An adult man of methylmalonic acidemia combined with hyperhomocysteinemia is reported. He presented with progressive walking instability with mental and behavioral alterations when aged 24 years. Physical examination showed significant cerebellar ataxia and pyramidal signs. Brain magnetic resonance imaging revealed symmetric lesions of bilateral cerebellum. His plasma total homocysteine and urine methylmalonic acid were significantly elevated. Compound heterozygous mutations, c.482G>A and c.217C>T, were found in his MMACHC gene, confirming the diagnosis of cblC deficiency. Improved clinical manifestations and decreased plasma total homocysteine were observed one month after treatment.

PURPOSE: Sacral nerve stimulation has been used to treat overactive bladder. This study evaluated the effects of stimulation using different pulse widths on the inhibition of bladder overactivity by sacral nerve stimulation (SNM) in pigs. METHODS: Implant-driven stimulators were used to stimulate the S3 spinal nerve in 7 pigs. Cystometry was performed by infusing normal saline (NS) or acetic acid (AA). SNM at pulse widths of 64 μsec to 624 μsec was conducted at the intensity threshold at which observable perianal and/or tail movement was induced. Multiple cystometrograms were performed to determine the effects of different pulse widths on the micturition reflex. RESULTS: AA-induced bladder overactivity reduced the bladder capacity to 46.9%±7.1% of the NS control level (P<0.05). During AA infusion, SNM at 64 μsec, 204 μsec, and 624 μsec increased the bladder capacity to 126.1%±6.9%, 129.5%±7.3%, and 140.1%±7.6% of the AA control level (P<0.05). No significant differences were found among the results obtained using pulse widths of 64 μsec, 204 μsec, and 624 μsec (P>0.05). The actual intensity threshold varied from 0.7 to 8 V. The mean intensity threshold (T visual) for pulse widths of 64 μs, 204 μs, and 624 μs were 5.64±0.76 V, 3.11±0.48 V, and 2.52±0.49 V. T visual for pulse widths of 64 μsec was larger than the other two T visual for pulse widths of 204 μsec and 624 μsec (P<0.05). No significant differences were found among the T visual for pulse widths of 204 μsec and 624 μsec (P>0.05). CONCLUSIONS: This study indicated that different pulse widths could play a role in inhibiting bladder overactivity. It is not yet certain which pulse widths increased bladder capacity compared with AA levels, to minimize energy consumption and maintain patient comfort during stimulation, 204 μsec may be an appropriate pulse width for SNM.
Acetic Acid ; Humans ; Reflex ; Spinal Nerves ; Swine ; Tail ; Urinary Bladder ; Urinary Bladder, Overactive ; Urination

Objective: To compare the apical sealing effects of two root canal fillers, GuttaFlow and AH Plus, for clinical reference. Methods: The Cochrane system evaluation method was used to search the Cochrane Library, Embase, CBM, PubMed, CNKI, Weipu, and Wanfang databases. Additionally, relevant journals and conference papers were manually retrieved, and relevant randomized controlled trials were collected. Two reviewers independently evaluated the quality of each study and extracted the data. A meta-analysis was performed using the RevMan5.3 software for homogenous studies, and a descriptive analysis was performed for studies with poor homogeneity. Results: In total, 10 randomized controlled trials containing 398 isolated teeth were included. The meta-analysis results showed that the difference in apical microleakage was statistically significant at 1 week and 3 months [1 week: MD=-0.13, 95% CI (-0.22,-0.04), P=0.007; 3 months: MD=-1.27, 95% CI (-1.94,-0.60), P=0.000 2] but not at 6 months [MD=-0.10, 95% CI (-0.26, 0.06), P=0.23]. Conclusion Based on existing research results, GuttaFlow may achieve better results than AH Plus in the short term (≤ 1 week). Because it is subject to limitations of time, quality, and research methods, this conclusion requires more long-term, high-quality, large-sample, multimeasurement randomized controlled trials for further validation.

OBJECTIVES: To evaluate the effectiveness of an acellular dermal matrix or a connective tissue autograft in the treatment of multiple adjacent gingival recessions through Meta-analysis. METHODS: Randomized controlled trials were screened in four electronic databases in English according to the inclusion and exclusion criteria until April 20, 2022. The main outcome indicators were keratinized gingival tissue width, recession depth, probing depth, clinical attachment level, complete root coverage, and root coverage esthetic score. RESULTS: Seven randomized controlled trials were included. After 12 months, the connective tissue graft in the control group could increase the keratinized gingival tissue width [mean difference (MD)=-0.28 (-0.47, -0.08), P=0.006], reduce the gingival recession depth [MD=0.23 (0.12, 0.35), P<0.000 1], and improve the complete root coverage [risk ratio=0.80, 95% confidence interval (0.69, 0.93), P=0.003] compared with the acellular dermal matrix in the experimental group. No significant difference was found in probing depth, clinical attachment level, and root coverage esthetic score between groups. CONCLUSIONS Connective tissue grafts have advantages in increasing the keratinized gingival tissue width, reducing the gingival recession depth, and improving the complete root coverage in surgeries for treating multiple adjacent gingival recessions. Acellular dermal matrices also have some clinical value in terms of operation simplicity and similar effectiveness.
Humans ; Gingival Recession/surgery* ; Acellular Dermis ; Surgical Flaps ; Esthetics, Dental ; Connective Tissue/transplantation*