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Aim and Objective The main aim of this study was to evaluate the effect of three different types of pattern materials on the vertical marginal accuracy of complete cast crown. Material and Methods Three groups of 20 specimens each were made based on three pattern materials, that is, blue inlay wax, autopolymerizing acrylic resin, and light cure pattern resin. Castings were made and examined using stereo microscope for vertical marginal discrepancy. Results The result showed that the highest mean gap was noticed in the castings fabricated using inlay type B pattern wax followed by the castings fabricated using autopolymerizing resin and the least mean gap was observed in the castings fabricated using light cure modeling material. Conclusion It was concluded from this study that the use of light cure modeling material to make patterns for casting with lost wax technique is best recommended than inlay type B pattern and autopolymerizing resin.

Dental implants are fixtures that constitute for the replacements of the root of a missing natural tooth. Dental implant therapy has been widely used for the restoration of partially and fully edentulous patients. The implant literature emphasizes the importance of a passively fitting prosthesis to prevent prosthodontic complications or even loss of fixture integration. Failure to achieve a passively fitting prosthesis and force tightening of superstructure may result in complications such as abutment, framework, and gold screw loosening or fracture. Various materials that can be used for making an implant impression are polyether, polyvinylsiloxane, condensation silicone, polysulfide, irreversible hydrocolloid material, and various others. There are various studies in relation to the accuracy of these impression materials out of which various scientists concluded different results with most studies stating polyether with the maximum amount of dimensional accuracy in comparison to other materials. An accurate implant impression plays a significant role and serves as a starting point in the process of producing good working casts. Thus, the accuracy of impression techniques becomes a significant issue in consideration of passive fit. Reproduction of intraoral relationship of implants through impression procedures is the first step in achieving accurate fit prosthesis. This transference is still complicated by the number, angulation, depth, and position of implants. The advent of computer-aided design/computer-assisted manufacturing technology improved the framework fabrication procedures and has increased the precision of fit of implant prosthesis.

Detection and responding to a player’s affect are important for serious games. A method for this purpose was tested within Chem-o-crypt, a game that teaches chemical equation balancing. The game automatically detects boredom, flow, and frustration using the Affdex SDK from Affectiva. The sensed affective state is then used to adapt the game play in an attempt to engage the player in the game. A randomized controlled experiment incorporating a Dynamic Bayesian Network that compared results from groups with the affect-sensitive states vs those without revealed that measuring affect and adapting the game improved learning for low domain-knowledge participants.

Aim The aim of this study was to evaluate the distribution of stresses in osseointegrated crestal and basal implant in zygomatic region of maxilla and to identify the preferable implant option for better stress distribution. Material and Method The present in vitro study was performed to evaluate stress patterns in bone around basal and crestal dental implant under axial and oblique loading in maxillary zygomatic region with the help of a finite element analysis (FEA). To conduct this study, the following materials were used: computer software ANSYS, basal implants with dimensions 3.7 × 10 mm, and crestal implants with dimensions 3.7 x 10 mm. The amount of load transferred on the bone adjacent to the implant in an axial and transverse load of 100 N at 0 and 45 degrees, respectively, was placed on both types of implants. A three-dimensional (3D) scanner was use to generate 3D simulated model of basal and crestal implants. FEA modelling was generated that replicated the zygomatico maxillary region with special emphasis on bone architecture, bone density, angulation, width, and length of implant prototype. Further, material properties were defined for cortical bone, dense trabecular bone, low density trabecular bone, and titanium on the basis of Young’s modulus of elasticity. Results These values were used by FEA software (ANSYS) to generate a 3D mesh model of bone and implant. Finally, Von Mises (equivalent stress) (MPa) values on the implant were computed using FEA software. The values of maximum Von Mises equivalent stress on the implant collars, body, apex, and bony interface were obtained. Conclusion Maximum stresses were seen at the cortical bone with basal implant placed inside the bone. Stresses that are transferred more to the bone through implant promote bone remineralization. Maximum Von Mises stresses were observed on basal implant body. Thus, these greater stresses have the capacity to simulate mineralization in the cortical bone; this makes basal implant a suitable option for placement inside the cortical bone.

Immediate loading of dental implant in the anterior tooth region has been a growing trend and eliminates the compromised esthetics, function, discomfort, and inconvenience associated with traditional two-stage implant procedures. This case report presents the clinical application of implant placement with immediate loading using leukocyte-platelet-rich fibrin (L-PRF) in the anterior esthetic region. The implant was planned to rehabilitate in the anterior missing tooth region. As per the patient's desire, the implant was immediately loaded and L-PRF membrane was placed around the implant under local anesthesia on the day of surgery. The use of L-PRF for the maintenance of crestal bone and soft tissue at the implant sites provided an adequate clinical condition for better esthetics.

The conventional crestal implants are used only when there is adequate jawbone height and width. Results of conventional implants are good in patients with healthy bone at the time of treatment, but prognosis gets deteriorated when surgical augmentation of bone is included with implant placement. These augmentation procedures have surgical risks and are costlier to the patients. Patients with atrophied jawbones are given no treatment, until crestal implants are seen as the last option. In this article, the indications for basal implants and functional differences between basal implants and crestal implants have been discussed.Patients with extreme jawbone atrophy do not benefit from crestal implants. The basal bone is the (cortical) osseous tissue of the mandible and maxilla, and lies below the alveolar process, which has a relatively strong and no resorbing framework.Basal osseointegrated and basal cortical screw (BCS) are two types of implants designed to take anchorage from the cortical bone of the jaw. BCS implants have long shafts and can be placed immediately in the socket after extraction and provided with immediate loading within 72 hours of implant placement. Basal implants are also called bicortical or cortical implants as they utilize the cortical portion of the jawbones for anchorage and implant stability. The basal bone has better quality and quantity of cortical bone for retention of these unique and highly advanced implants. The other names for these implants are lateral implants or disk implants.

Background and Aims: Men are at a higher risk for Barrett's esophagus (BE) and esophageal adenocarcinoma (EAC), but little is known about BE progression to dysplasia and EAC in women. We performed a retrospective, multicenter cohort study to assess risk of BE progression to dysplasia and EAC in women compared with men. We also investigated comorbidities, medication use, and endoscopic features that contribute to sex differences in risk of BE progression. Methods: We collected data from large cohort of patients with BE seen at 6 centers in the United States and Europe, followed for a median 5.7 years. We obtained demographic information (age, sex, ethnicity), clinical history (tobacco use, body mass index, comorbidities), endoscopy results (procedure date, BE segment length), and histopathology findings. Neoplasia was graded as low-grade dysplasia, high-grade dysplasia (HGD), or EAC. Rates of disease progression between women and men were compared using χ2analysis and the Student t test. Multivariable logistic regression was used to assess the association between sex and disease progression after adjusting for possible confounding variables. Results: Of the total 4263 patients in the cohort, 2145 met the inclusion criteria, including 324 (15%) women. There was a total of 34 (1.6%) incident EACs, with an overall annual incidence of 0.3% (95% confidence interval: 0.2%-0.4%). We found significant differences between women and men in annual incidence rates of EAC (0.05% for women vs. 0.3% in men; P=0.04) and in the combined endpoint of HGD or EAC (0.1% for women vs. 1.1% for men; P

Introduction This study was undertaken to assess the influence of different superstructure materials, when subjected to occlusal loading, on the pattern of stress distribution in tooth-supported, implant-supported, and tooth implant-supported fixed partial prostheses, using the finite element analysis with a comparative viewpoint. Materials and Methods The geometric models of implant and mandibular bone were generated. Three models were created in accordance with the need of the study. The first model was given a tooth-supported fixed partial prosthesis. The second model was given tooth implant-supported fixed partial prosthesis, and the third model was given implant-supported fixed partial prosthesis. Forces of 100 N and 50 N were applied axially and buccolingually, respectively. Results The present study compared the stresses arising in the natural tooth, implant, and the whole prostheses under simulated axial and buccolingual loading of three types of fixed partial dentures, namely, tooth-supported, tooth implant-supported, and implant-supported fixed partial dental prostheses using three different types of materials. Conclusion The pattern of stress distribution did not appear to be significantly affected by the type of prosthesis materials in all models. The maximum stress concentrations were found in the alveolar bone around the neck of the teeth and implants.

Introduction Replacing missing anterior teeth with a prosthesis that resembles natural form and function has always been challenging for a prosthodontist. Removable and fixed options both have been extensively studied and researched upon. In modern dentistry, implants have proved to be a more logical option for the same. The morphology of bone present in the premaxilla serves as guide to plan implant angulation during osteotomy. Factors such as age-related bone resorption, trauma or pathologic bone resorption due to periodontitis, etc. causes implants to be placed at angles that are difficult to restore with conventional straight abutments. Angled abutments can help build up favorable functional prosthesis in such cases, but they experience the drawback of transferring unfavorable forces to the implant or bone, thereby compromising the prognosis of the treatment. Clinically, the effect of these forces is difficult to evaluate, so a finite element analysis was done to estimate stress distribution at the bone implant interface. Materials and Methods In this study, premaxilla was modeled with 15 mm in bone height, 7 mm in bone length, and 12 mm in bone width with 1.5 mm thick cortical bone surrounded by a core of cancellous bone. The implant was modeled as a cylindrical, round-ended device with dimensions, 4.3 mm × 11.5 mm. Abutments with angulations 0°, 10°, 15° and 25° were used. To simulate clinical conditions, a 100 N load axially and 30 N load obliquely was applied. Result It was seen that, as the abutment angulation changes from 0° to 25°, both the compressive as well as tensile stresses increased; however, they were within the tolerance limit of the bone. Conclusion The study suggests angled abutments can be used with reasonable success, keeping in mind the basics of implant prosthodontics intact.

Esophageal adenocarcinoma (EAC) continues to be a significant public health problem with survival rates that have remained stagnant. Although the population at the highest risk for EAC, i.e., patients with Barrett's esophagus (BE) has been clearly defined, patients with EAC continue to do poorly due to advanced stage at diagnosis. The field of extracellular vesicles (EV) could have huge application for the management of patients with BE and EAC by allowing timely diagnosis, serial monitoring, and improved understanding of disease biology. EV are actively packaged and actively secreted vesicles and contain microRNAs, proteins, lipids, and DNA. The contents of EV have been shown to provide useful insights into cellular transformation and pro-oncogenic processes. Early work shows promise but suffers from a high degree of technical and biological variation. The current review not only summarizes the current knowledge about EV as diagnostic biomarkers and their role in disease progression of BE and EAC but also provides the reader practical guidance to devise future experiments to perform well-designed studies.

Introduction The overdenture is an alternative to fixed implant-supported prosthesis for its relatively low-cost and in clinical cases where it is impossible to place multiple implants with appropriate number and arrangement in the arch to support a fixed prosthesis. In implant-supported overdentures, many attachments such as bars, ball, and magnets can be used. The anchorage system affects the retention and stability of the overdenture as well as the load transfer to the implant and the bone. The purpose of this study was to evaluate the exerted stresses on implants and implant–abutment interface by comparing different attachment systems used for implant-supported maxillary and mandibular overdentures using finite-element analysis. Materials and Methods Stress distribution in five different models with different attachments were evaluated using finite-element analysis. The studied attachment systems were Ball/O-ring and bar-clip attachments. Three models in mandible were studied, two implants with ball attachments, two implants with bar, and four implants connected with a bar. In maxilla, two models were studied, four implants with ball attachments, and four implants connected with bar. Forces were applied bilaterally on each model in the canine and molar region separately. The forces applied were 35N axially, 70N obliquely, and 10N horizontally. Results The ball attachments models showed the highest amount of stresses on the bone and on the implants in maxilla and mandible. The bar-clip attachment with four implants showed least stress in maxilla as well as in the mandible. The bar on four implants has better stress distribution as compared with the bar on the two implants.

Introduction Marginal bone level is the criterion for implant success. Patient expectations for more natural looking implant restorations created the need to restore implants with more esthetically pleasing materials like Zirconia rather than conventional porcelain-fused to-metal (PFM) crowns. The aim of this study was to evaluate marginal bone loss around dental implants clinically and radiographically when restored with Zirconia and PFM prosthesis. Materials and Methods Two groups (control and test) were formed with 14 patients each. In the control group, the subjects were rehabilitated with PFM crowns and in the test group, the subjects were rehabilitated with Zirconia crowns. Rehabilitation was done after the healing period of 3 months. Radiographic evaluation was done at regular (baseline, 3rd, 6th, and 12th month) intervals. Results The results were statistically analyzed. Keeping in mind the limitations of the study, it was revealed that the difference in the crestal bone resorption in both the groups was not significant.

Introduction Dental implants are common treatment modality for tooth loss which leads to unaesthetic appearance and may also cause deterioration of mastication and speech. The aim of implant therapy in dentistry is to restore tissue contour, function, comfort, aesthetic, and speech. Dental implant role is to transfer the mechanical force created during chewing to the supporting osseous tissues within the mandible and maxilla. The importance of biomechanical factors such as the bone-implant interface, implant thread design, the length and diameter of implants, type of loading, the quality and quantity of surrounding bone have been strained by various authors. The selection of implant thread design plays an important role in the outcome of the treatment. This study was done to evaluate the influence of different thread designs on stress distribution of osseointegrated implant using three-dimensional (3D) finite-element analysis. Materials and Methods Three implants with different thread designs, namely V-thread, buttress, and reverse buttress thread designs were considered and dimensions were standardized. The site considered was the mandibular molar region with cortical and cancellous bone assuming to be isotropic and homogeneous. The implant modeling was done with the ANSYS 18.1 software. Axial load (100N) and buccolingual load (50N) were applied. The stresses were calculated as Von Mises stress criterion. Results Minimum von mises Stress concentration was seen for tapered implant body with reverse buttress thread design under axial load 100N and tapered implant body with V-thread under buccolingual load of 50N at cortical bone which signifies bone preservation. Stress levels were observed maximum at implant and minimum at the cancellous bone. Conclusion Hence, within the limitations of this study the results obtained can be applied clinically for appropriate selection of implant thread design for a predictable success of implant therapy.

Any kind of deformity or injury to the finger or hand is one of the most encountered type of injuries, which may cause psychological and emotional disturbance to the patient. The prosthetic rehabilitation of the amputed part of the finger supports the patient emotionally as well as physically and also has a role in making the patient socially more acceptable. This case report highlights on a simple technique for fabricating a thimble prosthesis using silicone elastomers.

In this paper, we bring together our efforts in identifying and understanding nonequilibrium phase segregation driven by active processes in the living cell, with special focus on the segregation of cell membrane components driven by active contractile stresses arising from cortical actomyosin. This also has implications for active segregation dynamics in membraneless regions within the cytoplasm and nucleus (3d). We formulate an active version of the Flory-Huggins theory that incorporates a contribution from fluctuating active stresses. Apart from knitting together some of our past theoretical work in a comprehensive narrative, we highlight some new results, and establish a correspondence with recent studies on Active Model B/B+. We point to the many unusual aspects of the dynamics of active phase segregation, such as (i) anomalous growth dynamics, (ii) coarsening accompanied by propulsion and coalescence of domains that exhibit nonreciprocal effects, (iii) segregation into mesoscale domains, (iv) emergence of a nonequilibrium phase segregated steady state characterised by strong macroscopic fluctuations (fluctuation dominated phase ordering (FDPO)), and (v) mesoscale segregation even above the equilibrium Tc. Apart from its implications for actively driven segregation of binary fluids, these ideas are at the heart of an Active Emulsion description of the lateral organisation of molecules on the plasma membrane of living cells, whose full molecular elaboration appears elsewhere.

Content Agnostic Game Engineering (CAGE) architecture utilizes content agnostic mechanics to create educational games that can teach multiple contents. However, the player engagement goes down when second content is played using the same game mechanics. A content agnostic stealth assessment can aid a CAGE game in sustaining the engagement level of its players. A potentially generalizable method for this was tested using Chem-o-crypt, a CAGE game that can teach chemistry and cryptography contents. The game automatically detects frustration, flow, and boredom using the Affdex SDK from Affectiva. A randomized controlled experiment incorporating real-time game adaptation revealed that using stealth assessment can help sustain engagement in a CAGE game when playing multiple contents.

Fixed prosthetic option is the most accepted treatment desired by the patient in modern times. Malpositioned implant presents a challenge, especially during prosthetic phase. The prosthetic achievement of various complex cases can be done by following appropriate procedure; one of which has been discussed in this report. The use of transmucosal abutment with castable abutment is successful treatment option for complex malposed single dental implant.

Microsatellite instability‑high/deficient mismatch repair colorectal cancer (MSI‑H/dMMR CRC) is a molecular subtype characterized by high‑frequency mutations within DNA mismatch repair genes. Defects in the DNA mismatch repair machinery lead to subsequent frame‑shift mutations, resulting in the generation of frame‑shift peptides that serve as neoantigens. This has translated into exquisite sensitivity to immune checkpoint inhibitors (ICIs) and a significant clinical benefit from immune therapies in this patient population. The present article provides a comprehensive review of the advances in the field of immune therapies for MSI‑H/dMMR metastatic CRC, with a focus on the major randomized clinical trials that led to Food and Drug Administration approval of specific ICIs for this population, a detailed review of the molecular background responsible for tumor response, as well as the mechanisms of resistance to ICI therapy. Finally, ongoing investigations of other immunotherapeutic strategies to address and overcome the challenges that currently limit response and long‑term response to ICIs were presented.

For improvement in longevity of complete denture prosthesis in place of conventional poly methyl methacrylate denture base material, metal denture base is used to rehabilitate complete edentulous maxillary arch as it helps in preventing resorption of residual ridges and improves fracture resistance, better dimensional stability, more accuracy, less weight, and better retention of prosthesis. For better prognosis there are many factors, but major factors such as retention, stability, and support are more important. Metal denture base leads to improvement in physical properties of the prosthesis.

Statement of Problem Acrylic teeth are preferred to porcelain teeth in dentures as they unite chemically with denture base resin, but their fracture from denture is common. Purpose The purpose of this study was to improve the bond strength of denture teeth to acrylic resin denture base by chemical or mechanical modification of the ridge lap surface of denture teeth. Materials and Methods Total 100 artificial cross-linked acrylic resin central incisors were divided into five groups: group A, 20 samples without modification (control group); group B, 20 samples (ridge lap surface of teeth treated with monomer); group C, 20 samples (ridge lap surface of teeth treated with monomer and the glaze layer removed with aluminum oxide abrasive stone); group D, 20 samples (ridge lap surface of teeth treated with dichloromethane); and group E, 20 samples (dichloromethane application followed by abrasion with aluminum oxide stone on ridge lap surface of teeth). They were mounted on wax blocks, and the blocks were acrylized. The bond strength values were obtained by subjecting the samples to shear compressive load under universal testing machine. Result The results were subjected to statistical analysis by applying analysis of variance and Bonferroni test for multiple group comparisons, and graphs were plotted. The mean value of bond strength was highest for group E (modified by aluminum oxide abrasion prior to dichloromethane application), followed by group C (modified by aluminum oxide abrasion prior to monomer application), group D (modified by dichloromethane application), group B (modified by monomer application), and lastly group A (control group). Significantly improved bond strength values were obtained in modified groups as compared with the control group. Conclusion Dichloromethane application followed by aluminum oxide abrasion provided the highest bond strength and is recommended to prevent debonding of the teeth from the denture base.

BACKGROUND & AIMS: European guidelines recommend different surveillance intervals of non-dysplastic Barrett’s esophagus (NDBE) based on segment length, as opposed to guidelines in the United States, which do recommend surveillance intervals based on BE length. We studied rates of progression of NDBE to high-grade dysplasia (HGD) or esophageal adenocarcinoma (EAC) in patients with short-segment BE using the definition of BE in the latest guidelines (length ≥1 cm). METHODS: We collected demographic, clinical, endoscopy, and histopathology data from 1883 patients with endoscopic evidence of NDBE (mean age, 57.3 years; 83.5% male; 88.1% Caucasians) seen at 7 tertiary referral centers. Patients were followed for a median 6.4 years. Cases of dysplasia or EAC detected within 1 year of index endoscopy were considered prevalent and were excluded. Unadjusted rates of progression to HGD or EAC were compared between patients with short (≥1 and

Purpose of review This review will focus on how the extent of Barrett's metaplasia influences the risk of esophageal adenocarcinoma (EAC). More specifically, this review will discuss the concepts of long and short-segment Barrett's metaplasia and irregular Z line as they relate to EAC risk. Recent findings The Prague classification can standardize reporting of Barrett's metaplasia. Recent literature has found significant associations between the length of Barrett's metaplasia and increased progression risk to EAC in multiple geographically distinct populations. Length of Barrett's metaplasia has been incorporated into the Progression of Barrett's esophagus (PIB) model that can predict individualized life-time risks of progression. The risk of malignant transformation appears to be very low in patients with irregular Z line. Summary Length of Barrett's metaplasia has emerged as an important predictor that can influence the risk of EAC and should be reported using the Prague classification. The PIB model, if further validated, could help a practicing gastroenterologist to inform patients with Barrett's metaplasia about their personal risk of progression to tailor surveillance intervals. Current guidelines do not recommend surveillance in patients with irregular Z line, but careful examination is recommended.

Colorectal cancer (CRC) is one of the most common types of cancer with a high mortality rate. Colonoscopy is the preferred procedure for CRC screening and has proven to be effective in reducing CRC mortality. Thus, a reliable computer-aided polyp detection and classification system can significantly increase the effectiveness of colonoscopy. In this paper, we create an endoscopic dataset collected from various sources and annotate the ground truth of polyp location and classification results with the help of experienced gastroenterologists. The dataset can serve as a benchmark platform to train and evaluate the machine learning models for polyp classification. We have also compared the performance of eight state-of-the-art deep learning-based object detection models. The results demonstrate that deep CNN models are promising in CRC screening. This work can serve as a baseline for future research in polyp detection and classification.

PURPOSE OF REVIEW: Molecular pathways in colorectal carcinogenesis involve several complex genetic and epigenetic modulations that cause normal colonic mucosa to metamorphose into a benign polyp and subsequently into a malignant tumor. Our purpose is to recapitulate historical and recent genomic research in order to augment the understanding of colorectal cancer pathogenesis. RECENT FINDINGS: In 2015, the molecular classification for colorectal cancers was unified into one system with four distinct groups, also called as consensus molecular subtypes. This led to an enhanced understanding of molecular and immune signatures which has implications on predicting the clinical behavior as well as response to different therapeutic agents. SUMMARY: In this review, we expound on the current literature as well as draw on our own experience to present the important molecular pathogenesis pathways, key genetic mutations, differences in pathogenesis of left versus right sided tumors as well as the molecular classification of colorectal cancers.

Multiple genome-wide association studies (GWAS) have linked Forkhead Box F1 (FOXF1) to Barrett’s esophagus (BE). Understanding whether FOXF1 is involved in initiation of Barrett’s metaplasia could allow FOXF1 to be used for risk stratification and for therapy. Two-dimensional cell cultures and three-dimensional organoid cultures and well-annotated human biopsies were used to determine the role of FOXF1 in BE pathogenesis. Multiple established esophageal squamous and BE cell lines were tested in gain- and loss-of-function studies. Initiation of a BE-like metaplastic change was evaluated by measuring characteristic cytokeratins and global gene expression profiling and by culturing organoids. Epithelial–mesenchymal transition (EMT) was evaluated by immunostaining for E-cadherin, vimentin and Snail, and by cell motility assay. Columnar esophageal epithelium of BE patients exhibited higher expression of FOXF1 compared to normal squamous esophageal epithelium of GERD patients (P

Summary Esophageal foreign body impaction (EFBI) is a gastrointestinal emergency, mostly requiring endoscopic management. The aim of this study is to evaluate the epidemiology, adverse events, and outcomes of patients following the episode of EFBI. All esophagogastroduodenoscopy (EGD) reports of admitted patients for EFBI at the University of Kansas Medical Center between 2003 and 2018 were retrospectively reviewed. Of 204 patients, who met the inclusion criteria, 60% were male and the mean age was 54.7 ± 17.7 years. The encounter was the first episode of EFBI in 76% of cases. EGD in less than 24 hours of patients’ admission was required in 79% of cases. The distal esophagus was the most common site of impaction (44%). Push and pull techniques were used in 38 and 35.2% of cases, respectively, while 11% were managed by a combination of both techniques. Structural causes were the most common etiologic findings including benign strictures and stenosis in 21.5% of patients, followed by Schatzki’s ring (7.8%) and hiatal hernia (6.9%). Of all cases, 45% did follow-up in up to 1 year, and biopsy was done in 34% of cases. Out of 43 patients who had endoscopic findings suspicious for eosinophilic esophagitis (EoE), the diagnosis was confirmed by pathology in 37. The rate of recurrence EFBI was significantly higher in patients with EoE (P

In an attempt to predict the cognitive-affective states of a player during an educational video game session, this study used a self-emote procedure in which participants’ facial expressions and emotions were continuously recorded along with self-reported data about their emotional states. Participants’ facial expressions and emotions were captured using Affdex SDK from Affectiva. The captured data were used for binomial logistic regression to predict the cognitive-affective states of flow, frustration, and boredom. The binomial logistic regression uncovered that expressions and emotions could be used to predict these cognitive-affective states of a player. We discuss these predictors and their potential to adapt an educational video game session with non-intrusive and affect-sensitive personalization capabilities. The current study provides a pathway for the educational play design and suggests that it should be non-intrusive while being adaptive to a player’s capabilities.

Colorectal cancer is the third most common cancer diagnosed in both men and women in the United States. Most colorectal cancers start as a growth on the inner lining of the colon or rectum, called ‘polyp’. Not all polyps are cancerous, but some can develop into cancer. Early detection and recognition of the type of polyps is critical to prevent cancer and change outcomes. However, visual classification of polyps is challenging due to varying illumination conditions of endoscopy, variant texture, appearance, and overlapping morphology between polyps. More importantly, evaluation of polyp patterns by gastroenterologists is subjective leading to a poor agreement among observers. Deep convolutional neural networks have proven very successful in object classification across various object categories. In this work, we compare the performance of the state-of-the-art general object classification models for polyp classification. We trained a total of six CNN models end-to-end using a dataset of 157 video sequences composed of two types of polyps: hyperplastic and adenomatous. Our results demonstrate that the state-of-the-art CNN models can successfully classify polyps with an accuracy comparable or better than reported among gastroenterologists. The results of this study can guide future research in polyp classification.

A removable dental prosthesis that covers and rests on two or more remaining natural teeth, the roots of natural teeth, and/or dental implants is known as overdenture. This leads to less resorption of residual alveolar ridges. Restoration and modified teeth coronally can also be used as multiple abutments. In most cases, abutments are treated endodontically. In most patients with complete dentures, mandibular denture is difficult to adapt, and there is loss of retention because of less surface area. This case report represents prosthetic rehabilitation of a mandibular edentulous patient with cast coping with short dowels supported overdenture.

“The best of friends fall out with time and so do teeth.”Thus, there is a need to replace the lost teeth and the supporting structures for the patient's social demands and functional rehabilitation. Prosthetic treatment with complete dentures is a very common treatment modality; the biggest challenge in its fabrication is to duplicate the normal vertical dimension. Failure can be avoided by completing the treatment without changing the vertical dimension and obtaining an optimal facial proportion. There are many methods to record VD. Radiographic cephalometry has been used as a diagnostic tool in Prosthodontics for over five decades and numerous authors, like Ricketts (1981), McNamara (1984) and Slavicek (1984) developed and computerized these techniques to co-relate and record VD in patients. However cephalometric analysis can help to visualize skeletal and facial proportion relation. The present study was done to use the lateral radiographs with cephalometric analysis, as it could be a simple, non-technique sensitive, non-invasive and atraumatic way to determine VD for complete denture patients and also to compare physiologic methods (swallowing/phonetics) with cephalometric method to record lower facial height.

Background and Aims EMR is being increasingly practiced for the removal of large colorectal polyps. A variety of solutions such as normal saline solution (NS) and other viscous and hypertonic solutions (VS) have been used as submucosal injections for EMR. A systematic review and meta-analysis is presented comparing the efficacy and adverse events of EMR performed using NS versus VS. Methods Two independent reviewers conducted a search of all databases for human, randomized controlled trials that compared NS with VS for EMR of colorectal polyps. Data on complete en bloc resection, presence of residual lesions, and adverse events were extracted using a standardized protocol. Pooled odds ratio (OR) estimates along with 95% confidence intervals (CI) were calculated using fixed effect or random effects models. Results Five prospective, randomized controlled trials (504 patients) met the inclusion criteria. The mean polyp sizes were 20.84 mm with NS and 21.44 mm with VS. On pooled analysis, a significant increase in en bloc resection (OR, 1.91; 95% CI, 1.11-3.29; P = .02; I 2 = 0%) and decrease in residual lesions (OR, 0.54; 95% CI, 0.32-0.91; P = .02; I 2 = 0%) were noted in VS compared with NS. There was no significant difference in the rate of overall adverse events between the 2 groups. Conclusions Use of VS during EMR leads to higher rates of en bloc resection and lower rates of residual lesions compared with NS, without any significant difference in adverse events. Endoscopists could consider using VS for EMR of large colorectal polyps and NS for smaller polyps because there is no significant difference in the outcomes with lesions

Introduction Smartphone-based applications (apps) have been used to improve the quality of bowel preparation (prep) but the success rates have been variable. We have performed a systematic review and meta-analysis to evaluate the impact of smartphone apps on bowel preparation. Methods Electronic databases (MEDLINE, Embase, CINAHL and Cochrane) were reviewed for eligible studies of smartphone apps versus standard education before colonoscopy. The following outcomes were analyzed: pooled rate of adequacy of bowel prep among both arms and Boston bowel preparation score (BBPS) when reported. Pooled analysis was reported as odds ratio (OR) or mean difference in random effect model with Review Manager 5.3 (P ≤ 0.05 for statistical significance). Results Six studies were eligible with smartphone app (810 patients) vs. standard education (855 patients, control group) for bowel prep. The smartphone app group had a higher proportion of adequate bowel prep compared to the control group: 87.5 % vs 77.5 % (five studies), pooled OR 2.67; 95 %CI 1.00 – 7.13 with P = 0.05. There was substantial heterogeneity in studies with I 2 = 78 %. When analysis was limited to randomized controlled trials (RCTs), smartphone app users had a numerically higher rate of bowel cleansing: 87.1 % vs 76.9 %; however, pooled OR was not statistically significant (OR 2.66, 95 %CI 0.92 – 7.69, P = 0.07). When studies using BBPS were evaluated (n = 3), smartphone app users had higher mean scores (better bowel prep) with a mean difference of 0.9 (95 %CI 0.5 – 1.3), which was statistically significant (P Conclusion The smartphone app is a novel educational tool that can assist in achieving adequate and better bowel cleansing before colonoscopy.

Exosomes, which act as biological cargo vessels, are cell-released, phospholipid-enclosed vesicles. In eukaryotic cells, exosomes carry and exchange biological materials or signals for the benefit or detriment to the cells. Thereby, we consider exosomes to be molecular Palkis (carriers). Although exosomes are currently one of the most popularly researched cellular entities, they have remained largely enigmatic and warrant continued investigation into their structure and functions. These membraned vesicles are between 30 and 150 nm in diameter and are actively secreted by all cell types. While initially considered cellular "trash bags," recent years have revealed exosomes to be dynamic and multi-functional vesicles that may play a crucial role in cancer development, progression and metastasis. Thereby, they have the potential to be used in development of therapeutic modalities for cancer and other diseases. As more research studies emerge, it's becoming evident that exosomes are released by cells with a purpose and are representatives of certain cell types and disease conditions. Hence, they may also be used as biomarkers for the detection of cancer initiation, progression and organotropic metastatic growth of cancer cells. This review will focus on the recent developments achieved in identifying the role of exosomes in cancer development and progression as well as therapeutic implications. The review will also discuss the pitfalls of methodologies used for the extraction of exosomes.

The prevalence of advanced histology in flat adenomas is uncertain. There are limited data on the prevalence of synchronous adenomas in patients with flat adenomas. The aims of this study were to determine whether the flat adenomas harbor advanced histology more than the polypoid adenomas and whether the presence of flat adenomas is an independent predictor of synchronous adenomas.A retrospective analysis of data from 3 prospective clinical trials conducted at 2 tertiary care referral centers that included patients undergoing screening or surveillance colonoscopy was performed. The location, size, and morphology of each polyp resected was documented and sent for histopathological examination in a unique specimen jar.A total of 2931 polyps were removed in 1340 patients. Of the 1911 adenomas (65.2%), 293 (15.3%) were flat and 1618 (84.7%) were polypoid. The prevalence of advanced histology did not differ between flat and polypoid adenomas (1.4% vs 3.1%; P = .13). Multivariate analysis confirmed that the presence of at least 1 flat adenoma was a predictor of the presence of a large adenoma (P.01; odds ratio [OR], 2.80; 95% CI, 1.86-4.22), advanced adenoma (P.01; OR, 2.70; 95% CI, 1.80-4.06), and 3 or more adenomas (P.01; OR, 2.44; 95% CI, 1.66-3.59).Although the prevalence of advanced histology in flat adenomas is similar to that of polypoid adenomas, flat adenomas are associated with increased prevalence of synchronous large and advanced adenomas. Whether these results imply shorter surveillance intervals in patients with flat adenomas needs to be explored in future studies.

The rapid increase and poor survival of esophageal adenocarcinoma (EAC) have led to significant efforts to promote early detection. Given that the premalignant lesion of Barrett's esophagus (BE) is the major known risk factor for EAC, multiple investigators have studied biomarker signatures that can predict malignant progression of BE to EAC. MicroRNAs, a novel class of gene regulators, are small non-coding RNAs and have been associated with carcinogenesis. MicroRNAs are ideal biomarkers because of their remarkable stability in fixed tissues, a common method for collection of clinical specimens, and in blood either within exosomes or as microRNA-protein complexes. Multiple studies show potential of microRNAs as tissue and blood biomarkers for diagnosis and prognosis of EAC but the results need confirmation in prospective studies. Although head-to-head comparisons are lacking, microRNA panels require less genes than messenger RNA panels for diagnosis of EAC in BE. MicroRNA diagnostic panels will need to be compared for accuracy against global measures of genome instability that were recently shown to be good predictors of progression but require sophisticated analytic techniques. Early studies on blood microRNA panels are promising but have found microRNA markers to be inconsistent among studies. MicroRNA expression in blood is different between various microRNA sub-compartments such as exosomes and microRNA-protein complexes and could affect blood microRNA measurements. Further standardization is needed to yield consistent results. We have summarized the current understanding of the tissue and blood microRNA signatures that may predict the development and progression of EAC.

Lynch syndrome (LS) is the most common inherited colorectal cancer (CRC) syndrome with lifetime CRC risks of up to 70%.1 Conventionally, CRC specimens are screened for LS postoperatively but preoperative diagnosis of LS could impact decisions, such as the extent of resection and the need for additional risk-reducing surgeries for uterine and ovarian cancers. Few studies have addressed this issue2-5 and surveys indicate that most gastroenterologists are unsure that LS can be screened for preoperatively.6 We compared the yield of preoperative versus postoperative screening of LS by immunohistochemistry (IHC) and microsatellite instability (MSI) in unselected patients with newly diagnosed CRC who underwent testing under real-life laboratory conditions to mimic clinical practice.

Ischemic colitis due to medications is common, and a number of cases have been described with pseudoephedrine as the culprit agent. We present here an interesting case of a healthy female with no risk factors who developed pseudoephedrine induced ischemic colitis. This case serves to remind the healthcare providers about the utmost importance of obtaining a comprehensive history to aid with the diagnosis.

Early carcinomas of the esophagus are histologically classified as adenocarcinoma or squamous cell carcinoma and microscopically subdivided into mucosal and submucosal carcinomas depending on infiltration depth. The prevalence of lymph node metastasis in mucosal carcinoma remains low. However, lymph node metastases arise frequently from tumors with submucosal infiltration, with increasing prevalence in the deeper submucosal sublayers. According to current German guidelines, endoscopic resection is the recommended treatment in mucosal adenocarcinoma without histologic risk factors (lymphatic invasion 1, vascular invasion 1, >grade 2, R1-margin). In superficial submucosal infiltration without histologic risk factors, endoscopic resection can be considered. In squamous cell carcinoma, endoscopic resection is indicated up to middle layer mucosal carcinoma. Beyond these criteria, surgical resection should be considered. The gold standard is a subtotal transthoracic esophagectomy with two-field lymphadenectomy. Total esophagectomy is performed in cervical esophageal carcinoma and transhiatal extended gastrectomy in carcinoma of the cardia. Minimally invasive procedures show good oncologic results and reduce the morbidity of radical esophagectomy. Reduced morbidity might be an argument for surgical resection in borderline cases between endoscopic and surgical resection. In early squamous cell cancer, the combination of endoscopic resection and adjuvant chemoradiotherapy is a therapeutic option with promising results.

Background & Aims A system is needed to determine the risk of patients with Barrett's esophagus for progression to high-grade dysplasia (HGD) and esophageal adenocarcinoma (EAC). We developed and validated a model to determine of progression to HGD or EAC in patients with BE, based on demographic data and endoscopic and histologic findings at the time of index endoscopy. Methods We performed a longitudinal study of patients with BE at 5 centers in United States and 1 center in Netherlands enrolled in the Barrett's Esophagus Study database from 1985 through 2014. Patients were excluded from the analysis if they had less than 1 year of follow up, were diagnosed with HGD or EAC within the past year, were missing baseline histologic data, or had no intestinal metaplasia. Seventy percent of the patients were used to derive the model and 30% were used for the validation study. The primary outcome was development of HGD or EAC during the follow-up period (median 5.9 years). Survival analysis was performed using the Kaplan-Meier method. We assigned a specific number of points to each BE risk factor, and point totals (scores) were used to create categories of low, intermediate, and high risk. We used Cox regression to compute hazard ratios (HR) and 95% CIs to determine associations between risk of progression and scores. Results Of 4584 patients in the database, 2697 were included in our analysis (84.1% men; 87.6% Caucasian; mean age, 55.4±20.1 years; mean body mass index, 27.9±5.5; mean length of BE, 3.7 cm±3.2). During the follow-up period, 154 patients (5.7%) developed HGD or EAC, with an annual rate of progression of 0.95%. Male sex, smoking, length of BE, and baseline-confirmed low-grade dysplasia were significantly associated with progression. Scores assigned identified patients with BE that progressed to HGD or EAC with a c-statistic of 0.76 (95% CI, 0.72–0.80) ( P P =.99), determined from the validation cohort. Conclusions We developed a scoring system (called progression of BE (PIB) score) based on male sex, smoking, length of BE, and baseline low-grade dysplasia) that identified patients with BE at low, intermediate, and high risk groups for HGD or EAC. This scoring system might be used in management of patients.