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Berangan banana were treated with hot water at 50 ºC for 0 (control), 10, and 20 min and then kept at room temperature (25±2 ºC), 75-80% RH to observe the ripening progress. Firmness and activity of cell wall degradation enzymes such as polygalacturonase (PG), pectin methylesterase (PME), and pectate lyase (PL) were determined for treated and untreated banana. The microstructure of banana peel cell wall was observed by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Treated fruit was firmer than the control fruit during ripening process. PG, PME, and PL activities were reduced in the treated bananas when compared with the control treatment. Hot water treatment disturbed cell wall degrading enzymes activity and delayed the disassembling of pectin fraction of Berangan banana. The micrographs of SEM and TEM exhibited lower changes in cell compartment and less loosening of cell wall fibril fractions in treated fruits. The electrolyte leakage in Berangan banana decreased with the increase of exposure time. The results of this study indicated that hot water treatment at 50 ºC slowed down the ripening process and extended shelf life of banana. [ABSTRACT FROM AUTHOR]

Aims: The comprehensive effects of maxillary posterior tooth extraction on the maxillary sinus (MS) morphology remain to be thoroughly elucidated. This retrospective cohort study aimed at evaluating the influence of different extraction indications on the morphological changes in the MS by utilizing cone-beam computed tomography (CBCT)., Methods: One hundred and seventy-eight of maxillary posterior tooth extractions underwent CBCT scans before and after extraction using 3D Slicer software. Parameters such as maxillary sinus pneumatization (MSP, the primary outcome measure), buccal bone height (BBH), palatal bone height (PBH), mucosal thickness (MT), and other anatomical structures were measured for patients undergoing extraction due to periodontitis, periapical lesions, or tooth fracture. Multiple linear regression analysis was employed to assess the effect of extraction indications on the MS., Results: While the primary outcome, MSP, did not reveal statistically significant differences across various indications for tooth extraction (p > .05), extraction itself resulted in MSP (p < .05). The rate of this pneumatization was influenced by the position of the extraction site (p < .05). Additionally, baseline values of bone height and mucosal thickness showed an inverse correlation with the rate of change in these parameters following tooth extraction (p < .001)., Conclusions: Tooth extraction led to increased pneumatization of the maxillary sinus while simultaneously reducing bone height and mucosal thickness. However, these outcomes were not influenced by the reason for tooth extraction., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objects: This study aims to explore the etiology of peri-implantitis by comparing the metabolic profiles in peri-implant crevicular fluid (PICF) from patients with healthy implants (PH) and those with peri-implantitis (PI)., Materials and Methods: Fifty-six patients were enrolled in this cross-sectional study. PICF samples were collected and analyzed using both non-targeted and targeted metabolomics approaches. The relationship between metabolites and clinical indices including probing depth (PD), bleeding on probing (BOP), and marginal bone loss (MBL) was examined. Additionally, submucosal microbiota was collected and analyzed using 16S rRNA gene sequencing to elucidate the association between the metabolites and microbial communities., Results: Significant differences in metabolic profiles were observed between the PH and PI groups, with 179 distinct metabolites identified. In the PI group, specific amino acids and fatty acids were significantly elevated compared to the PH group. Organic acids including succinic acid, fructose-6-phosphate, and glucose-6-phosphate were markedly higher in the PI group, showing positive correlations with mean PD, BOP, and MBL. Metabolites that increased in the PI group positively correlated with the presence of Porphyromonas and Treponema and negatively with Streptococcus and Haemophilus., Conclusions: This study establishes a clear association between metabolic compositions and peri-implant condition, highlighting enhanced metabolite activity in peri-implantitis. These findings open avenues for further research into metabolic mechanisms of peri-implantitis and their potential therapeutic implications., (© 2024 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: To date, the clinical evidence regarding the effectiveness of alveolar ridge preservation (ARP) in restricting alveolar bone height and width change after extraction at periodontally compromised molar extraction sockets still remains controversial. This retrospective cohort study aims to evaluate the effect of ARP in molars extracted for periodontal reasons., Methods: Retrospective data were collected from patient electronic records from January 2019 to December 2023. Patients with Stage III/IV periodontitis who underwent extraction of molars for periodontal reasons were screened for eligibility. The outcomes included the horizontal and vertical dimensions of alveolar bone. The need for additional augmentation procedure during implantation was also evaluated. A linear regression model was used to adjust for known confounders., Results: A total of 80 sockets were included in this study, of which 27 sockets received ARP therapy after extraction while 53 sockets experienced natural healing (NH). ARP resulted in significantly less bone height change in the periodontally compromised molar sites compared to the NH group (p < 0.001). In sockets displaying a height disparity of >2 mm between the buccal and palatal/lingual walls, the ARP group exhibited advantageous outcomes in terms of ridge width change, surpassing the NH group (p = 0.004). Moreover, the percentage for additional augmentation was significantly reduced in the ARP compared to the NH group (p = 0.006). Age, sex, smoking, jaw, location, and buccal wall thickness did not show any significant effect on bone height change., Conclusion: ARP had benefits on limiting ridge resorption subsequent to molar extraction for periodontal reasons., (© 2024 American Academy of Periodontology.)

Background: The aim of this study was to assess the outcomes of the combination technique of strip free gingival grafts (SFGG) and xenogeneic collagen matrix (XCM) in augmenting the width of keratinized mucosa (KMW) around dental implants, and compare its efficacy with the historical control group (FGG)., Methods: Thirteen patients with at least one site with KMW ≤ 2 mm after implant surgery were included and received SFGG in combination with XCM. Another thirteen patients with the same inclusion and exclusion criteria from the previous trial received FGG alone. The same outcomes as the previous trial were evaluated. KMW, thickness of keratinized mucosa (KMT), gingival index (GI) and probing depth (PD) were measured at baseline, 2 and 6 months. Postoperative pain, patient satisfaction and aesthetic outcomes were also assessed., Results: At 6 months after surgery, the combination technique could attain 3.3 ± 1.6 mm of KMW. No significant change could be detected in GI or PD at 6 months compared to those at 2 months (p > 0.05). The postoperative pain and patient satisfaction in VAS were 2.6 ± 1.2 and 9.5 ± 1.2. The total score of aesthetic outcomes was 3.8 ± 1.2. In the historical FGG group, 4.6 ± 1.6 mm of KMW was reported at 6 months, and the total score of aesthetic outcomes was higher than the combination technique (4.8 ± 0.7 vs. 3.8 ± 1.2, p < 0.05)., Conclusions: The combination technique of SFGG and XCM could increase KMW and maintain peri-implant health. However, this combination technique was associated with inferior augmentation and aesthetic outcomes compared with FGG alone., Trial Registration: This clinical trial was registered in the Chinese Clinical Trial Registry with registration number ChiCTR2200057670 on 15/03/2022., (© 2024. The Author(s).)

Objective: To evaluate the effects of photodynamic therapy (PDT) in extraction sockets of periodontally compromised molars on soft tissue healing, postoperative pain, bone density and bone height changes. Methods: This study is a single-center, single-blind, randomized controlled superiority clinical trial. Thirty-eight periodontally compromised molars requiring extraction in patients attending the Department of Periodontology, Stomatology Hospital, School of Stomatology, Zhejiang University School of Medicine, from December 2022 to September 2023 were included, and randomly assigned to PDT group and control group. The control group received routine debridement after extraction, while PDT group received routine debridement followed by PDT. The bucco-lingual and mesio-distal wound distances at 7 and 14 d after extraction were measured, and then the wound closure rates were calculated. Evaluating the soft tissue healing indexes at 7 and 14 d after extraction. The visual analogue scale was used to assess the pain level at 6 h, 1 d, 2 d, and 3 d after tooth extraction. Apical radiographs were taken immediately and 2 months after extraction in order to compare the changes of the bone density and height. Results: The wound closure rate at 1 week was (78.08±5.45)% in PDT group and (71.03±6.82)% in control group, with significant differences ( P< 0.01). The wound closure rate at 2 weeks in PDT group [(85.88±3.84) %] was significantly higher than that in the control group [(81.66±3.79) %] ( P< 0.01), but did not reach the superiority value of the superiority test (superiority value=10%, 95% CI at 1 week: 3.00%-11.12%, 95% CI at 2 weeks: 1.71%-6.73%). The soft tissue healing index of PDT group at 1 week was significantly better than the control group ( P< 0.05), but there was no significant difference between the two groups at 2 weeks ( P> 0.05). There was no significant difference between the two groups in terms of postoperative pain at 6 h, 1 d, 2 d and 3 d as well as in bone density and height changes at 2 months after tooth extraction ( P> 0.05). Conclusions: PDT could promote soft tissues healing to some extent, but did not provide additional assistance in the healing of extraction sockets of periodontally compromised teeth. PDT did not show benefits on postoperative pain, changes of the bone density and bone height after tooth extraction.

The precise delivery of growth factors (GFs) in regenerative medicine is crucial for effective tissue regeneration and wound repair. However, challenges in achieving controlled release, such as limited half-life, potential overdosing risks, and delivery control complexities, currently hinder their clinical implementation. Despite the plethora of studies endeavoring to accomplish effective loading and gradual release of GFs through diverse delivery methods, the nuanced control of spatial and temporal delivery still needs to be elucidated. In response to this pressing clinical imperative, our review predominantly focuses on explaining the prevalent strategies employed for spatiotemporal delivery of GFs over the past five years. This review will systematically summarize critical aspects of spatiotemporal GFs delivery, including judicious bio-scaffold selection, innovative loading techniques, optimization of GFs activity retention, and stimulating responsive release mechanisms. It aims to identify the persisting challenges in spatiotemporal GFs delivery strategies and offer an insightful outlook on their future development. The ultimate objective is to provide an invaluable reference for advancing regenerative medicine and tissue engineering applications., (Copyright © 2024 Elsevier B.V. All rights reserved.)

OBJECTIVES : Distolingual root of the permanent mandibular first molar (PMFM-DLR) has been frequently reported, which may complicate the treatment of periodontitis. This study aimed to assess the morphological features of PMFM-DLR and investigate the correlation between the morphological features of PMFM-DLR and periodontal status in patients with Eastern Chinese ethnic background. MATERIALS AND METHODS : A total of 836 cone beam computed tomography (CBCT) images with 1497 mandibular first molars were analyzed to observe the prevalence of PMFM-DLR at the patients and tooth levels in Eastern China. Among them, complete periodontal charts were available for 69 Chinese patients with 103 teeth. Correlation and regression analyses were used to evaluate the correlation between the morphological features of DLR, bone loss, and periodontal clinical parameters, including clinical attachment loss (CAL), probing pocket depth (PPD), gingival recession (GR), and furcation involvement (FI). RESULTS : The patient-level prevalence and tooth-level prevalence of DLR in mandibular first molars were 29.4% and 26.3%, respectively. Multiple linear regression analysis suggested that bone loss at the lingual site and CAL were negatively affected by the angle of separation between distolingual and mesial roots in the transverse section, while they were significantly influenced by age and the angle of separation between distobuccal and mesial roots in the coronal section. CONCLUSIONS : The prevalence of PMFM-DLR in Eastern China was relatively high in our cohort. The morphological features of DLR were correlated with the periodontal status of mandibular first molars. This study provides critical information on the morphological features of DLR for improved diagnosis and treatment options of mandibular molars with DLR.

Periodontitis (PD) is the primary cause of tooth loss in adults. Porphyromonas gingivalis ( P.g ), a keystone pathogen, has been identified as a crucial contributor to this process. Pyroptosis activation in PD is acknowledged, with accumulating evidence underscoring the crucial role of Caspase-11 (described as Caspase-4/5 in humans)-mediated noncanonical pyroptosis. However, the mechanism behind its impact on PD remains unclear. In this study, we delved into the interplay between the Caspase-11-mediated noncanonical pyroptosis, subgingival microbiota alteration, and macrophage polarization. Clinical samples from PD patients revealed heightened expression of Caspase-4, gasdermin-D, and their active fragments, pointing to the activation of the noncanonical pyroptosis. Single-cell sequencing analysis linked Caspase-4 with gingival macrophages, emphasizing their involvement in PD. In vitro cell experiments confirmed that P.g -induced pyroptosis was activated in macrophages, with Casp11 deficiency attenuating these effects. In an experimental PD mouse model, Casp11 deficiency led to an alteration in subgingival microbiota composition and reduced alveolar bone resorption. Casp11 -/- mice cohousing with wild-type mice confirmed the alteration of the subgingival microbiota and aggravated the alveolar bone resorption. Notably, Casp11 deficiency led to decreased M1-polarized macrophages, corresponding with reduced alveolar bone resorption, uncovering a connection between subgingival microbiota alteration, macrophage M1 polarization, and alveolar bone resorption. Taken together, we showed that Caspase-11 fulfilled a crucial role in the noncanonical pyroptosis in PD, potentially influencing the subgingival microbiota and linking to M1 polarization, which was associated with alveolar bone resorption. These findings underscored the pivotal role of the Caspase-11-mediated noncanonical pyroptosis in PD pathogenesis and may provide critical insights into potential therapeutic avenues for mitigating PD., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Soft tissue substitutes have been developed to treat gingival recessions to avoid a second surgical site. However, products of pure collagen for clinical application lack their original mechanical strengths and tend to degrade fast in vivo. In this study, a collagen-based scaffold crosslinked with oxidized sodium alginate (OSA-Col) was developed to promote mechanical properties. Compared with commercial products collagen matrix (CM) and collagen sponge (CS), OSA-Col scaffolds presented higher wet-state cyclic compressibility, early anti-degradation ability, similar hemocompatibility and cytocompatibility. Furthermore, in the subcutaneous implantation experiment, OSA2-Col3 scaffolds showed better anti-degradation performance than CS scaffolds and superior neovascularization than CM scaffolds. These results demonstrated that OSA2-Col3 scaffolds had potential as a new soft tissue substitute for the treatment of gingival recessions., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Oral microbial community, as an important part of human microbial community, is closely related to oral and general health. Oral microbiological research has become the forefront of international microbiological research. Standardized and unified nomenclature for oral microorganisms in Chinese is of great significance to support the development of oral medicine research. Standardized translation of microbial names is the basis for writing canonical and authoritative professional textbooks and reference books, which helps students to accurately acquire the characteristics and classifications of oral microbes. Unified translation of oral microorganisms is also conducive to academic communication and cooperation, and plays an important role in oral health education and science popularization, which enables oral microbiology knowledge to be accurately disseminated to the public. Therefore, in order to standardize the words in scientific research, funding application, publications, academic exchanges and science popularization within the field of oral medicine, we have fully discussed and revised the Chinese names of oral microorganisms in 2017 edition and ones of newly discovered oral microbes, finally reaching a consensus to form the 2023 edition of Chinese names of oral microorganisms.

Autophagy is an immune homeostasis process induced by multiple intracellular and extracellular signals. Inflammation is a protective response to harmful stimuli such as pathogen microbial infection and body tissue damage. Porphyromonas gingivalis infection elicits both autophagy and inflammation, and dysregulation of autophagy and inflammation promotes pathology. This review focuses on the interaction between autophagy and inflammation caused by Porphyromonas gingivalis infection, aiming to elaborate on the possible mechanism involved in the interaction., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Kang, Dai, Wang and Ding.)

Aim: To evaluate the outcomes of an apically repositioned flap (ARF) plus xenogeneic collagen matrix (XCM) in augmenting keratinized mucosa width (KMW) around dental implants when compared with ARF plus free gingival grafts (FGG)., Materials and Methods: Twenty-six participants with at least one site with KMW ≤2 mm were randomized into FGG or XCM group. Clinical examinations were performed at baseline and at 2 and 6 months after surgery, including KMW, keratinized mucosa thickness, gingival index (GI), and probing depth (PD). Post-operative pain and patient satisfaction were also evaluated., Results: At 6 months, FGG attained a greater increase of KMW and thicker mucosa than XCM (4.1 ± 1.6 mm vs. 1.8 ± 1.0 mm, p < .001; 1.7 ± 0.6 mm vs. 1.2 ± 0.3 mm, p < .01). Regarding GI, PD, post-operative pain, aesthetic outcomes, and patient satisfaction, no significant difference could be detected. Moreover, the operation time of XCM group was shorter (60 ± 9 min vs. 39 ± 8 min, p < .001)., Conclusions: FGG could result in greater increase of KMW than XCM, though both could increase KMW, maintain peri-implant health, and attain comparable aesthetic outcomes. The use of XCM was associated with reduced operation time., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objective and Background: Recently, decellularized matrix (DCM) is considered as a new biomaterial for tissue regeneration. To explore the possible application of DCM in periodontal regeneration, the effect of DCM from three different cells on the proliferation and differentiation of human periodontal ligament stem cells (PDLSCs) was investigated., Methods: DCM derived from human periodontal ligament cells (PDLCs), dental pulp cells (DPCs), and gingival fibroblasts (GFs) were fabricated using Triton X-100/NH 4 OH combined with DNase I. Allogeneic PDLSCs were cultured on PDLC-DCM, DPC-DCM, and GF-DCM, respectively. The proliferative capacity of PDLSCs was evaluated by PicoGreen assay kit. The expression of alkaline phosphatase (ALP), runt-related transcription factor-2 (RUNX2), osteocalcin (OCN), collagen I (COL1), periostin (POSTN), and cementum protein 1 (CEMP1) were detected by qRT-PCR and western blotting., Results: PDLC-DCM, DPC-DCM, and GF-DCM had similar and integrated networks of extracellular matrix, as well as significantly decreased DNA content. Compared with control group in which PDLSCs were directly seeded in culture plates, PDLC-DCM, DPC-DCM, and GF-DCM promoted the proliferation of re-seeded PDLSCs. Additionally, PDLSCs on DCM exhibited higher mRNA and protein expression levels of ALP, RUNX2, OCN, and COL1. The expression of POSTN in PDLC-DCM group was significantly higher than control group at both mRNA and protein levels., Conclusions: PDLC-DCM, DPC-DCM, and GF-DCM could enhance the proliferation of PDLSCs. PDLC-DCM facilitated osteogenic differentiation and periodontal ligament differentiation of PDLSCs, while DPC-DCM and GF-DCM promoted osteogenic differentiation., (© 2021 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Pyroptosis is a pro-inflammatory form of programmed cell death that has been gradually recognized in recent years. It plays an important role in recognizing the invasion of exogenous pathogens and sensing endogenous danger signals. The initiation of pyroptosis depends on the activation of intracellular inflammasome and its downstream caspases, as well as the active fragment of the key protein Gasdermin. The invasion of periodontal pathogens induces an inflammatory response of the host, involving the activation of inflammasome and triggering pyroptosis as well. Meanwhile, it leads to the release of a large number of inflammatory cytokines such as interleukin (IL)-1β and IL-18 to amplify the inflammatory response and mediate periodontal tissue destruction eventually. This article reviews the research progress of the signaling pathways of pyroptosis, as well as its mechanism induced by periodontal pathogens and the mechanism of periodontal tissue damage in periodontitis in order to provide new targets and ideas for the prevention and treatment of periodontitis.

Periodontal disease (PD), as an age-related disease, prevalent in middle-aged and elderly population, is characterized as inflammatory periodontal tissue loss, including gingival inflammation and alveolar bone resorption. However, the definite mechanism of aging-related inflammation in PD pathology needs further investigation. Our study is aimed at exploring the effect of inflamm-aging-related cytokines of interleukin-17 (IL-17) and interferon- γ (IFN- γ ) on osteoclastogenesis in vitro and periodontal destruction in vivo . For receptor activator of nuclear factor- κ B ligand- (RANKL-) primed bone marrow macrophages (BMMs), IL-17 and IFN- γ enhanced osteoclastogenesis, with the expression of osteoclastogenic mRNA (TRAP, c-Fos, MMP-9, Ctsk, and NFATc1) and protein (c-Fos and MMP-9) upregulated. Ligament-induced rat models were established to investigate the role of IL-17 and IFN- γ on experimental periodontitis. Both IL-17 and IFN- γ could enhance the local inflammation in gingival tissues. Although there might be an antagonistic interaction between IL-17 and IFN- γ , IL-17 and IFN- γ could facilitate alveolar bone loss and osteoclast differentiation., Competing Interests: All authors declare that there are no conflicts of interest associated with this study., (Copyright © 2021 Jingyi Tan et al.)

Introduction: Ulcerative colitis (UC) is a chronic inflammatory bowel disease (IBD) characterized by a relapsing-remitting course owing to recurrent intestinal inflammation. UC often has symptoms such as intermittent rectal bleeding, diarrhea, and abdominal pain. As the precise etiology of UC has not completely clarified, UC has become a public health challenge worldwide. According to an epidemiological survey, there were about 350,000 new cases of IBD in China from 2005 to 2014. By 2025, the number of IBD patients in China will reach 1.5 million. Traditional Chinese medicine (TCM) has been widely used to treat UC in China, however, it is still challenging to systematically determine the efficacy of in UC. Therefore, this trial aims to evaluate the clinical efficacy and safety of CHM in the treatment of mild active UC patients., Methods: A multi-center, double-blinding, double-dummy, active-controlled, randomized trial will be established. A total of 240 patients in 6 centers with mild active UC (Mayo score is 3-5 points) and TCM syndrome of damp-heat stasis blocking and spleen-qi deficiency will be randomly allocated in the ratio of 1:1 to 2 groups: the experimental group and the control group. The experimental group will receive Hudi enteric-coated capsules (HEC) and enteric-coated mesalazine tablets placebo; the control group will receive enteric-coated mesalazine tablets and HEC placebo. Each group will be treated for 8 weeks. The primary therapeutic outcome: the rate of clinical efficacy and clinical remission at 8 weeks of treatment (last survey point) according to the modified Mayo score. The secondary outcomes: individual symptom score, TCM syndrome score, endoscopic response rate, mucosal healing rate, and quality of life scale score. Outcomes will be assessed at baseline and the end of the trial. Besides, intestinal mucosa, stools and blood biopsies from the mild active UC patients before and after treatment will be collected to reveal the underlying mechanisms., Discussion: The results of this trial will provide compelling evidence of the efficacy and safety of HEC for treatment of mild active UC and preliminarily show the potential mechanism of how HEC acts. Finally, it will widen treatment options for patients with mild active UC.

Background : Oral commensals contribute to microbe-host symbiosis in periodontal homeostasis, and Porphyromonas gingivalis ( P. gingivalis ) as the keystone pathogen critically accounts for the shift of symbiosis to dysbiosis and periodontal destruction. Nucleotide-binding oligomerization domain (NOD)-like receptor (NLR) family pyrin domain containing 3 (NLRP3) inflammasome-mediated interleukin-1β (IL-1β) is significantly involved in periodontal diseases, and notably P. gingivalis enables to modulate the induction and expression of NLRP3. Whereas, the exact mechanism by which NLRP3 inflammasome is regulated in response to commensal and pathogenic bacteria remains unclear. Methods : To examine the expression of IL-1β and NLRPs inflammasome in tissues with severe chronic periodontitis, and further investigate how Caspase-4-dependent non-canonical NLRP3 inflammasome pathways functioned during the interactions of Streptococcus mitis ( S. mitis ) and P. gingivalis with human THP-1 cells. Results : IL-1β and NLRP3, NLRP6, NLRP12, and absent in melanoma 2 (AIM2) inflammasomes are highly expressed in gingival tissues with severe chronic periodontitis. In human THP-1 cells, P. gingivalis activates the synthesis and secretion of IL-1β to higher levels than S. mitis . Importantly, NLRP3-, Caspase-1-, and Caspase-4-siRNA knockdown THP-1 cells treated with P. gingivalis exhibited a lower expression level of IL-1β as compared to the control cells. In addition, silencing of either CASP4 or CASP1 can lead to a concurrent or reciprocal decrease in the expression of the other. Of note, the IL-1β induction is not affected in the S. mitis -treated THP-1 cells with the silence of NLRP3, Caspase-1, and Caspase-4 genes. Conclusion : NLRP3/Caspase-4 and NLRP3/Caspase-1 dependent IL-1β production may crucially contribute to the dysregulated immuno-inflammatory response in periodontal pathogenesis., (Copyright © 2020 Ding, Yang, Wang, Jin, Dong, Cai and Chen.)

Background: Dentine hypersensitivity (DH) could occur or intensify after non-surgical periodontal therapy because of the exposure of dentine tubules, but currently no gold standard exists to treat DH. It has been demonstrated that nano-sized particles presented potential for dentine tubules blocking and remineralization. This randomized controlled trial aimed to investigate the efficacy of dentifrice containing nano-carbonate apatite (n-CAP) in reducing dentine hypersensitivity (DH) after non-surgical periodontal therapy., Methods: 48 periodontitis patients with DH were included in this clinical trial. After non-surgical periodontal therapy, patients included were randomized to test and control group and the respective dentifrices were applied at chairside, after which they were instructed to brush teeth with the allocated dentifrices twice a day at home. Periodontal parameters were recorded at baseline and the last follow-up. DH was measured by air-blast test and recorded by visual analogue scale (VAS) and Schiff sensitivity scale at baseline, after polishing (0 week) and 2/4/6 weeks., Results: 45 participants completed the follow-up. Periodontal parameters were improved and comparable between groups. Significant reduction in DH was observed in both groups at all time-points compared to baseline in terms of VAS and Schiff score. The test group achieved significantly greater relief from hypersensitivity compared with the control group after 4-week at-home use (for change of VAS, test group: 2.27 ± 2.47 versus control group: 1.68 ± 2.24, p = 0.036; for change of Schiff, test group: 0.94 ± 0.92 versus control group: 0.61 ± 0.83, p < 0.001). The 6-week results showed borderline significance between groups in terms of change of Schiff (p = 0.027) and no significance in terms of change of VAS (p = 0.256)., Conclusions: Home-use of n-CAP based dentifrice had some benefit on alleviation of DH following non-surgical periodontal therapy after 4 weeks compared to the control product., Trial Registration: Chinese Clinical Trials Registry (No. ChiCTR-IPR-17011678, http://www.chictr.org.cn/, registered 16 June, 2017).

Research have indicated that inadequate keratinized tissue has a negative effect on patient oral hygiene, resulting in peri-implant inflammation. It has been recommended that an apically repositioned flap alone or in combination with autogenous soft tissue grafts can increase the width of keratinized mucosa around dental implants, which promotes long term peri-implant health. This review summarized research progress on augmentation techniques of keratinized tissue arround implants in recent years, so as to provide reference for clinical practice and research design in the future.

Heweijiangni decoction (HWJND) is an effective traditional Chinese medicine prescription in clinical treatment of nonerosive reflux disease (NERD). Esophageal hypersensitivity and acid contribute to the disease. However, the exact underlying mechanism of action remains unclear. In this study, we observed the effect of HWJND on esophageal morphology in a rat model of ovalbumin (OVA)-induced visceral hypersensitivity followed by acid exposure. Esophageal morphology was assessed by measuring the extent of dilated intercellular spaces (DIS), desmosome disruption, and mitochondrial fragmentation. HWJND in low, moderate, and high doses relieved DIS and desmosome disruption in esophageal epithelium compared with model group (P&lt;0.05 for all doses). In addition, HWJND in high dose protected mitochondria from fragmentation (P&lt;0.05). Other findings suggest that DIS and mitochondrial fragmentation are independent events, and that omeprazole protects mitochondria. Overall, HWJND significantly resists esophageal morphology changes in OVA-induced and acid exposure rat model.

Aim: To evaluate the long-term (≥2 years) stability of root coverage procedures for single gingival recessions., Materials and Methods: A complete literature search was performed up to July 2018. Randomized controlled trials (RCTs) following ≥2 years were selected. Primary outcomes were complete root coverage (CRC) and mean root coverage (MRC). Secondary outcomes were width of keratinized tissue (KTW) and patient-centred parameters. Meta-analysis was conducted when possible., Results: A total of fifteen RCTs were included. The results demonstrated significantly higher MRC in short-term than long-term after coronally advanced flap (CAF; 7.29%, p = 0.006). When CAF combined with connective tissue graft (CTG), no significant difference was observed in CRC or MRC for short-term versus long-term (1.00, p = 0.97; 2.35%, p = 0.09), and it resulted in better long-term efficacy than CAF alone in terms of CRC (0.69, p = 0.0006) and KTW (-0.63 mm, p = 0.04). For CAF plus enamel matrix derivative, the meta-analysis showed no significant difference between the short-term and long-term results of CRC (1.26, p = 0.21)., Conclusions: CAF alone could result in decreased postoperative percentage of root coverage with time. CAF + CTG could maintain long-term stability and result in better root coverage outcomes than CAF., (© 2019 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Objectives: This review aims to evaluate the efficacy of xenogeneic collagen matrix (XCM) for the treatment of single or multiple gingival recessions in terms of clinical parameters and patient-related outcomes., Materials and Methods: Various electronic databases (The Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, etc.) from 1966 to April 2018 and hand literatures were searched. Quality of the included studies was assessed through the Cochrane Collaboration's Risk of Bias tool. A meta-analysis was performed to calculate risk ratios and mean differences., Results: Nine randomized controlled trials were included. The results revealed a higher percentage of mean root coverage (MRC) and a greater recession reduction (RecRed) for single recessions for the combination of coronally advanced flap (CAF) with XCM compared to CAF alone (n = 3; MD = 10.00%; 95%CI [3.56%; 16.43%]; p = 0.002) (n = 3; MD = 0.35 mm; 95%CI [0.10 mm; 0.60 mm]; p = 0.005). Comparing XCM with connective tissue graft (CTG), no significant differences were detected in MRC or RecRed for single and multiple recessions., Conclusions: The addition of XCM under CAF could improve MRC and RecRed at single tooth recessions. Initial data suggest that XCM shows promising results to improve the clinical efficacy of CAF for multiple recessions. In addition, XCM could be a valid alternative to CTG in terms of MRC and RecRed at both single and multiple recessions. Based on limited evidence, XCM may decrease postoperative morbidity and operation time compared to CTG., (© 2018 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd. All rights reserved.)

Gingival recession could result in root exposure, dental hypersensitivity and poor aesthetics. It has been demonstrated that varieties of root coverage procedures can significantly improve gingival recession in short-term (≤6 months), of which coronally advanced flap combined with connective tissue graft is the gold standard technique for treatment of gingival recession. It could obtain the optimally complete root coverage and maintain long-term stability (≥2 years). However, clinical knowledge about the long-term effectiveness of the other alternative graft materials remain very limited. Based on the existing clinical evidence, this article reviews coronally advanced flap, coronally advanced flap combined with connective tissue graft or alternative graft materials, with particular attention to the long-term stability of them, in order to provide reference for the design of further clinical trials and the plan of clinical treatments.

Gut microbiota play an important role in modulating energy contribution, metabolism, and inflammation, and disruption of the microbiome population is closely associated with chronic metabolic diseases, such as nonalcoholic fatty liver disease (NAFLD). Gegen Qinlian decoction (GGQLD), a well-known traditional Chinese herbal medicine (CHM), was previously found to regulate lipid metabolism and attenuate inflammation during NAFLD pathogenesis. However, the underlying mechanism of this process, as well as how the gut microbiome is involved, remains largely unknown. In this study, we investigated the effect of varying doses of GGQLD on the total amount and distribution of gut bacteria in rats fed a high-fat diet (HFD) for 8 weeks. Our analysis indicates that Oscillibacter and Ruminococcaceae&#95;g&#95;unclassified are the dominant families in the HFD group. Further, HFD-dependent differences at the phylum, class, and genus levels appear to lead to dysbiosis, characterized by an increase in the Firmicutes/Bacteroidetes ratio and a dramatic increase in the Oscillibacter genus compared to the control group. Treatment with GGQLD, especially the GGQLL dose, improved these HFD-induced changes in intestinal flora, leading to increased levels of Firmicutes, Clostridia, Lactobacillus, bacilli, and Erysipelotrichales that were similar to the controls. Taken together, our data highlight the efficacy of GGQLD in treating NAFLD and support its clinical use as a treatment for NAFLD/NASH patients.

Interleukin (IL)‑17A exhibits pleiotropic biological activities and serves a role in the progression of periodontitis. However, data describing the association between IL‑17 and osteogenesis are not conclusive. It was previously demonstrated that RAC‑β serine/threonine protein kinase (AKT2)‑specific knockdown in MC3T3‑E1 cells weakened osteogenic effects. The role of AKT2 in the regulation of IL‑17A for osteoblast differentiation and calcification remains unclear. The MTT method was adopted in the present study to assess cell proliferation; cell cycle distribution was analyzed by flow cytometry. Following osteogenic induction treatment, the involvement of phosphatidylinositol 3‑kinase (PI3K) and phosphorylated‑PI3K was evaluated by western blotting. The effects of IL‑17A on osteogenesis‑associated markers, including Runt‑related transcription factor 2 (Runx‑2), alkaline phosphatase (ALP) and osteocalcin (OCN) were evaluated by reverse transcription‑quantitative polymerase chain reaction (RT‑qPCR) analysis. An ALP activity assay and Alizarin Red S staining were used to assess the differentiation and calcification functions. AKT2 knockdown inhibited MC3T3‑E1 cell proliferation, inducing significantly increased G0/G1 cell counts, and reduced S and G2/M cell numbers. IL‑17A exerted no significant effects. The protein levels of p‑PI3K, gene expression levels of IL‑17A, Runx‑2, ALP and OCN, and relative ALP activity and calcification areas were increased in the induction group, and these effects were markedly promoted by treatment with IL‑17A. AKT2 knockdown in MC3T3‑E1 cells resulted in reduced IL‑17A‑induced differentiation and calcification, although it was not completely inhibited. The results of the present study suggested that AKT2 signaling was required for MC3T3‑E1 cell proliferation. IL‑17A promoted osteoblast differentiation and calcification in a partly AKT2‑dependent manner in MC3T3‑E1 cells in vitro, possibly reflecting compensation by other signaling pathways. The results of the present study may offer novel perspectives to guide the clinical strategy for the prevention and treatment of periodontitis.

Both air pollution and meteorological factors in metropolitan areas increased emergency department (ED) visits from people with chronic obstructive pulmonary disease (COPD). Few studies investigated the associations between air pollution, meteorological factors, and COPD-related health disorders in Asian countries. This study aimed to investigate the relationship between the environmental factors and COPD-associated ED visits of susceptible elderly population in the largest Taiwanese metropolitan area (Taipei area, including Taipei city and New Taipei city) between 2000 and 2013. Data of air pollutant concentrations (PM 10 , PM 2.5 , O 3 , SO 2 , NO 2 and CO), meteorological factors (daily temperature, relative humidity and air pressure), and daily COPD-associated ED visits were collected from Taiwan Environmental Protection Administration air monitoring stations, Central Weather Bureau stations, and the Taiwan National Health Insurance database in Taipei area. We used a case-crossover study design and conditional logistic regression models with odds ratios (ORs), and 95% confidence intervals (CIs) for evaluating the associations between the environmental factors and COPD-associated ED visits. Analyses showed that PM 2.5 , O 3 , and SO 2 had significantly greater lag effects (the lag was 4 days for PM 2.5 , and 5 days for O 3 and SO 2 ) on COPD-associated ED visits of the elderly population (65-79 years old). In warmer days, a significantly greater effect on elderly COPD-associated ED visits was estimated for PM 2.5 with coexistence of O 3 . Additionally, either O 3 or SO 2 combined with other air pollutants increased the risk of elderly COPD-associated ED visits in the days of high relative humidity and air pressure difference, respectively. This study showed that joint effect of urban air pollution and meteorological factors contributed to the COPD-associated ED visits of the susceptible elderly population in the largest metropolitan area in Taiwan. Government authorities should review existing air pollution policies, and strengthen health education propaganda to ensure the health of the susceptible elderly population., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Lipopolysaccharide (LPS)-binding protein (LBP) as an acute-phase protein plays a crucial role in innate host response to bacterial challenge. Our previous study shows that LBP expression in human gingiva is associated with periodontal status. Porphyromonas gingivalis is a keystone periodontopathogen, and its LPS with lipid A structural heterogeneity critically accounts for periodontal pathogenesis. This study investigated the effects of LBP and its interactions with two featured isoforms of P. gingivalis LPS (tetra-acylated LPS1435/1449 and penta-acylated LPS1690) on the expression of pro-inflammatory cytokines in human oral keratinocytes (HOKs), and the involvement of Toll-like receptor (TLR) signaling. HOKs were pre-incubated with recombinant human LBP (rhLBP) at 10ng/ml, 100ng/ml and 1μg/ml for 1 h, followed by the treatment of P. gingivalis LPS1690 or LPS1435/1449 for 3h or 24h respectively. The expression of IL-6 and IL-8, and involvements of TLR2 and TLR4 were analyzed. The genes associated with TLR signaling were assessed by PCR array. Interestingly, rhLBP per se significantly up-regulated the expression of IL-6 and IL-8 in HOKs (p<0.05), which was blocked by TLR2 antibody (p<0.001). LPS1435/1449 down-regulated more significantly rhLBP-induced IL-6 and IL-8 mRNAs with reference to P. gingivalis LPS1690 (approximately 80% vs. 40%, p<0.05; and 90% vs. 36%, p<0.001, respectively). Moreover, rhLBP markedly down-regulated the gene expression of TLRs and their adaptors such as CD180 (-2.44 folds) and MD-1 (-9.62 folds), while the interaction of P. gingivalis LPS1435/1449 with rhLBP greatly up-regulated both transcripts (7.11 and 4.05 folds, respectively). Notably, P. gingivalis LPS1690-rhLBP interaction dramatically up-regulated CD180 transcript (20.86 folds) and significantly down-regulated MD-1 transcript (-6.93 folds). This pioneering study shows that rhLBP enables to enhance the expression of pro-inflammatory cytokines in HOKs through TLR2 signaling pathway. P. gingivalis LPS with different lipid A structures down-regulates to different extents rhLBP-induced cytokine expression, possibly through fine-tuning of the CD180-MD1 complex and relevant TLRs.

Background: 15-Deoxy-Δ12,14-prostaglandin J2 (15d-PGJ2), one of the major metabolites from prostaglandin D2 in arachidonic acid metabolic pathway, has potential anti-inflammatory properties. The objective of this study was to explore the effects of 15d-PGJ2-loaded poly(D,L-lactide-co-glycolide) nanocapsules (15d-PGJ2-NC) on inflammatory responses and bone regeneration in local bone defect., Methods: The study was conducted on 96 Wistar rats from June 2014 to March 2016. Saline, unloaded nanoparticles, free 15d-PGJ2or 15d-PGJ2-NC, were delivered through a collagen vehicle inside surgically created transcortical defects in rat femurs. Interleukin-6 (IL-6), interleukin-1 beta (IL-1β), and tumor necrosis factor-alpha (TNF-α) levels in the surrounding soft tissue were analyzed by Western blot and in the defect by quantitative real-time polymerase chain reaction over 14 days. Simultaneously, bone morphogenetic protein-6 (BMP-6) and platelet-derived growth factor-B (PDGF-B) messenger RNA (mRNA) in the defect were examined. New bone formation and EphrinB2 and osteoprotegerin (OPG) protein expression in the cortical defect were observed by Masson's Trichrome staining and immunohistochemistry over 28 days. Data were analyzed by one-way analysis of variance. Least-significant difference and Dunnett's T3 methods were used with a bilateral P< 0.05., Results: Application of l5d-PGJ2-NC (100 μg/ml) in the local bone defect significantly decreased IL-6, IL-1β, and TNF-α mRNA and protein, compared with saline-treated controls (P < 0.05). l5d-PGJ2-NC upregulated BMP-6 and PDGF-B mRNA (P < 0.05). New bone formation was observed in the cortical defect in l5d-PGJ2-NC-treated animals from 7th day onward (P < 0.001). Expression of EphrinB2 and OPG presented early on day 3 and persisted through day 28 in 15d-PGJ2-NC group (P < 0.05)., Conclusion: Stable l5d-PGJ2-NC complexes were prepared that could attenuate IL-6, IL-1β, and TNF-α expression, while increasing new bone formation and growth factors related to bone regeneration., Competing Interests: There are no conflicts of interest.

Urbanization causes air pollution in metropolitan areas, coupled with meteorological factors that affect air quality. Although previous studies focused on the relationships of urbanization, air pollution, and climate change in Western countries, this study evaluated long-term variations of air quality and meteorological factors in Taiwanese metropolitan areas (Taipei area, Taichung City, and Kaohsiung City) and a rural area (Hualien County) between 1993 and 2012. The influence of a mass rapid transit (MRT) system on air quality was also evaluated. Air pollutant concentrations and meteorology data were collected from Taiwan Environmental Protection Administration (TEPA) air monitoring stations and Central Weather Bureau stations in the surveyed areas, respectively. Analyses indicate that levels of air pollution in metropolitan areas were greater than in the rural area. Kaohsiung City had the highest levels of O, SO, and particulate matter 2.5 or 10 µm in diameter (PM and PM). Clear downward trends for CO, NO, PM, PM, and especially SO concentrations were found in the surveyed areas, whereas O showed no decrease. Both O and PM concentrations showed similar bimodal seasonal distributions. Taiwan's air quality has improved significantly since 1993, indicating the effectiveness of promoting air pollution strategies and policies by the TEPA. Air pollution had an obvious improvement in Taipei area after the MRT system began operations in 1996. Because global climate may potentially affect urban air pollution in Taiwan, further study to clarify the mechanisms by which air pollution may affect human health and other biological effects is warranted., (Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.)

Lipopolysaccharide (LPS)-binding protein (LBP) functions as an acute phase protein and plays a key role in the innate immune response to bacterial challenge. It is a potential acute-phase biomarker in monitoring the progress of severe sepsis, infectious endocarditis and cardiovascular disease. LBP is mainly synthesized in hepatocytes and generates binding of bacteria and/or their products such as LPS to cell surface receptors, thereby initiating an innate host response. Interestingly, LBP has a dual role depending on its relatively low or high concentrations, and augments or downregulates the innate host defense accordingly. Emerging evidence indicates that LBP can be produced by non-hepatocytes, including respiratory type II epithelial cells, intestinal epithelial cells and human gingival epithelia. These findings suggest that LBP formation at extrahepatic cells may be crucial in containing microbial in situ challenge constantly, critically contributing to tissue homeostasis. This review provides an update on the characteristics and novel functions of LBP as well as its gene polymorphisms and potential use as a biomarker in assessing common infectious and inflammatory diseases such as periodontal disease. This paper highlights the expression profiles of LBP in human oral/gingival cells, how its expression could be modulated by periodontopathogens such as Porphyromonas gingivalis, as well as the relevant regulation mechanisms and signaling pathways involved. The critical roles of LBP in periodontal homeostasis and perspectives for its clinical application are discussed., (© 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Lipopolysaccharide (LPS) -binding protein (LBP) plays a crucial role in innate host response to bacterial challenge. Porphyromonas gingivalis is a keystone pathogen in periodontal disease and the shift of P. gingivalis LPS lipid A structure from penta-acylated (LPS(1690)) to tetra-acylated (LPS(1435/1449)) isoform may significantly contribute to periodontal pathogenesis. We recently demonstrated that LBP is expressed in human gingiva and contributes to periodontal homeostasis. Furthermore, different isoforms of P. gingivalis LPS differently modulate the immuno-inflammatory response, and P. gingivalis LPS(1690) induces LBP expression in human oral keratinocytes (HOKs). This study further examined the signaling mechanisms of P. gingivalis LPS(1690) -induced and Escherichia coli LPS-induced LBP expression in HOKs. Both P. gingivalis LPS(1690) and E. coli LPS were potent inducers of LBP expression in HOKs. The former activated phosphorylation of IκBα, p65, p38 mitogen-activated protein kinase (MAPK) and stress-activated protein kinase/c-Jun N-terminal kinase (SAPK/JNK), whereas the latter phosphorylated IκBα, p38 MAPK and SAPK/JNK. A nuclear translocation of NF-κB transcription factor was confirmed upon stimulation by both forms of LPS. Further blocking assay showed that P. gingivalis LPS(1690) induction of LBP was through NF-κB and p38 MPAK pathways, whereas E. coli LPS-induced LBP expression was mediated by NF-κB, p38 MPAK and JNK pathways. This study demonstrates that NF-κB and p38 MAPK signaling pathways are involved in P. gingivalis LPS(1690) induction of LBP expression in HOKs. The current findings could enhance the understanding of the molecular mechanisms of innate defense in maintenance of periodontal homeostasis., (© 2012 John Wiley & Sons A/S.)

LPS-binding protein (LBP) functions as a crucial molecule in innate immune responses to bacterial challenge. Our study has shown the expression of LBP in human gingiva and its significant association with periodontal health and disease. Porphyromonas gingivalis is a key pathogen of periodontal disease. P. gingivalis LPS as a main virulence factor is strongly involved in periodontal pathogenesis and it displays a significant lipid A structural heterogeneity. Currently, it remains unknown whether, and to what extent, the lipid A structural heterogeneity of P. gingivalis LPS affects LBP expression. The present study investigated the expression profile of LBP in human oral keratinocytes (HOKs) stimulated by two isoforms of P. gingivalis LPS [tetra- (LPS(1435/1449)) and penta-acylated (LPS(1690))] and Escherichia coli LPS, and the involvement of TLRs in LBP expression. The results showed that the expression of LBP mRNA and peptide was significantly up-regulated by P. gingivalis LPS(1690) and E. coli LPS, while P. gingivalis LPS(1435/1449) did not affect LBP expression. Blocking assay and siRNA gene silencing revealed that P. gingivalis LPS(1690)-induced LBP expression was through both TLR2 and TLR4. This in vitro study demonstrates that P. gingivalis LPS with a lipid A structural heterogeneity differentially modulates LBP expression in HOKs.

Objective: To investigate if Drynariae rhizoma (DR) and its main ingredient Naringin could reduce alveolar bone loss by stimulating the proliferation and differentiation of osteoblasts., Materials and Methods: The effect of DR water (DRWE), ethanolic extract (DREE), and Naringin on MC3T3-E1 cells was evaluated respectively by MTT method and by measuring the activity of alkaline phosphatase (ALP activity) as well as the level of osteocalcin in medium. Bone mineral density (BMD) detection, osteoclast counting by tartrate resistant acid phosphatase staining, and histopathological analysis were performed in an induced rat model of alveolar bone resorption after gastric perfusion with DR extracts or Naringin., Results: DRWE and Naringin effectively increased the proliferation of MC3T3-E1 cells, whilst DREE and Naringin enhanced the differentiation of osteoblastic cells. The in vivo study indicated an elevated BMD value in the tooth-periodontal tissues from DRWE, DREE and Naringin treated groups after 10, 20 and 30 days of perfusion (P<0.05). In DRWE treated group, the number of osteoclasts at days 10, 20 and 30 decreased remarkably as compared to the corresponding negative controls (P<0.05), and no osteoclast could be found at day 30. New non-calcified bone-like matrix attached by osteoblasts at the root furcation was also shown., Conclusions: DR could be a supplementary medicine for periodontal therapy as it could reduce bone resorption in rat model of alveolar bone resorption and exert osteogenic effect on osteoblasts., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

This was an open-label, uncontrolled study with the aim of assessing the efficacy and safety of pegylated interferon alfa-2b plus ribavirin in the treatment of chronic hepatitis C. The study was conducted in Island Hospital, Penang beween January 2002 and December 2003. Thirty-three patients were enrolled in this study with ten defaulters. The overall sustained virological response (SVR) (Intention-To-Treat analysis) in naïve patients was 39.10%. However, when the study was adjusted to only include those who completed treatment and follow-up, overall SVR as 52.9%. Side-effects were tolerable in most patients with anaemia occurring in 22 patients (66.7%), leukopenia 23 patients (69.7%) and thrombocytopenia in 15 patients (45.5%). This study showed that pegylated interferon alfa-2b 1.5 mcg/kg/week plus ribavirin > 10.6 mg/kg/day is efficacious and safe to be used in the treatment of: chronic hepatitis C.

This study evaluated the efficacy and safety of endoscopic pneumatic balloon dilatation as the initial treatment for achalasia of the cardia. 15 patients with achalasia underwent a total of 19 dilatations using the new polyethylene dilator (Microvasive Rigiflex Balloon Dilator) over the last 6 years. An overall treatment success rate of 93% was achieved. 11 patients (73.3%) have not required a further dilatation and 3 patients (20%) required between 1 and 2 further dilatations. Elective surgery was necessary in 1 patient. The mean follow-up period was 31.5 months. There was no complication or death attributable to the procedure. Endoscopic pneumatic balloon dilation is a safe and effective treatment for achalasia and should be considered as the initial treatment of choice in most patients with achalasia.

Two cases of leiomyomas of the jejunum presenting with gastrointestinal bleeding of uncertain origin are described. Diagnosis was finally established by selective angiography. Laparotomy and resection of the tumour were successfully performed. The approach and management of this rare tumour are outlined.