concluded that sliding mechanisms are widely employed in orthodontic treatment, but temporary anchorage devices and sliding mechanisms deliver great results. There is a need to raise awareness about these devices and use them with care., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ahuja et al.)

Objectives: To prospectively evaluate sacral magnetic high-frequency stimulation as a treatment option for patients with non-inflammatory chronic pelvic pain syndrome (CPPS, category IIIB)., Patients and Methods: Fourteen men with CPPS IIIB were treated with high-frequency sacral magnetic stimulation, with 10 treatment sessions once a week for 30 min at a frequency of 50 Hz. The National Institutes of Health Chronic Prostatitis Symptom Index (NIH-CPSI) and quality-of-life index were determined before and after treatment., Results: All patients tolerated the stimulation well and 12 of 14 reported agreeable sensations during stimulation. There were no complications; only one patient did not complete the treatment course. The mean (range) total NIH-CPSI score did not change with treatment, at 27 (18-38) before and 27 (4-40) after treatment. Moreover, there was no sustained effect on the mean scores for pain, micturition complaints or quality of life., Conclusions: High-frequency sacral magnetic stimulation in patients with CPPS IIIB only reduces pain during stimulation, with no sustained relief of symptoms. Therefore, intermittent sacral magnetic stimulation cannot be recommended as a treatment option for CPPS IIIB.

Hepatocellular and hepatobiliary damage was assessed in equine acute, subacute and chronic grass sickness cases (AGS, SAGS, CGS). Histopathological analysis showed that even in some early AGS cases enlarged hepatocytes, hepatocyte vacuolation indicative of lipid accumulation (steatosis), intrahepatocyte, canalicular and periportal deposition of pigments, frequent leucocyte infiltration and cholangitis occurred. Analysis of serum indicated significantly increased levels of unconjugated bilirubin in all groups and conjugated bilirubin in AGS and SAGS groups, increased levels of bile acids in some individuals from each group and significantly increased levels of glutamate dehydrogenase (GLDH) in AGS and SAGS cases. Conjugated bilirubin was significantly elevated in urine of AGS and SAGS cases. The evidence suggests that abnormal liver function involving moderate hepatocellular pathology in conjunction with steatosis and cholestasis may contribute to the pathogenesis of GS.

The specificity of a monoclonal antibody (mAB) raised against recombinant bovine prion protein (PrP) for the immunohistological detection of PrP accumulation in the medulla oblongata of bovine spongiform encephalopathy (BSE) and ovine scrapie cases was investigated. mAB KG9 showed a diffuse low intensity reaction with the cytoplasm of neurones in normal cattle and sheep sections. In BSE sections the mAB detected widespread granular deposits of PrP associated with neurones and the neuropil. Although scrapie sections showed similar levels of granular deposits with another antibody to PrP these were not detected by KG9 which did however detect diffuse staining in neuronal cytoplasm. Possible explanations for the specificity of binding of KG9 are discussed.

In the autonomic nervous system (ANS) of equine grass sickness (GS) cases, some neurones show abnormal changes while neighbouring neurones are unaffected. To test whether noradrenergic neurones showed variable susceptibility to the GS toxin in culture, clonally-derived populations isolated from the same fetal thoracic sympathetic chain ganglion were challenged with plasma from GS cases previously shown to induce ANS damage when injected into normal horses. During the early stages of exposure to toxic plasma, cells within a clonal population showed variable susceptibility ranging from no obvious effect to characteristic patterns of pathology. However, after 3 days of exposure to toxic plasma all cells were killed. Dose response analysis on selected clonal populations showed no significant difference in TD(50) values.

To enable direct testing of a range of potential toxins or pathogens that might be involved in grass sickness, equine thoracic sympathetic chain ganglion cell lines were established from primary cell cultures by retroviral-mediated transduction of the temperature-sensitive mutant of the establishment oncogene encoding SV40 large T antigen. Morphological and behavioral features, temperature dependence, and immunocytochemical characteristics of the cell lines were investigated. The majority of cells were noradrenergic neurons in which dopamine-beta-hydroxylase, the enzyme that catalyzes norepinephrine synthesis, and neuropeptide Y coexisted. Cells treated with plasma from grass sickness cases that had previously been shown to induce autonomic nervous system damage when injected into normal horses showed significantly decreased mitochondrial function after 1 day. After 3 days exposure most cells showed severe degeneration in contrast to those treated with normal plasma. Liver and lung cell lines were also susceptible to plasma, suggesting that the toxin is not specifically neurotoxic.

Objectives: To describe the patterns of growth, nutritional status, body composition, and resting energy expenditure (REE) in prepubertal children with Alagille syndrome (AGS) before the onset of end-stage liver disease., Study Design: Thirteen prepubertal subjects with AGS (8 male; mean age, 6.8 2.8 years) were evaluated for growth parameters, body composition by skinfolds and by dual-energy x-ray absorptiometry, and REE by indirect calorimetry. The children with AGS were compared with a healthy, age-matched reference group of 37 prepubertal children., Results: Compared with healthy children, children with AGS had significantly reduced (P <. 05) growth (weight, weight z score, height, height z score), nutritional status (midarm circumference, triceps skinfold, and midarm muscle area), and body composition (fat mass and fat-free mass). Subscapular thickness, percent body fat, and REE were not different. The AGS subgroup (n = 4) with REE greater than 110% predicted value had a reduced percent body fat (P <.02)., Conclusions: Growth and body composition abnormalities are common in prepubertal children with AGS.

A cell line (designated BMpXT1) was generated from sheep bone marrow using the Moloney murine leukemia virus-based retroviral vector pXT1. BMpXT1 cells resembled mature alveolar macrophages in being adherent and esterase positive, in expressing certain cell surface antigens, and in secreting granulocyte-macrophage colony-stimulating factor (GM-CSF) when stimulated by ovine interferon-gamma and lipopolysaccharide (LPS) in combination. The absence of a proliferative response to ovine GM-CSF and macrophage colony-stimulating factor, the absence of other cell antigens found in mature macrophages, and low-efficiency phagocytosis suggested that the cells may be at an intermediate to late stage of myelomonocytic differentiation.

Failure to inhibit proteinases can lead to excessive tissue damage. The possibility that the severity of endometritis in Thoroughbred mares correlates with the haplotypes of plasma alpha 1-proteinase inhibitor (alpha 1-PI) expressed was investigated in two groups of mares. In mares with pyometritis before treatment, the frequency of the N haplotype, which is already high in the Thoroughbred population, was significantly increased when compared with that in a large published population. In mares with acute endometritis which persisted after treatment followed by sexual rest, the absence of S and T haplotypes was significant, suggesting that, when present, they may have a protective function.

The relative efficiency of retroviral-mediated gene transfer into early-passage cultures of different tissues of fetal lamb was investigated. Monolayer cultures prepared by plating 1 x 10(6) cells were infected with the Moloney murine leukemia (MoMLV)-based vector pZIP Neo at a multiplicity of infection (moi) of approximately 1 pfu per 2 x 10(2) recipient cells prior to selection for neomycin resistance. At the low moi used, cells from different tissues showed marked differences in efficiency of colony formation in the descending order: brain > kidney > muscle, lung > skin. Brain cells were transduced at least an order of magnitude more efficiently than other cell types, despite the doubling time of brain cell cultures being five times as long. Cultures were analyzed by morphological and immunocytological criteria to determine whether any particular cell types were transduced. A wide variety of morphologically distinct neuron-like and glial-like brain cells were neomycin resistant. The majority of muscle cell colonies were myogenic. Approximately half of the large kidney colonies were epithelial-like. The majority of lung colonies consisted of fibroblasts. The results suggest that cells originating from the surface embryonic germ layer (ectoderm) and/or occupying positions near the fetal external surface have a markedly lower susceptibility to retroviral-mediated gene transduction.

The relative efficiency of retroviral-mediated gene transfer into early passage cultures of different tissues of fetal lamb was investigated. Cells which originate from different embryonic germ layers showed marked differences in infectibility in the descending order: brain (neuroectoderm) > kidney (nephrogenic mesoderm) > muscle (somite mesoderm), lung (endoderm) > skin (ectoderm). In an attempt to generate immortalized brain cell lines, primary cultures were transduced with various oncogenes. A wide variety of morphologically distinct, dividing cells, including neurone-like and glial-like cells, were obtained using some oncogenes but also using the vector without an inserted oncogene.

1. Antiproteinase deficiency can result in excessive proteinase-induced tissue damage. The major anti-elastase (Spi1) protein of equine alpha 1-proteinase inhibitor (alpha 1-PI) was isolated from the plasma/serum of three common haplotypes (I, L and U). 2. The N-terminal amino acid sequences of the three inhibitors were identical, but were only approx 65-77% homologous with two other published equine Spi1 sequences. 3. All three inhibitors complexed quickly and irreversibly with equine leucocyte proteinase 2A (kass = 2 x 10(7) M-1 sec-1). They were also efficient inhibitors of chymase (rat mast cell proteinase-II; kass = 2 x 10(5) M-1 sec-1; Ki = 2 x 10(-10) M). There was therefore no evidence of deficient inhibition in the Spi1 variants of the I,L and U haplotypes.

Blue dextran was incorporated into the stacking layer of one-dimensional polyacrylamide gels to prevent the migration of albumin into the resolving gel during the electrophoresis of native plasma samples. Human and horse plasma proteins normally masked by albumin were revealed by this method.

A significant decrease in major urinary protein (MUP) in adult male Bar Harbor 129REJ dystrophic mice correlated with a marked decrease in the amount of translatable MUPmRNA in the liver. Previous investigations have shown that MUP synthesis is under complex multihormonal regulation suggesting that the dystrophic mouse may have a hormonal deficiency.

Some young Duchenne muscular dystrophy (DMD) patients (3-7 years) had total thyroxine (T4) levels and T4 to thyroxine binding globulin (TBG) ratios above the normal range and significantly increased free thyroxine indices (fT4I) which, however, remained within the normal range. Older DMD patients (7-11 years) had T4 and TBG levels and fT4I similar to normal. In both DMD groups the thyroxine binding index (TBI) values were in the normal range.

The protein composition of normal spinal roots and the partially myelinated spinal roots of Bar Harbor 129 ReJ dystrophic mice was analyzed by 2D-gel electrophoresis which resolved basic proteins. The normal roots contained proteins with mobilities identical to two of the three 18.5 kDa and two of the three 14 kDa myelin basic protein spots resolved in purified spinal cord myelin suggesting that normal root myelin may have some of the characteristics of CNS myelin. In contrast dystrophic roots contained spots with mobilities identical to only one of the spots resolved for each myelin basic protein. The possibility that the difference in microheterogeneity may be responsible for the decreased myelination is discussed.

Proteins of lumbosacral spinal roots and sciatic nerves of adult dystrophic mice (Bar Harbor 129REJ dydy) were analyzed by SDS gel electrophoresis to determine if identifiable proteins were affected. All peripheral nerve myelin proteins (P0 glycoprotein, P1 and Pr basic proteins, X protein and a high-molecular-weight protein) were decreased in the roots but not in the sciatic nerves. Central nervous system myelin proteins were not increased in either roots or sciatic nerves. Although dystrophic spinal roots and sciatic nerves contained less collagen, Type I, III and V collagens were present.