Effect of Smoking Cessation Programs on Periodontal Disease Progression

Background

In this research study, we delve into the effects of smoking cessation programs on the progression of periodontal disease, particularly focusing on the potential benefits experienced by individuals who successfully quit smoking.

Materials And Methods

The research involved the participation of 200 individuals, all of whom were active smokers and exhibited varying degrees of periodontal disease. These participants enrolled in a comprehensive smoking cessation program that included regular counseling sessions and, when necessary, the provision of nicotine replacement therapy to facilitate smoking cessation. Over a 12-month period, the progression of their periodontal disease was systematically monitored through a series of dental check-ups and measurements of critical clinical parameters. These parameters included probing depth (PD), which assesses the spaces between teeth and gums, and clinical attachment level (CAL), which evaluates the attachment of gum tissue to tooth surfaces.

Results

After 12 months of active participation in the smoking cessation program, several noteworthy results were observed among the participants. On average, participants experienced a reduction in PD by approximately 1.5 mm, indicating a shallower space between the teeth and gums and, thus, healthier periodontal tissues. In addition, the CAL improved by an average of 1.2 mm, signifying enhanced attachment of gum tissue to the tooth surface, which is essential for dental stability. Participants also exhibited a significant reduction in plaque accumulation on tooth surfaces, indicative of improved oral hygiene practices. Furthermore, gingival inflammation, a common symptom of periodontal disease, notably decreased among participants, suggesting an overall improvement in gum health.

Conclusion

In conclusion, this study provides compelling evidence supporting the positive impact of smoking cessation programs on the progression of periodontal disease.

Biophotonics in Dentistry-An Overview

Biophotonics, an interdisciplinary field merging biology with photonics, has transformed dentistry by offering innovative techniques and tools for diagnosis, treatment, and research. This overview explores the applications and benefits of biophotonics in dentistry, including early disease detection, precision in procedures, restorative dentistry assessment, real-time monitoring, and teeth whitening. We discuss how biophotonics improves patient care and the potential for future developments in personalized treatment, targeted therapy, enhanced imaging, and pain management. Biophotonics promises to continue revolutionizing oral healthcare, leading to better patient outcomes worldwide.

Effectiveness of Online vs. In-Person Periodontal Health Workshops for Public Awareness

Background

Periodontal health is a critical aspect of overall oral health, yet public awareness and education on this topic remain limited. With the increasing prevalence of online health education platforms, it is essential to evaluate the effectiveness of online periodontal health workshops compared with traditional in-person workshops on improving public awareness.

Materials and Methods

Study Design: This randomized controlled trial (RCT) aimed to assess the impact of online and in-person periodontal health workshops on public awareness. Participants (N = 500) were randomly assigned to one of two groups: the online workshop group or the in-person workshop group. Online Workshop: Participants in this group accessed an interactive online periodontal health workshop, consisting of video presentations, animations, and quizzes. The workshop covered topics, such as gum disease prevention, oral hygiene, and the importance of regular dental checkups. In-Person Workshop: Participants in this group attended a traditional in-person periodontal health workshop conducted by dental professionals. The content and duration of this workshop mirrored the online version. Pre- and Postworkshop Assessments: Both groups completed pre-workshop and postworkshop assessments, including a knowledge questionnaire and a self-assessment of oral health habits. Arbitrary scores were assigned to quantify knowledge gain (0-100%).

Results

Participants in the online workshop group showed a mean knowledge gain of 30% (standard deviation (SD) = 5.2), while those in the in-person workshop group exhibited a mean knowledge gain of 35% (SD = 4.7). The self-assessment of oral health habits indicated an improvement in both groups, with 60% of participants reporting better oral hygiene practices.

Conclusion

Both online and in-person periodontal health workshops demonstrated effectiveness in improving public awareness and promoting better oral health habits. Combining both modalities could be an effective strategy for comprehensive public education on periodontal health.

An In Vitro Investigation of the Role of Implant Abutment Materials on the Fracture Resistance and Failure Mode of Implant-Supported Restorations

BACKGROUND

Implant-supported restorations have gained popularity in modern dentistry, and the choice of abutment material is crucial for their long-term success. This in vitro study aimed to evaluate the fracture resistance and failure mode of implant-supported restorations using different abutment materials.

METHODS

Ninety standardized implant-supported restorations were included in the study. Abutments made of titanium, zirconia, and a hybrid material (titanium base with a zirconia veneer) were evaluated. Standardized abutments were fabricated, and screw-retained restorations were fabricated using a resin-based composite material. Cyclic loading was applied using a universal testing machine to simulate masticatory forces. Fracture resistance was measured in terms of the number of cycles to failure (NCF), and failure modes were analyzed.

RESULTS

The findings indicate that zirconia abutments exhibited higher fracture resistance compared to titanium and hybrid abutments. Longer implants demonstrated higher fracture resistance, suggesting improved stability and resistance to mechanical forces. Increased loading angles resulted in decreased fracture resistance of implant-supported restorations, emphasizing the need for proper occlusal adjustment. Central loading showed higher fracture resistance than lateral and posterior loading locations. The distribution of failure modes varied among the abutment materials, with bulk prosthesis fracture being the most common in the titanium group, while abutment fracture was predominant in the zirconia and hybrid groups.

CONCLUSION

This in vitro study demonstrated that the choice of abutment material significantly influenced the fracture resistance and failure mode of implant-supported restorations. Zirconia abutments exhibited the highest fracture resistance, followed by hybrid and titanium abutments. The failure mode analysis revealed different patterns of failure for each abutment material.

Invesigate How Cultural and Socioeconomic Factors Influence Oral Cancer Prevention Behaviors, Screening Uptake, and Treatment Outcomes

Background

Oral cancer is a significant global health issue, with prevention and early detection being pivotal for improved outcomes. This study investigates the impact of cultural and socioeconomic factors on oral cancer prevention behaviors, screening participation, and treatment outcomes.

Materials and Methods

A cross-sectional study design was employed, involving a sample size of 1,000 participants. Participants were recruited through stratified sampling to ensure cultural and socioeconomic diversity. Statistical analyses, including logistic regression, were used to explore associations between factors and outcomes.

Results

The study revealed multifaceted influences of cultural and socioeconomic factors on oral cancer-related aspects. Cultural factors significantly influenced prevention behaviors, with participants from certain cultural backgrounds exhibiting higher rates of tobacco use and lower rates of dietary adherence). Socioeconomic status played a role in screening uptake, with individuals from lower income brackets less likely to undergo regular screenings.

Conclusion

Cultural and socioeconomic factors have a substantial influence on oral cancer prevention behaviors, screening participation, and treatment outcomes.

Community Water Fluoridation and its Influence on Periodontal Health in Different Age Groups

Background

Community water fluoridation is a well-recognized public health initiative known for its efficacy in preventing dental cavities. The positive effects of fluoride on tooth enamel have led to widespread implementation of water fluoridation programs.

Materials and Methods

This cross-sectional study involved 1,000 participants from diverse age groups, spanning children, adolescents, adults, and older adults, residing in both fluoridated and non-fluoridated communities. Comprehensive periodontal assessments included measurements of probing depth (PD), clinical attachment level (CAL), and the presence of gingival inflammation. Participants were categorized into "fluoridated" or "non-fluoridated" groups based on their residential history.

Results

Fluoridated communities consistently displayed lower mean PDs, CALs, and rates of gingival inflammation across all age groups. Notably, the reduction in PD and CAL reached approximately 0.5 millimeters and 0.3 millimeters, respectively, while the decrease in gingival inflammation ranged from 3% to 5.

Conclusion

This study suggests a potential link between community water fluoridation and enhanced periodontal health, as evidenced by improved PDs, CALs, and reduced gingival inflammation.

Dose to Organ at Risk and its Characteristic Variation with the Clinically Used Different Prescription Levels for Early-stage Left-sided Breast Cancer

AIMS

To evaluate the organ at risk (OAR) dose and its characteristic variation with different clinically usable prescription doses (RxD) for breast and chest wall radiotherapy in patients with early-stage left-sided breast cancer.

MATERIALS AND METHODS

In total, 145 patients with early-stage breast cancers (T1N0M0-T2N0M0) on the left side were treated with radiotherapy after a modified radical mastectomy or breast conservation surgery, with a mean age of 45.1 ± 21.6 years. The patient received 4050 cGy of field-in-field (three-dimensional conformal radiotherapy) treatment limited to the breast or chest wall, excluding the supraclavicular node, axillary node and internal mammary chain, over 15 fractions. Additional plans of 5000 cGy/25 fractions, 4500 cGy/20 fractions and 2600 cGy/5 fractions were created with no or minor changes to the original plan. Mathematical modelling was used to study the distinctive change in the dose-volume characteristics for various OARs as a function of the RxD. OAR dosages, both absolute and normalised, were expressed in terms of the RxD. The mathematical (functional) relationship between OAR doses and different prescription levels was deduced by the least squares fit method.

RESULT

The left lung mean dose, V5Gy (%), V10Gy (%) and V20Gy (%) and the heart mean dose, V10Gy (%) and V20Gy (%) were evaluated. The dose-volume parameters showed a parabolic variation (x2) with the RxD. Prescription normalised OAR doses showed a linear relationship with the RxD; relative dose increased with diminishing RxD. Normalised lung and heart mean doses exhibited saturation (linear relationship) with RxD variation. Paired sample t-test results between RxD versus all evaluated parameters were found to be statistically significant (P = 0.004). The Pearson correlation coefficient between different prescription levels for left lung mean dose (range 0.942-1.0), heart mean dose (range 1.0-1.0), left lung V5Gy (%) (range 0.987-1.0), left lung V10Gy (%) (range 0.991-0.999), heart V10Gy (%) (range 0.998-1.0).

CONCLUSION

The functional form of absolute OAR dose-volume parameters versus RxD is parabolic and the RxD normalised OAR dose-volume parameter versus RxD is a straight line with a negative slope as RxD increases. This indicates an increase in the relative OAR dose-volume parameters if the RxD is reduced. This study is the first of its kind to compare the OAR doses as a function of clinically used degenerate prescription levels. These data will help to comprehend the OAR doses while adopting a new dose fractionation regimen and reviewing the radiotherapy treatment plans.

An Online Survey to Examine the Dental Students Awareness, Knowledge, Prevention and Early Detection of Oral Cancer

Background

Although oral cancer is known to be particularly aggressive and to have a poor prognosis, early detection is often connected with a better outlook. Consequently, the purpose of this research was to evaluate dental students' and interns' understanding of oral cancer prevention strategies and practices, as well as their motivations for engaging in such efforts.

Material and Methods

The dental interns and undergraduates in their last years of the dental school participated in a cross-sectional questionnaire study. All eligible participants (N = 300) were asked to fill out a 48-item questionnaire on oral cancer prevention and early detection. The questionnaire was broken down into four parts covering demographic information, knowledge, behaviors, and attitudes.

Results

The percentage of people who answered the survey was 65% (N = 300). Interns outperformed dentistry school freshmen by a substantial margin (P = 0.05) on tests of both knowledge and attitude. Some people avoid being screened for oral cancer because they feel they do not have the knowledge, skills, self-assurance, or time to do so effectively.

Conclusions

The majority of those polled in this research seemed to lack the necessary knowledge and abilities in mouth cancer prevention and early detection, but they had high levels of desire and a positive outlook toward oral cancer preventive education.

Knowledge, Attitude, and Practice of Patients toward Dental Implants in Need of Prosthodontic Rehabilitation

Background

Our goal in conducting this study was to see how well-informed patients are about dental implants as a method of prosthodontic rehabilitation.

Materials and Methods

"In this cross-sectional study, 500 new dental students were asked questions using a pre-made, self-administered questionnaire. A pilot study was carried out to verify the reliability of the survey instrument. Analysis of the data was performed in SPSS 16 (SPSS). We used the P 0.05 thresholds for the Student's T-test and the ANOVA to determine statistical significance."

Results

In all, there were 500 people involved: 320 men and 180 women. The media and dentists were the two most common places to learn about implants, and as patients received more information, they became more informed consumers. Many people put off getting therapy because of how expensive it is.

Conclusion

Only a small percentage of individuals had implants, and more than half knew nothing about them. This finding also highlighted the need of educating patients more thoroughly on this therapy option. As a result, the public has to be educated about oral health and implants in order to adopt a more favorable perspective.

A Study to Assess Etiology and Prevalence of Signs and Symptoms of Temporomandibular Disorder

Aim

The purpose of this epidemiological research was to determine how common temporomandibular disorder (TMD) symptoms are.

Materials and Methods

Among the outpatient population, a sample of 100 people was chosen at random. A patient survey was presented to each person, and points were allotted based on their responses. Participants were categorized as having no symptoms of TMD, mild TMD, moderate TMD, or severe TMD based on their total score.

Results

One hundred adults aged 18 and above were selected from the general public to take part in the research. Temporomandibular disorder was present in no more than 30% of those studied, in the mild range in 50%, in the moderate range in 15%, and in the severe range in 5%. 0.602 was determined to be the dependability of Fonseca's questionnaire.

Conclusion

The Fonseca questionnaire is a useful instrument for gauging the extent to which TMD symptoms are present in a given population. The screening questionnaire may be received in a short amount of time and for little money, making it a good option for public health services.

A Study to Assess Knowledge, Attitude, and Perception of Dental Practitioners on Minimally Invasive Dentistry Concepts

Background

Minimally invasive dentistry (MID) includes caries detection using caries risk assessment (CRA), early localization of nascent carious sores including necessary and voluntary avoidance, and remineralization of demineralized veneer and dentin when diagnosed early for these reasons. Although the dentistry curriculum prioritizes the benefits of MID in tooth protection, this research is seldom included in classroom instruction.

Aim

The purpose of this research was to gauge the level of understanding that dental professionals have about MID ideas.

Methods

An online questionnaire measuring MID knowledge and application was used to compile the data. The Chi-square tests were run for statistical analysis in the Statistical Package for the Social Sciences (SPSS).

Results

Just 42.2% of the dentists who replied had MID training during their undergraduate or internship years, and the majority of that training came via lectures (45.2%). The majority (almost 81%) of respondents believed that CRA should be performed on all patients. Differences in knowledge and experience with atraumatic restorative therapy and the sandwich approach for treating caries in permanent teeth and high caries risk children were shown to be statistically significant (P 0.05).

Conclusion

Dentists know about the benefits of MID, but their patients are not reaping those benefits since so many dentists still use the old methods of treating complete caries.

A Study to Assess and Evaluate the Gingival Response During and after the Fixed Orthodontics Treatment Experienced by Adult Patients

Objective

The purpose of this research was to examine patients' periodontal health before, during, and after treatment using a fixed orthodontic device.

Methods

Forty normal teenagers with full sets of permanent teeth and a clinical need for fixed orthodontics participated. Individuals were chosen from the Class I population who would benefit from utilizing traditional orthodontic braces and techniques that did not need extractions. Respondents were sent to the periodontist for required checkups after the placement of a fixed orthodontic device at 3-, 6-, 12-, and 24-month intervals, respectively, till the conclusion of orthodontic treatment.

Results

After having a fixed orthodontic device put in place, patients had a rise in the average values of the Plaque Index and Sulcus Bleeding Index at each checkup. Keeping an eye on the progression three months, six months, a year, and two years after the initiation of orthodontic treatment reveals a statistically significant difference in the presence of gingival hyperplasia.

Conclusion

Patients' periodontal health before, during, and after fixed orthodontic treatment shows the need for close collaboration between the orthodontist and the periodontist.

A Study to Assess the Awareness of Adults about Precancerous and Cancerous Lesions and the Associated Risk Factors

Aim

The purpose of this study was to determine which factors contribute to the development of oral precancerous lesions and subsequent mouth cancer.

Materials and Methods

Throughout the trial, 450 patients agreed to participate in the investigation. The subjects comprised patients with squamous cell carcinoma (n = 79), oral submucous fibrosis (OSF) (n = 200), leukoplakia (n = 41), lichen planus (n = 10), and controls (n = 120). Statistical analysis of the data was carried out using the Chi-square and regression analysis.

Results

All oral precancerous lesions were shown to have a high prevalence of chewing, which was found to have a strong link with oral cancer. Oral precancerous lesions and cancer were also substantially connected with the length of time someone had the habit and how often they engaged in it.

Conclusion

Oral cancer and precancerous lesions were determined to be less of a worry when other risks such as drinking and smoking were taken into account.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Management of childhood MDR-TB in Europe and Central Asia: report of a Regional WHO meeting

BACKGROUND: As the WHO European Region has the highest proportion of multidrug-resistant TB (MDR-TB) among total incident TB cases, many children and adolescents are at risk of MDR-TB infection and disease.METHODS: We performed an electronic survey of clinicians and TB programme personnel who attended the 2020 Regional Consultation on child and adolescent TB organised by the WHO Regional Office. We characterised access to diagnostics and drugs, and practices in the prevention and management of child and adolescent MDR-TB.RESULTS: Children and adolescents are inconsistently represented in national guidelines and budgets; child-friendly drug formulations for MDR-TB treatment are insufficiently available in 57% of countries, and 32% of countries reported paediatric drug stock-outs. The novel drugs, bedaquiline and delamanid, are accessible by respectively 80% and 60% of respondent countries. Respondents were asked how many children were diagnosed with MDR-TB in 2019, and a comparison of this number to modelled estimates of incidence (to identify the case detection gap) and WHO notifications (to identify the case reporting gap) showed substantial differences in both comparisons.CONCLUSIONS: Better representation of this patient group in guidelines and budgets, greater access to drugs and improved reporting are essential to reach TB elimination in this Region.

An In Vitro study to compare dental laser with other treatment modalities on biofilm ablation from implant and tooth surfaces

Background:

Methodology:

Results:

Conclusion:

An In Vitro trial to estimate the retention ability of luting agents utilized with dental implant-supported prosthesis

Aim:

The trial's goal was to assess the retentiveness of specially formulated implant cement besides comparing it to dental cements that are widely utilized by means of implant systems.

Materials and Procedures:

Twenty implant analogs were implanted in auto-polymerizing acrylic resin blocks and bonded to titanium abutments. Fifty uniform copings were waxed and cast unswervingly onto the abutment. (1) Resin-bonded zinc oxide eugenol cement, (2) purposefully designed implant cement, (3) zinc phosphate cement, (4) zinc polycarboxylate cement, and (5) glass ionomer cement were the cements used. Following cementation, each sample was pulled out by utilizing a widespread testing machine, and the stresses necessary to confiscate the crowns were recorded. The ANOVA and Bonferroni tests were used to examine the mean values and standard deviations of cement failure loads.

Results:

Zinc polycarboxylate cement had the peak mean cement failure load, followed by glass ionomer cement. Zinc phosphate cement had the next highest mean cement failure load, followed by resin-bonded zinc oxide eugenol cement. The mean cement failure load for Premier implant cement was the lowest. The difference in mean cement failure loads across the groups was statistically significant (P < 0.001).

Conclusion:

The findings do not imply that one type of cement is superior to another, but they do present a ranking directive of cements based on their capacity to maintain the prosthesis and facilitate retrievability.

In Vitro Assessment of Intracanal Calcium Hydroxide Removal Using Various Irrigation Systems: An SEM Study

AIM

The aim of this research was to assess the effectiveness of three different irrigation systems in elimination of calcium hydroxide [Ca(OH)2]from root canals.

MATERIALS AND METHODS

This in vitro research included ninety recently extracted mandibular premolar teeth with a solitary root. The sample teeth were subjected to disinfection employing sodium hypochlorite at 5.25%. The root canal preparation was performed followed by placement of premixed Ca(OH)2 within every canal. The sample teeth were then randomly allocated into one of the three experimental groups (each comprising 30 samples) as follows: Group 1, NaviTip FX irrigation system; group 2, Vibringe sonic irrigation system; and group 3, EndoVac apical negative pressure irrigation system. Following the preparation, each of the sample teeth was examined beneath a scanning electron microscope (SEM) at a magnification of 1000×.

RESULTS

An intragroup comparative analysis revealed that the highest Ca(OH)2 elimination was seen at middle third (0.82 ± 0.09, 0.30 ± 0.11) in NaviTip FX irrigation system and Vibringe sonic irrigation system, respectively. Higher Ca(OH)2 was eliminated at the apical third (0.26 ± 0.02) by the EndoVac irrigation system. At coronal third, maximum Ca(OH)2 removal was seen in EndoVac irrigation system (0.49 ± 0.03). A statistically significant difference was noted amid Vibringe sonic irrigation and EndoVac irrigation systems. The intergroup evaluation of Ca(OH)2 elimination at coronal, middle, and apical third showed a statistically significant difference between NaviTip FX irrigation and Vibringe sonic irrigation as well as between NaviTip FX irrigation and EndoVac irrigation at a p value of 0.001. The difference between EndoVac irrigation and Vibringe sonic irrigation was not statistically significant.

CONCLUSION

Amid the limitations of this research, this research concludes that none among the irrigation methods employed could totally eliminate the Ca(OH)2 off the root canals. Nevertheless, EndoVac apical negative pressure irrigation has slightly superior potential in eliminating Ca(OH)2 from the root canals in comparison with Vibringe sonic irrigation as well as the NaviTip FX irrigation system.

CLINICAL SIGNIFICANCE

Even though the Ca(OH)2 is largely suggested as medicament, its elimination at the point of canal obturation is likewise significant and complex as any remaining portion may avoid sealer diffusion inside the dentinal tubules, consequently substantially escalating the apical leakage of endodontically treated teeth.

Assessment of Penetration Depth and Microleakage of Different Pit and Fissure Sealants Using Dye Penetration Method: An In Vitro Study

AIM AND OBJECTIVE

The aim of this study was to evaluate the depth of penetration as well as the microleakage of three different pit and fissure sealant materials employing the dye penetration method.

MATERIALS AND METHODS

Sixty healthy human mandibular premolar teeth without dental caries that were extracted for orthodontic treatment constituted the study samples. These 60 premolar samples were subjected to an equal division (20 in every group) into three groups. Group I: self-adhering flowable composite, group II: flowable nanocomposites, group III: classical pit and fissure sealants. Every sample tooth underwent thermocycling amid 4°C ± 2°C and 60°C ± 2°C for 1,000 cycles. The samples were placed in 1% methylene blue solution for 24 hours to permit diffusion of the dye into probable gaps in between the restoration and the tooth. The teeth were sectioned and evaluated below a stereomicroscope at 10× magnification with image analysis software.

RESULTS

Flowable nanocomposites (3.69 ± 0.10) exhibited a slightly greater mean depth of penetration as compared to classical pit and fissure sealants (3.58 ± 0.16) and self-adhering flowable composites (3.51 ± 0.13) in that order. This difference between the three sealants was not significant statistical. Amid the three sealant study groups, the lowest mean marginal microleakage was exhibited by the flowable nanocomposites (1.06 ± 0.03), followed by self-adhering flowable composites (1.98 ± 0.06), and classical pit and fissure sealants (2.74 ± 0.11). Analysis of variance revealed statistically significant differences among the three sealants that were studied.

CONCLUSION

This study concludes that flowable nanocomposites depicted enhanced penetration and reduced marginal leakage as compared to the self-adhering flowable composites and classical pit and fissure sealants.

CLINICAL SIGNIFICANCE

An efficient approach to preventing dental caries on the occlusal surfaces of teeth is the use of pit and fissure sealants. The efficiency of sealants chiefly depends on the morphological characteristics of the fissures and properties of dental materials used.

Analysis of Remineralization Potential of Three Different Remineralizing Pastes on Demineralized Enamel: A Comparative Study

AIM

Aim of this research was to evaluate the remineralizing potential of three different remineralizing pastes on enamel that has been demineralized.

MATERIALS AND METHODS

Sixty healthy mandibular single-rooted human premolars extracted for orthodontic reasons from subjects between 18 and 25 years of age were included in this research. An area of 4 mm × 4 mm (window) was marked on the buccal surfaces of teeth samples, coated with nail varnish except for the window, which was scrutinized for changes in the values subsequent to demineralization as well as remineralization. Samples were kept in demineralizing solution for 96 hours to produce the artificial lesion in the enamel. Consequent to this process of demineralization, the 60 premolar teeth were randomly allocated to the following three groups (20 in each group) depending on the remineralizing paste used for application as group I: bioactive glass constituting remineralizing paste; group II: tricalcium phosphate (TCP) comprising remineralizing paste; and group III: calcium sucrose phosphate (CaSP) remineralizing paste. Following the pH-cycling process, the confocal laser scanning microscope was used to assess the area of demineralization and remineralization.

RESULTS

The mean areas of demineralization were slightly more (133.24 ± 0.09) in the remineralization paste comprising bioactive glass seconded by the remineralization paste having CaSP (131.39 ± 0.18), and lastly the remineralizing paste constituting TCP (129.59 ± 0.14). Maximum areas of remineralization were found in the pastes that had CaSP group (96.14 ± 0.04), next by the paste having bioactive glass group (102.18 ± 0.17), and then the remineralization paste constituting TCP (118.37 ± 0.21). The difference was statistically significant among the three remineralization pastes used.

CONCLUSION

Amid the confines of this in vitro research, a conclusion that the remineralization pastes comprising CaSP exhibited enhanced remineralization capacity in comparison to the group having bioactive glass and TCP was established.

CLINICAL SIGNIFICANCE

Caries is a highly prevalent multifactorial disease, but its progression can be prevented in the initial stage of demineralization through remineralization. Significantly increasing attention to the treatment of carious lesions that are not cavitated by employing noninvasive remineralization methods to achieve restoration of enamel has been rendered in the field of research.

Impact of Various Desensitizing Agents on Occlusion of Dentinal Tubules: A Scanning Electron Microscopic Study

AIM

The aim of the present study was to compare the capacity of three dissimilar commercially accessible desensitizing products for the occlusion of dentinal tubules using a scanning electron microscope (SEM).

MATERIALS AND METHODS

The nondiseased human mandibular premolar teeth, ninety in number, were amassed for this study. The blocks subsequently made were subjected to polishing using abrasive paper to facilitate dentinal surface exposure. The samples were randomly allocated to one of the following three groups: Group I, samples to be treated with Admira Protect; Group II, samples to be treated with MI paste, Group III, samples to be treated with Remin Pro. Photomicrograph of every sample was taken to evaluate the occlusion of the dentin tubule under 2000× magnification of the SEM.

RESULTS

MI paste exhibited the greatest dentin tubular occlusion with a value of 2.746 ± 0.530 followed by Admira Protect (3.498 ± 0.202) and Remin Pro (4.594 ± 0.364) in that order. Amid the various desensitizing materials used, statistically significant differences (p <0.001) were noted.

CONCLUSION

Within the confines of the limitations of the present research, following a comparative assessment of the three desensitizing materials used, it can be concluded that all of them were efficient in sealing off the dentin tubules in spite of differing chemical constitutions and techniques of application. When compared with the agents, Admira Protect and Remin Pro, MI paste exhibited the maximum occluding capacity of the dentinal tubules.

CLINICAL SIGNIFICANCE

A short, sharp shooting pain characterizes the frequent problem of dentin hypersensitivity (DH). Sealing off the open dentin tubules, thereby reducing dentinal permeability, is a known method in the treatment of DH. As several agents exist to reduce DH, the best commercially marketed product for decreasing this condition by occluding the tubules should be identified by the clinicians.

Enhanced expression of recombinant proteins in Escherichia coli by co-expression with Vibrio parahaemolyticus CsgG, a pore-forming protein of the curli biogenesis pathway

AIM

To test whether engineered nanopores on the outer membrane (OM) of Escherichia coli can increase expression of heterologous proteins by making additional nutrients available to the host.

METHODS AND RESULTS

Outer membrane nanopores were generated by expressing recombinant Vibrio parahaemolyticus CsgG (rVpCsgG), which spontaneously assembles into a pore-forming channel on the OM, allowing spontaneous diffusion of small chemical entities from the exterior. Protein expression was probed using a reporter protein, sfGFP, expressed on a second compatible plasmid. OM pore formation was shown by acquired erythromycin sensitivity in cells transformed with rVpCsgG, influx of propidium iodide as well as by surface localization of recombinant CsgG by immunogold-labeled transmission electron microscopy. Expression of recombinant CsgG showed increased growth and also enhanced expression of sfGFP in minimal medium and is due to both enhanced transcription as well as translation. Similar enhancement of expression was also observed for a number of different proteins of different origin, sizes and nature.

CONCLUSIONS

Our findings clearly demonstrate that engineered nanopores on the OM of E. coli enhance expression of different heterologous proteins in minimal medium.

SIGNIFICANCE AND IMPACT OF THE STUDY

Vibrio parahaemolyticus CsgG β-nanopore mediated co-expression strategy to improve recombinant protein expression is fully compatible with other methods of protein expression enhancement, and therefore can be a useful tool in biotechnology particularly for whole-cell bio-transformations for production of secondary metabolite.

Immunomodulatory activity of glycodelin: implications in allograft rejection

Glycodelin is an immunomodulator, indispensable for the maintenance of pregnancy in humans. The glycoprotein induces apoptosis in activated CD4⁺ T cells, monocytes and natural killer (NK) cells, and suppresses the activity of cytotoxic T cells, macrophages and dendritic cells. This study explores the immunosuppressive property of glycodelin for its possible use in preventing graft rejection. Because glycodelin is found only in certain primates, the hypothesis was investigated in an allograft nude mouse model. It is demonstrated that treatment of alloactivated mononuclear cells with glycodelin thwarts graft rejection. Glycodelin decreases the number of activated CD4⁺ and CD8⁺ cells and down-regulates the expression of key proteins known to be involved in graft demise such as granzyme-B, eomesodermin (EOMES), interleukin (IL)-2 and proinflammatory cytokines [tumour necrosis factor (TNF)-α and IL-6], resulting in a weakened cell-mediated immune response. Immunosuppressive drugs for treating allograft rejection are associated with severe side effects. Glycodelin, a natural immunomodulator in humans, would be an ideal alternative candidate.

Pharmacophore modelling, virtual screening and molecular docking studies on PLD1 inhibitors

Lipid metabolism plays a significant role in influenza virus replication and subsequent infection. The regulatory mechanism governing lipid metabolism and viral replication is not properly understood to date, but both Phospholipase D (PLD1 and PLD2) activities are stimulated in viral infection. In vitro studies indicate that chemical inhibition of PLD1 delays viral entry and reduction of viral loads. The current study reports a three-dimensional pharmacophore model based on 35 known PLD1 inhibitors. A sub-set of 25 compounds was selected as the training set and the remaining 10 compounds were kept in the test set. One hundred and twelve pharmacophore models were generated; a six-featured pharmacophore model (AADDHR.57) with survival score (2.69) produced a statistically significant three-dimensional quantitative structure-activity relationship model with r² = 0.97 (internal training set), r² = 0.71 (internal test set) and Q² = 0.64. The predictive power of the pharmacophore model was validated with an external test set (r² = 0.73) and a systematic virtual screening work-flow was employed showing an enrichment factor of 23.68 at the top 2% of the dataset (active and decoys). Finally, the model was used for screening of the filtered PubChem database to fetch molecules which can be proposed as potential PLD1 inhibitors for blocking influenza infection.

Hydrogeological typologies of the Indo-Gangetic basin alluvial aquifer, South Asia

The Indo-Gangetic aquifer is one of the world's most important transboundary water resources, and the most heavily exploited aquifer in the world. To better understand the aquifer system, typologies have been characterized for the aquifer, which integrate existing datasets across the Indo-Gangetic catchment basin at a transboundary scale for the first time, and provide an alternative conceptualization of this aquifer system. Traditionally considered and mapped as a single homogenous aquifer of comparable aquifer properties and groundwater resource at a transboundary scale, the typologies illuminate significant spatial differences in recharge, permeability, storage, and groundwater chemistry across the aquifer system at this transboundary scale. These changes are shown to be systematic, concurrent with large-scale changes in sedimentology of the Pleistocene and Holocene alluvial aquifer, climate, and recent irrigation practices. Seven typologies of the aquifer are presented, each having a distinct set of challenges and opportunities for groundwater development and a different resilience to abstraction and climate change. The seven typologies are: (1) the piedmont margin, (2) the Upper Indus and Upper-Mid Ganges, (3) the Lower Ganges and Mid Brahmaputra, (4) the fluvially influenced deltaic area of the Bengal Basin, (5) the Middle Indus and Upper Ganges, (6) the Lower Indus, and (7) the marine-influenced deltaic areas.

Apolipoprotein A-I in Labeo rohita: Cloning and functional characterisation reveal its broad spectrum antimicrobial property, and indicate significant role during ectoparasitic infection

Apolipoprotein A-I (ApoA-I) is the most abundant and multifunctional high-density lipoprotein (HDL) having a major role in lipid transport and potent antimicrobial activity against a wide range of microbes. In this study, a complete CDS of 771 bp of Labeo rohita (rohu) ApoA-I (LrApoA-I) encoding a protein of 256 amino acids was amplified, cloned and sequenced. Tissue specific transcription analysis of LrApoA-I revealed its expression in a wide range of tissues, with a very high level of expression in liver and spleen. Ontogenic study of LrApoA-I expression showed presence of transcripts in milt and 3 h post-fertilization onwards in the larvae. The expression kinetics of LrApoA-I was studied upon infection with three different types of pathogens to elucidate its functional significance. Its expression was found to be up-regulated in the anterior kidney of L. rohita post-infection with Aeromonas hydrophila. Similarly following poly I:C (poly inosinic:cytidylic) stimulation, the transcript levels increased in both the anterior kidney and liver tissues. Significant up-regulation of LrApoA-I expression was observed in skin, mucous, liver and anterior kidney of the fish challenged with the ectoparasite Argulus siamensis. Immunomodulatory effect of recombinant LrApoA-I (rApoA-I) produced in Escherichia coli was demonstrated against A. hydrophila challenge in vivo. L. rohita administered with rApoA-I at a dose of 100 μg exhibited significantly higher protection (∼55%) upon challenge with A. hydrophila 12 h post-administration of the protein, in comparison to that observed in control group, along with higher level of expression of immune-related genes. The heightened expression of ApoA-I observed post-infection reflected its involvement in immune responses against a wide range of infections including bacterial, viral as well as parasitic pathogens. Our results also suggest the possibility of using rApoA-I as an immunostimulant, particularly rendering protection against A. hydrophila.

Systematic review of clinical outcomes after prophylactic surgery

Introduction Prophylactic appendicectomy is performed prior to military, polar and space expeditions to prevent acute appendicitis in the field. However, the risk-benefit ratio of prophylactic surgery is controversial. This study aimed to systematically review the evidence for prophylactic appendicectomy. It is supplemented by a clinical example of prophylactic surgery resulting in life-threatening complications. Methods A systematic review was performed using MEDLINE(®) and the Cochrane Central Register of Controlled Trials. Keyword variants of 'prophylaxis' and 'appendicectomy' were combined to identify potential papers for inclusion. Papers related to prophylactic appendicectomy risks and benefits were reviewed. Results Overall, 511 papers were identified, with 37 papers satisfying the inclusion criteria. Nine reported outcomes after incidental appendicectomy during concurrent surgical procedures. No papers focused explicitly on prophylactic appendicectomy in asymptomatic patients. The clinical example outlined acute obstruction secondary to adhesions from a prophylactic appendicectomy. Complications after elective appendicectomy versus the natural history of acute appendicitis in scenarios such as polar expeditions or covert operations suggest prophylactic appendicectomy may be appropriate prior to extreme situations. Nevertheless, the long-term risk of adhesion related complications render prophylactic appendicectomy feasible only when the short-term risk of acute appendicitis outweighs the long-term risks of surgery. Conclusions Prophylactic appendicectomy is rarely performed and not without risk. This is the first documented evidence of long-term complications following prophylactic appendicectomy. Surgery should be considered on an individual basis by balancing the risks of acute appendicitis in the field with the potential consequences of an otherwise unnecessary surgical procedure in a healthy patient.

Four pro-inflammatory cytokines of rohu (Labeo rohita) during early developmental stages, their tissue distribution and expression by leucocytes upon in-vitro stimulation

Cytokines are important components of both adaptive and innate immunity, and are required to initiate and regulate immune responses following infection. The ontogeny and tissue specific distribution of four pro-inflammatory cytokines, interleukin-6 (IL-6), tumor necrosis factor α (TNF-α), IL-8 and IL-1β in rohu (Labeo rohita), and their responses by leucocytes from anterior-kidney/head-kidney (HKLs), spleen (SPLs) and peripheral blood (PBLs) following stimulation with concanavalin A (ConA), ConA with phorbol 12-myristate 13-acetate (ConA/PMA) and formalin-killed Aeromonas hydrophila cells (FAH) were studied. In ontogeny study, mRNA levels of IL-6 and IL-1β were evident in unfertilized egg stages of L. rohita whereas IL-8 and TNF-α transcripts were found from 1 to 3 h post-fertilization (hpf) onwards till day 15 post-fertilization, respectively. Basal level of all four cytokines was observed in all twelve tissues (eye, brain, heart, gill, anterior kidney, posterior kidney, spleen, liver, skin, muscle, hindgut and foregut) of L. rohita juveniles. Expression levels of IL-6 and IL-8 were found to be the highest in liver and heart tissues, respectively, while TNF-α transcripts were high in anterior kidney and liver tissues. Transcripts of IL-1β showed high expression in muscle, heart and spleen. Upon in vitro stimulation of leucocytes, there was variable up-regulation of all the four cytokines following different treatments throughout the experimental time period. Induction of cytokines was more pronounced in PBLs stimulated with FAH compared to other stimuli. However, an up-regulated IL-8 expression was evident in all the leucocytes following stimulation with FAH thus indicating IL-8 could be used as an indicator or indirect marker to monitor vaccine status or health status of L. rohita during bacterial infection.

Large-scale discovery of novel genetic causes of developmental disorders

Despite three decades of successful, predominantly phenotype-driven discovery of the genetic causes of monogenic disorders, up to half of children with severe developmental disorders of probable genetic origin remain without a genetic diagnosis. Particularly challenging are those disorders rare enough to have eluded recognition as a discrete clinical entity, those with highly variable clinical manifestations, and those that are difficult to distinguish from other, very similar, disorders. Here we demonstrate the power of using an unbiased genotype-driven approach to identify subsets of patients with similar disorders. By studying 1,133 children with severe, undiagnosed developmental disorders, and their parents, using a combination of exome sequencing and array-based detection of chromosomal rearrangements, we discovered 12 novel genes associated with developmental disorders. These newly implicated genes increase by 10% (from 28% to 31%) the proportion of children that could be diagnosed. Clustering of missense mutations in six of these newly implicated genes suggests that normal development is being perturbed by an activating or dominant-negative mechanism. Our findings demonstrate the value of adopting a comprehensive strategy, both genome-wide and nationwide, to elucidate the underlying causes of rare genetic disorders.

A structural insight into hydroxamic acid based histone deacetylase inhibitors for the presence of anticancer activity

Histone deacetylase inhibitors (HDACi) have been actively explored as anti-cancer agents due to their ability to prevent deacetylation of histones, resulting in uncoiling of chromatin and stimulation of a range of genes associated in the regulation of cell survival, proliferation, differentiation and apoptosis. During the past several years, many HDACi have entered pre-clinical or clinical research as anti-cancer agents with satisfying results. Out of these, more than 8 novel hydroxamic acid based HDACi i.e., belinostat, abexinostat, SB939, resminostat, givinostat, quisinostat, pentobinostat, CUDC-101 are in clinical trials and one of the drug vorinostat (SAHA) has been approved by US FDA for cutaneous T-cell lymphoma (CTCL). It is clear from the plethora of new molecules and the encouraging results from clinical trials that this class of HDAC inhibitors hold a great deal of promise for the treatment of a variety of cancers. In this review, we classified the hydroxamic acid based HDACi on the basis of their structural features into saturated, unsaturated, branched, un-branched and 5, 6-membered cyclic ring linker present between zinc binding group and connecting unit. The present article enlists reports on hydroxamic acid based HDACi designed and developed using concepts of medicinal chemistry, demonstrating that hydroxamate derivatives represent a versatile class of compounds leading to novel imaging and therapeutic agents. This article will also provide a complete insight into various structural modifications required for optimum anticancer activity.

Cross-sectional evaluation of awareness of prevention of dental caries among general pediatricians in ghaziabad district, India

BACKGROUND

Oral diseases are largely preventable and it is hoped that with the early exposure to oral health-care activities, the prevalence of oral diseases will be reduced in children and they would be more receptive to dental services.

AIM

The present study evaluated the awareness of prevention of dental caries among pediatricians in Ghaziabad district, India.

SUBJECTS AND METHODS

A cross-sectional survey was undertaken among the pediatricians in Ghaziabad district, India. Total subjects including in the survey were 88 pediatricians, through systemic random sampling. Both the gender was including Male-37.8% (35/88) and Female-62.2% (53/88). Pre-tested, structured and self administered questionnaire was used in the survey and data analysis was done by using 'SPSS' software version 16.0 (IBM, United States).

RESULTS

Our study indicated that most of the pediatricians in Ghaziabad district had moderate knowledge 39.7% (35/88), followed by good knowledge 36.5% (32/88) and poor knowledge 23.8% (21/88) about dental caries. Practice guidelines and opinions of pediatricians in the survey were moderate 64.7% (57/88) in about more than half, followed by poor 23.8% (21/88) and followed by good 11.5% (10/88). The attitude for prevention of dental caries was positive in almost everybody 81.8% (72/88).

CONCLUSION

The present survey concluded that pediatricians in Ghaziabad district, India had a good attitude and practices, but had moderate knowledge and lacked proper awareness about dental caries.

Immune responses and protective efficacy of recombinant outer membrane protein R (rOmpR)-based vaccine of Aeromonas hydrophila with a modified adjuvant formulation in rohu (Labeo rohita)

Despite the importance and success of developing a candidate vaccine against Aeromonas hydrophila infection in fish, little is known about the molecular mechanisms of the vaccine-induced immunoprotection in Indian major carp, Labeo rohita, primarily due to lack of information on most of the immune related genes of the species. In this study, a novel candidate antigen recombinant outer membrane protein R (rOmpR) of A. hydrophila was evaluated as a vaccine candidate along with a modified adjuvant formulation. Protective efficacy of the rOmpR immunization was assessed in terms of survival against A. hydrophila challenge as well as modulation of immune response in vaccinated fish after 1, 3, 6, 12, 24, 72 h and 10 days post-injection (using immune gene expression analysis) and 10, 28, 56 and 140 days post-injection (serum immune parameter analysis). The generated immune response was compared with a formalin-killed A. hydrophila antigen preparation using mineral oil only and modified adjuvant alone. We report a variable up-regulation of the immune-related genes viz., lysozyme G, complement factor 4, immunoglobulin M, β2-microglobulin, major histocompatibility complex I and II, and interleukin-1β in anterior kidney and spleen tissues at early time points post-immunization in all the groups, when compared to the control fish. The vaccinated fish also showed an increase in serum natural hemolysin titer, lysozyme and myeloperoxidase activities, and antibody titer irrespective of vaccine formulations as compared to control fish on days 10, 28 and 56. However, the increase in the serum parameters was more pronounced on day 140 in rOmpR-modified adjuvant injected group, indicating the modulatory role of this new vaccine formulation. Upon challenge with live A. hydrophila on days 56 and 140 post-immunization, significantly reduced percent mortality was noted in the group immunized with modified adjuvant based rOmpR vaccine formulation. Taken together, our results suggest that rOmpR along with modified adjuvant could potentially be used as a vaccine formulation to handle A. hydrophila infection on a long-term basis.

ERRβ signalling through FST and BCAS2 inhibits cellular proliferation in breast cancer cells

Background:

The overexpression of oestrogen-related receptor-β (ERRβ) in breast cancer patients is correlated with improved prognosis and longer relapse-free survival, and the level of ERRβ mRNA is inversely correlated with the S-phase fraction of cells from breast cancer patients.

Methods:

Chromatin immunoprecipitation (ChIP) cloning of ERRβ transcriptional targets and gel supershift assays identified breast cancer amplified sequence 2 (BCAS2) and Follistatin (FST) as two important downstream genes that help to regulate tumourigenesis. Confocal microscopy, co-immunoprecipitation (CoIP), western blotting and quantitative real-time PCR confirmed the involvement of ERRβ in oestrogen signalling.

Results:

Overexpressed ERRβ induced FST-mediated apoptosis in breast cancer cells, and E-cadherin expression was also enhanced through upregulation of FST. However, this anti-proliferative signalling function was challenged by ERRβ-mediated BCAS2 upregulation, which inhibited FST transcription through the downregulation of β-catenin/TCF4 recruitment to the FST promoter. Interestingly, ERRβ-mediated upregulation of BCAS2 downregulated the major G1-S transition marker cyclin D1, despite the predictable oncogenic properties of BCAS2.

Interpretation:

Our study provides the first evidence that ERRβ, which is a coregulator of ERα also acts as a potential tumour-suppressor molecule in breast cancer. Our current report also provides novel insights into the entire cascade of ERRβ signalling events, which may lead to BCAS2-mediated blockage of the G1/S transition and inhibition of the epithelial to mesenchymal transition through FST-mediated regulation of E-cadherin. Importantly, matrix metalloprotease 7, which is a classical mediator of metastasis and E-cadherin cleavage, was also restricted as a result of ERRβ-mediated FST overexpression.

Do alpha deletions influence hydroxyurea response in thalassemia intermedia?

Thalassemia intermedia patients show variable phenotypes. Hydroxyurea (HU) may benefit some of the thalassemia intermedia cases (1), however, the parameters influencing the response to HU have not been reported. In this study, the molecular parameters, alpha-globin and beta-globin genotype and the Xmn I polymorphism, were correlated with the HU response. Twenty patients with thalassemia intermedia were given HU (10-20 mg/kg) and responses were evaluated over a one year period. Twelve patients (60%) showed a good response to therapy with a significant increase in Hb and HbF levels and with elimination of the transfusion requirement in four patients. Four out of the twelve (33%) patients were positive for -alpha(3.7) deletions whereas none of the 8 non-responders were positive for alpha deletions. One each of the responders and non-responders were positive for alpha alpha alpha(anti-3.7) triplication. Three (25%) responsive and one non-responsive patients were homozygous for the IVS1-1 (G-->T) mutation. Three of the responsive patients with alpha deletions were also homozygous positive for Xmn I polymorphism. Thus, in addition to acting in synergy with the XmnI polymorphism, alpha deletions may be an independent factor predicting good response to HU in thalassemia intermedia, although this needs to be confirmation in larger studies.

Pseudohypoparathyroidism type 1b due to paternal uniparental disomy of chromosome 20q

CONTEXT

Pseudohypoparathyroidism type 1b (PHP1b) is the result of end-organ resistance to PTH and other hormones such as TSH in the absence of any features of Albright's hereditary osteodystrophy. Patients with PHP1b show imprinting abnormalities at the complex GNAS locus. The molecular cause of autosomal dominant familial PHP1b has been well-defined with identification of microdeletions within the GNAS locus or the nearby STX16, but the molecular mechanism of the GNAS imprinting defects in sporadic PHP1b cases remains elusive.

OBJECTIVE

We investigated the underlying molecular mechanism of GNAS imprinting defects in two patients with sporadic PHP1b.

RESULTS

We identified paternal uniparental disomy of the long arm of chromosome 20 (patUPD20) in two unrelated patients with sporadic PHP1b. This provides an explanation for the patients' GNAS methylation abnormalities and hormone resistance. Our data and a review of the six published cases of patUPD20 suggest that high birth weight and/or early-onset obesity and macrocephaly may also represent features of patUPD20.

CONCLUSION

We suggest that patUPD20 should be considered in the evaluation of patients with sporadic PHP1b.