Mucosal Elevation Research Articles

The Effects of Septorhinoplasty Techniques and Poly-P-Dioxanone Plate Use on Maxillofacial Growth: An Experimental Study.

Since the septum plays a key role in maxillofacial growth, the effect of septorhinoplasty maneuvers and the use of poly-p-dioxanone plate during growth on maxillofacial growth was investigated in our study. Thirty-three New Zealand rabbits each with an age of 8 weeks were included in the study. Maxillofacial computed tomography was performed on all 8-weeks old rabbits. Then, the rabbits were divided into 5 groups randomly. No intervention was done on the rabbits in group 1. Nasal dorsum of the rabbits in the 2nd group were opened, and the mucosae were bilaterally elevated. In the third group underwent limited cartilage resection by preserving the nasal dorsum. Removed cartilage was crushed and placed back between the mucoperichondrial flaps for the rabbits in the 4th group. Crushed cartilage with Poly-P-Dioxanone plate was used for the rabbits in the 5th Group. Maxillofacial computed tomography was performed at the end of the 20th week and growth parameters were investigated. When the group 2 was compared with the control group, the nasal bone length was observed to be significantly shorter (P < 0.05). Group 5 compared with group 4, incisive bone volume remained significantly low (P < 0.05) and malocclusion developed. Nasal bone length was affected negatively in the group that underwent osteotomy and mucosa elevation. Although positive results related to poly-p-dioxanone plate use have been reported for adults, incisive bone development retarded in noses that had not yet reached adult size in our study and the maxillofacial development was affected adversely.

Fibrin glue: Novel submucosal injection agent for endoscopic submucosal dissection.

Background and study aims Adequate mucosal elevation by submucosal injection is crucial for patient safety and efficiency during endoscopic submucosal dissection (ESD). This study aimed to evaluate the efficacy of fibrin glue (FG) as a long-lasting submucosal injection agent and to evaluate the technical feasibility of FG injection for ESD. Materials and methods To compare the capabilities of different agents in maintaining submucosal evaluation, we injected FG, hyaluronic acid solution, and normal saline into the porcine gastric specimen that was incised into approximately 5 × 5 cm squares. Then, we measured the height of submucosal elevations over time. Moreover, three hypothetical lesions from the resected porcine stomach underwent ESD with FG injection. Thereafter, we conducted macroscopic and histopathologic analyses. Results FG maintained the greatest submucosal elevation among all the injection agents. Three ESD procedures were performed with en bloc resection. Both macroscopic and histopathologic findings showed a thick FG clot on the ulcers. Conclusions The FG solution can be potentially used as an ESD submucosal injection agent in an in vitro model.

The Influence on Healing of Bony Window Elevated Inward in the Sinus Cavity as Cortical Bone Graft: A Histomorphometric Study in Rabbit Model.

To evaluate the influence on healing of the bony window elevated inward in the sinus cavity as a cortical bone graft. Eighteen rabbits were included in the experiment. At the test sites (bony window), the antrostomy was prepared and the remaining bony window was elevated together with the sinus mucosa. At the control sites, the bony window was gently detached before the sinus mucosa elevation and discarded. The space obtained was grafted with deproteinized bovine bone mineral (DBBM). A collagen membrane was positioned on the antrostomy at both sides. The rabbits were euthanized after 2, 4, and 8 weeks in groups of six each. Histologic analyses in different regions of the elevated space were carried out, and a Wilcoxon test was used to estimate differences. Microcomputed tomography (microCT) analyses were also performed. After 2 weeks of healing, higher proportions of new bone were found in the test group compared with the control group due to the higher amount of bone formed in the region subjacent to the sinus mucosa. In this region, higher amounts of new bone were also found in the test group after 4 (P = .028) and 8 weeks of healing (P = .345). After 8 weeks of healing, the percentage of new bone was higher at the control sites compared with the test sites, with the proportions being 25.4% ± 3.2% and 21.3% ± 6.1%, respectively. In this period of evaluation, the bony window contributed with 20.1% ± 5.3% of vital bone in the test group. A fraction of 60.4% ± 10.8% of its surface was surrounded by new bone. In the microCT analysis, after 8 weeks of healing, fractions of 22.3% ± 1.6% and 22.2% ± 0.7% of bone were found in the test and control groups, respectively. The presence of the bony window positively influenced the healing in the elevated space, especially in the submucosa region. The bony window was vital and incorporated into newly formed bone.

Clinicomorphological Profile of Gastric Polyps in Anatomical Pathology Department, Faculty of Medicine, Universitas Indonesia-Cipto Mangunkusumo Hospital (CMH): A Retrospective Study in Correlation of Long-Term Use of Proton-Pump Inhibitors

Background: Gastric polyps are mucosal elevation into the lumen, found incidentally during endoscopic examination and generally brings no specific symptoms. Long-term use of proton-pump inhibitors (PPIs) is related to the development of the fundic gland polyp (FGP). This retrospective study was conducted to determine the distribution of gastric polyps in CiptoMangunkusumo Hospital along with histomorphological features and their relation with long-term PPI use.Method: This retrospective review is a descriptive analytic study. Gastric polyp cases were taken consecutively from the archive of the Anatomical Pathology Department, Faculty of Medicine Universitas Indonesia/CiptoMangunkusumo Hospital the period of 2016-2017. Clinical data obtained from patient’s medical records. Statistical analysis was carried out with the IBM ® SPSS version 23 program.Results: Among 83 cases of gastric polyps, there were 66 cases of FGP, 11 cases of inflammatory polyps, 5 cases of hyperplastic polyps, and 1 case of Peutz-Jegher polyp. Long term PPI was used in 40 cases and was related with parietal cell hyperplasia.Conclusion: FGP is the most common type of gastric polyp in the Department of Anatomical Pathology CMH. Long term PPI use was found in half of gastric polyps and was related to parietal cell hyperplasia morphology.

Colon mucosal neoplasia referred for endoscopic mucosal resection: Recurrence of adenomas and prediction of submucosal invasion

BACKGROUNDEndoscopic mucosal resection (EMR) is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions. Gross morphology and surface characteristics may help predict submucosal invasion of the lesion (SMIL) during endoscopic evaluation. This is one of the largest single-center studies reporting endoscopic mucosal resection for larger (≥ 20 mm) colorectal lesions in the United States.AIMTo determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.METHODSThis is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions ≥ 20 mm, spanning a period from January 2013 to February 2017. The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.RESULTSA total of 480 patients with 500 lesions were included in the study. The median age was 68 (Inter quantile range: 14) with 52% males. The most common lesion location was ascending colon (161; 32%). Paris classification 0-IIa (Flat elevation of mucosa - 316; 63.2%); Kudo Pit Pattern IIIs (192; 38%) and Granular surface morphology (260; 52%) were most prevalent. Submucosal invasion was present in 23 (4.6%) out of 500 lesions. The independent risk factors for SMIL were Kudo Pit Pattern IIIL + IV and V (Odds ratio: 4.5; P value < 0.004) and Paris classification 0-IIc (Odds ratio: 18.2; P value < 0.01). Out of 500, 354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy. Recurrence was noted in 21.8% (77 cases).CONCLUSIONThere was overall low prevalence of SMIL in our study. Kudo pit pattern (IIIL + IV and V) and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion. The independent risk factor for recurrence was adenoma size (> 40 mm). Almost all recurrences (98.8%) were treated endoscopically.

A Comparative Study on Aqueous Chitosan Solution and Various Submucosal Injection Fluids Using a Three-Dimensional Sensor.

Background/AimsChitosan, a natural polymer widely used in the biomaterials field, has been proposed as a potential submucosal injection solution. The purpose of this study was to compare the performance and efficacy of aqueous chitosan solution and commercialized submucosal injection fluids using a three-dimensional sensor and to evaluate the efficacy of the measured parameters.MethodsNormal saline (0.9% NaCl), as a control, Eleview® (Poloxamer 188), Blue EyeTM (0.4% hyaluronic acid), and aqueous chitosan solution (2.0%) were injected into the submucosa of porcine stomachs ex vivo. The mucosal elevation height, elevated surface area, and angle of the tangent of the submucosal fluid cushion were measured using a three-dimensional sensor. The rates of change for each variable were calculated, and the correlation between parameters was analyzed. Tissue specimens were stained with hematoxylin and eosin.ResultsAll variables exhibited the highest values under chitosan injection. The mucosal elevation height rate of change differed significantly between normal saline and chitosan solution (p=0.024). The elevated surface area rates of change for normal saline and Eleview® were significantly different from those for TS-905 and chitosan solution (p=0.006 and p=0.009, respectively). Further, height, area, and angle showed a positive correlation (p<0.001). A histological examination revealed an even distribution of aqueous chitosan within the submucosa without tissue damage.ConclusionsAqueous chitosan was superior to normal saline and Eleview® and was noninferior to TS-905. A three-dimensional sensor and the measured parameters were effective and useful for evaluating the performance of submucosal fluids.

Novel Polymeric Formulation for Removal of Gastrointestinal Polyps by Digestive Endoscopy.

Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are two techniques used in the resection of gastrointestinal mucosal polyps. The aim of this work is the development and evaluation of an innovative polymeric solution containing sodium carboxymethylcellulose and hyaluronic acid. For this purpose, several mixtures of these two main components, as well as other components such as fructose, citric acid, and zinc, are evaluated in terms of physicochemical and microbiological properties, rheological behavior, extensibility, syringeability, and stability at different storage conditions. Furthermore, the potential production of mucosal elevation and duration is also studied by an ex vivo model using porcine stomach and colon. Results show that the developed polymeric solutions possess optimal values of pH, from 4.58 to 6.63, for their use in the gastrointestinal tract. The formulations exhibit both Newtonian and pseudoplastic behaviors with different viscosity values as a function of their composition. All formulations exhibit high stability properties and no bacterial or fungal growth is detected. MCS01 and MCS05 are the polymeric solutions with the best syringeability results. In this line, MCS05 is the formulation that provides the highest, 2.20 ± 0.18 cm and 1.40 ± 0.11 cm, and longest-lasting, for more than 120 min, elevation effect on porcine submucosal stomach and colon tissues, respectively. Thus, it can be concluded that polymeric solution MCS05 might be considered as a promising tool for use in human EMR and ESD.

Oral Administration of Hydrogel-Embedding Silk Sericin Alleviates Ulcerative Colitis through Wound Healing, Anti-Inflammation, and Anti-Oxidation.

Silk sericin (SS) is abundant in silk industry wastewater, and it has emerged as a promising natural protein for biomedical research. However, its therapeutic potential against ulcerative colitis (UC) has not been exploited. The objective of this study is to investigate the therapeutic effects of SS in a dextran sulfate sodium-induced UC mouse model, and further discover its underlying mechanisms. The purified SS molecules showed negative cytotoxicity, and could be efficiently internalized by colonic epithelial cells and macrophages. In vitro experiments revealed that it could accelerate the mucosal healing, down-regulate the production of pro-inflammatory factors, increase the secretion of anti-inflammatory cytokines, and eliminate the intracellular reactive oxygen species. Finally, animal experiments confirmed that oral administration of hydrogel (chitosan/alginate)-embedding SS molecules attenuated UC-induced symptoms (e.g., body weight loss, colon shortening, increase of spleen weight, and histopathological appearance), which was supported by signs of mucosal healing, anti-inflammation, and elevation of the amounts of tight junction proteins (occludin and zonula occludens-1) and mucin protein (MUC2). Taken together, our results demonstrate that SS can be exploited as a promising oral natural therapeutic for UC treatment with the aid of hydrogel.

Two-Step Procedure for the Treatment of a Maxillary Sinus with Complex Sinus Septa: A Highly Predictive Method for Sinus Floor Augmentation After Perforation of the Maxillary Sinus Membrane.

A strategic surgical approach is necessary for patients who cannot undergo maxillary sinus augmentation due to a large perforation of the sinus membrane as a result of complex sinus septa. The technique includes partial cutting and removal of the sinus septum and graftless mucosal elevation of the concavity area. Six months after the procedure, bone growth was observed in the area where the septum had been partially removed. The sinus mucosa was slightly thicker because of scarring; consequently, maxillary sinus augmentation was safely achieved. This two-step procedure is effective for safe maxillary sinus augmentation in patients with complex sinus morphology.

A novel injectable thermo-sensitive binary hydrogels system for facilitating endoscopic submucosal dissection procedure.

Making an optimal and lasting submucosal cushion is critical for endoscopic submucosal dissection. The thermo-sensitive binary hydrogels system composed of poloxamer 407 and poloxamer 188 might be an excellent submucosal injection solution considering the unique feature that it remains liquid at room temperature and becomes gelatinous after being injected in the submucosa of the digestive tract. The present study focuses on preparing the thermo-sensitive binary hydrogels system and testing its capacity in mucosal lifting and its role in the endoscopic submucosal dissection procedure. Various concentrations of poloxamer 407 and poloxamer 188 were added to normal saline. The gelation temperature viscosity of the thermo-sensitive binary hydrogels system was measured to choose the best formula. The thermo-sensitive binary hydrogels system and normal saline were first compared in extracted porcine stomach. For in vivo study, the thermo-sensitive binary hydrogels system and normal saline were compared for facilitating the endoscopic submucosal dissection procedure. Among the 46 kinds of thermo-sensitive binary hydrogels system, gelation temperatures of the thermo-sensitive binary hydrogels system I (poloxamer 407/poloxamer 188, 17%/0.5%, w/w) and the thermo-sensitive binary hydrogels system II (poloxamer 407/poloxamer 188, 18%/2%, w/w) were among the ideal range of gelation temperature. The injecting pressure in vitro study of thermo-sensitive binary hydrogels system II was significantly higher than that of thermo-sensitive binary hydrogels system I and normal saline (p < 0.001). Sixteen gastric endoscopic submucosal dissection procedures were performed in a porcine model. The initial volume of normal saline injection (13.88 ± 3.91 ml vs 5.88 ± 3.44 ml, p = 0.001) was significantly larger than the thermo-sensitive binary hydrogels system group. The postoperative wound showed a significant difference in the two groups (p = 0.023) indicating that the thermo-sensitive binary hydrogels system can create a cleaner wound. Considering the gelation temperature, viscosity, injection pressure, and the height of the mucosal elevation, the thermo-sensitive binary hydrogels system I was the better submucosal injection solution.

Potential of temperature-response collagen-genipin sols as a novel submucosal injection material for endoscopic resection.

Background and study aims We developed a novel submucosal (SM) injection material that contained pepsin-solubilized collagen (PSC), genipin (Ge) and phosphate buffer (PB). The aim of this study was to validate safety and usability of it for endoscopic resection (ER). Materials and methods In preliminary studies, 1) appropriate warming time and concentration of Ge, and concentration of NaCl in PB, 2) storage modulus of PSC, Ge, and PB mixture (PSC/Ge), and PSC as a mechanical property, 3) histological finding after injection, and histological toxicity of PSC/Ge was evaluated. We injected PSC/Ge, PSC, sodium hyaluronate (SH), dextrose (DW), and normal saline (NS) into SM of resected porcine stomach. We compared mean height of mucosal elevation after immediate injection (MH) and mean retaining rate at 60 minutes (MR) as ex vivo study. Results Optimal condition of PSC/Ge was Ge 5.5 mMol with 24 hours worming time and NaCl 280 mMol. PSC/Ge had better mechanical property than PSC. It was efficiently integrated and confined to the SM with acceptable toxicity. MH of PSC/Ge (5.1 ± 0.74 mm) and PSC (4.8 ± 0.84 mm) were significantly higher than NS (3.2 ± 0.84 mm). MR of PSC/Ge (100 ± 0.0%) was significantly higher than NS (61.7 ± 11.2%), DW (58.3 ± 11.8%) and SH (61.8 ± 8.6%). Conclusion PSC/Ge and PSC has potential to be safe and usable for ER. PSC/Ge was better than PSC because of better mechanical property than PSC.

Efficacy and safety of 0.6% sodium alginate solution in endoscopic submucosal dissection for esophageal and gastric neoplastic lesion: A randomized controlled study.

ObjectivesSodium alginate (SA) solution has characteristic viscoelasticity. We aimed to determine efficacy and safety of 0.6% SA for submucosal injection during endoscopic submucosal dissection (ESD) in patients with localized neoplastic lesion in the esophageal and gastric mucosa.MethodsWe conducted a randomized controlled study at six major hospitals in Japan including 130 patients with endoscopically localized neoplastic lesion in the esophageal and gastric mucosa and eligible for ESD. Patients were randomly assigned to SA or 0.4% sodium hyaluronate (SH) group (control); ESD was performed using a submucosal injection of SA/SH. As a primary outcome measure, non‐inferiority of SA against SH was investigated using en bloc complete resection in ESD and formation and maintenance of mucosal elevation upon injection as an efficacy index. Adverse events during the study were evaluated as safety outcome measures. This study was registered with Pharmaceuticals and Medical Devices Agency (clinical trial no. 28‐277/2016‐18; clinical trial identification no. KP2013‐009_C001).ResultsEfficacy rate of submucosal injection during ESD was 91.7% (55/60) and 88.7% (55/62) in the SA and SH groups, respectively, demonstrating non‐inferiority of SA against SH. Adverse events for which a causal relationship with submucosal injection solution could not be eliminated were noted in 8.2% (5/61) and 4.7% (3/64) in the SA and SH groups, respectively, but symptoms disappeared without treatment/after drug administration in both groups.ConclusionsIn Japan, 0.4% SH is the only commercially approved formulation for submucosal injection during ESD. The study results may expand submucosal injection solution options in clinical practice.

Antrostomy Preparation for Maxillary Sinus Floor Augmentation Using Drills or a Sonic Instrument: A Microcomputed Tomography and Histomorphometric Study in Rabbits.

To evaluate the healing after sinus floor augmentation at antrostomies prepared with either drills or a sonic instrument. Sinus mucosa elevation was performed bilaterally in 18 rabbits. The antrostomy was prepared with either drills or a sonic instrument. The elevated space was filled with a collagenated porcine bone, and the access antrostomy was covered by a collagen membrane. The animals were euthanized in groups of six after 2, 4, and 8 weeks of healing. Microcomputed tomorgraphy (microCT) and a histologic analysis was performed. After 8 weeks of healing, remaining defects occupying about 28.9% and 26.0% of the antrostomy were found at the microCT analysis. At the histologic analysis, new bone was formed from the margins of the antrostomy, reaching the central region over time. After 8 weeks of healing, 29.1% ± 18.6% and 28.4% ± 15.6% of new mineralized bone was occupying the analyzed zone in the antrostomy at the drill and sonic sites, respectively. The use of a sonic device to prepare the antrostomy resulted in similar healing outcomes in both the antrostomy and the elevated regions.

Injectable Hybrid Hydrogels, with Cell-Responsive Degradation, for Tumor Resection.

Biocompatible soft materials have recently found applications in interventional endoscopy to facilitate resection of mucosal tumors. When neoplastic lesions are in organs that can be easily damaged by perforation, such as stomach, intestine, and esophagus, the formation of a submucosal fluid cushion (SFC) is needed to lift the tumor from the underlying muscle during the resection of neoplasias. Such procedure is called endoscopic submucosal dissection (ESD). We describe an injectable, biodegradable, hybrid hydrogel able to form a SFC and to facilitate ESD. The hydrogel, based on polyamidoamines, contains breakable silica nanocapsules covalently bound to its network and able to release biomolecules. To promote degradation, the hydrogel is composed of cleavable disulfide moieties that are reduced by the cells through secretion of glutathione. The same stimulus triggers the breaking of the silica nanocapsules; therefore, the entire hybrid material can be completely degraded and its decomposition depends entirely on the presence of cells. Interestingly, the hydrogel precursor solution showed rapid gelation when injected in vivo and afforded a long-lasting high mucosal elevation, keeping the cushion volume constant during the dissection. This novel material can provide a solution to ESD limitations and promote healing of tissues after surgery.

Morphological Studies of the Oral Roof of the Egyptian Laughing Dove (Streptopelia senegalensis aegyptiaca) and Japanese Quail (Coturnix coturnix japonicum)

This study aimed to determine the morphological characteristics of the palate, choanal slit of two birds of different families; Japanese Quail (JQ) for family Phasianidae and Laughing Dove (LD) for family Columbidae by gross anatomy, scanning electron microscopy and light microscopy. The organs of 16 birds (eight laughing doves and eight Japanese quails) were used. The length of the oropharyngeal roof was nearly equal in both birds; it was divided into oral and pharyngeal roofs. The oral roof (palate) was narrow elongated triangular shaped in LD and wide triangular shaped in JQ, and the oral roof (palate) was longer in LD than that of JQ. The ratio of the oral roof (palate) to the total length of the oro- pharynx was 86.36% in LD and 72.82% in JQ. The choanal slit constituted a nearly same percentage of the length of the palate which was 49-50% while to the total length of the oropharynx was 43.19% in LD and 36.75% in JQ. The line of separation between narrow and wide parts of the choanal slit demarcated by caudolaterally directed papillae and mucosal elevation in LD and by a transverse row of V-shaped papillae in JQ. The edges of the rostral narrow part bear small sized wide-spaced papillae having serrated appearance, while the edges of the wide part were smooth in LD. In JQ 3 transverse rows of papillae and one transverse mucosal fold were presented around the choanal slit. The lamina propria of the palate consisted of dense connective tissue, rich in several types of sensory corpuscles; Merkel's corpuscles were the majority of the sensory corpuscles in LD. Herpst corpuscles with variable sizes and shapes were the majority of sensory corpuscles in JQ. Submucosa of the palate on each side of the choanal slit consisted of 2 groups of palatine salivary glands; medial and lateral groups in JQ and few lobules of the medial salivary glands were observed in LD.

Endoscopy on a Human Cadaver: A Feasibility Study as a Training Tool

Background: Simulation device and porcine models are increasingly being used for training in gastrointestinal endoscopy. However reports on the use of human cadaver for training in diagnostic or therapeutic endoscopy are limited. Method: Human cadavers were preserved at our center in a customized non formalin based solution which retains organoleptic properties (preserves the colour, feel, inflation of gut). We studied the feasibility of using these cadavers for training in endoscopy. Endoscopy was performed using PENTAX/ EP 2940 with a light source processor PENTAX/EPM 3500. Participants performed endoscopy and submucosal injection on cadaver as well as simulator. Before and after simulator and cadaver training, attendees completed a questionnaire on intubation, manoeuvring esophagus, stomach and duodenum for diagnostic endoscopy and scope positioning, needle out, submucosal injection and elevation of mucosa and needle in. The steps of ESD- marking, precut and submucosal dissection were attempted on the stomach of human cadaver. Results: Ten participants with very little prior experience of endoscopy felt the cadaver based training more beneficial in obtaining the sub mucosal plane and positioning the needle for four quadrant injection as compared to the endoscopic simulator (ES). The attendees felt that while ES has the advantage of providing feedback for the procedure, training on cadaver gave more realistic tactile experience and feel of the elasticity of the gut wall. Overall, diagnostic endoscopy was comparable in both cadaver and simulator except for difficulty in intubation in the former due to supine cadaver position. The steps of ESD were done only in the cadaver with limited success. Conclusion: This study shows the feasibility of using human cadaver for simulation-based training programs in gastrointestinal encoscopy.

Histopathological changes in the gastroduodenal mucosa of children with functional dyspepsia

Introduction and ObjectiveFunctional dyspepsia (FD) is a functional gastrointestinal disorder that affects a significant number of children presenting with chronic abdominal pain. A high proportion of these children undergo endoscopy to obtain mucosal biopsies which, by standard criteria, generally do not identify a clear explanation for symptoms. We undertook this study of children diagnosed with FD to elucidate the histopathological changes of gastroduodenal mucosa and to describe mast cell and eosinophil densities. MethodsIn this retrospective study, we evaluated 114 FD subjects and 10 control subjects from whom gastric antral and duodenal biopsies were available as formalin-fixed paraffin embedded tissue. We reviewed the H&E stained slides and performed immunohistochemistry for tryptase, to determine eosinophil and mast cell densities, respectively. ResultsWe found that the duodenal mucosa showed no evidence of inflammation in 86% of subjects, a median peak eosinophil count of 24 and a median peak mast cell count of 22. The histopathological features of the gastric antral mucosa comprised no evidence of inflammation in 52% of subjects, mild chronic inflammation in 41% of subjects, a median peak eosinophil count of 11.5 and a median peak mast cell count of 18. ConclusionsA significant proportion of children with FD do not show chronic or active inflammation, but have increased mast cell density and eosinophil density in the stomach and duodenum mucosa. Our study adds functional dyspepsia to the list of various abnormalities that have increased gastroduodenal mucosal elevations of eosinophils and/or mast cells.

Reposition of the bone plate over the antrostomy in maxillary sinus augmentation: A histomorphometric study in rabbits.

To test if repositioning the bony plate secured with a cyanoacrylate over the antrostomy in maxillary sinus augmentation was superior to covering the antrostomy with a collagen membrane in terms of the bone augmentation area and the bone density. After the exposure of the nasal bone in eighteen rabbits, a rectangular access window was prepared with a sonic instrument, and the bony plate was removed. A bilateral sinus mucosa elevation was performed, and the space was filled with a resorbable xenograft. On the test side, the bone plate was repositioned over the antrostomy and fixed with a cyanoacrylate. On the control side, a collagen membrane was placed over the opening. Per group, six animals were sacrificed after 2, 4, and 8weeks of healing, respectively. Histological ground sections were prepared. The augmented area after elevation decreased between 2 and 8weeks from 9.4±1.8 to 4.8±2.8 mm2 at the test and from 9.5±2.6 and 5.1±1.6 mm2 at the control sites. Small amounts of new bone were seen after 2weeks in both groups (~1.6%-2.5%) forming from the bony sinus walls. New bone density increased over time in both groups reaching~10%-11% and~23%-25% after 4 and 8weeks, respectively. No statistically significant differences were found. Small residual defects were present both at the test sites in the margin of the bone plate, and at the control sites in the center of the antrostomy. The bone healing in the elevated sinus space was similar irrespective of the coverage of the antrostomy. After 8weeks, the bone plate repositioned on the antrostomy was incorporated while at the control sites the healing was still incomplete. Residual defects were still present in both groups.

Factors Associated with Gastric Black Spot, White Flat Elevated Mucosa, and Cobblestone-Like Mucosa: A Cross-Sectional Study

Background/Aims: Previous studies have reported a possible relevance between proton pump inhibitor (PPI) use and 3 new gastric mucosal changes: black spots (BSs), white flat elevated mucosa (WFEM), and cobblestone-like mucosa (CLM). The aim of this study was to investigate the association between these mucosal changes and multiple factors including PPI use. Methods: All subjects who underwent a routine esophagogastroduodenoscopy (EGD) were successively enrolled. Endoscopists carried out the EGD after being blinded about ­information on patient PPI usage and determined the presence of these mucosal changes. The ratio of each factor was ­compared in cases with and without each gastric finding. Results: Out of 1,214 patients, BSs were recognized in 75 (6.2%) cases, WFEM in 59 (4.9%), and CLM in 41 (3.4%). In logistic regression analysis, PPI use was significantly correlated with all of these findings (BSs: OR 2.94; 95% CI 1.66–5.21), (WFEM: OR 3.58; 95% CI 1.94–6.61), and (CLM: OR 4.57; 95% CI 2.34–9.96), and Helicobacter pylori eradication was related to BSs (OR 3.01; 95% CI 1.73–5.24) and WFEM (OR 2.11; 95% CI 1.08–4.11). Decision-tree analyses showed that H. pylori eradication was associated with all findings. Conclusions: All of the considered findings were correlated with PPI and H. pylori eradication.

Assessment of palatal rugae pattern and its significance in orthodontics and forensic odontology.

Background:Palatal rugae are nonidentical mucosal elevations seen on anterior third of palate. They are arranged in transverse direction on either side of the mid-palatine raphe. Although they are the most stable anatomical structures in the oral cavity, certain conditions such as expansion in orthodontic treatment contribute to some amount of variations in their pattern qualitatively. The aim of this study was to compare the shape of rugae and its positional changes before and after rapid maxillary expansion.Materials and Methods:Fifteen pairs of pre- and post-maxillary expansion casts showing finer details of palatal rugae from seven males to eight females in the age group of 10 ± 2.5 years were selected for this study with transverse maxillary deficiency reporting to Department of Orthodontics, VS Dental College and Hospital. The shape of rugae and the distance between the median points and lateral points of the first and the last two rugae on either side of the mid-palatal raphe were noted and marked. The data collected was statistically analyzed using SPSS program.Results:There was statistically significant difference in the distance between medial and lateral points of first two and last two rugae.Conclusion:During maxillary expansion, there is stability of palatal rugae with respect to its shape, number but not with respect to its position. Clinically, the orthodontist can quantify the palatal separation after expansion of the maxillary arch using the interruga distance.