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It is increasingly evident that cytokines and growth factors produced in the decidua play a pivotal role in the regulation of the local immune microenvironment and the establishment of pregnancy. One of the major growth factors produced in the decidua is vascular endothelial growth factor (VEGF), which acts not only on endothelial cells, but also on multiple other cell types, including macrophages. We sought to determine whether decidua-derived VEGF affects macrophage recruitment and polarization using human endometrial/decidual tissue samples, primary human endometrial stromal cells (ESCs), and the human monocyte cell line THP1. In situ hybridization was used for assessment of local VEGF expression and immunohistochemistry was used for identification and localization of CD68-positive endometrial macrophages. Macrophage migration in culture was assessed using a transwell migration assay, and the various M1/M2 phenotypic markers and VEGF expression were assessed using quantitative real-time PCR (qRT-PCR). We found dramatic increases in both VEGF levels and macrophage numbers in the decidua during early pregnancy compared to the secretory phase endometrium (non-pregnant), with a significant increase in M2 macrophage markers, suggesting that M2 is the predominant macrophage phenotype in the decidua. However, decidual samples from preeclamptic pregnancies showed a significant shift in macrophage phenotype markers, with upregulation of M1 and downregulation of M2 markers. In THP1 cultures, VEGF treatment significantly enhanced macrophage migration and induced M1 macrophages to shift to an M2 phenotype. Moreover, treatment with conditioned media from decidualized ESCs induced changes in macrophage migration and polarization similar to that of VEGF treatment. These effects were abrogated by the addition of a potent VEGF inhibitor. Together these results suggest that decidual VEGF plays a significant role in macrophage recruitment and M2 polarization, and that inhibition of VEGF signaling may contribute to the shift in macrophage polarity observed in different pregnancy disorders, including preeclampsia.

Key Points Defines and explores social media and its uses in dentistry. Discusses the advantages and disadvantages of social media, and how it could be used to improve learning in dental foundation training. Encourages safe use of social media for all dental care professionals, and for Dental Foundation Trainees in particular. The use of social media has greatly expanded in the last decade, with widespread use of smartphones, the internet, and other multimedia to enhance learning. There is evidence to suggest that social media has a place in healthcare education, but there is limited research to suggest the effectiveness or use of it in dental foundation training. This paper discusses the risks and benefits of social media and suggests that a better understanding of social media and its role in the development and practice of newly qualified dental professionals could benefit both trainees and trainers.

Background: In spite of significant advances in the management of heart failure (HF), morbidity and mortality remain high. Therefore, there is a need for additional strategies. We did a randomized clinical trial to study effect of yoga in patients with HF in terms of quality of life (QOL), left ventricle ejection fraction (LVEF), C-reactive protein (CRP), and NTproBNP. Materials and Methods: 60 patients with stable HF New York Heart Association Class II with LVEF 30%-40% were randomized into control group (CG) and yoga group (YG). CG received the guideline-based therapy and YG in addition practiced the yoga, one hour daily for 3 months. All patients were assessed for QOL, CRP, NTProBNP, and LVEF at baseline and after 3 months. Results: A significant difference was observed in all four parameters in the YG as compared to the CG (P < 0.01) after 12 weeks. QOL as assessed by Minnesota living with heart failure questionnaire score improved significantly in YG as compared to CG (10 V/s 14, P < 0.001). There was a significant improvement within YG in terms of LVEF (33.4-36.8, P = 0.001), and the percentage change in LVEF was significant between the groups (10% V/s 5%, P = 0.001). NTproBNP also significantly reduced by 69.8% from 755 to 220 Pmol/l in YG as compared to 39.3% in CG (679-406 Pmol/l). CRP decreased by 49.3% (5.36-2.73 mg/L) in YG and 35.8% (5.39-3.45 mg/L) in CG. Conclusion: The result of this pilot study suggests that addition of yoga to guideline-based therapy for HF patients significantly improves QOL, LVEF, and NTProBNP and reduces CRP level. Larger studies are needed to confirm these findings.

Coronectomy procedures are widely carried out in secondary care, involving the removal of the dental crown, while retaining the roots in situ. This paper defines and explains the rationale behind coronectomy. It also seeks to review the indications for referral of wisdom teeth, and how to identify high-risk wisdom teeth radiographically using two- and three-dimensional imaging. Using this information, this article aims to provide the practitioner with information on short- and long-term management of high-risk wisdom teeth and discusses coronectomy versus extraction. It also discusses the complications of coronectomy and the importance of adequate consent.

Dramatic increase of diabetes over the globe is in tandem with the increase in insulin requirement. This is because destruction and dysfunction of pancreatic β-cells are of common occurrence in both Type1 diabetes and Type2 diabetes, and insulin injection becomes a compulsion. Because of several problems associated with insulin injection, orally active insulin mimetic compounds would be ideal substitute. Here we report a small molecule, a peroxyvanadate compound i.e. DmpzH[VO(O2)2(dmpz)], henceforth referred as dmp, which specifically binds to insulin receptor with considerable affinity (KD-1.17μM) thus activating insulin receptor tyrosine kinase and its downstream signaling molecules resulting increased uptake of [14C] 2 Deoxy-glucose. Oral administration of dmp to streptozotocin treated BALB/c mice lowers blood glucose level and markedly stimulates glucose and fatty acid uptake by skeletal muscle and adipose tissue respectively. In db/db mice, it greatly improves insulin sensitivity through excess expression of PPARγ and its target genes i.e. adiponectin, CD36 and aP2. Study on the underlying mechanism demonstrated that excess expression of Wnt3a decreased PPARγ whereas dmp suppression of Wnt3a gene increased PPARγ expression which subsequently augmented adiponectin. Increased production of adiponectin in db/db mice due to dmp effected lowering of circulatory TG and FFA levels, activates AMPK in skeletal muscle and this stimulates mitochondrial biogenesis and bioenergetics. Decrease of lipid load along with increased mitochondrial activity greatly improves energy homeostasis which has been found to be correlated with the increased insulin sensitivity. The results obtained with dmp, therefore, strongly indicate that dmp could be a potential candidate for insulin replacement therapy.

Removable partial dentures (RPDs) are still a very important treatment modality in general dentistry to replace missing teeth. With the increase in popularity of implants, RPDs are sometimes seen as an 'old-fashioned' treatment option and if not carefully designed can be damaging to oral tissue and aesthetically less favourable. However, there is still a significantly large cohort of patients for whom RPDs are the best option for replacement of teeth either due to a failing dentition, inappropriate anatomy or financial considerations. This article explores the importance of effective three way communication with the patient, the laboratory and the dental nurse to support the provision of reliable and predictable prosthodontic outcomes.Introduction

The neuromuscular junctions (NMJs) connect muscle fibers with motor neurons and enable the coordinated contraction of skeletal muscles. The dystrophin-associated glycoprotein complex (DGC) is an essential component of the postsynaptic machinery of the NMJ and is important for the maintenance of NMJ structural integrity. To identify novel proteins that are important for NMJ organization, we performed a mass spectrometry-based screen for interactors of α-dystrobrevin 1, one of the components of the DGC. The guanidine nucleotide exchange factor Arhgef5 was found to be one of the α-dystrobrevin 1 binding partners that is recruited to Tyr-713 in a phospho-dependent manner. We show here that Arhgef5 localizes to the NMJ and that its genetic depletion in the muscle causes the fragmentation of the synapses in conditional knockout mice. Arhgef5 loss in vivo is associated with a reduction in the levels of active GTP-bound RhoA and Cdc42 GTPases, highlighting the importance of actin dynamics regulation for the maintenance of NMJ integrity.

This paper presents optimization and uncertainty analysis of operation policies for Hirakud reservoir system in Orissa state, India. The Hirakud reservoir project serves multiple purposes such as flood control, irrigation and power generation in that order of priority. A 10-daily reservoir operation model is formulated to maximize annual hydropower production subjected to satisfying flood control restrictions, irrigation requirements, and various other physical and technical constraints. The reservoir operational model is solved by using elitist-mutated particle swarm optimization (EMPSO) method, and the uncertainty in release decisions and end-storages are analyzed. On comparing the annual hydropower production obtained by EMPSO method with historical annual hydropower, it is found that there is a greater chance of improving the system performance by optimally operating the reservoir system. The analysis also reveals that the inflow into reservoir is highly uncertain variable, which significantly influences the operational decisions for reservoir system. Hence, in order to account uncertainty in inflow, the reservoir operation model is solved for different exceedance probabilities of inflows. The uncertainty in inflows is represented through probability distributions such as normal, lognormal, exponential and generalized extreme value distributions; and the best fit model is selected to obtain inflows for different exceedance probabilities. Then the reservoir operation model is solved using EMPSO method to arrive at suitable operational policies corresponding to various inflow scenarios. The results show that the amount of annual hydropower generated decreases as the value of inflow exceedance probability increases. The obtained operational polices provides confidence in release decisions, therefore these could be useful for reservoir operation.

Povidone-iodine and various bactericidal agents used in dental procedures may affect the corrosion response of an implant/prosthesis in the oral environment. The effect of various concentrations of povidone–iodine (PI) on the corrosion behavior of a low modulus beta titanium alloy, Ti-45Nb, has been investigated in normal saline solution. The open circuit potential, electrochemical impedance spectroscopy and potentiodynamic polarization measurements have been used to assess the electrochemical response of the alloy surface on PI addition so as to effectively predict the prosthetic treatment outcome. As the concentration of PI is increased, the corrosion rate decreases, suggested by decreased R p values. Povidone–iodine acts as an anodic inhibitor by adsorbing on the anodic sites of the alloy. Addition of PI to a simulated body fluid such as normal saline leads to a decrease in corrosion rate of Ti-45Nb alloy.

Optic neuropathy in HIV-infected patients results from the HIV infection itself, post-infectious auto-immune disease, opportunistic infections and drugs. Nucleoside reverse transcriptase inhibitors (NRTIs) such as zidovudine and stavudine have known mitochondrial toxicity and can cause mitochondrial myopathies, neuropathies, hyperlactataemia, and can induce mitochondrial genetic disorders. Individuals with the mutation for Leber's hereditary optic neuropathy (LHON), a mitochondrial disorder, are usually asymptomatic but develop visual loss when exposed to external triggers such as smoking. We report on two HIV-infected patients with LHON mutations (m.14484T>C and m.11778G>A) who developed profound visual loss with antiretroviral therapy. We postulate that the phenotypic expression of LHON in these genetically predisposed individuals was triggered by NRTI drugs lamivudine and tenofovir when used in combination, despite their relatively weak mitochondrial toxic effects.