Non-shivering thermogenesis in brown adipose tissue is mediated by uncoupling protein 1 (UCP1), which provides a carefully regulated proton re-entry pathway across the mitochondrial inner membrane operating in parallel to the ATP synthase and allowing respiration, and hence thermogenesis, to be released from the constraints of respiratory control. In the 40 years since UCP1 was first described, an extensive, and frequently contradictory, literature has accumulated, focused on the acute physiological regulation of the protein by fatty acids, purine nucleotides and possible additional factors. The purpose of this review is to examine, in detail, the experimental evidence underlying these proposed mechanisms. Emphasis will be placed on the methodologies employed and their relation to the physiological constraints under which the protein functions in the intact cell. The nature of the endogenous, UCP1-independent, proton leak will also be discussed. Finally, the troubled history of the putative novel uncoupling proteins, UCP2 and UCP3, will be evaluated.

Cone-beam computed tomographic (CBCT) imaging is a valuable diagnostic tool for endodontics. Some studies report that CBCT images have limitations in representing the true clinical presentation. This prospective, invivo study compared limited field of view (LFOV) CBCT measurements with clinical measurements made during endodontic surgery.

Eighty-seven subjects requiring endodontic surgery and LFOV CBCT acquisition of the surgical site were enrolled. Data collection involved clinicians answering standardized questions during the radiographic and surgical assessment. Intraoperatively, data were collected and photographically documented. Postoperatively, CBCT scans were evaluated by 3 calibrated, board-certified specialists 2 endodontists and 1 oral and maxillofacial radiologist. The 2 subsets of data were compared through statistical analysis to quantify their relationship.

The subjects included 65 maxillary and 29 mandibular teeth from 87 subjects 25 women and 62 men with an average age of 42 years old. The CBCT evaluators correctly identified the presence or absence of buccal plate fenestrations with 91.0% accuracy (95% confidence interval, 83.1-96.0) with 89.4% sensitivity and 92.9% specificity. The area of fenestrations measured clinically (mean = 19.6 ± 33.4 mm

) was generally larger than the area measured by CBCT imaging (mean across CBCT evaluators = 12.2 ± 19.1 mm

). Fenestration size in the maxillary arch was more likely to be underestimated than in the mandibular arch (P < .0001). Vertical bone height was also underestimated when measured on CBCT imaging.

Based on the findings of this study, LFOV CBCT imaging accurately identifies the presence or absence of buccal plate fenestrations, yet, when a fenestration is present, underestimates its area.

Based on the findings of this study, LFOV CBCT imaging accurately identifies the presence or absence of buccal plate fenestrations, yet, when a fenestration is present, underestimates its area.

Colorectal neoplasms with submucosal fibrosis are the most challenging targets of endoscopic resection. Water pressure endoscopic submucosal dissection (WP-ESD) is a recently introduced procedure that has several advantages over conventional endoscopic submucosal dissection (C-ESD). This study aimed to assess the efficacy and safety of WP-ESD for fibrotic colorectal neoplasms.

This retrospective observational study investigated 133 colorectal neoplasms expected to have submucosal fibrosis that were resected by WP-ESD or C-ESD between April 2012 and April 2020. Eighty-seven lesions after endoscopic or surgical treatment, 18 with biopsy scar with fold convergence and 28 in patients with ulcerative colitis, were included. The differences in treatment outcomes, including procedure time and adverse event proportions, between the WP-ESD and C-ESD groups were analyzed. The clinical course after perforation using WP-ESD was also evaluated, including postprocedural multidetector CT findings obtained immediately after WP-ESD.

Severe submucosal fibrosis was observed in 96 lesions (72.2%). The median procedure time was significantly shorter in the WP-ESD group than in the C-ESD group (43.5 minutes [interquartile range IQR, 32.8-73] vs 72 minutes[IQR, 45-105]; P= .0041). The multivariate analysis revealed WP-ESD as an independent factor for a shortprocedure time (odds ratio, 2.90; 95% confidence interval, 1.28-6.55). The proportions of post-ESD electrocoagulation syndrome (11.6% vs 13.1%) and perforation (20.4% vs 22.8%) were similar between the groups. Four of 11 patients withperforation who underwent WP-ESD showed fluid collection on postprocedural multidetector CT images.

WP-ESD can shorten procedure time for treating fibrotic colorectal neoplasms.

WP-ESD can shorten procedure time for treating fibrotic colorectal neoplasms.

Patients with primary sclerosing cholangitis (PSC) and dominant biliary strictures carry increased risk for the development of cholangiocarcinoma. Although ERCP-based techniques including brush cytology and intraductal biopsies represent first-line tissue sampling methods for dominant strictures, sensitivity is low. Probe-based confocal laser endomicroscopy (pCLE) offers microscopic level imaging of subepithelial biliary mucosa. As data regarding the use of pCLE in PSC are limited, we aimed to investigate its diagnostic performance in dominant strictures.

This was a multicenter prospective study involving PSC patients with dominant strictures. ERCP with pCLE was performed with use of the Miami Classification (2+ criteria for malignant diagnosis) and Paris Classification. find more Final malignant diagnoses required histopathologic confirmation and benign diagnoses required a minimum of 1 year of follow-up without development of cancer.

A total of 59 patients (mean age of 49, 59% males) with 63 strictures were incer study, pCLE had a high sensitivity in detecting cholangiocarcinoma, but technical aspects of the probe may limit evaluation in the common bile duct and left hepatic duct. Further evaluation is needed to elucidate the role of pCLE in the algorithm of excluding neoplasia in biliary strictures associated with PSC. (ClinialTrials.gov NCT02736708.).