JL McCarville | JS Ayres
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Σάββατο 16 Δεκεμβρίου 2017
Ewing’s Sarcoma of the Maxillofacial Region In Greek Children: Report of 6 Cases and Literature Review
Ewing's sarcoma (ES) is the second most common primary bone tumor in children and adolescents after osteosarcoma, initially described by Ewing in 1921 as an undifferentiated tumor involving the diaphysis of long bones that, unlike osteosarcoma, was radiation sensitive (Thorn et al. 2016). It accounts for approximately 3% of pediatric cancers and is most commonly diagnosed during the second decade of life, with a male to female ratio of 1.3:1 (Bernstein et al. 2006; Grevener et al. 2016). It usually affects the pelvis and long bones; extraskeletal tumors are rare in children (Osborn et al.
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“Three-dimensional Analysis of Cranial Base Morphology in Patients with Hemifacial Microsomia.”
Many researchers have studied the relationship between facial asymmetry and cranial base morphology, but they have failed to reach a consensus. In this study, we aimed to verify whether the cranial base is involved in hemifacial microsomia (HFM).
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IgE promotes type 2 innate lymphoid cells in murine food allergy
Abstract
Background
Mast cells serve an important sentinel function at mucosal barriers and have been implicated as key early inducers of Type 2 immune responses in food allergy. The generation of Th2 and IgE following food allergen ingestion is inhibited in the absence of mast cells. Group 2 innate lymphoid cells are also thought to play an important early role in nascent allergic responses.
Objective
To test whether IgE-mediated mast cell activation promotes intestinal ILC2 responses following ingestion of food allergens and whether ILC2 amplify food allergy.
Methods
Two different mouse models of food allergy, one using intraperitoneally ovalbumin (OVA) primed BALB/c animals and the other using enterally peanut-sensitized inherently atopic IL4raF709 mice, were applied to test the contributions of IgE antibodies and mast cells to ILC2 responses. The effect of ILC2 on mast cell activation and on anaphylaxis was tested.
Results
ILC2 responses were significantly impaired in both models of food allergy in Igh7-/- mice harboring a targeted deletion of the gene encoding IgE. A similar reduction in food allergen-induced ILC2 was observed in mast cell deficient Il4raF709 KitW-sh mice and this was partially corrected by reconstituting these animals using cultured bone marrow mast cells. Mast cells activated ILC2 for IL-13 production in an IL-4Rα-dependent manner. Activated ILC2 amplified systemic anaphylaxis by increasing target tissue sensitivity to mast cell mediators.
Conclusions & clinical relevance
These findings support an important role for IgE-activated mast cells in driving intestinal ILC2 expansion in food allergy and reveal that ILC2, in turn, can enhance responsiveness to the mediators of anaphylaxis produced by mast cells. Strategies designed to inhibit IgE signaling or mast cell activation are likely to inhibit both Type 2 immunity and immediate hypersensitivity in food allergy.
This article is protected by copyright. All rights reserved.
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Typical sensory organization test findings and clinical implication in acute vestibular neuritis
Sensory organization test (SOT) is used to evaluate postural instability. We wanted to characterize the SOT findings in patients with acute vestibular neuritis (VN).
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Fibrous Cephalic Plaques in Tuberous Sclerosis Complex
Fibrous cephalic plaques (FCPs) stereotypically develop on the forehead of tuberous sclerosis complex (TSC) patients. They constitute a major feature for TSC diagnosis, and may present before other TSC-related cutaneous hamartomas.
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A systematic review of validated sinus surgery simulators
Abstract
Background
Simulation provides a safe and effective opportunity to develop surgical skills. A variety of endoscopic sinus surgery (ESS) simulators have been described in the literature. Validation of these simulators allows for effective utilisation in training.
Objective of review
To conduct a systematic review of the published literature to analyse the evidence for validated ESS simulation.
Search strategy
Pubmed, Embase, Cochrane and Cinahl were searched from inception of the databases to January 11th, 2017.
Evaluation method
12,516 articles were retrieved of which 10,112 were screened following the removal of duplicates. 38 full text articles were reviewed after meeting the search criteria. Evidence of face, content, construct, discriminant and predictive validity was extracted.
Results
20 articles were included in the analysis describing 12 ESS simulators. 11 of these simulators had undergone validation; 3 virtual reality, 7 physical bench models and 1 cadaveric simulator. 7 of the simulators were shown to have face validity, 7 had construct validity and 1 had predictive validity. None of the simulators demonstrated discriminate validity.
Conclusion
This systematic review demonstrates that a number of ESS simulators have been comprehensively validated. Many of the validation processes, however, lack standardisation in outcome reporting, thus limiting a meta-analysis comparison between simulators.
This article is protected by copyright. All rights reserved.
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Prevalence of skin disease in a population based sample of adults out of five European countries
Abstract
Background
There is a lack of prevalence data on skin diseases in the general adult population, most studies were carried out in small, national or consecutive clinical samples.
Objectives
To determine the prevalence of common skin disease in the general European population and to additionally assess differences in the characteristics of treatment between countries.
Methods
A random sample consisting out of 12,377 subjects aged 18 to 74 years was drawn from the general population of five European countries (Germany, Italy, The Netherlands, Portugal and Sweden). This was a cross-sectional study and all participants were interviewed with a standardized questionnaire assessing the occurrence of 10 common skin diseases during lifetime, past year and past month. If a skin disease was reported we additionally assessed who performed diagnosis and treatment and if drugs were prescribed.
Results
The most common skin disease was warts (41.3%) followed by acne (19.2%) and contact dermatitis (15.0%). In general females were more often affected by skin diseases compared to males, only in skin cancer the prevalence in males was slightly higher. The prevalence of skin diseases in northern countries (Germany, Netherlands & Sweden) was in general higher than in the southern countries (Italy & Spain). In the Netherlands the treatment of skin diseases was less often performed by a dermatologist compared to the other countries.
Conclusion
The prevalence estimates reported in this study are derived from a representative sample of the general population. Data assessment was performed comprehensively across countries, thus country specific prevalence estimates are comparable.
This article is protected by copyright. All rights reserved.
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Scleroderma skin ulcers definition, classification and treatment strategies our experience and review of the literature
Publication date: Available online 2 December 2017
Source:Autoimmunity Reviews
Author(s): Dilia Giuggioli, Andreina Manfredi, Federica Lumetti, Michele Colaci, Clodoveo Ferri
BackgroundSkin ulcers (SU) are one of the most frequent manifestations of systemic sclerosis (SSc). SSc-SU are very painful, often persistent and recurrent; they may lead to marked impairment of patient's activities and quality of life. Despite their severe impact on the whole SSc patient's management, the proposed definition, classification criteria, and therapeutic strategies of SSc-SU are still controversial.ObjectiveThe present study aimed to elaborate a comprehensive proposal of definition, classification, and therapeutic strategy of SSc-SU on the basis of our long-term single center experience along with a careful revision of the world literature on the same topic.MethodsA series of 282 SSc patients (254 females and 28 males; 84% with limited and 16% diffuse cutaneous SSc; mean age of 51.5±13.9SD at SSc onset; mean follow-up 5.8±4.6SDyears) enrolled during the last decade at our Rheumatology Unit were retrospectively evaluated with specific attention to SSc-SU. The SSc-SU were classified in 5 subtypes according to prominent pathogenetic mechanism(s) and localization, namely 1. digital ulcers (DU) of the hands or feet, 2. SU on bony prominence, 3. SU on calcinosis, 4. SU of lower limbs, and 5. DU presenting with gangrene. This latter is a very harmful evolution of both DU of the hands and feet needing a differential diagnosis with critical limb ischemia.ResultsDuring the follow up period, one or more episodes of SSc-SU were recorded in over half patients (156/282, 55%); skin lesions were often recurrent and difficult-to-heal because of local complications, mainly infections (67.3%), in some cases associated to osteomyelitis (19.2%), gangrene (16%), and/or amputation (11.5%). SSc-SU were significantly associated with lower patients' mean age at the disease onset (p=0.024), male gender (p=0.03), diffuse cutaneous subset (p=0.015), calcinosis (p=0.002), telangiectasia (p=0.008), melanodermia (p<0.001), abnormal PAPs (p=0.036), and/or altered inflammation reactant (CRP, p=0.001).Therapeutic strategy of SSc-SU included both systemic and local pharmacological treatments with particular attention to complicating infections and chronic/procedural pain, as well as a number of non-pharmacological measures. Integrated local treatments were often decisive for the SSc-SU healing; they were mainly based on the wound bed preparation principles that are summarized in the acronym TIME (necrotic Tissue, Infection/Inflammation, Moisture balance, and Epithelization).The updated review of the literature focusing on this challenging issue was analyzed in comparison with our experience.ConclusionsThe recent advancement of knowledge and management strategies of SSc-SU achieved during the last years lead to the clear-cut improvement of patients' quality of life and reduced long-term disability.
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Clinical and immunological aspects of anti-peptidylarginine deiminase type 4 (anti-PAD4) autoantibodies in rheumatoid arthritis
Source:Autoimmunity Reviews
Author(s): Zyanya Reyes-Castillo, José Francisco Muñoz-Valle, Mara A. Llamas-Covarrubias
Rheumatoid arthritis (RA) is the most common rheumatic autoimmune disease worldwide, which causes progressive joint damage and can lead to functional disability. Despite prominent advances in RA diagnosis and treatment during the last 20years, there is still a need for novel biomarkers that aid in diagnosis and prognosis of this heterogeneous disease. Citrullination is a key post-translational modification implicated on anti-citrullinated protein/peptide antibodies (ACPA) production in RA, catalyzed by human peptidylarginine deiminases (PADs). Among these enzymes, PAD4 has been recognized as an important player in RA pathogenesis and the enzyme itself is a target of autoantibodies (anti-PAD4) in a subgroup of RA patients. Accumulating evidence suggests that anti-PAD4 autoantibodies may be useful as a severity biomarker in RA and recent studies have also shed light on the functional significance of these autoantibodies. This review summarizes the evidence on anti-PAD4 autoantibodies in RA, and addresses its usefulness for disease diagnosis and prognosis. Novel immunological aspects of anti-PAD4 antibodies and their relevance to RA pathogenesis are also discussed.
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Pitfalls in the detection of citrullination and carbamylation
Publication date: Available online 2 December 2017
Source:Autoimmunity Reviews
Author(s): M.K. Verheul, P.A. van Veelen, M.A.M. van Delft, A. de Ru, G.M.C. Janssen, T. Rispens, R.E.M. Toes, L.A. Trouw
Carbamylation and citrullination are both post-translational modifications against which (auto)antibodies can be detected in sera of rheumatoid arthritis (RA) patients. Carbamylation is the chemical modification of a lysine into a homocitrulline, whereas citrullination is an enzymatic conversion of an arginine into a citrulline. It is difficult to distinguish between the two resulting amino acids due to similarities in structure. However, differentiation between citrulline and homocitrulline is important to understand the antigens that induce antibody production and to determine which modified antigens are present in target tissues.We have observed in literature that conclusions are frequently drawn regarding the citrullination or carbamylation of proteins based on reagents that are not able to distinguish between these two modifications. Therefore, we have analyzed a wide spectrum of methods and describe here which method we consider most optimal to distinguish between citrulline and homocitrulline.We have produced several carbamylated and citrullinated proteins and investigated the specificity of (commercial) antibodies by both ELISA and western blot. Furthermore, detection methods based on chemical modifications, such as the anti-modified citrulline-"Senshu" method and also mass spectrometry were investigated for their capacity to distinguish between carbamylation and citrullination.We observed that some antibodies are able to distinguish between carbamylation and citrullination, but an overlap in reactivity is often present in the commercially available anti-citrulline antibodies. Finally, we conclude that the use of mass spectrometry is currently essential to differentiate between citrullinated and carbamylated proteins present in complex biological samples.
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Imaging modalities for the diagnosis and disease activity assessment of Takayasu's arteritis: A systematic review and meta-analysis
Source:Autoimmunity Reviews
Author(s): Lillian Barra, Tahir Kanji, Jacqueline Malette, Christian Pagnoux
BackgroundEarly diagnosis of Takayasu's Arteritis (TAK) and detection of disease activity may reduce the risk of vascular complications. The objective of this study was to determine the effectiveness of imaging modalities for the management of TAK.MethodsMEDLINE and EMBASE were searched for studies of patients undergoing various imaging modalities for TAK diagnosis or to assess disease activity. We excluded case reports, reviews and case series with <10 patients. The methodologic quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2). Random effects meta-analyses with inverse-variance weighting were performed.ResultsFrom the 1126 citations screened, 57 studies met our inclusion criteria. Many of the studies were of small sample size (average N=27), cross-sectional design and low methodological quality. Ultrasound (US) had a lower pooled sensitivity (SN) of 81% (95% CI: 69–89%) than Magnetic Resonance Angiography (MRA) with SN=92% (95% CI: 88–95%) for TAK diagnosis (by clinical criteria and/or X-Ray angiography). Both had high specificities (SP) of >90% for TAK diagnosis. Fewer studies investigated computed tomography angiography (CTA), but SN and SP for TAK diagnosis was high (>90%). The utility of vessel wall thickening and enhancement by MRA and CTA to predict disease activity varied across studies. The pooled SN and SP of 18F-fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) for disease activity was 81% (95% CI: 69–89%) and 74% (95% CI: 55–86%), respectively.ConclusionUS, CTA and/or MRA are effective for the diagnosis of TAK. The utility of these imaging modalities for assessing disease activity remains unclear.
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Combined therapies to treat complex diseases: The role of the gut microbiota in multiple sclerosis
Source:Autoimmunity Reviews
Author(s): Laura Calvo-Barreiro, Herena Eixarch, Xavier Montalban, Carmen Espejo
The commensal microbiota has emerged as an environmental risk factor for multiple sclerosis (MS). Studies in experimental autoimmune encephalomyelitis (EAE) models have shown that the commensal microbiota is an essential player in triggering autoimmune demyelination. Likewise, the commensal microbiota modulates the host immune system, alters the integrity and function of biological barriers and has a direct effect on several types of central nervous system (CNS)-resident cells. Moreover, a characteristic gut dysbiosis has been recognized as a consistent feature during the clinical course of MS, and the MS-related microbiota is gradually being elucidated. This review highlights animal studies in which commensal microbiota modulation was tested in EAE, as well as the mechanisms of action and influence of the commensal microbiota not only in the local milieu but also in the innate and adaptive immune system and the CNS. Regarding human research, this review focuses on studies that show how the commensal microbiota might act as a pathogenic environmental risk factor by directing immune responses towards characteristic pathogenic profiles of MS. We speculate how specific microbiome signatures could be obtained and used as potential pathogenic events and biomarkers for the clinical course of MS. Finally, we review recently published and ongoing clinical trials in MS patients regarding the immunomodulatory properties exerted by some microorganisms. Because MS is a complex disease with a large variety of associated environmental risk factors, we suggest that current treatments combined with strategies that modulate the commensal microbiota would constitute a broader immunotherapeutic approach and improve the clinical outcome for MS patients.
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A concise review of significantly modified serological biomarkers in giant cell arteritis, as detected by different methods
Source:Autoimmunity Reviews
Author(s): B. Burja, T. Kuret, S. Sodin-Semrl, K. Lakota, Ž. Rotar, R. Ješe, K. Mrak-Poljšak, P. Žigon, G.G. Thallinger, J. Feichtinger, S. Čučnik, M. Tomšič, S. Praprotnik, A. Hočevar
Giant cell arteritis (GCA) is a primary systemic vasculitis present in subjects older than 50years with involvement of large- and medium-sized arteries. Early diagnosis for GCA is essential to prevent serious complications, such as permanent vision loss and/or cerebrovascular events. Elevated inflammatory cytokines, with acute phase and other proteins dominate large- and medium-sized arteries leading to stenosis or occlusion of arterial lumen. To date, there are no reliable serological markers for monitoring GCA. The review aims to provide concise overview of published GCA studies in order to: a) identify significantly changed serological biomarkers in GCA and compare the influences of techniques for marker evaluation and b) investigate most promising markers in GCA using analyte frequency and meta-analysis.
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Imaging aspects of interstitial lung disease in patients with rheumatoid arthritis: Literature review
Source:Autoimmunity Reviews
Author(s): Alexandra Balbir-Gurman, Ludmila Guralnik, Mordechai Yigla, Yolanda Braun-Moscovici, Emilia Hardak
ObjectiveInterstitial lung disease (ILD) is a frequent and severe complication of rheumatoid arthritis (RA), resulting in pulmonary fibrosis (PF) and respiratory failure.MethodsChest computed tomography (CT-c) or high resolution CT (HRCT) is the main modality for assessment of ILD. We performed a systematic literature review on CT-c/HRCT findings in patients with ILD-RA, using the MEDLINE database for the period from 1991 to 2015.ResultsFindings on CT-c/HRCT attributed to ILD-RA are variable (ground glass opacities, reticular and nodular pattern, as well as a combined pattern of emphysema and PF). Correlation of CT-c/HRCT findings with clinical data is inconsistent.ConclusionsILD-RA is part of a general autoimmune inflammation and should be integrated into the decision-making process for the treatment of RA. There is an unmet need to design an algorithm which will allow prediction of CT-c changes compatible with ILD-RA with a high probability. Hopefully, this will enable treating patients with ILD-RA early, with possible halting of the progression of ILD-RA toward PF.
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NK cells in autoimmune diseases: Linking innate and adaptive immune responses
Source:Autoimmunity Reviews
Author(s): Elena Gianchecchi, Domenico Vittorio Delfino, Alessandra Fierabracci
The pathogenesis of autoimmunity remains to be fully elucidated, although the contribution of genetic and environmental factors is generally recognized. Despite autoimmune conditions are principally due to T and B lymphocytes, NK cells also appear to play a role in the promotion and/or maintenance of altered adaptive immune responses or in peripheral tolerance mechanisms.Although NK cells are components of the innate immune system, they shows characteristics of the adaptive immune system, such as the expansion of pathogen-specific cells, the generation of long-lasting "memory" cells able to persist upon cognate antigen encounter, and the possibility to induce an increased secondary recall response to re-challenge.Human NK cells are generally identified as CD56+CD3−, conversely CD56+CD3+ cells represent a mixed population of NK-like T (NK T) cells and antigen-experienced T cells showing the up-regulation of several NK cell markers. CD56dim constitute about 90% of NK cells in the peripheral blood, they are mature and involved in cytotoxicity responses; CD56bright instead are more immature, mostly involved in cytokine production, having only a limited role in cytolytic responses, keen to leave the blood vessels as the principal population observed in lymph nodes. NK cells have been identified also in non-lymphoid tissues since, in pathologic conditions, they can quickly reach the target organs. A cross-talk between NK with dendritic cells and T cells is established throughout different receptor-ligand bindings.Several studies support the correlation between NK cell number and/or functional alterations, such as a defective cytotoxic activity and several autoimmune conditions. Among the different autoimmune pathologies and even within the same disease, NK cell function is significantly different either promoting or even protecting against the onset of the autoimmune condition.In this Review, we discuss recent literature supporting the role played by NK cells, as a bridge between innate and adaptive immunity, in the onset of autoimmune diseases.
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Curcumin: A natural modulator of immune cells in systemic lupus erythematosus
Source:Autoimmunity Reviews
Author(s): Amir Abbas Momtazi-Borojeni, Saeed Mohammadian Haftcheshmeh, Seyed-Alireza Esmaeili, Thomas P. Johnston, Elham Abdollahi, Amirhossein Sahebkar
Curcumin is a polyphenol natural product isolated from turmeric, interacting with different cellular and molecular targets and, consequently, showing a wide range of pharmacological effects. Recent preclinical and clinical trials have revealed immunomodulatory properties of curcumin that arise from its effects on immune cells and mediators involved in the immune response, such as various T-lymphocyte subsets and dendritic cells, as well as different inflammatory cytokines. Systemic lupus erythematosus (SLE) is an inflammatory, chronic autoimmune-mediated disease characterized by the presence of autoantibodies, deposition of immune complexes in various organs, recruitment of autoreactive and inflammatory T cells, and excessive levels of plasma proinflammatory cytokines. The function and numbers of dendritic cells and T cell subsets, such as T helper 1 (Th1), Th17, and regulatory T cells have been found to be significantly altered in SLE. In the present report, we reviewed the results of in vitro, experimental (pre-clinical), and clinical studies pertaining to the modulatory effects that curcumin produces on the function and numbers of dendritic cells and T cell subsets, as well as relevant cytokines that participate in SLE.
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Belimumab in the treatment of systemic lupus erythematous: An evidence based review of its place in therapy
Source:Autoimmunity Reviews
Author(s): Frederico Marcondes, Morton Scheinberg
IntroductionSystemic lupus erythematous is an autoimmune disease with diverse clinical features and has its development associated with a complexity of genetic, hormonal and environmental factors and the development of autoantibodies. Identification of new treatments is currently an area of intense investigation. Belimumab is the first biologic approved for the treatment of the disease inhibiting the excessive B cell activity observed in these patients and consequently reduction of autoantibodies.AimTo review the current transition of the evidence available of its use in real life patients with persistent active disease while on conventional therapies.EvidenceThe results observed on the large series of patients (over 50 patients) followed for at least six months confirm the observations from phase 3 trials. In clinical practice close to two third of the patients remained on belimumab and one third discontinued mostly due to evaluation by the doctor or the patient or both of no detectable positive response. The presence of adverse events was considerably low and the subgroups with skin and joint manifestations appear to benefit the most. Daily steroid use is usually reduced to a significantly low when compared with the intake before introduction of the biologic Although not seen on trials in real life the addition of belimumab to the conventional therapy in lupus nephritis is being reported in several patients. Cost of the medication is still an issue that hampers its use. Further evidence of its use in certain specific groups is under investigation and its results should shed light on additional indications.Place in therapyConsidering what is currently published on the evidence here reviewed in the use of belimumab in clinical practice it is our understanding that belimumab it will be gradually incorporated in the armamentarium of treatment not necessarily on refractory patients. We believe that with the upcoming of the subcutaneous route in the near future should also help in widen the use of the belimumab to be considered in first line combination set ups.
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Clinical and microbiological characteristics of the infections in patients treated with rituximab for autoimmune and/or malignant hematological disorders
Source:Autoimmunity Reviews
Author(s): Jean-Jacques Tudesq, Guillaume Cartron, Sophie Rivière, David Morquin, Laura Iordache, Alfred Mahr, Valérie Pourcher, Kada Klouche, Diane Cerutti, Alain Le Quellec, Philippe Guilpain
IntroductionRituximab is commonly used for the treatment of hematological malignancies and autoimmune diseases. Despite a reputation for good tolerance, case-series and registries reported rituximab-related infections of variable severity including opportunistic infections. We aimed at describing the natural history of infectious events (IE) after treatment by rituximab providing clinical and microbiological features and outcome.Patients and methodsWe retrospectively analyzed the medical records of patients treated with rituximab in an internal medicine department of a tertiary hospital between 2007 and 2015, and identified all IE after this therapy. Events' severity was assessed using the Common Terminological Criteria of Adverse Events (version 4.3) definitions.ResultsAmong 101 patients treated with rituximab, we identified 228 IE in 74 (73.3%) of these patients (median follow-up 30.4months). Indication for rituximab was either autoimmune disease (AID) (52.5% of patients), or monoclonal hematological disease (MHD) (47.5%). Patients received an overall median number of 5 rituximab infusions [interquartile range: 4–8], representing a cumulative dose of 4340mg [2620–6160]. After last rituximab infusion, IE occurred after 3.1months [0.7–9.4]. Respectively, IE were severe in 28.1% of cases in patients treated for AID vs 58.0% in patients treated for MHD (p<0.001), due to opportunistic pathogens in 7.8% vs 11.0% (p=0.49) and fatal in 4.7% vs 13.0% (p=0.044). Factor associated with mortality were polymicrobial infection (p<0.001), monoclonal hematological disease (p=0.035), use of steroids over 10mg/d within the last two weeks (p=0.003), and rituximab cumulative dose (p<0.001). We identified a group of 10 patients (9.9%) showing life-threatening, polymicrobial, and opportunistic infections constituting a 'catastrophic infectious syndrome', which was lethal in 7 cases.ConclusionIE after treatment by rituximab can be extremely severe, especially in patients immunocompromised by several other drugs. Further studies should focus on the group with life-threatening polymicrobial infections.
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Childhood- versus adult-onset ANCA-associated vasculitides: A nested, matched case–control study from the French Vasculitis Study Group Registry
Source:Autoimmunity Reviews
Author(s): Michele Iudici, Christian Pagnoux, Pierre Quartier, Matthias Büchler, Ramiro Cevallos, Pascal Cohen, Claire de Moreuil, Philippe Guilpain, Alain Le Quellec, Jacques Serratrice, Benjamin Terrier, Loïc Guillevin, Luc Mouthon, Xavier Puéchal
ObjectiveTo investigate differences between childhood-onset ANCA-associated vasculitides (cAAVs) and matched adult-onset controls (aAAVs).MethodscAAV clinical pictures at onset and outcomes were compared to a randomly selected sample of aAAV patients from the French Vasculitis Study Group Registry. Cases and controls were matched for AAV (granulomatosis with polyangiitis [GPA], microscopic polyangiitis [MPA] or eosinophilic granulomatosis with polyangiitis [EGPA]), sex and year of enrollment. Medications, disease activity and damage were prospectively recorded. Kaplan–Meier curves and the log-rank test were used to analyze case-vs.-control differences for predefined outcomes.ResultsComparing 35 cAAVs (25 GPA, 4 MPA, 6 EGPA) to 151 aAAVs (106 GPA, 17 MPA, 28 EGPA), their respective median follow-up durations were 71 and 64months (P=0.49), and, at baseline, children had less frequent myalgias (P=0.005) and peripheral neuropathy (P<0.001) but were more frequently febrile (P<0.05). Rates of renal involvement were comparable (13 [37%] cAAVs vs. 73 [48%] aAAVs; P=0.31). Initial GPA-associated ischemic abdominal pain and nasal cartilage damage were more common in cAAVs than aAAVs (P<0.05). During follow-up, the cAAV relapse rate was higher (24.5 vs. 18.7 flares per 100 patient-years; P<0.05) and, at last visit, cases had accumulated more damage, mostly ear, nose & throat sequelae (P=0.001), associated with longer maintenance therapy (P=0.03), than aAAV controls. Four (11.4%) cAAV and 13 (8.6%) aAAV patients died (P=0.53).ConclusioncAAVs are severe diseases, characterized by a higher relapse rate, more accrued damage and longer maintenance therapy than for aAAVs.
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Oropharynx-directed ipsilateral irradiation for p16-positive squamous cell carcinoma involving the cervical lymph nodes of unknown primary origin
Abstract
Background
The purpose of this study was to present our findings on the use of limited-field, oropharynx-directed ipsilateral irradiation for p16-positive squamous cell carcinoma of unknown primary origin.
Methods
Between April 2011 and January 2016, 25 patients with a histological diagnosis of p16-positive squamous cell carcinoma were selectively irradiated to the ipsilateral oropharynx and cervical neck for tumors of unknown primary origin. The dose to the oropharynx ranged from 54-60 Gy (median 60 Gy) in 30-33 fractions. Concurrent cisplatin-based chemotherapy was administered to 8 patients (32%).
Results
The actuarial 2-year estimates of locoregional control, progression-free survival, and overall survival were 91%, 87%, and 92%, respectively. One patient failed in the contralateral neck. There was no grade 3 + toxicity in either the acute or late setting.
Conclusion
Oropharynx-directed, ipsilateral radiation results in disease control that compares favorably with historical controls treated by comprehensive mucosal and bilateral neck radiation.
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American Thyroid Association ultrasound system for the initial assessment of thyroid nodules: Use in stratifying the risk of malignancy of indeterminate lesions
Abstract
Background
The ultrasound risk stratification system of the American Thyroid Association (ATA) is frequently adopted in clinical practice. Here, we evaluated its performance in a series of nodules with indeterminate fine-needle aspiration cytology (FNAC) report.
Methods
Indeterminate thyroid nodules diagnosed at 2 medical centers were retrospectively screened, ultrasound images were reevaluated, and lesions were classified according to the ATA. Single ultrasound parameters were also analyzed.
Results
One hundred seventy-three indeterminate lesions were included with 24.8% of malignancy. The high suspicion class showed a cancer rate (75%) significantly (P < .001) higher than that recorded in the other categories (16.8%). Between ultrasound parameters, halo and microcalcifications were the most sensitive and specific ones. The most accurate receiver operating characteristic (ROC)-derived cutoff of nodule's diameter was >4.1 cm. At multivariate analysis, only the ATA class of high suspicion and size >4.1 cm were significantly associated with cancer (odds ratios [ORs] 19.4 and 5.4, respectively).
Conclusion
The ATA ultrasound system is reliable in the risk stratification of indeterminate thyroid lesions.
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Risk factors affecting the prognosis of descending necrotizing mediastinitis from odontogenic infection
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Luyao Qu, Xiang Liang, Bin Jiang, Wentao Qian, Weijie Zhang, Xieyi Cai
PurposeDescending necrotizing mediastinitis (DNM) is a serious complication of head and neck infections, and has an excessively high mortality rate due to the lack of understanding of DNM. Assessing the clinical characteristics, diagnosis, treatment, outcomes of odontogenic DNM, and evaluating the risk factors affecting the prognosis of DNM to provide an up-to-date overview for clinical practice.MethodsThis research was based on a retrospective cohort study that enrolled a sample of patients with DNM due to odontogenic infection who were referred from January 2013 to December 2016. The patients were classified into the survivors and the deceased groups. The primary predictor in this study were multiple comorbidities, complications, demographic (age, gender), laboratory tests (white blood cell, percentage of neutrophils )and time (duration before diagnosis, hospital stay). The primary outcome variable was outcome of patients (dead or alive). The continuous variables were evaluated by Student's t test or the t' test ,and the categorical and binary variables were compared by the χ2 test or the Fisher exact test.ResultsA total of 81 patients were included. The 68 males and 13 females had a median age of 57.2 ± 12.2 years. The mortality was 4.9%. The most frequent cause of DNM was periapical periodontitis (66.7%). The lower posterior molars were involved in 39.5% of the cases. Treatments consisted of antibiotic therapy, aggressive transcervical mediastinal drainage (74 cases) and thoracotomy (7 cases). The associated risk factors for mortality were complications (P<0.005) and severe sepsis or septic shock (P<0.001) by bivariate analysis.ConclusionSeptic shock and complications, which are risk factors correlated with poor prognosis. We considered that timely diagnosis and aggressive mediastinal drainage are fundamental to reduce the incidence of complications and septic shock in odontogenic DNM patients.
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Temporomandibular Joint Disc Repositioning by suturing through open incision: A technical note
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Dongmei He, Chi Yang, Huimin Zhu, Edward Ellis
It is technically difficult to arthroscopically reposition and suture the temporomandibular joint disc to the auricular cartilage. This article introduces a straightforward method to reposition the disc and suture it to the auricular cartilage through a small incision.
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AAOMS Author Disclosure forms
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 12
http://ift.tt/2opGzpJ
The Utilization of Computer Aided Design and Manufacturing in Acute Mandibular Trauma Reconstruction
Source:Journal of Oral and Maxillofacial Surgery
Author(s): George Kokosis, Edward H. Davidson, Rachel Pedreira, Alexandra Mcmillan, Amir H. Dorafshar
PurposeVirtual surgical planning (VSP) with subsequent computer aided design and manufacturing (CAD/CAM) have proved efficacious in improving efficiency and outcomes of a plethora of surgical modalities including mandibular reconstruction and orthognathic surgery.MethodsFive patients underwent complex mandibular reconstruction following traumatic injury, utilizing VSP from July 2016 until August 2017 at our institution. The institutional review board at the Johns Hopkins University Hospital approved this study. The patient`s occlusion was restored virtually and a milled 2.0 mm plate was created that would bridge the defect with the patient in occlusion.ResultsAppropriate occlusion was confirmed with postoperative CT scan. No patient developed any adverse outcomes except a minor dehiscence of the intraoral incision in one, treated with local wound care. The average time from injury to the custom plate availability was approximately 7 days.ConclusionThe utility of this technology in acute complex mandibular trauma can overcome the challenges of traditional treatment; custom patient specific pre-bent and milled plates permit the use of lower profile and therefore less palpable hardware, can guide reduction, avoid the need for plate bending and obviate the need for an extraoral incision.
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“Effects of Leukocyte- and Platelet-rich Fibrin alone and Combined with Hyaluronic Acid on Pain, Oedema, and Trismus after Surgical Extraction of Impacted Mandibular Third Molars”
Source:Journal of Oral and Maxillofacial Surgery
Author(s): İbrahim Murat Afat, Emine Tuna Akdoğan, Onur Gönül
PurposeIn this prospective randomised double-blind controlled study, we evaluated the effects of leukocyte- and platelet-rich fibrin (L-PRF) alone and combined with hyaluronic acid (HA) sponge on pain, oedema, and trismus after mandibular third molar (M3) surgery.MethodsIn total, 60 patients were included in this study. The patients were randomly divided into 3 groups: Group L-PRF (L-PRF was applied to the socket), Group L-PRF+HA (L-PRF+HA was applied to the socket), Group Control (nothing was applied). The primary outcome variables were oedema (tragus to pogonion (TPO), tragus to labial commissure (TCO), angulus mandibula to lateral canthus (ACA)), trismus on post-operative days 2 and 7, and visual analogue scale (VAS) post-operative pain scores from hour 6 to day 7.ResultsThe results after extraction on TPO values were significantly higher in Control Group both on day 2 (higher than Group L-PRF+HA) and on day 7 (higher than both Groups). The mean increase in TCO on day 2 was significantly higher in the control group than in the L-PRF+HA group. The mean increase in ACA at days 2 and 7 was significantly higher in the control group than in the L-PRF and L-PRF+HA groups. There was no significant difference among groups in trismus and visual analogue scale (VAS) pain scores. Analgesic intake on surgery day in the L-PRF+HA group was significantly lower.ConclusionOur results imply that L-PRF, particularly when combined with HA, can be used to minimise post-operative oedema after M3 surgery. However, further studies with larger samples are required.
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Custom implant for reconstruction of mandibular continuity defect
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Sang-Woon Lee, Hyung Giun Kim, Min Ji Ham, Do Gia Khang Hong, Seong-Gon Kim, Horatiu Rotaru
PurposeThe purpose of this study was to compare the daily food intake rate and the rate of screw loosening between two groups of rabbits with mandibular continuity defects: a custom implant group and a 5-hole mini-plate group.Materials and MethodsTwo types of cylindrical implants were printed and their physical strength was compared. In a study using rabbits, one group (CI, n=5) received a custom implant for the reconstruction of a mandibular continuity defect and the other group (RP, n=5) received a 5-hole mini-plate without a bone graft. After reconstruction, the daily food intake rate and the rate of screw loosening were examined after operation. Histological exam for the CI group was done at 3 months after the operation.ResultsThe design which mimicked the mandible showed greater physical strength. The date required for 50% recovery was faster in the CI group than that in the RP group (P=0.011). The total number of loosened screws for the CI group was lower than that for the RP group at 3 months post-operative (P=0.008). New bone formation in the porous custom implant was evident in the CI group.ConclusionRabbits with mandibular continuity defects treated with custom implants for reconstruction showed faster recovery of daily food intake rate and fewer loosened screws than those treated by a 5-hole mini-plate without bone graft.
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Does Intra-alveolar application of chlorhexadine gel in combination with PRF has advantage over PRF application in reducing Alveolar Osteitis following Mandibular Third Molar Surgery? A Double-Blind Randomized Clinical Trial
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Majid Eshghpour, Nasrin Danaeifar, Hamed Kermani, Amir Hossein Nejat
PurposeTo evaluate the effectiveness of chlorhexidine (CHX) gel and platelet-rich fibrin (PRF) in comparison to the PRF in preventing development of alveolar osteitis (AO).Materials and MethodsIn a double blind trial, patients in need of surgical management of bilateral impacted mandibular third molars were randomly divided into two groups; one group receiving PRF in one of the extraction sockets with the other socket as control and the other group receiving 0.2% CHX gel plus PRF in one socket with the other socket serving as a control. Study and control side was unknown to both the surgeon and the patient. The predictor variables were PRF and PRF plus CHX application with categorization of PRF or non-PRF and PRF/CHX or non-PRF/CHX, respectively. The outcome variable was AO development during the first week after the surgery. Age, gender, surgical difficulty score, surgeon experience, number of anesthesia cartridges injected, and irrigation volume were other variables. Data were analyzed in SPSS software using t-test and Chi-square, with the confidence interval set at 95%.ResultsA total of 482 surgeries performed on 241 patients with a mean age of 24 years. The overall frequency of AO in all surgeries, PRF, and PRF/CHX group was 15.14, 17.37, and 13%, respectively. The frequency of AO in PRF and PRF/CHX sockets was significantly lower than the non-PRF (relative risk 0.46) and non PRF/CHX (relative risk 0.18) sockets, respectively (P < 0.05). Moreover, the risk of developing AO in PRF/CHX sockets was significantly lower than PRF sockets with the relative risk of 0.37 (P < 0.05).ConclusionAccording to the current findings, the application of CHX gel with PRF increases the efficiency of PRF in reducing the risk of AO development following surgical removal of impacted mandibular third molars.
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Utilization of Intraoperative CT in Craniomaxillofacial Trauma Surgery
Publication date: Available online 13 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Karl Cuddy, Baber Khatib, R. Bryan Bell, Allen Cheng, Ashish Patel, Melissa Amundson, Eric J. Dierks
PurposeThe utilization of technology to aid in assessment, planning and management of complex craniomaxillofacial injuries is increasingly common. Pre-operative CT evaluation is considered standard of care and intraoperative imaging is becoming increasingly accessible. Limited data exists regarding the implication of intraoperative CT on decision making in management of all sites of facial fractures. The purpose of this study was to characterize the utilization of the intraoperative CT scanner for craniomaxillofacial surgery within our institution, to quantify the effect of intraoperative CT on surgical decision-making and to attempt to provide guidance on when to utilize this technology.MethodsThis retrospective case series characterizes the use of the intraoperative CT scanner for craniomaxillofacial trauma surgery at a level 1 trauma center in Portland, Oregon from February 2011 to September 2016. We evaluated the following variables: the number of intraoperative CT scans performed for craniomaxillofacial surgery including the number of scans for each patient, the number of scans for each operative visit, CT directed revision rate (overall and for specific pre-operative diagnoses) and the indication for imaging. This information was evaluated to provide guidance on appropriate utilization of an intraoperative scanner.ResultsA total of 161 patients were identified to have intraoperative facial CT scans from February 2011 to Sept 20, 2016 at Legacy Emanuel Medical Center. A total of 212 intraoperative facial CT scans were performed over 168 separate operations. The overall CT directed revision rate was 28%. CT directed revision rates for fracture sub-sites are listed as follows: orbital – 31%, ZMC - 24%, LeFort 1 – 8%, LeFort II and III - 23%, naso-orbital ethmoidal - 23%, mandible – 13%, frontal sinus 0%. No CT directed revisions were made during removal of hardware, placement of craniofacial implants or in TMJ replacement surgery.ConclusionIf available, intraoperative CT should be routinely considered in the operative management of orbital fractures, panfacial fractures as well as complex ZMC, LeFort II and III, and NOE fractures. Consideration should also be given for the utilization of intraoperative CT in cases of complex mandible fractures involving severe comminution or the condylar region. Intraoperative CT should not be routinely utilized for management of LeFort 1 fractures or frontal sinus fractures.
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Do postoperative antibiotics decrease the frequency of inflammatory complications following third molar removal?
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Andrew J. Morrow, Thomas B. Dodson, Martin L. Gonzalez, Sung-Kiang Chuang, Melanie S. Lang
PurposeThe purpose of this study was to answer the following clinical question: Among patients having their third molars (M3s) removed, do those who receive only postoperative antibiotics compared to those who receive no perioperative antibiotics have a lower frequency of postoperative inflammatory complications?Materials and MethodsThe investigators designed and implemented a prospective cohort study and enrolled a sample of patients who had at least one M3 removed in an ambulatory private practice setting between June, 2011 and May, 2012 by oral and maxillofacial surgeons participating in a practice-based research collaborative (P-BRC). The predictor variable was postoperative antibiotic use categorized as postoperative antibiotics alone or no antibiotics. The primary outcome variable was the presence or absence of an inflammatory complication, i.e. alveolar osteitis (AO) or surgical site infection (SSI), following M3 removal. Descriptive, bivariate, and multiple logistic regression statistics (adjusted for clustering within surgical practices) were computed to measure the association between postoperative antibiotic use alone and inflammatory complications following M3 removal with statistical significance set at a p-value ≤ 0.05.ResultsThe study sample was composed of 1,877 patients having 5,631 M3s removed of which 61% received postoperative antibiotics only. The overall inflammatory complication frequencies in the postoperative antibiotic only and no antibiotic groups were 4.3 and 7.5%, respectively (p=0.003). After adjusting for the differences between the two study groups and clustering of subjects within surgical practices, postoperative antibiotic use was associated with a 40% decreased risk of developing postoperative inflammatory complications (p=0.04) with marginal statistical significance.ConclusionsThe results of this study suggest that postoperative antibiotic therapy is associated with statistically significant decreased risk of inflammatory complications following third molar removal when compared to no antibiotic therapy.
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Gapo Syndrome -A Rare Cause of Osteomyelitis of Jaws; Report of Four Cases With Brief Review of Literature
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rudrayya S. Puranik., Surekha R. Puranik, Neelakamal Hallur, Deepak Venkatesh
The GAPO syndrome is characterised by growth retardation, alopecia, pseudoanodontia and ophthalmic abnormalities. This very rarely reported syndrome is known to affect various ethnic groups and may present with manifestations other than the usually reported. Pseudoanodontia is a rare clinico-radiologic manifestation known to be always associated with GAPO syndrome. Osteomyelitis of jaws is a less common disease that is usually attributed to odontogenic causes. This case report illustrates osteomyelitis of the mandible in a patient with GAPO syndrome. Further, an additional three cases of GAPO in the patient's family, with special emphasis on oral mucosal changes and pseudoanodontia, are discussed.
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Using An In-House Approach to Cad/Cam Reconstruction of the Maxilla
Publication date: Available online 12 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Toshiaki Numajiri, Daiki Morita, Hiroko Nakamura, Shoko Tsujiko, Ryo Yamochi, Yoshihiro Sowa, Kenichiro Toyoda, Takahiro Tsujikawa, Akihito Arai, Makoto Yasuda, Shigeru Hirano
BackgroundComputer-assisted design (CAD) and computer-aided manufacturing (CAM) techniques are now in widespread use for maxillofacial reconstruction. However, CAD/CAM-manufactured surgical guides are commercially available only in the limited areas. To use this technology in areas where these commercial guides are not available, we have developed a CAD/CAM technique in which all processes are performed by the surgeon (in-house approach).PurposeOur aim is to describe our experience and the characteristics of our in-house CAD/CAM reconstruction of the maxilla.MethodThis was a retrospective study after maxillary reconstruction with a free osteocutaneous flap. Free CAD software was used for the virtual surgery and to design the cutting guides (maxilla and fibula), which were printed by a 3D printer. After the model surgery and prebending of the titanium plates, the actual reconstructions were performed. We compared the clinical information, preoperative plan, and postoperative reconstruction data. The reconstruction was judged as accurate if >80% of the reconstructed points were within 2 mm deviation.ResultsAlthough on-site adjustment was necessary in particular cases, all four reconstructions were judged as accurate. In total, 3 days were needed before the surgery for planning, printing, and prebending of the plates. The average ischemic time was 134 minutes: 70 minutes for flap suturing and bone fixation, and 64 minutes for vascular anastomoses. The mean deviation after reconstruction was 0.44 mm (standard deviation, 0.97). The deviations were 67.8%, 1 mm deviation; 93.8%, 2 mm deviation; and 98.6%, 3 mm deviation. The disadvantages of regular use of CAD/CAM reconstruction are the intraoperative changes in the defect size and local tissue scarring.ConclusionGood accuracy was obtained for CAD/CAM-guided reconstructions based on an in-house approach. The theoretical advantage of computer simulation contributes to the accuracy. An in-house approach may be an option for maxillary reconstruction.
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Fixed, fiber-reinforced resin bridges on 5.0mm implants in severely atrophic mandibles: up to 5-years follow-up of a prospective cohort study
Publication date: Available online 12 December 2017
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Rudolf Seemann, Florian Wagner, Mauro Marincola, Rolf Ewers
PurposeThe aim of this study is to evaluate the midterm outcomes of fixed full arch fiber-reinforced resin bridges on ultrashort implants in terms of marginal bone loss and overall implant survival.MethodsPatients with severely atrophic mandibles, corresponding to Cawood and Howell Class V and VI, were included in this prospective temporal cohort study. Mesial and distal peri-implant bone levels were measured on panoramic radiographs taken at the time of implant insertion (baseline) and at follow-up visits.ResultsA total of 17 patients with atrophic mandibular jaws with an average follow-up of 2.9 ±1.5 years were included. The cumulative one-, three- and five-year patient-based implant survival rates (CSR) were 94.1%, and the cumulative implant survival rates 98.5%, respectively.The marginal bone level of the mesial implant was 0.0±0.3mm at the time of loading (n=33), -0.1±0.3mm (n=20) after one year, -0.4±0.5 (n=10) after three years, and-1.5±1.0 (n=4) after five years. The mesial bone level depended significantly on time and insertion depth. The marginal bone level of the distal implant was -0.4±0.4mm (n=34) at the time of implantation, -0.4±0.6mm (n=20) after one year, -0.5±0.5 (n=10) after three years, and -2.2±1.7 (n=4) after five years. The distal bone level depended significantly on time and insertion depth.ConclusionFixed full arch fiber-reinforced resin bridges retained by four ultrashort implants provide a comparatively cost-effective, safe and stable alternative for prosthetic restoration of the severely atrophic mandible. The overall implant survival rate, and the MBL after 5 years are equivalent to threaded implants of conventional lengths.
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Regarding “Is It Time to Reexamine Reexamination?”
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Mark D. Zajkowski
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Digital diagnosis and treatment program for maxillofacial fractures: a retrospective analysis of 626 cases
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Wei Zeng, Xiaotian Lian, Gang Chen, Rui Ju, Weidong Tian, Wei Tang
PurposeThe purpose of this study is to evaluate the accuracy of digital diagnosis and treatmentprogramformaxillofacial fractures.MethodsThe data of 626 patients with maxillofacial fractures were analyzed retrospectivelyduring the period fromJanuary 2010 to August 2016. These patients were divided into two groups. In the experimental group, preoperativeplanning was conducted and transferred to the patients with guiding templates and navigation according tothe digital diagnosis and treatment programfor maxillofacial fractures. In the control group, post-surgery planning was performed instead of preoperative planning. Aimed to assess the accuracy of digital diagnosis and treatment program for maxillofacial fractures, preoperative planning and postoperative CT image models were superimposed and imported to the dedicated software (Geomagic studio 13.0) for calculating the difference between the two models in both groupsResultsThe results of experimental set revealed that the mean error between preoperative planning model and postoperative model ranged from 0.65 to 0.97mm, with an average value of 0.89mm. While for the control group, the mean error range was from 0.78 to 1.45 mm, and the average was 1.01 mm. Thus, the mean error of the experimental group was statistically lower than that of the control group (P< 0.0001). Postoperative analysis of the subjective evaluation of occlusionrecoverydemonstrated that 92.13% of the patients achieved good occlusion recovery in the experimental group, compared with the percentage of only 84.91% in the control group.The digital diagnosis and treatment programfor maxillofacial fractures is more accurate.ConclusionAided by the digital diagnosis and treatment program, the accuracy for maxillofacial fractures is significantly improved. In order to facilitate the application and promotion of the digital technology, further modification of the digital complete diagnosis and treatment pathway for maxillofacial fractures is highly desired.
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Table of Contents
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 12
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Upper Airway Areas, Volumes and Linear Measurements Determined on CT during Different Phases of Respiration Predict the Presence of Severe Obstructive Sleep Apnea
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Khaisang Chousangsuntorn, Thongchai Bhongmakapat, Navarat Apirakkittikul, Witaya Sungkarat, Nucharin Supakul, Jiraporn Laothamatas
PurposeThe objective of this study was to analyze the potential of using low-dose, volumetric computed tomography (CT) during different phases of respiration for identifying patients likely to have severe obstructive sleep apnea (OSA) defined as having a respiratory disturbance index (RDI) of more than 30.Patients and MethodsA prospective study was undertaken at the Ramathibodi Hospital. Patients with diagnosed OSA (N = 82) were recruited and separated into two groups: Group 1 (RDI of ≤30, N = 36) and Group 2 (RDI of >30, N = 46). Both groups were scanned by low-dose volumetric CT while they were i) breathing quietly, ii) at the end of inspiration, and iii) at the end of expiration. Values for CT variables were obtained from linear measurements in lateral scout images during quiet breathing, and from upper airway area and volume measurements in axial cross-sections during different phases of respiration. All CT variables were compared between study groups. A logistic regression model was constructed to calculate an individual's likelihood of having an RDI of >30, and the predictive value of each variable and of the final model.ResultsThe minimum cross-sectional area (MCA) measured at the end of inspiration (cut-off point of ≤0.33 cm2) was the most predictive variable for identification of patients likely to have an RDI of >30 [adjusted odds ratio (OR) = 5.50, 95% confidence interval (CI) = 1.76–17.20] with sensitivity 74% and specificity 72%, followed by the MCA measured at the end of expiration (cut-off point of ≤0.21 cm2) [adjusted OR = 3.28, 95% CI = 1.05–10.24] with sensitivity 70% and specificity 68%.ConclusionCT scanning at the ends of both inspiration and expiration helped identify patients with RDI of >30 based on measurement of MCA. Low-dose volumetric CT can be a useful tool to help the clinician rapidly identify patients with severe OSA and decide upon the urgency to obtain a full-night PSG study and to start treatment.
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Teacher? Teacher, I Declare
Source:Journal of Oral and Maxillofacial Surgery, Volume 75, Issue 12
Author(s): Thomas B. Dodson
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“How do Le Fort-type Fractures Present in a Pediatric Cohort?”
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Alexandra Macmillan, Joseph Lopez, J.D. Luck, Muhammad Faateh, Paul Manson, Amir H. Dorafshar
PurposeLe Fort-type fractures are very rare in children and there is a paucity of literature presenting their frequency and characteristics. The purpose of this study is to determine the etiology, frequency, and fracture patterns of children with severe facial trauma associated with pterygoid-plate fractures in a pediatric cohort.MethodsWe performed a retrospective cohort study of all children aged < 16 years with pterygoid plate and facial fractures that presented to our institute from 1990-2010. Patient charts and radiological records were reviewed for demographics and fracture characteristics. Subjects were categorized into two groups as per facial fracture pattern: non Le Fort-type fractures (Group A) and Le Fort-type fractures (Group B). Other variables including dentition age, frontal sinus development, mechanism of injury, injury severity, and concomitant injuries were recorded. Univariate methods were employed to compare groups.Results24 children were identified, 25% were female, and 20% non-white race. The majority presented with Le Fort-type fracture patterns (group B; 66%). Age was significantly different between group A and group B (mean 5.9 vs 9.9; p=0.009). No significant differences in injury severity score, rate of operative repair, and length of stay were found between groups.ConclusionThe majority of children with severe facial fractures and pterygoid plate fractures present with Le Fort-type fracture patterns in our cohort. The mean age of children with Le Fort-type fractures is greater than those with non-Le Fort-type patterns. However, Le Fort-type fractures do occur in younger children with deciduous and mixed dentition.
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Improving Quality of Life for Oral Cancer Patients
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Roger A. Meyer
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Correlation Between the Posterior Mandibular Width and the Lingual Gap caused by Symphyseal Fractures, Using a Virtual Model
Source:Journal of Oral and Maxillofacial Surgery
Author(s): Christian Pedemonte Trewhela, Andrea Carmona Avendaño, Edgardo González Mora, Ilich Vargas Farren, Francisco Lopetegui Caceres, Erick Rojas Quiroz
PurposeThe objective was to determine the dimensional impact on an occlusal and articular level of the gap produced in the lingual plate from symphyseal fractures, correlated with the dimensional change in the posterior mandibular width.MethodsAn observational experimental study based on 30 CT scans of patients in the Maxillofacial Surgery Service at the Hospital Clínico Mutual de Seguridad in Santiago, Chile, between 2012 and 2016. The inclusion criteria were jaws without traces of fractures or pathologies, absence of orthodontic appliances and complete dentition to the first mandibular molar. Using Digital Dental Service® 3D planning software, a vertical mandibular fracture was made, leaving lingual gaps of 1, 2, and 3 mm, recording the dimensional changes with regard to the posterior facial width.ResultsThe mandibular height did not vary with regard to the lingual gap; the mandibular length was inversely proportional to the lingual gap and, the intermolar, intergonial and intercondylar distances are directly proportional to increases in the lingual gap.ConclusionThe larger the lingual gap, the shorter the mandibular length and the larger the mandibular transverse dimensions. Special attention must be paid to the occlusal and articular level.
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R-loops cause genomic instability in Wiskott-Aldrich syndrome Thelper lymphocytes
Publication date: Available online 15 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Koustav Sarkar, Seong-Su Han, Kuo-Kwang Wen, Hans D. Ochs, Loïc Dupré, Michael M. Seidman, Yatin M. Vyas
BackgroundWiskott-Aldrich syndrome (WAS), X-linked thrombocytopenia (XLT), and X-linked neutropenia (XLN), caused by WAS mutations affecting WASp expression or activity, manifest in immunodeficiency, autoimmunity, genomic-instability, and lymphoid-cancer. WASp supports filamentous-actin formation in the cytoplasm and gene-transcription in the nucleus. Although the genetic basis for XLT/WAS has been clarified, the relationships between mutant forms of WASp and the diverse features of these disorders remain ill-defined.ObjectiveTo define how dysfunctional gene transcription is causally linked to the degree of Thelper (Th) cell deficiency and genomic instability in XLT/WAS clinical spectrum.MethodsIn human Th1- or Th2-skewing cell culture systems, co-transcriptional R-loops (RNA:DNA duplex and displaced single-stranded DNA) and DNA double-strand breaks (DSBs) were monitored in multiple XLT and WAS patient samples, and in normal T cells depleted of WASp.ResultsWASp-deficiency provokes increased R-loops and R-loop-mediated DSBs in Th1-cells relative to Th2-cells. Mechanistically, chromatin-occupancy of Serine2-unphosphorylated-RNA Polymerase II is increased and that of topoisomerase-1, a R-loop preventing factor, is decreased at R-loop-enriched regions of IFNG and TBX21 (Th1 genes) in Th1-cells. These aberrations accompany increased unspliced (intron-retained) and decreased spliced mRNA of IFNG and TBX21 but not of IL13 (Th2-gene). Significantly, increased cellular load of R-loops and DSBs, which are normalized upon RNaseH1-mediated suppression of ectopic R-loops, inversely correlates with disease severity scores.ConclusionTranscriptional R-loop imbalance is a novel molecular defect etiologic in Th1-immunodeficiency and genomic-instability in WAS. The study proposes that cellular R-loop load could be used as a potential biomarker for monitoring symptom severity in the XLT-WAS clinical spectrum, and could be targeted therapeutically.
Graphical abstract
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Neonatal hyperoxia promotes asthma-like features through IL-33-dependent ILC2 responses
Publication date: Available online 15 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): In Su Cheon, Young Min Son, Li Jiang, Nicholas P. Goplen, Mark H. Kaplan, Andrew H. Limper, Hirohito Kita, Sophie Paczesny, Y.S. Prakash, Robert Tepper, Shawn K. Ahlfeld, Jie Sun
BackgroundPremature infants often require oxygen supplementation and, therefore, are exposed to oxidative stress. Following oxygen exposure, preterm infants frequently develop chronic lung disease and have a significantly increased risk of asthma.ObjectiveWe sought to identify the underlying mechanisms by which neonatal hyperoxia promotes asthma development.MethodsMice were exposed to neonatal hyperoxia followed by a period room air recovery. A group of mice were also intranasally exposed to house dust mite antigen (HDM). Assessments were performed at various time points for evaluation of airway hyperresponsiveness (AHR), eosinophilia, mucus production, inflammatory gene expression, T helper (Th) and group 2 innate lymphoid cell (ILC2) responses. Sera from term- and preterm-born infants were also collected and the levels of IL-33 and type 2 cytokines were measured.ResultsNeonatal hyperoxia induced asthma-like features including AHR, mucus hyperplasia, airway eosinophilia, and type 2 pulmonary inflammation. In addition, neonatal hyperoxia promoted allergic Th responses to HDM exposure. Elevated IL-33 levels and ILC2 responses were observed in the lungs most likely due to oxidative stress caused by neonatal hyperoxia. IL-33 receptor signaling and ILC2s were vital for the induction of asthma-like features following neonatal hyperoxia. Serum IL-33 levels correlated significantly with serum levels of IL-5 and IL-13, but not IL-4 in preterm infants.ConclusionThese data demonstrate that an axis involving IL-33 and ILC2s is important for the development of asthma-like features following neonatal hyperoxia and suggest therapeutic potential for targeting IL-33, ILC2s, and oxidative stress to prevent and/or treat asthma development related to prematurity.
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Fat Graft with Growth Factors
Source:Atlas of the Oral and Maxillofacial Surgery Clinics
Author(s): Farzin Sarkarat, Roozbeh Kahali
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Incorporating Oculoplastic Surgery exposure into OMFS Specialist Training
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Karl Payne, Nicola Mahon, Al Mustafa, Christopher Fowell, Neal Barnard, Philip Earl, Julia Sen
http://ift.tt/2j97ctO
Pilot experience of acupuncture in ameliorating the gag reflex in posterior tongue and oropharyngeal biopsies
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Mohamed Imran Suida, Michael Ho
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Grafts of autogenous coronoid process to reconstruct the mandibular condyle in children with unilateral ankylosis of the temporomandibular joint: long-term effects on mandibular growth
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Y.T. Yang, Y.F. Li, N. Jiang, R.Y. Bi, S.S. Zhu
Injury to the mandibular condyle in children usually leads to malocclusion and disharmony of facial growth. Our aim was to study the facial growth after reconstruction of the mandibular condyle using autogenous coronoid process grafts in children with unilateral ankylosis of the temporomandibular joint (TMJ). We followed up 10 growing patients with unilateral bony ankylosis of the TMJ who had been admitted to the West China Hospital of Stomatology, Sichuan University (Chengdu, China) between 1 January 2008 and 31 December 2012. There were three boys and seven girls, age range 5–12 years at the time of operation. In each case, patients were treated by gap arthroplasty, reconstruction of the condyle with an ipsilateral coronoid process, and interposition of the pedicled temporalis fascial flap during one operation. The mean (range) postoperative follow up was 4.73 (3–6) years. Postoperative panoramic radiographs were taken, and the growth of the mandibular height and length on the affected side was measured and compared with the healthy side. All patients had an uneventful, normal recovery. The mean (range) maximal mouth opening at the end of follow up was 35.6 (32–41) mm. Both the height of the ramus and the length of the mandible continued to grow after successful treatment of the ankylosis (using autogenous coronoid process grafts for reconstruction of the condyle) but the deficit in growth was not completely made up. The final height of the ramus on the affected side (at the end of follow up) had increased by 25% (p=0.012) and the final length of the mandible on the affected side by 26% (p=0.010) compared with immediately after operation. For comparison of the rate of growth, the increased height of the ramus of the affected side was 47% lower (p=0.003), while the increased length of the mandible on the affected side was 27% shorter (p=0.008) compared with the healthy side. The mandible on the affected side continued to grow after successful treatment of the ankylosis, but the growth deficit was not made up completely. The rate of growth of the affected mandible seemed to be less than on the undisturbed side even after treatment of the ankylosis.
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Comparison of the AJCC and Brigham and Women's Hospital Staging Systems for Cutaneous Squamous Cell Carcinoma of the Head and Neck: A 6 year review
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Conor Bowe, Samantha Houlton, Mandeep Bajwa, Stephen Walsh
http://ift.tt/2zh4Gua
Epidemiology of basal cell carcinoma: a 10-year comparative study
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C. Devine, B. Srinivasan, A. Sayan, V. Ilankovan
Basal cell carcinoma (BCC) is a slow-growing and locally aggressive skin cancer. Despite its high incidence, good quality epidemiological data are sparse. We therefore organised a retrospective study of two separate years' incidence of BCC in one county within the United Kingdom (Dorset) with an interval of 10 years between them. There were 2455 patients in 2006, and 3797 in 2016, who had a new diagnosis with corresponding crude incidences of 459.99 and 491.92/100,000 person-years. The male:female ratio was 1:071 for both years. The head and neck was the most common site, with the cheek, nose, and forehead being the most common subsites. This is a substantial increase in the incidence of BCC, and is much higher than previous reported rates for the UK. More stringent local and national registries are required to monitor the increasing numbers of BCC and help health care systems to plan preventive strategies and provide the most effective treatment.
http://ift.tt/2j9779u
New technique to contour the paramedian forehead flap in nasal reconstruction
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): P. Padaki, A. Wilson, C. Johnston
http://ift.tt/2zh3WVU
The UK national histopathology form for skin biopsies: a potential solution for the future. Understanding difficulties encountered during data analysis for cutaneous malignancies
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Samantha Houlton, Conor Bowe, Stephen Walsh
http://ift.tt/2j7U9bZ
Primary intraosseous squamous cell carcinoma of the mandible: locoregional control and survival is significantly reduced if the tumour is more than 4cm in size
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Q. Shen, Y. Chen, S. Gokavarapu, W. Cao, T. Ji
To establish the prognostic factors for primary intraosseous squamous cell carcinoma we designed a retrospective study of patients treated in the head and neck department of a tertiary referral centre in China from 2010–2015. We collected clinical, radiological, and histopathological data from 36 patients treated during the given time period, among which 34 were followed up. There were 22 male and 12 female patients, 13 of whom gave a history of smoking tobacco and four who drank alcohol. All 34 patients were treated by segmental mandibulectomy and neck dissection. Nine had cervical lymph node metastases on histopathological examination, and none had invaded surgical margins. Twenty-eight were treated with radiotherapy postoperatively. During follow up nine died of locoregional recurrence or metastases. Specific factors such as cervical lymph node metastases were related to a greater likelihood of locoregional recurrence. Patients who drank alcohol were also more likely to develop metastases postoperatively. Tumours more than 4cm in size were significantly associated with reductions in locoregional control and survival.
http://ift.tt/2zhrTg2
Effectiveness of irrigation with chlorhexidine after removal of mandibular third molars: a randomised controlled trial
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): H. Cho, M.C. David, A.J. Lynham, E. Hsu
To evaluate the effect of postoperative irrigation with chlorhexidine on inflammatory complications after the extraction of lower third molars under local anaesthesia, we recruited 100 patients to participate in a controlled, single-blind, randomised clinical trial. They were assigned to one of two groups: the intervention group (postoperative irrigation of the surgical site with chlorhexidine for seven days) or the control group (postoperative chlorhexidine mouth rinse for seven days). The primary outcome variables were pain, swelling, trismus, infection, and alveolar osteitis. The secondary outcome variables were wound dehiscence and food impaction. A total of 95 participants completed the study (47 in the irrigation group and 48 in the rinse group). In the irrigation group, alveolar osteitis and facial swelling had reduced significantly at seven days postoperatively (both p<0.01). Pain scores had also reduced significantly at seven days (p<0.01), but not at 48hours, and patients had lower levels of food impaction (p<0.01) and less severe symptoms (p=0.02). Routine irrigation with chlorhexidine after the extraction of third molars helps to reduce pain and lowers the incidence of alveolar osteitis.
http://ift.tt/2zhKit1
An audit of unplanned returns to theatre in a regional Oral and Maxillofacial Surgery Unit
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Hao-Hsuan (Mark) Tsai, Christopher McDonald, Patrick Magennis
http://ift.tt/2j96ZXy
Can dietary supplements improve a clinician’s well-being and health?
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): D.A. Parry, R.S. Oeppen, M. Amin, P.A. Brennan
Many people use dietary supplements to improve their physical and mental well-being and their general health, but do not know if they really have any benefit. To our knowledge, little has been published on their use in the clinical environment, so we evaluated the evidence for their benefits in people whose work is physically and mentally challenging. Studies on nutrition and supplementation in athletes and military personnel have clearly shown that several compounds improve cognition, mental well-being, and physical performance. Based on this evidence, and with the many pressures faced by healthcare workers, as well as the need for concentration and endurance, some dietary supplements might be beneficial. Supplementation of a balanced diet with omega-3 fatty acids, vitamin B3, vitamin C and associated antioxidants, vitamin D, and protein, may improve a clinician's physical and mental health and their performance at work. Specific research is, however, needed to evaluate this more fully.
http://ift.tt/2j96RY4
Is it better to bend wires occlusally or apically during placement of arch bars for intermaxillary fixation?
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): Ashwant Kumar Vadepally, Ramen Sinha
We evaluated 78 patients who had intermaxillary fixation (IMF) of fractured mandibular condyles with arch bars and wires. Depending on whether the wires were bent apically or occlusally during placement of the arch bars, we randomly divided the patients into two groups (n=39 in each), then compared pain, satisfaction with oral hygiene, and complications between the groups at five to six weeks postoperatively when the arch bars were removed. Outcomes were significantly better in the occlusal group than in the apical group.
http://ift.tt/2zhKaK3
The composite palatal island flap: modification of an existing technique to reconstruct the maxillary alveolus
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Mosea
http://ift.tt/2j96M6I
Cutaneous Squamous Cell Carcinoma (CSCC) of the Head and Neck: An analysis of 691 patients over 6 years
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Samantha Houlton, Conor Bowe, Stephen Walsh
http://ift.tt/2zh2eUo
Revisiting lip shave: a solution for disorders of the vermilion border
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): A. Sayan, S. Wijesinghe, S. Paraneetharan, V. Ilankovan
Actinic keratosis, leukoplakia, carcinoma in situ, and superficially invasive carcinomas of the lower lip are caused mainly by the cumulative effects of exposure of the vermilion of the lower lip to ultraviolet radiation. Current treatments all have limitations: cryosurgery or electrosurgery is suitable to treat only focal lesions; topical chemotherapy, which is an option for diffuse actinic damage, yields unreliable results; and laser treatment fails to rejuvenate the vermilion. However, "lip shave", which involves full-thickness excision of the damaged vermilion and reconstruction with an advancement labial mucosal flap, will produce a fresh mucosal lining to the vermilion border. We describe our experience of the technique and evaluate the functional and aesthetic outcomes in 20 patients treated between January 2011 and January 2016. The follow-up period ranged from 24 to 60 months. Three-quarters of the patients had dysplasia or superficially invasive malignancy. Resected lesions were about 63mm long, 13.7mm wide, and 3.9mm deep. No patients had recurrence or secondary lesions during follow up, functional disturbance was minimal, and the cosmetic outcome pleasing. Lip shave can efficiently reconstruct the vermilion of the lower lip with minimum deformity.
http://ift.tt/2j8wjgm
Dermoscopy – Dermatologists only?
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Lisa Greaney, Ian King
http://ift.tt/2zgmIN7
Re: Pentoxifylline: a review of its use in osteoradionecrosis
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): K. Martin, S. Nathwani, R. Bunyan
http://ift.tt/2j8xJqT
Confidential Image Transfer: An Ethico-Legal Dilemma
Source:British Journal of Oral and Maxillofacial Surgery, Volume 55, Issue 10
Author(s): Rhea Chouhan, James Higginson, Timothy Martin
http://ift.tt/2zgY6UE
Three-dimensional superimposition for patients with facial palsy: an innovative method for assessing the success of facial reanimation procedures
Source:British Journal of Oral and Maxillofacial Surgery
Author(s): C. Sforza, E. Ulaj, D.M. Gibelli, F. Allevi, V. Pucciarelli, F. Tarabbia, D. Ciprandi, G. Dell'Aversana Orabona, C. Dolci, F. Biglioli
Facial palsy is a severe condition that may be ameliorated by facial reanimation, but there is no consensus about how to judge its success. In this study we aimed to test a new method for assessing facial movements based on 3-dimensional analysis of the facial surfaces. Eleven patients aged between 42 and 77 years who had recently been affected by facial palsy (onset between 6 and 18 months) were treated by an operation based on triple innervation: the masseteric to temporofacial nerve branch, 30% of the hypoglossal fibres to the cervicofacial nerve branch, and the contralateral facial nerve through two cross-face sural nerve grafts. Each patient had five stereophotogrammetric scans: at rest, smiling on the healthy side (facial stimulus), biting (masseteric stimulus), moving the tongue (hypoglossal stimulus), and corner-of-the-mouth smile (Mona Lisa). Each scan was superimposed onto the facial model of the "rest" position, and the point-to-point root mean square (RMS) value was automatically calculated on both the paralysed and the healthy side, together with an index of asymmetry. One-way and two-way ANOVA tests, respectively, were applied to verify the significance of possible differences in the RMS and asymmetry index according to the type of stimulus (p=0.0329) and side (p<0.0001). RMS differed significantly according to side between the facial stimulus and the masseteric one on the paralysed side (p=0.0316). Facial stimulus evoked the most asymmetrical movement, whereas the masseteric produced the most symmetrical expression. The method can be used for assessing facial movements after facial reanimation.
http://ift.tt/2j7TzuP
Rearthroscopy of The Temporomandibular Joint: a Retrospective study of 600 Arthroscopies
Publication date: Available online 15 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): R. Martin-Granizo, D.C. Correa, E. Varela
PurposeArthroscopic surgery is an effective treatment for patients with temporomandibular disorders, releasing symptoms and restoring the mandibular function. In patients with poor arthroscopic outcomes, several options of treatment can be considered such as conservative nonsurgical therapy, open surgery, or a second arthroscopy. The purpose of this study was to evaluate our results after 619 arthroscopies.Materials and MethodsThe clinical data of 619 arthroscopies performed between 1996 to 2015 were reviewed retrospectively. Outcome assessments were based on reductions in pain, measured using a visual analog scale (VAS), and improvement in maximal interincisal opening (MIO). The minimum follow-up period was 24 months.ResultsThe incidence of TMJ reoperation in the 371 patients who underwent arthroscopic surgery was 5.9%, with a mean time between surgeries of 66.73 months. Significant improvement between presurgical and postsurgical pain and presurgical and postsurgical MIO at months 6 and 12 were evident. The mean of preoperative MIO was 30.84 mm, which increased to 35.92mm 1-year postsurgery, these results being statistically significant (p<0,05).ConclusionsIn most of the cases the result of a new arthroscopy is satisfactory. Rearthroscopy of the TMJ is a valid and effective method for patients with a first unsuccessful arthroscopy.
http://ift.tt/2k4X85K
Comparison with clinicoradiologic findings between patients with recovering and those with residual diplopia after surgery of pure orbital blowout fracture
Publication date: Available online 15 December 2017
Source:Journal of Cranio-Maxillofacial Surgery
Author(s): Hye Na Jung, Sang-il Suh, Hyung-Jin Kim, Inseon Ryoo
PurposeDiplopia is a common symptom of blowout fracture (BOF), and can persist after proper surgical management. We compared clinicoradiological findings between patients with recovering diplopia and those with residual diplopia after surgery for orbital BOF.Materials and methodsWe retrospectively evaluated the CT images of 170 patients with orbital BOF and preoperative diplopia. We reviewed the following factors: sex, age, mechanism of injury, presence of diplopia before surgery, presence of enophthalmos before surgery, presence of an ocular motility abnormality before surgery, time interval between the trauma and surgery, fracture type, fracture size, volume of herniated orbital soft tissue, ratio of the volume of herniated orbital soft tissue to fracture size, number of points of contact between the extraocular muscle (EOM) and bony edge, EOM swelling, EOM swelling ratio, EOM displacement, EOM circling, EOM tenting, and EOM entrapment.The associations between the presence of diplopia 6 months after surgical repair and various clinicoradiological findings were analyzed using Wilcoxon rank-sum tests, Student's t-tests, Fisher's exact tests for univariable analysis, and logistic regression analysis for multivariable analysis. A Kaplan–Meier curve and log-rank test were used to identify the recovery status from diplopia.ResultsThe following findings were significantly different between patients with recovering diplopia and those with residual diplopia on univariable analysis (p < 0.05 for each): patient age, EOM entrapment, EOM circling, and EOM tenting. Multivariable analyses showed that patients who were older or those who had EOM circling or tenting on CT images had a greater probability of residual diplopia after surgery [p-values: 0.006, 0.013, and <0.001, respectively; odds ratio (95% confidence interval): 1.035 (1.010–1.061), 14.809 (1.775–123.556), and 4.851 (2.069–11.375), respectively]. The recovery rate for diplopia was significantly different between patients with EOM tenting and those without (p = 0.02). Additionally, young patients (0–12 years) showed a shorter recovery time from diplopia compared with older patients (>24 years) (p < 0.05)ConclusionPatients with residual diplopia after surgical management have different clinicoradiological findings compared with patients with recovering diplopia. Patients who are older, or those who have circling or tenting of the EOM on CT scans, are more likely to have residual diplopia.
http://ift.tt/2kxOCf4
Assessment of Lingual Stability in Mandible Fracture: Monocortical Versus Bicortical Fixation Using FEM Analysis
Abstract
Aim of the study
The present study compares lingual stability of monocortical miniplate fixation with that of bicortical miniplate fixation in parasymphysis fracture using FEM analysis.
Materials and methods
Using multislice CT scanner, 3D FEM of patient's mandible was created. Fracture was simulated at parasymphysis region and fixed with 2-mm titanium miniplates and screws of length 8, 10, 12 mm, respectively. Loading force of 120 N applied at molar region and 62.8 N at incisor region. These three models were imported into ANSYS Workbench FEM software.
Result
There is no significant difference in results between bicortical fixation and monocortical fixation.
Conclusion
It was concluded that use of monocortical fixation provides sufficient lingual stability. This suggests monocortical fixation system is as reliable as bicortical fixation.
http://ift.tt/2omzvtY
Effects of occlusal cavity configuration on 3D shrinkage vectors in a flowable composite
Abstract
Objective
The objective of this study was to investigate the effects of cavity configuration on the shrinkage vectors of a flowable resin-based composite (RBC) placed in occlusal cavities.
Materials and methods
Twenty-seven human molars were divided into three groups (n = 9) according to cavity configuration: "adhesive," "diverging," and "cylindrical." The "adhesive" cavity represented beveled enamel margins and occlusally converging walls, the "diverging" cavity had occlusally diverging walls, and the "cylindrical" cavity had parallel walls (diameter = 6 mm); all cavities were 3 mm deep. Each prepared cavity was treated with a self-etch adhesive (Adper Easy Bond, 3 M ESPE) and filled with a flowable RBC (Tetric EvoFlow, Ivoclar Vivadent) to which had been added 2 wt% traceable glass beads. Two micro-CT scans were performed on each sample (uncured and cured). The scans were then subjected to medical image registration for shrinkage vector calculation. Shrinkage vectors were evaluated three-dimensionally (3D) and in the axial direction.
Results
The "adhesive" group had the greatest mean 3D shrinkage vector lengths and upward movement (31.1 ± 10.9 μm; − 13.7 ± 12.1 μm), followed by the "diverging" (27.4 ± 12.1 μm; − 5.7 ± 17.2 μm) and "cylindrical" groups (23.3 ± 11.1 μm; − 3.7 ± 13.6 μm); all groups differed significantly (p < 0.001 for each comparison, one-way ANOVA, Tamhane's T2).
Conclusion
The values and direction of the shrinkage vectors as well as interfacial debonding varied according to the cavity configuration.
Clinical relevance
Cavity configuration in terms of wall orientation and beveling of enamel margin influences the shrinkage pattern of composites.
http://ift.tt/2BhGrvg
Early prelingual auditory development in Italian infants and toddlers analysed through the Italian version of the Infant-Toddler Meaningful Auditory Integration Scale (IT-MAIS)
Abstract
Purpose
To evaluate the reliability and validity of the Italian version of the Infant-Toddler Meaningful Auditory Integration Scale (I-IT-MAIS), and to assess the normal trajectory of early prelingual auditory (EPLAD) development from birth to 24 months in a group of normal-hearing Italian children using the I-IT-MAIS.
Methods
The study consisted of four phases: item generation, reliability analysis, assessment of the normal trajectory for EPLAD, and validity analysis. A group of 120 normal-hearing children and a group of 31 deaf children wearing hearing aids and on a waiting list for cochlear implantation were enrolled. All the parents completed the I-IT-MAIS. Sixty of them completed the I-IT-MAIS twice, 2 weeks apart, for test–retest reliability analysis. The I-IT-MAIS scores were used to assess the normal trajectory of EPLAD development from birth to 24 months in normal-hearing children. For criterion validity analysis, the I-IT-MAIS scores were correlated with production of infant scale evaluation (PRISE) scores in 60 normal-hearing children. For discriminant validity analysis, the I-IT-MAIS scores obtained in normal and deaf children were compared.
Results
Internal consistency of I-IT-MAIS was satisfactory as well as individual item reliability, test–retest reliability, and discriminant validity. EPLAD development in normal-hearing Italian-speaking children was evaluated. As far as the criterion validity of the I-IT-MAIS is concerned, a strong correlation between I-IT-MAIS and PRISE scores was found.
Conclusion
I-IT-MAIS is reliable and valid. Its application is recommended for clinical practice and outcome research.
http://ift.tt/2yI7CfN
Down-regulation of inflammatory signaling pathways despite up-regulation of Toll-like receptors; the effects of corticosteroid therapy in brain-dead kidney donors, a double-blind, randomized, controlled trial
Source:Molecular Immunology, Volume 94
Author(s): Reza Jafari, Reza Aflatoonian, Reza Falak, Gholamreza Pourmand, Sanaz Dehghani, Mojgan Mortazavi, Adeleh Adelipour, Abbas Rezaei, Nader Tajik
BackgroundThe brain death of a potential organ donor induces a systemic inflammatory response, resulting in inferior organ quality and function. Our study aimed to evaluate the effects of methylprednisolone (MPN) therapy on pattern recognition receptor (PRR) signaling in potential brain-dead (BD) kidney donors.Material and methodsTo evaluate the effects of MPN therapy on PRR signaling in BD kidney donors we performed a prospective randomized treatment-versus-control study. Fifty-one potential kidney donors were randomly divided into three groups: brain-dead donors (BDDs) who received 15 mg/kg/d of methylprednisolone (group T1, n = 17), BDDs who received 15 mg/kg/d of MPN at the time of filling consent for kidney donation and 100 mg/2 h until kidney harvest (group T2, n = 17), and normal donors as controls n = 17. Gene expression for Toll-like receptors (TLRs) 1–9 and their signaling pathway molecules including MYD88, TRIF, NF-KB1, IRAK, IRF3, and IRF7, as well as the inflammatory cytokines RANTES, IL-1β, TNF-α, IL-6, CXCL8, IL-18, IFN-α, and IFN-β was determined by PCR array. Due to the crucial role of TLRs 2 and 4 in pattern recognition, surface expression of these molecules was analyzed by flow cytometry. Plasma levels of inflammatory cytokines were measured by immunoassay. Finally, serum creatinine and cystatin C were measured in 100 kidney recipients one week and one, three, and six months after transplant.ResultPolymerase chain reaction (PCR) array gene expression revealed greater expression of TLRs and signaling molecules in group T1 than in the controls. Surface expression of TLRs 2 and 4 were significantly greater in group T2 than in group T1 (P < .05). Plasma concentrations of inflammatory cytokines were significantly greater in group T1 than in controls (P < .05). The recipients that received kidneys from group T1 had significantly higher levels of creatinine and cystatin C than the recipients of kidneys from both group T1 and controls (P<0.05).ConclusionAdministration of MPN to BDDs at specified periods until kidney harvest resulted in less systemic inflammation in the BDDs and improved renal function in kidney graft recipients compared with common MPN therapy.
http://ift.tt/2BhURvl
Loxosceles venom Sphingomyelinase D activates human blood leukocytes: Role of the complement system
Source:Molecular Immunology, Volume 94
Author(s): Daniel Manzoni-de-Almeida, Carla Cristina Squaiella-Baptistão, Priscila Hess Lopes, Carmen W. van den Berg, Denise V. Tambourgi
Envenomation by Loxosceles spiders can result in severe systemic and local reactions, which are mainly triggered by Sphingomyelinase D (SMase D), a toxic component of Loxosceles venom. SMase D induces a systemic inflammatory condition similar to the reaction observed during an endotoxic shock. Considering the potent pro-inflammatory potential of Loxosceles venom and the SMase D, in this study we have used the whole human blood model to study the endotoxic-like shock triggered by SMase D. Recombinant purified SMase D from L. intermedia venom, similarly to LPS, induced activation of blood leukocytes, as observed by the increase in the expression of CD11b and TLR4, production of reactive oxygen and nitrogen species (superoxide anion and peroxynitrite) and release of TNF-α. Complement consumption in the plasma was also detected, and complement inhibition by compstatin decreased the SMase D and LPS-induced leukocyte activation, as demonstrated by a reduction in the expression of CD11b and TLR4 and superoxide anion production. Similar results were found for the L. intermedia venom, except for the production of TNF-α. These findings indicate that SMase D present in Loxosceles venom is able to activate leukocytes in a partially complement-dependent manner, which can contribute to the systemic inflammation that follows envenomation by this spider. Thus, future therapeutic management of systemic Loxosceles envenomation could include the use of complement inhibitors as adjunct therapy.
http://ift.tt/2CkztVS
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