Bacterial-derived secondary caries is a primary cause of dental treatment failure at the artificial material-tissue interface. We previously developed ultra-long-term antimicrobial/antidegradative drug-silica particles (DSPs) to counter this interfacial failure. The aim of the current study was to evaluate a novel DSP-filled-adhesive system via in vitro and in vivo (rat) anti-secondary-caries studies. DSPs were incorporated into commercial total-etch dental adhesive at 10 % wt. to make DSP-SBMP. Interfacial specimens of DSP-SBMP-dentin and control SBMP-dentin were incubated 0- or 6-months in simulated salivary esterase, and subsequently with S. mutans/L. rhamnosus co-culture. Interfacial biomarkers were assessed via confocal microscopy and micro-computed-tomography. DSP-SBMP and SBMP were used to restore teeth in 16 SD rats in a 7-week split-mouth secondary caries study followed by clinical and µCT caries analysis and organ histology to assess biocompatibility. In vitro, interfacial biofilm viability (-23.1 ± 4.3 %) and biomass (-19.2 ± 4.9) were reduced by DSP-SBMP, as was cavitated (-78.6 ± 13.8 %) and demineralized (-33.4 ± 8 %) volume (ANOVA, Tukey HSD, p < 0.05). In vivo clinically observed primary and secondary caries counts were reduced on DSP-SBMP-restored teeth (χ² p < 0.05). No significant toxic effects were observed. This comprehensive in vitro and in vivo antimicrobial/antidegradative analysis of a new dental biomaterial, accurately modeling the chemical and biological environment these materials must perform in, provided comprehensive understanding of potential material performance that strongly supports continued development and clinical evaluation. The clinical relevance of the in vitro model used in this study was validated by the in vivo animal model and could be used to assess new dental biomaterials.

Idiopathic myointimal hyperplasia of the mesenteric veins (IMHMV) is a rare entity reported in adults, frequently mimicking inflammatory bowel disease (IBD). We report the first case of intestinal ischemia secondary to IMHMV presenting as IBD in a pediatric patient with Down syndrome. Chronic intestinal ischemia is rare in children, and this case emphasizes the need to consider this in the differential, when histopathology is suggestive. Clinical findings and colonoscopy in these patients may mimic IBD. The mucosal biopsies do not show classic features of IBD. Instead, there can be variable extent of mucosal changes such as dilated small capillaries in the lamina propria, edema, and early fibrosis. These changes may in fact represent early chronic ischemia. These findings should alert for vascular imaging and a full‐thickness biopsy to assess submucosal and subserosal larger vessels since medium‐ and large‐caliber veins in the colonic wall and mesentery are affected in IMHMV.

Background: Cytomegalovirus (CMV) colitis is commonly seen in patients who are immunodeficient or have inflammatory bowel disease. Among the gastrointestinal sites affected by CMV, the colon is the most frequently affected, though rectal involvement is relatively rare. Reactivated CMV proctitis primarily occurs in elderly patients with comorbidities and is quite uncommon in immunocompetent individuals. Patients with reactivated CMV typically present with symptoms such as diarrhea, hematochezia, or tenesmus. Case presentation: We report a case of a female patient with uncontrolled diabetes who presented to the clinic complaining of perianal pain. She had no history of diarrhea or rectal bleeding. Lower GI endoscopy reported a small, localized, approximately 0.5 cm swelling in the proximal anal canal in addition to sigmoid diverticulosis. The biopsy revealed a small ulcer at the anorectal junction caused by CMV and confirmed by immunohistochemistry. Unfortunately, the patient was lost to follow-up before antiviral therapy could be initiated. Conclusions: This case highlights an uncommon presentation of reactivated CMV proctitis in an older diabetic patient presenting solely with perianal pain. Clinicians should maintain a high index of suspicion for CMV infection in elderly patients with comorbidities, even when classical colitis symptoms are absent, to avoid delayed diagnosis and management.

Background: Basal plasma cells (BPC) are a diagnostic criterion for inflammatory bowel disease (IBD) and their persistence following therapy also indicates an increased risk of relapse. However neither the definition of basal plasma cells nor what is normal has been well established. We examined these parameters and determined whether there is reginal variability throughout the large bowel. Methods: We looked at two patient populations. Group A) Biopsies from 6 standardised sites around the colon (cecum to rectum) from 37 patients who had normal colonoscopy at IRCCS Sacro Cuore Hospital, Negrar, Verona, Italy for symptoms suggesting irritable bowel syndrome, who were free of all medical therapy. Group B) a validation cohort from Mt Sinai Hospital Toronto using sections from the same 6 sites from 16 subtotal and total colectomy specimens performed for non-obstructing colonic carcinoma, primarily Lynch syndrome. Basal plasma cells were counted between two crypts in both the basal 5%, and the basal 20% of the mucosa. A partitioned visual analogue scale (PVAS) was also developed to see if this could replace counting, especially as the distance between crypts in IBD is variable Results: In group A, in the lowest 5% part of the lamina propria, basal plasma cells were found throughout the large bowel and were highest in the proximal colon and lowest in the rectosigmoid. The maximum number of plasma cells between crypts was seven for the cecum and two for the rectum, with a gentle gradation between these two. The PVAS (range 1–5) varied from a maximum of 2 proximally to 1 distally. When the basal 20% was counted, the scores ranged from 35 in the cecum to 12 in the rectum, again with a gradation between, but the PVAS increased from a maximum of 3 proximally to 2 in the rectum. In group B the results were virtually to Group A and the PVAS scores were also virtually identical, The main difference was that at least one plasma cell was seen in all sections, likely because tissue sections encompass a much larger area. These results were all statistically significant. Conclusion: The normal large bowel has a gradation of plasma cells that is highest proximally and lowest distally, however assessed, and needs to be taken into account when assessing the presence of basal plasma cells as an indicator of increased likelihood of relapse of IBD. The PVAS developed can replace the chore of counting, and is likely more meaningful when architectural distortion is present.

Background/Objectives: Thalassemia, a hereditary blood disorder, leads to reduced hemoglobin levels, impairing oxygen transport and negatively impacting patient health. Recent research suggests a possible association between thalassemia and gastrointestinal (GI) symptoms, such as abdominal pain, diarrhea, and GI bleeding, potentially due to immune compromise and iron overload. This systematic review aims to explore the prevalence and underlying factors of GI pathologies in thalassemia patients, excluding treatment-related effects and iron overload. Methods: A comprehensive search following the PRISMA guidelines was conducted to identify the prevalence and causes of GI disorders in thalassemia patients. Studies assessing non-treatment-related GI symptoms and their links to thalassemia were analyzed. After screening 1902 studies, 13 were included to investigate gastrointestinal manifestations in thalassemia patients. Results: Evidence indicates potential associations between thalassemia and GI disorders, including malabsorption, inflammatory bowel disease, Heliobacter pylori (H. pylori) infection, and celiac disease. Findings highlight immune compromise and iron dysregulation as possible contributing factors. Conclusions: This review highlights the importance of further research into the GI manifestations of thalassemia to enable early detection and improve patient health outcomes and quality of life. Addressing this gap may provide insights into better clinical management strategies for thalassemia patients.