An extraordinary variation in origin of inferior alveolar nerve and its clinical significance: a case report

Infratemporal fossa is a clinically significant site for delivery of local anaesthesia during dental procedures and maxillofacial surgeries. An extraordinary variation involving formation of inferior alveolar nerve was revealed during routine dissection of infra temporal region for teaching undergraduate medical students. Inferior alveolar nerve was seen to be incongruously originating from two separate roots from the posterior division of mandibular nerve. Furthermore, these two roots of inferior alveolar nerve were divulging unusual relationship with the maxillary artery. Superficial root of inferior alveolar nerve was coursing superficial to second part of maxillary artery and deep root was found to be emerging posterior to this part of maxillary artery. Additionally, deep root was sending a well-defined twig which when traced was found to be communicating with Lingual nerve. This unusual type of variation of Inferior alveolar nerve in this region may result in atypical symptoms of pain, numbness, headaches, interfere with outcome of injection of local anaesthesia and even surgical interventions in the infratemporal fossa.

The (In)Stability of Heterostructures During the Oxygen Evolution Reaction

The urgent need for efficient oxygen evolution reaction (OER) catalysts has led to the development and publication of many heterostructured catalysts. The application of such catalysts with multiple phases tremendously increases the material design dimensions, and numerous interface‐related effects can tune the OER performance. In this regard, multiple of these heterostructured electrodes show remarkable OER activities. However, it is not clear if these carefully designed interfaces remain under prolonged OER conditions. Herein, a molecular approach is used to synthesize four different nickel‐iron phosphide (heterostructured) materials and deposit them on fluorine‐doped tin oxide and nickel foam electrodes. The OER performance of the eight electrodes and the reconstruction of the four materials is investigated by in‐situ spectroscopy after one day of operation, enabled by a freeze‐quench approach. The most active electrode is also applied under industrial OER conditions and for the value‐added oxidation of alcohols to ketones. Before catalysis, this electrode comprises crystalline 4 nm nickel phosphide particles on an amorphous iron phosphide matrix. However, after 24 h, a homogenous nickel‐iron oxyhydroxide phase has formed. This work questions to which extent the design of heterostructures is a suitable strategy for non‐noble metal OER catalysis

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

A Low-Temperature Molecular Precursor Approach to Copper-Based Nano-Sized Digenite Mineral for Efficient Electrocatalytic Oxygen Evolution Reaction

In the urge of designing noble metal-free and sustainable electrocatalysts for oxygen evolution reaction (OER), herein, a mineral Digenite Cu$_{9}$S$_{5}$ has been prepared from a molecular copper(I) precursor, [{(PyHS) $_{2}$Cu$^{l}$ (PyHS)} $_{2}$] (OTf)$_{2}$ (1), and utilized as an anode material in electrocatalytic OER for the first time. A hot injection of 1 yielded a pure phase and highly crystalline Cu$_{9}$S$_{5}$, which was then electrophoretically deposited (EPD) on a highly conducting nickel foam (NF) substrate. When assessed as an electrode for OER, the Cu$_{9}$S$_{5}$/NF displayed an overpotential of merely 298±3 mV at a current density of 10 mAcm$^{-2}$ in alkaline media. The overpotential recorded here supersedes the value obtained for the best reported Cu-based as well as the benchmark precious-metal-based RuO$_{2}$ and IrO$_{2}$ electrocatalysts. In addition, the choronoamperometric OER indicated the superior stability of Cu$_{9}$S$_{5}$/NF, rendering its suitability as the sustainable anode material for practical feasibility. The excellent catalytic activity of Cu$_{9}$S$_{5}$ can be attributed to the formation of a crystalline CuO overlayer on the conductive Cu$_{9}$S$_{5}$ that behaves as active species to facilitate OER. This study delivers a distinct molecular precursor approach to produce highly active copper-based catalysts that could be used as an efficient and durable OER electro(pre)catalysts relying on non-precious metals

Digitized radiovisiographic analysis of dental pulp of permanent mandibular first molar and second premolar for age estimation using tooth coronal index method

Background: Teeth have become a valuable index to estimate age of an individual in forensic odontology. The advent of radiovisiography (RVG) has led to accurate calculation of dental age, which may be due to more precise RVG images than other radiographic techniques. Objectives: The study aimed at estimating the age of an individual from mandibular premolar and molar through tooth coronal index (TCI) measured from digital intraoral radiographic images (RVG). Materials and Methods: Using RVG 176 periapical radiographs of mandibular second premolar and first molar of individuals of either sex aged 20–70 years residing in Chhattisgarh were taken by paralleling angle technique for the study. The RVG images of selected teeth were analyzed and height of the crown, i.e., coronal height and the height of the coronal pulp cavity, i.e., coronal pulp cavity height of each tooth were measured in millimeters using KODAK software to calculate TCI. The real age of a subject was compared with TCI of tooth and the acquired data was subjected to Pearson's correlation test. Bland and Altman regression analysis was carried out to estimate limit of agreement between the two measurements (real and calculated age). Results: Negative correlation was observed between the real age and TCI of mandibular first molar (r = −0.149, P = 0.166) and second premolar (r = −0.20, P = 0.061). The difference between real age and calculated age for premolar ranged from − 38.11 to 23.51 years (mean difference 7.30) and for first molar it was from − 34.82 to 25.22 years (mean difference 4.799), which suggested acceptable agreement. Conclusion: TCI method provides accurate estimation of age from RVG images of teeth. RVG is convenient to use, has low radiation dose, and produces sharper images than other imaging methods

Orocutaneous Fistula or Traumatic Infectious Skin Lesion: A Diagnostic Dilemma

Orocutaneous fistula (OCF) (of dental origin) is an uncommon but well-described condition in the literature. These are often misdiagnosed by physicians and dentists. Careful selection of investigating modality is important in case of diagnostically challenging cases. A 19-year-old female came with a complaint of a lesion on the chin reported with h/o trauma with the impact on chin presented as diagnostic dilemma because of unusual case history and clinical examination. Commonly used radiographic investigations like IOPA and orthopantomograph did not resolve the dilemma whereas advanced imaging modality like CT scan, 3D volume imaging, and contrast enhanced CT played an important role in the diagnosis of OCF and selecting the treatment plan

Glucagon-like peptide-1 receptor agonists in the treatment of type 2 diabetes: Past, present, and future

Glucagon-like peptide-1 (GLP-1)–based therapy improves glycaemic control through multiple mechanisms, with a low risk of hypoglycaemia and the additional benefit of clinically relevant weight loss. Since Starling and Bayliss first proposed the existence of intestinal secretions that stimulate the pancreas, tremendous progress has been made in the area of incretins. As a number of GLP-1 receptor agonists (GLP-1 RAs) continue to become available, physicians will soon face the challenge of selecting the right option customized to their patient's needs. The following discussion, derived from an extensive literature search using the PubMed database, applying the terms incretin, GLP-1, exenatide, liraglutide, albiglutide, dulaglutide, lixisenatide, semaglutide, and taspoglutide, provides a comprehensive review of existing and upcoming molecules in the GLP-1 RA class in terms of their structure, pharmacological profiles, efficacy, safety, and convenience. Search Methodology: A literature search was conducted using the PubMed database, applying the terms incretin, GLP-1, exenatide, liraglutide, albiglutide, dulaglutide, lixisenatide, semaglutide, and taspoglutide. Relevant articles were those that discussed structural, pharmacokinetic and pharmacodynamic differences, classification, long-acting and short-acting GLP-1 RAs, phase 3 trials, and expert opinions. Additional targeted searches were conducted on diabetes treatment guidelines and reviews on safety, as well as the American Diabetes Association/European Society for Study of Diabetes (ADA/EASD) statement on pancreatic safety

A Low‐Temperature Molecular Precursor Approach to Copper‐Based Nano‐Sized Digenite Mineral for Efficient Electrocatalytic Oxygen Evolution Reaction

In the urge of designing noble metal‐free and sustainable electrocatalysts for oxygen evolution reaction (OER), herein, a mineral Digenite Cu₉S₅ has been prepared from a molecular copper(I) precursor, [{(PyHS)₂CuI(PyHS)}₂](OTf)₂ (1), and utilized as an anode material in electrocatalytic OER for the first time. A hot injection of 1 yielded a pure phase and highly crystalline Cu₉S₅, which was then electrophoretically deposited (EPD) on a highly conducting nickel foam (NF) substrate. When assessed as an electrode for OER, the Cu₉S₅/NF displayed an overpotential of merely 298±3 mV at a current density of 10 mA cm⁻² in alkaline media. The overpotential recorded here supersedes the value obtained for the best reported Cu‐based as well as the benchmark precious‐metal‐based RuO₂ and IrO₂ electrocatalysts. In addition, the choronoamperometric OER indicated the superior stability of Cu₉S₅/NF, rendering its suitability as the sustainable anode material for practical feasibility. The excellent catalytic activity of Cu₉S₅ can be attributed to the formation of a crystalline CuO overlayer on the conductive Cu₉S₅ that behaves as active species to facilitate OER. This study delivers a distinct molecular precursor approach to produce highly active copper‐based catalysts that could be used as an efficient and durable OER electro(pre)catalysts relying on non‐precious metals