Impact of self-assessment on dental student's performance in pre-clinical conservative dentistry course

BACKGROUND

Self-assessment (SA) is an interactive course that endorses the accomplishment of learning objectives through learners' identification of insufficiencies in their didactic knowledge and pre-clinical skills. This study was planned to determine whether there is any improvement in the faculty assessment (FA) score following the implementation of SA in the Pre-clinical Conservative Dentistry Course.

METHODS

Fifty-four first-semester dental students were given an introductory lecture followed by a demonstration for Class I Cavity Preparation in typhodont mandibular first molar. At the end of the demonstration, the Scoring Rubric (SR) was explained point-wise in the prepared cavities. During the next session, all students performed Class I cavity preparation and they were given an assessment sheet to enter their scores (SA1). All teeth were evaluated by the Grading Faculties in a blinded manner (FA1). Each participant was explained the difference in their respective SA1 from FA1 and their queries were resolved individually. During the next sessions, Students and Grading Faculties followed the same protocol and scores were recorded as SA2, FA2, SA3 and FA3.

RESULTS

The mean score of SA1 was significantly higher than that of FA1 (p < 0.001). However, no significant difference was obtained between SA and FA in the second (p = 0.352) and third (p = 0.434) assessments. In contrast with first assessment, mean marks obtained in FA were higher compared to SA in both second and third assessments. There was a statistically significant improvement in mean marks obtained by the students over time (p < 0.001).

CONCLUSION

SA endorsed student-faculty communication and enhanced student's poise and technical skills in operative pre-clinical dentistry.

RI2AP: Robust and Interpretable 2D Anomaly Prediction in Assembly Pipelines

Predicting anomalies in manufacturing assembly lines is crucial for reducing time and labor costs and improving processes. For instance, in rocket assembly, premature part failures can lead to significant financial losses and labor inefficiencies. With the abundance of sensor data in the Industry 4.0 era, machine learning (ML) offers potential for early anomaly detection. However, current ML methods for anomaly prediction have limitations, with F1 measure scores of only 50% and 66% for prediction and detection, respectively. This is due to challenges like the rarity of anomalous events, scarcity of high-fidelity simulation data (actual data are expensive), and the complex relationships between anomalies not easily captured using traditional ML approaches. Specifically, these challenges relate to two dimensions of anomaly prediction: predicting when anomalies will occur and understanding the dependencies between them. This paper introduces a new method called Robust and Interpretable 2D Anomaly Prediction (RI2AP) designed to address both dimensions effectively. RI2AP is demonstrated on a rocket assembly simulation, showing up to a 30-point improvement in F1 measure compared to current ML methods. This highlights its potential to enhance automated anomaly prediction in manufacturing. Additionally, RI2AP includes a novel interpretation mechanism inspired by a causal-influence framework, providing domain experts with valuable insights into sensor readings and their impact on predictions. Finally, the RI2AP model was deployed in a real manufacturing setting for assembling rocket parts. Results and insights from this deployment demonstrate the promise of RI2AP for anomaly prediction in manufacturing assembly pipelines.

Undergraduates' comparative assessment, utilizing a structured rubric, of hands-on versus video-supported presentation in class II cavity preparation

BACKGROUND

Dental education is considered as a complex, challenging and often stressful educational procedure. Acquisition of psychomotor skills by undergraduate students is an important step in many health professions to become a successful professional. During under graduation, class II cavity preparation exercise is of utmost important in dentistry.

OBJECTIVE

To compare class II cavities prepared by students after hands-on live demonstration and pre-recorded video demonstration using well-organised evaluation rubrics.

METHOD

Preclinical dental students (n= 50) were divided into two groups. The students in group I (n= 25) attended a hands-on live demonstration performed by one faculty while students in group II (n= 25) watched a 15-minute pre-recorded procedural video on the projector. Both groups were appealed to prepare class II cavity for amalgam involving disto-occlusal surface of mandibular second molar articulated on jaw model (TRU LON study model, Jayna industries, Ghaziabad U.P., India). Following completion of the preparations, all teeth were collected, and labelled grades of prepared cavities were given according to prespecified rubrics. The data of scores were presented as means and standard deviation. Statistical analysis of data was executed using SPSS software. A paired t-test was used to compare scores between groups.

RESULTS

The study shows that the video-supported demonstration of a cavity preparation was better than the live hands-on demonstration. A higher mean response for the procedural video group was found compared to the live demonstration group (p= 0.000133).

CONCLUSION

Pre-recorded video-supported demonstration along with guidance by a tutor may be a viable alternative to hands-on live demonstration in cavity preparation procedures during undergraduate dental training. Moreover, rubric methods can be implemented in the teaching of various preclinical exercises for conservative dentistry and endodontics.

Development of erlotinib-loaded nanotransferosomal gel for the topical treatment of ductal carcinoma in situ

Aims: This study was aimed to formulate erlotinib (ERL)-loaded transferosomal gel (ERL@TG) intended for topical application for the treatment of ductal carcinoma in situ. Materials & methods: The optimized process involved a thin-film hydration method to generate ERL-loaded transferosomes (ERL@TFS), which was incorporated into a carbopol gel matrix to generate ERL@TG. The optimized formulation was characterized in vitro followed by cytotoxicity evaluation on MCF-7 breast cancer cell lines and acute toxicity and skin irritation studies was performed in vivo. Results: In a comparative assessment against plain ERL, ERL@TG displayed enhanced efficacy against MCF-7 cell lines, reflected in considerably lower IC50 values with an enhanced safety profile. Conclusion: Optimized ERL@TG was identified as a promising avenue for addressing ductal carcinoma in situ breast cancer.

Targeting DCAF5 suppresses SMARCB1-mutant cancer by stabilizing SWI/SNF

Whereas oncogenes can potentially be inhibited with small molecules, the loss of tumour suppressors is more common and is problematic because the tumour-suppressor proteins are no longer present to be targeted. Notable examples include SMARCB1-mutant cancers, which are highly lethal malignancies driven by the inactivation of a subunit of SWI/SNF (also known as BAF) chromatin-remodelling complexes. Here, to generate mechanistic insights into the consequences of SMARCB1 mutation and to identify vulnerabilities, we contributed 14 SMARCB1-mutant cell lines to a near genome-wide CRISPR screen as part of the Cancer Dependency Map Project1-3. We report that the little-studied gene DDB1-CUL4-associated factor 5 (DCAF5) is required for the survival of SMARCB1-mutant cancers. We show that DCAF5 has a quality-control function for SWI/SNF complexes and promotes the degradation of incompletely assembled SWI/SNF complexes in the absence of SMARCB1. After depletion of DCAF5, SMARCB1-deficient SWI/SNF complexes reaccumulate, bind to target loci and restore SWI/SNF-mediated gene expression to levels that are sufficient to reverse the cancer state, including in vivo. Consequently, cancer results not from the loss of SMARCB1 function per se, but rather from DCAF5-mediated degradation of SWI/SNF complexes. These data indicate that therapeutic targeting of ubiquitin-mediated quality-control factors may effectively reverse the malignant state of some cancers driven by disruption of tumour suppressor complexes.

Biomimetic approach to strengthen the incisal fracture composite build-up: an in vitro study

OBJECTIVE

Incisal composite build-up shows a high failure susceptibility. The incorporation of fiber-reinforced composite (FRC) during composite restoration could improve its strength. Hence the study was planned to compare the effect of various positions of FRC on the strength of composite resin incisal build-ups.

METHODS

In maxillary incisors (n = 90), 3 mm of the incisal edge was cut and teeth were categorized into three groups based on the location and number of fibers used during incisal composite build-up - Group I: composite resin; Group II: composite resin and a single fiber palatally and Group III: composite resin along with two fibers palatally.

RESULTS

The data showed that group II had the maximum load-bearing values followed by group I and group III.

CONCLUSION

Within the confines of our study, it can be concluded that the addition of FRC to the conventional incisal composite build-up increased the overall strength restoration. Such composite restoration reinforced with a single fiber on the palatal side showed the highest load-bearing capacity compared to two fibers reinforced and unreinforced composites. The common mode of failure in group I was in composite resin, in two fibers reinforced at fibers-composite junction, and in one fiber reinforced composite was in the remaining part of the tooth.

Comparative evaluation of effect of sodium hypochlorite and chlorhexidine in dental unit waterline on aerosolized bacteria generated during dental treatment

BACKGROUND

In dentistry, nosocomial infection poses a great challenge to clinicians. The microbial contamination of water in dental unit waterlines (DUWLs) is ubiquitous. Such infected DUWLs can transmit oral microbes in the form of aerosols. Previous studies have suggested treating DUWLs with various disinfectants to reduce cross-contamination. The literature lacks a comparative evaluation of the effect of the use of 0.2% chlorhexidine (CHX) and 0.1% sodium hypochlorite (NaOCl) in DUWLs on aerosolized bacteria generated during dental procedures.

OBJECTIVE

To compare the effect of NaOCl and CHX in DUWLs on aerosolized bacteria generated during restorative and endodontic procedures.

MATERIALS AND METHODS

A total of 132 patients were equally divided into three groups (n = 44 in each group) according to the content of DUWL as follows. Group I-0.1% NaOCl Group II-0.2% CHX Group III-distilled water (Positive control) One-way ANOVA was performed and the Kruskal-Wallis test was used for intergroup comparison.

RESULTS

For the restorative procedure, inter-group comparison of mean colony-forming units (CFU) scores showed a statistically significant difference between the groups (p - .001) with the score of group 3 higher than group 2 followed by group 1. For the endodontics, an inter-group comparison of CFU scores showed a statistically significant difference between the groups (p - .003) with the mean score in group 1 being the lowest and group 3 being the highest.

CONCLUSION

The addition of NaOCl or CHX in DUWLs shows an effective reduction in aerosolized bacteria compared to distilled water.

Comparative evaluation of four different root canal irrigation techniques for apical extrusion of sodium hypochlorite - An in vitro study

Objective

This study compared the potential for apical extrusion of sodium hypochlorite (NaOCl) when using needle irrigation (NI), passive ultrasonic irrigation (PUI), passive subsonic irrigation (PSI), and negative pressure system (NP).

Materials and Methods

One hundred freshly extracted human permanent anterior teeth with complete root formation were embedded rigidly in agarose gel-containing cresol purple. Teeth were randomly allocated to six groups: G1-NI; G2-PUI; G3-PSI; G4-NP; G5-positive control; and G6-negative control. The chemomechanical preparation was completed and 12 ml of 3% NaOCl was delivered for 180 s in all groups. Dye diffusion was standardized by doing gel photography after the NaOCl final irrigation the Chi-square test and Kruskal-Wallis one-way analysis of variance test were used for the data analysis.

Results

G1 had statistically significant apical extrusion compared to G2 (P = 0.001), G3 (P = 0.001), and G4 (P = 0.001) groups. G4 showed the least amount of apical extrusion.

Conclusions

pH-sensitive gel model is useful in evaluating NaOCl extrusion. NP produced least NaOCl extrusion as compared to the other three systems. Due consideration should be given to the potential for apical extrusion of the irrigant before the selection of an irrigation system.

PSORIASIS PATHOGENESIS: INSIGHTS FROM TRANSCRIPTOMICS AND PROTEOMICS STUDIES OF KERATINOCYTES

Complex inflammatory skin disease with autoimmune roots is psoriasis. This disease affects various cell types, and the underlying signaling processes are complicated yet not fully understood. Extensive psoriatic lesions' proteome and transcriptome of several researches were combined to understand disease's underlying biological mechanisms. According to a network-based study, both transcriptomics and proteomics control were comparable. They discovered many pathways of signaling previously undiscovered and possibly involved in overexpression of psoriasis genes. They also found a collection of transcription factors in charge of this process. The functional overlap between the results of transcriptomics and proteomics was also examined. There created a network-based method for combining the analysis of many high-throughput data sources. Proteomic and transcriptome studies of psoriasis data sets demonstrated regulatory flexibility apparatus underpinning disease and complementary relationships within two cellular organizations.

Management of separated endodontic instruments: case reports

Successful management of separated endodontic instruments is difficult, but several techniques are available for the retrieval of a separated instrument (SI). An appropriate treatment plan depends on various factors, including the anatomy and location of the tooth; the size, type, and location of the SI; and the skill of the clinician. However, the selection of the most appropriate management technique based on these factors can be a challenging decision that directly influences the success of the procedure. This article presents 4 symptomatic cases of SIs managed with various modalities as well as 1-year clinical and radiographic follow-up results. The management techniques applied in these cases included the use of ultrasonic tips, the wire loop method, safe-sided H-files, the braiding technique, and bypassing of the file. The medical history of the patients was noncontributory except for a single patient who had type 2 diabetes mellitus, which might have delayed healing. After instrument retrieval, the patients were evaluated clinically for relief of signs and symptoms as well as for their responses to various tests such as percussion, palpation, and tooth mobility. Radiographic evaluation at the 12-month follow-up was used to determine the periapical index. The clinical and radiographic results and patient-reported outcomes were satisfactory in all cases. The 4 cases presented demonstrate that the keys to successful management of an SI are understanding the factors that influence the case and selecting an appropriate therapeutic technique.

Total laparoscopic hysterectomy (TLH) with endosuturing compared with conventional technique using energy sources

Background

The aim of the study was to demonstrate the technique of total laparoscopic hysterectomy (TLH) with intra-corporeal endosuturing using simple sutures and basic surgical instruments and compare with TLH using electric coagulation equipment i.e. energy sources with regard to operative time, blood loss, postoperative stay and pain scores.

Methods

A retrospective study was undertaken, in Max Super Specialty Hospital Saket, from June 2015 to May 2018, which included 586 cases of TLH (for benign gynecological conditions), of which 287 were performed using intra-corporeal endosuturing (Group 1) and 299 were performed using energy sources (Group 2). To avoid bias, baseline matching was done for body mass index (BMI), indications for surgery, size of uterus, previous abdominal surgeries and comorbidities like diabetes and hypertension after which there were 172 patients in each group.

Results

The mean age of patients was 48.24 ± 6.76 years. All operative outcomes including operative time (104.1 ± 22.6 vs 107.6 ± 32.6 mins, p=0.25), blood loss (78.9 ± 101.6 vs 99.7 ± 177.6 ml, p=0.19), pain score (2.5 ± 1.3 vs 2.7 ± 1.2, p=0.13) and post-operative stay (2.05 ± 0.2 vs 2.07 ± 0.3 days, p=0.36) were similar between the two groups. Uterine size was the major determinant of operative time and operative blood loss.

Conclusion

TLH with intracorporeal endosuturing can be performed safely and gives results comparable with TLH performed using energy sources. Advancement in suturing devices can decrease operative time further and potentially make it easier and more acceptable.

Evaluation of aromatherapy on success rate of inferior alveolar nerve block in teeth with irreversible pulpitis: a prospective randomized clinical trial

OBJECTIVE

This prospective, block randomized clinical trial was conducted to evaluate the effect of aromatherapy on the success rate of inferior alveolar nerve block (IANB) in teeth with irreversible pulpitis.

METHOD AND MATERIALS

In this clinical trial, 46 patients fulfilling the inclusion criteria were randomly divided into two equal groups: group I (n = 22) received IANB in a closed operatory without any fragrance, whereas group II (n = 24) received IANB in a separate closed operatory saturated with lavender fragrance using a candle warmer. The modified dental anxiety scale (MDAS) for anxiety and visual analog scale (VAS) for pain were recorded preoperatively as well as during access cavity preparation. For MDAS, a total score of more than 18 was considered as tremendously anxious or dental phobic. No or mild pain on VAS was considered as success. Data were analyzed using paired t test and independent sample t test. P < .05 was considered as statistically significant.

RESULTS

Difference in mean VAS (P = .749) and MDAS (P = 1.000) between both the groups was statistically nonsignificant. However there was a statistically significant difference in mean VAS (P = .000) and MDAS (P = .001) during access opening.

CONCLUSION

Lavender aromatherapy can be used successfully to alleviate dental anxiety as well as to increase the anesthetic success rate of IANB in teeth with irreversible pulpitis.

Effect of genotype, seed development stages, and processing treatments on Bowman-Birk inhibitor in soybean and its level in commercial soy products

Bowman-Birk inhibitor (BBI) is a protease inhibitor that affects protein digestibility; however, it is increasingly being recognised as anutraceutical and cosmeceutical molecule. In the present study, BBI concentration during soybean seed development, its loss during processing treatments, and the level in commercial soy products were determined. Significant differences for BBI concentration were observed across the genotypes and seed development stages. Genotype × seed development stage interaction was also found to be significant (P<0.05) for BBI concentration. Boiling, autoclaving, microwave irradiation, and sprouting resulted in significant (P<0.05) loss of BBI. Minimum loss was observed in sprouting, while autoclaving for 5 min completely deactivated BBI. Microwave irradiation of the soaked seeds resulted in higher BBI loss than of dry seeds. Among the commercial soy products, BBI concentration was high in soy flour brands, minuscule in ready-to-cook miso soup and undetectable in extruded soy products and roasted soy nuts.

Global Collaborations for Cervical Cancer: Can the East-West Alliance Facilitate Treatment for all?

Despite the advances in the primary prevention of cervical cancer, there is an absolute increase in the incidence of cervical cancer as a result of an increase in world population. A vast majority of patients in low and low-middle income countries continue to present at a locally advanced stage, necessitating treatment with chemoradiation and brachytherapy. There is a dearth of equipment and trained professionals for the treatment of cervical cancer, especially in low and low-middle income countries. There is an urgent need to improve treatment availability and develop better treatments. Worldwide trends, however, reveal a low number of therapeutic and innovative research trials in cervical cancer. The present article elucidates the existing challenges and provides solutions to improve outcomes. The proposed strategies hinge on strengthening collaborations for global advocacy.

Med12 regulates ovarian steroidogenesis, uterine development and maternal effects in the mammalian egg

The transcriptional factor MED12 is part of the essential mediator transcriptional complex that acts as a transcriptional coactivator in all eukaryotes. Missense gain-of-function mutations in human MED12 are associated with uterine leiomyomas, yet the role of MED12 deficiency in tumorigenesis and reproductive biology has not been fully explored. We generated a Med12 reproductive conditional knockout mouse model to evaluate its role in uterine mesenchyme, granulosa cells, and oocytes. Mice heterozygous for Med12 deficiency in granulosa cells and uterus (Med12fl/+ Amhr2-Cre) were subfertile, while mice homozygous for Med12 deficiency in granulosa cells and uterus (Med12fl/fl Amhr2-Cre) were infertile. Morphological and histological analysis of the Med12fl/fl Amhr2-Cre reproductive tract revealed atrophic uteri and hyperchromatic granulosa cells with disrupted expression of Lhcgr, Esr1, and Esr2. Med12fl/fl Amhr2-Cre mice estrous cycle was disrupted, and serum analysis showed blunted rise in estradiol in response to pregnant mare serum gonadotropin. Uterine atrophy was partially rescued by exogenous steroid supplementation with dysregulation of Notch1 and Smo expression in steroid supplemented Med12fl/fl Amhr2-Cre uteri, indicating intrinsic uterine defects. Oocyte-specific ablation of Med12 caused infertility without disrupting normal folliculogenesis and ovulation, consistent with maternal effects of Med12 in early embryo development. These results show the critical importance of Med12 in reproductive tract development and that Med12 loss of function does not cause tumorigenesis in reproductive tissues.

Dietary supplementation of vitamin C: an effective measure for protection against UV-B irradiation using fish as a model organism

The development of UV-B protective mechanisms in aquacultural species is essential for the sustainable production of healthy aqua crop. Freshwater carp Catla catla larvae (13.5 ± 1.12 mg) were fed with a diet containing 0.5% vitamin C (D1) and a control diet (D2) for 40 days. Each group was exposed to two doses of UV-B irradiation: 360 (5 min, D1_{5 min} and D2_{5 min}) and 720 mJ cm^-2 (10 min, D1_{10 min} and D2_{10 min}) for 15 days. Significantly (p < 0.05) higher survival and average weight were recorded in D1 compared to D2 exposed to the same dose. Also, significantly (p < 0.001) higher nitric oxide synthase and lower thiobarbituric acid reactive substances and heat shock protein 70 levels were recorded in D1_{5 min} compared to the other groups. A direct relationship was found between the dose of UV-B and DNA fragmentation in muscles. DNA damage indices such as tail DNA, tail extent moment and olive tail moment were significantly (p < 0.01) lower in D1_{5 min}. Thus, supplementation of vitamin C in the diet provides UV-B protection to larvae.

The burden of hepatitis C virus infection in Punjab, India: A population-based serosurvey

Introduction

Hepatitis C virus (HCV) infection prevalence is believed to be elevated in Punjab, India; however, state-wide prevalence data are not available. An understanding of HCV prevalence, risk factors and genotype distribution can be used to plan control measures in Punjab.

Methods

A cross-sectional, state-wide, population-based serosurvey using a multi-stage stratified cluster sampling design was conducted October 2013 to April 2014. Children aged ≥5 years and adults were eligible to participate. Demographic and risk behavior data were collected, and serologic specimens were obtained and tested for anti-HCV antibody, HCV Ribonucleic acid (RNA) on anti-HCV positive samples, and HCV genotype. Prevalence estimates and adjusted odds ratios for risk factors were calculated from weighted data and stratified by urban/rural residence.

Results

5,543 individuals participated in the study with an overall weighted anti-HCV prevalence of 3.6% (95% Confidence Interval [CI]: 3.0%–4.2%) and chronic infection (HCV Ribonucleic acid test positive) of 2.6% (95% CI: 2.0%–3.1%). Anti-HCV was associated with being male (adjusted odds ratio 1.52; 95% CI: 1.08–2.14), living in a rural area (adjusted odds ratio 2.53; 95% CI: 1.62–3.95) and was most strongly associated with those aged 40–49 (adjusted odds ratio 40–49 vs. 19–29-year-olds 3.41; 95% CI: 1.90–6.11). Anti-HCV prevalence increased with each blood transfusion received (adjusted odds ratio 1.36; 95% CI: 1.10–1.68) and decreased with increasing education, (adjusted odds ratio 0.37 for graduate-level vs. primary school/no education; 95% CI: 0.16–0.82). Genotype 3 (58%) was most common among infected individuals.

Discussion

The study findings, including the overall prevalence of chronic HCV infection, associated risk factors and demographic characteristics, and genotype distribution can guide prevention and control efforts, including treatment provision. In addition to high-risk populations, efforts targeting rural areas and adults aged ≥40 would be the most effective for identifying infected individuals.

Osteopontin is linked with AKT, FoxO1, and myostatin in skeletal muscle cells

Introduction: Osteopontin (OPN) polymorphisms are associated with muscle size and modify disease progression in Duchenne muscular dystrophy (DMD). We hypothesized that OPN may share a molecular network with myostatin (MSTN). Methods: Studies were conducted in the golden retriever (GRMD) and mdx mouse models of DMD. Follow‐up in‐vitro studies were employed in myogenic cells and the mdx mouse treated with recombinant mouse (rm) or human (Hu) OPN protein. Results: OPN was increased and MSTN was decreased and levels correlated inversely in GRMD hypertrophied muscle. RM‐OPN treatment led to induced AKT1 and FoxO1 phosphorylation, microRNA‐486 modulation, and decreased MSTN. An AKT1 inhibitor blocked these effects, whereas an RGD‐mutant OPN protein and an RGDS blocking peptide showed similar effects to the AKT inhibitor. RMOPN induced myotube hypertrophy and minimal Feret diameter in mdx muscle. Discussion: OPN may interact with AKT1/MSTN/FoxO1 to modify normal and dystrophic muscle. Muscle Nerve56: 1119–1127, 2017

Role of oral doxycycline in the management of conjunctival dehiscence following glaucoma drainage device

Importance of matrix metalloproteinase inhibitor like Doxycycline in the management of conjunctival dehiscence following glaucoma drainage device. A 50 years old man developed conjunctival retraction after a glaucoma grainage device with was managed with oral doxycycline. After 4 month of continuous treatment there was complete healing of conjunctival defect. Oral doxycycline is a viable alternative in the conservative management of conjunctival retraction obviating the need for surgical intervention.

Applications of Mass Spectrometry Imaging to Cancer

Pathologists play an essential role in the diagnosis and prognosis of benign and cancerous tumors. Clinicians provide tissue samples, for example, from a biopsy, which are then processed and thin sections are placed onto glass slides, followed by staining of the tissue with visible dyes. Upon processing and microscopic examination, a pathology report is provided, which relies on the pathologist's interpretation of the phenotypical presentation of the tissue. Targeted analysis of single proteins provide further insight and together with clinical data these results influence clinical decision making. Recent developments in mass spectrometry facilitate the collection of molecular information about such tissue specimens. These relatively new techniques generate label-free mass spectra across tissue sections providing nonbiased, nontargeted molecular information. At each pixel with spatial coordinates (x/y) a mass spectrum is acquired. The acquired mass spectrums can be visualized as intensity maps displaying the distribution of single m/z values of interest. Based on the sample preparation, proteins, peptides, lipids, small molecules, or glycans can be analyzed. The generated intensity maps/images allow new insights into tumor tissues. The technique has the ability to detect and characterize tumor cells and their environment in a spatial context and combined with histological staining, can be used to aid pathologists and clinicians in the diagnosis and management of cancer. Moreover, such data may help classify patients to aid therapy decisions and predict outcomes. The novel complementary mass spectrometry-based methods described in this chapter will contribute to the transformation of pathology services around the world.

Highly heterogeneous genomic landscape of uterine leiomyomas by whole exome sequencing and genome-wide arrays

OBJECTIVE

To determine the genomic signatures of human uterine leiomyomas and prevalence of MED12 mutations in human uterine leiomyosarcomas.

DESIGN

Retrospective cohort study.

SETTING

Not applicable.

PATIENT(S)

This study included a set of 16 fresh frozen leiomyoma and corresponding unaffected myometrium specimens as well as 153 leiomyosarcomas collected from women diagnosed with uterine leiomyomas or leiomyosarcomas who underwent clinically indicated abdominal hysterectomy.

INTERVENTION(S)

None.

MAIN OUTCOME MEASURE(S)

Whole exome sequencing and high-resolution X-chromosome and whole genome single nucleotide polymorphism microarray analyses were performed on leiomyoma samples negative for the known MED12 mutations and compared with their corresponding myometrium. Leiomyosarcoma specimens were examined for exon 2 MED12 mutations to evaluate the frequency of MED12 mutated leiomyosarcomas.

RESULT(S)

Our results indicate remarkable genomic heterogeneity of leiomyoma lesions. MED12-negative leiomyomas contain copy number alterations involving the Mediator complex subunits such as MED8, MED18, CDK8, and long intergenic nonprotein coding RNA340 (CASC15), which may affect the Mediator architecture and/or its transcriptional activity. We also identified mutations in a number of genes that were implicated in leiomyomagenesis such as COL4A6, DCN, and AHR, as well as novel genes: NRG1, ADAM18, HUWE1, FBXW4, FBXL13, and CAPRIN1.

CONCLUSION(S)

Mutations in genes implicated in cell-to-cell interactions and remodeling of the extracellular matrix and genomic aberrations involving genes coding for the Mediator complex subunits were identified in uterine leiomyomas. Additionally, we discovered that ∼4.6% of leiomyosarcomas harbored MED12 exon 2 mutations, but the relevance of this association with molecular pathogenesis of leiomyosarcoma remains unknown.

Comparative evaluation of canal cleaning ability of various rotary endodontic filesin apical third: A scanning electron microscopic study

BACKGROUND

The purpose of this study was to evaluate the canal cleaning ability of three novel endodontic rotary instruments and compare with ProTaper files as a control in apical third of root canals under scanning electron microscopy (SEM).

MATERIALS AND METHODS

Eighty freshly extracted mandibular premolars were selected according to inclusion criteria. Buccal cusp tips were ground to ensure having a flat coronal reference point with a total tooth length of 16 mm for all samples. Teeth were divided equally into four groups: Group I (ProTaper group), Group II (ProTaper next group), Group III (variable taper group), and Group IV (self-adjusting file [SAF] group). Using SEM, the dentinal surfaces were observed and rated at apical thirds with a magnification of ×1000 for the presence/absence of smear layer and debris. Descriptive analysis was performed, and analysis of variance with Bonferroni post hoc test was carried out for comparison between the groups, at a significance level of 0.05.

RESULTS

There was statistically significant difference between Group II and Group IV for debris (P = 0.047) and smear layer (P = 0.037).

CONCLUSION

In apical third of root canal, SAF showed statistically significant canal cleaning ability due to combined effect of continuous streaming irrigation with effectively replacing the irrigant from the apical portion of the root canal, irrigants activation through the creation of turbulence, and its self-adapting design to root canal anatomy with a scrubbing motion on the canal walls.

Effect of apical clearing technique on the treatment outcome of teeth with asymptomatic apical periodontitis: A randomized clinical trial

Aim:

This study aims to compare the periapical healing of teeth with asymptomatic apical periodontitis treated either by conventional apical preparation (CAP) or apical clearing technique (ACT).

Materials and Methods:

Twenty subjects with bilateral nonvital similar teeth exhibiting comparable periapical index (PAI) score were enrolled and randomly allocated. Group I (CAP, n = 20): Apical preparation three sizes greater (master apical file [MAF]) than the first binding file at the established working length. Group II (ACT, n = 20): Apical preparation three sizes greater than the MAF that was followed by dry reaming. Root canal therapy was accomplished in single-visit for all the teeth. They were pursued radiographically at 3, 6, 9 and 12 months. Pre- and post-treatment PAI scores were compared. To ascertain the proportion of healed teeth between the two groups, McNemar Chi-square test was applied.

Results:

At 3, 6, and 9 months’ time interval the proportion of healed teeth for Group II (ACT) was greater in comparison to Group I (CAP) (P < 0.05). However, at 12 months follow-up period this difference was not significant (P = 0.08).

Conclusion:

ACT enhanced the healing kinetics. However, the long-term (12 months) radiographic outcome was similar for either technique.

Comparative evaluation of effect of preoperative alprazolam and diclofenac potassium on the success of inferior alveolar, Vazirani-Akinosi, and Gow-Gates techniques for teeth with irreversible pulpitis: Randomized controlled trial

Introduction:

In teeth with irreversible pulpitis, successful local anesthesia is hard to achieve irrespective of the amount of local anesthesia and technique used. Such cases can be managed by concoction of pre-medications like anxiolytics, analgesics and effective local anesthesia. This double-blind, placebo-controlled study was planned to evaluate the effect of oral administration of alprazolam and diclofenac potassium on the success rate of inferior alveolar nerve block (IANB), Gow-Gates (GG) and Vazirani-Akinosi (VA) techniques for the root canal treatment of mandibular molars with irreversible pulpitis.

Method:

198 emergency patients with symptomatic irreversible pulpitis were randomly divided into three groups as – A, B and C receiving IANB, GG or V-A respectively using 2% lidocaine with 1: 100,000 epinephrine. These groups were sub-divided into sub-groups I and II as control and pre-medication groups. Patients who did not react to the stimulus made by an explorer between the canine and first premolar and showing subjective lip and tongue numbness were included in the study.

Result:

All sub-groups showed statistically significant reduction in VAS score. However sub-groups V and VI (that is GG with and without pre-medication respectively) showed best improvement in initial severe pain in mandibular molars with irreversible pulpitis. Moreover, all pre-medication sub-groups showed better pain control compared to respective control groups.

Conclusion:

It was concluded that use of pre-medications in the form of combination of anxiolytics and analgesics improves the success rate of local anesthesia in teeth with irreversible pulpitis. Use of anxiolytics eases the patient in endodontic emergencies. Also use of GG along with pre-medication is the best method for effective pain management of acute pain in irreversible pulpitis.

Cone-Beam Computed Tomography-Guided Management of C-Shaped Type III Dens Invaginatus With Peri-invagination Periodontitis in a Maxillary Canine: A Case Report

Dens invaginatus (DI) is a developmental anomaly seen infrequently in maxillary canines. This article describes cone-beam computed tomography-guided nonsurgical management of type III (subtype B) DI in a permanent maxillary canine associated with a sinus tract and peri-invagination periodontitis in a 17-year-old female. After gaining access to the root canal, thorough chemo-mechanical preparation was performed and usage of intracanal medicament of calcium hydroxide was prescribed for 3 weeks, during which the sinus tract healed completely. Obturation was completed by a technique of down-packing master-cone gutta-percha, followed by backfilling with thermoplasticized gutta-percha. At 12-months follow-up, the patient was asymptomatic with complete resolution of the sinus tract and radiographic evidence of healing of periapical pathology.

Anaesthesia Techniques for Maxillary Molars - A Questionnaire-Based Retrospective Field Survey of Dentist in Western India

INTRODUCTION

Clinicians use various anaesthesia techniques like Posterior Superior Alveolar (PSA) nerve block, buccal infiltration with or without supplemental anaesthesia like palatal and intraligamentary infiltrations for root canal treatment in maxillary molars. However there is no general consensus regarding which technique is enough for performing endodontic treatment in maxillary molars.

AIM

The aim of this questionnaire-based survey is to compare and evaluate the various techniques used to anaesthetize the maxillary molars and its effect on postoperative pain.

MATERIALS AND METHODS

The data were obtained from 290 dental practitioners using a specially prepared questionnaire survey conducted anonymously. The questionnaire contained questions covering data such as years in dentistry, acquired specialty, techniques used for anaesthetizing maxillary molars, success of anaesthesia, and postoperative pain, etc.

RESULTS

Buccal infilteration with supplemental anaesthesia in the form of palatal (82%) and intra-ligamentary infilteration (88%) show higher success rate compared to only buccal infilteration (69%). However, intra-ligamentary infilteration group showed highest rate (75%) of postoperative pain. General practitioners (62% of clinicians) prefer to give both buccal and palatal infilterations and specialists opt for only buccal infilteration (66-74% of specialists).

CONCLUSION

Only buccal infilteration is sufficient during root canal treatment of maxillary molars. Routine use of supplemental anaesthesia in the form of palatal and intra-ligamentary infilteration is not necessary unless patient experiences discomfort during endodontic treatment. However, intra-ligamentary infilteration may lead to postoperative discomfort in the form of pain.