Follow-up endoscopies have been performed to date on 16 patients (50%) at an average of 5.8 months. No recurrence has been noted in any case. Post-procedural bleeding requiring presentation to hospital but not transfusion occurred in one patient (3%). 1. Mannath J, Subramanian

V, Singh R, Telakis E, Ragunath K. Polyp recurrence after endoscopic mucosal resection of sessile and flat selleck compound colonic adenomas. Dig Dis Sci. 2011;56:2389–2395. 2. Binmoeller KF, Weilert F, Shah J, Bhat Y, Kane S. “Underwater” EMR without submucosal injection for large sessile colorectal polyps. Gastrointest Endosc. 2012;75:1086–1091. R BOYAPATI,1 M ROBERTSON,1 A MAJUMDAR,1 W CHUNG,1 R TURBAH,1 R VAUGHAN,1 S LONTOS1 Selleck LBH589 1Department of Gastroenterology and Liver Transplant, Austin Health, Heidelberg, Victoria Introduction: The increased risk of upper gastrointestinal (UGI) bleeding in patients on antiplatelet agents (APA) and anticoagulant agents (ACA) has been well established. However, it is unclear whether patients who are on APA or ACA and are admitted for UGI bleeding have a higher morbidity and mortality. Aim: To evaluate clinical outcomes in

patients on APA and ACA with acute UGI bleeding requiring endoscopy compared to those on neither agent. Methods: ICD-10 codes were used to identify all patients presenting with a primary diagnosis 上海皓元医药股份有限公司 of UGI bleeding requiring gastroscopy

at the Austin Hospital over a 36-month period from 2010 to 2012. Medical records for all patients were analyzed to determine demographic, clinical and endoscopic data. Continuous data was assessed using the Mann-Whitney test and categorical data using Fisher’s exact test. The primary endpoints were death and a combined end point of death, need for re-endoscopy, re-bleeding, need for surgery and need for radiological embolization. Secondary endpoints were length of stay, need for ICU, hemoglobin on admission and transfusion requirements. Data are expressed as medians [IQR] and odds ratios [95% CI]. A p-value of 0.05 or less was considered statistically significant. Results: 373 patients were identified with UGI bleeding requiring gastroscopy. 87 (23%) were on aspirin alone, 16 (4%) were on clopidogrel alone and 19 (5%) were on dual antiplatelet therapy. 43 (12%) were on warfarin or clexane alone of which 23 (6%) had a supratherapeutic INR on presentation (>3.5). 175 (47%) were on no APA or ACA. 66% of patients were male. Those on APA (77 years [70–84]) and ACA (75 years [67–81]) were significantly older than those on neither agent (60 years [47–72], p < 0.0001). Both the APA group (OR 4.4 [2.4–8.0], p < 0.0001) and the ACA group (3.7 [1.6–8.7], p = 0.002) were more likely to have major comorbidities.

Methods: A total of 21 Patients with Portal hypertension from the First Affiliated Hospital of Nanchang University were exeeuted TIPS with Covered Stent in rencent 2 years and

were followed up for 4 to 14 months. The portal venous pressure pertosystemic pressure gradients, alimentary tract hemorrhage, stent reocclusion, hepatic encephalopath, blood coagulation, hepatic function, blood ammonia, iconography and endoscopy results were monitored before and after Tips treatment. Results: In all of the 21 Patients,18 cases were sueeessfully completed the operation. The rate of hemostatsis in 24 hours was 1 00%. HVPG dropped from (41.9 ± 15.9)cm H20 to (25.5 ± 13.5)cm H20, there was significant www.selleckchem.com/products/Maraviroc.html statistical signifieance. During in the 4 months–14 months of follow-up, HIF pathway The relapse rate of rehaemorrhagia was 26.7% (4/15), and occurred in 1, 2, 6, 8 month after the operation. Esophageal varices of 11 cases release, another 6 cases did not change significantly. Stent reocclusion rate 16.7% (3/18), and the total of 3 cases rehaemorrhagia. The incidence rate of hepatic encephalopathy was16.7% (3/18), symptoms of every cases disappear after symptomatic

treatment. Refractory ascites of all cases remission obviously and even disappear. The difference of hepatic function and platelet between before and after operation was not significant statistically (P > 0.05). Conclusion: The curative effect of TIPS in treating portal hypertension caused by liver cirrhosis

is exact, and is worthy of clinical application. Key Word(s): 1. TIPS; 2. Portal HyPenension; 3. Liver cirrhosis; Presenting Author: CHAO DU Additional Authors: MINGDE JIANG Corresponding Author: CHAO DU Affiliations: Chengdu Military Command Objective: Liver fibrosis is the pathological basis of chronic liver disease and it must lead to the cirrhosis. There is still no effects of drugs to reverse the liver fibrosis. In recent years medchemexpress numerous studies have confirmed that bone marrow-derived mesenchymal stem cells in the the body and outward have the potential of differentiation to liver cell, it is expected to repair or reverse the process of liver fibrosis. The genetically modified stem cells maintain the directly differentiation characteristics, while corresponding factor can improve the efficacy and is compensate for the lack of simple MSCs transplantation therapy. Matrix metalloproteinases in the liver was expressed and secreted by hepatic stellate cells (HSC) and Kupffer cell. It was zinc – calcium-dependent family of endogenous proteolytic enzymes involved in extracellular matrix degradation. It was the only enzyme that breaks down collagen fiber and almostly breaks down the ECM components outside the polysaccharide, it plays an important role in physiological and pathological processes.

IPGTT revealed impaired glucose tolerance in HFD mice, as evidenced by delayed glucose clearance at 45, 60, 90, and 120 minutes after infusion (Fig. 1A,B). In addition, there was simultaneous compensatory increase in insulin secretion AUY-922 mw (Fig. 1C,D). ITT revealed a reduced blood glucose decrease in HFD mice, compared to Chow-fed mice (Fig. 1E,F), indicative of insulin resistance in HFD mice. Together, these

results show that HFD mice were glucose intolerant, insulin resistant, hyperglycemic, and hyperinsulinemic, clear indications of pre–type 2 diabetes.11 We next examined whether metabolic changes in gluconeogenesis could be detected in vivo with hyperpolarized [1-13C]pyruvate. Pyruvate is at a major metabolic junction and generates four metabolite intermediates, each catalyzed by a distinct enzyme or enzyme complex: lactate by LDH (lactate dehydrogenase);

alanine by ALT; acetyl-coA by PDHC (pyruvate dehydrogenase complex); and oxaloacetate by PC (pyruvate carboxylase). Because of the abundance of LDH and ALT in the liver, rapid 13C label exchange from [1-13C]pyruvate to [1-13C]lactate and [1-13C]alanine rendered the lactate and alanine the two largest metabolite SB431542 peaks in the MRS spectrum (Fig. 2A). PDH flux could be assessed by the changes in [1-13C]bicarbonate levels (Fig. 2A,B). The anaplerotic role of pyruvate was observed by its conversion into OAA, a vital intermediate metabolite involved in gluconeogenesis and oxidative phosphorylation. [1-13C]OAA can be rapidly converted into [1-13C]phosphoenolpyruvate, [1-13C]malate, [1-13C]aspartate, and [6-13C]citrate, catalyzed by PEPCK, malate dehydrogenase (MDH), aspartate transaminase (AST), and citrate synthase,

respectively. In the MRS spectra, we were able to detect [1-13C]malate and [1-13C]aspartate peaks, consistent with observations in the perfused mouse liver.4 Because the conversion of OAA to malate and aspartate are reversible reactions, there is 13C label exchange between these three metabolites. In addition, reversible dehydration of [1-13C]malate to [1-13C]fumarate, catalyzed by fumarase, MCE resulted in the repositioning of the 13C label between the C1 and C4 positions of fumarate. This, in effect, gave rise to [4-13C]malate, [4-13C]aspartate, and [4-13C]OAA peaks.4, 12 A representative time course displaying the progression of metabolite signals is shown in Fig. 2B. These results show that the major downstream pathways of pyruvate can be monitored with hyperpolarized [1-13C]pyruvate. We next examined the metabolic changes in gluconeogensis in HFD mice. When compared to control mice, the ratios of [1-13C]malate/tCarbon, [4-13C]OAA/tCarbon, [1-13C]aspartate/tCarbon, and [1-13C]alanine/tCarbon were significantly larger in fatty livers of HFD-fed mice (Fig.

These features particularly apply to DILI, and they also explain a long period of slow progress in the past where mechanisms and risk factors of hepatotoxicity have remained largely unknown for most drugs. However, the last 5 years find more have seen a pronounced increase in the publication rate of genetic association studies, and together with input

from other areas of research they have contributed to a breakthrough in the mechanistic understanding of DILI. In contrast, as far as prediction of DILI is concerned, the challenges that are intrinsically related to rare complex diseases are more difficult to overcome. Whereas even a factor that confers only a small risk of disease can strongly

suggest the involvement of a specific Cytoskeletal Signaling inhibitor hepatotoxic mechanism, from a clinical and regulatory point of view, one aims to identify factors that predict a population-attributable risk and an absolute risk that are both high enough to be of clinical relevance. This is a necessary requirement in order to establish genetic screening tests that will guide the decision whether an individual patient should receive a potentially hepatotoxic drug. Abacavir is a good although rare example, where pretherapy genetic screening (for the human leukocyte antigen [HLA] B*5701 allele) has been shown to significantly reduce drug toxicity (confirmed hypersensitivity reactions of 0% instead of 2.7%), with

a high negative predictive value (100%) and a reasonable positive predictive value (47.9%), and subsequently led to a labeled recommendation of routine screening.1 However, genetics of idiosyncratic hepatotoxicity are more complex. DILI typically occurs with a risk of less than 0.1% or even 0.01%,2-4 i.e., far less than the prevalence of genetic variants MCE公司 that have been associated with DILI (Table 1). Although other as-yet unidentified very rare high-risk genetic variants may also play a role, this implies that interactions between several risk factors are a necessary requirement for the development of rare DILI, and it is likely that these affect different subsequent steps in the complex mechanistic pathways. Consequently, the decryption of these interactions is a necessary requirement for a better prediction of DILI. This review summarizes and integrates recent genetic and mechanistic findings, methods, and concepts relating to DILI and discusses their implications for future research.

As changes in pharmacokinetic parameters (incremental recovery, half-life, area under the curve, clearance and mean residence time) could give a clue Barasertib in vivo about the occurrence

of weak inhibitors, the same patients had to be retested for the same pharmacokinetic parameters after 6 months, using the same dose as in the initial study; Clinical efficacy and overall safety should be reported in a minimum of five haemophilia A patients undergoing at least 10 surgical procedures; At least 50 PTP should be followed up for at least 50 exposure days or 6 months for FVIII inhibitors (determined every 3 months); A paediatric trial should be initiated before product submission for licensing and should include a minimum of 12 patients under the age of 6 years regardless of prior treatment. They had to be followed up for clinical Venetoclax mw efficacy, immunogenicity and safety parameters until they had received at least 50 exposures to the product or had been treated for 6 months (whichever came first); The protocol of a post-marketing surveillance study should be submitted together with the licensing product file. The aforementioned 1995 European guidelines dealt with regulatory requirements regarding

both FVIII and factor IX, but it was subsequently decided to have separate protocols for FVIII and factor IX products. EMA/CHMP/BPWP/144533/2009 was devoted to clinical investigations required for FVIII, and dealt with both plasma-derived and recombinant

products. The 2009 guidelines took into account the conclusions of an EMA expert meeting on the risk of inhibitor development, held in 2006 and gathering specialists from EU, MCE USA, Japan, Canada, representatives from the ISTH, the World Health Organization, patient organizations and manufacturers. As compared to previous guidelines, the main changes were as follows: Pharmacokinetic data were now required for 12 paediatric patients under the age of 6 years; Pharmacokinetic and safety data were also required for paediatric patients between 6 and 12 years age; Clinical, immunogenicity and safety data were required for 50 haemophilic children, allocated in two cohorts of 25 patients each, one under the age of 6 years and the other between 6 and 12 years; Still expected to include a total of 200 patients, the post marketing study should include 60 paediatric PTPs under the age of 12 years; There was a new shift regarding PUPs, because: clinical pre-approval study was now presented as necessary in this population, including 50 patients and post approval follow-up was required in a total of 100 patients (allowing the inclusion of those investigated in the pre-approval study).

Conclusion: ESP for ampullary tumors is effective and safe. It can be curative for most ampullary adenomas. ESP for localized adenocarcinoma may be potentially curative in >50% patients.

Key Word(s): 1. ampullary tumours; 2. endoscopic papillectomy Presenting Author: YOUNG OOK EUM Additional Authors: SANG EON JANG, BYEONG SEONG KO Corresponding Author: YOUNG OOK EUM Affiliations: Cheongju Saint Mary’s Hospital, Cheongju Saint Mary’s Hospital Objective: Cholecystocolonic fistulas are rare complications of gallstones with a variable clinical presentation. Cholecystocolonic fistulas are often asymptomatic and it is difficult to diagnose them preoperatively. Methods: A patient who complaint diarrehea for one month visited local clinic and underwent colonoscopy. During colonoscopy, an 1 cm sized polypoid lesion was noted on ascending colon. During suction the air to observe the lesion closely, the polypoid lesion was sucked up and a hole like perforation was appeared. Selleckchem Roscovitine The patient was transferred to our hospital suspected bowel perforation. Results: On the physical exam, there was no specific findings such as abdominal tenderness. On abdominal computed tomography, small air was noted in the gallbladder and several common bile duct stones and gallbladder stones. We did ERCP (endoscopic

retrograde cholangiopancreatography) and removed CBD stones. Then cholecystectomy with segmental colonic resection was done. Conclusion: On operation field, a cholecystocolonic fistula was noted. After the operation, AUY-922 clinical trial the diarrhea was stopped and the patient recovered completely. Key Word(s): 1. cholecystocolonic fistula Presenting Author: HISASHI HATANAKA Additional Authors: TOMONORI YANO, NORIKATSU NUMAO, KENSUKE YOKOYAMA, JUN USHIO, TAKESHI TOMIYAMA, KIICHI TAMADA, HIRONORI YAMAMOTO Corresponding Author: HISASHI HATANAKA Affiliations: Jichi Medical University,

Jichi Medical University, Jichi Medical University, Jichi Medical University, Jichi Medical University, Jichi Medical University, Jichi Medical University Objective: This study was undertaken medchemexpress to evaluate the efficacy of indigo carmine (IC) method in identifying the afferent limb with Roux-en Y (RY) reconstruction during double-balloon ERCP (DBERCP). Methods: DBERCP was performed in 94 patients with RY reconstruction from February 2009 to October 2013 at Jichi Medical University Hospital. We investigated accuracy rate of IC method in total gastrectomy (TG) group and in non TG group. In the second portion of the duodenum or at the distal site of esophagojejunostomy, after inflation of a balloon at the tip of the endoscope, 50 ml of IC was injected into the lumen. At the RY site, we evaluated the inflow of IC into both limbs and identified the limb with less inflow as the afferent limb. When the limb with less inflow was confirmed as afferent limb, the case was classified as “correct group”. Insertion time in correct group was compared to that in incorrect group.

As shown in Fig. 5A, TZM cells cocultured with HIV-infected HSCs showed a significant increase in luciferase activity versus coculture with mock-infected HSCs. To further confirm this finding, HSCs were

infected with the HIV-GFP–expressing constructs, washed, trypsinized, and subsequently cultured with MT4 lymphocytes (Fig. 5B). Over time, MT4 cells became infected with HIV, which was blocked by AZT. NVP-LDE225 These results indicate that HSCs are able to capture HIV and transfer viable virus to surrounding lymphocytes. Given that most of the viral particles released in culture supernatants were defective and unable to infect cells, this phenomena appears to require cell–cell contact and potentially occurs through a virological synapse, as demonstrated for other cells,20 and thus requires further investigation. HIV/HCV coinfection is associated with rapid fibrosis progression and increased necro-inflammatory activity on biopsy compared with HCV monoinfected patients.4 Therefore, we hypothesized that direct effects of HIV on HSCs may contribute to these clinical observations. Because HSC expression of collagen I is critical to fibrosis, we examined whether HIV infection of HSCs results in increased expression check details of collagen I. As shown in Fig. 6A, a greater than two-fold increase in collagen I expression

by HSCs was observed 48 hours after HIV infection. Chronic inflammation is important for activation of HSCs and fibrogenesis. Because MCP-1 is a potent chemoattractant for

monocytes and lymphocytes, is up-regulated during chronic hepatitis, and correlates with the number of cells infiltrating the portal tract,21 we examined whether HIV stimulates the HSC secretion of MCP-1. An average 80-fold increase in MCP-1 secretion was observed 48 hours after HIV infection (Fig. 6B). Therefore, HIV may have both profibrogenic and proinflammatory effects on HSCs. HIV/HCV-coinfected patients have accelerated fibrosis progression rates compared with HCV-monoinfected patients with the development of cirrhosis 12-16 years earlier.4, 22 Moreover, HIV/HCV-coinfected patients with ongoing HIV viremia have faster rates of HCV-related MCE公司 fibrosis progression,7 suggesting an accelerating effect of HIV on fibrosis progression. When HIV is successfully suppressed with HAART, fibrosis progression rates and necro-inflammatory activity are reduced, closely resembling HCV-monoinfected patients. These observations reinforce the role of HIV in promoting inflammation and fibrosis in HIV/HCV-coinfected livers. The molecular mechanisms by which HIV accelerates fibrosis are not clearly understood, and direct HIV infection of activated HSCs, the main fibrogenic cell in the liver, has not been reported. In the present study, we provide some insight into potential molecular mechanisms by which HIV, through its effects on activated HSCs, can accentuate liver injury in chronic liver diseases.

, 2006; Anderson et al., 2011). To avoid accidental misidentification of lineage due to enzyme inactivity, all digestion assays included a known J1 sample as a positive control. Because mtDNA is inherited matrilinearly, offspring from nests with queens that differed in lineage were typed in the same click here manner to identify matriline. The offspring of pairs of queens from the same lineage were distinguished using six highly variable microsatellite loci: Pb2,

Pb4 and Pb9 (Volny & Gordon, 2002b), and Po3, Po7 and Po8 (Wiernasz, Perroni & Cole, 2004). Both queens and all offspring were genotyped for each pair. Offspring maternity was assigned using a strict maternity exclusion criterion (i.e. no alleles in common between the offspring and one queen at a microsatellite locus). Maternity exclusion is facilitated in these populations because worker offspring are exclusively of J1/J2 hybrid ancestry (Julian et al., 2002; Volny & Gordon, 2002a); because the J1 and J2 lineages show diagnostic or strong

allele frequency differences at most microsatellite loci (Volny & Gordon, 2002b; Table 2), the paternal allele was invariably from the alternate lineage and thus was rarely shared with either putative mother. This combination of loci allowed one parent to be excluded as the mother at one or more loci for NVP-AUY922 solubility dmso all offspring in all but 2 out of 20 surviving pairs, which were excluded from parentage analysis. We took a uniform statistical approach to quantify the relative contribution of each queen to aggression, excavation and reproduction. For each behavior, we used a simple measure of task sharing that ranged from 0 (all actions by a single queen) to 1 (equal task performance): the number of times that the lower frequency (LF) queen performed the task divided by the number of times the higher frequency queen (HF) performed the task. For aggression, a decreasing value in this index measures social dominance of one queen over the other, as indicated by the extent to which aggressive behaviors

are one sided. For excavation and reproduction, a decrease in the index represents more pronounced division of labor. Although queens perform many individual acts of excavation during nest construction, 上海皓元 relatively few worker offspring are produced in the first cohort of workers (range = 0–17). This makes it difficult to achieve sufficient statistical power to test whether queens contribute equally to offspring production at the level of individual colonies. Instead, for both tasks, we focus here on whether the entire distribution of values matches the distribution expected if any bias in task performance were produced solely by intrinsic variation among queens in propensity to perform the behavior in question (excavation or reproduction).

The changes in weight, serum AST, ALT, glucose, total cholesterol, and triglyceride

levels were evaluated. H&E and immunohistochemical (CD34, Caspase-3) analysis were performed on tissue samples. Quantitative real time PCR was performed to evaluate de novo lipogenesis markers (SREBP1c, FAS, and SCD-1), cholesterol synthesis marker (SREBP2), lipids uptake markers (PPAR-α, PPAR- γ), and inflammatory markers (TNF-α, MCP-1). Results: Compared to NAFLD both the liver (2.3±0.3 vs. 2.0 ±0.5, 1.9± 0.4, and 1.5± NVP-AUY922 datasheet 0.5 respectively) and liver to body weight ratio (0.049±0.004 vs. 0.044±0.01, 0.042±0.007, and 0.033±0.009 respectively) were significantly reduced in G1-G3 groups. Moreover, compared to the NAFLD, only G3 group showed significant reduction in serum ALT (88.0± 47.2 vs 32.3±10.3 mg/dl, p=0.013), total cholesterol (152.6±25.3 vs.121.9±35.0mg/ dl, p=0.015) and triglycerides (52.0± 11.8 vs. 30.1 ±12.1 mg/dl, p=0.033), respectively; however, G1 and G2 groups showed slightly deviations in results. The histological and immu-nohistochemical analysis showed decreased intrahepatic fat and caspase-3 activities (26.14±27.7 Ulixertinib price vs 12.2±17.8, p<0.01) in G3 group only. G1 and G2 groups showed statistically insignificant decrease in fat contents and caspase-3 activity. The decrease in CD34 activity in all GCS-F groups was also statistically

insignificant. All G-CSF groups showed decreased lipid de novo synthesis markers including SREBP1c, FAS, and SCD-1. Moreover, compared to NAFLD the TNF- α was also decreased in all G-CSF groups. However,

cholesterol synthesis marker and lipid uptake markers did not show significant results. Conclusions: G-CSF administration twice weekly for 4 weeks not only significantly decreased intrahepatic fat contents but also medchemexpress prevented apoptosis via decreased caspase-3 activity. Disclosures: Waqar K. Saeed – Grant/Research Support: Hanyang University Department of Internal Medicine Min Young Kim – Grant/Research Support: Hanyang University The following people have nothing to disclose: Ho Hyun Nam, Dae Won Jun, Sunmin Kim, Tae Yeob Kim, Joo Hyun Sohn, Eun Kyung Kim Nonalcoholic steatohepatitis (NASH) progression involves an initial inflammatory phase followed by a regenerative response that can lead to fibrosis. Molecular pathways of NASH are still evolving and there exists no proven treatment regimen in patients. Studies have shown that there is an activation of M1 macrophages in the NASH liver following several external or endogenous factors that can include inflammatory stimuli from adipose tissue, oxidative stress from altered fatty acid oxidation and cytokines. However, a direct role of oxidative stress in causing M1 polarization in NASH has been unclear.

305, respectively) (Pearson’s correlation coefficient). Conclusion: Although all four IRCs presented nonsignificant DC values, flexural strength MK 1775 and microhardness values varied between materials with and without thermocycling. “
“Restorative material selection in complete mouth rehabilitation is an important factor in long-term management of potential technical complications. The aim of this study was to evaluate in vitro the reliability (fracture resistance) of lithium disilicate fatigued with different restorative materials. A step-stress

accelerated life-testing model was used. Seventy disc specimens were heat-pressed. Five groups of different indenter materials fatigued the lithium-disilicate specimens: group WC (tungsten carbide served as a control),

group PR (interpenetrating polymer network [IPN] resin-based denture tooth), group POM (heat-pressed leucite glass-ceramic), group LD (heat-pressed lithium disilicate), and group ZR (zirconium BMS-777607 nmr dioxide). Lithium-disilicate specimens were randomly divided into four groups (n = 14). Specimens were fatigued to failure according to three step-stress profiles: light, moderate, and aggressive. Use level probability Weibull plots were generated, and each group’s reliability, failure rate, and mean life to failure were calculated. The IPN resin-based denture tooth group had the highest reliability and mean life to failure, and lowest failure rate as compared to lithium disilicate and zirconium dioxide. No significant difference existed between the reliability of the tungsten carbide

MCE公司 and leucite glass-ceramic groups and the IPN resin-based denture tooth group. Lithium-disilicate specimens fatigued with IPN resin-based denture teeth exhibited higher reliability than specimens fatigued with lithium disilicate and zirconium dioxide. There was a difference in fracture characteristics in lithium-disilicate specimens fatigued with tungsten carbide, lithium disilicate, and zirconium dioxide, versus those fatigued with IPN resin-based denture teeth and leucite glass-ceramic material. “
“In an abutment screw fracture, it is generally a challenge for the clinician to remove fractured fragments. In some cases, the screw cannot be removed, and alternative solutions should be considered. This clinical report describes the replacement of a ball attachment with a fractured screw, which was impossible to retrieve, with a cast dowel with ball attachment. The patient who presented to the Department of Prosthodontics, Yeditepe University, Faculty of Dentistry was a 65-year-old woman, wearing a mandibular complete denture supported by two implants for 4 years. She complained about the loss of retention of the denture because of the fractured abutment screw, and it was found that another dentist had previously tried to retrieve the fractured screw with no success. It was decided to construct a cast dowel with ball attachment to improve retention without sacrificing the implant.